I.T Health Board Newsletter

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April 2012

I know you are well aware of the vision for eHealth in New Zealand.

But have you ever looked ahead to 2014 and wondered what this ‘core set of personal health information available electronically’ might actually look like on screen? Or what it might be called? Or how it could improve your health and well being? We've been busy thinking about all these things.

The National Health IT Board, and our clinicians, reached the conclusion in 2010 that the term 'electronic health records' is not a helpful description. If you think about it, an electronic health record sounds like something an IT professional is going to provide you with – something that just ‘turns up’.

As well, an electronic health record (if you've ever seen one) is not particularly interesting. You look at the screen and see an historical view of your data. The really exciting part is how you can use your data – and that's where we're heading with integrated care. We want something that uses the power of the internet – with great security and privacy settings – which shows how your care team is working with you and your family to get the best outcome. What we want is a plan with an outcome statement that is person-centred, and we want to be able to measure the delivery of the outcome against the plan. Shared care plans are more than just historical data sets, they are an active process of creating health outcomes.

Something else I’ve been thinking about is the vital importance of standards. In this issue of the newsletter there is a focus on the HISO standards activity underway. Kathy Farndon provides updates on a number of standards, and we also take a look at the benefits of developing standards.

On a more personal note, I'm pleased to have been appointed as the Director, Information Group in the Ministry of Health's National Health Board Business Unit, after acting in the role since October last year. My new role blends significant internal responsibilities for the Ministry's IT systems with my previous external focus as Director of the National Health IT Board. I believe the synergy this generates will benefit both the Ministry and sector. We'll be setting a common direction through an IT Implementation Plan for the Ministry of Health, in the context of the National Health IT Plan, that tightly integrates with the objectives of the Ministry and the sector.

Graeme Osborne
Director
National Health IT Board

Clinician’s Corner –
Sadhana Maraj

Telehealth is an important component of the integrated care model and a key enabler of self-care and self-management models. It was therefore exciting to see the first meeting of the Telehealth Leadership Group take place recently.

The Telehealth Leadership Group is a clinically led group that includes consumers, policy makers, planning and funding managers, information technology experts and some industry suppliers, who will together deliver the forum’s work programme.

Key functions of the group include driving increased awareness of telehealth initiatives currently occurring and promoting adoption and investment in initiatives that are demonstrating improved integrated care and showing benefits realised as a result of telehealth.

Telehealth is a priority for the National Health IT Board and is a powerful enabler of the Ministry’s clinical integration programme of work. Ways telehealth supports clinical integration include:

•	supporting the effective delivery of services through Integrated Family Health Centres
•	promoting improved care in the community and preventing acute (unplanned) admissions to hospital
•	supporting aged care services and the care of the elderly in their homes
•	supporting newer service delivery models for care of people with long term conditions.

Opportunities to use telehealth will be further enhanced by the introduction of ultrafast broadband and rural broadband.

For telehealth to lead to successes and demonstrate benefits, its value needs to be considered in any new service delivery model being planned.

A stocktake of New Zealand’s telehealth activity has been completed. It confirmed the innovative but fragmented nature of current delivery. Within the next few weeks, the Telehealth Leadership Group will have a confirmed action plan for the next 12 to 18 months to kick-start this area on a broader base.

We need health care organisations and vendors to engage and support the Telehealth Forum as it develops its value proposition and operating model.

I look forward to sharing our progress in telehealth with you in future issues of this newsletter.

In this issue...

Graeme Osborne

The New Zealand Formulary

Clinician’s Corner – Sadhana Maraj

Shared care workshops

Profile - Vicky Noble

Health Identity Programme update

Hospitals Go for Gold

Going for Gold in Taranaki

New Transfer of Care standards being developed

HISO UPDATE

The benefits of developing HISO standards

METeOR update

PRIMHD review update

The New Zealand Formulary

The New Zealand Formulary is on track for release in July.

The formulary is a resource for healthcare professionals prescribing, dispensing and administering medicines across primary and secondary care, says Shayne Hunter.

