Accession improving consumer access to medical rec

Accessionimproving consumer access to medical records via the web: 

Accession improving consumer access to medical records via the web Dr Chris Miller Business Analyst Intrahealth Limited Mr Paul Geyer General Manager Intrahealth Limited

Objectives: 

Objectives Examine the environment and rationale for allowing consumer access to medical records Propose a model for allowing access to records via the world wide web Introduce Accession, Intrahealth’s web interface to patient clinical records practice appointment system

The clinician-client relationship: 

The clinician-client relationship Evolving to a partnership between clinician and client, where information is increasingly shared. There is evidence that the degree of partnership correlates with: Patient satisfaction Compliance with management plans Reduction of complaints Increased morale of GPs Tito F, Roche S, 1999. Partnerships in general practice: a discussion paper. Consumers’ Health Forum, Melbourne

Privacy legislation: 

Privacy legislation Patients have a right to see their full medical record Patients must agree on the form of access, and may have “direct access” if desired Implications for electronic records Direct implies access to working data Legislation allows for access via the internet RACGP, 2002. Handbook for the management of health information in private medical practice. First edition. RACGP, Melbourne. http://www.racgp.org.au/document.asp?id=6528 (Accessed 6 August 2003)

Consumer demand: 

Consumer demand Consumers indicate that they want access to their records… 94% believe they should have the right to see their records 56% believe seeing records will improve their understanding of their health Pyper C et al, 2002. ERDIP online patient access project, evaluation report. Bury Knowle Health Centre and Department of Public Health, University of Oxford.

The role of the Internet: 

The role of the Internet 1.4 million Australians regard the internet as their preferred source of medical and health information after their doctor ACNeilsen.consult, 2003. The second annual Australian eHealth study. Sydney: ACNielsen.consult

Consumer interest in online interaction: 

Consumer interest in online interaction Surveys indicate consumers desire to manage a number of health care needs online reviewing test results (84%) making appointments (71%) receiving reminders and recall notices (81%) request scripts for regular medications (71%) Taylor H, Leitman R (editors), 2001. Study reveals big potential for the Internet to improve doctor-patient relations. Health Care News 1 (1) 8 January 2001. Rochester: Harris Interactive von Knoop C, Lovich, D; Silverstein, M, 2003. Vital signs: e-health in the United States. [online] Boston: Boston Consulting Group. http://www.bcg.com/publications/files/Vital_Signs_Rpt_Jan03.pdf  [8 Aug 2003]

Paying for online services?: 

Paying for online services? Harris Interactive survey, 2002 37% indicated that they would pay to interact with their health provider online 56% say that ability to interact online would influence their choice of doctor (14% would be “strongly influenced”) Taylor H, Leitman R (editors), 2002. Patient/Physician Online Communications: Many patients want it, would pay for it, and it would influence their choice of doctor and health care plan. Health Care News 2 (8) 10 April 2002. Rochester: Harris Interactive

Clinician perspective: 

Clinician perspective Potential resistance from clinicians to engage in online interaction with patients complexity duplication of information; possibility of transcription error expense increased workload non-income generating work medicolegal implications Scott L, 2000. Online patient records heating up. Modern Healthcare, February 2000

Making e-health acceptable to clinicians: 

Making e-health acceptable to clinicians Avoid duplicate data entry Use existing clinical software; avoid the need to learn web content management systems Gather meaningful, structured data from patients Automatic response/escalation where required Do not substitute for face to face consultation Maintain ownership of the data and control over who sees what Reduce administrative burden Online appointments Electronic reminders/recalls (reduce postage costs) .

Introducing Accession: 

Introducing Accession Web interface to clinical and practice records (real time, live data) The interface resides on the same server as the clinical records owned and controlled by the clinician in the practice, or externally (e.g. in a Division of General Practice) Interfaces with Intrahealth’s products: Profile (clinical / practice management) InSync (health system management / population health application) Allows consumers to view and contribute to the records maintained by their health providers

Single practice model: 

Single practice model Accession web server Practice-maintained database Provider’s data Patient

Integrating health information: 

Integrating health information Patients can view an integrated record comprising data from more than one practice Centralised provider representation Shared reference data Provider data sources

Functions for registered patients: 

Functions for registered patients Log on to health providers’ database Make appointments, change or cancel appointments or confirm pending appointments Review recalls, see upcoming recalls, read the reason for a recall, make an appointment for a recall Reorder standing medication orders Check laboratory results, graph them, seek interpretation using a clinical rule (set by provider) Review problem lists, read more information about specific problems and be routed to approved web sites for additional details Undertake self assessments that are reviewed by a clinical rule and escalated if necessary

Functions for other visitors: 

Functions for other visitors Search for providers who use Accession Search for health care providers of certain types, locations and characteristics Register with a new health provider

Control: 

Control Accession provides a view of the practice’s working data in real time The information is owned and controlled by the practice The practice can decide which information and functions are available via Accession Whole of practice Patient by patient Patient groups

Control of patient access (Profile): 

Control of patient access (Profile)

Accession quick tour: Logging in: 

