HiNZ 2015: New Zealand to introduce national EHR, digital hospitals blueprint
The New Zealand government has announced plans to build a single, national electronic health record (EHR) for all of its citizens, with a base platform up and running within three years.
It has also outlined plans to introduce a common blueprint for digital hospitals that will measure all hospital and specialist services against the HIMSS electronic medical record adoption model (EMRAM).
In addition to developing a common IT platform for preventive health that will cover immunisations and health screening programs, the government’s new plan also emphasises the necessity for data to be used to support health and social investments.
National Health IT Board director Graeme Osborne told the Health Informatics New Zealand (HiNZ) conference in Christchurch today that the board would now 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 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.
“We are going to have a single EHR,” Mr Osborne said. “It is going to be a longitudinal record from the consumer’s experience, so they understand that wherever they touch the health system, a base set of information is available to every clinician and health provider who is engaging with them.
“We are going to develop a blueprint for a digital hospital on a national basis. It is going to be common, it will be about uniformity, and we have set a challenge of November next year – 12 months.
“And instead of getting alongside you and encouraging you to do the right things, we are going to measure ourselves against an international standard. We are asking all hospitals in New Zealand to be measured against the HIMSS EMR scale of maturity for their electronic health information environments.”
While there was no announcement of a funding package, several sources told Pulse+IT that the cost of the ambitious program could run into the hundreds of millions of dollars. However, both Mr Osborne and Health Minister Jonathan Coleman (pictured) said the plan was to leverage existing initiatives – such as Canterbury’s HealthOne shared care view system, the TestSafe system running in Auckland’s DHBs, the various eReferrals systems now rolling out and the government’s own patient portal push.
New Zealand is also currently rolling out a uniform, national clinical workstation built by Orion Health for secondary care clinicians.
Dr Coleman said that while about 260 general practices had adopted patient portals so far, partial solutions such as patient portals are not good enough.
“We need the benefits of digital systems to be widely available,” Dr Coleman said. “As I walk around hospitals I kept seeing examples of where individual clinicians have designed a stand-alone information system or programs to use in their own unit – we end up with 20 different systems.
“In my view it intuitively makes sense to have a more uniform IT environment with fewer systems, fewer vendors, more standardisation and greater functionality.”
Dr Coleman said he had commissioned an independent report from Deloitte on the benefits of a single electronic health record that showed there was growing international support for adopting what he called a “hybrid-best of suite” strategy for electronic health records where a single EHR is introduced to join up information held in a smaller number of electronic medical record systems.
He said there were five key findings in the report, including that quality and productivity benefits are available by rationalising the systems used by secondary care facilities.
It also found that creating a single EHR that physically consolidates health information in one place will improve decision support and care coordination, especially for complex patients with multiple long-term conditions. Primary care also needs to be connected in real-time with the single EHR, the report recommended.
Dr Coleman said the fourth area was the imperative to implement closed loop medications management, as this is the area that offers the highest benefits in terms of patient safety and quality, and the fifth is to develop consumer portal access.
“This leverages the ability to serve up information from a physical repository in real-time, through digital channels to consumers,” he said. “Consumer engagement around their health and wellness is key to implementing a preventative or primary care-led strategy.
“We have laid much of the groundwork by linking up our health information systems and securely sharing a considerable amount of patient information. However, we are entering a new and vital phase.
“We need a platform that lets us consistently and widely share information and integrate services across hospitals and communities. We need this platform in place so we can hit the ‘go’ button and really deliver the same high quality health services to all New Zealanders, no matter who they are or where they live.”
Dr Coleman said he had asked the Health IT Board to establish a work plan that will see the DHBs finish the work already under way from the previous national health IT plan, such as the replacement of legacy patient administration systems, the common clinical workstations in all public hospitals and fully joined-up electronic medication systems.
“Secondly, over the next 12 months, we need to complete the design-thinking and investment plans for a hybrid/best of suite approach,” he said.
“A national electronic health record is a critical tool for providing the best care, whether in hospital or in the community. It will provide information via a patient portal and enable clinicians to view comprehensive patient information in one place.
“It will include a person’s allergies and alerts, medications and diagnostics, and will have clinical decision support tools. It will also incorporate data from all the current population screening programs and accommodate any new screening requirements. The record will be able to be accessed via portals and apps running on a variety of devices.
“In a digital hospital, all patient information is linked up into a standard electronic medical record and can be accessed from anywhere in the hospital. This means a nurse taking a patient’s vital signs can send them electronically straight to a central database, where they can be securely accessed by everyone caring for that patient.
“So that we do it once, and do it right, a blueprint of a digital hospital will be developed for the sector, and will be available by November 2016.”
He said the national, whole-of-person IT prevention platform will capture information relating to current and future population screening and prevention programs, and as with the electronic medical record, this prevention information will form part of the national electronic health record.
The independent review from Deloitte will be available on the Ministry of Health website in the next few days, he said.