Debbie Chin, Deputy DirectorGeneral, Corporate

1
E-health and the E-citizen Implementing e-govt
through developing e-health communities

• Debbie Chin, Deputy Director-General, Corporate
  Information, MoH
• Peter Aagaard, Senior Advisor, Corporate
  Information, MoH
• Tony Cooke, CIO, Hutt Valley DHB

2
Presentation outline

• Ministry of Healths strategic context
• Debbie Chin
• Implementing e-health
• Peter Aagaard
• A DHB perspective
• Tony Cooke

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A day in the life
157 babies are born 73 people die 105,000
prescriptions are filled 50,000 people take a
cholesterol-lowering drug 50,000 people take one
of the new antidepressants, eg Prozac 40,000
laboratory tests are analysed 1,167 people are
admitted to our hospitals 4,000 outpatients
visit hospitals for care 432 people have
elective surgical operations 1,960 people are
seen in Emergency Departments 27 people are
admitted to hospital with asthma 50,000 people
visit their GP 21 people have heart attacks 19
people are diagnosed with diabetes 637 children
are immunised 2,124 children and adolescents
have a dental check up 3,000 new claims received
by ACC
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Overview of the health sector
Minster of Health
Annual output plan
Reporting
Ministerial accountability
21 District Health Boards
Ministry of Health (MoH) Policy advice Funding
Monitoring Ministerial services
Private
Crown Funding Agreement
Reporting
Reporting
Service Agreements
Internal Service Agreements
ACC
Reporting
Service Agreements
Private and NGO Providers
District Health Boards Provider Arm
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MoH IM units
Chief Advisor IM Policy Security Health
Intranet Standards E-health
Deputy Director Corporate Information
CA HSIT
HealthPAC
Strategy
DHBs
Development
Sector Strategy Linkages
Operational Delivery

Think
-
tank

Visionaries
MoH
NZHIS
IMAT
Managing
Reporting
Information Gathering Dissemination
Sector
Sector
-
wide
Monitoring and Analysis
Technology development Support
Common

Audit
Interest Management

Compliance

Project Management

Performance

Knowledge
Management

Development
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Implementing e-govt through e-health
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Implementing e-govt through e-health vision
mission
e-government
e-health

•  
• Vision New Zealand is a world leader in
  e-government
• Mission By 2004 the Internet will be the
  dominant means of enabling ready access to
  government information, services and processes.

• Vision Ministry of Health continues to be
  recognised as world leader in e-health
•  
• Mission Grow information systems that support
  better health outcomes, improve the delivery of
  care, and the sharing of information.

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Implementing e-govt through e-health - goals
e-Government
e-health

• Better services more convenient and reliable,
  with lower compliance costs, higher quality and
  value
• Cost effectiveness and efficiency cheaper,
  better information and services for customers,
  and better value for taxpayers.
• Improved reputation building an image of New
  Zealand as a modern nation, an attractive
  location for people and business.
• Greater participation by people in government
  making it easier for those who wish to
  contribute.
• Leadership supporting the knowledge society
  through public sector innovation.

• Ensure the integrated delivery of safe,
  high-quality services and support that are
  centred on the needs of individuals, families,
  whanau and communities.
• Develop policy and plan services that meet the
  needs of New Zealanders on the basis of evidence.
• Allow communities and groups within the
  community, such as Maori, to be involved in
  decision-making in the sector.
• Allow individuals to participate in decisions
  about their own care and support.
• Support ongoing knowledge development programmes
  and strategic planning.

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Informations strategic role

• The ability to exchange high-quality information
  between partners in health care processes will be
  vital for a health system focused on achieving
  better health outcomes.
• Better access to timely and relevant clinical
  information can improve clinical decision-making
  and, therefore, health outcomes for individual
  patients.
• The New Zealand Health Strategy, 2000

WAVE Working to Add Value through E-information
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Primary Health Care Strategy

• People have diverse health needs, and use a
  number of services provided by different
  providers in various settings.
• It is important that there is coordination of
  care between these services, so that the best
  possible total package of care is provided to the
  patient without unnecessary duplication.
• Accurate and useful information about enrolled
  populations and their health needs is critical to
  quality as well as to the successful adoption of
  a population health focus in primary health care

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NZ international position

• The Australian National Electronic Health Records
  Taskforce report states that the decision by New
  Zealand
• to invest in and promote key items of health
  information management infrastructure has
  positioned it as a world leader in the field,
  particularly in the primary care sector. 1
• 1 A Health Information Network for
  Australia National Electronic Health Records
  Taskforce. July 2000. Australian Department of
  Health and Aged Care. p43

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Health electronic claims
 
Note Excludes ACC claims
Plus 8,000 agreements 6,000 section 88 notices
 
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Embedding knowledge
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Selecting the agreement terms
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Adding the services
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So, good progress..but.
"In terms of standards and infrastructure, New
Zealand is ahead of the UK and NZHIS has been
used as a model for other countries, including
Singapore." 1 1http//computerworld.co.nz/webhom
e.nsf/UNID/43BBCFFAB259B170CC256C8B00731CBB!opendo
cument
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Improving quality an international challenge

