Keith Newman discovers a digital makeover of health data designed to end eternal form filling and speed delivery of your health information to where it’s most needed.
Hawke’s Bay is heavily involved in a plan to standardise the sharing of medical records between hospital boards, doctors and other health professionals, and enabling patients greater involvement in their own diagnosis, treatment and recovery.
Currently the nation’s health IT systems and data processing networks suffer from clogged arteries, privacy phobias and silo thinking that prevents the timely sharing of patient data across the country.
However, a multimillion dollar shot of adrenaline is being injected into a 15-year-old Ministry of Health plan to shift the focus of the health industry from being provider-centric to patient focused as part of a massive medical makeover.
Health boards, doctors, pharmacists and other specialists are currently working through compatibility and privacy concerns with a view to sharing their patient records, as the country prepares to adopt an integrated electronic health record (IEHR).
This national approach to health data will make smarter use of the National Health Index (NHI), a database giving a unique identifier to everyone using the health and disability system, the Healthzone nationwide ultrafast health network, and secure clinical and patient portals.
Locally the Hawke’s Bay District Health Board (HBDHB) is leading the way in regionalising through integrating its core systems with MidCentral, Wanganui, Hutt Valley, Wairarapa, and Capital and Coast district health boards as part of the Central Region Information Systems Plan (Crisp).
Our DHB is also well advanced in harmonising its Patient Management Systems (PMS), radiology, PACs (Picture Archiving and Communication System), and Clinical Portal, which provides a common front-end view of patient-related data to health professionals.
Single point of access
Information services manager Gina McEwen says Hawke’s Bay is ahead of the game, particularly when it comes to GPs having a single point of access to hospital systems, such as test and radiology results.
McEwen has been with Hawke’s Bay board for 36 years, initially as a nurse before migrating into IT. “I was involved in the first implementation of computers in Hawke’s Bay; in those days you didn’t talk to each other, you were siloed, you did everything within your four walls.”
Clearly her current responsibilities, which include assisting the five central health board systems to become standardised and connected, are a huge contrast to those first stand-alone steps into the digital world.
The emerging system is already reducing the need for duplicating tests and enabling speedier access to radiology images so doctors don’t have to wait for patients to turn up with a CD.
The shift started when Hawke’s Bay’s radiology system changed to enable GPs to collaborate with hospital doctors. “The first day a GP who didn’t agree with the radiology report was able to log on and then discuss an anomaly he had seen with his counterpart in the DHB.”
Doctors and specialists at Hawke’s Bay Hospital can also log into a summary of patient information at the GP level and have successfully trialled electronic referrals so GPs and specialists can directly refer patients for specialist outpatient assessment. This is now being rolled out to all local GP practices.
Patient portal promised
Unifying the various health-related systems is about efficiency, consistency and accuracy so the patient gets the best possible care. “Hopefully it will remove some of the ambiguity, making it clearer and simpler so the patient has a better understanding of what’s going on,” says McEwen.
The patient portal already being trialled in some areas, will be optimised for desktop, laptop, tablet and smartphone use so patients can communicate with their GPs using social media style tools.
After logging on, patients will be able to see their medical conditions, medications, notifications and lab results, request prescription repeats and make doctor’s appointments.
One of the issues will be how much data patients have access to, for example avoiding the use of complex medical terminology so people don’t Google and make assumptions about their diagnosis. “We need to provide the right information so we don’t scare the living daylights out of people.”
One of the challenges is finding the balance between privacy concerns and what is of benefit to the patient. “In one breath patients will say we don’t want our information shared and then come into the emergency department and expect staff to know they were at their GP the day before.”
Upgrading for the upload
Meanwhile the pressure is on to modernise or replace older health board IT systems that may struggle with the flood of new data processing requirements. There are stringent standards-based guidelines to ensure consistency and support for the various integration projects.
In the past, McEwen says some boards didn’t see IT as important, but they must now work with the changes if the needs of the nation are to be met. There’s no point having something that’s incompatible, or is only used by one DHB or set of GPs.
She admits it may take some while to achieve a single patient administration system.
Each health board will continue running some localised systems, but the main shared applications will be run from a regional data centre in Wellington with disaster recovery in Auckland. As part of the transition, Hawke’s Bay will move to a regional service delivery and virtual support model.
The Christchurch earthquakes inadvertently gave the integrated health record project a boost. In September the Canterbury District Health Board (CDHB) introduced a Shared Care Record View (eSCRV) opening up patient records to thousands of community nurses, GPs, pharmacists and hospital clinicians.
“They’ve had significant government investment and resourcing to re-establish good processes rather than putting back the old systems, and have been able to jump the gun in some cases and bring in all the new ways,” says McEwen.
HBDHB already has some community nurses, district nurses and pharmacists accessing its system and along with its central region partners is liaising with Canterbury to share lessons learnt.
Medical modules embraced
A range of medical modules are currently being trailed that can hook directly into the integrated health record including e-medication, e-prescribing, e-dispensing, safe medications and e-discharges.
The New Zealand ePrescription service (NZePS), used at more than 240 sites, has processed over two million prescriptions since it went live in July 2013.
The barcode-based approach improves accuracy and legibility on the 20 million prescriptions written annually, rapidly enabling GPs and pharmacists to determine which of the 60 million medicines have been dispensed or collected.
Hawke’s Bay specialists are helping co-ordinate the move to digitally connected systems, including pharmacies. There’s a close relationship with MidCentral Health which is currently upgrading to the same e-pharmacy technology as Hawke’s Bay which will in effect become the regional system.
It’s all well and good gearing up doctors and pharmacies and specialist services to connect into the hospital systems, but the reality is some of those digital arteries are too thin.
While the Healthzone national fibre optic backbone provides an ultrafast link to the premises of most hospitals and district health board facilities, McEwen admits, “internally most DHBs are challenged.”
Ideally the next generation health system will facilitate tele-health, so city-based specialists can consult with smaller towns and remote areas using remote diagnostic tools, share radiology images and engage in high definition conferencing.
McEwen says Hawke’s Bay Hospital already uses videoconferencing to link emergency department specialists with the new GP-run accident and emergency centre in Wairoa, for example.
“There’s a two and a half hour trip so we often get acute injury or illness cases taking advice so they can decide whether to put the patient on a helicopter or not.”
While high resolution images can be shared in some places, it still depends on the internal infrastructure, which often needs beefing up. “We can get a six lane highway to the door but internally we struggle,” she says.
Warehouse for data
McEwen is responsible for the team managing the Hawke’s Bay data warehouse, where all the patient-related information is stored and analysed for clinical auditing, reporting, trend monitoring and decision support.
“That’s part of our bread and butter … it’s the platform for our business intelligence team to report on the different systems or ‘universes’ such as emergency department, inpatient, outpatient and community.”
The map-based demographic outputs prove compliance with Ministry of Health requirements and ultimately support the level of government funding allocated.
As the various systems are linked together the pool of data will grow exponentially, providing better “cross boundary access” to the big picture of our national health.
“We’ll be able to make comparisons and have an intelligent conversation about why some things are happening in certain places and what, for example, might have caused an outbreak in one area,” says McEwen.
While the idea of a single patient record moving transparently around the country to each point of care, reducing form filling and frustration, can’t come soon enough for some, it’ll most likely unfold in increments slowed by competing priorities, budgets, bureaucracy and ongoing privacy concerns.