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Hello, I'm Norman Swan.
Welcome to Getting Started With The PCEHR -
I'll get that right by the end of the program -
the Personally Controlled Electronic Health Record.
We're coming to you on the Rural Health Channel.
I'd like to acknowledge that this program is being broadcast
from the land of the Wangal people of the Darug tribe,
traditional custodians of the land.
We pay respects to elders past and present.
The Australian Government's
Personally Controlled Electronic Health Record, the PCEHR,
is part of the federal government's Health Reform agenda.
Tonight, we'll talk about myths and misconceptions about the PCEHR
and what you can expect from it at this stage.
We'll also help you understand the options for registration,
including the new simplified and fast Assisted Registration Tool.
This Rural Health Education Foundation program
not only helps you with all that,
it also gives you accreditation and CPD opportunities.
We're coming to you live via webcast
and on the Rural Health Channel.
Get in touch and ask questions, comments,
whatever you want to say via phone, text, email, fax or online.
Send your emails to:
You can text us on:
I know it's old-fashioned, but you can phone us:
Remember fax machines? If you've still got one, you can fax us on:
We'll be very impressed if you've still got a fax machine.
If you're watching via webcast on your computer,
type questions into the Live Talk box and click 'Submit'.
We're taking questions live throughout the panel discussion,
so please send them in as they arise or occur to you.
Our first question to you -
it would be good to know who's watching.
Let me introduce the panel while you're answering that.
Click on the answer and we'll come back with the results shortly.
Mukesh Haikerwal is a general practitioner
in Melbourne's Western Suburbs,
where he's practised for quite a while.
He was national president of the AMA from 2005 to 2007
and is currently working with NEHTA,
the National E-Health Transition Authority,
as well as being Chair of Council of the World Medical Association.
- Welcome, Mukesh. - Thank you.
-Did I miss anything? - Lots, but don't worry.
Lots that you'd probably rather people don't know.
Chris Mitchell is Head of Adoption, Benefits and Change
at NEHTA, the National E-Health Transition Authority.
He's worked as a rural GP for more than 20 years in northern NSW.
- Welcome, Chris. - Thank you.
Chris is a former president
of the Australian College of General Practitioners
and a clinical professor at the University of Wollongong.
Eleonor Pritchard is the team leader for eHealth
at the ACT Medicare Local.
- Welcome, Eleonor. - Thanks, Norman.
Eleonor is responsible for the local implementation
of national eHealth initiatives, including the PCEHR.
Last and certainly not least is Adrian Verryt,
who's health-service manager at St Vincent's Hospital in Sydney.
His role includes implementing the National E-Health record system
within St Vincent's public and private hospitals.
Good luck to him with private specialists
at St Vincent's clinic.
- Welcome, Adrian. - Thank you, Norman.
Welcome to you all.
What are you up to at the hospital?
You're one of the pilot sites, aren't you?
We are one of the 12 eHealth pilot sites.
We have been implementing the PCEHR
in public and private hospitals
and we've been live now for several months
with PCEHR in public and private hospitals.
You've got rural and remote patients and practices registering with you.
Yeah, that's right. Well over half of our registrations
are coming from rural and remote areas
of particularly New South Wales,
but we've had registrations from all over the country.
That's primarily relating to our cardiothoracic transplant program
within the hospital
that our patients are coming from far and wide.
Right. How are registrations going, Chris?
Consumer registrations are over 90,000 now.
NORMAN:Quite fast, then. Last time I looked, it was 15.
It is increasing. We're getting almost 1,000 a day.
A lot of that is being driven by the Assisted Registration Tool,
which we'll talk about today, which allows providers
to register within their practice if they wish to.
What's the proportion registering from rural and remote sites?
Rural Australia makes up about 30% of Australia's population.
In terms of registration, it's a little under that.
We're running at around 20% rural registration.
That's still surprisingly high.
A lot of investment has been in eHealth sites,
and a lot of those eHealth sites are metro.
It's important for all of us to do what we can to close the gap
between mortality in rural Australia,
particularly remote Australia, and our urban practices.
A better connected health system helps do that,
and the eHealth record is part of that solution.
Tell me where we're at as of today,
'cause it's changing all the time.
We really are in a developmental phase, Mukesh.
Where are we at now with PCEHR?
To make the PCEHR, the eHealth system in Australia, work,
we need a critical mass of practitioners
to be part of that process, and we need members of the public
to be participating in this program.
- Are you registered as a patient? - I am registered as a patient.
All my family are registered as patients.
In fact, in my practice, over the summer months,
we register about 250 patients
to give a real field trial to the way the whole record works.
I personally registered the numbers I need to register
and started sending out shared health summaries and so on
from December.
What's the needed-to bit?
To register for the PCEHR, I need to have various numbers.
I see - the codes. There's not some person telling you
you've got to get to 250 or you don't get paid next week.
No, if I ask others to do this,
I need to have taken the journey myself.
What's on the record, so to speak?
The record came into being on 1st July.
The first cut brought into play consumer registration,
where consumers could register online.
That process has improved from being 29 screens down to about 8.
Chris will talk about the Assisted Registration Tool
which helps that process as well.
You no longer have to go into a Medicare office to do it?
You wouldn't have had much success if you went there anyway
because they're having difficulty registering from there.
The real options were doing this online or using the phone
because there was a lack of capacity in the Medicare offices.
Nonetheless, people have registered.
We as practitioners have started to register as well.
When people get a record,
they will see immediately when that record becomes active,
a dump of the last two years' worth of Medicare benefits
they have accrued, the Medicare benefits schedule items,
including the name of drugs that they have,
whether they are onthe Australian organ donation register,
and also if they're a child, what immunisations they have
from the Childhood Immunisation Register.
