The announcement by Health Minister Jonathan Coleman at the HiNZ conference in Christchurch that New Zealand would build and roll out the basics of a national electronic health record (EHR) by 2018 was big news on both sides of the Tasman in October, and helped to round off a year in which NZ continued on its steady, sensible path towards a health system supported by sound, functioning health IT initiatives.

The general consensus of opinion from Pulse+IT’s informal survey at HiNZ of reaction to the announcement was that if there was one country that was at the right level of maturity and would do the job with the minimum of fuss, it was New Zealand. Unlike certain other countries that shall remain nameless, there were no large sums of money thrown around and no exaggerated promises of what could be achieved.

While the announcement of the national EHR – and the equally interesting plan to develop a digital hospital blueprint – was unexpected, it was known that this would be a year in which a new health IT plan would be announced to accompany the review of the New Zealand Health Strategy, which had its last update in 2000.

But while those announcements were to pop up at the end of the year, at the beginning of the year the industry was digesting the results of a stocktake of telehealth activity by district health boards, part one of a two-part plan to gauge the extend of telehealth use in New Zealand. The stocktake found that telehealth was at a “tipping point” in NZ, with all of the DHBs making use of telehealth technology to some degree.

The next phase saw the NZ Telehealth Forum look at the use of telehealth by primary health organisations and non-government organisations, and they didn’t have far to look as news began to surface of a new start-up telehealth service called Doctor2Go. Run by an Auckland company called Concierge Medical Services, itself a division of Waitemata practice Third Age Health, the service said it would use WebRTC technology for video conferencing and its GPs would use the MyPractice patient management system hosted in the cloud.

That venture was overtaken somewhat later in the year by the announcement that Homecare Medical had won the contract to provide New Zealand’s new national telehealth service, which saw it take over some existing services from Medibank Health Solutions such as the Healthline nurse triage and advice service.

Homecare Medical is a partnership between Canterbury PHO Pegasus Health and Auckland PHO ProCare. While the majority of the telehealth service provision is telephone-based with some web-based information portals, the company does expect to introduce video conferencing in the future.

In February, Midlands Health Network announced that 1000 Waikato newborns had been enrolled on the new National Child Health Information Platform (NCHIP). Developed in association with the Ministry of Health, the National Health IT Board, Orion Health and BPAC, the service includes shared data repository as well as a telephone-based coordination service based in Hamilton. It is being rolled out to Taranaki next month and the Lakes region in March.

Also in February, Orion Health and the five South Island DHBs signed a new agreement covering the roll out of the South Island Patient Information Care System (SI PICS). Set to replace seven legacy patient administration systems used in hospitals in the region, it is set to go live at Christchurch’s Burwood Hospital in April or May, followed by Nelson Marlborough DHB in September and the rest of Canterbury DHB in early 2017. It will then roll out to the other three DHBs in time.

In what would prove to be the last hurrah for Health Benefits Limited, four DHBs signed on to migrate to the national infrastructure platform developed by IBM. By mid-year, eleven DHBs had signed on and seven more had given verbal assurance they would too. The NIP will consolidate the 40 different data centres currently being used into two IBM data centres, one in Auckland and one in Christchurch.

Responsibility for the platform moved over to NZ Health Partnerships, the DHB-led organisation that has replaced HBL, which was axed in November last year, with the NIP the only one of HBL’s four business cases that was on track. While it was set up to allegedly consolidate services and save on duplication, it was widely seen as a cost-cutting exercise.

The Ministry of Health also signed on to IBM’s specifically designed cloud-based managed infrastructure service for a minimum of five years. The platform will support the National Health Index database and other national health systems.

It was a huge year for Orion Health following its keenly observed listing on both the NZ and Australian stock exchanges in December 2014 for a paper value of $1 billion. Shares were priced at $5.70 on listing but had dropped to $3.10 a year later, but this was always expected as the company announced it was putting a large amount of capital and effort into R&D and would continue trading at a loss for the next few years.

