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 Reflecting on the first 12 months
We've been up and running for 12 months so it is timely to reflect on what we've achieved in our first year – as well as where we're heading.
I'm no longer being asked "why should we do this", instead it is increasingly "how do we get there?" As you'll see in our profile on Johan Vendrig, others in the sector are also noting this shift in perception.
Introducing new ways of operating and new systems takes hard work and perserverance. A recent example is the commitment shown by those involved in the project with the Central Region CEOs and Boards to approve their long-term Regional IT Plan. This project represents a joint investment over four years.
It's really exciting to see the sector embracing the eHealth vision and experiencing the sense of purpose this generates. This momentum is spurred on by the progress we're making and the projects being delivered. The following projects are good examples: GP2GP, South Canterbury's new clinical information system, the New Zealand Universal List of Medicines and medicine reconciliation.
GP2GP is a new electronic service, which 65 GP practices are using already. Over the next 12 months, all GPs will be able to make this service available to patients who are moving location.
The last 12 months has also seen the first example of two DHBs in a region choosing to share the same clinical information system in their hospitals. South Canterbury DHB has chosen to join up with Canterbury DHB so clinicians in both regions can view patient information through a single, secure web-based system.
The health sector also now has an up-to-date, trusted, one-stop-shop of core and commonly used information about medicines, with the recent general release of the New Zealand Universal List of Medicines. The list, known as the NZULM, is a dictionary of medicines that contains non-clinical terms. Having a consistent dictionary of terms prevents potentially harmful mix-ups. There's an article further on in this newsletter if you'd like to know more.
These success stories give a small insight into our achievements over the last 12 months and it has been a privilege to work with the sector on these projects.
We've had great feedback about the case studies in our recent eBooklet, so please take a look if you haven't already.
As we look ahead, one of this year's priorities is in the shared care space. There's a lot happening and we've got an article in this issue with more detail. A trial of a national shared care solution for long-term conditions went live in early August in the greater Auckland area and saw 28 plans created in the first two weeks. The maternity shared record of care trial will be operational later in 2011.
We have released a Shared Care Paper: Enabling Integrated Health Care.The paper aims to further explain the initiative, identify issues inherent in developing a shared care programme and define a set of principles that provide a framework for shared care.
The New Zealand Institute of Economic Research is also preparing a report for the National Health IT Board on the costs and benefits of a shared care approach. I'll let you know more about these papers in the next newsletter, in which I will also discuss the importance of 'beneficial owners'. Graeme Osborne
Director
National Health IT Board
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healthAlliance has 560 staff in eight locations. It serves 36 percent of New Zealand's population. It provides services to 26,000 customers.
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Bringing together the systems underpinning the four Northern District Health Boards is all in a day's work for healthAlliance's new General Manager of Information Services, Johan Vendrig.
healthAlliance aims to reduce duplication and increase the efficiency of support services across Auckland, Counties Manukau, Waitemata and Northland DHBs through alignment and sharing of processes and systems.
"The opportunities around regionalisation are rapidly emerging and very exciting."
Johan took up his new position in May and was previously Chief Information Officer at Auckland DHB.
"I'm finding the new role challenging and very interesting. It's a shame you have to start with a restructure but it is exciting to be near the end of it and have assembled our team."
Johan sees bringing people together, especially clinical leaders across the northern region, as a key part of his role.
He says messages about the importance of regional collaboration, consolidation and common platforms are getting out there and the questions he is being asked are shifting.
"A few years ago people were asking why on earth would you want to line up DHB systems, now it's 'how do we get there'. It's exciting, challenging and sometimes scary but there's really good support from the clinical teams."
Shared care is at the heart of this new integrated approach, says Johan.
"It is challenging because it will drive a lot more integration of information systems across the sector than we've ever had before. The new approach also brings up funding and clinical process issues.
The shared care pilots currently underway are taking small steps towards getting it right, and the support is there – the demand for shared care projects from clinical teams is increasing rapidly, with a number of opportunities waiting in the wings."
