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New zealand health information tech

  1. 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 .
  2.  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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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
  8. 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
  9. 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”.
  10. 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
  11. 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
  12. 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."
  13. A pediatric cardiology clinic in Auckland NZ supervises babies at home using ISDN videoconferencing May 2005 The New Zealand Health Care Experience
  14. 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
  15. HealthLink increasingly used to assist with chronic disease management
  16. 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
  17. Future State -- The portal is the Key Workflow Applications Knowledge Repositories Information Model Meta-Knowledge Repository Collaborative Knowledge Authoring Tools Portal Knowledge-based Services
  18. 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.