Orion Health has been a big supporter of the development of the FHIR standard, with Orion’s product strategist David Hay writing a white paper on its potential. The company was one of the first in the world if not the first to add FHIR capabilities to a commercial product, adding it to Rhapsody integration engine in February.

It was a big year for Rhapsody too, with a long-term release launched in December and the announcement that it would be used as the link between civilian healthcare facilities and the new electronic health record being built by the US Department of Defense as part of the monumental Defense Healthcare Management System Modernization (Dim-sum) project, which is costing $US4.3 billion.

Apart from the revised health IT plan, perhaps the most high-profile effort from the National Health IT Board and the minister himself was the push to expand the use of patient portals. The use of portals was a big part of the existing health IT plan and the board had originally hoped they would be available to all New Zealanders by the end of 2014. That was certainly overly ambitious and the target was halved in February 2014, but by the end of 2015, only about one in four practices were offering one.

To give the technology and the policy a bit of a boost, last year the then health minister, Tony Ryall, announced a group of seven ‘eHealth ambassadors’ hired to encourage GPs to establish a portal, and later managed to snare $3 million to assist in the roll-out. However, there is still a lot of reticence among GPs for a number of reasons, high on the list of which is the cost, with some portal vendors even charging for training. A number of PHOs are now looking at models where licences are purchased in bulk on behalf of member practices.

Later in the year, Patients First released modelling commissioned from Sapere Research Group that provided different scenarios in which practices could gauge the benefit of patient portals on a number of different criteria, including time and money saved. They also developed an interactive tool that allows practices to add their patient population data to help model what effect a portal would have on their particular practice.

While Patients First CEO Jayden MacRae would not go so far as to describe GP reaction to patient portals as reticence, he did say that like any new technology or initiative, it can take a while to build up a head of steam. Sapere’s Tom Love gave a presentation at HINZ in October in which he said research showed that doctors’ fears that patients would start stalking them with persistent emails about clinical matters were unfounded.

In July, HealthLink announced a new capability for GPs to lodge medical certificates with Work and Income New Zealand (WINZ) electronically, rather than having to print them out and give them to the patient. While it may sound a bit ho-hum, Pulse+IT believes that this new SmartForms technology, based on HISO standards and integrated into all of the PMSs, is going to be truly revolutionary for the general practice sector, in New Zealand and Australia.

HealthLink uses similar technology for its CareSelect eReferral system, which in August it made available to all GPs in NZ for secure ‘any to any’ referrals to specialists, allied health and non-government organisations. It has also offered the CareConnect eReferral service for GP to hospital referrals in the Auckland region for about three years. A real breakthrough in the WINZ case is in developing the capability for the data contained in the medical certificates to be integrated into the Ministry of Social Development’s own systems, as well as for GPs to send it off with just a click of the mouse. Australian PMS vendor MedicalDirector is about to go live with this capability and we believed both countries will be hearing a lot more about this technology in 2016.

Everyone then got a big surprise when connected care system vendor HSAGlobal sold up to Whanau Tahi, the IT arm of west Auckland healthcare provider the Waipareira Trust. HSAGlobal’s Connected Care Management Solution (CCMS) is widely used in NZ, including for Auckland’s shared care plan program and Canterbury’s collaborative care program, as well as new one aimed at at-risk individuals in Counties-Manukau.

When HSAGlobal was liquidated the next month, it became obvious just how hard it is to market shared care planning systems. CCMS has now been rebranded as the Whanau Tahi Connected Care (WHCC) system, and is being deployed by Hawke’s Bay DHB to support the coordination of community services for its over 65 patient population.