Over the next year, Johan has a long list of other DHB priorities, including joining up Northland DHB with the region's clinical workstations and TestSafe data repository, standardisation of patient administration systems and rolling out eReferrals. All these projects securely share clinical information across the region and bring enormous benefits for patient care. At the same time business support processes and systems are being aligned, including the finance, rostering and Enterprise Content Management systems.
"With all these projects on the go, blocking out time to relax is essential," says Johan. He winds down by mountain biking, hiking and fishing and is looking forward to a trip to Nepal in October.
Read more about the shared care pilots, later in this newsletter.
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The National Health IT Board has decided to turn over the 'too hard' basket, empty its contents and formulate a comprehensive process for addressing health information questions and issues.
For some time progress on using health information to improve quality of care has been hampered by a reluctance or inability to tackle some of the information usage and sharing issues faced by the sector. This has led to inefficiency, fragmentation, duplication of effort, wasted resources, increased risk and indecision and delay.
The National Health IT Board has therefore asked for further work to be undertaken by the Information Strategy Group of the National Health Board to develop:
This framework is proposed to address issues of policy, standards and strategy; data quality; privacy and compliance; architecture and integration; and business alignment.
Examples of these issues include:
• How do we adequately inform individuals about the purpose/s for collecting health information?
• Is it appropriate for health information to be hosted or held outside of New Zealand? Is an opt-on or opt-off model most appropriate for an electronic health record?
Wide stakeholder engagement is proposed throughout the development and implementation of these initiatives.
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The health sector now has an up-to-date, trusted, one-stop-shop of core and commonly used information about medicines thanks to the recent general release of the New Zealand Universal List of Medicines (NZULM).
The NZULM is a dictionary of medicines that uses a standard terminology to describe each medicine and provides information about packaging, manufacturers and subsidies. It is a central building block for supporting New Zealand Community ePrescribing.
Doctors and pharmacists were operating off different lists of medicines which meant the right subsidised medicine was not always prescribed. Varying descriptions of the same medicine can cause a situation where the patient suffers harm, and lead to problems across all care situations.
The NZULM is the first of several phases building up to the New Zealand Medicines Formulary, a more complete information system that will include clinical information about medicines.
This first general release of the information covers medicines used in primary and secondary care and will be updated and released monthly.
Users will usually access the NZULM information through their business or clinical software. They can also use the NZULM website at www.nzulm.org.nz to obtain NZULM information directly.
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For the health information technology community, the Health Informatics New Zealand (HINZ) conference has been an annual highlight for almost a decade and this year's event promises to keep up the tradition.
The 10th Annual Health Informatics Conference & Exhibition is being held in Auckland's Aotea Centre from Wednesday 23 to Friday 25 November 2011 and will be bigger and brighter than ever, say organisers.
International keynote speakers include Dr David Blumenthal, until recently President Obama's National Coordinator for health IT, and Andrew Howard, the Australian National e-Health Transition Agency's Chief Architect.
Health Minister Tony Ryall is opening the conference, while National Health IT Board Director Graeme Osborne is outlining how the eHealth Strategy supports integrated care.
As usual, the conference is experimenting with new ideas. Last year's National Health IT Board-sponsored 'Clinicians' Challenge' was so popular that a new twist is being added – sending the winner to an overseas destination to see innovation in action!
Clinicians enter the challenge by outlining a problem they face in their day-to-day practice that the innovative use of information technology could help solve. A winner is chosen from the three best entries. Health IT vendors are then asked to come up with a solution to the top Clinicians' Challenge and the winning vendor response will be announced at the conference.
This year's conference theme is Working together... working smarter. Collaboration remains a major focus of HINZ, from interoperability to multidisciplinary teams and partnerships between DHBs, vendors and primary care organisations. Working smarter is about doing more with less and also about getting the maximum value from information, particularly when it comes to improving the quality of care.
For more information about the conference see www.hinz.org.nz.
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The three Auckland region District Health Boards (DHBs) are testing new ways of managing the care of people with long-term health conditions. Three pilots involving selected GP clinics, community pharmacies and hospitals across Auckland, Counties Manukau and Waitemata have been launched.
