Private Pathology and Diagnostic Imaging integration with ... · 6/15/2017 · • Once a document...
Transcript of Private Pathology and Diagnostic Imaging integration with ... · 6/15/2017 · • Once a document...
www.digitalhealth.gov.au
Private Pathology and Diagnostic Imaging integration with My Health Record
Christian Holmes & Angus Millar
Digital Health Solution Architects
Australian Digital Health Agency
15 June 2017
www.digitalhealth.gov.au2
Patient Consent
Healthcare Identifiers
My Health Record Connectivity
Pathology and Diagnostic Imaging Reports
Integration Tools & Libraries
My Health Record Viewing
www.digitalhealth.gov.au3
Patient Consent
www.digitalhealth.gov.au
Patient consent
Healthcare Identifiers
My Health Record uploading
Diagnostic Report CDA/PDF
Healthcare Identifier Service
My Health Record System
Healthcare Identifier Service
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www.digitalhealth.gov.au5
• The My Health Record operates on the principle of standing consent.
• Healthcare providers do not need to explicitly obtain permission from the patient before accessing or uploading information to their My Health Record.
• However controls need to be in place to prevent information (such as a diagnostics report) being sent to the My Health Record if the patient tells their provider that they don’t want it sent.
Patient Consent
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Patient Consent
There are only two consent states:
• Patient consent not withdrawn (default)
• Patient consent withdrawn
The diagnostics industry have agreed that consent is applied on a per request / episode basis, it is not at the order item level.
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Patient Consent
• A “withdrawal of consent” question will begin to appear on printed request forms, and where applicable, on the electronic request.
• The agreed question to appear on printed request forms is:‘Do not send reports to My Health Record [tick box]’
(default is unticked)
• We are currently working with the diagnostics sector to agree where this should appear on the paper forms.
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Patient Consent
Best Practice (beta version under development)Pathology ordering screen
This description will be changed in the final release to:
‘[tick box] Do not send reports to My Health Record’
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Patient Consent
In electronic orders, the status takes the form of:
‘Patient consent withdrawn’
Or
‘Patient consent not withdrawn’
The full Health Level Seven (HL7) V2 technical specification for the consent messaging can be found in the documents:
IndicationOfConsent_HL7v2Implemenation_dv011 20161229.pdf
IndicationOfConsent_MessageScenarios_dv007 20170117.pdf
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Patient Consent
GP Diagnostic Order Request
Do not send reports to My Health Record [ ]
FBC
LFT
BSL
HL7 V2 ORM Electronic Order
FBC: Patient consent withdrawn
LFT: Patient consent withdrawn
BSL: Patient consent withdrawn
LIS / RIS Diagnostic Service system
Do not send reports to My Health Record [ ]
FBC
LFT
BSL
Current Implementations
GP Diagnostic Order Request
Do not send reports to My Health Record [ ]
FBC
LFT
BSL
HL7 V2 ORM Electronic Order
FBC: Patient consent not withdrawn
LFT: Patient consent not withdrawn
BSL: Patient consent not withdrawn
LIS / RIS Diagnostic Service system
Do not send reports to My Health Record [ ]
FBC
LFT
BSL
Electronic order consent scenarios
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Document Consent
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Key elements specified in an electronic order for My Health Record:
• My Health Record document withdrawal of consent
• Patient Demographics (family, given, middle name, date of birth)
• Patients Individual Healthcare Identifier (IHI)
• My Health record disclosure indicator
• Requesting providers Healthcare Provider Identifier for Individuals (HPI-I)
(Note: elements will be supplied by the ordering system where known.)
Patient Consent
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Document Consent
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• Consent can be withdrawn at any time prior to document upload.
• Once a document is uploaded, if a patient later informs that they wish to change their consent to withdrawn, providers are not obliged to remove the document.
• Patients are able to remove the document from their own record via the consumer portal or may contact the consumer hotline for assistance: Help line: 1800 723 471
• Providers are not obliged to upload a document; if in doubt regarding consent, then do not upload.
• Independent of the patients consent, providers can choose to not upload for other reasons relating to clinical or mental health concerns, sexual health, etc.
Patient Consent
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Healthcare Identifiers
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Patient consent
Healthcare Identifiers
My Health Record uploading
Diagnostic Report CDA/PDF
Healthcare Identifier Service
My Health Record System
Healthcare Identifier Service
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Individual Healthcare Identifier (IHI)
Healthcare Identifiers
Healthcare Provider Identifier for Individuals (HPI-I)
Healthcare Provider Identifier for Organisations (HPI-O)
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Healthcare Identifiers
• The Healthcare Identifiers (HI) Service is operated by the Department of Human Services (Human Services)
• Authentication to the HI Service is via a HI certificate which is identical to the Medicare online certificates used for billing. You are able to link both services under the same certificate or keep them separate.
