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NEHTA E-Health Transition Data Quality Clinical Safety
- 1. The National E-Health Transition Authority (NEHTA) From Data Quality to Clinical Safety Tatiana Stebakova 19 April 2010
- 2. Page 2 Role of NEHTA • NEHTA was set up and funded by Federal, State and Territory Governments as a separate entity in 2005 • We facilitate and progress e-health for Australia • Our Board comprises heads of health departments in all Australian States and Territories Page 2
- 3. Page 3 E-health foundations • Right information – Terminology • Right patient, Right provider – Healthcare Identifiers • Right technological standards – Secure Messaging • Complementary legislation – Authentication Page 3
- 4. Page 4 • Identifiers for Individuals, Providers and Organisations • Ensures that the right information is associated with the right person • Healthcare Identifiers Bill 2010 legislation currently before parliament • Operational July 2010 pending legislation New Healthcare Identifiers Page 4
- 5. The Healthcare Identifiers (HI) Service has three primary core service components: 1. Individual Healthcare Identifier (IHI) 2. Healthcare Provider Identifier – Individual (HPI-I) 3. Healthcare Provider Identifier – Organisation (HPI-O) Healthcare Identifiers Page 5
- 7. Page 7 Data quality in healthcare Click to add text DQ Impact Clinical Scenario DQ Problem Clinical A letter of invitation for the follow-up service or a check- up was sent to a patient, who recently died from cancer No Date of Death recorded Inability to manage patients with chronic diseases Multiple identities Mismatch of patient’s information No single source of truth Avoidable Costs Increasing costs of mail-outs with little business impact Addresses missing, incorrect or out of date Operational costs of data cleansing and manual data validation High costs of duplicate resolution process Service efficiency Diminishing number of patients registered with the practice Lack of knowledge on service demand Difficulties in inviting people for the service or follow-up Contact details are missing or incorrect A new service was created or improved, but there is not have enough utilization Inaccurate information Overestimation of the demand due to duplicate entries Change Management Difficulties in DQ improvement Data Quality governance is missing. Too hard
- 8. HI Service data quality challenges 1. Existing Mental Models on Data Quality 2. Interoperability within Federated Community 3. Quantification and DQ Measurement 4. Leveraged Solution-Legacy data and systems 5. Privacy/Legal Page 8
- 9. Existing mental modes on data quality Page 9
- 11. Data quality strategy Page 11
- 12. Data Quality Strategy: maturity & implementation roadmapMCA DQ CMM Initial Assessment 1 3 3 22 2 1 0 1 2 3 4 5 Governance Dimensions Standards & Practices PoliciesProtocols Technology & Operations Performance Management
- 13. Data Quality Framework: Governance Page 13 http://members.ozemail.com.au/~enigman/australia/tas.html WA DQ Forum SA DQ Forum NT DQ Forum VIC DQ Forum TAS DQ Forum DQ Steering Committee 4 members QLD DQ Forum ACT DQ Forum MCA HI Operations Review Forum NEHTA DQ Forum Workgroups (9 members in each group) Public and Private Hospitals Workgroup Trusted Data Sources (TDS) Workgroup Diagnostics and Pharmacy Workgroup Primary Care Workgroup (includes allied health) Jurisdictional Working Party Structure (5 members - each workgroup representative and a chair Public and Private Hospitals Workgroup Trusted Data Sources (TDS) Workgroup Diagnostics and Pharmacy Workgroup Primary Care Workgroup (this will include allied health) NEHTA DQ Forum Structure: DQ Forum Director DQ Technical Certification and Audit Group 5 members DQ Technical Advisory Group 5 members DQ Oversight Board DQ Standards Advisory Group 5 members NSW DQ Forum
- 14. Data Quality Framework: Dimensions Page 14 1. Semantic 2. Structure 3. Provenance 4. Completeness 5. Consistency 6. Timeliness 7. Accuracy 8. Fitness for Use 9. Quality Rating
- 15. Data Quality Framework: Standards and practices • Structure and format standards for data exchanges • Certification of trusted data sources • Community-wide data standards & metadata management Page 15
- 16. Data Quality Framework: Policies & Protocols • Policy-based Data Quality management on a centralised system and community level • Data validation protocols • Data provenance management
- 17. Data Quality Framework: Technology and operations guidelines (in progress) • Standardisation of technology components across the community • Design and service use guidelines • Standardised techniques and procedures for data validation, certification, quality assurance, and reporting Page 17
- 18. Data Quality Framework: Performance measurement- Metrics Page 18 Dimension Characteristic Number of Metrics Semantic Data Definitions 3 Name Ambiguity 3 Structure Structural Consistency 22 Provenance Originating Data Source 3 Completeness Optionality 41 Population density 35 Consistency Capture and collection 14 Presentation 4 Currency Age/Freshness 17 Temporal 1 Time of Release 1 Timeliness Accessibility 3 Response Time 3 Accuracy Precision 15 Value Range 44 Fitness for Use Coverage 49 Identifier Uniqueness 40 Search and match 27