The pilots are part of a National Shared Care Plan Programme sponsored by the National Health IT Board, and the three DHBs.
Long-term conditions include cardiovascular disease, cancer, diabetes, respiratory disorders, chronic pain, depression and arthritis. People with long-term conditions use about 70 percent of the health care spend.
The pilots involve eight GP practices in greater Auckland, several hospital speciality services – including heart failure, gout and acute intervention respiratory services (AIRS), pharmacies and community care services. They are being managed by HealthAlliance and funded by the National Health IT Board.
People with long-term conditions will have a shared care plan, which includes a summary of personal health information, their health goals, and the treatment and follow up care they receive. They can access the plan electronically, as can the doctors, nurses and other health professionals caring for them.
Evaluation of the pilots will focus on whether shared care will be supported and used by clinicians and health care consumers, whether the technology needed for shared care works, whether shared care makes a difference, and how it can be extended in a cost-effective way.
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HISO (2010) UPDATE
The Health Information Standards Organisation (2010) (HISO) is an advisory group to the National Health IT Board. HISO (2010) advises on the development and implementation of health information standards across the health and disability sector.
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 New chair for HISO (2010)
Dr Richard Medlicott, a practicing GP and partner in Wellington's Island Bay Medical Centre, has been appointed as chair of HISO (2010).
Richard has a longstanding interest in health information and has represented the Primary Care Information Management Group (PCIM) on HISO (2010) since January 2010. He has also been on expert advisory committees which developed standards under the
previous iteration of HISO (2010).
Richard is chair of the PCIM and Compass Health Information Management group. He is also a member of the International Health Terminology Standards Development Organisation, of which New Zealand is a founding member, and the Medtech Advisory Group.
In his spare time he can be found playing his guitar or, if the snow allows, up on Ruapehu finding the best lines with his daughters not far behind.
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In a move in line with international trends, HISO (2010) has endorsed the GS1 standards for automated product identification for all pharmaceutical products and supplies. This includes data carriers (barcodes etc) and the GTIN product identifier and associated data definitions. We will undertake further consultation around the application and the timing of the application of GS1.
Worldwide, about 90 percent of pharmaceuticals have a GTIN – a unique identification number that is assigned to an item. Many New Zealand manufacturers are already barcoding products with a GTIN. So far more than 145 countries have adopted or are committed to adopting GS1 standards.
Before considering full endorsement, HISO (2010) supports further consultation with relevant bodies and stakeholders about GS1 standards as the automated product identification for all medical devices and equipment.
HISO (2010) also supports the use of GS1 in a National Product Catalogue, subject to appropriate consultation and agreement with relevant bodies and stakeholders. HISO's future involvement in developing the catalogue will be agreed at a later date.
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A Radio New Zealand documentary about the possible shape of New Zealand's health services in future decades featured our own National Health IT Board Director Graeme Osborne.
Health Correspondent Karen Brown spoke to those planning for the future about new technologies, and developments in information technology.
Graeme Osborne outlined how the eHealth vision of an electronic health record for every New Zealander by 2014 will help revolutionise the way care is provided.
The future is about using information technology to support shared care, with patients and clinicians able to access the same information and work to the same plan, he said.
"It will be a combination of systems that work in a very smart way to link together and provide a comprehensive record."
Graeme Osborne also described the benefits of electronic prescribing, electronic file transfers between GPs, and the TestSafe system for laboratory results and detailed the progress already made.
The documentary was broadcast on the 21 August Insight programme and is available here.
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The National Institute for Health Innovation (NIHI) recently released a report evaluating the eReferrals systems introduced at three District Health Boards.
As part of a long-term plan to replace paper records and improve the flow and safety of health information, New Zealand is moving towards electronic referrals (eReferrals) between GPs and hospitals.
The evaluation report provides findings and valuable insights about projects in Hutt, Northland and Canterbury, with brief findings on the early stages of the Auckland metropolitan region's implementation included as an appendix.
All sites found eReferrals offered faster, more reliable and more transparent referrals from community to secondary services.