• My Health Record connectivity uses a separate National Authentication Service for Health (NASH) certificate
• The HI service provides a set of web services for managing IHIs, HPI-Is and HPI-Os
Healthcare Identifiers (HI) Service
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Individual Healthcare Identifiers (IHI)
Healthcare Identifiers
• The IHI is a consumer / patient identifier
• It is a nationally and globally unique identifier
• Every Australian with a Medicare number has been assigned an IHI
• The Healthcare Identifiers (HI) Service, provides web services to search for and validate IHIs
• Pathology and Diagnostic Imaging service providers are not required to validate IHIs, only if the that IHI is received in an electronic request and the Pathology or Diagnostic Imaging provider does not have HI Service connectivity
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Healthcare Identifiers
Healthcare Provider Identifier for Individuals (HPI-I)
• The HPI-I is a healthcare provider identifier e.g. Doctor
• It is a nationally and globally unique identifier
• Healthcare providers registered with Australian Health Practitioner
Regulation Agency (AHPRA) are automatically assigned a HPI–I
• Providers not registered with AHPRA can apply for a HPI–I from the HI
Service operator
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Healthcare Identifiers
Healthcare Provider Identifier for Individual (HPI-I)
• For Pathology and Diagnostic Imaging Report Clinical Document Architecture
(CDA) documents, it is mandatory that the author’s HPI-I is provided
• The author in this context maybe the chief or department head reporting
Radiologist / Pathologist
• In exceptional circumstances a temporary HPI-I exception can be applied for
and a modified CDA template package implemented
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Healthcare Identifiers
• Organisations that provide healthcare services and employ one or more healthcare providers can apply for an HPI-O from the HI Service.
• It is a nationally and globally unique identifier
• My Health Record uploading systems must upload under the context of a HPI-O
• NASH certificates can be issued and linked to a HPI-O and are required for My Health Record connectivity
• Organisations can create a seed and networked HPI-O structure
Healthcare Provider Identifier for Organisations (HPI-O)
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Healthcare Identifiers
HPI-O Network structure
Seed HPI-O
Networked HPI-O Networked HPI-O Networked HPI-O
What is a HPI-O Network structure?
• Each network node is assigned a HPI-O• The seed node is the root parent, this may be the overarching organisation e.g. (Acme Healthcare)• Each child node is an organisation associated under the seed node e.g. (Acme NSW, Acme VIC, Acme QLD)• You may even have more networked child nodes under child nodes, although this is not common• Some organisations may choose to only have a seed, or perhaps a seed and one networked node
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Healthcare Identifiers
HPI-O Network structure
Seed HPI-O
Networked HPI-O Networked HPI-O Networked HPI-O
Why have HPI-O Network structure?
• When you upload to the My Health Record each upload will be recorded and visibly seen as being uploaded by one and only one HPI-O
• It allows your organisation to maintain its commercial sub branding • The patient My Health Record access controls are applied against HPI-Os, having a structure allows the
patient to block one while allowing access to another• As commercial sub brands are bought and sold between larger organisations they can be easily disassociated
and reassociated to a new seed organisation without the need for a new HPI-O
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Healthcare Identifiers
HPI-O and certificates
Seed HPI-O
Networked HPIO
Networked HPIO
Networked HPIO
• The HPI-O is only an identifier and it must be linked to a certificate to allow that HPI-O’s system to authenticate and access the My Health Record
• Connecting systems authenticate with the My Health Record using a NASH certificate
• The HI Service requires a HI Service (Medicare) certificate
• Both certificates are linked to HPI-Os, you can have both linked to a single HPI-O
• You only need a single HI Service (Medicare) certificate, recommended at the seed HPI-O level
• Depending on the organisational structure you may require one or many NASH certificates
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Healthcare Identifiers
HPI-O Network structure with linked certificates
Seed HPI-O
Networked HPI-O Networked HPI-O Networked HP-IO
HI Service Certificate
My Health Record NASH Certificate
HI Service
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My Health Record Connectivity
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Patient consent
Healthcare Identifiers
My Health Record uploading
Diagnostic Report CDA/PDF
Healthcare Identifier Service
My Health Record System
Healthcare Identifier Service
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www.digitalhealth.gov.au
• Prior to upload, the connecting system must have evidence that a record exists for the patient’s My Health Record you wish to upload to
• You can obtain this by either calling the My Health Record web service ‘Does PCEHR Exist’ or due to the disclosure of a record via the patient or third party system e.g. via an electronic order.