Accession quick tour: Logging in

Patient home page: 

Patient home page

Recalls: 

Recalls

Recalls 2: 

Recalls 2

Medication management: 

Medication management

Appointments: 

Appointments

Clinical notes: 

Clinical notes

Benefits for Consumers: 

Benefits for Consumers Improved health outcomes through Better understanding Playing a greater role Streamlining the interaction with their providers (online appointments) Receiving reminders/recalls by email Access to up to date, medically-relevant data Available anywhere, any time (useful when seeing new/remote providers)

Benefits for GPs/health providers: 

Benefits for GPs/health providers Improved patient partnership/compliance (e.g. better medication management, more likely to keep appointments) Increased efficiency; time saver (e.g no extra effort in order to provide information to patients, reduce load on reception staff) Potential to reduce administrative costs (printing and postage) Tracking/documentation (e.g. know when people have viewed their reminders or pathology results) Patient loyalty New revenue stream

Questions and answers: 

Questions and answers What server platform is required? Is the data encrypted? How are the passwords managed? What about HealthConnect? Can patients send emails to their doctors? Who actually holds the data? Can the practice control which information is available to patients? Can the patient decide who sees what? What if patients don’t want their information available on the web? Can information be shared with other health providers? Has Intrahealth had legal advice about implications of privacy legislation? How much does it cost?

What server platform is required?: 

What server platform is required? Requires Microsoft Internet Information Server

Is the data encrypted?: 

Is the data encrypted? Same level as online banking - 128 bit, managed by web browser on the client side and Internet Information Server.  When a browser requests data, it is automatically encrypted 

How are passwords managed?: 

How are passwords managed? Managed by the practice's system administrator - they allocate the password to the patient and are responsible for maintaining it. The patient is responsible for the security of their own password. At this stage there is no capability for the patient to manage/change their own password

What about HealthConnect?: 

What about HealthConnect? Accession had not been released into the Australian market in time for consideration for the current round of HealthConnect trials.  We believe that The Accession/Profile/InSync combination provides a feasible solution and Intrahealth's Australian general Manager has had discussions with senior HealthConnect personnel regarding possible future involvement.

Can patients send emails to their doctors?: 

Can patients send emails to their doctors? Possible, but currently not supported for business reasons. Accession is an interface to the medical record, allowing patients to view and contribute to it. It is not intended to be a substitute for a clinical consultation or a channel for ad hoc communication between patients and doctors. This is because unstructured email communication can lead to large amounts of extra work for which a fee is not claimable Accession does allow for the input of structured data into forms and can alert the doctor if information of concern is entered (e.g. a high blood glucose level) An automated rule, rather than the clinician, can assess structured data

Who actually holds the data?: 

Who actually holds the data? The practice holds and manages the data, so at all times it is under their control.

Can the practice control which information is available to patients?: 

Can the practice control which information is available to patients? The practice can decide which functions are accessible to which patient, e.g. if you only want patients to be able to book appointments, you can disable all clinical features Can also vary by groups of patients (e.g. diabetics can see/perform certain things, but others can’t) Potential to hide certain problems within the medical record from the Accession interface by making them "private“ The practice can define views, which are specifically designed perspectives of the information

Can the patient decide who sees what?: 

Can the patient decide who sees what? The practice sees whatever information has been entered into the record because their view of the data is via their clinical software, not the web. The data is the clinical record owned and maintained by the practice. The patient cannot use Accession to pick and choose who has access to what information within the practice (although this could be done within the practice in consultation with the patient) If more than one clinical database is Accessible via Accession, each practice can see only its own data, while the patient can see a combined record.

What if patients don't want their information available on the web?: 

What if patients don't want their information available on the web? This is controlled at the practice level within Profile, the clinical software. The patient must consent, or opt-in, to Accession. The default is for data not to be accessible. Practice staff then adjust settings in Profile to enable Accession to display the required information on the web.   

Can the information be shared with other health providers?: 

Can the information be shared with other health providers? Where Accession interfaces with data from multiple providers/practices, this information can be shared in customisable HTML views For single practice databases, this functionality is currently under development. (For example a specialist practice wishing to share information with the GPs who referred patients to them. The referring GP will be able to read letters and investigation results on the web. Online referrals are currently under development. 

Has Intrahealth had legal advice about implications of privacy legislation?: 

Has Intrahealth had legal advice about implications of privacy legislation? That is an issue for the users because what they can present and the mode of presenting it is so flexible. Laws vary by country and region; advice obtained in one area may not be valid in another. Accession creates capabilities. How those are used and in what way, is up to the users.

Who is using Accession?: 

Who is using Accession? No-one at preset; we are finalising preparations for our first site.

How much does it cost?: 

How much does it cost? Accession is part of a package including other programs and the total cost varies according to number of workstations and server configuration. As a ballpark figure, it would cost "a few thousand" for a typical general practice

Intrahealth Limited: 

Intrahealth Limited For more information about Accession and other Intrahealth products: Stand: 8 Telephone: 03 8412 8100 Email: enquiries@intrahealth.com