By Fiona Miles, Customer Engagement Manager
I have been working as a Health Information Manager in the Victorian Health System for the past 25 years. When I finished secondary school, I knew I wanted to work in health, but didn’t necessarily want client/patient contact, so Health Information Management seemed like a good option; the ‘heart of health, behind the scenes’. With a visit to La Trobe University to find out more about what being a Health Information Manager was all about, here I am all these years later with so much experience and highlights that have fulfilled all expectations.
Health Information Managers are integral to effective health care with the equipped skills to collect, maintain and analyse health data. It’s all about health data management, which takes many different forms in the current industry. This can include concepts of health informatics, which is the computing side of things; health data analysis, which is related to research; clinical classification and extracts, which is the method by which community health are funded; and then management itself, which involves management of health staff.
When considering a Client Management System and considering what Health Information Managers do, below are the top 5 considerations I would look for when selecting a system:
1. Data Management
Data and information must be collected and reported in accordance with the various funding streams within the jurisdiction of Community Health. The Minimum Data Set for each extract must be collected and then be able to be reported on through a specific extract, meeting Department requirements for reporting.
For funding purposes, it is also necessary that the Client Management System has the required specification written into the application to allow for reporting. The extract should have been substantiated through testing with the Department. Credibility of an extract comes from knowing this has been undertaken as is knowing that the extract has been implemented in other organisations and is working as it should.
2. Forms Design
An EMR must be able to allow for the design of administrative and clinical forms that are in accordance with regulations and meeting digitisation standards, both for the manual and electronic collection of information. Forms need to be able to be designed collecting the relevant information, they need to be user friendly and the content within them, needs to be able to be reported on, for both internal and external requirements.
For example, one of our clients who supports NDIS needed to be able to generate forms that address the use of a care plan where a multidisciplinary approach is used to treat clients under their NDIS package. It is important that clinicians from various teams and disciplines can add to the plan and that any changes to the plan are appropriately tracked and can be viewed by all.
3. Security, Privacy and Confidentiality
Collectively security, privacy and confidentiality are essential requirements for any EMR. How does the system manage information, is there password security, what does the audit trail look like, can information from the audit trail be accessed easily when needed quickly, and how does the client know that all the information collected about them that is stored in the system is safe and secure?
There are requirements set by the Department for security standards and as a minimum all requirements should be met within a Client Management System. Community Health settings can have client groups where some information is considered very sensitive with a higher level of confidentiality required within the system. Having the ability to configure a Client Management System in a team-based approach for access is necessary. This means only those clinicians assigned to the team have have access to client information that is attached to that team. An example of this could be for a sexual health clinic.
4. Contemporary, User Friendly Design
How a Client Management System looks and feels will ensure success when being implemented to an organisation. The system needs to have a contemporary feel, it must be user friendly, colours, fonts and layout are equally important, the ability to configure and design sections that are specific to the organisation also ensures accurate and consistent use by clinicians.
The more an organisation does to configure a system themselves, the better. For example, create locally defined look up tables for internal data reporting needs so local teams can see what they need to see easily and management can get the data that they need easily.
5. Reports
As well as having in-house reporting capabilities that meet the need of a Community Health setting, a Client Management System must have the ability for the client to be able to write and publish their own reports. The data dictionary should be easy to follow, and give access to the client to be able to generate reports as needed. One thing we have learned from our experience is that the reports a client wants on day one are very different to the reports they want a year later so a system that allows the client to develop reports without constantly having to pay a provider to make changes is an important consideration.
Our electronic medical record (EMR) is an emerging Client Management System in the Victorian Community Health setting. Having worked in community health settings that are part of a hospital and also standalone community health settings, I truly believe MasterCare EMR is one of the best systems I have used. Why? Well, because it allows for the effective collection and reporting of data and information, it gives the clinician access to record electronic notes in purpose built forms and templates, and it collects outcome measures, assessments and other clinician information electronically. All of which compiles a structured electronic medical record that can be viewed in a multidisciplinary area.
MasterCare EMR is also one of the better systems I have seen that allows the collection of reportable data, both in the form of direct and indirect client time attributed to the clinician. All too often we focus on the face-to- face time with a client, reporting only the direct time, but indirect time is equally as important when looking at what the clinician does in their working day; recording time for writing reports, conducting secondary meetings, recording travel time and case management contribute to the day too.