Modelling communication requirements in aged care using HL7 V3 methods

Australia and other western nations are actively formulating strategies that will increase the adoption of information and communication technology (ICT) amongst privatesector providers of aged care. The drivers for this technological change involve population ageing reforms, concerns about the quality and safety of healthcare, and global strategies encouraging governments to transform the way they do business. This research set out to examine these drivers and to inform development of a national aged care ICT strategy in Australia. The research questions prompted an examination of how national health information systems and e-health reforms in Australia and overseas address aged care, with a view to describing a hierarchical structure of standards for interoperability using the Health Level Seven (HL7) Reference Information Model (RIM). HL7 refers to the international organisation involved in developing and supporting healthcare standards. A review of the implementation of national health and technology reforms revealed there are gaps in most western nation’s approaches to e-health reform when it comes to identifying the information management and communication requirements of privatesector aged care providers. Through the participation of aged care provides in Australia, detailed requirements were gathered using a Delphi approach and analysed using healthcare information modelling methods to inform the development of a hierarchy of Australian aged care messaging and communication standards. The methodology chosen for ocumenting these requirements was the HL7 Development Framework (HDF), the methodology which all HL7 Technical Committees are required to follow in the development of Version 3 (V3) standards. The first three of the seven formal phases to the HDF were employed to document a consensus business vision for nteroperability in aged care and some 82 storyboards. This provided detailed understanding of the likely system-to-system interactions and the associated application roles and receiver responsibilities of some 121 discrete interactions. Ten of these storyboards were subjected to international review as part of the published requirements for the HL7 V3 Care Provision standard in 2005. This comprehensive set of requirements informed development of an aged care Domain Analysis Model (DAM) whose elements were mapped to the HL7 RIM. This enabled the development of some early examples of how the aged care domain might be modelled using RIM conformant design models and how these might in turn be represented in an aged care Domain Information Model (DIM). Modelling the requirements of aged care providers using the HDF revealed four areas of communication complexity: Accessing an aged care service; Contractual documentation associated with securing and funding an aged care service; Effective coordination of service delivery; and Consistent documentation of services delivered. A number of solutions for addressing these complexities are proposed including migration of the current aged care referral process to an electronic application process; adoption of a new aged care case-management structure by collaborating healthcare and aged care providers; and adoption of a suite of national forms-based specifications using the HL7 Clinical Document Architecture (CDA) standard. These proposals offer possible solutions for achieving the interoperability vision described in this research and they are supported by the proposed aged care DIM. They will, however, rely upon the adoption of uniform messaging standards by aged care providers and by healthcare providers interfacing with them such as hospitals, General Practitioners and Aged Care Assessment Teams. To engender adoption of such standards, a role delineation model for implementation of the proposed hierarchy of aged care messaging standards is described. Together, these finding offer practical contributions towards the development of a national strategy for the adoption of ICT in aged care which is capable of supporting the objectives of population ageing and quality and safety reforms

Health Information Interchange

Health is information intensive: it has many disparate groups with multiple perspectives and subcultures. Each group sees things slightly differently, but they must all capture, communicate, reliably retrieve and re-use information between each other and across multiple settings. This chapter examines some of the methods used to represent data and to enable information interchange across the health spectrum

Health Information Interchange

Health is information intensive: it has many disparate groups with multiple perspectives and subcultures. Each group sees things slightly differently, but they must all capture, communicate, reliably retrieve and re-use information between each other and across multiple settings. This chapter examines some of the methods used to represent data and to enable information interchange across the health spectrum

Consumer preferences for telehealth in Australia: A discrete choice experiment.

This study aims to elicit consumer preferences regarding telehealth and face-to-face consultations in Australia. It used a discrete choice experiment, presenting participants with a series of hypothetical choices, and based on their responses, infer what is most important to them. Data were analysed using conditional logit regression and latent class analysis. A total of 1,025 participants completed the survey, considering four different clinical scenarios. Face-to-face contacts were, on average, preferred to either telephone or video services. However, telehealth was identified as an attractive option if it prevents significant travel and can be conducted with a familiar doctor. Participants were strongly driven by cost, particularly greater than $30. Telehealth was least preferred for situations involving a new and unknown physical symptom, and relatively more preferred for surgical follow-up. The latent class analysis demonstrates only 15.9% of participants appeared unwilling to consider telehealth. The findings of this study suggest that meeting the needs of the Australian population requires a blended approach to service delivery, with telehealth being valued in a range of clinical scenarios. Price sensitivity was evident, therefore if telehealth services can be delivered with lower patient cost, then they are likely to be attractive

Educational attainment and willingness to use technology for health and to share health information – The reimagining healthcare survey

