eServices quality checking in QST 111-22070000

A healthcare identifier is a unique 16 digit number. The HI Service forms the basis of other eHealth initiatives such as the My Health Record System. This is a national system for uniquely identifying healthcare providers (organisations and individua).

National Authentication Service for Health (NASH) Public Key Infrastructure (PKI) certificates allow organisations to connect to digital health systems securely such as:

• HI Service
• MyHealth Record
• ePrescribing

Services Australia manages the allocation, maintenance and disclosure of healthcare identifiers to healthcare providers and the public. This is legislated under the Healthcare Identifiers Act 2010.

The HI Service responsibilities include:

• Initial registration and maintenance of a Seed Organisation, Responsible Officers (RO) and Organisation Maintenance Officers (OMO) details
• Initial registration and maintenance of a Network Organisation and OMO
• Initial registration of Healthcare Provider Individual applications, where the provider's profession is not within coverage of the Australian Health Practitioner Regulation Agency (Ahpra) and maintenance of all Healthcare Provider Identifier - Individuals (HPI-I) records
• Healthcare Provider Directory (HPD) entry on request, and
• Registration of Individual Healthcare Identifiers (IHI) where the individual does not have a Medicare or Department of Veterans' Affairs (DVA) entitlement

The eServices quality checking process aligns Services Australia's Enterprise Quality Framework and the 7 quality principles. See Resources for a link to the Enterprise Quality Framework.

The quality checking process for the HI Service program aims to make sure:

• quality is maintained or improved, and
• processing errors are reduced or eliminated

Reporting of HI Service quality checking results provides stakeholders with an assessment of quality checking accuracy. For example, consistent application of the business rules.

The Service Delivery Support team is responsible for:

• analysing national quality reports to identify learning needs or process improvement opportunities
• escalating national quality issues to the relevant program or policy area and/or the Quality and Skill Tags team
• reviewing and updating the relevant Operational Blueprint files and training materials
• reviewing suggestions and working collaboratively with the Quality, Performance and Technical Support team to improve Operational Blueprint quality checking process and resources
• identifying strategic and operational risks or issues that impact customer outcomes

Managers/team leaders are responsible for ensuring:

• quality checkers complete the process for quality checker accreditation
• quality checkers hold appropriate skill tags in the Quality and Support Tool by sending an email to the Quality and Skill Tags team
• timely error feedback is discussed with the service officer as part of the coaching conversation to support any learning and development opportunities
• analysis of errors, that is, if errors occurred due to factors such as limited training, understanding the business rules, environmental or system-based issues
• positive quality checking outcomes are acknowledged with service officers
• analysis of data to identify learning needs or process improvement opportunities

Quality checkers are responsible for:

• carrying out quality checks as specified in the sampling plan
• updating and maintaining technical knowledge, procedures and policies
• maintaining a correctness standard for personal accuracy
• identifying root cause analysis and identifying systemic issues
• reporting and escalating trends or concerns to their team leader
• providing constructive and non-judgemental feedback including appropriate reference materials such as Operational Blueprint
• explaining the impact of errors and action to be taken to correct the error (where applicable) when providing feedback
• make sure they do not check their own work. If the quality checker's work is selected, it must be given to another accredited checker to check

Quality team must:

• provide support for quality checking in the Quality and Support Tool (QST)
• provide relevant reports as required
• support the business with flexible and fit for purpose quality approaches

To attain accreditation, quality checkers must:

• have knowledge of relevant policies and procedures
• maintain a high correctness standard in the program they are checking
• understand the quality checking procedure
• meet accreditation standards

See Quality checker accreditation for Health Service Delivery Division.

Pre-checks

Pre-checks will be applied to new starters and when there are new processes for the Program. Staff will have their work 100% reviewed and corrected until deemed proficient. These results are not included in accuracy of processing results.

Program/post-checks

Randomly selects work completed the previous business day in PaNDA. The results are provided to management and external stakeholders as needed.

Targeted checks apply:

• in response to business triggers or when there is a consistent/long-term quality issue identified
• to Aim for Accuracy process (check the checker) which is completed every 12 months. This is to confirm the accuracy of quality checking results. The process involves rechecking a representative sample of previously checked work to determine if quality checking procedures have been followed correctly

Pre-checks

Pre-checks will be applied to new starters and when there are new processes for the Program. Staff will have their work 100% reviewed and corrected until deemed proficient. These results are not included in accuracy of processing results.

Program/post-checks

100% of the monthly total of HI manual work types are selected for checking. For HI online SEED Application 5% of the monthly total work types are randomly selected for checking.