It's initially something that seems like not being much,
but working with these patients and new patients,
there is some benefit coming through from having those.
What we're seeing now is additional benefits
as clinical information systems - Medical Director, Zedmed,
Best Practice, Medtech32 and the like -
start getting connected,
it means we can start sending clinical documents of value,
summary clinical documents, that can add to the patient journey
by allowing good, reputable clinical information
to be available from one practitioner to another.
So is all this shared? Is everything shared, Chris?
The National E-Health record system is fundamentally
a system to allow consumers to share the information they want
with their provider of choice.
Whoever they want to share it with, they can.
When you register, the default is that you share with everyone.
If you want to restrict access
of differenthealth-care organisationsto information,
you can do that.
Less than 1% of people who have registered
have chosen to restrict access.
Basically most people are sharing.
I want to emphasise something that Mukesh said.
The Pharmaceutical Benefits Scheme for subsidised medicines,
patients have the opportunity of loading that up when they join.
That is really valuable information.
The way it's presented is really valuable as well.
You know, for those of us working in rural EDs,
we're sick of trying to work out what tablet it is
based on somebody's recollection of the colour.
That PBS covers 75% of the dispensed medicine.
So that's really important information available right now.
It will get richer with more information,
but that's a big win right now.
How tough is it to put the shared summary on there?
The shared summary uses the practice-management software
that we have already.
So this is the problem-oriented medical record
when you've got summary in front, diagnoses, history, allergies -
that's what you're going to put in front.
Right. That's what we've been doing.
If you're in an accredited practice.
Using RACGP standards, starting with the paper record.
We've transferred the settings for that
into the electronic world,
so the shared health summary basically is derived from
what's in our clinical information system packages.
There's a template.
As you connect to the PCEHR -
personally controlled electronic health record -
you can select which of those diagnoses, medications,
allergies are correct,
make sure the patient is comfortable with that,
then upload it.
That takes 25, 30 years of having a system
and making sure the knowledge is there in a way that can be used.
What myths and misconceptions are you finding about PCEHR
when you talk to general practitioners?
There's a few myths and misconceptions out there.
One of them is that a GP is always going to have to look at
a person's personally controlled eHealth record.
I've had GPs say, 'Every time a patient comes in,
do I have to look at their eHealth record?'
I say, 'If it's your regular patient, then no.
You have all that information.'
What's more important is that you work with your patient
to create that shared health summary of their important information
to upload for other health-care providers to look at.
But for your regular patient, you have their health information,
you're their regular GP, you're ordering their tests
and seeing the allied health you're referring to,
you have that information.
If you were going to change the summary
in the front of your electronic record,
which is already on your computer system,
you've got to do it on...
Have you got to double-enter?
Because you've already entered the information
into your clinical software,
it's just a matter of confirming with the patient, getting consent
and uploading a new shared health summary
if something changes in that patient's condition.
NORMAN: Does it take a long time? ADRIAN: It's very quick.
The experience I've had working with clinical desktop systems
to create a shared health summary, it is in minutes.
The really critical question is...
How good is the information to start with?
ADRIAN: Exactly.
You were saying before we came on air,
there's some scrubbing that needs to be done.
There is, but there are always going to be times
when the record is in a really good shape.
That would be a good time to target sharing that information -
when you've done a health assessment or home medication review,
or for people with chronic and complex health conditions,
when you're doing a GP management plan or team-care arrangements,
or when you're referring to a specialist
or sending somebody to hospital.
These are times when most of us do look at the summary on record
and make sure it's up-to-date.
The other thing that we did in our practice
which was one of the eCollaborative practices
that was rolling out some of these
was to actually print out the patient's health summary
and give it to them when they're in the waiting room
before they came in to see me.
They had the opportunity of updating it.
It's not very high-tech, just updating it on paper,
but it saved me a lot of time.
The reality is, even good practices,
data quality isn't always a hundred per cent.
There is new workflow there, particularly in general practice.
The shared health summary can actually be sent up
from anybody involved in long-term care.
That's a practice-improvement thing.
It makes a big difference to the quality of your records.
It means you're able to provide better care,
so it has value for the practice as well.
NORMAN: Mukesh?
The difficult part of this is getting the record right.
As we've said, that's very much a pride thing
in the quality of the record we provide
and the letters we generate from that.
But also, it's about getting the technology right.
What we're finding is, the actual upload might not be difficult,
but getting ready for all that, that's not an easy process.
That's been recognised by the Minister
in comments she's made about this,
and Medicare access is available for this purpose
when people upload.
- It's easier than it was. - Much easier now than it was.
Let's get the answer to that first poll question,
which is, who's watching? Who's out there tonight?
16% of you are GPs, 25% nurses.
Unfortunately, we don't have any Aboriginal
or Torres Strait Islander health workers watching on the webcast.
I'm sure there are millions watching via the regular cast.
10% pharmacists, 9%, and quite a few allied health
and a small number of specialists, students
and the odd manager - that's good.
And 32% are 'Other.'
I don't know what 'Other' is, but let's hope you're consumers
and that you're going to push your practitioner into registering
and getting you registered.
My next question to those of you watching via webcast is,
how much do you already know about the PCEHR?
Quite a lot, a bit but not enough,
not much at all?
What does a patient need
to register with PCEHR?
There's lots of ways to register. I registered online.
To register online, I needed my identification details.
I also needed to know when my last GP visit was.
So I did it the day after I last went to a GP,
so that was very easy to do that online.
We can also use this new Assisted Registration Tool.
I want to go through some questions that we've got
from our webcast audience.
