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Interoperability directions and intiatives for ehealth in New Zealand
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The destination is …
Person-centred, integrated health care
Clinicians, consumers and IT people working in co-production
Providers having the confidence to invest in new solutions
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National priorities 2012-14
eMedicines programme Pharmacy clinical integration eMR, ePA NZULM, NZ Formulary
Regional information platforms eReferral and eDS CDRs, CWS, ED solution PACS LIS, pharmacy PAS
National solutions Cancer information Cardiac health Comprehensive clinical assessment Health identity platform FMIS, procurement, supply chain
Clinical integration LTC shared care Maternity and well child Patient portal View of primary health info Urgent and unplanned care
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Realising the 2014 vision
Offered by IFHCs Personal health info Appointments Repeat prescriptions Email consultations
Common regional CWS and CDR
Accessible both hospital and community
Inter-regional view
Patients with LTCs and high needs
Multidisciplinary input
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Repository-based information sharing
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GP2GP
Currently about 4000 medical records transfers per month
About 50% of GPs are users
Files over 5 MB have to be sent the old fashioned way (a future upgrade will allow files to be sent in pieces)
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The solution space
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Connected care
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Pharmacy clinical integration
eRx via NZePSeReferral via (eg) ERMS
Pharmacy desktop Dispensing system Assessment tool
Shared care system
Assess eligibilityCentrally register
Create medications plan
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SHARED CARE
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Emergency care
Common ED solution based on hospital PAS and CWS
Ambulance sends ePRF (as a kind of referral, but also an event summary) to hospital ED
Ambulance accesses primary care info and previous discharge summaries
Presenting complaint, diagnoses etc are SNOMED coded
eDS shared via R-CDR
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Discharge and follow ups
Discharge Rx via NZePS
eDS shared via R-CDR
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My List of Medicines
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My List of Meds – a repository-based application
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Going for Gold programmeeMR and ePA in all wardsShared medications lists
Transition to eMR and ePA
Standardised paper based eMRand medications charts
eMR system separate to ePA Outdated pharmacy systems Shelves versus drawers versus robots Medical oncology ePA
CHALLENGES
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Medications management
Community
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Hospital
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Paperless hospitals
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Comprehensive clinical assessments
Home care assessment Long term care assessment
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Comprehensive clinical assessments
PDF (current)
CDA + PDFCDA level 3 (Mar 12)
XDS (August 13)
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CRISP (Central DHBs)
Regional PACS archive
Regional CDR
Regional PAS
Regional clinical workstation
Regional ED solution
Regional RIS
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South Island initiatives
eSCRV sources information from GPs, pharmacy, community nursing and hospitals
ERMS is the regional electronic request management system (8,000 referrals per month)
Health Pathways has 400+ treatment plans and pathways (74,000 page views per month)
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South Island SPaCE programme
Support patients and clinicians electronically
Integrate primary care and hospital workflow
Incrementally replace eight systems across five DHBs
Streamline the patient journey
Go well beyond replacing the incumbent systems
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Community lab and radiology test ordering solutions are appearing (with decision support and order tracking functions)
Lab information standards review –
NZPOCS overhaul
HL7 v2.4 messaging implementation
Judicious coding
Message integrity between sender and receiver
Lab test orders and results
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Baltimore Fire 1904 …
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Baltimore FHIR 2012 (HL7 WG)