BACKGROUND: Australia has seen a rapid uptake of virtual care since the start of the COVID-19 pandemic. We aimed to describe the willingness of consumers to use digital technology for health and to share their health information; and explore differences by educational attainment and area of remoteness. METHODS: We conducted an online survey on consumer preferences for virtual modes of healthcare delivery between June and September 2021. Participants were recruited through the study's partner organisations and an online market research company. Australian residents aged ≥18 years who provided study consent and completed the survey were included in the analysis. We reported the weighted percentages of participants who selected negative response to the questions to understand the size of the population that were unlikely to adopt virtual care. Age-adjusted Poisson regression models were used to estimate the prevalence ratios for selecting negative response associated with education and remoteness. RESULTS: Of the 1778 participants included, 29% were not aware of digital technologies for monitoring/supporting health, 22% did not have access to technologies to support their health, and 19% were not willing to use technologies for health. Over a fifth of participants (range: 21-34%) were not at all willing to use seven of the 15 proposed alternative methods of care. Between 21% and 36% of participants were not at all willing to share de-identified health information tracked in apps/devices with various not-for-profit organisations compared to 47% with private/for-profit health businesses. Higher proportions of participants selected negative response to the questions in the lower educational attainment groups than those with bachelor's degree or above. No difference was observed between area of remoteness. CONCLUSIONS: Improving the digital health literacy of people, especially those with lower educational attainment, will be required for virtual care to become an equitable part of normal healthcare delivery in Australia

Patient Use, Experience, and Satisfaction With Telehealth in an Australian Population (Reimagining Health Care): Web-Based Survey Study

BackgroundThe COVID-19 pandemic triggered a rapid scale-up of telehealth services in Australia as a means to provide continued care through periods of physical restrictions. The factors that influence engagement in telehealth remain unclear. ObjectiveThe purpose of this study is to understand the experience of Australian people who engaged in a telehealth consultation during the pandemic period (2020-2021) and the demographic factors that influence engagement. MethodsA web-based survey was distributed to Australians aged over 18 years that included 4 questions on frequency and type of clinical consultation, including with a general practitioner (GP), specialist, allied health, or nurse; 1 question on the experience of telehealth; and 2 questions on the quality of and satisfaction with telehealth. Statistical analysis included proportion of responses (of positive responses where a Likert scale was used) and regression analyses to determine the effect of demographic variables. ResultsOf the 1820 participants who completed the survey, 88.3% (1607/1820) had engaged in a health care consultation of some type in the previous 12 months, and 69.3% (1114/1607) of those had used telehealth. The most common type of consultation was with a GP (959/1114, 86.1%). Older people were more likely to have had a health care consultation but less likely to have had a telehealth consultation. There was no difference in use of telehealth between metropolitan and nonmetropolitan regions; however, people with a bachelor’s degree or above were more likely to have used telehealth and to report a positive experience. A total of 87% (977/1114) of participants agreed or strongly agreed that they had received the information they required from their consultation, 71% (797/1114) agreed or strongly agreed that the outcome of their consultation was the same as it would have been face-to-face, 84% (931/1114) agreed or strongly agreed that the doctor or health care provider made them feel comfortable, 83% (924/1114) agreed or strongly agreed that the doctor or health care provider was equally as knowledgeable as providers they have seen in person; 57% (629/1114) of respondents reported that they would not have been able to access their health consultation if it were not for telehealth; 69% (765/1114) of respondents reported that they were satisfied with their telehealth consultation, and 60% (671/1114) reported that they would choose to continue to use telehealth in the future. ConclusionsThere was a relatively high level of engagement with telehealth over the 12 months leading up to the study period, and the majority of participants reported a positive experience and satisfaction with their telehealth consultation. While there was no indication that remoteness influenced telehealth usage, there remains work to be done to improve access to older people and those with less than a bachelor’s degree

Selected dimensions and levels.

This study aims to elicit consumer preferences regarding telehealth and face-to-face consultations in Australia. It used a discrete choice experiment, presenting participants with a series of hypothetical choices, and based on their responses, infer what is most important to them. Data were analysed using conditional logit regression and latent class analysis. A total of 1,025 participants completed the survey, considering four different clinical scenarios. Face-to-face contacts were, on average, preferred to either telephone or video services. However, telehealth was identified as an attractive option if it prevents significant travel and can be conducted with a familiar doctor. Participants were strongly driven by cost, particularly greater than $30. Telehealth was least preferred for situations involving a new and unknown physical symptom, and relatively more preferred for surgical follow-up. The latent class analysis demonstrates only 15.9% of participants appeared unwilling to consider telehealth. The findings of this study suggest that meeting the needs of the Australian population requires a blended approach to service delivery, with telehealth being valued in a range of clinical scenarios. Price sensitivity was evident, therefore if telehealth services can be delivered with lower patient cost, then they are likely to be attractive.</div

Example of a choice set.

In this example, the participant is being asked to consider a situation where they need a repeat prescription for a condition they have. To comply with the rules about plausible combinations of levels, both options do not involve travel, and do have a risk of distortion.</p

Demographic characteristics.

This study aims to elicit consumer preferences regarding telehealth and face-to-face consultations in Australia. It used a discrete choice experiment, presenting participants with a series of hypothetical choices, and based on their responses, infer what is most important to them. Data were analysed using conditional logit regression and latent class analysis. A total of 1,025 participants completed the survey, considering four different clinical scenarios. Face-to-face contacts were, on average, preferred to either telephone or video services. However, telehealth was identified as an attractive option if it prevents significant travel and can be conducted with a familiar doctor. Participants were strongly driven by cost, particularly greater than $30. Telehealth was least preferred for situations involving a new and unknown physical symptom, and relatively more preferred for surgical follow-up. The latent class analysis demonstrates only 15.9% of participants appeared unwilling to consider telehealth. The findings of this study suggest that meeting the needs of the Australian population requires a blended approach to service delivery, with telehealth being valued in a range of clinical scenarios. Price sensitivity was evident, therefore if telehealth services can be delivered with lower patient cost, then they are likely to be attractive.</div