Patients First set to release PMS review round two

New Zealand's not-for-profit health IT organisation Patients First is getting ready to release the first of four reports in round two of its practice management system (PMS) review, focusing on the capabilities and potential for patient portals in line with the NZ National Health IT Board's roadmap.

Patients First is also set to release an updated version of the GP2GP electronic transfer of notes system, which will allow practices to transfer and receive far larger file sizes directly into their PMSs.

The company is also set to farewell founding CEO Andrew Terris after more than four years in the role. Mr Terris is taking a sabbatical in early July and will be replaced by Jayden MacRae, formerly director of research and tech innovation with Wellington-based primary health organisation Compass Health.

Patients First published the original version of its PMS review in 2012, which investigated and scored the capabilities of the four main primary care PMS vendors – Medtech, Houston Medical, Intrahealth and myPractice.

For the second round of the review, Patients First has taken a different tack and will focus on four main areas, only one of which will be scored.

“There's quite a lot of learning that we took out of the first review and that was applied to the second one,” Mr Terris said. “What we've elected to do in this review is rather than produce a large report, we are going to be releasing it in sections, like a series of briefing papers.

“Whereas the last review focused on some specific areas that we scored, what we've agreed with this review is that some of the areas are pretty nascent in terms of the technology or expertise in New Zealand, so rather than have a full scored report for all of the areas, we are actually treating this more as an educational resource for the sector.”

The four areas are patient portals, hosting in the cloud, support and prescribing, with only the latter receiving a score in comparison to the other PMSs. Mr Terris said the portal report will hopefully be released in early July, with the cloud report to come several weeks after that. Prescribing and support are due later in the year.

The choice of portals for the first paper was driven by the emphasis that is being placed on offering all patients a portal to view their medical records by the National Health IT Board, Mr Terris said. Some estimates put GP provision of a portal at about 20 per cent of all practices in the country.

“When we set out on this journey for the second review about 14 months ago, we said we would like the review to focus on some specific questions and reflections from the expert panel, and rather than scoring the capability of each of the portal offerings we'd rather … publish the results as a Q&A in a document and then put some commentary on the front end of that,” Mr Terris said.

“That commentary includes what are some of the reflections from the expert panel in terms of how to convince [practices] that portals would be useful to adopt and in what circumstances, and some of the enablers and barriers to doing that.”

The report is currently in draft form and is with the four vendors at the moment to check for accuracy. Mr Terris said Patients First had also contracted well-known health IT expert Sue Wells, who completed a Harkness Fellowship at Harvard University on patient portals, to help frame the report.

“We also went back to some consumers, borrowing from the National Health IT Board's consumer group, and asked them to provide not their comments on the report itself but a separate annexe to the report about consumer reflections on portals,” he said.

“We think it will end up as a pretty well-rounded briefing document for the sector showing here is what some of our clinical colleagues' questions and comments are, here's what the vendors offerings are and what they have to say about it, and here is what the consumers think. We are also going to offer it to the National Health IT Board for the opportunity for their comment.”

Mr Terris said three of the PMS vendors currently offer a portal, including Medtech's ManageMyHealth, myPractice and Intrahealth. Houston Medical managing director Derek Gower said his company was working with Medtech to integrate ManageMyHealth into the Houston system.

In addition to the primary care PMS vendors, portals are increasingly used in community care in New Zealand, including Orion Health's offerings such as that used in the Canterbury eSCRV project and Auckland's connected care portal using HSAGlobal's CCMS. Mr Terris said that while the scope of the review was predominantly around PMSs, there is also a brief view on the broader application of patient portals.

Both Mr Terris and Mr MacRae said it was unclear whether the first review, which did rank the PMSs, had led to any changes in purchasing decisions, but it was certainly a discussion point.

“My observation is that some of the issues highlighted in the first review have been brought to the attention of the vendors,” Mr MacRae said. “We've certainly witnessed over the last couple of years that some of those issues around interoperability and security have been improved by the vendors.

“I also think it's had an influence on their behaviour and their priorities, which has been a really positive outcome for everyone.”

The other three areas of hosting in the cloud, prescribing and support will also be released as separate reports. Mr Terris said the cloud paper would be similar to the one on portals in that cloud is still a nascent technology in New Zealand's primary care sector.

“There's really not much expertise in the health environment in New Zealand to be able to make a judgement call on the capability of the vendors,” he said. “So what we've done is ask the vendors about their architectural approach and capability for their systems … about how well they've geared or architected their products for a cloud environment.

“The second briefing paper probably won't be a lengthy paper and it will try to talk in relatively practical terms rather than technical terms, so it will translate or demystify what cloud means. Most of the vendors responded to that more from a hosting lens rather than a cloud lens.

“We will try to use some metaphors like the accounting software Xero and Google Docs and also describe the differences in functionality between a desktop app and a hosted in the cloud app. We don't have a timeframe around that one but would like to think it will come out about two to three weeks after the portal paper.”

The prescribing paper will be scored, predominantly on clinical and safety and quality standards rather than technical. Mr Terris said there were about 30 or 40 questions included that have been sent to the vendors and which will be gathered together under five key themes in the resulting report.

The final paper will be on support for users. Patients First hopes to survey a large population of GPs and practice managers about their thoughts on the support offered by their vendors. This will require more work so a publication date has not yet been decided, Mr Terris said.

What the company hopes to do is add the information gained in these reviews to its plans for a national certification system for medical software. Patients First has already built an integration platform through which vendors can test their products against certain technical standards.

The idea is to ensure that there is an independent way to assess vendor offerings and offer guidance to vendors on how to comply.

“One of the original criticisms that was levelled at us – and it was probably fair – was that the first review was quite subjective and not that objective,” Mr Terris said. “It was probably 70 to 80 per cent subjective and 20 per cent objective, and the goal is basically to invert that ratio.

“We still see a need for a clinical expert group of users to be able to make comments on the various PMSs' usability, but we want to balance that out with ... published standards that PMSs should be complying with. That will provide a very easy way for purchasers and the user community to look online and see that if they are choosing this product, how do they know it is actually compliant with the standards.

“Rather than just asking them 'do you comply', we want to be able to look at it independently and be able to say these vendors have tested themselves against these standards and they either comply or they don't.”

Posted in New Zealand eHealth

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