The report tests a 'health innovation evaluation framework', developed particularly for IT projects that focus on transforming healthcare delivery.
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By Ernie Newman, Chair, National Health IT Board Consumer Panel
Health information is uniquely personal. Privacy and access rules are absolutely essential to public confidence, and the needs of the health consumer must be taken into account at every step along the way. That's why the National Health IT Board has set up a consumer panel to support its work.
The panel comprises about 20 ordinary New Zealanders. They come from a mixture of walks of life, ethnicities, age groups, regions and health status. Some have a background in the health sector as consumer representatives, but all are there to wear their consumer hat and scrutinise project details to make sure every aspect is optimised for the average user.
Panel members meet three or four times a year to compare notes. More importantly, in ones and twos, they go into the many governance groups and project teams. They look at everything from a consumer perspective, and make input constantly.
Currently, members of the panel have been assigned as members of about 10 groups, governing projects as diverse as long-term conditions, health identity, medications management, standards, maternity care, and telehealth. One of the main projects the panel is involved with is the implementation of shared care records for all New Zealanders. They are also attached to umbrella groups such as the national clinical leadership group, and several more localised programmes.
Panel members have no constraints put on them other than integrity and common sense. The Board funds the panel's costs, but does not influence its day-to-day operations. Panel members communicate frequently among themselves for guidance and support, but are not bound by specific policies. Nonetheless, when members get together, a very high degree of alignment emerges on the key issues.
The panel is not the final word on consumer issues. As the programme matures there will be many other opportunities for input through various channels. Its role is to be part of the projects from the outset so that, as people learn more about the various projects, they will be agreeably surprised about how consumer-focused and friendly the projects are.
Members of the panel change from time to time, and expressions of interest in becoming a panel member are always welcome. Any ideas should be sent to the chair of the panel, Ernie Newman ernie@ernienewman.com.
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Clinician's Corner
 Dr Sadhana Maraj
A new forum has been set up to promote the use of telehealth – or health care at a distance – and maximise the benefits of the Government's broadband programme.
The National Health IT Board funded the establishment of the New Zealand Telehealth Forum as telehealth is such an important part of an integrated model of health care and a powerful enabler of change in health care delivery.
Telehealth is the term used when patients and care providers are not in the same physical location but health care is delivered using information and communication technologies.
Telehealth enables health professionals to diagnose illnesses and provide treatment without being in the room with the patient. Health care-related education, research and evaluation can also take place remotely. Telehealth enables exciting changes in clinical practice.
The fastest growing area of telehealth is patients using simple medical devices in their homes to let their care providers know how they are getting on. New smartphone applications are even being used for this! The Ministry of Health's award-winning website The Lowdown – with its interactive journal – is another example of telehealth.
Telehealth provides many benefits:
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better, sooner, more convenient services for New Zealanders |
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more flexibility for the health workforce |
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ability to personalise public health messages |
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provision of lower-cost services. |
Telehealth is particularly relevant in areas that have greater workforce shortages and limited specialty services.
Dr Michael Sullivan, a Paediatric Oncologist and Telehealth Clinical Leader for Canterbury and West Coast DHBs says equity of access is a cornerstone of our health system but increased specialisation in health care delivery has brought challenges for rural and smaller regional centres.
The National Health IT Board is keen to promote the two key functions of the telehealth forum to:
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be an integral coordination and facilitation centre of current successful telehealth activity |
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actively seek out telehealth solutions to address challenges in the NZ healthcare sector. |
Focus areas for the telehealth forum over the next two years include:
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managing the challenges of service provision for smaller hospitals |
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promoting in-home monitoring |
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enabling improved video conferencing and supporting multi disciplinary meetings. |
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A group of sector architects has been working on a Healthbase Interoperability Reference Architecture to help define a common set of data and interfaces to be used by the sector when exchanging health information.
The data flows necessary for the implementation of the IT Plan need new levels of interoperability. These documents, developed by the Sector Architecture Group's Interoperability sub-group, outline how this interoperability could be achieved in the future.
These documents are now available for public comment.
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