National mental health information priorities 2nd edition

2.8 - Upgrading of information systems

Page last updated: June 2005

The collection of minimum data sets, outcomes and casemix measures and their incorporation into routine clinical practice require functional clinical information systems at the local service delivery level. Lack of progress in this area was identified as a major obstacle at the close of the First National Mental Health Plan. An independent evaluation of the Plan concluded:

"Information in mental health is grossly undeveloped ... A precondition to the changes proposed ... is the existence of an information infrastructure built from the clinical services level that contributes to individual consumer care and service quality improvements as well as feeding into higher level planning and policy review. ...Putting such systems in place needs to be identified as an imperative for the next Strategy period".17
Each jurisdiction faced unique challenges, as well as issues that were common across all States and Territories. Starting from different points, the major challenges for all has been to incorporate the new mental health data within 'mainstream' hospital-based systems.

The solutions pursued differ across jurisdictions, with choices driven by local preferences and the need to interface with wider corporate systems operating across their health portfolios. At the end of the Second National Mental Health Plan, the extent of implementation of upgraded systems differed significantly across jurisdictions, with all foreshadowing further work being needed to complete the task. Table 2 summarises the development phases within each jurisdiction.

Table 2: Summary of the development of mental health information systems in each of the States and Territories and the private hospital sector

Table 2 is presented as text in this HTML version for accessibility reasons. It is presented as a table in the PDF version.

New South Wales
Victoria
Queensland
Western Australia
South Australia
Tasmania
Australian Capital Territory
Northern Territory
Private hospital sector
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New South Wales

Pre-National Mental Health Strategy:
  • Limited participation by psychiatric inpatient services in mainstream inpatient data.

  • No systems for community mental health services. Proliferation of local developments but no requirements for state reporting of unit records, only aggregate counts of occasions of service.

  • No standard for unique patient identifiers.

  • No systems in place to promote information sharing between service provider agencies.
Key system developments 1993-2003:
  • All mental health inpatient data reported from mainstream hospital systems.

  • Major investment in development of enterprise-wide community health information system 'CHIME'.

  • Pilot process for unique patient identifiers trialed.

  • Introduction of interim local systems to collect ambulatory and outcome data.

  • Area and State data warehouses configured to accept mental health admitted and ambulatory data with unique patient identifiers.
Future direction/next steps:
  • Possible inclusion of outcome data in hospital systems.

  • Migration from interim local systems to CHIME for non admitted and outcome data where permitted by dept/Area.

  • Inclusion of non admitted and outcome data in strategic systems (eg CERNER) in some Areas.

  • Strategic State wide Unique identifier process established.

  • Implement multilevel integrated reporting from data warehouses with 'Business Objects'.

  • Warehouses used as repository of all mental health data from disparate systems.
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Victoria

Pre-National Mental Health Strategy:
  • Comprehensive information system for mental health services (PRISM) covering inpatient and community services. Developed separately from mainstream health collections as a reporting system, with limited functionality for service providers.

  • Statewide unique patient identifiers in place.

  • Inpatient and community systems shared information through 'live' statewide network.
Key system developments 1993-2003:
  • Major investment in replacement of PRISM by new 'RAPID' system, designed to modernise the statewide network.
Future direction/next steps:
  • Developing functionality in RAPID to improve access to information to support and assist in decision-making by services.

Queensland

Pre-National Mental Health Strategy:
  • No systems for community mental health services.

  • Paper-based reporting to head office of patient registrations in community mental health care, partial coverage only.

  • No standard for unique patient identifiers.

  • Specific mental health requirements in hospital-based systems not addressed.
Key system developments 1993-2003:
  • Development of CESA system for community mental health services, comprehensive statewide rollout. Operated as a series of stand alone systems.

  • Development of separate 'add on' systems for collection of outcomes data.

  • Unique patient identifiers established at district level.

  • Mental health admitted patient collection mainstreamed into hospital-based systems.
Future direction/next steps:
  • Replacement of CESA by a integrated patient management system for community mental health care as part of, or linking to, enterprise system.

  • Development of single Statewide identifier.

  • Development of hospital system to incorporate mental health requirements with linkages to the community system(s).

  • Development of reporting and decision support tools.
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Western Australia

Pre-National Mental Health Strategy:
  • No systems established for community mental health services. Paper-based reporting arrangements for community patient registrations and service use.

  • Statewide case register covering inpatient and community services bringing together mental health activity data from paper-based and electronic sources.

  • Statewide unique patient identifiers for research purposes in place, managed through central allocation within statewide case register.
Key system developments 1993-2003:
  • Development of LAMHIS as stand alone electronic system for community mental health services.

