Tuesday, October 27, 2015

What Is Happening In New Zealand Looks Very Interesting. I Hope They Are Careful As It Looks Complicated.

These two articles appeared last week.

E-health records in Government's sights again after 2014 target missed

Health Minister Jonathan Coleman says information technology has a 'crucial role' in making the health system more 'sustainable'.
Electronic health records are back on the Government's agenda after it missed a target of introducing them by 2014.
A government source said without electronic health records, patients could not assume healthcare providers would always have access to key clinical information about them, such as whether they were allergic to a common drug such as penicillin.
Health Minister Jonathan Coleman told a conference in Christchurch that the Government had commissioned consultants Deloitte to undertake a study into the benefits of electronic health records.
He said they would create efficiencies by "joining" up patient information held by hospitals and other healthcare providers.
Electronic health records had been the cornerstone of a National Health IT Plan agreed by the Government in 2010.
The goal then was that all Kiwis would be able to access an online record by 2014 that would contain a summary of their GP visits, specialist and hospital treatment, test results and prescriptions.
However, National Health IT Board chairman Murray Milner admitted in December 2013 that the health sector would struggle to achieve the deadline.  
Coleman did not set out a new timetable for electronic health records in his speech to the Health Informatics conference in Christchurch.
However, he said the Government wanted to establish a "blueprint for a digital hospital" by November 2016, "where all patient information is linked up into a standard electronic medical record" and can be accessed from anywhere in the hospital.
Iain McCrae, chief executive of Orion Health, New Zealand's largest health software firm, was not able to speculate on why the 2014 target had been missed, but said electronic health records were key to the future delivery of healthcare.
More here:
There is also coverage here:

NZ announces plan for single national e-health record

Thursday, October 22, 2015 - 14:21
The New Zealand government has announced plans to build a single, national electronic health record (EHR) able to be accessed via portals and apps running on a variety of devices.
Minister of Health Dr Jonathan Coleman said a report on the benefits of an electronic health records had been commissioned from consulting firm Deloitte which found that there is growing international support for adopting a “Hybrid/Best of Suite strategy for Electronic Health Records, where a ‘single’ EHR is introduced to join up information held in a smaller number of Electronic Medical Record systems.”
The Deloitte report will be published shortly on the Ministry of Health website
In a speech to the Health Informatics New Zealand Conference held in Christchurch this week, Coleman said “As I travelled around meeting clinical leaders, patients and IT providers it became clear that our eHealth system was complicated, fragmented and not as user friendly as it could be.
More here:
Here is a link to the full speech.

Health Informatics New Zealand Conference, Christchurch

Hon Dr Jonathan Coleman
Minister of Health
20 October 2015
Health Informatics New Zealand Conference, Christchurch
Thank you for inviting me here today to open the 2015 Health Informatics New Zealand conference – the most important fixture on the health IT calendar.
It’s great to be in the South Island – the first time in 14 years the conference has been held here.
I’d like to acknowledge Liz Schoff, HiNZ chair, and David Meates, chief executive of Canterbury DHB.
Attending the HINZ conference in Auckland last year was one of my first speeches as a Minister of Health. I am pleased to be part of your conference again this year. You have chosen a highly relevant and important theme - Collaborate: Share. Solve. Achieve. Measure.
The full speech is here:
Here is the report:

Independent Review of New Zealand's Electronic Health Record Strategy

Published online: 
21 October 2015


The Minister of Health has requested an independent report on the benefits of a single electronic health record in New Zealand.
There are five key findings in the report.
  • Quality and productivity benefits are available by rationalising the systems used by secondary care facilities (eg, hospitals).
  • Creating a ‘single’ electronic health record that physically consolidates health information in one place will improve decision support and care coordination especially for complex patients with multiple long-term conditions.
  • Primary care needs to be connected real-time with the ‘single’ electronic health record.
  • Implement closed loop medicine management, as this is the area that offers the highest benefits in terms of patient safety and quality.
  • Develop consumer portal access to improve the ability to serve up information from a physical repository in real-time, through digital channels to consumers. Consumer engagement around their health and wellness is key to implementing a preventive or primary care-led strategy.
The Minister referred to this report during the Health Informatics New Zealand conference in Christchurch on 20 October 2015, where he announced a new health IT programme for 2015-2020.
Here is the link:
This report needs close reading and I look forward to comments:
I note the examples of success used are Kaiser Permanente, Denmark, Singapore and British Columbia. Australia is not even mentioned in passing - and neither is the PCEHR which clearly is not anywhere close to what is being discussed in the Deloitte Report. The five bullets above make that clear - and also note just where the consumer fits. This is a system for carers not for consumers as far as I can tell.
Must read stuff and I look forward to comments.


