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.

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 Veteran's Affairs entitlement

The Quality Checking process for the HI Service program aims to ensure 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 ensure 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:

• applications to be quality checked by National Office (NO) are placed in the appropriate folders on a daily basis
• quality checking for specific form types is performed on site on a daily basis for
• timely feedback is provided to processing staff on accuracy of processing results
• for recurring errors, staff are given extra training, or notify NO if training material may need updating

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

• subject matter expertise
  the staff member 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) advising procedures have been reviewed and understood
• undergone refresher training (of the quality checking process) if required

Pre-checks

Pre-checks are completed on staff 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 staff member'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

Staff members who have been 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 such time accuracy of processing consistently meets the required KPM of ≥95%.

The sampling methodology will be reviewed annually, or as required, to ensure there is capacity to complete the required quality checking.

Timeframes

Quality checking must be conducted as soon as possible after processing is complete. This ensures processing service level agreements are met.

Resources

Quality checkers must have access to:

• Healthcare Identifiers eHealth Programme (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
• HW041 - Application to Register a Network Organisation
• HW040- Application to replace a Responsible officer or add/ remove an Organisation Maintenance Officer for an 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
• HW014 – Application to link or unlink a Contracted Service Provider to or from a healthcare provider organisation record
• 3054i - Application to request or update a PKI certificate
• 2888 - Application to create, verify or merge an Individual Healthcare Identifier

If a field on the form has incomplete or insufficient information, or the information has been omitted, a Service Officer may be required to verify this information 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 defined as critical when there is an impact to the:

• agency by allowing the registration to proceed without sufficient information to support legislative requirements
• individual or organisation, affecting the use of a PKI certificate. An error which impacts either the issuance of a PKI or the requirement to issue a new PKI due to an error in processing. There is potential for the agency to lose their Gatekeeper accreditation if PKI certificates are issued in error
• agency's reputation, by keying errors being available for viewing externally, by either being sent in a successful registration letter, or by an individual viewing the incorrect information in the Healthcare Provider Directory

Non-critical errors

An error is defined as non-critical when there is no identifiable risk to the business process (registration) and will not impact on Services Australia reputation.

Non critical errors will 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'. A new spreadsheet is to be created every month populated with the quality checking results, one by Operations, and one by the Programme area.

The Process page has information 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 performing the quality check on each work item, the Local Peer Support (LPS) is to provide 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 the quality check has been undertaken
• must determine the reason for the error/s (underlying factors). This helps identify 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 staff member, analyses the error/s to determine the underlying factors for the error occurring. This helps identify any weaknesses in processing, gaps in relevant business rules, and issues relating to environmental factors, system faults and limitations.

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.

Analysis of errors will be completed by the Team Leader (TL5) or Local Peer Support (LPS). 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.

Analysis on errors is to be completed by the Team Leader (TL5). Error documentation to be kept on site (for root cause analysis) should it be required.

As part of continuous improvement, the quality checking procedure is to be reviewed annually by the HI Service programme and the Quality Framework Section (QFS). This incorporates endorsed changes to programme business policy and procedures, and ensures error codes are current and appropriate.

It is the responsibility of both Local Peer Support (LPS) and Team Leaders to ensure issues with the quality checking procedure or tools are escalated to QFS using the applicable Quality Checking contact on the Quality Processes page. See Resources page for a link.

Any changes that require immediate action will be advised and updated accordingly. Any changes that 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