Paul Grundy, MD, MPH
May/2005
Trends in Healthcare for “an” IBM
Business The New Zealand Experience
Health Care and a ROCKET Launches are both just to
COMPLICATED TO MANAGE WITHOUT COMPUTER
ASSISTANCE in the 21st Century .

 As a result of these applications of information technology in
primary care:
immunization rates went from 73.7% to 98.5%.
Control of diabetes improved – for patients with HbA1c higher than 9
pre-enrolment was 64% and this was reduced to 7% post EMR
enrolment
There was an 83% Improvement in lipid control with the elimination of
wait time for statins for diabetes patients.
There was a reduction in acute DM admissions - this was running at 9%
per year in 2000. By 2005, the growth rate was reduced to below 0%
actually declining.

New Zealand Facts
 Used by 92% of all healthcare sector organizations in New
Zealand.
All hospitals, radiology clinics, private laboratories
~1,800 general practices.
> 800 specialists, physiotherapists, other allied health
workers
 Over 3 million messages a month are exchanged,
95% of the communication in the primary health care
sector.

New Zealand Facts
 Over 98% of GP offices are using one of nine Practice
Management Systems
95% use their systems to electronically send and receive
clinical messages such as laboratory results, radiology
results, discharge letters, referrals, delivery of age-sex
registers to their IPA/PHO, etc.
 ~ 99% of GPs now use the Internet on a regular basis from
their offices - including communicating with their patients.

New Zealand Facts (cont’d)
Specialists use of computers range from
70-90% depending on their region.
GPs increasingly favor referring patients to
specialists who are able to send
information back to them electronically.

Driving Forces
The development of IPA’s (Independent
Practitioner Associations) encouraged the uptake
of information technology in primary care in New
Zealand.
IPAs paid the costs for their member GPs to
access the HealthLink network as part of their
membership services.
HealthLink facilitated change by offering an
“electronic claiming only” service for claims
submission free of charge for the first 6 months.

New Zealand’s critical success factors
A national health identifier NHI
Early adoption of HL7
Development and acceptance of the 1993 Privacy
Act and the 1994 Health Information Privacy
Code along with “practical” implementation of
these
Mandatory electronic claiming for GMS
(government subsidies for GP care)
Collaboration with private and public
organizations
Multi-vendor co-operation and understanding
of the business opportunities

NZ critical success factors (cont’d)
 HealthLink employs nurses to act in liaison roles with
General Practice, and so provide direct contact with the GPs.
 HealthLink provides a help desk that has become the GP’s
first point of contact when requesting help with their EMRs
 HealthLink has also stayed very close to the GP system
providers

NZ critical success factors (cont’d)
Healthlink’s strategy has always been to work
very closely with primary care physicians
to stay close to them and provided the
infrastructure to support them.
HealthLink is intricately and comprehensively
tied to the GPs
“like the parmesan in the spaghetti is how one
observer described it”.

NZ critical success factors (cont’d)
 HealthLink spend a lot of effort on demonstrator and beta
testing sites.
 They also work closely with the physician EMR vendors to
debate projects thoroughly at all stages – before during
and after implementation.
 Many of the HealthLink initiatives were a result of
demand of the primary care physicians
e.g. discharge summary from hospitals, radiology test
results (DI), orders (still in progress), delivery of
claiming data – i.e. responding to market needs

An interesting aside
 At one stage the New Zealand Government spent several
millions of dollars on an alternative product “The Health
Intranet of New Zealand”.
 This failed at the point where they tried to connect the
Intranet to General Practice computer systems.
The GPs were very unhappy to let government
representative agents touch their computers – making the
Health Intranet impossible to implement on the ground.
The government agents had no understanding of how
General Practice works

In terms of standards and
infrastructure, New Zealand is ahead and
NZ-HIT has been used as a model for other
countries, including Denmark and
Singapore."

A pediatric cardiology clinic in Auckland NZ supervises babies at
home using ISDN videoconferencing
May 2005
The New Zealand Health Care Experience

GP Uptake of I.T. in New Zealand
0
20
40
60
80
100
1994 1997 2000 2003
Year
PercentageofGPs
GP Computer
Use
EDI Network
Subscriptions
Clinical Use
of Internet

HealthLink increasingly used to assist with chronic disease management

Medical
Claims
Pharmacy
Claims
Lab
Data
Data Warehouse
Chronic
Disease
Registry
Health
Risk
Indicators
Risk Stratification
& Patient Assignment
INTERVENTIONS
CLINIC/”CENTER OF EXCELLENCE” REFERRALS
MAILINGS & PATIENT EDUCATION
HIGH
RISK
LOW &
MED
RISK
Automated Disease Management Model
Chronic Disease Registry
Systematic Evaluation of
“Gaps-In-Care” based
Risk Assessment
Based on:
Utilization
Pharmacy
Lab Scores
All Patient Data Stored on
Same Platform
IDENTIFY & SCREEN
PRIORITIZE & ASSIGN
Automated Disease Management Model

Future State -- The portal is the Key
Workflow Applications
Knowledge Repositories
Information Model
Meta-Knowledge
Repository
Collaborative
Knowledge
Authoring
Tools
Portal
Knowledge-based Services

So Why Aren’t We There Yet?
 IBM has not decided to go for it yet?
 IBM has not figured out to turn it into the business yet?
 IBM has not figured out how to fit the pieces together on the financial side

 SO LETS FIGURE IT OUT TODAY
1) IBM finances the portal, translator and IT service to make it happen where we are
the large employer, have other large employer friends and have plan support.
Create a EMR and PHR portal for providers and patients
2 IBM establishes the standards
3) IBM charges the payers large employers plans CMS and providers for the service.
Give ourselves a 1 year 18 month time line to build at least ten RHIOS and make a
billion or 2.
sell the service to the plans and large employers in the USA and/or to the MOH in
AP and EMEA.
Sell it to the docs all over the world at a per month cable fee of say $500 to $800.