• In the US (To Err is Human, IOM Report)
• Up to 88,000 death pa. caused by medical errors
  ahead of motor vehicles and AIDS
• Hospital errors exceed 8.8 billion per year
• In NZ (Peter Davis, National Survey)
• 4.5 of all hospital admissions associated with
  highly preventable adverse events
• Adverse events increase average hospital stays
  by 9 days

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How to get there
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Integrated care changing the information
landscape
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Improving connectivity
The ability of government organisations to share
information and integrate information and
business processes by use of common standards
Def. of interoperability. E-gif v1.0, p7

• Right information
• Right time
• Right person
• Right format
• Right place

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Strategic change management

• Define a goal and a path
• Increase strategic IM capacity (HSIT)
• Establish sustainable structures (HISO)
• Develop sector IM Standards Plan
• Improve communication coordination
• Undertake IT infrastructure work
• Provide e-health capability
• Develop e-health applications

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(1) The WAVE forward
Short-Term
Improvements
lt 24 Months
WAVE Report
Incremental
Strategic IT Sector Framework
Improvements
2 3 years
Strategic Change
and Innovation
gt 3 years
WAVE early Opportunity Identification
WAVE
Longer Term Strategic Change
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Fill the Gap - The reality can be moved closer to
the concept by a series of interlocking Smart
projects - stabilising foundations and building
in an integrated way
(1) Bridging the Concept Reality Gap

• Leap across it- Hope grand vision will carry
  across

• Narrow the Gap- by moving the concept closer to
  reality

Concept
Reality
Acceptance Gap
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(2) MoH Capability
Chief Advisor IM Policy Security Health
Intranet Standards E-health
Deputy Director Corporate Information
CA HSIT
HealthPAC
Strategy
Development
Sector Strategy Linkages
Operational Delivery
DHBs

Think
-
tank

Visionaries
MoH
NZHIS
IMAT
Managing
Reporting
Information Gathering Dissemination
Sector
Sector
-
wide
Monitoring and Analysis
Technology development Support
Common

Audit
Interest Management

Compliance

Project Management

Performance

Knowledge
Management

Development
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(3) Standards enabling connections
B
A
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(3) Health Information Standards Organisation
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(4) NZ Health Information Standards Plan - content

• NZ standards history
• Why standards are necessary
• Review of existing standards / proposed
  initiatives
• Australian situation
• Framework for standards development and
  implementation in NZ
• Process for standards development and
  implementation in NZ
• Prioritised Programme of implementation actions

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(5) Communication

• Quarterly Health e-Newsletter
• DHB CIO, CFO, CEO, SIG forums
• Conferences and presentations
• DHB Information Liaison Group - DHB/MoH
  information initiatives and services
• MoU developed between MoH ACC
• Linkages with Health Information and Technology
  Cluster
• Health Informatics NZ participation
• Examples of excellence studies

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(5) Coordination

• Common DHB ISSP frameworks
• Transparent investment criteria
• DHB IM Indicators established for 03/04
• Electronic referrals discharges
• Access to knowledge-bases like Cochrane
• DAP guidelines
• Ethnicity data quality improvement
• NHI data quality improvement
• MHINC data quality improvement
• Outpatient information

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(6) Info-structure programme

• Upgrade of National Health Index (Patient id)
• New search engine
• Change history
• New fields to support population register use
• New geo-coding software
• New architecture population register access
• Better management of data quality
• Health Practitioner Index (Provider id)
• Single identity for practitioners
• E-Lookup for practitioners
• Linkage to digital security

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(7) E-capability

• Broadband - PROBE
• PAS - Authentication agreement development
  project (ACC E-govt)
• E-government LEGO project
• MoH gateway - HADIE
• Telecom Next Generation Internet
• ProClaim - electronic claiming data processing
  
• E-procurement

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(8) E-health applications

• Capitated Based Funding - PHOs
• Electronic laboratory ordering programme
• Electronic transfer of lab. data to NCR
• National immunisation register
• Pharmaceutical special authorities
• DSS devolution projects
• Maternity section 88 changes
• Redeveloped Cancer Mortality systems

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Conclusion

• Significant progress in increasing e-govt through
  e-health
• Developing a plan and an implementation approach
• Improving capacity
• Health Information Standards Plan Oversight
• Communication Coordination
• Info-structure programme e-capability
• E-health applications

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A DHB perspective
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District Health Boards

• Key issues
• Fragmented health care delivery services
• Allocating best use of resources
• Patient is not a reliable transport mechanism for
  their own health information
• Reliance on paper based medical records
• Health information is sensitive
• Monitoring patient outcomes

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E-Health in Action

• DHBs as users of e-health
• National Health Index
• Access to HealthPAC services
• Healthlink services
• Electronic transfer of lab results
• Electronic transfer of discharge summaries
• Web sites
• On-line access to patient information

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Gaps in E-Health

• Health Practitioner Index
• Broadband network access (schools, GPs)
• Community based electronic clinical record
• Immunisation
• Upcoming appointments
• Electronic referrals
• Order processing

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Opportunities for E-health

• Do away with the paper!
• Measure outcomes
• Allocate resources
• Allow providers to talk to each other securely
• Information follows the patient
• Authorised access dependant on role
• Nivarna Electronic Patient Records
• Accessible in more than one place at one time
• Delivers relevant data at the point of care
• Legible, timely, accurate, complete

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Implementing e-govt through developing e-health
communities
Thank you