Healthcare Identifiers Service (HI Service) quality checking 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.

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 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.

Quality Checkers:

• examine the documentation to make sure the accuracy of the HI Service processing
• make sure the business rules of the programme are adhered to and the data entered into the system is accurate

Quality Checkers must not check their own work.

Team Leaders (TL5) make sure:

• they place applications for quality checking by National Office (NO) in the appropriate folders daily
• quality checking for specific form types is performed on site daily
• they give timely feedback to processing Service Officers on the accuracy of processing results
• for recurring errors, Service Officers are given extra training, or notify NO if training material needs updating

To complete quality checks for the HI Service, the Quality Checker must have:

• subject matter expertise - the Service Officer completing the check:
• has product knowledge
• understands the business rules, and/or
• knows where to source them, (typically Local Peer Support (LPS) (PS04) or higher)
• reviewed Quality Checking HI Service Procedures and emailed Team Leader (TL5 and TL6) to advise they have reviewed and understood procedures
• undergone refresher training of the quality checking process if required

Pre-checks

Pre-checks are completed for Service Officers who are new to HI Service processing. New starters generally have their work reviewed and corrected with the guidance of a mentor until they are deemed capable. The pre-checking is a safeguard to improve the quality of the business process.

Any errors detected by the mentor during this process are not reported for accuracy of processing purposes. The combined efforts between the mentor and new starter will be subject to quality checking the following day. Any errors identified for a new starter in transactions selected for quality checking must be recorded as errors.

Localised spreadsheets have been created and kept on site to track the pre-checks. The results are not included in the accuracy of processing results.

Pre-check Capability Standard

The following details the amount of pre-check to establish a Service Officer's capability to move to post-check.

• Level of pre-check: period - condition
• 100%: 4 weeks - Nil errors for 3 consecutive days
• 50%: 2 weeks - Nil errors for 3 consecutive days
• 25%: 2 weeks - Nil errors for 3 consecutive days

Post-checks

The quality checks to be completed for HI Service processing are set at 20% of the previous day's processed work.

Targeted checks

Service Officers identified with quality issues should have the same amount of checking as the new starters (see above standards).

A separate procedure has been created for Aim for Accuracy and is held by the helpdesk.

It is a program requirement that 100% of HI Service applications undergo quality checking until accuracy of processing consistently meets the required KPM of ≥95%.

A review of the sampling methodology occurs annually, or as required, to make sure there is capacity to complete the required quality checking.

Timeframes

Quality checking must be undertaken as soon as possible after processing is complete. This is to make sure processing service level agreements are met.

Resources

Quality checkers must have access to:

• Healthcare Identifiers eHealth program (EHP) through eBusiness Systems
• Shared drive where the following are stored:
• electronic applications
• quality checking spread sheets

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 on the HI Service file note in the workflow management database.

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

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.

Post Checks

Quality checking is recorded on the 'HI Service QC Spreadsheet - template'. Every month Operations and the Programme area each create a new spreadsheet populated with the quality checking results.

The Process page contains details about the spreadsheet.

These spreadsheets are:

• sent to the quality Framework Section each Monday (by midday) for weekly reporting, and
• completed and forwarded by the first working day of the new month for monthly reporting

After doing the quality check on each work item, the Local Peer Support (LPS) gives feedback to the appropriate service officer.

This feedback:

• includes positive feedback for transactions identified as error free
• should be given the same day the quality check is completed, or as soon as possible after completing the quality check
• must decide the reason for the error/s (underlying factors). This helps to recognise:
• any weaknesses in processing
• gaps in relevant business rules, and
• issues relating to environmental factors, system faults and limitations

Identification of underlying factors for errors

The Team Leader/LPS, in consultation with the processing Service Officer, analyse the error/s to decide the underlying factors for the error/s occurring.

Information gathered in the feedback process must be entered in the underlying factors on the HI Service quality checking spreadsheet.

Managing and storing feedback

The feedback will be recorded in the coaching files and addressed if required during coaching sessions.

The Team Leader (TL5) or Local Peer Support (LPS) will complete the analysis of errors. The HI Service quality checking results are maintained by the business areas. This information includes the details of the errors as recorded on the quality checking spreadsheet.

Error documentation to be kept on site for root cause analysis if required.

As part of continuous improvement, the HI Service programme and Quality Framework Section (QFS) will review the quality checking procedure annually. This incorporates endorsed changes to programme business policy and procedures and makes sure error codes are current and appropriate.

It is the responsibility of Local Peer Support (LPS) and Team Leaders to make sure they escalate issues with the quality checking procedure or tools, to QFS using the applicable Quality Checking contact on the Quality Processes page.

The Resources page contains a link.

Any changes that:

• need immediate action will be advised and updated accordingly
• do not have critical to quality implications will be incorporated in the review of the procedures

All quality checking enquiries are to be directed to:

• Medicare and Aged Care - Local Peer Support (LPS)
• Team Leader (TL5) - eServices team - Transformation and eServices Programme. Any enquiries that cannot be resolved on site can be directed to the programme area
• Provider Operations Assistant Director - Digital Health programme - National Office