• Disclosure occurs by a patient informing you or a third party that they have a My Health Record. If you have obtained disclosure then you can attempt to upload without calling ‘Does PCEHR Exist’
• The ‘Does PCEHR Exist’ call will return False if a patient has chosen to hide their record via their access control settings in the My Health Record
• A ‘Does PCEHR Exist’ call returning False does not prevent systems from uploading if they have obtained disclosure
• Record access controls prevent systems from viewing a patient’s My Health Record unless a code is provided, this is independent from the ability to upload
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My Health Record ConnectivityMy Health Record discovery
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• Once a system has discovered the existence of a patient’s My Health Record, either by ‘Does PCEHR Exist’ or via disclosure, the system can hold this information indefinitely.
• Should an upload fail this status should be set back to False until rediscovered
• System are advised to display the existence of a record to it’s users
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My Health Record Connectivity
My Health Record Discovery
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• The My Health Record system allows documents that have been previously uploaded to be replaced with a newer version through a supersede operation. This will occur when a diagnostics report has been uploaded and is subsequently amended or corrected.
• Systems will need to keep track of the document IDs that it has uploaded in order to later supersede that document e.g. (new Doc ID ‘50a1569a-190d-4fa6-bc72-6ecc02467ebd’ supersedes -> old doc ID ‘70c33b91-2490-44c2-9441-a52decd92c52’ )
• If consent is withdrawn after a document is uploaded, yet before a supersede is required, systems must either:
• Proceed with the supersede despite the current consent setting, or
• Remove the older document
The system MUST not leave orphaned or stale documents in the patient’s My Health Record
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My Health Record ConnectivitySuperseding Documents
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• Once a document (Pathology or Diagnostic Imaging report) is uploaded it can later be removed
• All removals are logical removals, the document is still available for audit purposes although now inaccessible to most users
• By request, and under authorisation, the system operator can retrieve the entire audit in full
• There are two types of removals that provider systems can perform:
• Remove (Withdrawn):Used to remove a document with incorrect information, the document may be superseded with the correct information at a later point in time, or not
• Remove (Incorrect identity):Used to remove a document that has been inadvertently uploaded to an incorrect patient record. The document may not be reinstated or superseded
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My Health Record ConnectivityDocuments Removals
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Remove (Withdrawn): • The Author organisation or the Consumer or the System Operator can look at the document Audit and will see a line item
entry for the document but will not be able to open the document. • The document will be marked with the status of ‘Withdrawn’ for the Consumer and ‘Reinstate’ for the Author organisation. • Only the Author organisation will be able to reinstate the document. • The document will not be returned in the Get Document view or other specialised views. • Other providers who are not the Author, Consumer or System Operator will not see the audit line item at all. • The Author organisation can supersede the document which will bring the document set back into view for all.
Remove (Incorrect identity): • The Author organisation or the Consumer or the System Operator can look at the document Audit and will see a line item
entry for the document but will not be able to open the document. • The document will be marked with the status of ‘Incorrect Identity’ and all above will be able to see this status. None of the
above will be able to reinstate the document. • The document will not be returned in the Get Document view or other specialised views. • Other providers who are not the Author, Consumer or System Operator will not see the audit line item at all. • If the Author organisation attempts to supersede the document that is marked as ‘Incorrect Identity’ they will receive an
error.
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My Health Record Connectivity
Documents Removals
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Pathology and Diagnostic Imaging Reports
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Patient consent
Healthcare Identifiers
My Health Record uploading
Diagnostic Report CDA/PDF
Healthcare Identifier Service
My Health Record System
Healthcare Identifier Service
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Specifications are available on the website:
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Pathology and Diagnostic Imaging Reports
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Relevant Specifications are available on the web site: www.digitalhealth.gov.au
Pathology and Diagnostic Imaging Reports
Pathology Report CDA Specs
Diagnostic Imaging Report CDA Specs
Diagnostic Imaging Report view specs(required for implementing viewing)
Pathology Report view Specs (required for implementing viewing)
Common Clinical Document(applied to all CDA document types)
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Pathology and Diagnostic Imaging Reports
Pathology Report metadata (summary)
Patient• IHI (mandatory)• Family Name (mandatory)• Address (optional)• Sex (mandatory)• DOB (mandatory)• Indigenous Status “can be set to 'Not Stated‘” (mandatory)
Author• Must be a Health Professional and most likely a Pathologist in charge• Must have, at a minimum, the persons HPI-I, the persons Family name, and
the Organisations they work for HPI-O and name (mandatory)
Requester:• Date of Request (mandatory)• Some Identifier for the requesting person, can be a local code or
a HPI-I (mandatory)• Requester Address (optional)• Requester Telephone / Email (optional)• Requester Family Name is the only mandatory name part• Requester' organisation is optional
Order Identifier:• External order number, only one (optional)
Reporting Pathologist (only one for the Document)• The reporting Pathologist is akin to the author although does not have to
be the same person, it is not literally the person who wrote the report• Must be a healthcare professional, most likely a Pathologist• Must have, at a minimum, a HPI-I, Family name, address, phone number
organisation’s HPI-O and organisation’s name.
