My Health Record (Provider) quality checking processing 111-22120010

The quality checking process for the My Health Record System provider program aims to ensure that quality is maintained or improved and processing errors are reduced or eliminated.

Reporting of My Health Record System provider quality checking results provides stakeholders with an assessment of quality checking accuracy; for example: consistent application of the business rules. This procedure will assist staff members to complete quality checking for the My Health Record System Provider program registrations.

Role of Quality Checker

The quality checker is:

• responsible for the examination of the documentation to ensure the accuracy of the My Health Record application processing
• to ensure that the business rules of the program are adhered to and the data entered into the system is accurate.

Role of Team Leader

The Team Leader is responsible for ensuring:

• that daily pre-check is performed for every processing day
• that weekly post-checking and aim for accuracy checking is performed on the Monday following the processing week
• that timely feedback is provided to processing staff on accuracy of processing results
• where errors are recurring, staff are provided with additional training, or notifying National Office (NO) where training material may need updating

Quality checking of own work

Quality checkers must not quality check their own work. If a quality checker's own work is selected, it must be passed to another staff member who has been accredited to conduct quality checks.

See Also Quality Checking Own Work Policy

Staff members who complete quality checks 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) or higher)
• reviewed the Quality Checking My Health Record - Provider procedure (this document) and email Team Leader advising procedures have been reviewed and understood
• Checkers are to undergo refresher training if required

My Health Record Provider program will be subject to the following checks:

• pre-checks
• letters
• new staff proficiency

Note: the results of the pre-check are not included in the accuracy of processing results.

• post checks
• a sample of all registrations processed will be subject to post-checking
• targeted check
• closed registrations
• open registrations
• staff members with identified quality issues
• Aim for Accuracy

Due to the sensitive nature of the My Health Record System Provider program a number of checks are undertaken to ensure quality outcomes.

The sampling methodology will be reviewed annually or as required.

Pre-checks: New Starters

Pre-checks are completed on the complete registration process for staff new to My Health Record Provider processing. New starters have their work reviewed and corrected with the guidance of a mentor until they are deemed proficient. 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 normally reported for accuracy of processing purposes. The combined efforts between the mentor and new starter may be subject to post quality checks. Any errors identified for a new starter in transactions selected for post checking must be recorded.

The information below guides the amount of checking to be completed for new starters:

• Level of pre-check - Time 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

Pre-checks: Letters

All letters are system generated on the Provider Participation Register (PPR) at 2:00am (Canberra time) on the day after the application is processed. 100% of applications supporting these letters must be checked before close of business on the same day of processing, to ensure the legislative requirement has been met.

Post-checks

100% My Health Record Provider applications will be subject to a post check. Note: This is subject to volumes and should be reviewed if volumes increase.

Targeted Checks: Closed registrations

A list of Service Officer created applications from an EDW report will be sent from Provider Healthcare Identifiers (HI) Service and My Health Record Subject Matter Expert (SME) each Monday morning. Applications closed off on the My Health Record Tracking Database need to be compared against the list. Any anomalies, such as missing applications, or applications that are not on the list, must be investigated, and an email reply sent to Provider HI Service and My Health Record SME.

Targeted Checks: Open Registrations

To ensure applications are not missed, and are processed within KPM, a database check needs to be conducted weekly on HI and My Health Record applications processed. These checks will help to ensure that no applications are left unattended or missed.

Targeted Checks: Staff members with identified quality issues

Where critical error/s are identified in any checking process for a Service Officer, every registration processed will be checked for the following week or until no further errors are identified.

Targeted Checks: Aim for Accuracy

The Aim for Accuracy check (check the checker) is completed on work previously checked. Aim for Accuracy will be undertaken weekly. A separate procedure exists for Aim for Accuracy checks.

See Resources for a link to Aim for Accuracy policies

Time frames

Pre-checks should be conducted before the close of business same day, ensuring that processing service level agreements are met. Post checks are to be completed no later than the Monday of the week after processing.

All checking needs to be finalised by the first working day of the new month, and the spreadsheet sent to the Quality Management Section by close of business on that day. This will ensure timely reporting of the accuracy of processing results.

Resources

Quality checkers must have access to the

• The Provider Participation Register (PPR) through eBusiness Systems
• Customer Relationship Management (CRM) web based application
• HI/My Health Record joint workflow management access database
• Shared drive where the electronic applications are stored
• TRIM access to relevant My Health Record containers
• The relevant drives
• Managers\HI_ehealth\Quality Control
• access to the protected spreadsheets where quality checking is recorded

Source documentation

My Health Record applications subject to quality checking can be actioned from several different sources. This includes, but is not limited to:

• HW018 (previously 2978) Healthcare Identifiers Service - My Health Record System - Application to Register a Seed Organisation form
• Application to register Network Organisation in the My Health Record system (states in foot note: All information in this publication is correct as of November 2014)
• 10616 (previously HAO916) - Application to establish list of authorised healthcare provider individuals
• Telephony requests where the action taken is sent as an email to the shared email box

Where a notation has been made electronically on the application and in CRM, this becomes part of the supporting documentation that is subject to quality checking.

All quality checking for the My Health Record Provider program is conducted on site in the Melbourne office. Reporting to program area and program executive occurs monthly.

All quality checking enquiries are to be directed to:

• Local Peer Support (LPS) - eServices - Specialised Provider Services section
• Team Leader - eServices - Specialised Provider Services section

Any enquires that cannot be resolved on site can be directed to the program area:

• Provider Operations Assistant Director - eHealth program - National Office

Definition of 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
• the individual or organisation, affecting the use of a NASH certificate. An error which impacts either the issuance of a NASH certificate or the requirement to issue a new NASH certificate due to an error in processing
• the agency’s reputation, by keying errors being available for viewing externally, by incorrect information being sent in a successful registration letter

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 (i.e. only critical errors are used to calculate the accuracy of processing results).

Document errors

For the purposes of 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 that 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 the purposes of 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.

Quality checking is recorded on the ‘My Health Record Provider Quality Checking Results’ spreadsheet. This will record the results for financial year to date, with a tab for each month.

Additionally there is an:

• accuracy tab which will display the accuracy results for each type of check by month and year to date
• error register tab that will allow for analysis of errors for exception reporting

This spreadsheet is to be sent to the Quality Management Section and the Provider Healthcare Identifiers (HI) Service and My Health Record Subject Matter Expert (SME) each Monday and by close of business on the first working day of the new month for monthly reporting.

See Process for the Recording Post Checking Results process table.

After performing the quality check on each work item, the quality checker 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 quality checker, 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 needs to be entered in the underlying factors on the My Health Record provider Quality Checking spreadsheet.

Method for 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 or nominated Local Peer Support (LPS). The My Health Record provider 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 of errors is to be completed by the Team Leader. 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 My Health Record program and the Quality Management Section. This incorporates endorsed changes to program business policy and procedures, and ensures that error codes are current and appropriate.

It is the responsibility of both Local Peer Support (LPS) and the Provider Healthcare Identifiers (HI) Service and My Health Record Subject Matter Expert (SME) to ensure that issues with the Quality Checking procedure or tools are escalated to Quality Management Section using the applicable Quality Checking contact on the Quality Processes page. See Resources for a link.

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