A few days ago (14/08/2009) NEHTA released the following:
Discharge Summary Release 1.0 - Executive Summary
Discharge Summary Release 1.0 - Release Note
Discharge Summary Release 1.0 - Business Requirements Specification
Discharge Summary Release 1.0 - Solution Design
Discharge Summary Release 1.0 - Core Information Components
As far is it goes this is good stuff and the various documents can be downloaded from the links above.
Also good is the request for feedback from the Executive Summary:
“Feedback
Feedback on this release is requested before September 30th 2009 and can be emailed to dischargesummary@nehta.gov.au as can any questions relating to this package. Priority areas for feedback include errors of omission or commission, inconsistent descriptions and editorial rule concerns.”
Also very good indeed is that there has been widespread consultation on this work before it is brought to this Version 1.0 status.
The web page describes this program thus:
e-Discharge Summaries
e-Discharge Summaries will enable the electronic exchange of comprehensive and accurate patient reports between hospitals and primary healthcare sectors. Major benefits of a nationwide e-Discharge Summary system include:
Improved continuity
The primary function of an e-Discharge Summary is to support the continuity of care as the patient returns to the care of their community health care provider(s). e-Discharge Summaries improve continuity of care and patient handover and offer security, accessibility and timeliness of health information.
Increased safety
The electronic exchange of patient reports between hospitals and the primary healthcare sectors will ultimately lead to improved safety and quality, through the exchange of timely, accurate and structured discharge summary information to health care providers, enabling better patient outcomes.
The e-Discharge Summary Program
We will work with healthcare organisations to understand the technologies and processes currently used for e-Discharge Summaries, and collaboratively plan the most effective approach to introduce alignment of these technologies and processes with national standards and NEHTA’s blueprint for e-Discharge Summaries.
Once the most effective solution is established, the e-Discharge Summary program will create recommendations to bring existing projects in line with national standards and establish a blueprint for future e-Discharge projects.
Source:
http://www.nehta.gov.au/e-communications-in-practice/edischarge-summaries
Can I say that the goals and objectives of this program I totally support –as I do the goals of all the workstreams that are being worked on in the e-Communications is practice arena.
So why any brickbats?
Well the devil is in the detail.
As admitted above, and in the documents discussed here, each of the jurisdictions is off and rolling on some sort of project to address discharge summaries and they are essentially – in a standards sense – all over the place like a ‘dogs breakfast’. Getting any sense of uniformity and direction will take years and it need not have been so.
Over two and a half years ago NEHTA released this (it is so old it is now even off the website).
DISCHARGE SUMMARY CONTENT SPECIFICATIONS
Release Notes
21 December 2006
NEHTA announces the release of specifications to standardise the information content of hospital discharge summaries in Australia.
(Release 2 took until 30 June 2009 to appear).
It is this failure to actually get on with things that has provided the window for the present state.
NEHTA in the Solution Design describes the present situation thus.
“Today, State and Territory jurisdictions are at varying stages of developing and deploying electronic discharge summary systems. They are maintaining their own indexes/directories of service providers and have embraced an array of methods for enabling access to discharge summaries.”
And the future is planned to be:
“In the future, it is envisaged that the discharge summary will be initiated at admission and be pre-populated with a wide variety of structured data from information systems related to IEHRs (Individual Electronic Health Records), incoming referrals, emergency department and existing pre-admission systems. Distribution lists will be pre-populated with accurate identification of the patient's usual and referring clinicians through the use of the single national UHI (Unique Health Identifier) service while the ELS (Endpoint Locator Service) will subsequently provide electronic addresses of these recipients. Clinical data will be structured, based on Australian data modelling standards, with source systems using Australian terminology standards. The security and integrity of discharge summary messages will be enhanced by the use of approved secure messaging and NASH (National Authentication Service for Health) authentication services. Consumers will have the ability to create customised presentations of discharge summary information and incorporate selected data into recipient clinician systems, including the Summary Health Profile.”
This vision can be seen visually on page 13 of the Business Requirements Document.
Frankly this is a classic ‘boil the ocean’ view of e-Health in Australia with at its centre and IEHR which is unlikely ever to get funded given that it is not even mentioned by the NHHRC and is very much on the ‘back-burner’ behind some much more important priorities the Deloittes National E-Health Strategy. As much as I would love all this to be real I fear it is just glossy ‘foilware’!
At best this is a 10 year project which should only be undertaken after the basics are addressed and operational.
Just having a basic text admission summary able to be simply created and moved between hospital and GP would be a good first step while the wrinkles in this over complex, over engineered specification is further developed (it is nowhere near final yet - see the pathetic comments on privacy that just list the NPP principles without comment.) and then implemented on a test basis to show it is actually practical. The more of this documentation I read, the larger the number of gaps I see and the more ‘pie in the sky’ it feels.
Sad that. I know the journey of a thousand miles begins with a single step but there are some steps we can take at the 100 mile point that could really help and can be made to work.
Someone needs to sit NEHTA down and say it is not documents that save lives, it is actual working systems and we can’t wait for the unaffordable, perfectly engineered systems of 2030 they seem to want to give us for some incomprehensible reason.
David.
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