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February 2013
 
I.T Health Board Newsletter
   


The period of intense activity that characterised 2012 is set to continue this year as the National Health IT Board works with all health care organisations to achieve the eHealth vision that all New Zealanders will have electronic access to their health information by the end of 2014.

This year is all about working on a refined set of priorities which will significantly improve the way IT solutions support the delivery and experience of health care. This will require a focus on good governance and leadership at all levels of health information technology decision-making, and telling the stories of IT innovation and success from a clinician and patient perspective.

The NHITB has been working with the Health Quality & Safety Commission, Health Benefits Limited and other agencies to align our work programmes and identify the top information technology priorities for the health sector. A work list has been agreed that better fits the sector’s capacity to implement over the next three years – and you can read about this here.

A project that is building momentum in 2013 is the national Maternity Clinical Information System, which provides portal access for a mother-to-be. You can read about this here.

Interest from primary health organisations (PHOs) and primary care is continuing to grow in the development and use of online patient portals to manage aspects of an individual's health care and to share important information between patients and their GPs, and we are keen to see real progress in this area during 2013. The NHITB supports development of patient portals on two levels: a self-care patient portal for managing everyday health, and the addition of a shared care plan for more complex health needs.

We are already seeing significant progress in the area of eReferrals and the electronic transfer of patient files. Most GPs – 80 percent – now use GP2GP to send files electronically from one general practice system to another, and are sending more than 7000 patient files a month around New Zealand. Meanwhile, 16 DHBs are using eReferral systems and are sending 36,000 eReferrals around New Zealand each month.

Electronic prescribing is starting to take off, with three DHBs now using electronic prescribing in their hospitals. They were granted waivers to do so by the Director-General of Health because electronic sign off for prescriptions does not meet the requirements of the relevant legislation. This allows medicines to be prescribed and administered electronically, thereby reducing the potential for medication errors.

In another development, a waiver has just been granted to the Southern Cancer Network (SCN) to use an electronic prescribing and administration (ePA) module in its oncology software system, MOSAIQ. This is the first waiver application that has been granted for a specialist medical area. Dunedin Hospital is now using the ePA module for oncology services that will also be implemented across all of the South Island DHBs and one private hospital.

Our mantra is ‘maintaining the focus in 2013’.
Have a satisfying year!

Graeme Osborne
Director
National Health IT Board
     
    Clinician’s Corner –
Dr Sadhana Maraj

Here at the NHITB we have been thinking about the stories we want to tell in 2013. There are a lot of significant work programmes underway which will make a real difference for both clinicians and consumers, some involving national initiatives and others focused on improvements at regional and local levels.

We hope that telling these stories of innovation and improvement will inspire people to take part in, champion and promulgate the benefits being realised – or even lead – particular work streams.

Innovative use of information technology is driving sector-wide changes in practices and processes, and is also working away quietly in the background to underpin, enable and add value to work being led by others. For example, I attended a Rheumatic Fever governance group recently, and in the course of discussions it became apparent that down the track we may well see an IT component develop to support this work.

There is a lot to be excited about happening in the sector, both the success stories and the challenges ahead. Challenges are progressively being overcome by clinical, technical and process standardisation. At every turn, adequate change management is critical to ensuring the success of initiatives.

I’d like to congratulate Waitemata district health board (DHB) for successfully implementing ePrescribing (ePA) in a number of wards. I understand this has been very successful, which is a credit to everyone involved in the transition. As a sector, we need to learn from examples of good practice like this, so we can repeat it.

Clinicians will also welcome the rollout of the national Maternity Clinical Information System in five DHBs (Counties Manukau, MidCentral, Whanganui, Tairawhiti, and Capital & Coast) this year. The first two are expected to be live by July 2013. The system will collect a standardised set of maternity and neonatal data and will link with existing systems such as Maternity Plus. A portal for women to access their own information electronically will also be developed. The new system will be a significant improvement, and will make it easier to collect good quality information about maternity.

