What is Primary Sense?

It is a clinical decision support, population health management and data extraction tool. Primary Sense analyses and manages general practice data in a confidential and safe way.

Who developed Primary Sense?

The original version of Primary Sense has been developed by Gold Coast Primary Health Network (PHN) in 2018 and used by various Gold Coast GPs since. Supported by Gold Coast PHN, WA Primary Health Alliance (WAPHA) has led the development of Primary Sense 2.0, which is due to be made available to GPs in some PHNs from mid-2022.

Who can use Primary Sense?

Primary Sense is only used by general practices and PHNs.

How is Primary Sense funded?

As not for profit organisations, participating PHNs fund the operation of Primary Sense on a cost recovery basis and invest in further development of the tool. Learn more about the role of PHNs at the Department of Health.

How is Primary Sense different to other extraction tools?

• Provides ‘one click’ reports about issues that matter to GPs.
• Stratifies patients into different ‘bands’ or ‘levels’ of complexity using the Johns Hopkins University ACG® System.
• Uses real time data in reports and alerts because it extracts new information every three minutes.
• Is owned and managed by PHNs and the team can quickly respond to the feedback and requests from practices.

What PHNs use Primary Sense?

The current list of PHNs involved in rolling out Primary Sense is:

• Brisbane North
• Brisbane South
• Gold Coast
• Nepean Blue Mountains
• Northern Sydney
• Primary Health Tasmania
• Northern Territory
• WA Primary Health Alliance (Perth North, Perth South and Country WA PHNs)

Contact PHNs for more details on plans, timing and approach to rolling out Primary Sense in their region.

What are the components of Primary Sense?

Four components work together to provide ‘real time’ reports and medication alerts. These include:

1. A data extractor tool – the extractor is installed on the server of the practice
2. A desktop app for generating reports and managing alerts
3. A database – located in the Azure cloud
4. The Johns Hopkins University ACG® System – located in the Azure cloud

Is Primary Sense listed on the Australian Register of Therapeutic Goods (ARTG)?

Under the current regulations and guidelines managed by the Therapeutic Goods Administration (TGA), certain types of medical devices that are electronic clinical decision support systems (eCDS) are now exempt from any requirement to be listed on the ARTG. Primary Sense meets all criteria required for exempt clinical decision support software under the current TGA regulations.

Can an external organisation e.g. a hospital, research project use Primary Sense?

Researchers from universities or other organisations can submit proposals for research that uses Primary Sense data to improve the health of the general practice population by completing this form: https://forms.office.com/r/hA5xzwgk0J

Research or quality improvement applications need to add to the knowledge base of the clinical content and usability of Primary Sense to ensure it remains evidence based. All research applications need to align with the Quintuple Aim, PHN objectives and data use principles of peak bodies such as the Australian College of Rural and Remote Medicine (ACCRM), the Australian Primary Health Care Nurses Association (APNA), the Australian Association of Practice Management (AAMA) and the Royal Australian College of General Practitioners (RACGP).

Can my practice use Primary Sense?

Primary Sense is compatible with Medical Director and Best Practice. There are a small number of minimum hardware requirements which are described in the Primary Sense IT checklist , and it is important the checklist is completed prior to installation.

Can I use CAT Plus as well?

Absolutely. There are no software conflicts between Primary Sense and CAT Plus. Both software packages have unique strengths and limitations. Ultimately, what practices do with their data is more important than the software package they use.

How much does Primary Sense cost?

Primary Sense is subsidised by participating PHNs so practices can use it without any direct financial cost. The practice is responsible for any costs incurred from their IT provider relating to Primary Sense installation and maintenance.

Does Primary Sense need to be installed on every computer in the practice?

The extractor only needs to be installed once on your server. The desktop app needs to be installed on as few or as many computers and workstations as you like but is designed to be installed on any computer with Best Practice or Medical Director.

Will Primary Sense slow down our practice system?

Primary Sense has been designed to work in harmony with your IT systems without slowing down performance. We have extensively tested Primary Sense with practices and found no evidence that it affects practice systems. However, in the unlikely event that your system appears to be slower, our technical team can adjust your Primary Sense settings further.

What is patient ‘complexity’and what are the levels?