Pathology Test Result (1..*) ‘the ordered item e.g. FBC, LFT, MSU)’• Collection Date Time mandatory• Accession number, only one (mandatory)• Test result name (e.g. FBC, LFT) can use local code or PITUS SNOMED-
CT-AU or both• Diagnostic Service Section ID (Department)• Test Result Status = Panel Status (OBR-25)• Observation Date Time (Which is 1 to 1 with Collection Date and Time)
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Pathology and Diagnostic Imaging Reports
Diagnostic Imaging Report metadata (summary)
Patient• IHI (mandatory)• Family Name (mandatory)• Address (optional)• Sex (mandatory)• DOB (mandatory)• Indigenous Status “can be set to 'Not Stated‘” (mandatory)
Author• Must be a Health Professional and most likely a Radiologist in charge• Must have, at a minimum, the persons HPI-I, the persons Family name, and
the Organisations they work for HPI-O and name (mandatory)
Requester:• Date of Request (mandatory)• Some Identifier for the requesting person, can be a local code or
HPI-I (mandatory)• Requester Address (optional)• Requester Telephone / Email (optional)• Requester Family Name is the only mandatory name part• Requester‘s organisation name (mandatory)
Order Identifier:• External order number, only one (optional)
Reporting Pathologist (only one for the Document)• The reporting Radiologist is akin to the author although does not have to
be the same person, it is not literally the person who wrote the report• Must be a healthcare professional, most likely a Radiologist • Must have, at a minimum, a HPI-I, Family name, organisation’s HPI-O and
organisation’s name.
Imaging Examination Result (1..*) ‘the ordered item e.g. Abdo, Mamo)’• Image Date Time (mandatory)• Reported Date Time (mandatory)• Exam result name (e.g. Abdo, Mamo) can use local code or SNOMED-
CT-AU or both (mandatory)• Modality can be local code (mandatory)• Anatomical Location Description, text (mandatory)• Test Result Status = Panel Status ‘HL7 V2 OBR-25’ (mandatory)• URL to related information (optional)
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My Health Record Viewing
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My Health Record ViewingGet Document List
• Simple list of all documents within a patient’s My Health Record
• Filters can be applied to remove particular document types
Med
ical
Dir
ecto
r
Ge
nie
Be
st P
ract
ice
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My Health Record Viewing
Diagnostic Imaging View
• Specific view for Diagnostic Imaging reports
• Provides search for Examination type
Med
ical
Dir
ecto
r
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My Health Record Viewing
Pathology Report View
• Specific view for Pathology reports
• Provides search for Test Name type
My
Hea
lth
Rec
ord
Pat
ho
logy
Vie
w
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Integration tools & development libraries
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• Can display you CDA documents as they will render to the consumers
• Runs the Schematron rules over your CDA documents and reports errors
Clinical Package Validator
Integration tools & development libraries
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Integration Toolkits and Sample Code
Integration tools & development libraries
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Healthcare Identifier and PCEHR System (HIPS)
• Designed to assists large health organisations, including health departments, to integrate their suite of clinical and administration systems to the My Health Record system and HI Service
• Middleware product providing proxy web services to the MyHR & HI Service
• Integration via an Enterprise Service Bus (ESB)
• Leverages Patient Administration System (PAS) Admission Discharge and Transfer (ADT) messaging
• Provides HL7 V2 adapters for ORU^R01 messages
• Integrated hospital episodic patient consent service
• My Health Record viewing capabilities
Integration tools & development libraries
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Healthcare Identifier and PCEHR System (HIPS)
Patient Administration System (PAS)
HIPS
Hi Service
My Health Record
Discharge Summary
System
Laboratory Information System (LIS)
Radiology Information System (RIS)
Enterprise System Bus
(ESB)
Enterprise Patient Master Index (EMPI)
Medication Dispensing
System
Backend & TransportPresentation National Infrastructure
Integration tools & development libraries
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