Thelma Tantalos, a pharmacist from Tasmania, it looks like,
asks, 'Did you say two years of drug history will show?'
Two years of the PBS -
the Pharmaceutical Benefits Scheme past information.
That information is already held by DHS.
Some people can already see that online
if they make the effort to access it.
But Mukesh...
There is a slight additional to that.
If you've got a list of medications for the last two years
and some medications are connected to that,
you'll get a history predating that two years as well.
But in general, it's a two-year dump of information
from the MBS, PBS -
Pharmaceutical and Medical Benefits Scheme -
a database which you can see on your PCEHR.
A question from Tracy Maynard,
I think also from Tasmania, from a Medicare Local,
asks, 'What work has been done
with residential aged-care facilities?' Christopher?
Well, there's a lot of work that's gone on
to support the vendors that actually produce the software
that rolls out to the aged-care system.
That's not as well advanced as the general-practice software,
but that will be rolling out through the year.
That will allow aged-care facilities
that use a clinical information system
to share the personally controlled electronic health record
if they choose.
And the GP who visits can have access in his or her own practice.
Yeah, absolutely.
I think, the feedback we get from the aged-care sector,
it's this transition of care from the aged-care sector
to the hospital and from the hospital to the aged-care sector.
It's the information with those transitions
that's really critically important.
In order to get that,
we need hospitals and aged-care vendors on board.
John Molloy from New South Wales asks, 'I'm an optometrist.
Will relevant information be available
to allied health practitioners,
and will we be able to add information?'
The answer is that all health-care providers
will be part of the build.
If you are a registered health professional
through the Australian Health Practitioner Regulation Agency,
you already have a health identifier
and the ability to get a health identifier for your organisation.
So even if you're not able to bill through Medicare,
as long as you're registered through the Authority,
you can do that.
MUKESH: Yes, you get those.
Those who are not registered with AHPRA,
the registrable practitioners
like speech therapists, physiologists,
there is a scheme for getting your health identifiers as well
through Medicare.
The answer is, yes, we want people to participate
in this scheme from every discipline.
Another question comes from Stephanie
asking about Aboriginal community controlled health centres.
Presumably, they're like general practices
and registered accordingly.
- Not just like general practices. - In that sense?
Often the clinical information systems they use are similar
and they've been covered off by and large by the GP vendor panels.
We are running out a program in 13 AMSs
to make sure the policies and processes
that we've got for general practice
are also going to be fit for purpose in that environment.
The learnings from that, we'll be rolling out
with the support of NACCHO and MSAT particularly,
to get that information out
to community controlled health sectors.
Don't forget, if you're watching the regular way,
via the old-fashioned telly, you can ask a question,
you can fax it in to us, you can phone us.
The phone number is 1800 817 258. I think that's right.
We'll show you the numbers on the screen in a moment.
You can phone and fax us with your questions too.
Adrian, do you need broadband in your practice
if you're in a remote location?
You certainly do need a reliable internet connection.
You could realistically access the PCEHR via dial-up,
but that would only be in the instances
where you're dialling in.
You really need a fairly reliable broadband connection.
A question from Jenny Donaldson asks -
'Can you give us a sense of what's the buy-in for allied health
at this early stage?' Is it only secured messaging?
Allied health definitely needs to be part of the system.
We in general practice are prepared through various schemes.
We've got 98% of general practitioners
ready to participate in using technology in the health sector,
and many of those will be using the system.
We need to communicate with all practitioners in the community.
The buy-in is being able to get good summary information
about the patient who is before you.
You should get that from referral from the GP,
but often those refer letters don't come to you.
They will help get that information to you
from a reputable source.
Also, you've got other information available from other places
and you can see medications,
even when you last did a consultation,
whether your five consultations for the year
are due to be renewed or not.
So there are some benefits now
and many more later when these documents come in.
If you've got a clinical information system,
you can upload summary information in the form of an event summary
of what you've done for the patient.
So there is some continuity, one practitioner to the other,
of the care of that one patient.
CHRIS: Could I make another comment?
'Cause I think this is a really important benefit
for allied health.
I'll usually get the discharge summary from the hospital anyway.
It will usually be sent to me
because I'm looking after the person on a regular basis.
But it's very unusual for the speech therapist or the physio
to also get a copy of that discharge summary.
That is critical information for them in managing their patients
when they've been discharged from hospital.
This is really about connecting our health system.
NORMAN: One less phone call to make.
Allied health will really benefit from it.
While they will need a clinical information system
to share information,
they can receive information through their browser
if they register.
Allied health are really keen to be involved in eHealth and PCEHR.
They'll be accessing the provider portal
and actually seeing this information.
We've certainly been doing work with AHPA,
the allied health professionals
and also SARRAH,
which is the regional allied health care providers,
and we now have a chief allied health officer coming through.
So I think the standing of allied health in the community
is being recognised, which is really good.
Are all practice software systems now compatible with PCEHR?
No. There are eight tools that you can use at the moment
for GP systems that will connect with the PCEHR.
You've got to download a dongle or something?
No, if you've got that system,
it's been funded to be able to be connected to the system.
I can go through them, but I probably won't.
We've also got three aged-care sector providers
and some pharmacy providers as well.
We're now trying to work with the...
If you look at the market for clinical-software systems,
how covered are you?
We've got 96%, Chris?
Yeah, so we're well over 90% for general practice.
The other areas aren't available yet.
But our aim is to cover 90% of pharmacy
and aged care as well.
But we do hear that work needs to be done for allied health.
We do hear that.
We need to start somewhere, and we've started in those areas.
Eleonor, what does a practice need to get going?
They need to get identifying numbers that Mukesh alluded to earlier.
