Fraame Solutions Forum

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Fraame Solutions Forum

• Effective Sharing of Health Information

23/09/08
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AGENDA

• Health Information Strategy New Zealand
• New Zealand Health IT Cluster
• Collaborative project examples.
• E-Labs
• Consumer Health Portal

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Health Information Strategy New Zealand

• Developed in 2005 the strategy identified that
  New Zealand
• Faces significant pressures to provide more and
  better health care delivery. We have
• an ageing population
• rising incidences of chronic diseases
• the re-emergence of some diseases
• the emergence of new infectious diseases
• new technologies and advances in medicine that
  are making more effective treatments available

• Health care spending typically ranges from 7 to
  10 percent of Gross Domestic Product.
• Health Inflation is unsustainable.
• We need to work smarter to better target our
  resources.

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What role does information play?

• To make effective, informed decisions about
  targeting services, we need quality information.
• Information needs to be available at the right
  time and place and in the right format.
• Health services are becoming more team based and
  collaborative across the continuum of care. There
  is an increasing need for providers to share more
  health information safely.
• To enable safe, accurate and timely communication
  of health information, we need standards.
• If we do not share information and collaborate,
  then we risk duplication, wastage and poor
  quality service delivery.

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HIS-NZ Implementation

• (HISAC) is a Ministerial Advisory Committee
  established to provide governance, oversight and
  leadership for the implementation of HIS-NZ
• HIS-NZ has been divided into 12 action zones
• National network strategy
• NHI promotion
• Health Provider Index (HPI) implementation
• ePharmacy
• eLabs
• Hospital discharge summaries
• Chronic care and disease management
• Electronic referrals
• National outpatient collection
• National primary and community care collection
• National system access
• Anchoring Framework.

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New Zealand Health IT Cluster

• The Cluster is an alliance of organisations
  interested in health IT, comprising software and
  solution developers, consultants, health policy
  makers, health funders, infrastructure companies,
  healthcare providers, and academic institutions -
  who have agreed to work collaboratively.
• Our Vision is NZ is a Centre of Excellence for
  Health Technology
• Our Mission is to collaborate to position New
  Zealand as a world leader in the supply and use
  of innovative health technology
• Our Goals include
• To help members grow their business capability
• To foster collaboration
• To catalyse innovation and investment in health
  technology
• To be financially sustainable

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The Role of the Cluster in Projects

• To initiate, govern, and direct the development
  of innovative health solutions consistent with
  HIS-NZ and national strategies
• Secure sources of suitable project funding
• During implementation, The Cluster will act as
  the prime contractor, will produce the
  contractual framework, provide project
  directorship, programme and project management
  resources.

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Cluster Project Principles

• Cluster projects should
• Encompass innovation
• Improve the effectiveness and/or efficiency of
  the healthcare system
• Enhance the value of members businesses
• Align the contribution of participants around a
  common need
• Enable the participation in projects for all
  interested Cluster members
• Address priority sector strategies and change
  programmes
• Deliver innovative proofs of concept
• Reference relevant national and international
  standards
• Promote open solution architecture, with
  relevance to the wider sector
• Protect the IP of members and other confidential
  data
• Inform aligned initiatives (for example, HISNZ
  Action Zone projects) and sector processes (for
  example, HISO Standards development).

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Collaborative Project Examples

• E-Labs Orders and Results
• Consumer Health Portal

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E-Labs Orders and Results Project

• A Midlands Regional Initiative

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E-Labs Project Background

• Cluster labs reports
• Feasibility Study November 2004
• Clinical Data Repository Options report Feb 2006
• Cluster seeks formal HISAC, MOH and DHBNZ support
  and funding
• HISAC agree to champion project.
• MOH and Lakes DHBs agree to sponsor project.
• Additional stakeholders invited to participate.
• Project Kick off meeting 28 June 07

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Project participants

• Ministry of Health
• Health Information Strategy Action Committee
• NZ Health IT Cluster
• Midlands Region DHBs
• Lakes DHB
• Taranaki DHB
• Bay of Plenty DHB
• Rotorua General Practice Group
• Diagnostic MedLabs

• Pathology Associates
• Sysmex
• IntraHealth
• MedTech
• i-Soft
• HIQ
• Gen-i
• Simpl
• University of Auckland
• Sanguine Consultancy
• HealthLink

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Project Deliverables

• The e-labs project has now
• Developed the costed proposal for the
  implementation of the e-labs programme of work.
  This proposal is supported by
• The agreed vision for e-labs orders and results
  processing, order management capabilities and
  storage of test result data,
• A documented statement of the requirements with
  input from the clinical and commercial members of
  the project team and
• The draft logical architecture which is capable
  of supporting several different implementation
  approaches, rather than prescriptively defining
  only one solution option.

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Overview of the Project Principles

• Must enable primary / secondary data sharing
• Capture data once and use many times
• Enable patient choice
• Scalability
• Quality of service
• Access is controlled by a Privacy Authentication
  and Security framework
• Persistence of data.
• Comply with relevant standards

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Proposed Implementation Approach

• There will be one programme of work with four
  concurrent projects each with phases and
  independent benefits that will be measured.
•  The projects are
• Stakeholder Engagement
• Community Laboratory Orders
• Establishes the Clinical Data Repository
  combining Community and Secondary lab results.
• Focussed on GP electronically ordering and
  receiving the results.
• Secondary Laboratory Orders
• Phase 1 will provide access to the CDR followed
  by a requirements gathering phase.
• Community Laboratory Collection Process
  Improvement
• Focussed on driving automation into the
  collection process and integrating it into the
  overall lab order workflow.

