Sam Jacobs DrInfo LLc (3/11/10, Civic 1, 3.00)

1. Placing the Next Pieces in New Zealand’s EHR Jigsaw PuzzleSam JacobsTom Bowden

2. New Zealand: No national electronic health record system. But one of the world’s most advanced HIT frameworks. Laissez faire approach reconfirmed - 2009 Goal is to develop a patient centred record by 2014. What do we need to do next?

3. Practices with Advanced Electronic Health Information Capacity 3 Percent reporting at least 9 of 14 clinical IT functions* * Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test results, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test results, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests or preventive care. Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

4. Electronic Clinical Transactions (Per Month) National Child Immunisation Register

5. Number of electronic partners (monthly average per general practice) 100% EMR UPTAKE

6. High Road or Low Road? Shared electronic records based on regional models? Decision: Develop an interoperable model An interoperable and connected/ distributed approach is a key priority.

7. Electronic Referrals Development of New Zealand’s Electronic Health Records System 1993-2012 Multiple specialised chronic care services Hospitals Referrals Status Reports Discharge Summaries Specialists ALL HOSPITAL DOCUMENTS On-Line Queries 1100 General Practices Ancillary -Hospital Professionals Practice Support Systems -Specialist -Pharmacy Pharmacies ORDER ENTRY -Pharmacy EMR Access -Laboratory Electronic Messaging Services (50 million messages per annum) Patient Connection to GP -Radiology 4.5 million patients Laboratory Services Any authorized provider may send a structured online query to any EMR system Radiology Services NB: This is still a work in progress…

8. The Next Few Steps? Personal Authentication Electronic prescribing services; Ability to query a GP’s system; Meaningful use of primary care data Modification of the NHI to link a patient’s NHI number with the enrolled GP; Encouraging GPs to use ASP services

9. Provider Authentication immediate, reliable, non-repudiable identification of a healthcare provider is essential. Clinicians move between departments and organisations. Current electronic signatures are generally used at the organisation level. Their use is not well integrated into hospital systems.

10. Electronic prescribing services New Zealand’s pharmacies have been fully automated for even longer than New Zealand’s general practices. Prescriptions still paper-based. Lack of medicines coding. Significant progress is being made in Australia NZ government sponsored ‘Safe Medication Management’project is likely to accelerate this.

11. Real-time enquiries to GP systems The technology is a lot more straight forward than negotiating the manner in which information can be exchanged and upon what basis. GPs must agree the basis upon which information can be divulged. Meaningful use of primary care data

12. Linking the patient’s NHI and registered GP Dependent upon the New Zealand Government. The current NHI system is in the early stages of an upgrade and this is an essential first step. Must enable practices to automatically update it when a patient changes GP.

13. Encouraging General Practices to use ASPs The general practice’s computer system must be able to respond to queries on a highly reliable basis. Systems need to be securely hosted and made accessible on a 24 hour basis.

14. Concluding Comments Some of these tasks are relatively major ones. We must continue to develop our capacity and make incremental progress at every opportunity. Fortunately what we have done has required very little direct investment The remaining tasks will take some focused effort to design develop and implement New Zealand is making good progress with an incremental approach

15. Thank-you Sam@drinfo.co.nztom.bowden@healthlink.net