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May 2013 |
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 Investing in innovative information technology systems is a win-win for patients, clinicians and health providers. It's about harnessing IT to improve interactions between clinicians and their patients, and to support the best possible clinical decisions. Giving people more access to their own health information is the next big step forward for community-based health professionals. It is cost-effective and will deliver measurable benefits.
For example, there are early signs that the provision of self-care online patient portals are becoming an essential part of delivering primary health care. As Auckland GP David Thompson says, providing a patient portal is both good clinical practice and a sound business decision, while patient Blair Polly makes it clear that people increasingly want – and expect – to use IT to manage their own health care.
By providing shared care and improved electronic access to patient information, health providers are actively building a better service model and better service outcomes for their patients, especially those with long-term or complex health issues. The IT Board's goal is to ensure patient information is available for them in a secure, online environment and the health professionals treating them at the point of care, wherever that might be.
Work is underway with community-based healthcare providers to implement and roll out secure online patient portals around the country to support the Government’s eHealth vision of all New Zealanders having electronic access to their health information by the end of 2014. The use of online patient portals is gaining momentum, and already showing benefits. We want to see further progress in 2013, and are relying on health professionals, general practices, primary health organisations and district health boards to lead the way.
2013/14 is shaping up as a year of significant change on a number of fronts. DHBs have described their plans for IT investment in Regional Service Plans and improved governance.
We are also working to expand our engagement and dialogue with DHB CEOs. The four regional DHB CEO representatives attended their first IT Board meeting in April, which offered opportunities to discuss progress on the refresh of the National Health IT Plan, the current work programme and priorities, as well as the milestones being met to achieve the eHealth vision.
Graeme Osborne
Director
National Health IT Board
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 Clinician’s Corner –
Dr Sadhana Maraj
The need for innovation is well accepted but equally important is the need for integrating the information technology systems and solutions being offered to clinicians and consumers to use. It's about providing clinicians with the right tools so they can access the information they need at the right time, and about providing innovative products that are user-friendly, easy to navigate, and meaningful.
Innovative, integrated use of IT is a common theme emerging in the draft regional service plans prepared by the 20 DHBs. For example, there is increased interest in telehealth activities, investment in clinical pathways and the requirement for advanced care plans. A commitment to strengthened regional collaboration and a greater willingness to work together are also apparent in the plans. The regional service plans, which cover activity for 2013/14 through to 2015/16, are currently in the process of being finalised.
The importance of leadership came through strongly for me at a seminar I attended at the Ministry recently. Discussion on leadership highlighted the need for us to be clear about the 'why' of our initiatives before we get into the details of 'what' and 'how'. The seminar highlighted for me how clinical leadership aligned with strong programme management is particularly critical in the area of health IT technology innovations and implementations. In other words, we need strong clinical leadership across every IT programme to ensure we have a very clear idea of the purpose and value of each piece of work from the outset and to have a clear line of sight to what we are hoping to achieve.
The Central Region Information Systems Plan (CRISP) is an example of where strong clinical leadership aligned with programme management is integral to operationalising regional IT plans. CRISP is now live with the region's first version of the Clinical Workstation and Clinical Data Repository (MidCentral DHB), the Radiology Information System (Whanganui DHB), and on 26 April the PACS archive went live across all the central region DHBs. Now clinicians can view images from any DHB in the region and this is hugely significant for service delivery, patient care and clinical collaboration.
Some clinical leaders are being invited to an upcoming workshop in June on eReferrals implementation, which the NHITB is coordinating. We want to share insights and build on the learnings from each other’s experience so we don't 'reinvent the wheel'. We also want to ensure a consistent approach based on agreed standards, while still leaving room for supporting local requirements.
Finally, this month I attended a Vendor Boardroom meeting. This meeting is led by the NHITB and aims to strengthen our partnership approach to health IT and to promote engagement between vendors and clinicians. We want to ensure we are producing systems that are integrated, easy to use and, of course, meet clinician requirements.
The meeting discussed the challenges of providing online patient portals to manage aspects of health care and health information, both from a clinician's point of view but also from the perspective of consumers. Again, this reinforced the need for clinical involvement to help us understand what drives consumer uptake and encourage adoption. It also identified the challenges ahead, which include developing consistent funding model options with clear incentives for uptake.
I have been very heartened in the past two months to see the greater focus on integration, collaboration and clinical involvement that is coming through in the sector’s work.
Sadhana Maraj
eHealth Clinical Lead
Manager, Health IT Engagement
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Patient portals: the way of the future
The National Health IT Board (NHITB) wants integrated family health centres, general practices and primary health organisations (PHOs) to provide patients with electronic access to their health information within the next two years.
NHITB Director Graeme Osborne says a number of district health boards (DHBs) and GPs are already leading the way with developing and using patient portals, and he’s urging other health professionals to drive further progress.
