The eHealth Update April/May 2016 issue is now available.
In this issue:
- Chief Officer’s editorial
- Clinician’s corner
- Design workshop further progresses a consumer-centric EHR
- Canterbury DHB tests NZULM–Medchart integration
- All systems go for SNOMED CT Expo
- Feature: Ohope Beach Medical Centre’s two-pronged approach to promote patient portals
- HISO Updates
If you have any suggestions for topics you’d like covered in this newsletter, email us at Enquiries@ithealthboard.health.nz
My first few weeks with the Ministry have been spent understanding the role and significance of technology in delivering better health outcomes.
I’m very excited for this opportunity to work in such a complex sector. I believe that not having a health or technology background lets me look at things with a fresh pair of eyes, as we set out to bring significant technology-enabled changes to the health system.
We launched the New Zealand Health Strategy during the health symposium on 18 April, which was attended by around 250 national and international health leaders. The strategy sets the direction that New Zealand’s health and disability system needs to take in the future. Its key themes – people-powered, closer to home, value and high performance, one team and a smart system – have been confirmed following extensive consultation with the public and the health sector. This is our opportunity to develop a more integrated, cohesive and adaptable health and disability system, better able to meet the health needs of New Zealanders into the future.
The updated health strategy sets out a clear path to develop a smart system where data and smart information systems can support evidence-based decisions on treatments, options and interventions. Developing and implementing fit-for-purpose technology and information systems is pivotal to the success of the strategy’s five themes. The health sector will need to be adaptable in the coming years as developing technology changes how services can be delivered, in ways we do not yet understand.
Over the last six years, the National Health IT Board (NHITB) has delivered a number of initiatives such as regional systems, eMedicines, electronic prescribing in hospitals and community pharmacies, patient portals, and electronic referrals. These enable system efficiencies and more effective use of resources and are firm foundations for future innovations in the use of technology in health.
As you may know, the NHITB is now an advisory group reporting to the Director General of Health Chai Chuah. Chai has been considering the advice, function and leadership of the Board as we go forward. As technology and consumer expectations increasingly converge, we need to ensure the Ministry is best placed to meet changing needs and emerging technology. The achievements of the Board put us in a strong position from which to continue. I would like to thank the Board members for its efforts and contributions.
The current Board held its final handover meeting on 20 April 2016. New governance arrangements and terms of reference are being considered and will be finalised by 30 June 2016. In the meantime, I encourage our stakeholders to continue working with your contacts from the Ministry’s Technology and Digital Services team in the usual way.
As the Ministry heads in a new direction, it’s important for us to continue working closely with the sector to deliver a smarter, consumer-centric health system. I look forward to further engaging with our partners and stakeholders as we start our new journey.
About Giles Southwell
Giles Southwell has joined the Ministry of Health as the Acting Chief Officer, Technology and Digital Services. He has been seconded to the role from Inland Revenue, where he was acting as the Chief Technology Officer and has been the Chief Financial Officer since 2012.
Originally from the United Kingdom, Giles has worked across the public sector since the early 90s, in roles that have focused on improving business performance and value for money, identifying service improvements, and delivering effective corporate governance and assurance. He moved to New Zealand in 2008 to work for the Office of the Auditor-General where he was responsible for leading their work on improving service performance information.
Giles was educated at the University of Bradford where he achieved first class honours in Managerial Sciences and is a member of the Chartered Institute of Public Finance and Accountancy, Chartered Accountants Australia & New Zealand, and a Fellow of CPA Australia.
Change and continuity are key themes of our work to date.
Our work to deliver the Health IT Programme 2020 continues with the design workshop held in late March. Around 60 clinicians, district health board (DHB) IT professionals, vendors and consumers gathered for the 2-day workshop to further flesh out the single electronic health record's (EHR) key components.
There was significant support from sector stakeholders for the direction we’re taking towards an EHR. We will soon publish the workshop's conversation tracker on this website. This will feed into the Cabinet paper for the EHR currently being developed.
