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This is the prezo I used in Tokyo EHR Seminar
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Better Information, Better CareDirections for Health IT in New Zealand
Koray Atalag MD, PhD, [email protected]
About
National Institute for Health Innovation (NIHI)The University of AucklandPrivate Bag 92019, AucklandNew Zealand
Koray Atalag, MD, PhD, FACHI
Medical Doctor, PhD Information SystemsFellow of Australasian College of Health Informatics
Chair openEHR New ZealandopenEHR Localisation Program LeaderHL7 New Zealand Board MemberHealth Informatics New Zealand Executive MemberISO TC215 Working Group Member
New Zealand Quick Facts
• Population: 4.5million – (~20% Maori & Pacific)– <30 million sheep >60 million cattle!
• GDP (PPP) per Capita: USD 28,800• Good healthcare, low cost• High IT adoption, good integration• Single health identifier ~20 years• National eHealth strategy and plan
– National Health IT Board
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0
1000
2000
3000
4000
5000
6000
7000
8000
9000US ($8,233)
NOR ($5,388)
SWIZ ($5,270)
NETH ($5,056)
DEN ($4,464)
CAN ($4,445)
GER ($4,338)
FR ($3,974)
SWE ($3,758)
AUS ($3,670)*
UK ($3,433)
JPN ($3,035)*
NZ ($3,022)
Source: OECD Health Data 2012.
Average Health Care Spending per Capita, 1980–2010Adjusted for Differences in Cost of Living
4
Dollars ($US)
THECOMMONWEALTH
FUND* 2009
5Pharmaceutical Spending per Capita, 2010Adjusted for Differences in Cost of Living
US CAN GER FR JPN* AUS* SWIZ OECD Median
NETH SWE NOR UK** DEN NZ0
100
200
300
400
500
600
700
800
900
1,000 983
741
640 634 630
541510 508 481 474
395 369331
285
* 2009.** 2008.Source: OECD Health Data 2012.
THECOMMONWEALTH
FUND
Dollars ($US)
Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).
AUS CAN GER NETH NZ UK US
OVERALL RANKING (2010) 3 6 4 1 5 2 7
Quality Care 4 7 5 2 1 3 6
Effective Care 2 7 6 3 5 1 4
Safe Care 6 5 3 1 4 2 7
Coordinated Care 4 5 7 2 1 3 6
Patient-Centered Care 2 5 3 6 1 7 4
Access 6.5 5 3 1 4 2 6.5
Cost-Related Problem 6 3.5 3.5 2 5 1 7
Timeliness of Care 6 7 2 1 3 4 5
Efficiency 2 6 5 3 4 1 7
Equity 4 5 3 1 6 2 7
Long, Healthy, Productive Lives 1 2 3 4 5 6 7
Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290
Country Rankings
1.00–2.33
2.34–4.66
4.67–7.00
Exhibit ES-1. Overall Ranking
7
NETH NOR NZ UK AUS SWE GER US FR CAN SWIZ0
20
40
60
80
100 99 97 97 96 95 94
72
46
68
37
98 98 97 9792
8882
69 67
56
41
2009 2012
Source: 2009 and 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Percent
Doctors’ Use of Electronic Medical Recordsin Their Practice, 2009 and 2012
8
NZ SWE NET SWIZ NOR FRA UK US AUS GER CAN0
20
40
60
80
100
55 52 49 4945
39 3831
2722
14
Percent
Doctor Can Electronically Exchange Patient Summaries and Test Results with Doctors Outside their Practice
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
eHealth VisionTo achieve high quality health care and improve patient safety, by 2014 New Zealanders will have a core set of personal health information available electronically to them and their treatment providers regardless of the setting as they access health services.
Information will be recorded electronically Personal health information will be available, with appropriate access, across providers People will be more involved in the collection and use of their personal health information Providers will have clearly defined roles when collecting, using and sharing health information Optimise resources (time, facilities and equipment) and focus on the quality healthcare.
National Health IT PlanEnabling an Integrated Healthcare Model
National Health IT Board Programmes
eMedications Programme
1. Community E-prescribing Service
2. Inpatient e-prescribing
3. Medicines reconciliation, medication management and administration
4. Universal List of Medicines
5. NZ Formulary
National Systems
1. Health Identity (new NHI)
2. Connected Health Network
3. InterRAI for Aged Care
4. Oncology
5. Cardiology
Regional Information Platform (DHBs)
1. Clinical Data Repositories/ Workstation
2. Patient Administration Systems
3. Imaging/PACS
4. Clinical support – Labs/Pharms
5. Continuum of care: eReferrals/eDischarges
Integrated Care Initiatives
1. Shared Care - Maternity
2. Shared Care - Long-Term Conditions
3. Care/Clinical Pathways
4. Primary Care
5. Well child
National Health Index (NHI)
• Unique health identifier used >20 years• All NZ-born children receive NHI at birth• Information stored centrally:
• name and address• date of birth• sex & ethnicity
• Statistical search algorithms, adaptive• NZ has strict privacy and security laws• System also includes:
– Medical Warning System– Health Provider Index (Organisation, person, facility)
(GP) Practice Management Systems
• 4 major vendors; one >90% market• Very comprehensive EHR, all GPs really use it• Integrated w/ Labs, ePrescribing, Discharges,
secure messaging• Warnings & Reminders, patient recalls• Advanced decision support modules
– PREDICT CVD risk prediction tool ~400,000 pts.– Also provides clinician advice & patient guides
MedTech PMS Screenshots
PREDICT CVD Decision Support System
Hospitals
• Patient Admin Systems; ADT, billing etc.• LIS, RIS, PACS + clinical systems• Clinical Workstation – integrated view
– Orion Health’s Concerto Product– Rhapsody integration engine (Orion)
• Orion is rolling out integrated Hospital Information System in most of NZ– (Orion bought Microsoft’s Amalga HIS)
Clinical Workstation
Shared Care
Shared care is about caring for patients with high needs in collaboration with other healthcare professionals.
Central to shared care is the patient care plan. All team members can access and contribute to the care plan and communicate with each other to provide the best care for the patient.
18
19
Shared Care System (HSA Global CCMS)
Community Pharmacy
Emergency DepartmentsOutpatients
Inpatients
HOME-BASED SERVICES
Patient’s homeGeneral Practice
HML
St John
COMMUNITY SERVICES
Community-based Secondary Services -
Falls prevention
District nursing
Private/ public Allied Health
FAMILY MEMBERS
CENTRAL SERVICES
DHB Planning and Funding LTC Meds Contract Mgrs
Aged Care Providers
Hospice
Palliative care
CCMS Care Planning
20
Seismic Innovation!
• NZULM includes:– approval status and restrictions for use in NZ– subsidy info and any conditions that apply.
• SNOMED based terminology• NZ Formulary
– clinically validated medicines information and guidance on best practice
– Used for decision support
New Zealand Universal List of Medicines (NZULM) and Formulary
HISO 10040 Health Information Exchange
10040.1R-CDRs
XDS
10040.2 CCR
SNOMED CTArchetypes
10040.3Documents
CDA
Usage of the Content Model
Creating CDA Payload
LocalisationContent definition is language independent
Exploiting Content Model for Secondary Use
Single Content Model
CDA
FHIR
HL7 v2/3
EHR Extract
UML
XSD/XMI
Mindmap
PAYLOAD
System A
Data Source A
MapTo
Content Model
System B
Data Source B
Native openEHR Repository
Secondary Use
MapTo
Content Model
Automated Transforms
No Mapping