As the end of the year approached, all eyes turned to Christchurch, where HiNZ was holding its annual conference. The Wigram Air Base Museum proved an excellent, intimate venue for HiNZ, easily accounting for the 700 or so delegates and plenty of exhibitors. There were a number of announcements – Canterbury and West Coast DHBs announced they’d implement a new digital patient observation and alert response system called Patientrack, licensed from the NHS by MKM Health, and an excellent presentation on New Zealand’s move from using Read codes to SNOMED, which St John is using for its new electronic patient report form (ePRF) – but the big news was the announcement by Jonathan Coleman and NHITB director Graeme Osborne that NZ will introduce a national EHR.

Mr Osborne said the project would move into a design phase that will see three iterative cycles of design over the next six to nine months towards the goal of standing up a basic national EHR with medicines, problem lists, allergies and alerts by the middle of 2018, and that all DHBs will undergo an EMR maturity model survey in May-June next year to create a benchmark for productive digital hospitals in New Zealand.

He later told Pulse+IT that Deloitte, in the independent review it produced earlier in the year for the minister, had found that the NZ health system had matured to a point where investing in a single EHR solution was achievable. Unlike certain other attempts at a national EHR, NZ was ready and already had most of the building blocks in place.

He also said there is every possibility that rather than build or buy a new solution, NZ will put together existing solutions such as Health Connect South, HealthOne or TestSafe, all of which have some of the capability essential to an EHR with provider and public access.

The EMR adoption survey will be carried out next May and June, based on a project that surveyed five hospitals in 2013. While many hospitals are well on their way up the HIMSS ladder, it is expected that the average will actually be very low – around level 2 – as few have taken the step of introducing electronic nursing documentation.

As the ramifications of these announcements were still being digested, the year was rounded out by the announcement by three of the biggest vendors – Orion Health, Medtech Global and CSC – that they were getting together to work on bringing together their strengths in different fields in the health IT industry to position New Zealand at the forefront of precision medicine, an extended version of personalised medicine in which data from multiple sources is brought together with emerging disciplines such as genomics to treat and care for people on an individual level, including targeting medications for particular blips in a person’s genome.

Precision medicine is already happening, but the trio have decided to put New Zealand forward a world leader in introducing solutions on a national level. The initial three companies were quickly joined by more.

As many Australians who Pulse+IT spoke to about the national EHR plan reckoned, if any country outside of Scandinavia or Singapore can do it and do it well, it’s New Zealand.

Primary care

GP desktop software market leader Medtech Global releaseda new version in March, featuring new functionality for nurse practitioners, improvements to the ManageMyHealth portal and a new online chat function for customer support. As well as launching its Medtech Evolution cloud-hosted product on the Australian market in September, Metech also expanded its presence in the US market for its ManageMyHealth portal technology following the acquisition of the remaining shares in Colorado firm ConSova Corporation in November.

Plunket went live with its new cloud-based electronic Plunket Health Record (ePHR) application, built on Microsoft technologies and due to be deployed on around 800 Windows tablets to Plunket nurses across New Zealand. The app will replace the paper-based child health record, and is fully hosted in the cloud. Plunket is currently running a campaign to raise money to roll it out nationwide.

Secondary care

Despite the intense lobbying effort of specialist doctors, the three Wellington DHBs went ahead with outsourcing their pathology service infrastructure to Southern Community Laboratories (SCL), a subsidiary of Australian private hospital and laboratory provider Healthscope. The argument from the DHBs was that SCL would build a multimillion dollar, state of the art central lab with increased IT capabilities at Wellington Hospital and upgrade equipment at Wairarapa, Hutt and Kenepuru hospitals, something the DHBs said they didn’t have the money to do.

Lakes DHB rolled out the Midland region ePharmacy system at Rotorua and Taupo hospitals in April, joining Tairawhiti DHB and set to be followed by Waikato, Bay of Plenty and Taranaki. The $2.6 million roll-out is part of a regional shared solution approach from the DHBs, which are also currently implementing CSC’s MedChart electronic medications management (EMM) system as part of the nationwide roll-out. The progress of EMM is sure to be in the spotlight next year as part of the development of the national digital hospitals blueprint program, part of which will see all DHBs ranked on the HIMSS EMRAM scale. Closed-loop EMM is essential to qualify for HIMSS level 6.