Encouraging greater clinical integration is a priority for the NHITB in the coming year. Clinical integration is about clinicians working better together and having access to the information they need in order to deliver the best possible care to their patients. It’s about the right people having access to the right information at the right time, and people working in more of a multi-disciplinary way across the continuum of care. The old days of the right hand not always knowing what the left hand was doing is making way for a much more ‘joined up’ approach to health care – and again, IT developments and use underpin and enable this.

Finally, I’d like to make special note of the work being done by Health Informatics New Zealand (HINZ). HINZ executive and members have been working hard to develop relationships with a wide range of IT vendors, clinicians, consumer groups and health managers.

A recent HINZ strategy day looked at ways to increase membership of HINZ, explain the value of the work it is doing, and ensure the organisation remains agile and responsive to the needs of members and the current environment. This will be a challenge but one worth pursuing, especially as the NHITB continues to rely on good partnership models that co-design systems and solutions to meet the health IT needs of today’s New Zealanders.

Sadhana Maraj
eHealth Clinical Lead
Manager, Health IT Engagement
   
     
     
     
  Comprehensive clinical assessment (interRAI project) for aged care

The Comprehensive Clinical Assessment Project is about establishing the use of a standardised assessment tool, that uses software, and is designed to improve the care of older people in residential care facilities.

Developed by the interRAI network of health researchers in over 30 countries, this tool is a comprehensive clinical assessment of medical, rehabilitation and support needs and abilities such as mobility and self-care. This information helps nurses to write tailor-made care plans which, when implemented benefit both residents and staff.

The community version of this assessment tool is used for the assessment of needs for older people living at home who need home-based support services. The roll out was completed in June 2012 with all DHBs now using this tool for their community clients.

Assessment Tool now mandatory

In October 2012, the Associate Minister of Health announced that use of this tool would be mandatory in aged residential facilities by July 2015. For the first time in New Zealand, the tool is expected to help provide, detailed statistical information about the needs of older people in care. This information will better support policy development and implementation.

Project Manager, Dr Brigette Meehan says the Comprehensive Clinical Assessment (interRAI) project team has regional trainers who work with aged care residential facility managers and their registered nurses as part of implementing this tool.

"To support the rollout, we are recruiting more training staff and have developed a regional approach so nurses can be trained locally."

"To date 133 nurses in 100 facilities have been trained with another 30 nurses currently in training, says Brigette.

Training in Auckland and Tauranga began in late January with further training planned throughout the country.

For further information, email the project team on interrai@dhbsharedservices.health or view the overview on the
IT Health Board website
 
     
   



HISO UPDATE

The Health Information Standards Organisation (HISO) welcomes early engagement with projects to provide good quality advice and to save time and effort. We are regularly approached by project teams about suitable international standards that can be adopted or to check if a standard needs to be developed specifically for New Zealand.

HISO has recently revised its standard development processes to improve guidance to projects which may need to develop New Zealand-specific standards, and these are available on the NHITB’s website.

We are also updating the HISO section of the website to make it easier to find copies of the standards, details of our work programme and other useful standards-related information and links.

One of our senior advisors, Angie Quinn, has been appointed as a New Zealand representative on the Member Forum of the International Health Terminology Standards Development Organisation (IHTSDO). This is a really important appointment for us in the Information Group. SNOMED-CT has been endorsed by HISO as the clinical terminology for use in the recording, storing and transfer of electronic clinical information in New Zealand and we are working with several specialist groups looking to implement it in their projects.

Meanwhile, the HISO committee is farewelling Dr Rick Acland, who has resigned, and thanks him for the extremely valuable contribution he has made. The Medical Council, which he represented, will continue to advise the HISO committee, as required.

HISO Chair wins award

New Zealand Doctor magazine has published an article acknowledging Richard Medlicott as the recipient of the 2012 ‘To Infinity and Beyond’ award – as judged by NZ Doctor. The full text of this article is available at the NZ Doctor website NZ Doctor website under the title ‘Early adopter is light years ahead’. You will need a subscription to NZ Doctor to access the article.

