The core components of the PCEHR are centred around health and event summaries as can be seen in Fig. 15.3 [17]. These particular areas were seen to be the most important aspects to include in the initial version of the PCEHR with the focus on specific groups in the community such as aged care and chronic illness. The system has been developed to enable functionalities to be added as they are developed. The PCEHR is not a replacement for organisational clinical records and the clinical component contains copies, not originals and the “source of truth” remains where it is today – in local clinical records.
Consumers and health professionals have access to a Learning Portal (Fig. 15.4) [17] which covers the major aspects of the PCEHR such as why it is needed, how to access and how to use it. There are a number of modules which are easily accessible and easy to use from the website and as this is a national development there are no variations between Australian states and territories. Currently only Medical Practitioners, Registered Nurses and Aboriginal Health workers are the authorised health professionals who can upload and commence the original shared health summary in the PCEHR. Every Australian can register a PCEHR but it is only after they consent to having the PCEHR used can the above mentioned health professionals upload the health summary. Event summaries can be added by any registered health professional following the initialisation of the PCEHR and with the individuals consent. Individuals have control of the PCEHR and access to the majority of information and who can access it. They also have the ability to hide specific health information of a personal nature that they do not want shared.
As the PCEHR is a health record and not a medical or clinical record has resulted in some confusion but hopefully this will resolve over time as everyone becomes more confident and comfortable using the system. There is some conjecture that eventually the PCEHR will become the only electronic health record in the future in Australia. However, as this is still new in Australia with only being available since July 1 2012 it is still in its infancy and has more development needed over the next few years as it starts to mature and Australians become increasingly engaged in the use of eHealth.
Governance of the PCEHR is with the Australian Government. New federal legislation was enacted for the PCEHR and Individual Health Identifiers (IHI) in 2012 and 2010 respectively. Standards for these developments have been undertaken within Standards Australia and the National eHealth Transition Authority (NeHTA), which has developed the major infrastructure of the PCEHR and the IHI’s. National Privacy guidelines have also been incorporated into all developments however, some State and Territory laws must still be accommodated where appropriate. A number of other organisations are also involved in the PCEHR and the complexity of this type of development is shown in Fig. 15.5 [18].
The PCEHR has been rolled out in phases or managed stages. Individual information from Medicare, including Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Schedule (PBS), Australian Organ Donor Register and Australian Childhood Immunisation Register data, will be incorporated into the PCEHR system for individuals who request this information to be part of their record.
Significant advertising and promotion is underway nationally for individuals to sign up to the PCEHR. There is a dedicated web site [19] for anyone to access for further information on the PCEHR.
Healthcare Identifiers Service
Prior to 2010, Australia had no national system of individual identification and patients/clients were identified by their Medicare Number and each individual health care agency filing system. These are not individual identifiers for national use as Medicare numbers may have more than one individual person on each card with the same number however, each person will have a different list number For example see Fig. 15.6.
Fig. 15.6
Diagrammatic example of an Australian Medicare Card
An urgent need was identified to develop a system to ensure security, privacy and confidentiality of eHealth information. The Healthcare Identifiers Service (HI Service) was established in 2010–2011 as a foundation service for e-health initiatives in Australia. A healthcare identifier is a unique number that has been be assigned to healthcare consumers, and to healthcare providers and organisations that provide health services [20].
The identifiers are assigned, administered and operated by Medicare Australia.
A key aim of healthcare identifiers is to ensure that individuals and providers can have confidence that individuals are identified uniquely and unambiguously, and that the correct health information is associated with the correct individual at the point of care. This service is supported by a strong and effective legislative framework that includes governance arrangements, permitted uses, and privacy safeguards. The legislation and regulations to support the HI Service are available and can be viewed at ComLaw [20].
Health Workforce Australia Reform
For national health reform to succeed, the health workforce must have capacity to respond to future health system challenges and changes. Government priorities are concerned with improved access and health services for all Australians. Therefore, expansion of the health and aged care workforce and providing education, knowledge and skill opportunities for all health professionals is paramount to prepare for the future [21].
HWA is a national body and operates across the health and education sectors addressing Australia’s critical health workforce planning, training and reform priorities.
Health Information Workforce
Health Workforce Australia received requests from the National eHealth Transition Authority (NeHTA) and the Australasian College of Health Informatics (ACHI) to undertake a study of the Australian health information workforce. A discussion paper was released in 2011 with the proposed methodology for the project and the Final Report published in 2012 [22].