So, the first one for the organisation
is the health-care provider identifier organisation, HPI-O,
or 'Hippo', as some people call it.
Then there's provider identifiers, which are HPI-Is,
or health-care provider identify individuals - HPI-Is.
- How hard is it to get those? - It's not hard.
It's a bit of a cumbersome form, it's not at all hard.
Medicare Locals are there to help you
as a health-care provider organisation.
Once you get your HPI-O for your organisation,
you need to get a NASH certificate -
National Authentication Service for Health certificate.
It comes on a CD, and it's a digital credential
that allows your system to access the PCEHR securely.
That's a once-only load?
Once only. Stick that in,
and once you've registered with the PCEHR system, you're in.
And you've got your conformant software.
You'll be able to access, view patients' eHealth records,
uploading shared health summaries.
Briefly, what does the patient need?
The patient just needs to register.
To do that, identification and verifying your identity
is the cornerstone of registering.
We actually have a pseudopatient in the studio with us.
Mukesh, could you have a chat to Janet,
who might or might not be interested in
registering for PCEHR.
- Good evening. How are you, Janet? - Hi, how are you? Good.
I'm going travelling with my husband Tom.
We're going to go off. We've got a van.
I have heard about thiselectronic health-record thing, system,
and I thought it might be something
that would be useful for me, 'cause I've got a history.
Good to see you. You're looking great,
and going travelling sounds like a great idea.
How far away are you going?
I won't bore you with the details, but as far as we can,
as much time as we can afford.
You're an ideal candidate
for a personally controlled electronic health record.
We've known each other for quite some time.
JANET: Absolutely.
I have a significant amount of your health information
on my computer system here already.
That allows me to provide you directly through printout
with that information.
I used to only be able to get a printout.
If you register for the PCEHR - we can help you with that -
you will be able to have a summary that I provide onto that PCEHR.
- So other doctors will have access? - Other doctors can see it.
That's really what I'm worried about,
because I have ongoing medications.
The other thing is Mum. She's in the nursing home.
I've been taking care of what's happening for her
and keeping track on what's going on.
I'm wondering whether it would be helpful in that way as well.
It's fantastic that you do keep an eye on Mum.
That's been helpful for us to help look after her as well.
Obviously she needs to make her own decision
about having that record,
but if she did have that, it would be very useful for her.
But she could also make you a nominated representative.
OK.
You could look through, while you're travelling,
at information about her and keep people in the loop.
That's what I need, and you think that'll work for us.
If that's going to be useful, I'd like to register both of us.
We need to register yourself first, and there's many ways of doing that.
- OK. What do I have to do? - You can do that yourself online.
- I have to go and do that? - You can do it online.
We have something called the Assisted Registration Tool,
which we'll show you.
I could do it here? 'Cause I'm not real good on computers.
Sure. It's not as scary as it sounds. We can help with that process.
The benefits for you are, you'll get a set of summary information
about you that we have already, that we'll agree on,
and we can upload that.
That can be ready for you to look at to look after your health,
and for anybody else that you visit to see that.
Yeah. It's more important for someone else to look at it.
I know about me.
But I want other people to be able to know about me.
I want Tom to be registered too. My husband.
MUKESH: That's something that can be done as well.
NORMAN: Thank you very much, Mukesh. Thank you, Janet.
We'll come back to you in a moment.
While we're doing that, let's get the results of poll question 2 -
how much do you already know about the PCEHR?
A third of you said, 'Quite a lot.'
A third of you thought, 'A bit.'
And a third of you thought, 'Not much at all.'
We hope to help at least 60-odd per cent of you to do that.
Thanks very much for that.
Now we're talking about the Assisted Registration Tool,
the steps that you need to take to do that.
Eleonor, do you want to take Janet through
the next part of the process?
I'd love to.
- Hi. - Hello, Janet.
How are you going? I'm Eleonor.
I'm the practice manager at Mukesh's practice.
Oh, OK.
He told me you're interested in registering for eHealth.
Yes.
I'll talk you through how we can help you do that today.
JANET: Do you need my licence?
We need informed consent to process your registration.
We just need you to read some information,
complete a form and sign the form.
OK.
This basically says, 'I want you to do this.'
Exactly. That's your signature
to consent to your eHealth record being created.
Then I will scan the form into our computer,
and we use a tool.
You'll do it for me, I just fill this in?
ELEONOR: A one-page form, yeah.
We use the tool to create the eHealth record.
As soon as that's done, you'll have an appointment with your GP
to discuss what information you want on there.
Not all my information goes up? I thought it would all go up.
No, not automatically.
Some information goes up automatically -
your past Medicare benefits service information.
You know when you come here and have an MBS item?
You get that information.
Also Pharmaceutical Benefits Scheme information.
You'll see some past prescription information you may have had.
- But not everything else? - Not everything.
'Cause you need to have that conversation with your GP.
-There's a lot of it. - Exactly.
Have that conversation with your GP
about what is the most important information to be uploaded,
to be shared on your eHealth record.
- How do I look it up myself? - We'll give you a brochure.
You'll get an email where you get sent a code
so you can actually access it online.
- After you register? - Yeah.
You get sent an email, and there's a link in there.
There are simple steps to follow, so you can set up online access.
-I just follow it? - You just follow it.
And you can access it via the internet,
basically wherever you are.
OK. You said I'd get an email with my code.
I'm wanting to register Mum as well,
and she doesn't have email or electronic anything.
So what happens with that?
Well, to register your mum,
have a conversation with her or bring her in,
so we can have a conversation with her about the record.
- I should make an appointment? - Yeah.
See that she wants to register,
then she'll have to go through the same process
of consenting to have an eHealth record.