Videoconferencing Interoperability Interim Standard

The HISO 10049 Videoconferencing Interoperability Standard was published as an interim standard in December 2012 to promote the uptake of telemedicine.

Videoconferencing and telepresence are important technologies in establishing telehealth in New Zealand. Telehealth is the use of information and communication technologies to deliver health care across a wide range of health settings and physical locations, such as between DHBs, integrated family health centres and long term care facilities.

The standard provides guidance in procurement of videoconferencing and telepresence equipment, and it can be found here

HISO 10039 National Specialist Palliative Care Data Interim Standard

The HISO 10039 National Specialist Palliative Care Data Standard was published by HISO as an interim standard in December 2011.

Arohanui Hospice (Palmerston North) in conjunction with Houston Medical New Zealand, the providers of the hospice's patient management system, volunteered to pilot the interim standard.

HISO is evaluating that pilot to find out if the standard is fit-for-purpose and able to be moved to a Full Standard.

    
     
  In this issue...

•  Graeme's Editorial
•  Clinician's Corner
•  DHBs given technology priorities
•  HIGEAG advice on cloud computing
•  Major NCAMP upgrade planned for 2014
•  Comprehensive clinical assessment (InterRAI project) for aged care
•  HISO update
•  Health Identity Programme update
•  Introducing Mark Anderson




DHBs given information technology priorities

The NHITB has asked district health boards (DHBs) to focus on a refined list of information technology priorities.

Delivering on these priorities will help the NHITB achieve the Government’s eHealth vision of a central electronic health record for every person by the end of 2014 and greater opportunities for patient self-care.

The NHITB has three overall areas of focus between now and 2014: delivery of regional IT platforms, the medication safety programme, and patient access to their health information.

The priorities specifically for 2013 and into 2014 are:

•  Microsoft G2012
•  Health Benefits Ltd, Finance, Procurement and Supply Chain (FPSC)
•  Clinical Data Repositories (CDR) and Clinical Workstations (CWS)
•  Replacement of legacy Patient Administration Systems
•  eMedicines Reconciliation (eMR).

They were included in the Ministry of Health’s regional services planning guidance package to DHBs at the end of 2012.

NHITB Director Graeme Osborne says the National Health IT Plan sets realistic targets to achieve by 2014 and has broken these down into a smaller set of high priorities for DHBs to concentrate on.

“DHBs are operating within tight financial constraints so we want to make sure they focus on the things that will have the biggest impact on health care delivery, rather than being spread too thinly,” he says.

“Achieving the five priorities above will result in significant improvements in the health sector. As well as direct benefits from the initiatives themselves, savings programmes from other agencies require specific IT foundations to be in place in order to be implemented effectively.”

Graeme Osborne says the main factors contributing to improved IT service delivery include regional governance to support effective decision-making, a long-term commitment to IT investment, and a single IT delivery and operational capability.

The NHITB has also outlined information technology priorities for the primary/community sector – introducing patient portals, implementing the Community Pharmacy Services Agreement enabled by community ePrescription and shared care, and using clinical data repositories.


HIGEAG advice on overseas-based cloud computing

The NHITB and Health Information Governance Expert Advisory Group (HIGEAG) is advising the health and disability sector to tread cautiously when considering overseas-based cloud computing services to manage health information. This does not apply to services that run over Connected Health, which is a New Zealand-based ‘private cloud’ service.

Cloud computing provides access to computing resources over a network. The user’s data and application processing sits in the ‘cloud’, or network, and users interact with services through the screen of a network-enabled device.

Cloud computing offers organisations convenience and less cost, but it is not without risks, especially when the cloud is operated from an overseas location outside of New Zealand’s jurisdiction.

HIGEAG has outlined some of these risks in advice to health and disability agencies interested in using cloud computing. The full advice can be found here.

