Is Canberra’s new EHR the first step in the quest for interoperability?
GPs can now update patient hospital records in an Australian first as ACT Health trials an Epic digital health record transformation.
The trial has made Canberra “the most digitally advanced” jurisdiction in Australia according to Mallory Heinzeroth, Epic’s project head for the Canberra project.
“GPs can now review the real-time record for a patient, update the allergies, medications and problem list. They can place electronic referrals, monitor their status as well as write notes about care provided,” Ms Heinzeroth said.
Although GPs were excited about these features, let’s not mistake the Epic product as being interoperable. The Digital Health Record Link (DHR Link) is a cloud-based application powered by Epic’s Health Planet Link software. GPs will be credentialed to access a specific, consented subset of their patients records and will log in via an authentication spine including multiple-factor identification.
Michelle O’Brien, digital health consultant, said it was a step towards interoperability but it still did not create a single point of truth for a patient’s health records.
“It’s not two-way. Ideally a hospital should be able to access a patient’s primary care health record without the GP having to be involved in pushing the data up. There should only be one record for the patient anywhere. One single point of truth. That would be true interoperability,” she said.
First steps
Dr Paresh Dawda is a GP and owns one of the pilot sites, Next Practice Deakin. As a long-time advocate for interoperability he sees this Epic transformation as “horizon one” on the quest for interoperability.
“It’s not true interoperability but I’m excited. We normally spend an enormous amount of time chasing hospital records” he said.
Next Practice Deakin has many aged care patients with complex and chronic conditions. Dr Dawda said he looked forward to being able to interact with his patients’ hospital records in real-time.
“The downside at the moment is that it’s not interoperable. If we update some medication on our system that’s not going to flow through to Epic. But I think the potential is huge,” he said.
As exciting as this is for primary care, could Epic’s brave new world just become an accepted workaround that delays interoperability in Australia? Dr Dawda said it was an “absolute risk”.
“This is a significant and necessary step forward. But it’s not sufficient,” he said.
“Obviously, the next step in evolution is interoperability – to be able to go into the Epic view straight from our patient management system without another portal, another login, another two-factor authentication. That’s got to be the next horizon.”
The patient portal
Four clinics in Canberra started piloting DHR Link this month: Fisher Family Practice, Winnunga Nimmityjah Aboriginal Health Service, Gordon Family Practice and Next Practice Deakin.
Patients at those clinics will be able to access their public hospital records in real time via the MyDHR app. Ms Heinzeroth said the app empowers patients to engage in their own healthcare.
“Our customers love it. They get their entire health record in the palm of their hand via their phone or on a laptop. If they walk in somewhere new, and even if that GP isn’t participating in the trial, they can still share all of that real-time information with their GP,” she said.
The tech
Although Epic interacts seamlessly with some clinical management systems in the US, it’s not universally interoperable even in that jurisdiction.
Epic’s Health Planet Link software does, however, have more configurable options than those being trialed in the ACT this month. Other options include the ability to upload imaging and the functionality to interact with medical devices in the community or in external facilities such as nursing homes.
Ms Heinzeroth could not comment on whether NSW or ACT Health would be engaging Epic’s Cosmos data set. According to the Epic website, Cosmos has recorded more than five billion patient encounters and is used by doctors to quickly answer clinical questions.
Is Canberra now the most advanced health provider in the nation?
Queensland originally led the way for GP and hospital communication with The Viewer, powered by Cerner. Genuinely ground-breaking at the time, The Viewer does not allow primary care to add data to a patient’s record.
Melbourne’s Parkville Precinct implemented Epic’s electronic medical record platform in 2020 but not all the functionality went live. The four precinct hospitals turned on the patient portal but interaction with GPs was not prioritised.
South Australia appears to be making headway in planning digital linkage between the SA Health electronic medical record (Sunrise) and the various GP patient management systems. Wendy Keech, CEO of Health Translations SA, said that they were currently building a business case and planning to advocate for investment once specifications are finalised.
Impact on primary care
So, should GPs in NSW start getting excited given Epic’s recent win with NSW Health?
The jury is still out. The ACT pilot has only just started and Ms Heinzeroth was unable to comment on the full functionality that NSW Health has requested. NSW Health was equally silent on the matter.
Dr Dawda, who is trialing DHL Link, said he hoped it was the beginning of something more ambitious.
“This is the single public health record in the territory, but it’s not the patient single health record in Australia. And that’s where we need to get to,” he said.