Then we can process that registration
while she's in with the doctor.
When she comes out, we can actually give her that code.
- Oh, wow, that quick? - It's that quick, yeah.
She might want to give that code to you
so that you can access her record.
I wouldn't be able to access her records unless I had the code?
- Unless you had her permission. - OK.
I don't think she'll have a problem with that.
Of course not.
- I usually bring her in anyway. - Fantastic.
- I'll make an appointment for her. - That'd be great.
OK. That sounds good.
NORMAN: Thank you very much, indeed.
Thank you, Eleonor. Thank you, Janet.
So Mukesh is otherwise engaged now,
and Chris is his partner, who sees Janet a lot.
Janet has lots of issues in her past history,
and now's the time for Chris to have a chat to Janet
about what's going to go onto the health summary
and what might not go on. Chris?
- Hi, Janet. - Hi.
Chris. How can I help?
Well, I've just registered for this electronic thing,
and they said I had to talk to you about what I should put up there
or what you should put up there.
So you've registered for the eHealth record?
Yeah, and they said everything doesn't go up automatically.
One of the documents that is really valuable
for other people involved in your care,
it's called the shared health summary.
But it's a created summary of your history
over the time that we've known each other.
- A long time. - Seems like a long time.
That important summary information
that I would normally include in referrals to specialists
or in letters I might send to the hospital,
that's my GP health summary.
That's basically a summing-up of what's on my whole record?
Your major medical history, your allergies
and adverse reactions to medications in the past,
your current medication list and your vaccination status -
when you had a flu needle last, Pneumovax, things like that.
So when I'm travelling, if I go to see a doctor, if I have to,
are all doctors linked into this system?
That information is really valuable for anyone that you see,
not just doctors.
- It's valuable for the hospital. - So if I see a physio?
It's valuable for physiotherapists,
but it is valuable for other GPs.
Just as you've had to read some of the terms and conditions
around that record, providers have to do the same thing.
So, in answer to your question,
not every practice in Australia is registered yet.
If I go to a doctor,
should I check with them whether they're registered?
Is that the idea?
Well, this is very early days for the record.
At the moment, there are far more providers that are not registered
than providers that are registered.
If this is critical to your care right now,
that's something that you may choose to check.
But you'll actually have access to this information yourself.
That's available to you on an iPad or a PC.
Oh, of course,even on my mobile.
That information can be shared with the provider,
even if they're not registered, if you wish to share it.
I can show them.
Ideally, if you want providers to contribute to that record
in your travels, they will need to be registered.
What do you mean, if they're going to contribute?
If you see one of my professional colleagues on your travels
and you want information from that consultation
to be shared into your eHealth record...
- From that consultation? - They will need to be registered.
- They can put it in? OK. - That's correct.
So, what's this summary look like?
This is what your GP summary looks like now.
This is the summary that we use in the practice
with the different doctors and nurses in our practice
as a summary of your health status.
I notice that you've got my depression up here.
I'm not having any trouble with that anymore.
I'm not taking any medication or anything.
I'm just thinking,
maybe that's something that would be better not there,
'cause some people think that depression is causing things
that it's got nothing to do with.
I don't know whether I'm explaining myself well.
I'm wondering if that would affect
how people would look at my state. Does that make sense?
I'm hearing your concern.
I've got a couple of things I'd like to say.
First off, I think the more complete your record is,
the more valuable it is for other people involved in your care.
If you believe that that information,
you really would rather not have it in the record,
I don't think it needs to be in the record.
- It's not a current, active problem. - Exactly.
You're not having any treatment for it.
If you don't want it in the record, it doesn't have to be in the record.
I would say that there are some things in the record
that are critically important
that we would want to have a discussion
if you wanted to suppress it.
If there was a really important medication you were on,
for example, that had potential for interactions,
or if there was an active problem
that would affect the way we deliver care to you,
and depression can be like that.
But depression isn't really...
Look, I think in this particular case,
I'm comfortable with that.
We've had a discussion and we've got a shared understanding.
The important part is having that shared understanding.
The value of the shared health summary is greater
the more information that's in it
because that'll affect the quality of care people can provide.
So maybe it's good to leave it in?
I don't think people will be discriminating you
on the basis of that.
I think, let's just have a discussion.
Whatever you decide, I'll be comfortable to support.
Alright. I'll have a think about it and let you know.
If I don't get back to you, you can leave it there. Is that OK?
We'll be sending the shared health summary up
at the end of this consultation if you'd like.
If you're happy to have it in, I'm happy for it to go up.
If you don't want it in, we don't have to put it up.
If you change your mind in the future,
we can chat about what you'd like.
So things can be changed?
We update the shared health summary
when there's a significant change in your status.
But if there's something you feel that in retrospect
you'd like to discuss,
rather than just emailing or texting me or calling me,
come in and we'll have a proper conversation.
Alright.
We'll be really clear what gets shared.
Yeah. Before I go.
When you're ready to tell me what you'd like in there or not,
that's what we'll share.
Alright, I'll get back to you. OK.
NORMAN: Thank you very much indeed.
So...
..Adrian, do people's applications ever get rejected?
Never get rejected.
It may not be successful,
because the details we've provided in the registration process
may not match what DHS Medicare have on file for that patient.
But that instance, in my experience, has been rare.
NORMAN: This is usually an identification issue?
ADRIAN: That's right.
MUKESH: It's not that rare.
In our practice, we would have 80% matches.
We've been trying to bring down the health identifiers
into our clinical software package
and trying to match that up with Medicare.
Some of that's to do with having old data
on our home systems in the practice.
Some of it is because the numbers that Medicare have,
the date of birth, may be wrong.
They need to be reregistered. There are problems with that.