“The time is right for patient portals,” he says. “People increasingly want to manage aspects of their own health care and health information, and we need to respond to that. Secure online access to health information and health activities is the way of the future.”
The NHITB wants every New Zealander to have electronic access to their health information by the end of 2014. It 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.
Over the next two years the NHITB will work with general practices, district health boards (DHBs) and information technology vendors to provide improved electronic access to health information, and will develop information toolkits to support the process. The IT Board will also actively encourage people using health services to ask their providers for patient portals. Examples of companies providing self-care patient portals available in New Zealand include Medtech (ManageMyHealth), MyPractice, Intrahealth and Orion.
"We're expecting demand for improved electronic access to personal health information to grow as both clinicians and patients see the benefits," says Graeme Osborne.
Wellington GP Richard Medlicott, whose Island Bay Medical Centre offers patients use of an online patient portal, says people increasingly want to manage aspects of their own health care and health information.
"The days of people waiting for a phone call to confirm their medical laboratory results are coming to an end," he says.
"People want to be able to log in online to see for themselves if their lab results are available. And while they're logged in, they might decide to book an appointment with their GP, check when they're due for a mammogram, email the practice nurse with a question about their medicine, and confirm the vaccination schedule for one of their children."
He says patient portals also offer real benefits to clinicians. As well as saving time, the use of a patient portal will enhance the relationship doctors, nurses and other health professionals have with their patients.
Graeme Osborne says that having confidence in the security of information provided will be a key issue for organisations developing portals. The NHITB has developed a brand, Connected Health, so the public can see quickly and easily that the systems and portals which are collecting, transferring, storing and sharing their health information are secure and trustworthy. All private information will be encrypted on a secure Connected Health network. In the future, portals will be accredited to Connected Health standards.
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Patient portal delivers benefits to Auckland practice
Auckland GP David Thompson says a secure online patient portal used by his practice is proving a godsend.
“It’s easy to use, gives patients a lot more control over their health care, frees our staff from a number of administrative tasks, and we’re also seeing some clinical benefits,” he says.
The Torbay Medical Centre began offering an electronic patient portal, ManageMyHealth, two and a half years ago. David Thompson says 250 patients currently use it and it will be offered to all 10,000 people on the practice's books from next month.
"It's a really good tool. People can make appointments online, request repeat prescriptions, check their lab test results and send us messages.
"I love it most of all because I can email my patient. I don't have to play telephone tag with them. The telephone has been the bane of our lives but we don’t have to use it as much, and that’s been great."
He says the practice is noticing improvements in the management of some health conditions. For example, patients with diabetes who are using insulin are managing this better than previously.
"The portal is proving really useful for these patients," says David Thompson.
"They can send me their blood-sugar readings through the portal and I'll look at these and advise them what to do next with their insulin. This is all done electronically and in a secure environment. It was quite difficult doing this over the phone previously and I don’t like using open emails, so the security of the patient portal has been important."
He says the online portal enhances the doctor-patient relationship and the response from patients has been very positive.
He has a message for general practices considering a patient portal:
"I'd encourage them to do it. It's good clinical practice as well as a sound business decision. It will pay for itself at some point and will deliver a lot of value along the way. This is about thinking outside of the square and patients are increasingly expecting us to use technology in innovative ways to help manage their health care."
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In this issue...
Highlights
Update on regional clinical workstations
The regions are making good progress with implementing Clinical Workstations (CWS) and Clinical Data Repositories (CDR).
All district health boards (DHBs) currently operate their own clinical systems to store information about patients, and variation among these makes it difficult to share information and introduce common standards.
The NHITB views regional clinical workstations and clinical data repositories as a good foundation for shared access to health information across DHBs, within regions and throughout New Zealand.
Implementing similar systems will make it easier to share information when someone moves between DHBs for treatment and will reduce training requirements for clinicians who work in different locations as the systems will be familiar.
Having a single instance of the core systems across each region will mean all the DHBs will be on the same version, reducing the cost and effort of upgrades for the DHBs and the system vendors.
A clinical workstation is a secure web-based portal which allows clinicians to view integrated patient information from a number of sources. Clinical data repositories, meanwhile, contain a nationally agreed core set of clinical information, with additional data to be determined by each region.
