Easing the burden of providing and sharing necessary information
- greater continuity of care. For example, when there are staff changes (such as a new attendant carer) or movement from one service provider to another, an electronic record (with appropriate privacy safeguards) is an effective way of communicating essential information about support needs
- portability of entitlements. Barriers to geographical mobility for people with a disability would be greatly reduced if there was an electronic record of each client’s assessed need and financial entitlement applicable throughout Australia
- improved communication and collaboration between allied health professionals and service providers, and better coordination of care
- ease of billing. With appropriate IT infrastructure linking service providers to the NDIA, the electronic record could also house information about purchases made by people with a disability and expedite payment to service providers (for example something like HICAPS). It would also be useful to ensure that the services provided by specialist disability agencies and the prices they charged, were appropriate
- aggregate scheme monitoring and facilitating greater understanding of the costs of meeting the needs of people with disability. The ability to interrogate a central database (but still in a way that strictly protects privacy) could provide rich comparative analysis about the costs of different types of disability and the payoff to certain types of interventions (such as early childhood, or home modification rather than attendant care) in terms of future liabilities. It would also greatly improve the ability to anticipate and plan for changes in the overall cost of maintaining a NDIS (chapter 12)
- the ability to evaluate the effectiveness of therapies, treatments and aids and appliances based on systematic statistical data.
Box 10.6 Challenges involved in implementing PCEHRs
- the difficulty involved in finding solutions to some problems. Foremost amongst these are privacy and security issues, how to standardise the data that is input into the system and how to uniquely identify providers and people within the system
- the difficulty involved in coming to an agreement. There has been substantial growth in the use of IT and E-health technologies across Australia. However the technologies employed have not been coordinated between state health departments or within states (between GPs, specialists and hospitals), resulting in discrete, incompatible information systems. Transitioning from this situation to a unified system requires an agreement as to what the platform should look like — either picking a winner from existing platforms or designing a new one. As the transition from existing systems will be difficult, costly and potentially risky to patients, reaching such an agreement is not straightforward
- high set-up costs. In addition to the direct costs, such as hardware, software and training, there are also costs in finding solutions to problems and reaching an agreement about how to transition to a coordinated system. These costs involve consultation, research and pilots.
- In particular, the electronic record will assist core functions of the NDIA, such as: facilitating the financial sustainability of the scheme; building evidence about the effectiveness and cost effectiveness of different services and interventions (chapter 13); helping local area coordinators to monitor the welfare of their clients; and ensuring that appropriate and high quality services are being delivered (section 10.3).
- The database would be much smaller and more manageable, as its population would include only those eligible for tier three of the NDIS (as opposed to all Australians) and the disability industry is much smaller than the health sector. Also, the types of information recorded in the electronic disability record would tend to be simpler than the type of technical data required for clinical diagnosis and treatment. This would include things like: simple personal details; assessed need; services required, received and the prices paid; client outcomes and other additional notes.
- As technological legacy issues are likely to be less of a barrier, there is useful opportunity to develop a universal framework for the electronic record that is appropriate for the disability sector and can evolve according to changing needs. One option would be to develop a simple and secure web service accessible from any computer or mobile device (similar to current internet banking practices). The NDIS will be accompanied by an expansion of service provision, which allows new entrants to be given receive consistent advice about technological requirements and processes associated with the record. This is complemented by the relatively low use of E-health type technology in the disability sector, reducing the extent of disruptions caused by changes to IT systems or existing practises.