Bernard Robertson-Dunn said...

Here's a sixth bullet point they could have added if they weren't so one-eyed:

Creating a ‘single’ electronic health record that physically consolidates health information in one place will potentially give rise to data overload among health professionals unless careful categorization of data is performed and sophisticated search tools implemented. It will also create major privacy problems unless strict controls are implemented at the content level such that health professionals can only access data relevant to their area of concern. Making it accessible from the internet will make it highly attractive to cyber terrorists and those intent on committing fraud and identity theft.

Apart from those little downsides, everything should be fine and dandy.

Dr Ian Colclough said...

To my mind this lies at the heart of the eHealth conundrum - ie: "Implement closed loop medicine management, as this is the area that offers the highest benefits in terms of patient safety and quality."

The Government started out with MediConnect years ago because it was considered that if medicines management could be deployed successfully major gains would be realised all round. But the Department lost its way with MediConnect and with HealthConnect and the projects fell into disrepute and were discontinued leading to the formation of NEHTA which also lost its way.

Despite these failures at enormous cost to the taxpayer this fundamental message relating to medicines management was reinforced by the Deloitte National eHealth Strategy. Yet the Department would not heed Deloitte's advice; and neither would NEHTA.

The argument continues to be equally valid today and the Kiwis have put is so well:- "Implement closed loop medicine management, as this is the area that offers the highest benefits in terms of patient safety and quality." Achieve that pivotal goal and extended eHealth deployment in primary care will gain real traction nationwide.

Andrew McIntyre said...

There are significant issues consolidating records. One of the ideas that HL7V3 was built on was that "Everything is an observation" meaning that there is no truth, only opinion. While I agree with that what happened with V3 went significantly astray. I think this is now a generally accepted observation by most, but not all people.

What I call "Looks cyanosed" is not what someone else calls "cyanosed" and even things like DOB as recorded wrongly somewhere. The opinion of the narrow specialist may differ from the GP or another specialist and these opinions can vary hour to hour.

So consolidating a record is hard. The GP needs to keep his own record with his level of detail and the super specialist want a record with a lot of detail about a tiny part of the patient, with less detail about other areas.

This is why point to point messaging of other peoples view of the patient, sent to the relevant recipients is a much better model than the idea of one true record, as there is no one true record, just a view of the patient from a particular people perspective. They may differ and both be correct. The view that a eg Podiatrist needs to treat the patient does not need every detail about their psychiatric history or STD treatments.

Trying to consolidate the one true view is fraught with difficulty which is why the PCEHR is so flawed, its ideal for no one and most likely full of potential contradictions. There is no one truth, just snapshot observations based on a view of the truth. Individuals need to formulate their own truths based on their own observations and the opinions of others. It will be a long time for computers can do this well. We need to be able to communicate health information quickly, reliably and with the appropriate level of details. One size does not fit all. The privacy implications alone are significant. I guess however people seem comfortable with huge government snooping on everything else so maybe they don't care about their most intimate medical problems, but I think they should! I don't think your chemist needs access to your gynae/urology notes and at the moment the access controls of a central repository are a nightmare that is insolvable in our lifetime. I am keen to opt out as soon as I can!

Anonymous said...

It's good to see some smart experts making comments with their names attached rater than anonymously. Oh, that others would be prepared to do the same. The Department and NEHTA have truly stuffed everything up so it would be invaluable if others would 'come out' and let their view be known.

Bernard Robertson-Dunn said...

If anyone has seen this article:
E-health saving lives in Queensland: CSIRO

You would have read this claim:

"Australia's e-health record system has brought down the rate of mortality in Queensland, according to the CEO of CSIRO."

The only problem is it's a total fabrication.

I checked with the CSIRO and they said:

"we haven’t used any information from the PCEHR to date nor looked at the impact of the PCEHR on mortality in Queensland."


"While we have had some projects where we have used MBS and PBS data to look at the outcomes of an intervention, we haven’t used any information from the PCEHR."

It will be interesting to see if the government tries to make use of this rather misleading report and if the CSIRO issues a correction.