Health agencies are legally required to take all reasonable steps to protect the privacy and security of information they hold and the NHITB has released the following position statement:

Unless an exemption is granted by the NHITB, all personally identifiable health information and core operational data must be fully domiciled in New Zealand.

HIGEAG says agencies which want to use overseas-based cloud computing will need to apply for a special exemption and meet a number of stringent conditions. They will need to demonstrate that they have investigated the options fully and can meet their legal obligations.

“HIGEAG expects due diligence to include confirming that health information stored in a cloud based in New Zealand will not involve any health information or copies of that health information being transferred overseas,” says Tony Cooke, manager of health systems investment and planning, NHITB.

“Cloud computing offers a lot of possibilities for New Zealand’s health sector but it is important to proactively manage the risks to maintain the trust of patients, clinicians and the public in the security of health information held by agencies.”

The Health Information Governance Expert Advisory Group (HIGEAG) has been established to develop a health information governance framework (HIGF) for the New Zealand health sector.

The framework will help the Ministry of Health, DHBs, primary health organisations (PHOs) and service providers manage the sharing of health information across the sector consistently and safely. Click here to read more about HIGEAG


Major NCAMP upgrade planned for 2014

The clinical classification system used by the New Zealand health sector will undergo a major upgrade scheduled for July 2014.

These updates to ICD-10-AM will occur as part of the National Collections Annual Maintenance Programme (NCAMP).

New Zealand hospitals use a clinical coding classification developed by the World Health Organization (WHO) and modified by Australia’s National Casemix and Classification Centre.

Australia updates its clinical coding classifications every two years to reflect new information about diseases, medical or surgical techniques, and other particular areas of interest to do with health care provision.

New Zealand upgrades its system less frequently due to the cost and the resources required. It has been using the ICD-10-AM Sixth Edition since 2008 and had planned to upgrade to the eighth edition in July 2013, the same time as Australia. However, delays in obtaining the required licensing means that upgrade has been deferred until July next year.

In the meantime, a number of small changes will occur in July 2013, and the details of these are available on the Ministry of Health’s website: Ministry of Health’s website.

The upgrade in 2014 will be a significant one for the health sector, with major changes required to District Health Board (DHB) information systems, DHB district annual plans, funding and planning departments, clinical coder training, as well as the DHB monitoring carried out by the Ministry of Health.

Shifting to the ICD-10-AM Eighth Edition will involve changes to a number of data collections that use ICD-10-AM codes and methodologies, including the National Minimum Dataset (NMDS), National Book Reporting System (NBRS), New Zealand Cancer Registry (NZCR), Mortality Collection, Private Hospital System, and the Programme for the Integration of Mental Health Data (PRIMHD).

 
     
 
 
Introducing Mark Anderson

The NHITB has appointed a vendor portfolio manager to develop and nurture its relationships with information technology vendors.

Mark Anderson joins the NHITB after 25 years at IBM and says he is looking forward to his new role.

“Providing better information to the right people at the right time is recognised as key to improving the productivity of the health system,”
he says. “The vendor community plays a critical role in delivering better health information solutions. New technologies are creating the opportunity to capture, analyse and make accessible better information.”

During his time at IBM, Mark Anderson led a review of the health sector’s national data collections, conducted an independent quality assessment of the Southern DHB business intelligence programme, and worked on proposals and supported client visits by IBM within the health sector.

“When the vendor portfolio manager’s role arose within the NHITB, I was immediately interested as I saw it as a huge opportunity to make a contribution by drawing on my background and experience.”

He says there is a strong need to marry innovation with a more structured approach to achieving quality and productivity gains within the health sector, and to deliver on investment, and effective vendor relationships can help with that.

In his spare time Mark Anderson likes to walk in the Wellington hills with his family, go sailing, and read about management, science, social systems thinking and public policy theory. He has a PhD in experimental physics from the University of Texas at Austin.


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