“It addresses their need for general purpose, point of care information about the use of medicines in New Zealand. It will aid in decision making and contribute to best practice in medicines through standardised and evidence-based information about medicines.” An online interactions checker is an early deliverable for the formulary. For a sneak preview, visit: www.nzformulary.org

Content is based on the British National Formulary and the British National Formulary for Children but adapted for the New Zealand context. A team of clinical pharmacists and clinical advisors review and adapt the content before it is signed off by an editorial advisory board.

Over time, the formulary will be fully integrated into the ehealth environment including prescribing and dispensing systems across primary and secondary care.

"The formulary’s supplier, the New Zealand Medicines Formulary Limited Partnership, is committed to working closely with vendors to help them through the integration process," says Shayne Hunter.

Shared care workshops

A series of public workshops is planned for later this year, to further raise awareness about shared health information, and help people understand the benefits of this approach. They are a follow up to community workshops held in 2010 to introduce the concept of shared health care.

Further information on the 2012 workshops will be available soon on the National Health IT Board website.

Health Identity Programme update

The latest version of the Health Identity Programme's Bulletin is available now.

It includes:

a brief overview from Tony Cooke, HIP Governance Board chair
the Address Service Web trial at Hokianga Health
progress on replacing the Health Practitioner Index.

Vicky Noble

A passion for information technology as a tool for quality improvement was what spurred leading nurse Vicky Noble to join the National Information Clinical Leadership Group (NICLG).

"I've had a long-standing interest in IT as it relates to quality improvement. My nursing career has taken me in some very varied directions and over time I've increasingly understood the power of data and its ability to help you make really good assessments.

"IT is also an incredible enabler as we move into the next phase of health care service delivery. It's an area of huge change and it’s great to be in touch with it."

As Capital & Coast DHB's Director of Nursing, Primary Health Care & Integrated Care, Vicky Noble supports services that cross and are within primary and secondary care. She sees both nurses and better IT systems bridging gaps in the system.

"Nurses are the glue in the health system. It is nurses who help join the dots for people who are trying to find their way through a complex system and they have the time to help people navigate, especially people with very complex conditions.

“In this role, I'm also made really aware of how IT connectivity can help and support clinicians and patients and be a real time-saver."

When you’re making clinical decisions at the interface, having access to a really good history is critical, she says. Clinicians in an acute situation in ED, with a person who is confused or traumatised, have no way of knowing the patient’s primary care history. "They can order needless investigations or prescribe medication without knowing the full picture.”

At Capital & Coast DHB they've had some success with integration, she says, with a number of shared roles across services.

"There's also a lot of interest in technology that can support better understanding of patients and their history, and the potential of shared care records. It has been very exciting to hear about the work in Auckland with people with long-term conditions, and in Canterbury, particularly after the earthquake."

A challenge she faces, along with other NICLG members, is taking the message back to her constituency groups and peers.

"How do I keep my fellow professionals in touch? National IT development will deliver great benefits – the system will be much more effective, much safer and more efficient. But it's very hard to share some of the learnings and experience – it's a challenge."

Like many successful people, Vicky has also struggled with that elusive work-life balance. "I've found that I'm most relaxed when I'm creating something or doing something and I love cooking. I have a garden that I try to keep really beautiful and I also read, watch movies and spend time with family."

For more about NICLG, see the group's April Update.

Hospitals Go for Gold

It’s not just New Zealand Olympians who are going for gold this year – district health boards are also aiming for the top when it comes to medication management.

The new Go for Gold programme encourages DHBs to achieve ‘gold’ level medication management by the end of 2014 and hopes to have 100 percent of public hospitals participating in the electronic medicines management programme from 2012.

Medication errors and adverse drug events affect an unacceptable number of New Zealanders each year, with some resulting in permanent disabilities or death.

“Our programme is introducing electronic systems to support the safe, effective and appropriate use of medicines,” says eMedicines Programme Lead Shayne Hunter. The programme is jointly sponsored by the Health Quality & Safety Commission, and the National Health Board/ National Health IT Board.

