Welcome to our first issue for 2016! This is the first issue to be substantially produced by the HIM-I Subcommittee. This small band of HIMAA members has worked very hard, energetically led by Stella Rowlands, through the second half of 2015 to establish their processes and start to formulate their vision for the future of HIM-I while concurrently ensuring that enough papers were sourced, reviewed and signed off for publication in this issue.
There have been many changes in the health information and privacy space in the last five years. Technological advances continue to surpass us and the health industry is feverishly attempting to catch up with initiatives such as state-wide EHR programs and the National PCEHR, recently rebadged the ‘My Health Record’. As the healthcare industry digitises and moves into a new realm of individually controlled health records, the considerations of patient privacy and information security have become paramount. This issue of HIM-I canvasses topics such as privacy and confidentiality of linked health information data within the health sector, how a patient’s privacy is protected in their various dealings with the health sector, and how it can be maintained when data sets are linked for various purposes. The management of privacy issues for Victorian public health services and a case study on a recent privacy breach case decided by the new NSW Civil and Administrative Tribunal also make for interesting reading.
Privacy is both an expectation of the patient and a right provided for under legislation. In New South Wales the Health Records and Information Privacy Act 2002 (NSW) (HRIPA) is the primary legislation that governs privacy over personal health information. The Government Information (Public Access) Act 2009 (NSW) (GIPAA) and Privacy and Personal Information Protection Act 1998 (NSW) (PPIPA) are the other major pieces of legislation that provide related governance. While these two Acts do not specifically address ‘health information’ they do address privacy and access as well as security. The NSW Ministry of Health (2015) policy manual, Privacy Manual for Health Information, is applicable to all public health organisations in NSW. This manual provides and relates all relevant legislations and policies around privacy for health information and is the everyday ‘go to’ guide.
One person’s health record may contain the personal health information of another person. The difficulty for those who make decisions in relation to releasing the health record of the first person is determining whether the health information of the second person can be released without their consent and/or without breaching that person’s privacy. This is a particularly challenging area in relation to children’s health records as they are likely to include health information related to their parents.
How is a patient’s privacy protected in their various dealings with the health sector and, in particular, how is this achieved when data are linked for research purposes? Australians expect all sections of the health sector to protect their privacy and to maintain the confidentiality of their health information. They might also reasonably expect the health sector to actively use their information in an appropriate way to conduct health research, health service monitoring and performance measurement. So, how do these two aims work in practice?
The appropriate management of privacy issues in relation to health and personal information is a legal requirement, and has important implications for timely access to information used to support clinical decision making. There are also ethical issues involved, with an expectation from those whose information we access that it be handled in a professional manner.
In January 2017, a new $630 million Bendigo Hospital will be opened. One of the key features of the new hospital’s design is its ability to be ‘paper light’. BH planned for an EMR to be implemented with the move to the new building; however, the timeframe for implementation of this technology was considered too short. To ensure the new hospital would meet its ‘paper light’ requirements, a decision was made to tender for an Enterprise Content Management (ECM) solution in isolation from the EMR tender, as a risk mitigation strategy. The DMR is a component of the ECM solution.
The Statewide Health Information Manager-Clinical Coder Network (SHIM-CCN) was established in Queensland in 2012 following agreement from various state and regional stakeholders that there was a need to expedite clinical coding workforce development to improve coding quality and to assist in the development of resources and skills to support CC and HIM training and coding capability.
The release of Australian Refined Diagnosis Related Groups (AR-DRG) Version 8.0 sees a major change in the methodology used to measure case complexity. The new model represents a significant shift away from the Patient Clinical Complexity Level (PCCL) model using Complications and Comorbidities (C&Cs), and allows for greater scope and precision in splitting Adjacent DRGs (ADRGs) into DRGs. AR-DRG Version 8.0 will be used by the Independent Hospital Pricing Authority (IHPA) for the pricing of admitted acute care from July 2016. Given the significant changes from AR-DRG Version 7.0 with the implementation of the Episode Clinical Complexity (ECC) Model it is important that users of the AR-DRG Classification develop an understanding of the new model and the implications of the changes.
Poor documentation of healthcare data, including the recording of inaccurate and false information, is a concern for health data collections at all levels, whether large hospitals or small clinics (WHO 2003). The National Committee on Vital and Health Statistics (Meyer 2000; Center for Health Information Quality 2002) stated that high quality healthcare depends on access to accurate and comprehensive medical records. Such information is essential for effective diagnosis and treatment, measurement and improvement of healthcare quality, advancement of public health, improvement of healthcare productivity, and facilitation of cost reimbursement.Rigby et al. (1998) commented on the beneficial effects of high quality information on healthcare quality, arguing that data quality is at the very ‘heart’ of medicine.
This journey commenced in August 2013 when a single medical record, one of over one million medical and community health records held by the NSW Central Coast Local Health District (CCLHD) was identified as being damp and mouldy. Far from being a complete account of the process and decisions undertaken since that date, this article provides a background of events and reflects on how a HIM who is well versed in the traditional aspects of our profession broadened her scope and with the support of CCLHD Executive, responded to a major crisis that had no short-term solution.
In August 2013, The Central Coast Local Health District (CCLHD) identified that a number of medical records housed in their tertiary storage facility at West Gosford were mould affected. After stringent testing by an external company, the records were found to be contaminated with active bacterial mould. Through the NSW Government Advance Approved Supplier ICT Services list, CCHLD submitted an RFT (Request for Tender). ADEC Preview Solutions, a leading innovative and secure document scanning and document archiving company was awarded the tender.
Detailed activity and cost data across the continuum of care are the essential underpinning ingredients in the management of healthcare services in an ABF environment. While the best value for money in the delivery of healthcare services must be ensured, service delivery decisions cannot be based on cost alone. This updated article outlines the importance of the role of the clinical analyst in the review of costed patient-level data from ABF systems. It reviews the impact that data can have on ensuring the maintenance of quality clinical care within an era of fiscal regulation, through the identification, measurement and analysis of clinical care utilisation profiles against best practice. It also outlines a system maturity model for healthcare services using ABF systems and relates these milestones along a data-to-wisdom continuum.
October 2015 brought sombre news for Australian healthcare – another health service inquiry into poor care, this one concerning the deaths and stillbirths of a number of babies in a Victorian regional hospital. It’s caused me to reflect again about what is at the heart of our failure to guarantee safe, quality care for our consumers. An extract from the 16/10/15 Djerriwarrh Health Services (DjHS) media release1 stated: ‘A comprehensive, independent investigation of 11 cases at DjHS between 2013 and early this year found a series of failures and deficiencies may have contributed to the deaths of up to seven babies...Djerriwarrh has, in consultation with the Victorian Department of Health and Human Services, initiated all possible measures to reinforce the safety of its maternity and newborn services.’