Aged care

Data on the health of elderly people living at home in the South Island was released by the SI Alliance’s Health of Older People’s Group using tools developed by InterRAI. New Zealand is a world leader in the use of interRAI tools for its aged population, both in residential care and in the community.

MidCentral DHB agreed to fund some of the set-up costs to enable a full roll out of the Medi-Map electronic medications chart in all of the area’s aged care facilities and their supplying pharmacies. Medi-Map has been designed by Christchurch-based pharmacist Greg Garratt to give GPs, pharmacists and aged care nurses access to a shared interface for residents’ medications charts, which can be updated in real time and are accessible from any device. Medi-Map has received a waiver from the Ministry of Health to allow GPs to chart medications through the system.

A long-standing study by the University of Auckland and Gore Health released some more results, which showed that robots may lessen social isolation but also help with the provision of medical care. While the study is very small, it is being looked on with interest for its potential to help older people stay in their own homes for longer, particularly in rural areas.

Some of the more interesting software, apps and new players in the market that caught our eye this year included:

• Southern DHB joined Canterbury and Nelson Marlborough in rolling out the Safety1st electronic risk management system as part of a South Island-wide implementation
• Researchers from the University of Auckland’s National Institute for Health Innovation (NIHI) launched a study into the use of a smartphone-delivered personalised exercise prescription and behavioural support program for people with coronary heart disease or a recent coronary event
• Practice management system vendor Intrahealth integrated BPAC’s web-based eReferrals solution with Profile for Mac, allowing users to electronically refer patients to public and private specialists
• Bay of Plenty DHB launched a web-based monitoring tool that allows comparisons between DHBs on 16 different Māori health indicators
• ARANZ Medical took to the road in the US with partner Iron Bow Technologies to show off its Silhouette wound surveillance system to the US Department of Veterans’ Affairs
• Vensa Health will use an R&D growth grant from Callaghan Innovation to invest further in the apps-based version of its platform it says it will launch next year, and also launched version 4.0 of the TXT2remind practice-patient messaging system
• Patients First announced it would launch a secure email platform for the New Zealand healthcare sector aimed at preventing data breaches while allowing for informal communication about patients between healthcare professionals.

Pulse+IT is taking a break over the festive season but will be back in the new year with our regular fortnightly bulletins on New Zealand eHealth and health IT.

The announcement that New Zealand will create a national electronic health record (EHR) for all of its citizens was unsurprisingly the most-read Kiwi story on Pulse+IT in 2015. It’s also very apparent that anything to do with Orion Health is of real interest to readers, which again is no surprise.

Patient portals were of interest, as were new developments from GP desktop market leader Medtech, and the growing interest in telehealth also became apparent. Australian company Best Practice’s unexpected decision to buy Hamilton firm Houston Medical raised some eyebrows, as did the demise of Auckland’s HSAGlobal.

