Wednesday, March 19, 2014

New Zealand Seems To Be Rushing Forward With E-Health. A Much Cheaper And I Suspect Better Approach Than Australia And The PCEHR.

This very interesting article appeared a few days ago.

Health software puts patient in charge

Updated at 11:27 am on 16 March 2014
Karen Brown.
An online revolution is the biggest change for family doctors' practices in decades and it has big potential benefits for the public.
E-health through so-called patient portals will provide online access to personal health information, similar to online banking. The system enables patients to renew prescriptions, receive lab-test results online, book appointments and possibly even see doctor's comments written following consultations.
Wellington man Blair Polly was one of the first to trial ManageMyHealth through his GP, Richard Medlicott, and is a convert.
Patient portals are a key part of a raft of electronic health initiatives being promoted by the Government as the way of the future in health; it wants 90 percent of general practitioners' (GPs) patients to have access to the technology by the end of 2014.
Experience overseas has shown people love having easy access to health records, and the clinicians and others here say such systems will empower patients.
The patient portals use technology similar to that used in internet banking to provide secure access by patients to health summary information.
Mr Polly started using the portal several years ago, at about the time he was diagnosed with type two diabetes. He was seeing Dr Medlicott on a regular basis and keen to get the condition under control.
He gets an email from Dr Medlicott when a new lab result has come through, and he goes online to see what it is and read the comments the doctor has about the result. He also renews his prescriptions online and emails Dr Medlicott at Island Bay Medical Centre whenever he has a question.

Easy to use

The system is surprisingly easy to use, Mr Polly says.
"I've said to other people that if you can jump onto TradeMe or if you can use Facebook or anything like that, it's certainly no more difficult than those sorts of things and it just opens up the lines of communications between myself and my doctor."
Mr Polly he feels he's being more proactive about his health, and says it's convenient because he can do things online when he thinks of it or has time, without interrupting his doctor in any way.
He's looking forward to the day all his health records are online and easily accessed, no matter where he may be in the country -- something the health system is still working towards.
Mr Polly says it may also be saving him money; in the past he would have booked an appointment to see his GP over a possible problem but now he'll send a short email and often get an answer which resolves the query.
Listen to more on Insight ( 27 min 51 sec )
Lots more here:
Here we go with a properly considered system in NZ doing the things that people want and need, and improving interaction with their clinicians, via a sensibly considered patient portal.
The patient gets simple access to help, advice and information and the clinician retains their position as a trusted source of health information for the patient -as well as having just a single point of patient records.
That 750 patients of 850 offered the service took the offer up speaks volumes to me!
I bet this cost 1/10 of what Australia has paid for a much less useful system.
David.

7 comments:

Bernard Robertson-Dunn said...

a) there is no indication that the NZ system includes a patient's health record - "He's looking forward to the day all his health records are online ..."

b) it's a "start small, learn from experience, modify as required and grow gradually" approach.

Both of these make it very different from Australia's approach.

I don't think NZ is rushing anywhere, but I do think they have a better and less riskier strategy than we do.

Anonymous said...

The Australian market is much more fragmented than the NZ market, making the approach required different.

Oliver Frank said...

Sounds good. How does the GP get paid for his or her time spent communicating in this way with the patient?

Terry Hannan said...

INCREMENTALITY as Bernard indicates is one of the "commandments" for success in implementation and has been known for years. Also the lack of "rushing" in NZ should be a lesson for the PCEHR "pushers". This is not only from the technical perspectives but also the "socio-technical" perspectives. They are trying to change the clinical professions, in particular doctors, who are inherently resistant to change (See L. Leape, "Five Years After To Err is Human. What have we learned?"
To Anonymous "fragmentation" in Australia means we retain a broken and unfixable system.

K said...

+1 to Terry, but why is the kind of fragmentation they have in NZ different (good) to the kind we have here (bad)?

That's not a rhetorical question, btw. I personally think it's because they don't have states and federal systems working against each other, but they do have area health boards that don't do what the government wants... so why is it different?


Terry Hannan said...

To "K". I did not actually say that NZ fragmentation was good. ANY fragmentation is bad. From my understanding at least NZ appear to be trying to put the fragmented jigsaw together (from when I was there in 2012). These communications also remind me of a dialogue in Newswekk between two of the most eminent people on health quality-Edward Deming and Brent James.
Dialogue between Dr Brent James and Dr Edward Deming over a Newsweek article on quality control showing a man next to a mound of spark plugs.
Dr J. “The mound of spark plugs was higher than the man.”
(all failed spark plugs were discarded after each one was inspected)
Dr D. “What does this mean to you?”
Dr J. “The concept was absolutely clear.
If you bought a spark plug from this company, you got a high quality spark plug as each was individually inspected. It would not fail in my car.”
Dr D. “Who pays for the spark plugs in the pile?
You know it takes as much resource to manufacture a bad spark plug as a good one. So who pays for the ones in the pile?”
The question applies equally to health care.
Who pays for the adverse drug events, or post-operative wound infections?
Who pays for the unnecessary surgeries and wasteful, duplicate tests?
Who pays for the patient who cannot afford health care?
“ We all know the answer. It is every man, woman and child in this nation.”

Deborah Steele said...

NZ has been known for some time to have a pragmatic strategy for electronic patient records through regional clinical data repositories.
http://ehealthspace.org/casestudy/new-zealand-embraces-healthcare-records