Tuesday, August 30, 2016

New Zealand Seems To Be Moving In An Interesting Way In E-Heath. Not Risk Free!

The following tender appeared a few days ago:

Business Case for the Single Electronic Health Record RFP


RFx ID :                                   17820621
Tender Name :                    Business Case for the Single Electronic Health Record RFP
Reference # :                      
Open Date :                          Tuesday, 23 August 2016 9:00 AM (Pacific/Auckland UTC+12:00)
Close Date :                          Friday, 30 September 2016 12:00 PM (Pacific/Auckland UTC+13:00)
Tender Type :                      Request for Proposals (RFP)
Tender Coverage :             Sole Agency  [?]
  • Categories :        80000000 - Management and Business Professionals and Administrative Services
  • 83000000 - Public Utilities and Public Sector Related Services
  • 85000000 - Healthcare Services
  • Regions:                 New Zealand
Required Pre-qualifications :       None
Contact :                                Matt Price

Here is the link:
The motivation for this tender is found here:

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:
The scope being sought is pretty large:


Strategic environment

Improving how the health and disability sector uses and shares information is one of the practical steps arising from the refreshed New Zealand Health Strategy, and a primary enabler for delivering the Government’s objectives for Social Investment.
The ability to access and communicate accurate patient information delivers on a number of central Government strategies: it enables data to be shared across the frontline and utilised by planners under a social investment approach; it supports Better Public Services objectives to improve interactions with Government; and it contributes to the outcomes sought by the Government ICT strategy.
Importantly, the ability to access and communicate accurate patient information is the practical enabler of large parts of the refreshed New Zealand Health Strategy. Many of the changes to how the system functions requires professionals to have access to reliable information and it is critical to the delivery of each of the Strategy’s five themes:
·         People Powered: access to reliable information enables health consumers to have an active role in managing their health and more convenient engagement with the system;
·         Closer to home: interaction with health professionals relies on remote access to accurate information, for example, video conferencing and remote monitoring;
·         Value and high performance: better clinical decision making and care coordination based on accurate information prevents errors, improves quality and reduces wasted time, leading to higher productivity;
·         One team: a single source of accurate and up to date information enables collaboration between health professionals and prevents a patient having to repeat their ‘story’;
·         Smart system: access to up to date information enables a learning system where insights are identified from the data to improve performance and effectiveness.
This work programme importantly will also contribute to the social investment work that the Ministry is currently undertaking for disability support services, chronic conditions and zero to five year olds. It will enable access to information regarding the outcome of interventions that is held by frontline professionals and not immediately accessible to the centre.

Improving access to Ministry information

The Ministry holds an extensive range of datasets regarding activity in the health sector, registers of key conditions, and surveys. These collections contribute to regular Ministry reporting and are used by a wide range of users, including health sector organisations, social sector agencies, official statistics, clinicians, researchers and universities, patients and the public. Many of  these
data sets are also available in the Integrated Data Infrastructure (IDI), making the Ministry the largest single contributor to that platform.
There is potential to improve health information, by simplifying it and reducing complexity, by adding key datasets (especially clinical information which can be linked to outcomes), and by increasing its timeliness. The Ministry has received requests to make the underlying raw datasets more available to the health sector, such as Primary Healthcare Organisations.
The Ministry is investigating ways we can share health data to enable more open and flexible access, but in a safe way. These include:
·         providing guidance on what heath data is available and how to access it
·         being more proactive in releasing data, and in a way that is accessible for the public
·         collaborating with other agencies to make data sharing easier under privacy regulations
·         making and supporting efforts to integrate and store disparate data sets well to minimise complexity and make it is easier for people to access linked information
·         investigating options for collecting real-time information to supplement or replace current administrative data sources
·         finding out whether our data, information services and associated insights, and the way they are made available, meet patients’, health and social sector providers’ and government needs.

The Digital Health Work Programme 2020

The Digital Health Work Programme 2020 was announced at the Health Informatics conference in Christchurch in October 2015. The programme is fundamentally about ensuring appropriate access to the same health and wellness information by: an individual, their family and/or supporters; clinicians and the wider health workforce (and potentially, social sector professionals); policy analysts, planners and decision-makers.
The focus of this business case process will be on the single-electronic health record component; however, we have provided a full description of the five components that make up the Work Programme for completeness:
·         a single electronic health record that will allow individuals to store their preferences and ‘health story’. It will collect and present existing health information into a single longitudinal view accessible to consumers, carers and decision-makers. It has the future potential to be a store of detailed information to support precision medicine;
·         data to support health investments and the Government’s social investment approach courtesy of the more complete, real-time, record of health status provided by the electronic health record;
·         a digital hospital blueprint that will assist district health boards to lift the digital capability within hospitals and the integration with the wider sector, which will include compliance with common standards needed to feed data into an electronic health record;
·         a national prevention IT platform to consolidate and improve the targeting of screening, immunisation and other public health initiatives;
·         district health boards complete regional IT investments, as a pre-requisite for the electronic health record and digital hospital blueprint.
----- End Extract
Three things strike me about all this:
First the scope of the Digital Plans seems to be pretty impressive and very ambitious.
Second it is really good they are planning to do a Business Case to establish if all these plans are practical and make sense. Developing a national system of this complexity and reach is a genuinely non-trivial task!
Third, given the experience elsewhere, I am not sure just how a successful National Shared EHR can be done! There are dragons there!
I look forward to the outcomes of all this work.

1 comment:

Bernard Robertson-Dunn said...

If this is a national Electronic Medical Record system designed for point-of-care use with some access by patients, then there is a chance that it might work - subject of course to the usual problems of large scale IT system development.

If it's a Patient Health Record (PHR) system, designed to assist patients understand and manage their own health, then it looks like overkill.

BTW, the MyHealthRecord is neither. It is a PHR system with lots of extra, unnecessary, often un-reliable (in the sense it is without context), clinical data that just confuses the patient and duplicates, for no patient benefit, what's in other eMR systems.

It's a classic IT driven example of "let's put more data into this system, it will increase its value. Won't it?"

No, it won't.

This isn't the first time the government has fallen into the trap of expanding scope, expecting more benefits.

Way back in the 1990s someone did a study and came to the conclusion that by consolidating IBM mainframes into fewer data centres, they could save about 25% of costs.

The conclusion may or may not have been correct, but the really stupid thing was what they did next.

They (treasury and political minders - I know who they are 'cos they were the ones who told me the story) decided that not enough money would be saved. So they extended the scope of consolidation to include other mainframes, mid-range, desktop and network environments. More costs, bigger savings.

The problem was that the logic only applied to IBM mainframes of a particular type.

The rest is history. The initiative failed miserably. John Fahey, the Finance Minister, who had drunk the Kool Aid, was hauled over the coals in the Humphry Review and it all died a death, the casualties being Australian taxpayers and the government departments who had lost their corporate IT knowledge to a range of vendors.

This time round, it is still the taxpayers who have suffered, but it is also the Australian Health Sector that has to pay the cost of lost opportunities.

We'll never get back 10 years and $2billion.

I hope New Zealand doesn't fall into the same trap.