1. The national EHR announcement at HiNZ 2015 in Christchurch in October got massive hits

2. Best Practice’s buy-out of Houston Medical also rated highly on both sides of the Tasman

3. Three big names in NZ health IT got together to form NZ Health Inc

4. Orion’s Rhapsody is being used as part of the $4.3bn US armed forces EMR project

5. Telehealth start-up Doctor2Go made the news with its click and call’ service

6. Orion Health was probably the first vendor off the blocks to support FHIR

7. Patients First released economic modelling to support the take-up of patient portals

8. HealthLink went national with CareSelect for ‘any to any’ referrals for GPs

9. The NZ health minister is keen on patient portals

10. A study using robots for the elderly in Gore proved internationally popular

11. The NZ Health IT Board kicked off its national EHR design phase

12. Orion and the South Island formalised their agreement for new PICS system

13. Orion’s international plans were also of interest in NZ and Australia

14. Medicines New Zealand has a five-year plan, with IT at the heart

15. In May, a bunch of NZ health IT companies pitched across the ditch

16. HSAGlobal was wound up after the sale of its assets to Whanau Tahi

17. More on patient portals and how they are being used in general practice

18. The controversial Health Benefits Ltd was dumped and its assets returned to DHBs

19. National telehealth service provider Homecare Medical named its tech partners

20. Medtech geared up for a new release with enhanced ManageMyHealth capabilities

The National Health IT Board will hold a second workshop in late March to further flesh out the design of the national electronic health record (EHR) following an initial discovery workshop held in early December that covered the new health IT program’s four areas of focus.

The board is running a co-design phase for the EHR, first announced by Health Minister Jonathan Coleman at the HINZ conference in Christchurch in October.

The plan is to have the design ready by the middle of the year, when the board will also hold a survey of the country’s hospitals to measure their digital capabilities against the HIMSS electronic medical record adoption model (EMRAM).

The plan is to develop a blueprint for digital hospitals in NZ by the end of the year.

The next step is to hold a ‘digital health climate change’ workshop in March. The board has also set up an EHR design core group that is working on the preliminary design and scope.

NHITB director Graeme Osborne said there was strong agreement at the December workshop about the direction the board was heading, as well as many good ideas on what the EHR could include. The idea is to develop a high-level, consumer-centric view for the EHR and digital hospitals.

eHealth clinical lead Sadhana Maraj said workshop participants focused on creating a customer-centric health IT environment through the use of personas.

“Working on the personas helped to flesh out the actual users of the EHR (consumers and health professionals) to understand their needs, challenges and aspirations,” Dr Maraj said.

Health Minister Jonathan Coleman has highlighted the benefits to telehealth of the government’s rural broadband initiative (RBI), which has succeeded in hooking up all rural public hospitals and integrated family health centres to high speed broadband.

The 39 facilities were identified by district health boards as candidates for the RBI and are now all able to connect to fibre capable of peak speeds of at least 100 Mbps.

Dr Coleman said faster broadband would enabled healthcare to be delivered in new ways, including the ability to offer safer, more efficient healthcare closer to home.

“A good example of this is telehealth,” he said. “This technology enables patients to be seen by their health professional remotely which improves health monitoring, lowers healthcare costs, and gives more flexibility to patients and health professionals.

“Telehealth not only breaks down geographic barriers within New Zealand, but it also enables health practitioners to more easily discuss cases and exchange information with colleagues all over the world.”

Communications Minister Amy Adams said the government will extend the RBI, having allocated an extra $100 million to the project.

Photo courtesy of Vodafone.

New Zealand has launched a revision of its 2011 national cyber security strategy, which will now include an annual action plan to keep pace with emerging threats and the establishment of a CERT, or computer emergency response team.

Communications Minister Amy Adams said there were growing threats to the economy from cyber intrusions with serious implications for national security.

While New Zealand has yet to experience a significant cyber attack, Ms Adams said it was estimated that economic losses reached $257 million 2014.

According to research, 56 per cent of New Zealand businesses experience an information technology security attack at least once a year and only 65 per cent of businesses are confident that their IT security systems are effective.

Ms Adams said the government and the private sector needed to work together on cyber security by finding ways to share information and expertise to address risks.

The refreshed strategy will rely on a close and active public-private partnership through the Connect Smart initiative.

She said a key “action” in the new strategy is the development of a national CERT to reduce harm from cyber security incidents and improve New Zealand’s ability to deal with attacks.

The CERT will act as a single entry point for organisations or individuals needing assistance, and provide information to businesses, including small and medium enterprises, government and individuals.

“New Zealand’s key international partners each have a national CERT of some form, and creation of our national CERT brings us into alignment,” she said.

CERT is intended as a partnership between the public and private sectors and will work with companies and government agencies depending on the nature of the issue, she said.