Accurate data records and clinical coding play a pivotal role in not only ensuring the highest standards of patient care but also in achieving compliance with the Practice Incentives Program (PIP) incentives.
Achieving PIP compliance
Understanding PIP
The Practice Incentives Program (PIP) is a government initiative aimed at improving the quality of general practice. It offers incentives to GPs to encourage best practices and enhance patient care.
Compliance requirements
To qualify for PIP incentives, practices must meet specific compliance requirements. These requirements include data records and clinical coding standards. Maintaining accurate records and coding is not just a means to compliance but also a path to practice improvement.
The Practice Incentive Program eHealth Incentive (ePIP) has five eligibility requirements:
Requirement 1 - integrating healthcare identifiers into electronic practice records
The practice must:
- Apply to Services Australia to obtain a Healthcare Provider Identifier–Organisation (HPI–O) for the practice, and store the HPI–O in a compliant clinical software system
- Ensure that each general practitioner within the practice has their Healthcare Provider Identifier–Individual (HPI–I) stored in a compliant clinical software system
- Use a compliant clinical software system to access, retrieve and store verified Individual Healthcare Identifiers (IHI) for presenting patients.
Requirement 2 - secure messaging capability
The practice must have a standards-compliant secure messaging capability to electronically transmit and receive clinical messages to and from other healthcare providers, use it where feasible, and have a written policy to encourage its use in place.
RACGP Secure Messaging capability policy template
Requirement 3 - data records and clinical coding
Practices must ensure that where clinically relevant, they are working towards recording the majority of diagnoses for active patients electronically, using a medical vocabulary that can be mapped against a nationally recognised disease classification or terminology system. Practices must provide a written policy to this effect to all GPs within the practice.
Data Records and Coding Policy template from the RACGP
Requirement 4 - electronic transfer of prescriptions
The practice must ensure that the majority of their prescriptions are sent electronically to a Prescription Exchange Service (PES).
We usually recommend the largest vendor, which is eRX.
Requirement 5 — My Health Record system
The practice must use compliant software for accessing the My Health Record system, and for creating and posting shared health summaries and event summaries;
- Apply to participate in the My Health Record system upon obtaining a HPI–O; and
- Upload a shared health summary for a minimum of 0.5% of the practice’s standardised whole patient equivalent (SWPE) count of patients per PIP payment quarter.
Identifying patients with complex or chronic conditions, such as diabetes or heart disease, who require ongoing multidisciplinary care is essential. By uploading a Shared Health Summary, we can ensure secure and efficient sharing of up-to-date patient information among healthcare providers, facilitating informed decision-making and improved patient outcomes.
Shared health summaries: practical steps for identifying patients and incorporating them into your workflow
More info on ePIP - Australian Digital Health Agency
ePIP calculator
ePIP SHS calculator – MedicalDirector
MedicalDirector - ePIP Shared Health Summary Calculator
ePIP SHS calculator – Best Practice
Gold Coast PHN Best Practice Shared Health Summary Calculator walkthrough
Practice Nurse Digital Health Training Workbook - PracticeAssist
Uploading shared health summaries
The significance of data records and clinical coding
Why data records matter
Electronic health records provide a comprehensive view of a patient's medical history, treatments, and progress. They are not only the backbone of effective patient care but also support efficient practice management.
Clinical coding explained
Clinical coding is the systematic translation of patient diagnoses, treatments, and procedures into standardised codes. These codes align with national standards, ensuring consistency and interoperability in healthcare data.
Coding for quality care
Accurate clinical coding enhances the quality of patient care by facilitating the sharing of information among healthcare providers. It aids in the development of care plans and supports decision-making processes, ultimately benefiting patient outcomes.
Data cleaning in MedicalDirector
Requirement 3 - Data Records and Clinical Coding - MedicalDirector
Learning Workbook: Standardised Data Coding using MedicalDirector Clinical - Train IT Medical
Coding a diagnosis - Clinical by MedicalDirector
Maintaining high-quality health records - General Practitioner
Data Quality for Practice Nurses
Data cleaning in Best Practice
Data quality, coding and essential clinical data using BP Premier - Train IT Medical
Database cleansing in Best Practice webinar slides - Train IT Medical
Best Practice Data Cleaning (Steps taken from BP knowledgebase) - Eastern Melbourne PHN
How to Guide: Data Cleansing Using Best Practice Software - Nepean Blue Mountains PHN
Practice action plan
Creating an action plan
As per the RACGP Standards, it is necessary to develop business goals aimed at improving services, and then evaluate progress towards these goals.
Create a culture of good data quality
Changing from current practice to the consistent use of structured data requires a whole-of-practice effort. It is necessary to have the whole practice team on board. The key to change will be to create a culture of continuous improvement, where all team members are encouraged to work towards the goal.
Some things that your practice could do include:
- Creating a staff noticeboard for improvement activities, with reminders and graphs of progress etc.
- Considering KPIs for improving particular types of essential clinical data.
- Producing regular reports to show individual and practice progress towards the goal.
- Ensure all staff have sufficient time to update health records. For example, if required, provide brief gaps in daily appointment schedules for GPs to complete consultation notes.
Conclusion
Shared health summaries are a secure way of sharing up to date clinical information about patients with otherhealth care providers, identifying patients within the practice with conditions that would benefit from a shared health summary is a great way to increase your uploads for the ePIP compliance.
Data records and clinical coding are more than just compliance requirements; they are fundamental to providing exceptional patient care and practice management. With the support of SWSPHN's Digital Health team, you can navigate the complexities of data records, clinical coding, and PIP compliance with confidence.
Request Assistance: Don't hesitate to contact our Digital Health team to request training, support, or further information. We're here to partner with you on the journey to enhancing patient care and practice efficiency.