Thursday, November 10, 2011

An Update On The Progress of E-Health in The Shaky Isles. There Seems To Be Some Action!

A day or so ago the following press release piqued my interest in what was going on in NZ.

Important changes to accessing to personal medical records

West Coast DHB Friday 04 November 2011, 9:48AM
Media release from West Coast DHB
A new way of managing personal medical records is being introduced on the West Coast, and residents are encouraged to actively 'opt-in' to the system.
The Share for Care system is being introduced this month by Healthy West Coast. It is a way to safely share a summary of a person's General Practice based electronic health information with other health care providers on the West Coast.
Share for Care allows health workers approved access to necessary information. This will improve the care people receive across the health care system, for example at the pharmacy or at the hospital's Emergency Department.
David Meates, West Coast DHB Chief Executive, says while it is important medical records are protected for privacy reasons, medical staff also need to be able to quickly access information to ensure effective provision of the best patient care.
"Share for Care does this. Although, to ensure the system works, people have to sign a form to opt-in to the process. There is a choice to opt-out but that also requires a form to be signed," Mr Meates says.
'Opt-in' forms can be completed and returned to a person's general practice.
People who want to be excluded from the system also need to complete the appropriate form and return it to their general practice before November 30 to ensure their records will not be available to anyone other than the health provider who holds them (such as their GP).
If neither an opt-in nor an opt-out form is completed, health records will be available only in an emergency outside the general practice.
Mr Meates says a secure system is in place to ensure records are protected from being casually or inappropriately accessed and more personal information, such as notes made by a doctor or practice nurse, are not included in the information shared.
"This is a logical move to getting patient records more effectively stored for quick efficient access by those people providing health care," Mr Meates says
"We are urging people to take a quick moment to fill in the opt-in form so there is smooth access to their records when needed."
Mr Meates says the Healthy West Coast hopes to eventually expand the system to allow patients to be able to access their own medical records online.
• Opt-in and opt-out forms are available at all pharmacies, general practices, medical centres, DHB facilities and the West Coast Messenger or can be downloaded online at , or
• More information is also available from general practices and pharmacies
The release is found here:
This prompted me to ask my mate Tom Bowden for a quick update on the state of play over there.
Here is what I received (published with permission):
New Zealand’s health sector has decided it is time to take further steps to use IT to improve healthcare delivery. After several years with 100% of GPs using electronic medical records (since 2000) and being rated as one of the world’s most joined up health sectors (the average GP communicates electronically with 58 other parties, we are top of the Commonwealth Fund comparisons), the race is now on to make a patient’s records available to all providers involved in a patient’s care. 
Rather than develop a national strategy, build an architecture over several years and work through a Gordian knot of standards, funding arrangements and competing interests, the dwellers of the shaky isles have quietly pushed out their canoes and started paddling fiercely toward the far horizon (hoping they have their charts the right way up).  As of today, at least three politely competitive initiatives are trying to establish their bona fides in this space.  While some may take the view that contesting the exact approach to take is inappropriate, I believe that experimentation goes hand in hand with innovation and that by trying different health records paradigms we will learn from each others’ efforts and eventually settle upon a good approach, ideally it will be open, standards based and be replicable in a range of settings.
Following Hillary Clinton’s advice to “never waste a good crisis”, the good citizens of Christchurch decided to use the Canterbury earthquakes as an opportunity to try and create a universal patient health record in their region, ably assisted by local PCEHR expert Orion Health.  Armed with a toll free opt out number the eSCRV (electronic Summary Care Record View) burst into life a week ago, as a limited trial, ready to discover the myths and realities of an ‘opt out’ shared health record system.
See news item
Meanwhile, across the Southern Alps another breed of New Zealander, the rugged individualists of the West Coast region decided that a slightly more conservative approach was needed and with an opt in system (except in emergencies) this system is now in place also.  Both the Canterbury and West Coast systems involve aggregation of data into a shared record which is made available as needed.
See details here
Further north, in the Nelson and Napier regions, healthcare providers are experimenting with a third approach, in this one, no records are aggregated, they are dynamically accessed from general practices and pharmacies, at the point of emergency care, with the patient’s consent, on an as needed basis.  This system has been in place since March and its use is growing steadily.
See details
Further north again, the Auckland region is going live with an online referral system that will see all hospital referrals electronic, using online forms and a web services interface by March 2012.  This is one of the most advanced online referrals initiatives anywhere.  A large scale collaboration taking over two years to come to fruition, it is a very comprehensive approach to the transfer of care between primary and secondary care providers.
See details
A key point is that none  of this locally driven innovation requires any central government involvement except to keep an eye on use of standards (which we all view as most important).  Each of these projects involves extensive collaboration between local health authorities and vendors.
We are pretty busy right now with all of this but will be happy to let you know which of these new HIT paradigms are working best over the next 12- 24 months.  It is an exciting time to be involved in New Zealand healthcare IT.
Kind regards,
Disclosure of Interest:  Tom Bowden is CEO of HealthLink, the company that provides the CareInsight service used in the Nelson and Hawkes Bay regions and the CareConnect eReferrals system.
Many thanks Tom for the summary!
The number of lessons that flow from this are really legion. Among the most obvious are the totally ‘bottom-up’ driven approach, the use of a single common standardised communications infrastructure, an approach based on a small start and grow from there and so it goes on.
There is no doubt NEHTA and DoHA need to keep these basic initially provider centric approaches in mind as the over complex PCEHR totters off its pedestal. The Opposition could also look closely to this as a rather more vendor friendly approach to making some real progress in e-Health.

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