  • Redevelopment of LAMHIS to a new centralised mental health clinical information system (PSOLIS), covering all services within the State across all service settings (inpatient, community and community residential).
Future direction/next steps:
  • Further development of PSOLIS to:

    • build in reporting and clinical decision support tools to improve utility of information at service delivery level; and

    • establish a framework for a comprehensive Electronic Patient Record system.

South Australia

Pre-National Mental Health Strategy:
  • Several local sites with information systems established for community mental health services and data reported centrally.

  • Collection of limited Child & Adolescent community information.

  • Registration of adult & older persons by metropolitan services to create a limited unique patient identifier (community & inpatient).
Key system developments 1993-2003:
  • Implementation of CMS system to collect community mental health information.

  • Upgrade of systems, multi user access and extended collection of Child & Adolescent community information.

  • Country community systems (stand alone, incorporating mental health) implemented.

  • Central data consolidation for reporting & analysis purposes.
Future direction/next steps:
  • Replacement of CMS and CAMHS metropolitan mental health community systems with a new CBIS system.

  • CBIS to collect both community and inpatient NOCC data.

  • Consolidation of stand alone Country community information systems.

  • Development of reporting & decision support tools to improve utility of information.
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Tasmania

Pre-National Mental Health Strategy:
  • No systems established for community mental health services. Paper-based collections submitted to central office.

  • Statewide unique patient identifiers in place, but allocated manually, managed through central allocation, not full coverage of all services.
Key system developments 1993-2003:
  • Implementation of paper-based OARS information collection and reporting system for community mental health services.

  • Reviewed options for community system development.
Future direction/next steps:
  • Establishment of local clinical information systems for community mental health services.

  • Redevelopment of hospital systems to incorporate mental health requirements.

  • Statewide unique patient identifiers incorporated with new information system.

Australian Capital Territory

Pre-National Mental Health Strategy:
  • No organised mental health information system in place.
Key system developments 1993-2003:
  • Initial development of locally designed database (OSCAR), deployed as separate standalone system in each centre.

  • Subsequent development of the Mental Health Assessment Generation and Information Collection (MHAGIC) system, a networked electronic medical record which makes clinical information available in real time.

  • Implementation of Territory-wide Health Identifier.
Future direction/next steps:
  • Increase the use of MHAGIC in bed-based services.

  • Develop and deploy subsets of MHAGIC on hand-held devices.

  • Improve linkages with mainstream health collections.

  • Improve data quality and aggregate reporting.
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Northern Territory

Pre-National Mental Health Strategy:
  • General Hospital information system in place (Caresys), used by mental health services covering inpatient services only.

  • Statewide unique patient identifiers in place (community and inpatient).

  • Separate stand alone community statistical collection systems (FormOHSt) in major centres.

  • Community mental health data collection performed indirectly by administrative staff. No effective clinical reporting output.

  • Data accuracy and validation difficulties, no central coordination of information requirements.
Key system developments 1993-2003:
  • Major investment in development of a corporate Community Care Information System (CCIS), deployed across the Territory.

  • Client Master Index (CMI) fully integrated across NT community and inpatient information systems.

  • Generic aggregate service activity reporting available to all users.

  • Direct clinical data input and on-line access to individual consumer records available in real time and across all service settings and NT service locations.
Future direction/next steps:
  • Development of reporting and decision support tools to improve utility of information at service delivery, management and program levels.

  • Seamless integration of patient/client management system across hospital and community mental health services.

  • Integrated information development workforce training and support systems provided within MH Program.

Private hospital sector

Pre-National Mental Health Strategy:
  • Hospital data collections based on jurisdictional requirements. Quality of data was variable.

  • A small number of hospitals engaged in the routine collection of outcome measures. However there was no general agreement as to what measures were appropriate in the sector and no standard systems for their collection.
Key system developments 1993-2003:
  • Commencing 1995, implementation of standard data collection requirements under the Hospital Casemix Protocol, a collection maintained by the Australian Government.

  • During this period, private Hospitals were also required to meet their jurisdiction's increasingly sophisticated data submission requirements.

  • Implementation of the SPGPPS's National Model for the Collection and Analysis of a Minimum Data Set with Outcome Measures for Private Psychiatric Services was completed in over 95% of the private hospitals with psychiatric beds throughout Australia.
Top of pageFuture direction/next steps:
  • Maintain and improve adherence with nationally agreed data protocols.

  • Continuous improvement of the utility of information derived from these data collected.

  • Resolve problems with the uniform collection of service utilisation data in ambulatory care (same day, hospital outpatient, and community-based) services provided by private hospitals.

  • Refine the statistical reporting functions of the centralised data management service to improve their utility for both clinical and service management purposes, including benchmarking.

Footnotes

17 National Mental Health Strategy Evaluation Steering Committee, for the Australian Health Ministers Advisory Council, Evaluation of the National Mental Health Strategy: Final Report, Mental Health Branch, Commonwealth Department of Health and Family Services, December 1997.