In a sense, it is like data-scrubbing.
Once you start getting this data out there,
this is just purifying the system.
MUKESH: Absolutely.
It is, but it's not a completely new workflow for many of us
who are already using online billing.
We've got to go through those processes
to create that link with DHS Medicare for online billing.
It's not that dissimilar a process.
Do you have to keep this consent form?
We scan the form and attach it when we process the registration.
We've chosen, at ACT Medicare Local, to shred the forms.
If we're in a practice helping someone register,
once we process their application,
if we've scanned and attached the consent,
we can actually give the consent form back to the consumer.
Alternatively, we can post those forms into DoHA.
The consent forms need to be kept
because they are consenting to be part of a system.
If you're registering online, you complete your consent online,
and it's the same thing with the assisted registration -
that consent form does need to be kept in a certain manner
whether it's electronic or posted in in a hard copy form.
CHRIS:Norman, I'd just like to emphasise something.
Because, you know, the Assisted Registration Tool
is a really wonderful tool.
It's mostly going to be used in practices
for patients who the practice really wants to see registered.
You've seen that there is some time involved in that process.
There is no expectation that the practice is going to be donating
their practice management's, receptionist's, nurses'
or doctors' time to these processes for everyone.
But for people that they really want to see registered,
it makes an easy way to register.
The vast majority of registrations were online.
Give me an example of the people you're registering.
The people that I want to register in my practice
are people that I think are going to have particular difficulty
registering online.
For my patients that have disabilities, have had a stroke,
have difficulty with communication,
I know they'll have difficulty registering
and I know that they really believe
it's important that they have a connected health system.
I'm happy to put effort into registering them.
And because they've got chronic illness,
the potential for gain having the record is greater.
The record is clearly going to be more beneficial
for people with chronic and complex health conditions
and older Australians.
Mothers and young children is the other priority group.
Aboriginal and Torres Strait Islanders, rural patients.
These are all priority groups.
But I don't want people to get the wrong impression.
The vast majority of people are going to be registering online,
and the process of registering online
has been simplified significantly over the last few months.
For those that don't want to register online,
they can still register by phone, by post,
they can go to a Medicare office.
But practices who want to support this process
now have a tool they can do it with if they wish.
Online, you've still got to know when your last consultation was?
If you're doing it online, yes.
NORMAN: That's a problem, if you can't remember that.
That assumes you've got a chronic illness
and you remember when you last saw your doctor.
What you're calling out is that we do need to have a process
that ensures that people are who they say they are
when they register.
The last thing we want
is somebody registering for somebody else's record.
So there needs to be some security around the registration process.
Fundamentally, it needs to be information held by DHS Medicare
that they can compare to their records
to make sure that you are who you say you are
when you register online.
Are many hospitals registering patients using the ART?
Not many hospitals.
We understand that State jurisdictions are working very hard
to implement PCEHR
and along with that, assisted registration.
St Vincent's, I think, is the only hospital currently
that is connected to the PCEHR
and performing assisted registration,
with ACT Health shortly to follow.
The carrot you're dangling is, you'll get a discharge summary
straight into the electronic health record
if you're part of the St Vincent's system?
Part of the carrot for the consumer in the first instance
is, we want to make sure that health information about them
is shared with all practitioners involved in their care,
whether that's point-to-point messaging
or direct into GP desktop systems or via the PCEHR.
That's the carrot for the consumer.
Certainly for the health providers,
wanting to make sure that GPs are connected with us,
that they're receiving our specialist letters,
our discharge summaries.
That's a real benefit to the health community.
Eleonor, what if Janet had young kids?
If she had dependants under the age of 18 on her Medicare card,
we can register those through the assisted-registration process.
NORMAN: They don't need to consent?
She's consenting on their behalf.
We still need a consent form signed,
but it's signed by the mother or father.
And an older child who's still on your Medicare card?
If they're over the age of 18,
they'd have to register by themselves.
They could still register using the Assisted Registration Tool.
If you have a dependant who's over the age of 18
but unable to make their own decisions,
you need to register using the paper process.
There's a special section in the booklet, Section D.
So even though Janet rules her husband Tom with a rod of iron,
she can't register for Tom?
There's no assisted registration for husbands.
It's been requested a lot.
MUKESH: That would be very useful across the country.
It would. But they still have to make the conscious decision.
NORMAN: Dragging the man into the surgery is going to be difficult.
We don't need to get right into the detail,
but it is important for younger people listening to know
that they can take control of their own record
from the age of 14 if they wish.
We've got several questions here.
One is from Judith Krause, who asks,
'As an accredited mental-health social worker,
how do I register?'
As a mental-health nurse,
sorry, as a nurse, you're registered through AHPRA.
As a social worker,
I don't believe you're registered with AHPRA.
If patients who see you can get a Medicare rebate
for the services you provide through the mental-health scheme,
the allied health scheme, which you can,
you'll be eligible to get a health identifier from Medicare.
There's a process - a bit arduous but it's getting better -
there is a process for getting the practice in which you work in,
whether it's general practice
or a practice of health practitioners,
to get a health identifier for the organisation - a HPI-O.
Then that organisation can apply for
a National Authentication Service for Health, a NASH.
Then of course you need compliance software
if you want to write to this system.
You can go to ehealth.gov.au.
There's information there for providers on how to register
whether you're a general practice or a solo allied health provider.
The information is all there.
A solo allied health provider can still register
and access the PCEHR through the provider portal,
which you don't need conformant software.
You need internet access for that
once you actually go through the registration processes.
A question from Mary Garner
from Metro North Brisbane Medicare Local asks,
'Within aged-care facilities,
which health-care providers do you imagine
would share information to the PCEHR?' Chris?
