The NSW Government has successfully agreed with the lead Australian government e-health agency to integrate remnants of the Healthelink trial into the wider, $467 million personally controlled electronic health record (PCEHR) led by Federal Government.
Announced as one of the nine wave 2 e-health implementation sites by health minister, Nicola Roxon, last month, the nominated site in western Sydney will adopt and expand on the scope of the Healthelink pilot initiated by the state government.
The $20 million Healthelink trial first began in 2004, with pilot sites in the Hunter Valley and later in western Sydney focussing on the elderly and children under 15, respectively. As of 30 June last year, the Healthelink pilot counted more than 103,000 clients.
The pilot has continued since but was never extended beyond the two initial pilot sites, and updates on progress have ceased since June last year.
The Web-based e-health record included elements also used in the United Kingdom’s e-health record and flagged by National E-health Transition Authority (NEHTA) head of clinical leadership and engagement, Mukesh Haikerwal, as a potential starting point for an electronic health record for Australians. These included allergies and alerts, encounter history and medical prescriptions from participating health providers.
Though the pilot began as voluntary when first launched as a $19.4 million project in 2004, it became an opt-out trial, with a 2008 review of the pilot by KPMG pointing to opt-out rates of between four and six per cent in western Sydney and the Hunter Valley respectively at the time.
Health minister Roxon revealed last year that the NSW Government would attempt to integrate the failed pilot into the wider record project, as part of a $1.2 million commitment to the first wave e-health sites.
NSW Health confirmed with Computerworld Australia that negotiations had been successful with NEHTA and the Federal Government to utilise the western Sydney Healthelink pilot site.
NEHTA’s head of PCEHR, Andrew Howard, said the site had been chosen specifically because of the existing infrastructure around Healthelink and an established set of participating doctors.
However, the scope of the trial is likely to change significantly once implemented, with the area extending to all residents in the area rather than just children. Participation would not be restricted to postcodes either, but instead to all participating doctors in the region.
“[Postcode restrictions] created problems for the GPs because they were servicing people across all of the postcodes but they only had a small subset of their population base part of the opt-out process,” Howard said. “Those GPs can now say look, in this Greater Western Sydney area, you’re my patient so you’re part of the process. That’ll give us valuable information about yes, we have to get people to opt in.”
However, the move from an opt-out to an opt-in process for residents in the area will likely prove the most valuable aspect to the trial.
“The thing I’m going to be particularly interested in that implementation is the adoption challenges we’ll have moving to a broader population set and the opt-in processes that they’ll manage through that cycle.”
Those already assigned an electronic health record under Healthelink under the opt-out scheme will be automatically transitioned to any changes to health summaries under the national record rollout.
Potential changes to the summaries are currently being negotiated with NEHTA under an implementation planning study being undertaken by all nine wave 2 sites through to the end of May. A draft set of health summary specifications to be delivered to the sites on 18 April will provide a base to determine what changes will be necessary to the Healthelink health summary in order for it to become compliant with the national rollout.
NEHTA is yet to make a firm decision on how health records and summaries will be stored, with discussions revolving around a potential use of both a central and distributed repositories. Howard said in a distributed repository structure, Healthelink’s existing infrastructure would likely become part of the wider group once it is compliant.
NSW Health chief information officer, Greg Wells, said in an emailed statement that the department had established a panel of clinicians to provide advice and accountability on the trial site.
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