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Solution Architecture Overview
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Solution Architecture Features

• Uses Accredited Health Network
• Uses Standards
• Pathology and Radiology messaging
• LOINC 2 Clinical Coding
• NHI HPI
• Authentication and Security Framework.
• Develop new candidate standard for CDR data
  structures
• Architecture is independent of software systems,
  the sector can choose
• Hosting environment for regional CDR/s
• CDR software solutions
• Type of order management capability.

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Stakeholder Engagement Summary

• Stakeholders representing the different end user
  groups will be engaged and their needs and
  expectations identified. These will feed into the
  subsequent software development projects.
• This project will
• Be a first implementation of HISO Authentication
  and Security Framework
• Discuss and agree a patient information model.
• Deliver a stakeholder communication plan covering
  the introduction of the Clinical Data Repository
  and supporting consumer information and briefing
  materials.
• Undertake a review of the engagement processes.

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Laboratory Orders and Results Current State
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Community Lab Orders Summary

• This project will
• Implement the Clinical Data Repository, combining
  community and secondary lab results.
• Develop the capabilities to allow General
  Practitioners to order laboratory tests and
  receive their results electronically, closing the
  loop to identify tests not performed.
• Develop the functionality to assist General
  Practitioners in their laboratory ordering by
  advising them of potentially duplicate orders
• Provide advanced reporting options to assist
  General Practitioners and PHOs to understand
  ordering patterns
• Produce a proposal to implement the clinician
  recommended strategy for introducing decision
  support
• Produce a proposal outlining the preferred long
  term architecture for the regional introduction
  of e-labs.
• Produce a report that evaluates the user
  experiences and quantifies the benefits resulting
  from the introduction of the project.

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After Community Lab Orders
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Community Laboratory Collection Process
Improvement Summary

• This project will introduce process improvements
  and supporting technologies into the laboratory
  collection process.
• This project will deliver
• Computer workflow management system for
  labelling, identifying and tracking individual
  specimens.
• An evaluation report quantifying the benefits
  gained by the project.

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After Community Lab Collection Process Improvement
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Secondary Lab Orders Summary

• This project will
• Place secondary care results into the CDR.
• Functionality to enable secondary care clinicians
  will be able to view results from the CDR
• Scope and document the requirements for the
  implementation of electronic laboratory orders
  and results in a secondary care setting.
• Produce a business case and costed proposal.

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Consumer Health Portal
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Background

• Chronic conditions are the major health burden in
  developed countries. In 1999 CVD accounted for
  41 of Deaths in New Zealand
• The Primary Healthcare Strategy provides a clear
  direction for the future development of primary
  health care.
• The Key Directions project provides the
  information environment for the Primary
  Healthcare Strategy and has identified 5 key
  areas where information should help citizens take
  action to improve their health
• Support for self-care
• Support for tailored care
• Identifying and responding to population health
  needs
• Enabling the co-ordination of care and
  integration of service
• Improving performance and evidence-based
  decisions

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The Consumer Health Portal Project Beginning

• In 2006 The Cluster developed a solution concept
  for a consumer centric personal electronic health
  record.
• This concept focussed on providing information to
  the healthcare consumer in these areas
• Their condition
• Care plan and health goals
• Medication
• Appointments
• Enabling connection with friends and family
• The Cluster sought expressions of interest to
  assemble the project team.

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CHP Proof of Concept Scope

• Working with ProCare (the Customer) the Proof of
  Concept Scope was distilled to include
• A personal health record from the GPs PMS
  system.
• A patient journal
• A user group forum and discussion area
• Access to validated health news
• Integration with health tools to demonstrate
• Integration uses the Health Connection Engine
  (Provided by Simpl)
• Search for health service provider information
  (Provided by Healthpoint)
• Use of decision support and goal setting. (CVD
  risk assessment and Food Habits questionnaire
  provided by Enigma)
• Use of voice calls to compliment internet based
  services. (Provided by Telemessenger)
• The Cluster then sourced funding for the proof of
  concept project. The proof of concept was split
  into 2 iterations.
• Microsoft, FRST funding the initial iteration
• Ministry of Health funded the second iteration

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CHP Components
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Consumer Health Portal Demonstration

• Arnie is a 50 something year old man who was
  recognised as being obese with high cholesterol
  during a GP visit on 1st March 2007. 
• He was treated for his cholesterol, but not his
  raised blood pressure.  Over the next few months,
  his weight and his cholesterol improved, but not
  by enough. 
• In October he had a heart attack.  In November he
  visited his GP again and had a lot of medicines
  added.  At the 3rd Nov visit he had a Predict CVD
  risk assessment done.
• His compliance with his beta blocker was poor and
  he only got one prescription for it, but
  otherwise he continued to get prescriptions for
  the rest of his regime.  He is a smoker with a 20
  cigarettes a day habit and has been for the last
  30 years.

Patient Scenario Arnie Smith
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Registering the patient into the Portal
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Patient Data in the PMS
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Arnie using the Portal
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Medical Records
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Health Tools Search
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Food Habits Questionnaire
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Quit Smoking
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Further Functional Development

• The clinical review of phase 1 prioritises the
  features that need to be developed to transform
  the proof of concept into an operational clinical
  system.

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Thank You