A gold-level hospital would have electronic prescribing and administration (ePA) and electronic medicines reconciliation (eMR). To support change, the eMedicines Programme is undertaking a ‘readiness assessment’ to understand where each DHB is at now and help them plan their implementation.

“We’re rolling out electronic medications management in public hospitals in four phases and we’re just getting phase two underway. It’s going really well and I’d like to thank all the DHBs taking part for their enthusiasm and commitment,” says Shayne Hunter.

Electronic prescribing and administration is now in a further sevens wards at Southern DHB and will go live in three wards at Taranaki DHB and two wards at Waitemata DHB later this year. eMR has been expanded at Counties Manukau, Waitemata and Taranaki DHBs and is expected to go live in Auckland DHB and one other DHB later this year.

Meanwhile, work to support the national rollout of the New Zealand Electronic Prescription Service (NZePS) continues. NZePS lets GPs send prescriptions to community pharmacies electronically. In future, prescriptions given to people discharged from hospital or who attended a hospital outpatient clinic will also be sent via the service.

Going for Gold in Taranaki

An eMedicines project in Taranaki DHBis rewarding top performing staff with ‘gold’ coffee cups.

Electronic medicines reconciliation has been underway on Taranaki Base Hospital’s Ward Five since July 2011.

Before the electronic system was introduced, only 46 percent of medication differences were reconciled. By January this year, 94 percent were reconciled – “a massive achievement,” says Taranaki DHB’s Director of Medication Management Elizabeth Plant.

“After ironing out a few bugs and training issues, we were extremely pleased to report that doctors met three of the four targets for the first time in January.”

Taranaki DHB Going for Gold coffee cups were given to staff who did exceptionally well in helping meet the targets and the DHB will continue to present two awards monthly.

From left to right: Wendy Clarke,
Anna Mearns and Tim Cutfield
standing with the Medicines
Reconciliation target graphs and
holding their coffee cups.

What is electronic medicines reconciliation?

eMR captures a patient’s medication history from three or more sources, then matches it to their medicines on admission and electronically records any differences. Doctors then try to reconcile these differences. When the patient is discharged, the medicines on the admission list are reviewed to include any changes during admission and a summary is sent to the patient’s GP.

New Transfer of Care standards being developed

As technologies keep changing so do the standards required to support them. The Referral, Status and Discharge (RSD) standard is one example of this.

The RSD standard has been implemented in a number of regions, and found to be not quite ‘fit for purpose’. The experiences of the DHBs who have undertaken eReferrals projects have indicated that improvements and updates are required. The standard also needs to align with other developments, such as the endorsement of new clinical guidelines for the transfer of care and new interoperability reference architecture. These requirements will be incorporated into the new Transfer of Care standard, the replacement for the RSD standard.

Traditionally eReferrals are sent from primary to secondary care. The new standard will support the transfer of referrals between all providers. It will also support electronic discharge summaries to display and import data, including the new clinical guidelines endorsed by the National Information Clinical Leadership Group (NICLG), with support from Counties Manukau DHB, and update medication lists.

The Transfer of Care standard is being developed by Patients First, the Sector Architects Group and the Ministry’s Health Information Solutions and Standards team, in line with the HISO process. It is more detailed than the RSD it is replacing and is based on an XML standard using HL7 Clinical Document Architecture (CDA). DHBs wishing to implement eReferrals are advised to wait for the new standard to be developed before doing so. It is recommended that DHBs using the current RSD standard plan to migrate to the new standard in due course. In both cases, it is suggested that close contact with the Standards and Solutions team be maintained.

As part of the HISO process, the Transfer of Care standard will be ready for public comment and feedback in July 2012. It will be released as an interim standard once responses have been reviewed by an independent panel and endorsed by HISO. The HISO process emphasises the importance of vendor neutrality in standards.

