Dr Who? Creation of an Area Health Services Provider Directory

Northern Sydney Central Coast Area Health Service

Abstract

This submission details the development of the NSCCH Health Services Provider Directory (HSPD) including the motivation for development, the sustainability process, and its usage, benefits and contribution toward creating better experiences for people using health services. It also includes the planning for future developments and uses of the directory.

Aim

To collect, verify and maintain accurate provider and service information in a single Health Services Provider database for the population of clinical systems e.g. Electronic Medical Record (eMR), Electronic Discharge Referrals (eDRS), Community Information System (ICIS), and as an online tool to assist in service referrals.

Nature of the Problem

Numerous clinical information systems across NSCCH including eMR, eDRS & ICIS require reference to a code table of health care providers for population of relevant fields; however NSCCH and NSW Health had no single, accurate and consistent directory or source of provider information for these clinical systems to reference.

The need arose as part of the implementation of the electronic discharge referral system (eDRS) at NSCCH, as a provider directory is a fundamental building block for an electronic medical record to allow for the timely & reliable transmission of patient’s information to care providers. It is also required for NSW Health strategic initiatives such as Single Point of Access (SPA), and is invaluable for clinical staff to access relevant accurate local provider information.

Extent of the Problem

Previously, existing clinical systems requiring care provider information referenced their own stand-alone directories, each with varying accuracy & maintenance. For the Patient Administration System (PAS), this included 12 separate provider code tables (1 at each site) none of which were updated or maintained. Many areas (Wards, Units, and Services) also kept their own electronic or paper directories for transmission of patient’s information to care providers; however these were not accessible area wide, were often not regularly maintained and were in formats that were not compatible for electronic use (clinical systems or web based). For eDRS (and ultimately eMR) where documents need to be automatically transmitted to care providers (via fax or by secure messaging systems) these directories were inadequate.

Strategic Importance

Within the strategic direction of Creating Better Experiences for People Using Public Health Services, the HSPD supports the Information Management and Technology initiatives by providing access to care provider and service information required for the reliable transmission of patient’s information, for clarity of service provision for referring staff, and for the implementation of electronic health records. The HSPD service information has been provided to NSW Health for the population of HS-Net, Health Entity Registration database (HERO) and in order to assist the Redesigning Clinical Services initiatives, is also being used as the source of service information to support implementation of SPA.

Planning and Implementing Solutions

On conception of the directory, IM&T project staff met with health service Health Information Managers and Admissions staff to discuss the data elements required. The technical specifications required for the integration of the directory with the clinical applications (specifically eDRS) was also scoped and documented and functional requirements developed in association with the vendor.

The directory was initially populated with data from the 12 separate NSCCH hospitals PAS provider code tables, existing AHS directories and Division of General Practice databases, and every entry was validated individually by phone/fax contact prior to entry. The data sources can be seen in the Diagram below.

Once developed, the directory was loaded into eDRS and PAS and has since been loaded twice weekly to update the code tables with the most recent provider information.

Following the establishment of the directory and availability of the information via eDRS and PAS, there was increased demand for the access to the directory by NSCCH clinical staff, so the directory was launched on the NSCCH Intranet site to allow for provider and service searching by all NSCCH staff. To support this plan, additional codesets based on the NSW Data Dictionary were recommended and endorsed by the NSCCH Clinical Operations Committee and the additional service information was collected in collaboration with each of the facilities Outpatient Departments and Community Health Services.

The directory includes Individual Providers (GP, Specialists), Hospitals, Medical Centres, Nursing Homes, Outpatient Clinics and Community Health Centres and Services. Users can search the directory by Service or Name, Speciality, Provider Type, Suburb, Keyword, or LGA as seen below.

The information collected and displayed on Individual Care Providers and/or Services includes:

• Name
• Service Type & Description
• Provider Number/MPO Number
• Address (Location & mailing) including LGA
• Phone
• Fax
• Opening Hours
• Eligibility
• Referrals Instructions

On the intranet, these fields are displayed as below.

NSCCH staff participate in this project by contributing to the thorough maintenance process that has been established.

Outcomes and Evaluation

The implementation of the Health Services Provider Directory has resulted in accurate, unique and consistent provider information, and has eliminated the need for disparate directories across the AHS. The HSPD currently has 15,111 Providers and Services listed (as at 1st June 2008) and an example of the breakdown of these services can be seen in the table below.

The success of the directory can be measured by a number of methods. In regard to eDRS, currently on average 1896 discharge referrals are transmitted via fax per month on the day of discharge to patients care providers’ as a result of the directory (average over 6 months). This would not be possible without the relevant data in the provider directory.

The number of updates and additions received by IM&T from NSCCH staff highlights the wide-spread usage of the directory data, with 100 existing directory entries updated each month and 18 new entries added each month (average over 6 months) as a result of staff feedback and maintenance initiatives. There has also been positive qualitative feedback from many NSCCH staff regarding the availability and comprehensiveness of the provider directory on the intranet.

Finally, the number of regular requests that IM&T receive from NSCCH services and external organisations to access the data for provision of clinical services, also illustrates the outstanding need for an AHS directory of this nature. This includes the NSCCH Division of GP’s via their intranet, for population of ICIS, to be used as the source of service information for the SPA Project, and for patient access on the NSCCH Internet site.

Sustaining Change

The accuracy and comprehensiveness of the directory determines its value; therefore a thorough maintenance and feedback process has been established. These avenues for maintenance/updates can be seen in the diagram below.

These processes have been communicated to staff as part of their eMR and/or eDRS application computer training, communicated to staff on launch of the directory on the NSCCH Intranet site, and are available on the eMR & HSPD intranet site.

Since its launch in May 2007, 100 existing directory entries are updated each month and 18 new entries are added each month (average over 6 months).

Updates are identified in the directory by their ‘Update Date’ as seen below. All updates are performed through a custom designed MS Access administrative tool that populates the platform SQL database. Users access this information via a web based interface.

Future Scope

The primary lessons learnt from the implementation of the directory include the need for resources to maintain the comprehensive maintenance schedule, and the need for collaboration between all AHS providers and services as well as external organisations including the Divisions of General Practice and other professional associations.

Following the demand for the directory, the next steps are for it to be used as the primary source of service information for the NSSCH SPA implementation, and ultimately be made available to patients & carers on the NSCCH Internet site.  Given that the directory currently includes providers and services from across NSW, the directory certainly has the potential to be implemented by any Area Health Service or expanded as a model for a statewide directory.

Abbreviations

• eDRS – Electronic Discharge Referral System
• eMR – Electronic Medical Record
• ICIS – Community Information System
• HSPD – Health Services Provider Directory
• PAS – Patient Administration System
• CASU – Clinical Application Support Unit
• SQL – Structured Query Language

Contact

This project was entered in the 2008 NSW Health Awards, Make Smart Choices about the Costs and Benefits of Health Services category.

More about the 2008 NSW Health Awards