The consumer voice resonated strongly during the recent Health Symposium hosted by the Ministry. Among several powerful consumer presentations, Janet Peter’s ‘People-powered services’ stood out for me. Janet drew from her experience as a registered psychologist working with mental health patients and cited adverse childhood experiences (ACEs) such as physical or sexual abuse as having the potential to result in health and social problems in adulthood. She emphasised the importance of having ‘patients as part of the health workforce’, working with them to understand their issues in their context and not just engaging with them as passive recipients of health care.
Focus on innovation and emerging technologies
The health symposium also highlighted the need for clinicians to consider emerging technologies and innovation as core components of an evolving landscape. Key speakers talked about the practical value that nanotechnology, genomics and robotics can offer to complement clinical treatment.
Dr Catherine Mohr, vice president of Strategy, Intuitive Surgical USA, presented on the importance of science, innovation and maximising technology, and emphasised how minimally invasive surgery can be more cost-effective, less debilitating and enable faster return to work. Once data proves the benefits and safety of these new approaches, we need to adopt them rather than wait for more complex research.
Dr Michelle Dickinson, senior lecturer University of Auckland, spoke about how nanotechnology is already touching our lives in various ways. More collaborative conversations with the clinical community can, over time, position nanotechnology to add value to clinical practice and support more targeted therapies especially in the area of oncology.
At the recent New Zealand Health Information Technology (NZHIT) networking event in Auckland, Director General of Health Chai Chuah spoke about how these advances in technology are already happening, and we may miss out on their potential benefits if relevant conversations don’t happen now. The DG cited two megatrends that will disrupt the norm: the rise of consumerism and the pace, scale and convergence of knowledge and technology. He spoke about ensuring that as we focus on delivering core infrastructure, we need to also embrace the momentum of rapidly evolving technology while being fully aware of health's complex operating environment.
NHITB advisory groups
As you know, the NHITB is currently transitioning into a new structure to align with recent developments within the Ministry (such as the updated health strategy) and to better respond to emerging technology. As new governance options are being considered, the role of the NHITB advisory groups will also be considered as part of the review. This will be finalised by 30 June 2016.
In the meantime, the advisory groups will continue to focus on key activity and deliverables, and support current business processes.
Steady progress with eHealth initiatives
It’s great to see the steady progress of eHealth initiatives already in place. Patient portals continue to gather pace with over 110,000 registered users and 271 general practices now offering the service. We expect uptake to continue this year, driven by the second phase of our awareness campaign, our eHealth ambassadors and the development of more guidance to support practice uptake.
Three foundational eHealth initiatives have hit significant milestones recently. The GP2GP patient file transfer system, used by about 95 percent of practices in New Zealand, has reached one million messages transferred since it was launched in 2011. The uptake of eReferrals has also increased, averaging around 60,000 each month nationally. A recent milestone on NZULM-Medchart integration is also welcome news for eMedicines.
When it comes to designing the single electronic health record (EHR), the consumer is key.
This summarises the proceedings of the second design workshop for the EHR, which was held on 22–23 March 2016.
A bigger group of clinicians, DHB IT professionals, health IT vendors and consumers joined Acting Chief Technology and Digital Services Officer Giles Southwell, Graeme Osborne who hosted the event, NHITB Chair Dr Murray Milner, eHealth Clinical Lead Dr Sadhana Maraj and Ministry of Health representatives in further refining the EHR design.
Canterbury DHB has successfully tested the integration of the New Zealand Universal List of Medicines (NZULM) with MedChart, an electronic prescribing and administration system for hospitals. This was a joint project undertaken by CDHB with the Ministry, NZULM and CSC teams.
This significant milestone paves the way for an integrated electronic medicines management system within secondary care across New Zealand. It will allow ‘best of breed’ systems to be integrated using a national standard set of medicines terms.
NZULM directly supports the objectives of closed loop medication management, electronic medical records and the concept of ‘My List of Medicines’ within an electronic health record.
