General Practitioner

Role:

To provide primary care outside hospital setting

Data Collected: 

Patient demographics, Clinical data, Medicare number, Service provided

Data shared with:

Medicare (MBS), Billing data;

PHN (Primary Health Network), Mandatory minimum dataset for clinical audit and specific population studies.

Type of data shared:

Medicare number and MBS (Medicare Benefits Schedule) item number with MBS

Provider-id, Medicare Number, with Pharmacy (via e-RX script exchange)

Provider-id, Medicare Number with Lab/Radiology

Referral letter to specialists/hospitals

 

Specialist

Role:

To provide specialist medical care usually on referral from a General Practitioner (GP)

Data Collected: 

Patient demographics, Clinical data, Medicare number, Service provided

Data shared with:

Medicare, MBS Billing data;

PHI (Private Health Insurance) – Member number, MBS Data, Billing (Fees) for privately insured patients

Type of data shared:

Medicare number and MBS item number with MBS

Provider-id, Medicare Number, with Pharmacy (via e-RX script exchange)

Provider-id, Medicare Number with Lab/Radiology

Referral letter to specialists/hospitals

 

Radiologists

Role:

To provide specialist service related to diagnostic imaging tests and intervention procedures or treatments that involve the use of x-ray, ultrasound, and magnetic resonance imaging equipment.

Data Collected: 

Patient demographics, Clinical data, Medicare number, Service provided

Data shared with:

Medicare, Billing data;

Hospitals and referring GP/specialist test results

Type of data shared:

Medicare - Medicare number, MBS item number;

Referring GP/specialist - clinical findings

Hospitals – clinical findings

 

Pathologists

Role:

To provide pathology services privately or as part of a public or private hospital. Service involves identification of the cause and processes of diseases:  and illness by examining/testing samples of tissues, blood and body secretions.

Data Collected: 

Patient demographics, Clinical data, Medicare number, Service provided

Data shared with:

Medicare, Billing data;

Hospitals and referring GP/specialist, test results

Type of data shared:

Medicare - Medicare number, MBS item number;

Hospitals/GPs – Clinical data including test results

 

Pharmacies

Role:

To dispense prescription drugs as well as supply over-the-counter (OTC) medicines and supplements.

Data Collected: 

Patient demographics, Medicare number,

Provider Id, Prescription script details,

Prescription data – Non PBS

Other OTC medication purchased by consumer

Data shared with:

Medicare PBS (Pharmaceutical Benefits Scheme), Billing data;

 

Type of data shared:

Medicare - Medicare number, Provider-id and PBS prescription data

 

Public hospitals

Role:

To provide a range of non-admitted (e.g. emergency and outpatient clinics) and admitted patient health services including emergency, elective care, medical and surgical services, maternity services. Publicly funded.

Data Collected: 

Medicare number, Patient demographics, Clinical data,

Services provided including accommodation, theatre, pharmacy, laboratory and radiology services, other allied health services,

MBS procedures and Diagnosis codes, DRG (Diagnosis-Related Group) codes

Optional - Member number for private patients.

Data shared with:

Medicare (MBS) Billing data; PBS

LHN (Local Health Networks) a common governing structure for a group of hospitals within each state

State Department of Health (SDOH) (minimum data set – administrative and clinical data) – via LHNs

Australian Institute of Health and Welfare (AIHW) – via SDOH (as per minimum data set specified by AIHW)

PHI – Privately insured patients, all hospital services billed

TAC (Traffic Accident Commission)/WC (Workers Compensation) – Patient clinical data, for patients whose claims are due to traffic accidents or workers compensation.

DVA (Department of Veterans' Affairs) – Billing and Clinical data for people who are eligible under the Veterans affairs cases.

Type of data shared:

Medicare - Medicare number, MBS item number;

LHN (Local Health Network) – Complete patient admission records of hospitals within the governance framework)

State DOH – Patient data, minimum dataset specified by via LHNs

 

Private hospitals

Role:

To provide a range of non-admitted (e.g. outpatient clinics) and admitted patient health services including elective care, medical and surgical services, maternity services. Privately funded.

Data Collected: 

Medicare number, Patient demographics, Clinical data,

Member number for privately insured patients, Date of admission and discharge

All Services provided and costs of services - including accommodation, theatre, pharmacy, laboratory and radiology services, other allied health services,

Clinical data including diagnosis and procedure codes and DRG codes for the episode of care.

Data shared with:

PHI – Privately insured patients, all hospital services billed, including accommodation, prosthetics, laboratory and radiology services, other allied health services

PHI – Hospital Discharge Data (includes patient demographics, Date of admission and discharge, diagnosis, procedures, DRG codes)

Medicare MBS and PBS

AIHW – via (minimum data set specified by AIHW on behalf of FDOH)

TAC/WC – Patient clinical data, for patients whose claims are due to traffic accidents or worker’s compensation.

DVA – Billing and Clinical data for people who are eligible under the Veterans affairs cases.

Type of data shared:

PHI – Claims – list of services and associated costs for all services including accommodation, theatre charges, prosthetics, lab and radiology services

PHI – Hospital Discharge Data (includes patient demographics, Date of admission and discharge, diagnosis, procedures, DRG codes)

Medicare - Medicare number, MBS item number; State health dept. – Minimum Data Set; PHIs – Health Insurance identifier, item no.

 

Allied health services

Role:

To provide a range of health services not including medical, nursing or dental; Includes services such as dietitians, chiropractors, occupational therapists, physiotherapists etc.

Data Collected: 

Patient demographics, Clinical data, Medicare number, Health Insurance number, Service provided.

Data shared with:

Medicare (Dental and Optometrist services)

PHI for billing – all allowed ancillary services

DVA for claims related to eligible veterans

Worksafe/TAC – Billing for claims that fall under the preview of WC and TAC

Type of data shared:

Medicare - Medicare number,

Member Number – type of service, cost of service

 

Community Health Centres

Role:

To provide community based health promotion and disease prevention services such as advocacy, education, early intervention, mental health rehabilitation, immunization, screening services etc. to local populations.

Data Collected: 

Patient demographics, Clinical data

Data shared with:

LHNs (or Local Health Districts (LHDs)); DVA

Type of data shared:

Community Health Minimum Data Set – aggregate numbers (patient contacts, hours spent, number of sessions by service); DVA data - patient demographics, service type, entitlement.

 

Aboriginal Medical Services/Aboriginal Community Controlled Health Services

Role:

To deliver holistic and culturally appropriate health service to the community that controls it. Each state has its own set of local health clinics and community centres for delivering healthcare service across geographical regions within their state.

Data Collected: 

Not known

Data shared with:

Not known

Type of data shared:

Not known

 

Aged care services (Aged care homes and home based services)

Role:

Home based services: To provide entry-level support services for older people who need some assistance with daily living in order to live independently at home. This is delivered via the Commonwealth home support program (CHSP)

 

Aged care homes: Owned and run by Australian government approved private operators.

Data Collected: 

Not known

Data shared with:

Not known

Type of data shared:

Not known