Upload
alastair-kenworthy
View
2.483
Download
1
Embed Size (px)
DESCRIPTION
Standards and interoperability towards 2014 and the New Zealand national e-health vision - the not so unexpected journey towards core personal health information being available at all points of care
Citation preview
2
HINZ Nov 2012
Privacy breaches
Disruptive innovation
Fabula, syuzhet, syzygy
2014
trees data as an actorpersonalised medicine
CLAUDIA?
In the news
Novopay a $30m horror show‘… such rush-jobs are all too common … [the government] may be setting the stage for future horrors with its stated policy of getting a national patient-record system in place by 2014’
Sunday Star Times, 25/11/12
4
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
5
This tree represents the solution space
6
National priorities to 2014
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
7
Top priorities for the next twelve months
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
8
GP2GP
50% of GPs are users
5500 transfers alongside 36,000 e-referrals per month
Files over 5 MB have to be sent the old fashioned way
5500 (Nov)
9
The continuum of care
10
Pharmacy clinical integration
eRx via NZePS eReferral via (eg) ERMS
Pharmacy desktop Dispensing system
Assessment tool Shared care system
Assess eligibilityCentrally register
Create medications plan
11
The strategy
SHARED CARE
PHARMACY
SERVICES
AGREEMENT
12
Emergency care
Common ED solution based on hospital PAS and CWS
Ambulance accesses primary care info and any discharge summary
Ambulance shares ePRF (as an event summary, but also a kind of referral) with hospital ED
eDS shared via R-CDR
13
Discharge summary
eDS shared via R-CDR
SNOMED coded presenting complaint, diagnoses, procedures
Continually updated during hospital stay
Discharge Rx via NZePS
14
My List of MedicineseRx
My Listof Meds
eDS shared via R-CDR
15
My List of Medicines
16
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
17
End-to-end medications management
Community
-------------------------
Hospital
18
Paperless hospitals
19
Comprehensive clinical assessments
Home care assessment Long term care assessment
20
Comprehensive clinical assessments
PDF (current)
CDA + PDFCDA level 3 (March 12)
XDS (August 13)
21
Regional information platforms
Regional PACS archive
Regional CWS
Regional CDR
Regional PAS
Regional ED solution
Regional RIS
+
Regional ePharmacy
…
22
Regional CDRs (and national too)
4 DHB regions plus 5th nationally10, 20, … repositories?One registry?
23
Regional CDRs
24
Clinical integration
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)
Shared Care Systems for patients with long term conditions
TestSafe+ eSCRV North?
eSCRV+ TestSafe South
25
SPaCE programme
Supporting 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
26
Community lab and radiology test ordering solutions are appearing (with decision support and order tracking functions)
Laboratory information standards review –
NZPOCS overhaul
HL7 v2.4 messaging implementation
Judicious coding
Message integrity between sender and receiver
Orders and results
27
CDA HL7 v2
28
New standards development …
… An unexpected(-ly long) journey …
2010 Midland ‘core clinical dataset’
GP2GP
HISO 10040 HIEs
HISO 10041 – 2013 Q1/2
29
HISO standards for 2014
30
From: Bob DolinSent: Tuesday, November 29, 2011 12:55 PMTo: Rishel,Wes; Pratt, Douglas (H USA); robert worden; Structured Documents WGSubject: RE: CDA or greenCDA
Hi Wes,
What is CCDA?
Thanks,
Bob
31
Our family of CDA-based standards
32