The end goal of this standards work is to ensure patients are referred to the right practitioner with the right information at the right time, and receive the right response.

HISO UPDATE

SNOMED-CT Update

The National Health IT Board is working with the Health Quality & Safety Commission on the National Medication Safety Programme, which includes electronic medicines management, such as electronic medicine reconciliation, electronic prescribing and administration and electronic pharmacy systems. The use of SNOMED-CT (standardised medical terminology) is combined with the New Zealand Universal List of Medicines (NZULM), which is embedded in the New Zealand Medicines Formulary (NZMF), to enhance electronic medicine reconciliation.

HISO endorsed the use of SNOMED -CT as the clinical terminology for use in future system developments that involve transmitting health information and this is supported by NICLG. This is particularly relevant for the development of electronic referrals and electronic discharges.

SNOMED-CT has been added as an evaluation criterion for all major business cases for health IT systems.

Pilot development programmes are underway for emergency department systems (the assistance of Leeds NHS Trust Hospital who have developed an emergency department sub-set of diagnoses, is acknowledged) and laboratory systems, particularly in relation to the National Cervical Screening Programme. Early evaluation steps are being undertaken in the adoption of SNOMED-CT into cardiac, renal and dental systems developments.

The benefits of developing HISO standards

Health information standards are developed by experts, with the aim of improving health outcomes and safety through a coordinated, consistent approach.

New Health Information Standards Organisation (HISO) standards setting out how information about cancer should be defined, collected and shared nationwide mean we're one step closer to better data and improved services for people with cancer.

Steve Creed, who is Principal Technical Specialist (Cancer) for the Ministry of Health, says he found developing the core cancer standards through the HISO process more valuable and less onerous than it appeared at first glance.

"We wanted to go through the process as the HISO brand provides valuable recognition and credibility within the sector. HISO administered the process at no cost and this was huge as it allowed us to focus on the clinical side. HISO also added value through having an existing network of sector participants that we could use to establish a data working group."

HISO Senior Advisor Angie Quinn says participants are often surprised at how beneficial and flexible the HISO process is.

"While there are certain steps in the process we have to adhere to, we'll work with you to make it as easy as possible and we'll tailor the process to suit you, if at all possible."

Angie Quinn is keen to emphasise the benefit of involving HISO very early on, as was the case with the core cancer standards.

"Getting in touch with us early helped ensure a proven approach was followed. We provided some existing definitions that other groups had developed, and other work that had already been done, and this saved time and energy."

While the process took about 18 months from start to finish, Steve Creed says this was not too long.

"You need to get to know the sector and establish trust and a genuine relationship, and the process was part of the reason we achieved this. You also need to take enough time to allow the working group to communicate back and forth with the sector."

The core cancer standards allow data to be collected in a consistent way and shared between systems and regions across the country. They are a significant step toward a National View of Cancer, which aims to give those in the sector a one-stop shop for access to information on cancer incidence, treatment and outcomes.

The standards are currently being piloted by the Southern Cancer Network with its new regional clinical cancer data repository – METRIQ. METRIQ captures radiation and medical oncology data from the three South Island cancer centres, including St George’s private hospital.

This is a first for New Zealand and Steve Creed says METRIQ will be watched closely to see whether it is suitable for use in other regions.

METeOR update

HISO has agreed that only core patient/provider demographics will be inputted into METeOR in phase one of the project. METeOR is a meta-data electronic online repository that will be used in many National Health IT Board projects. Focusing on specific data requirements in phase one will enable us to provide better training and back up for other users before national rollout is considered. Phase two will focus on other demographic requirements, and the collation of clinical requirements.

PRIMHD review update

Part two of the Programme for the Integration of Mental Health Data (PRIMHD) review is underway.

A small working group met in March to start developing the requirements that were raised in the PRIMHD Review Recommendation Report published late last year.

Health Information Exchange Architecture Building Blocks update

The Health Information Exchange Architecture Building Blocks suite of documents which have been developed by the Sector Architects Group, were published on the HISO website site in early April.