It was identified that the definition of this workforce was not agreed upon and the workforce boundaries were ill-defined. However, this was not seen as uncommon with newer workforces and the factors that impact. This workforce has multiple occupational titles and discipline areas with workers drawn from the main discipline areas of health, information and computer science. The composition of this workforce varied considerably and appeared to be influenced by the adoption levels of electronic health records and processes [22]. Therefore these issues made it difficult to identify, quantify and predict workforce requirements now and for the future.
Much of the discussion and findings are about health information managers and clinical coders as they are the only current identified occupational code in this area in Australia. These areas have well documented workforce shortages [22–25]. However, this signifies that many health professionals working within the area of health and nursing informatics are not included and therefore the project outcomes may be misrepresenting current and future workforce issues. However, the report has identified in the findings that consensus on role descriptions and definitions are required. Education was also highlighted as a finding that requires review of current curricular in both the higher education and vocational education and training (VET) sectors as well as strategies to raise the profile to attract more students to this critical area. Formation of a single advisory council was an identified need for workforce issues in this area, which would act specifically for all health informatics stakeholders. Identification of exemplar EMR/EHR/digital adoption sites to identify implications for workforce issues over time was also seen as a critical development [22].
Australian Health Practitioner Regulation Agency (AHPRA)
The government established a single national registration and accreditation scheme for health professionals which was introduced in 2010. AHPRA’s operations are governed by the Health Practitioner Regulation National Law, and is in force in each state and territory (the National Law), which came into effect on 1 July 2010. This law means that for the first time in Australia, 14 health professions are regulated by nationally consistent legislation under the National Registration and Accreditation Scheme. It currently regulates the Health professions as listed in Table 15.1.
Nurses and midwives | Medical practitioners |
Dental practitioners (including dentists, dental hygienists, dental prosthetists & dental therapists) | Optometrists |
Chiropractors | Physiotherapists |
Pharmacists | Podiatrists |
Psychologists | Osteopaths |
Medical radiation practitioners | Aboriginal and Torres Strait Islander health practitioners |
Chinese medicine practitioners | Occupational therapists |
Australian Nursing Informatics
The discipline of Nursing Informatics (NI) in Australia has been slow in developing as with many other countries. It has mainly been early adopters and passionate advocates that have lead the discipline and developments for the past 21 years. It began with a small group of nurses in Victoria in 1989 who realised that technology was important for nursing practice and patient care. This group became the Nursing Computer Group Victoria (Inc) (NCGV Inc) and were successful in hosting the 1991 Fourth International Nursing Informatics Congress in Melbourne, Victoria in conjunction with International Medical Informatics Association (IMIA) – Working Group 8. This congress was very successful and a number of the early pioneers of NI in Australia emerged from this conference.
From this auspicious start developments in health and nursing informatics started to advance and from the NCGV grew two major groups: Health Informatics Society of Australia (HISA) [8] and Nursing Informatics Australia (NIA) [9]. The great platform originating all those years ago has been the catalyst for where both health and nursing informatics are in this country today.
Nursing Informatics Australia (NIA) celebrated their 21st birthday in 2012 at the annual NIA conference and are the preeminent group of nurse informaticians in the country. This was a great milestone to achieve and the members of this group over the years have added to the national and international nursing informatics knowledge and skill base. A number of current members are actively involved in national and international developments, professional and political organisations in this area. NI members have been resolute in ensuring nursing is on the current health reform and eHealth agendas in all political and professional arenas in Australia. For example; National Board position on HISA; NIA position on Coalition of National Nursing Organisations (CoNNO); selected as Clinical leads and Reference Group Chairs and members for eHealth developments at NeHTA; Australian representation on International Medical Informatics Association – Nursing Informatics (IMIA NI) which includes being a current Vice Chair and member of the Education Sub Committee; invitations to national eHealth workshops and events.
Nursing Informatics Competencies
Nursing Informatics Competencies have been and are still being developed globally. In Australia, a project to develop National Nursing Informatics Competencies for all Registered Nurses was undertaken from 2009 to 2011. This project was funded by the Australian Government Department of Health and Aging and managed through the Australian Nursing Federation (ANF). The ANF contracted Queensland University of Technology, School of Nursing to undertake the research and development of the NI Competencies. The final report and competencies, completed in 2011, are currently still with the ANF for publication. It was recommended that such competence development be a requirement for all higher education and vocational education nursing programs in Australia and for the competency standards to be adopted as one of the standards for registration as a nurse in Australia. However at this time, this has not been adopted.
Studies of Australian nurses and information technology reported that nurses generally are poorly prepared to engage with information technology in their practice. The study reported that almost two thirds of nurses had not received any formal training in basic software applications and of the 90 % of nurses who used computers or other information technology applications, only one third had any formal training [28]. This landmark study revealed a gross deficit in the capacity of the nursing workforce to engage in the digital processing of information.
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