There are six complexity levels, ranging from 0-5. Level 0 indicates a very low level of complexity with no known risks for poor health outcomes, while level 5 is the highest complexity. Patients with level 5 complexity typically have significant multi-morbidity and polypharmacy and are at greatest risk of poor health outcomes.

Is complexity different to hospitalisation risk?

Complexity levels reflect the current care needs of patients, while hospitalisation risk identifies estimated future care needs. While patients with higher levels of complexity are more likely to be hospitalised than those with lower levels, complexity is not directly associated with hospitalisation risk. Many Primary Sense reports, therefore, include both results.

How is complexity and hospitalisation risk calculated?

The same input data is used for both calculations. The complexity levels of patients in Primary Sense reports were calculated with Johns Hopkins University ACG® System. The Johns Hopkins University ACG® System is underpinned by a robust evidence base of >30 years of practical application. The tool is used in 20 countries and has been validated in different healthcare settings, including general practice.

How does stratifying hospitalisation risk and patient complexity benefit a practice?

Stratification identifies patients who are most likely to have poor health outcomes or benefit from assessments and other medical care. Stratification supports planned co-ordinated care for patients. Primary Sense™ also identifies patients who are eligible for reviews or occasions of service. Practices can use Primary Sense™ reports to prioritise patients and reassure themselves that no one is slipping through the proverbial gap.

Where is the information in the “existing appt” and other columns extracted from?

Primary Sense extracts information from the “appointment book” for each patient and displays this information on relevant reports. For Medical Director and Pracsoft users, the range is limited to the next four weeks (due to limitations of data available in Pracsoft to update changes in appointments e.g. change of date/cancellations). Best Practice will search for any future appointment, which is not time limited.

Who will receive medication alerts? Are these the same as Medical Director/BP alerts?

Medication alerts are generated at the point of prescribing, i.e., when a clinician is entering the prescription into the clinical software. Alerts are only sent to doctors who selected this function. Primary Sense medication alerts are different to Medical Director and BP alerts. They are more specific, relate only to high-risk medications and take individual patient factors into account. For example, an alert for prescribing metformin will only be generated when a GP prescribes it for a patient with a recent eGFR <30ml data-preserve-html-node="true"/min.

Do patients know that data is extracted and shared with the PHN and can they opt out?

General practices are required to adhere to privacy principles when sharing de-identified data. Generally, this is included in the patient registration form and patients can opt-out at any time. Primary Sense has a quick and easy opt out function for this purpose.

How does Primary Sense manage patient consent to data sharing?

Management of patient consent is a practice responsibility. If a patient wants to opt out of Primary Sense, this request can be performed in the administration screen by general practice staff.

What happens when a patient opts out of Primary Sense?

Patients who opt out are excluded from Primary Sense extractions and data already held is located via their unique ID reference and deleted overnight from the central database. Patients can opt out of data for secondary purposes which means the PHNs don’t receive the data but the GP will still get the alerts and prompts for the patient.

Primary Sense is hosted on Primary Health Insights, what does it do?

Primary Health Insights is a data storage and analytics platform developed collaboratively by PHNs and hosted in Australia. The platform provides leading edge data security and robust data governance to minimise the risk of data security breaches and unauthorised data management practices.

What does de-identified data mean?

PHNs are unable to accept identifiable data from practices. Identifiable patient information such as names and Medicare numbers are removed from data before it is sent to PHNs. Only practices can see patient identifiable data while using their computers and servers. No identifiable data leaves the practice.

What data is extracted from Primary Sense?

Primary Sense extracts de-identified data from a practice’s practice management system. The Primary Sense Data Extraction Guide specifies what tables are extracted. The following is not extracted:

• Data marked as confidential
• Family history
• Anything with terms such as mother, father, daughter etc.

What happens to the data that Primary Sense extracts?

De-identified data from a practice’s practice management system is transmitted to the Primary Sense system for processing and storage.

Where is the extracted data stored?

Data is de-identified and encrypted when it is extracted before it is forwarded to the database. Extracted de-identified data is stored in the Primary Sense Database, which is located in the cloud-based Microsoft Azure, in Australia.

How does Primary Sense use extracted data?

