UPI trials head HIC2002

UPI trials head HIC2002

Conference-goers hear of HealthConnect project for database-driven industry-wide intranet.

By Paul Montgomery

Reports from the front line in the race to implement a national health records management system headlined the Melbourne HIC2002 conference.

Several leaders from Australian projects to trial a unique patient identifier (UPI) system gave speeches at the conference, which spanned three days at the Melbourne Conference Centre during August.

HIC is the premier Australian event for health informatics professionals, organised jointly by the Health Information Management Association of Australia and the Health Informatics Society of Australia.

fast track trials

Dr David Rowlands, director of national infrastructure development at the Commonwealth Department of Health and Ageing, told the conference that the first two "fast track" trials for UPI systems would take place in Tasmania and the Northern Territory.

The Unique Patient Identifier is a number assigned to every patient who interacts with a health system, and is an important component of the national HealthConnect project to implement an intranet for the health care industry. New Zealand has already implemented a nationwide UPI project.

The initial trials in the national health information management project HealthConnect were delayed until September after funding wrangles between State and Federal Governments, he said.

The starting date had slipped from August to September or may be even October. Two longer-term trials will follow, starting in the second half of 2003 in Queensland and New South Wales.

"There are a series of potential uses for summaries of client data," he said. "The primary function is for clinical use, for consumers to have a record of their own health, and for health providers to have a more comprehensive database of patient needs."

Dr Rowlands said that the national event summary project - "event summary" is the term used in HealthConnect to refer to the basic record of an interaction between the health system and a patient - did not have funding yet, although he did predict that a state would "take the lead."

The Tasmanian trial will be based in the Clarence region of Hobart to concentrate on diabetes sufferers, and the longer Queensland trial will also concentrate on diabetics. The trial will involve the recording of vital data about patients, plus the capture of information about each visit that they made to a health care contact point. Dr Rowlands, who had been recruited from Queensland Health to help manage the Federal project, said the fast track trials would be used to highlight issues and problems, rather than resolve them. The thorniest issues are expected to be security, privacy, access control and how to capture data.

"The purpose of these trials is to test the core concepts of HealthConnect in a live setting," he said. Dr Rowland's speech was given to a tightly-packed audience of over 100.


Dr Tony Sara, associate director of clinical information systems at the South Eastern Sydney Area Health Service (SESAHS) and principal research fellow for the Initiative for e-Health at the University of Wollongong, joined with SESAHS colleague Linda Holen, who is now the manager of the state UPI project, to deliver a presentation to the HIC2002 conference on a Sydney trial.

Dr Sara said he expects a "working state" of the system to be available for the whole of New South Wales in 12 months.

"If you do it right the first time, you will save yourself lots of money," he said, to appreciative murmurs from the crowded audience of health informatics professionals.Dr Sara said the project grew from a test implementation of UPI within SESAHS to a "pilot" on mental health patients, and his team would be tasked with implementing a state-wide trial.

"Given the response we have had for the State UPI, we will have a working state of the UPI in 12 months," he said. "We hope to report on that at the next HIC conference."Dr Sara said the system would need "high quality data" to succeed, as well as a "bullet-proof" UPI implementation.

"That John Smith in front of you has to be the John Smith you have on your screen. Patients die if you get it wrong," he said.

The UPI is simply a number, but the system surrounding it is more complex. Attached to the UPI number is the patient's first name, surname, gender, date of birth and Medicare number.

The complexities come when a patient cannot provide some of these details, or there is the potential for duplication of records. A large part of the trial was spent developing a probabilistic matching algorithm to ensure that patients were not issued multiple UPIs.

Ms Holen said that privacy was a "major constraint" to the project, as the NSW Privacy and Personal Information Protection Act prevented the SESAHS from disclosing vital patient information. After what Ms Holen described as "extensive consultation" with NSW Privacy Commissioner Chris Puplick, the SESAHS was allowed disclosure for the trial.

To implement the UPI, the SESAHS selected the e*Index application from SeeBeyond, which consolidates data from disparate databases behind a global identifier. Ms Holen said there was some local customisation needed for the application, but that this was a minor issue, and the fact that the SESAHS used version 4.1.1, which was newer than what a lot of sister organisations were using, caused more trouble in terms of staff retraining.

The SESAHS comprises 18 hospitals and health centres in various locations in inner Sydney, including Kings Cross, Surry Hills, Randwick, Kogarah, Darlinghurst and Waverley.

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