- 19. Summary: Best Advice 1. Data quality means clinical safety in healthcare systems. 2. Write clear and detailed DQ requirements, measurements and KPIs . 3. Make sure they are included in the design and operational contract. 4. Define a clear DQ Strategy and Blueprint. Try to involve the best DQ practitioners. 5. Focus on the quality of attributes, which are strategic for your business. 6. Define a capability maturity model and a roadmap on how to achieve the desired level of maturity. 7. Participate in all specification reviews to ensure that strategic quality components, e.g. information validation, are addressed in design and operational policies. 8. Know the systems design well. Precise knowledge will help you to develop DQ architecture. 9. Do not compromise on data standards – it will save you money on the system integration. 10. Be brave and persistent. 11. http://www.telegraph.co.uk/news/newsvideo/7577801/Organ-donor-register-blunder Page 19
- 21. Page 21 Thank you and Questions
Hinweis der Redaktion
- So in this environment, with pressure for health reform, the National E-Health Transition Authority is working across the health sector to introduce the best e-health technology for Australia. NEHTA was set up and funded by Federal, State and Territory Governments as a separate and not-for-profit entity in 2005. As a collaborative vehicle, we have responsibility for many projects, all aimed at establishing the foundations for the widespread adoption of e-health. Our Board comprises the heads of health departments in all jurisdictions led by an independent chair, David Gonski – who is well recognised in business and is the Chairman of the Stock Exchange. The governments of Australia recognise that electronic health (e-health) and an Individual Electronic Health Record (IEHR) are vital to the achievement of major health reform in the next decade.
- Right information – described using common formats and terminology – so that everyone is ‘speaking the same language’ Common data groups agreed SNOMED CT and Australian Medicines Terminology (AMT) nationally available Working with major vendors to implement AMT and Emergency term set Right Patient, Right provider - Unique identification of patients/consumers, individual providers and institutional providers. New Zealand already has unique identifiers in place Australia is building its health identifier service – operational by mid 2010 Consultation on underpinning legislation Underpins most ehealth communication Right technological standards – for security HL7 CDA and Web services preferred way forward Working with community - PIP incentives Two jurisdictions moving to implement Statewide solutions Complementary legislation – for privacy Services based on PKI Delivered in same time frame Jurisdictions working with NEHTA on implementation, including single sign-on Ultimately building to Electronic records – for patients/consumers
- Earlier this year we set some key targets to achieve this year. The primary one was the development of healthcare identifiers by December, in time to use these live by June 2010. We contracted Medicare to complete this contract and we are on schedule for delivery.
- There will be three unique healthcare identifiers: An IHI is a unique 16 digit number that will be assigned to each Australian resident and others seeking healthcare in Australia. IHIs will be used in health information records alongside the person’s name and date of birth. (Number randomly generated.) A HPI-I will be used by healthcare providers and other health personnel involved in patient care. HPI-Is will enable consistent and up-to-date access to patient health information, and identification of healthcare providers. A HPI-O will identify the organisation (such as the hospital or health clinic) where care is provided. HPI-Os will enable accurate transmission of communications between healthcare providers and organisations.
- There will be three unique healthcare identifiers: An IHI is a unique 16 digit number that will be assigned to each Australian resident and others seeking healthcare in Australia. IHIs will be used in health information records alongside the person’s name and date of birth. (Number randomly generated.) A HPI-I will be used by healthcare providers and other health personnel involved in patient care. HPI-Is will enable consistent and up-to-date access to patient health information, and identification of healthcare providers. A HPI-O will identify the organisation (such as the hospital or health clinic) where care is provided. HPI-Os will enable accurate transmission of communications between healthcare providers and organisations.
- the Healthcare Identifiers Bill 2010, with the Government now adjourning the debate of the Bill to parliament’s first sitting day of the winter sittings – May 11.