I would hope all of the providers involved in the person's care
are going to be sharing the information -
the GP, the nurses involved in the care,
the pharmacists doing the visits,
the social worker, the dental visits, the specialist.
All of these people, we would hope,
would contribute to the record.
That's what we're trying to do -
join up the health system, as Mukesh said.
How do you do the event summary,
when you want to add something to it?
You know - you saw a dentist,
and you make sure he or she is given penicillin
to cover the heart problem.
These are very good questions.
I had the head of dentists in the practice two days ago.
I've had the allied health people last week.
These are very pertinent questions that they are asking.
Thank you for asking those again. The way you do that is the same.
To participate in the system as a practitioner,
you've got to have those prerequisites -
your identifier...
Let's say you registered and you've done something
and want to add it to the record. What do you do?
You need to have a clinical information system
that will allow you to do that.
Once you have that information on there,
it's written by yourself electronically onto your record.
I did the first one in Australia on Sunday, by the way.
It's new, really new.
It takes the information and data out of your system
in the same way.
NORMAN: You press a button to populate and off it goes?
Sort of. (Speaks indistinctly)
As far as consultation is performed,
you've got to be able to bring the information in.
Make sure it's in agreement with what you've formulated.
Agree with the patient that they're happy for that to be shared,
then it goes on the event summary
above the last shared health summary.
When you open the patient record, the PCEHR,
the first thing you will see is the landing page,
where you can see
the last shared health summary was created on this date,
so many new Medicare events
and pharmaceutical benefits events above that
and event summaries above that.
The first thing you see is a shared summary
and anything new above that, like the event summaries.
Anything historical is beneath that.
And other information available on the record as well.
Panos from Queensland asks,
'How are you going to cope with the new technology
with the present telecommunications infrastructure
of below-average speeds, especially in remote areas?'
CHRIS: Well, look. I mean...
..rural and remote health practitioners
have dealt with adversity since time immemorial.
That's what we do.
It is hard to deliver health services
when you don't have the same infrastructure
as our metro colleagues.
But the actual demands in terms of the data...
This is not like video consults.
The actual demand in terms of the amount of data being transferred
doesn't require high-speed internet connectivity.
NORMAN:It does require real-time connectivity.
It does require internet connectivity, absolutely.
A question from Joan Brodbeck, a nurse in New South Wales.
'Does this mean that prescribed medications will be shown
in terms of the frequency
that the patient is having their meds dispensed?'
In other words, a checkpoint on adherence?
No. The starter is not that rich.
What it is doing is, as Chris said,
it gives you about 75% of somebody's medications,
which tend to be prescribed and dispensed,
the PBS paying a subsidy on that.
It does not currently include traffic accidents.
It does not include private, does not include WorkCover.
If it's sub-$5.50 or sub-$30... (Speaks indistinctly)
..it's not on there.
But that still means 75% is on there,
but the actual data is not rich around it.
There are pieces of work being done
to make sure that more of that information is available.
That's something we're working towards.
It's not ready right now, but we hope it will be shortly.
Of course, medication information will also be available
from discharge summaries, from event summaries,
from shared health summaries.
That rich data set in terms of dose and modes of administration
and details on how to take that medicine
will be included in those documents.
And you can transfer that to the shared summary as you go through.
Adrian, another question from Mary
at Metro North Brisbane Medicare Local -
how long it's going to take to spread to other hospitals,
what you do at St Vincent's.
We understand that the jurisdictions
are on what we call a critical path to actually implement PCEHR.
The time frame I understand about that
is probably within June, July this year,
they will start going live with PCEHR.
Naturally, State jurisdictions have to come up with their own plan
on how they're going to deploy, whether they have the software
that is capable of connecting to the PCEHR.
There's a lot of work being undertaken at the moment
with the State jurisdictions to bring that.
MUKESH: There is a lot of work being done State by State. It will vary.
Some are at a different stage in their own internal
technology and health projects.
Some States have got some areas -
Albany in Western Australia is ready to do some of this stuff,
some places in South Australia, and some places aren't.
Burwood Health is doing stuff in this area.
It really is going to be...
NORMAN: A patchwork which will knit together.
A question from Jenni Knight,
who's at North Sydney Medicare Local -
'If you don't have a primary GP you'd nominate for your PCEHR,
can you nominate all the GPs you've consulted with
to be able to access my PCEHR?'
Once you have your PCEHR,
any health-care provider involved in your health care
that you give consent to can access your eHealth record.
They can access and view it.
NORMAN: How do I get a shared summary on if I don't have a primary GP?
No, you have to go in and have that conversation with your GP.
You have to speak to a GP that has some of your medical history.
A GP might not be comfortable doing a shared health summary for you
on the very first visit.
They might say, 'I don't know enough about you',
and want more of that information beforehand.
The shared health summary, in our build -
89% of people see the GP once a year,
GPs are 96% computerised, so it's a good starting place -
but any medical practitioner
can be a generator of the shared health summary.
Any registered nurse can be, and any registered Aboriginal
or Torres Strait Islander health worker can do that.
In general, the undertaking you make
on providing a shared health summary
is an ongoing relationship with a patient,
and the patient has consented to you providing that.
I'd like to comment as well
that the evidence base around continuity of care
is incontrovertible.
You clearly get better health outcomes with regular contact
with providers over time.
If you have a lot of different providers
providing the shared health summary,
technically you might be able to do that,
but the quality of those shared health summaries
won't be the same as a shared health summary
generated by somebody who's known you over a decade
and has been with you on that journey.
Rubbish in, rubbish out?
Well, excellence in, excellence out.
NORMAN: Very positive.