Targeted checks

To arrange a targeted check(s), team leaders send an email request to the Quality and Skill Tags team including the:

• percentage of work type to be checked. For example, 100%
• staff member's name and logon details
• quality checker's name and logon details
• the reason and length of time required for the targeted check
• details about how often a targeted check report is required. For example, weekly

Timeframes

Quality checks are:

• undertaken daily on a random sample of work
• completed within 1-2 business days to ensure timely feedback

All quality checks for the month must be actioned within 3 calendar days of the following month. After this time, remaining work is abandoned.

Resources

Quality checkers must have access to the following to undertake quality checks:

• Healthcare Identifiers eHealth program (EHP) through eBusiness Systems
• PaNDA and Workload Manager (WLM)
• Quality and Support Tool
• Skill tags added on the Quality and Support Tool

Documentation

HI Service applications subject to quality checking can be actioned from several different sources. This includes but is not limited to:

• HW018 - Application to register a Seed Organisation
• HW042 - Application to amend Organisation Officer's personal information
• HW037 - Application to amend a Healthcare Organisation record
• HW044 - Application to deactivate, reactivate or retire a Healthcare Organisation record
• HW033 - Application to Register a Healthcare Provider
• HW034 - Application to amend a Healthcare Provider Record

If a field on the form has incomplete or insufficient details, or the details have been omitted, a service officer may need to verify the details with the applicant. Information verified with the applicant must be notated in PaNDA Processing Notes.

Notations in the database become part of the source (supporting) documentation that is subject to quality checking.

Following are the various types of online application from Healthcare Identifier eHealth Program (EHP):

• Healthcare Identifiers - Register Allied Health Professional
• Healthcare Identifiers - Register Seed Organisation
• Healthcare Identifiers - Change Responsible Officer
• Healthcare Identifiers - Change Organisation Ownership -Seed
• Healthcare Identifiers - Change Organisation Ownership - Network

Critical errors

An error is classed as critical when it impacts:

• Services Australia by allowing the registration to continue without sufficient details to support legislative requirements
• an individual or organisation's ability to use the National Authentication Service for Health (NASH) Public Key Infrastructure (PKI) certificate. This includes errors that impact the:
  • issuance of a NASH PKI certificate, or
  • requirement to issue a new one because of processing errors.
    There is a potential for the agency to lose their Gatekeeper accreditation if the certificates are issued
• the agency's reputation by keying errors being available for viewing externally:
  • being sent in a successful registration letter, or
  • an individual viewing the incorrect information in the Healthcare Provider Directory

Non-critical errors

An error is classed as non-critical:

• when there is no identifiable risk to the business process (registration) and it will not impact the agency's reputation
• they will be recorded as feedback and any action required will be sent to the service officer for correction

Note: while non critical errors are recorded as part of the quality checking process, they do not impact the quality result reported to stakeholders that is, only critical errors are used to calculate the accuracy of processing results.

Document errors

For quality checking, a document error is defined as' a document received from an individual, provider or organisation representative which features omitted, incomplete or incorrect information'.

The error code(s) are applied when the service officer has not detected the document is in error and has processed the transaction without identifying/noting the use of additional evidence to support the action taken.

Processing errors

For quality checking, a processing error is defined as' information processed/keyed into the system which does not match the document submitted by an individual, provider or organisation representative'.

The error code(s) are applied when the service officer has keyed or not keyed information as per the business rules.

Each time a quality check is completed the quality checker records the outcome in the Quality and Support Tool (QST).

An email is sent in real time to the service officer and their team leader advising the quality check outcome. Individual results are captured in QST.

Feedback is emailed to the service officer and their team leader. It gives details about the:

• check
• result (including any errors identified)
• quality checking dispute process

Managing and storing feedback

Feedback is recorded/stored in the Quality and Support Tool. Discussion notes about the feedback should be detailed in coaching sessions.

For critical and non-critical errors, quality checkers provide instruction in the feedback email.

Service officers correct critical and non-critical errors. All corrections must be made as soon as possible once the service officer has been notified of the error.

Change Management

Quality checking procedures are reviewed and updated by the business and program in consultation with Quality and Skill Tags. The review ensures error codes are current and approved policy changes are included.

Any changes that need immediate action will be advised and updated accordingly. Any changes not critical to quality will be incorporated in the review of the procedures.

Quality checking procedures are reviewed and updated by the business and program in consultation with Quality and Skill Tags. The review ensures error codes are current and approved policy changes are included.

Any changes that need immediate action will be advised and updated accordingly. Any changes not critical to quality will be incorporated in the review of the procedures.

Quality checkers must consult a Local Peer Support (LPS) for any technical enquiries.

Enquiries about quality checking process or issues with checking results that cannot be resolved on site should be directed to Quality and Skill Tags by email.