NZULM is a trusted, up-to-date source of medicines information, designed to promote the safe use of medicines across the health system. It provides a series of standardised medicine terms designed specifically to meet the needs of groups of practitioners. These include charting terms for use in hospital, prescribing terms for use in general practice and label terms for use on medicine packaging.
Preparations are well underway for the SNOMED CT Expo on 27–28 October 2016, to be held at the Museum of New Zealand Te Papa Tongarewa in Wellington.
The Ministry is hosting the event to showcase SNOMED CT use in New Zealand as part of its active promotion and adoption of SNOMED CT as the clinical terminology standard for the single electronic health record and its broader use in the New Zealand health and disability sector.
The event is expected to attract around 300 representatives from the 28 member countries of the International Health Terminology Standards Development Organisation (IHTSDO), which produces SNOMED CT. Health Minister Hon Dr Jonathan Coleman will be delivering the keynote speech for the event, while Associate Health Minister Hon Peter Dunne will host a welcome reception at the Beehive.
Registrations for the SNOMED CT Expo are now open to everyone, and vendors are invited to participate as sponsors or exhibitors. There is also a call for papers to be presented during the event.
For health and health IT professionals, this is the perfect chance to learn more about SNOMED CT as a tool for trusted, actionable health information, and share experiences with peers and experts from around the world. The conference will include special interest group meetings and presentations on SNOMED CT for medicines and medical devices, adverse reactions, emergency care, cancer treatment, and dentistry and nursing, among other topics.
For vendors, the expo is a great opportunity to target international organisations with an interest in health IT, with a potential to reach overseas markets. For more information about the expo, check out the SNOMED CT Expo website.
Ohope Beach Medical Centre’s two-pronged approach to promote patient portals
Ohope Beach Medical Centre is a great supporter of patient portals. So far, around 250 of their patients have registered, with nearly 230 actively using the portal. With 2500 patients, there’s a way to go, but it’s a very positive start.
Office administrator Lisa White says the key to portal uptake is having a two-pronged approach – very proactive GPs to encourage patients to sign up, and having an iPad at reception so they can register there and then.
‘It really helps to have enthusiastic doctors,’ she says. ‘They are very keen for people to use the portal, they do the big push. So, for example, if the doctor is talking to a patient about getting their bloods done, they say how much more quickly they will be able to see their results if they register for the portal.’
Updated NZPOCS result codes in effect from 1 July 2016
In April 2015, the Ministry published a major update to the New Zealand Pathology Observation Code Set (NZPOCS) standard that covers all publicly funded laboratory tests. NZPOCS will be an important standard for the single EHR to ensure lab results are recorded consistently and comparably. DHBs and their lab providers are working to ensure that all lab test results are identified and trended over time using the updated code set from 1 July 2016. The Ministry is monitoring and reporting on DHBs’ adoption of the standard.
Public consultation on a set of codes for ordering groups and panels of tests closed at the end of February. Submissions are being evaluated and a finalised code set will be published on the HISO website by the end of May. DHBs and labs are expected to comply with this part of the NZPOCS standard from 1 July 2017.
Using SNOMED CT to order lab tests will be consulted on later this year as a promising further extension to the standard.
Updated Health Information Security Framework
In December 2015 the Ministry published a major update to the Health Information Security Framework (HISO 10029:2015). The framework is a toolkit enabling health providers to create and implement security policies, procedures and systems that are matched to security risk assessments and consistent with New Zealand Government security standards.
The Ministry is working with DHBs to ensure security risk assessments are performed regularly and will be monitoring compliance with the standard from 1 July 2016.
SNOMED CT for injury claims and medical certificates
The Ministry is working with ACC and the Ministry of Social Development to enable DHBs and primary care networks who are implementing new information systems to use SNOMED CT with personal injury claims and work capacity medical certificates. Using terms from SNOMED CT to describe medical conditions, functional problems and impact on life is a smarter system and people-powered initiative for connected health and social services.
Agencies are adapting their information systems to a timetable that will allow health providers to begin submitting SNOMED CT coded forms from early 2017. The outdated Read code system will continue to be supported until 2018 and then phased out.