A considerable amount of work has been completed by the Department Of Health and Ageing and the National E-Health Transition Authority (NEHTA) in attempting to characterise the readiness of health practitioners for eHealth initiatives. One particular piece of work has looked specifically at the attitudes and available infrastructure of practitioners in psychology and other fields. It was discovered that while many psychologists were sympathetic in attitude to the changes ahead, many lack the infrastructure to engage in the electronic components.
Three stages of readiness have been identified:
The impressions gained from talking to practitioners, and from basic surveys is that many psychologists are in Stages One and Two with only small numbers at Stage Three.
Many practitioners already utilising some form of electronic support to their practice were found not to be utilising aspects such as secure messaging in their communication. It is easy to conclude that there is a considerable amount of work to do and the APS is committed to assisting its members to make necessary changes as they transition to the eHealth record system.
As part of the National eHealth record system all registered psychologists have been automatically allocated an HPI-I by Medicare Australia through your registration with AHPRA. From July 1, 2012, this number will be your individual identifier as a provider within the eHealth record system, which will be used in all of your interactions with the PCEHR.
Most psychologists should have received a letter from AHPRA which included their HPI-I. Alternatively, to find your HPI-I, you can contact Medicare with your AHPRA registration number at hand.
Email: firstname.lastname@example.org or call 1300 361 457
Healthcare providers with an HPI-I can elect to have some of their details published in a Healthcare Provider Directory that can be accessed by other practitioners wanting to locate a provider and make a referral.
Information on how to grant consent to have details published in the Directory can be found at: www.medicareaustralia.gov.au/provider/health-identifier/feedback-form.jsp
The HPI-O is a unique 16-digit number that provides details of where the service was provided and the details of that business/location such as:
Some psychologists will need to register for a HPI-O and sign an agreement to participate in the eHealth system. This will include sole practitioners, owners of a group practice and even some of those conducting private practice in a public or private healthcare setting.
To be eligible for an HPI-O an organisation must: provide a healthcare service; be a legal entity; and employ or contract one or more individual healthcare providers. The HPI-O will be linked to identifying information such as the Australian Business Number (ABN) or Company Number (ACN), organisation's name, address, type of service, electronic communication details, and nominated officers responsible for involvement in the eHealth record system. As the HPI-O will be linked to a practice address, this allows identification of the location where the healthcare services were provided. This is useful when a practitioner provides services in more than one location.
You will need to apply to Medicare Australia to get an HPI-O by completing the forms and providing the supporting information as detailed on the Medicare Australia website.
Psychologists should also be familiar with the process of obtaining an individual health identifier (IHI) in order to assist clients in gaining that information.
An IHI is a unique 16-digit number that is linked to key identifying information about an individual such as:
Since 1 July 2010, IHIs have been allocated to all individuals enrolled in the Medicare program, and to those issued with a Department of Veterans' Affairs (DVA) treatment card and to some others who seek healthcare in Australia. Clients and patients do not need to know their IHI as it will be automatically provided by the system once they provide valid identification.
However, if interested, your patients/clients can obtain their personal IHI by visiting a Medicare office, calling the Medicare Australia enquiry line or logging on to Medicare Australia's Online Services.
‘NEHTA conformant’ software is required to enable access to the eHealth record system, but very few software vendors have this currently available (a few GP management software vendors are planning to have conformant software available by 1 July). While new software is under development for the market, a Provider Portal has been created to allow health professionals to have access to the eHealth record system. The current access via the Provider Portal only allows viewing and printing of an eHealth record, not uploading of information.
To enable use of the eHealth record system from 1 July 2012, individual health service providers and organisations will be issued with an authentication token with a NASH certificate to enable authentication when accessing an eHealth record. The NASH (National Authentication Services for Health) is a system under continuing development which will allow healthcare providers and organisations under the eHealth system to be accurately identified before they are able to access secure health information electronically.
The Provider Portal is accessible from the eHealth website by psychologists using their authentication token. The IHI of a particular client will need to be entered to access his or her eHealth record.
A simple case example may illustrate how different things may be under eHealth.
An email arrives in your practice inbox informing you that there is a referral on your server. You open it once you have authenticated yourself and receive not only an official referral from a local GP but also a copy of the Mental Health Treatment Plan. The GP, knowing your areas of expertise and service provision, may have even made an appointment for the client as you have allowed her agreed access to your electronic diary. This electronic referral has come to you in encrypted form and can only be downloaded and decoded by you. The form of the referral allows you to easily respond electronically and securely to report to the GP either acknowledging the referral, reporting after the first session or after the sixth. Each step should only take a few minutes of your time.
When the client arrives, having received an automatic reminder text message the day before, he gives permission for you to access his eHealth record via a web portal or through your compliant software and you can gain access to a brief history, medication list and reports and documents from the other health providers engaged with the client.
In the future you may be able to view X-rays, CT scans, MRIs – all while still at your desk. Fairly early in the piece pathology and radiological reports will be easily accessible. Specialist letters will also be available if appropriate. Also useful may be the discharge summary from a recent hospital admission - all at your finger tips.
Once you have seen the client, your notes and documents, taken on a tablet computer which converted them to standard text, can be encrypted and safely stored on your server leaving no messy or vulnerable files in your paperless office. The account will have already been lodged electronically with Medicare, the private health insurer or deducted from the client’s account.
The next client's electronic notes are already on your laptop ready for the next session. The template for the record of that session is already populated with basic information.
One thing that many psychologists will ask is "what's in it for me?" It is a fair question as, in many cases, the costs of setting up for eHealth will not mean great benefits for the practitioner as much as for the consumers.
In their excellent paper "Optimising E-Health Value" (2010), Booz & Co make a very perceptive and fundamentally valuable observation. It goes something like this: in any initiative or intervention, the costs of change do not always come to the ones who benefit from that change. In fact they often bear on those who benefit least. This inequality is fundamental in the healthcare provider sector. Were there to be a limited adoption (if not failure) of the eHealth record among both consumers and providers, it may be that this inequality would lie at the basis of that outcome.The essential point that Booz & Co make in response to that inequality is that it is the responsibility of government to ensure compensation for that inequality. It certainly will not be sufficient to rely on education alone to redress this imbalance. So practitioners who feel this inequality are not alone and the APS has repeatedly made this point in discussions.
InPsych June 2012
‘Getting ready for the new eHealth record system’
InPsych April 2012
‘eHealth records to be introduced for all Australians from 1 July 2012’