- One GP interviewed during the HPI requirements analysis has 14 identifiers that he requires to manage his practice. These include multiple ACC, HealthPAC and laboratory identifiers. He also has a New Zealand Medical Council identifier, IPA numbers, identifiers for screening programmes, and a maternity agreement number. This creates an administrative overhead, which is exacerbated when locums are used. The Health Practitioner Index will allow for each provider to have one unique identifying number for many types of transactions.
- During the requirements analysis phase of the HPI project, a DHB medical consultant was identified with 30 different identifiers used for managing results on the DHB laboratory results system. Whilst the majority of these identifiers were used for administrative purposes, the practitioner needed three different identifiers to log on to the computer to obtain the results for his patients. This impacts on clinical efficiency and creates administrative costs, which could be minimised through the implementation of the HPI. There are also issues associated with other clinicians or locums viewing results when clinicians are on leave.
- Clinicians in many organisations require multiple logons into various systems and are unable to move transparently from one system to another. This constrains access to information, and requires clinicians to spend valuable clinical time moving between systems. The HPI will provide a directory service that will in the future enable requirements for multiple system logons to be minimised.
- A laboratory interviewed during the requirements analysis phase of the HPI project required information from four separate sources to compile their practitioner database. This effort is duplicated by a large number of sector organisations. The HPI will provide a single point of access to all sources of practitioner information thereby minimising duplication of effort and minimising risks in management of this information.
- One shared service organisation estimates that the HPI will result in cost saving of between $250,000 and $400,000 as a result of not having to develop a directory for its own purposes.
Supporting electronic prescriptions
- The HPI will support future initiatives such as electronic prescribing. As clinicians make greater use of electronic systems, issues such as difficulty reading doctors’ handwriting on prescriptions will potentially be a thing of the past. The Health Practitioner Index will enable medical practitioners to send prescriptions electronically to the pharmacist of the patient’s choice. Many providers and pharmacists already operate in this way. The beauty of the HPI is that it will allow this to happen on a national scale, with (for example) a doctor in Northland prescribing medication through a pharmacist in Wellington.
- It is critical for applications such as electronic prescribing that the identity of the prescriber and the dispensing pharmacist are known and that the transaction can be confirmed (or not denied). The HPI will enable such transactions to be performed, ensuring that the identity of the prescriber and dispenser are known, and that they are suitably qualified professionals.
Checking credentials for access
- A GP is seeing a patient who has recently come out of hospital. The GP needs more specific information about the treatment in hospital, and medications prescribed in hospital and by other practitioners. So the GP, who also occasionally works at the local DHB, logs into the DHB system. The DHB system authenticates the GP against the HPI and also checks its own access control system — and determines that this GP may have access to selected data about the patient. The GP then wishes to refer the patient to a local specialist and forward associated notes. The GP queries the HPI to locate the details for the specialist on the HPI and sends a secure referral message.
- A general practitioner in Auckland needs to send a referral, including highly confidential patient information, to a consultant in Dunedin. The HPI could create an environment that allowed only that consultant to access the information, and the consultant could be assured that the information did in fact come from the GP.
- A physiotherapist in Timaru is treating a new patient and needs to access a discharge summary and digital radiology image held on the Capital and Coast DHB clinical information system. The HPI will ensure that when the physiotherapist goes to access the information, the system can confirm that the user is a registered physiotherapist, and can then allow appropriate access to the information.
- Human resources staff at a DHB can use the HPI to immediately confirm that a group of new healthcare professionals are all bona fide registered practitioners, with current practising certificates. The HPI will be the one national up-to-date repository of trusted information about registered practitioners.
- A practitioner who has been de-registered but continues to practise tries to use their HPI identifier to log on to the system to find out information about a patient. The de-registered practitioner’s credentials are automatically checked through the HPI when they try to log on and they are denied access to the information, thus protecting patient safety and privacy.