I hasten to add that my question now
has got nothing to do with a comment I just made -
is corporate general practice playing ball?
Absolutely, they are.
Everybody needs to make their own investment decisions
around IT infrastructure.
Whether you're a single allied health provider
or in a corporate practice, you need to make those decisions.
Individual corporates are making different decisions
along this track,
but there have been big peaks in terms of registration
when groups of corporate practices have got on board.
A question from Jenny Donaldson in Macedon Ranges
and North-Western Melbourne Medicare Local asks -
'Will the shared health summary provide an alert
to the reader of the record if a patient has decided
to conceal some medical information from their record?'
Is there a pulsating red light for Janet's depression?
No. This is a personally controlled electronic health record.
The patient may not have one.
If they do have one,
they may choose for you not to know about it.
If you have someone who,
you go onto your system and know they've got a record
because you can question the PCEHR system,
it will tell you the person has locked you down.
To get access, you can still... what's called 'break the glass'.
If they're unconscious
or there's a good reason for breaking the glass,
you can look at that information.
But if the patient is before you saying,
'You can't look at the record,' you can't.
It's just like right now.
It's really interesting,
but I've been in practice for quite a few years
and I've never seen a red light over somebody's head
when I'm taking a history.
Ah, but you can see it in their eyes!
It's just like the real world right now.
Patients choose every day to not talk about health information
with their providers.
It's our job to make sure the relationship is respectful
and encourages that release, but it won't always happen.
Eleonor, just to remind us -
what steps does a professional need to take
to register for PCEHR?
Get those identifying numbers - the HPI-O, the HPI-I.
They're through the HI Service. Lots of acronyms there.
Then you get your NASH certificate -
your National Authentication Service for Health certificate.
Then register for the PCEHR.
You sign the participation agreement as a practice,
or as an organisation.
Once you get all that and conformant software
or access to the provider portal, you're set.
From beginning to end, does it take about a week
to get your CD in the mail?
(Mukesh coughs) - A little bit longer.
NORMAN: Sorry, Dr Haikerwal had a fit as I asked that question.
It's a process, it takes time,
but it's a process you only do once.
Once you've done it, it's done and it's all set.
It is a process.
These things need to be processed by real people.
There's a lot of practices signing up for the eHealth system,
so there is a lot of workflow.
A final question for you watching on the webcast:
I hope the answer is yes.
I certainly know more than I did before.
There are a number of organisations out there to help.
Do you want to run through what's available?
Medicare Locals are all around
Australia to help organisations
with the eHealth system.
There's a couple of websites
on your screen:
There are resources available
for provider organisations.
Give your local Medicare Local
a call and they can
talk you through some steps
and the process of what you have to go through.
Adrian, what's your take-home message for those watching?
For consumers and for practitioners, just connect.
We want shared health summaries in hospitals.
That's going to really benefit patient care in hospitals.
And going back out into the community. Eleonor?
Call your Medicare Local for help.
It is confusing, it's not an easy process to start with.
Don't worry if you're confused, there are people to help.
We've done it with a heap of practices
so we're used to it and we can step you through it.
Christopher?
Rural practice has always been the great innovator
in Australian health care.
I'm sure for the PCEHR it'll be no different,
so get on board.
I do think it is hard, when we go through all this stuff.
ehealth.gov.au - that's the landing page.
It will take you through the education you need.
Right off the NEHTA website,
there is a landing page about assistance.
It is targeted for general practice, to help them register.
We'll be reformatting that information
for other health practitioners,
but that information summarises a checklist of what you need to do
to get registered, not just for the eHealth record,
and that's important enough,
but for all the other e-stuff going as well,
like electronic transmission of prescriptions,
secure message delivery.
- Those websites are critical. NORMAN: Mukesh?
This has been a very difficult journey
from the generation of the NASH certificate
at the end of December, trying to get people registered
for the practice-incentive payment starting in February.
We know that people have had a lot of pain with that process.
Nonetheless, once we get this through,
what we've achieved in Australia
is groundbreaking across the globe
in being able to allow people to write to a PCEHR
and read from a PCEHR,
whether it's community or the hospital sector.
We've started to get to a place
where we can join up the care of that one patient
from multiple places.
It's good for you and I as health-care professionals
and it's good for you and I as consumers, as patients,
because we've got better information from a trusted source
that we can refer to and get better care.
We need the critical mass of people out there
from consumers and from us as health-care practitioners
to make this work.
If there are problems, our job is to try and fix it.
Thanks, Mukesh. So as a result of watching this program,
do you feel you have greater understanding of PCEHR?
A resounding 96% of you said yes.
What a relief!
And 4% of you, no. Why 4%?
Why couldn't it have been 100%?
But thank you very much indeed.
Thank you all for watching.
Our special thanks to Jennie Dibley, our actor today.
I hope you've enjoyed this program, found it useful -
well, 96% of you seem to have.
Get started.
If you're interested in more information about the program
or you'd like to watch it again,
you can visit the Rural Health Education Foundation's website:
Click on the program page, 'Getting Started With PCEHR,
The Personally Controlled Electronic Health Record.'
If you're a clinician,
don't forget to complete your CPD evaluation form,
which can be completed online.
You'll receive a certificate of attendance,
and if eligible, CPD points.
We won't register you for PCEHR, you've got to do that yourself.
Our thanks to the Department of Health and Ageing
for making the program possible,
and to you for taking the time to watch
and to contribute so well to our discussion.
We'd like your feedback. Your comments are important to us.
Let us know you watched the program by sending us an email or text,
and share your views. We'd love to hear from you.
I'm Norman Swan.
Goodbye, and join us again on the Rural Health Channel.
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