Health Informatics NZ Conference

Energy Events Centre, Rotorua

E aku rangatira, tēnā koutou katoa. Ka nui te honore ki te mihi ki a koutou.

Thank you Michelle [A’Court] for the warm introduction. It is a great pleasure to be here addressing a group who are absolutely critical to the future provision of more efficient, better and safer health care.

I would like to start by extending a warm welcome to your overseas guests. It’s critical to learn, not only from our own IT challenges and successes, but also from what has worked well in other countries, and what hasn’t worked.

Welcome also to the clinicians and consumers here today. You are the people who use and benefit from the innovative application of information technology in the health and disability sector. It is in everyone’s best interests for your input to be early and often as we design more efficient, better and safer care.

All the work underway endeavours to improve clinical integration and practice, leading to a better experience for the consumer.

Health IT revolution

Health is an area of constant change, but nowhere is that change more evident than in information technology. IT is enabling a revolution to take place in the way health care is delivered.

That change is driven by the electronic sharing of information, to support New Zealanders to get the best possible health care within the best timeframe. Sharing health information between clinicians, consumers and the wider health workforce means they have fuller information available before they make treatment decisions.

It enables us to integrate services across hospitals and the community in ways that put patients' needs at the centre of health care.

It also enables shared care plans to be developed for those New Zealanders who require multidisciplinary care, for example, people who have a long-term condition. These consumers benefit from being involved in the development of a plan specifically for their conditions, in which they can set goals with their providers.

Knowing the right information is available increases everyone’s confidence that the right treatment plans are being put in place.

Benefits of information sharing

We are already seeing many benefits from increased electronic information sharing.

In some regions, emergency department staff have access to parts of GP records – so they can see what medication a person is on, and their medical conditions, before treating them. No more trying to track down information in the middle of the night. No more wondering whether an acutely ill patient can accurately recall their medications, dose and frequency.

There is now a national system in place to transfer patient information electronically when someone switches GPs. No more having to wait for paper records to arrive and then re-enter all the information.

Hospitals in some rural areas can videoconference with specialists in large hospitals, saving patients hours of travel. People can also go home from hospital sooner because they can be supported by a virtual care team or monitored by a specialist via videoconference.

It all sounds straight forward, but as everyone in this room knows, it takes an incredible amount of planning and coordination to put in place systems that enable seamless and safe information sharing to take place.

The eHealth environment is complex, with layers of information systems that need to connect securely. These include systems for managing core health information, shared care plans, patient information in communities and hospitals and an underpinning clinical data repository.

eHealth vision

The National Health IT Plan has a clear vision – by 2014 New Zealanders will have a core set of personal health information available electronically to them and their treatment providers, regardless of where they access health services. The plan is currently being updated and I look forward to the next version, which will focus on the priorities for investment over the next two years.

Before the original Plan was released, in 2010, there were many instances of health IT investment decisions being made locally rather than regionally or nationally; of systems being developed in silos, unable to exchange information with other systems; and of information and learnings not being shared.

The IT Plan gave the sector a focus, and two years on it is pleasing to see a big shift towards national and regional investment decisions and solutions, a bigger focus on supporting integrated care and a focus on a smaller number of key projects.

Recent successes

There have been a number of successes over the past year.

After the February 2011 Canterbury earthquake, InterRAI was invaluable in identifying older people most in need of help, and made their medication information available to the facilities they were transferred to. Today, InterRAI is being used by all DHBs and in an increasing number of aged residential care facilities.

GP2GP, which allows patients’ records to be transferred between GPs, recently clocked up 12,887 patient file transfers. It is being used in 647 practices throughout New Zealand, and this number is growing steadily.

The roll out of electronic prescribing and administration and electronic medicine reconciliation is continuing. Southern and Taranaki DHBs have introduced electronic prescribing and administration in some wards, and Waitemata DHB will be introducing it shortly. Electronic medicine reconciliation is currently carried out at Counties Manukau, Waitemata and Taranaki DHBs.

In Auckland nearly 300 patients with long term conditions have electronic shared care records available to them and their multi-disciplinary care team.
In Christchurch, the electronic shared care record view – born from necessity following the earthquake – has become a key tool for sharing patient information. eSCRV includes a summary of medical conditions, GP visits and list of medications, which can be securely shared between community, pharmacy and hospitals settings.

In July, the New Zealand Formulary was released, meaning there is now a one-stop shop for health professionals looking for high quality and up-to-date information about medicines that are used in New Zealand. The Formulary is fully integrated with the e-health environment, including prescribing and dispensing software.

One major success factor is clinicians, consumers and vendors increasingly working together on projects, and in the development of IT systems. Technology is rapidly changing the way in which clinicians support patients – creating opportunities for greater collaboration to make sure systems are safe and secure and that they fit into clinical practice.

You will see examples of this later, with presentations from the clinician and vendor finalists in the Clinicians’ Challenge. There were an impressive 55 clinician entries this year, in the challenge to find workable IT solutions to problems clinicians face every day.

A regional approach

Pivotal to future success is to continue taking a regional approach. New Zealand’s 20 DHBs have formed four regional groups, so they can cooperate, share resources and work jointly to ensure the right health services are provided in the right place, to meet the needs of the region.

Each regional group is charged with aligning the region’s IT systems. It must have a strong regional governance structure so decisions can be made in a timely way.

One example is the Central Region, which has developed the Central Region Information Systems Plan, or CRISP, that will see the region’s DHBs working towards a single, regional system for managing and sharing patient information.

Regions are at various stages in the formation of their IT groups, with some still building their business and IT infrastructure. I look forward to continued progress from all four regional groups.

Community seminars

Of course all your efforts are to ensure patients and consumers get the best possible care. A major project for the National Health IT Board this year has been continuing to introduce the concept of shared health information to New Zealanders.

A series of public and community seminars has recently been held. They were a chance for a two-way sharing of ideas and expectations.

There was widespread support for the electronic sharing of health information – interestingly; many people thought it was already happening throughout New Zealand. Consumers were quick to see the benefits although many had questions around security and confidentiality of information. The IT Board will be working these issues through with consumers, and the wider health sector.

A sensitive approach

We, as in all of us, live in an environment where the IT possibilities seem endless. But there are two very important sensitivities that we must acknowledge, take extremely seriously and work to overcome.

The first is the natural reluctance and anxiety from those for whom technology is an anathema – in fact maybe even downright scary. To be successful the benefits of technology and of sharing information must be accessible to all.

The second is the risk of enthusiasm overriding the caution that will ensure security of information, in other words making sure nobody’s privacy is breached. New Zealand patients express natural reticence about sharing some aspects of their medical history, often choosing to share only with those they, rightly or wrongly, feel need to know.

We should understand this, because it is real. If we allow any lapses that result in breaches of privacy we run the risk of undermining catastrophically the ability for progress to be made. It’s not enough for practitioners and IT experts to trust the system. Everyone who participates must.

In summary

There has been very good progress over the past year, but there is still much to do. Now, more than ever we need clinicians, consumers and vendors to keep working together so systems are created that work for everyone. DHBs must continue to prioritise investment in IT – and I realise this is a big ask in this tight fiscal environment.

This conference is an important opportunity for different parties to work together on the challenges faced by vendors, clinicians, administrators and planners.

I wish you all the best as you undertake this important work.

Nō reira, tēnā koutou, tēnā koutou, tēnā koutou katoa.