We have had the release of two documents last week which are really quite important (and one of which needs to be responded to by June 28, 2010).
See here for an Implementation Approach (This needs a response):
http://www.nehta.gov.au/component/docman/doc_download/1012-hi-service-implementation-approach
And here for the Communication Plan:
http://www.nehta.gov.au/component/docman/doc_download/1011-hi-service-communication-plans
The real core of what is contained in the 45 page document is in 2 sections (Page 14-15):
SECTION TWO
2. How will the HI Service be implemented?
Healthcare providers in both the private and public sector have made significant investments in technology over the past 20 years. Australian governments have agreed that any national program must recognise this investment and build on existing systems.
The HI Service will:
• Assign healthcare identifiers to individuals, healthcare providers and organisations to make sure that all can be consistently identified;
• Develop and operate a Healthcare Provider Directory to facilitate electronic communication between providers by enabling them to look up the contact details of other providers, either directly or through a local services directory;
• Support the implementation of a security and access framework to ensure the appropriate authorisation and authentication of healthcare providers who access national e-health infrastructure, including the HI Service; and
• Support secure messaging from one healthcare provider to another by providing a consistent identifier that can be used in e-communication.
A number of service channels are being established for both individuals and providers to access the HI Service. Medicare Australia as the initial HI Service Operator has several existing channels that can be leveraged; however, there will be separation between the Medicare payment system and the HI Service system.
Healthcare providers (individuals and organisations) will be able to look up or enquire about identifiers from the HI Service via a secure business-to-business web service, a secure web portal or telephone. Individuals will also be able to access their own information held by the HI Service through a web portal, by telephone or face-to- face.
Identifiers will be automatically assigned by the HI Service Operator to all individuals enrolled in Medicare Australia’s and Department of Veterans’ Affairs (DVA) programs. Those not enrolled with Medicare Australia or the DVA can be provided with a temporary (unverified) IHI when they seek healthcare, and can choose to validate (verify) this number through the HI Service by providing sufficient demographic information to ensure the IHI is uniquely assigned to that individual.
Individual healthcare providers will be issued with either a HPI-I as part of their professional registration process (for example, through the Australian Healthcare Practitioner Registration Authority) or obtain one directly from the HI Service.
Healthcare organisations will need to apply directly to the HI Service Operator to be issued with a HPI-O.
Healthcare identifiers are designed to improve information management and communication in the delivery of healthcare and related services. While identifiers are designed primarily for these purposes, there will also be benefits in using the identifiers for other health-related purposes such as health research and management of health services, which would improve the timeliness and accuracy of such activities. These additional purposes will be specified in the proposed healthcare identifiers legislation and will be permitted only in accordance with strict protocols and guidelines.
----- End Extract.
And here:
2.2 How will the health sector adopt and use identifiers?
The use of HIs will be adopted by the market in an evolutionary way to support strategic initiatives and priorities at the national, state and territory level including for example, medications management, discharge summaries, and referrals, as well as a future personally controlled electronic health record. Identifiers may be used for internal clinical purposes as well as for information exchange. There will be different drivers across the healthcare sector. Most healthcare organisations will ultimately only adopt identifiers when their systems are able to support them and if they see value in making the change.
A government-run service will issue and maintain a unique identifier for every healthcare recipient and healthcare provider. Supporting standards are being developed with Standards Australia through the IT-014 Health Informatics Committee and at a practice level through the Australian Commission on Safety and Quality in Healthcare.
NEHTA and governments will support strategic projects to move toward the ‘tipping point’ where most healthcare communications include identifiers. Clinical repository projects for public hospitals, discharge summary transmission projects between hospitals and GPs, and inter-jurisdictional transfers are examples of initiatives that will implement healthcare identifiers in key functions.
----- End Extract
The waffle and impracticality of all this is just amazing.
First it is clear there will be no secure provider authentication (NASH) any time soon.
Second it is clear no one has put together the set of compelling reasons for providers to use the identifiers and take the time, cost and trouble associated. All we get is waffle on this point.
Third it will be a good 12 months before seamless access to the HI Service from practice computers will be available. Once it is every practice staff member will need an individual identifier and some form of token for access to be properly managed and authenticated. How long this will take is anyone’s guess.
For all this to be made to work there need to be some pilot, incentivised implementations where all the moving parts (communications, modified software, authentication and so on) are brought together, made to work, and implemented as a package which can then be evaluated.
Once pilots are successfully shown to work, not be too onerous and offer benefit then a phased national roll out makes sense. Until then they are ‘whistling in the wind’.
The approach of doing one bit here and another bit there as seems to be planned is just ridiculous in my view! There is just no value in this sort of approach.
I am not sure which planet the authors of this document reside but it is not Earth in the year 2010.
For any real adoption to happen there has to be a compelling reason (or incentive) to do so and a seamless, fully complete and smoothly operational system available for easy installation and use by providers. Without this the whole thing will be a fiasco.
David.
Late Addition:
There is a bit of chatter in the document about the UK NHS Number. This might help.
http://www.nhs.uk/chq/Pages/897.aspx?CategoryID=68&SubCategoryID=162
How do I find out my NHS number?
All babies born in England and Wales are given an NHS Number at birth. Other people need to officially join the NHS to get an NHS number. You can do this by:
- approaching an NHS GP surgery, or health centre, and asking to permanently join their surgery list,
- contacting a Primary Care Trust (PCT) who will place you on a local NHS GP surgery list, or
- being treated at an NHS hospital that is able to allocate NHS numbers.
Your NHS number is printed on your medical card (FP4). However, if you have a medical card that is more than eight years old, it may show your old NHS number. The new number is 10 digits long.
Your NHS number is written on your medical history notes, so to find out what it is, you can simply ask your GP, or contact your local Primary Care Trust (PCT).
To get a new medical card and NHS Number, you will also need to contact your local PCT. See 'further information' to find the contact details of your local PCT.
When registering for your new medical card and NHS number, you will be asked for your name, date of birth, and the name of your GP. You may also be asked to confirm selected personal details in order to verify your identity.
The information that you provide will be treated confidentially and the PCT will not give out any personal information over the telephone. It will usually take about two working days for your new medical card to be issued.
---- End Extract.
As you can see the NHS Number is provided to patients printed on a card! Hardly the electronic service almost implied in the NEHTA documentation – the electronic system is an internal one for the providers and care trusts. Just so we are all clear on that! A reminder that there are many ways to skin the cat!
D.
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