Primary Sense uses the extracted de-identified data to:

• populate reports, notifications and alerts provided to users within the practice.
• provide PHNs with data for further population analysis e.g. health needs assessments, quality improvement and PIP QI reporting.

Primary Sense uses extracted de-identified data, so how does it send a GP information about a patient for medical alerts and prompts?

Primary Sense has been programmed to only re-identify the individual for alerts, prompts and reports within the practice where access to the underlying practice clinical information system has been permitted. It does this by:

1. Assigning an internal practice management system identifying number for individuals. This unique ID is a numeric count assigned as each new record is added and is not based on the individual’s details.
2. The unique ID is encrypted and used to track that individual’s records in Primary Sense.
3. When the Primary Sense desktop software requests information about specific individuals for an alert, prompt or report, the local application within the practice sends the unique ID to Primary Sense.
4. The data is returned to the desktop application (inside the practice) and then uses the unique ID to pull the identifying information from the practice management system to display on-screen to the practitioner.

No identifying information ever leaves the practice to perform this advisory service to the GP.

In the initial data extraction from a practice, where does the data go?

• When the data is initially extracted and is still being compiled, masked and de-identified, it sits solely on the practice’s own server.
• Once the extracted data set is ready, it gets sent over the internet via the Primary Sense API (Application Programming Interface) which allows the Primary Sense desktop software installed on a general practice’s computer to ‘talk’ to Primary Sense API. The Primary Sense API sits inside the Primary Health Insights (PHI) platform (located in Australia in Microsoft Azure cloud).
• The Primary Sense Core (located in PHI) is where all data processing and data enhancement code (such as the Johns Hopkins ACG® tool) occurs. It is what is used to provides alerts, prompts and reports back to the practice.
• All the data from all general practices within the same PHN are stored in a database and copies of the data is regularly moved over to the PHN’s own lockbox, which only that PHN can access. The extracted general practice data can be used by PHNs for further population analysis for things like health needs assessments, quality improvement and PIP QI reporting.

Are general practitioners’ notes extracted from Primary Sense?

No. Only de-identified data needed to generate reports, alerts and prompts for the practice is extracted.

Can Primary Sense access, remove or manipulate a patient data set in my practice management system?

No. Primary Sense does not write to a practice’s practice management system and has no access to do so.

Why does the PHN receive extracted data from practices?

PHNs use extracted data for population health management and to understand the needs of practices and patients in their region. PHNs are responsible for commissioning services for their communities and data informs what services may need to be commissioned. It is also now a PIP QI requirement that practices share data with their PHN.

Does anyone other than the PHN have access to the extracted data?

Only authorised WA Primary Health Alliance (lead PHN for Primary Sense) staff have access to the extracted de-identified data.

Is extracted Primary Sense data commercialised?

Extracted data from Primary Sense is not commercialised. Primary Sense is PHN owned and operated – PHNs are contractually prohibited to make any commercial gain from general practice data.

How secure is the extracted data and the cloud?

Microsoft Azure provides industry standard security and adheres to Australian Privacy Principles.

How is Primary Sense data kept safe from being hacked?

While it is never possible to guarantee that any system is 100% safe from being hacked, Primary has built-in measures to protect patients’ data from being re-identified outside the practice including:

De-identifying patient data

• No identifying information – such as a patient’s name, date of birth, post code or Medicare number – leaves the general practice.

Use of unique IDs

• Data is assigned a unique ID before it is extracted or transferred and is stored across multiple tables using reference numbers.

Data encryption

• With Primary Sense, the identifier used to re-identify the patient back in the practice is encrypted, both during transfer and in storage.

Data encoding on extraction

• Data is compressed and transferred as encoded data – adding a further layer of de-identification.

Breaking patient records into portions

• De-identified data is extracted by table so a whole patient record is not transferred at once.

Near real time extraction

• Primary Sense makes small data extractions every 3–5-minutes, which means in each extract, the data is meaningless should it be intercepted. This minimises the potential for any data to be identified in the unlikely event of a breach or if theft were to occur.

Data Sharing Agreements

• Agreements between each practice and its PHN control how, when and who can access and use data.

24-hour monitoring

• Intrusion prevention and detection systems detect any suspicious activity before it can turn malicious.