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In the Northern region all DHBs are using Regional Éclair with primary and community organisations contributing to and accessing the CDR (Testsafe). Each DHB, however, currently has a local version of Concerto. Implementation of a fully regional CWS has been agreed to occur in 2014. |
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MidCentral DHB is live on the first version of the CWS/CDR for the central region. The others are on local versions until they join the regional version in 2013/14 as part of the CRISP programme. |
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In the South Island three DHBs are already on the regional CDR/CWS (Health Connect South) while Nelson Marlborough DHB is likely to be the next DHB to implement. |
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In the Midland Region Lakes DHB is currently leading the implementation of the regional CWS/CDR. Clinicians have identified CWS/CDR as a priority for implementation in the region, although this depends on all DHBs committing to the roll-out. |
Health Information Standards Organisation Committee (HISO)
The HISO Committee records with regret the resignations of:
- Dr Richard Medlicott, the 2012 Chair of HISO, representing the Primary Care Information Management (PCIM) Group
- Kathy Farndon, Manager Health Information Solutions Standards, representing the Ministry of Health
Both are acknowledged for the effort they have contributed to the operation of HISO over the last few years. HISO wishes them well for their future endeavours in the health and disability sector.
Zeeman van der Merwe has been appointed by the NHITB as the HISO Chair for 2013.
In other news, the HISO standard development processes have been revised to make it easier and less daunting for any project that may need to develop NZ specific standards. The updated process maps are now available on the HISO website.
Zeeman van der Merwe
- Accident Compensation Corporation
Zeeman has been involved in the IT industry for 30 years and in health care for 10 years, initially starting in the academic field and later working for private and public organisations in the IT, healthcare and financial services industries. Before moving to New Zealand from South Africa, he was involved in health care insurance and also served on the national committee responsible for Private and Public Healthcare Information Standards in South Africa, known as PHISC.
He is currently the Manager of Information Strategy and Planning at ACC with additional responsibility for information exchange between ACC, government agencies and research organisations. Due to ACC's role, ACC's information is the main source for injury information in NZ. Zeeman currently represents ACC in a number of areas including HISO, the ACC Research Ethics Committee, the Injury Information Senior Officials Group for Statistics NZ and is involved in a number of joint initiatives with the Ministry of Health, and MBIE/Labour.
As a reasonably recent resident in NZ, he has really appreciated the quality of life here and found that New Zealand offers many opportunities. Being involved with a number of government agencies has taught him a lot about New Zealand while allowing him to be able to make a contribution to his new home.
The current HISO work programme is available on the HISO website
HISO standards open for public comment
Two new HISO draft standards have been issued for public comment.
Click here for more
HISO 10043 CDA Common Templates provides the basics on the use of HL7 Clinical Document Architecture (CDA) as a common currency for health information exchange.
HISO 10047 Comprehensive Clinical Assessments for Older People extends the CDA approach to interRAI clinical assessment reports, as a tool for interoperability.
Closing date for comments is 22 May 2013.
We are planning to refresh the IT Health Board website, to give it an improved "look and feel", and we are keen to make it easier to find the information you are looking for.
To help better understand why people visit the IT Health Board website and what the experience is like, we are asking people to complete this survey.
We would appreciate hearing your feedback on your experience. Pass this link on to your colleagues or anyone who may wish to complete the survey.
To complete the survey before Friday 3 May, please click here.
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Patient portal makes life easier for Wellington writer
Wellington crime novelist Blair Polly spends his days immersed in murder and mayhem but when he needs to attend to more mundane things, like renewing a prescription for medicine or asking his GP a question, he turns to technology.
He's one of 380 patients at the Island Bay Medical Centre in Wellington now using an online patient portal to manage aspects of their own health care and communicate with their GPs.
"It's really good," he says. "I'm pretty computer literate so I haven’t had any problems but anyone with average computer skills would be able to use this. If you can navigate around Facebook or Trade Me, you’ll be fine with a patient portal."
GP Richard Medlicott says the medical centre has offered a secure online portal, called ManageMyHealth, to a small group of 170 patients since 2009 and it has proven so successful they’re now making it available to other patients on their books.
The portal helps patients and doctors feel connected, provides a useful service, and saves the practice time (and money) by doing electronically things that would usually require a phone call.
Patients can log in to the portal to view diagnoses, a list of the medicines they're taking, their latest laboratory results, schedule of recalls, immunisations and medical alerts. They can renew prescriptions, make appointments and ask questions electronically of their GP.
Blair Polly, who has Type 2 diabetes, has been using the portal since July 2009, mostly for repeat prescription requests and to communicate directly with his doctor.
"I can just log on, see all of my medications and tick the ones which need renewing, press 'send' and then pick up the script from my doctor’s office," he says. "If I need to ask my GP a question, I can just send a message through the portal instead of having to phone his office, leave a message and wait for him to ring me back. This is a lot easier.”
He gets an alert in his email inbox when a new message has been posted on the system.
"I'll click on a tab and it will open up my lab results and there might be a comment from the doctor that relates to the results."
His message to doctors thinking about developing a patient portal?
"Jump on the train or get left behind," he says. "This is the way things are going and patients increasingly want to harness technology to manage their health information and health care."
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