GP2GP initiative achieves exponential adoption

This article first appeared in the October 2012 edition of Pulse+IT Magazine.

With over 375,000 patient files being transferred between general practices in New Zealand using traditional paper-based workflows, a group of software developers has collaborated with the support of Patients First to deliver an electronic alternative called GP2GP. First released in the middle of 2011, adoption rates are rapidly improving with practices at both ends of the transfer starting to benefit.

An initiative coordinated by Patients First, the Electronic Patient File Transfer project (GP2GP) was conceived to reduce the administrative burden and potential loss of clinical information that results when patients change general practices. Patients First reports that over 375,000 patient files are transferred between general practices as patients move around New Zealand.

While the country is a recognised leader when it comes to the secure electronic transfer of clinical messages between healthcare organisations, until last year the goal of easily sending entire patient records between general practices using electronic methods remained elusive.

However, as a result of work undertaken by clinical software developers Houston Medical, Intrahealth, Medtech Global and MyPractice, each of which incorporated a common data exchange toolkit produced by Health Alliance, it is anticipated that the vast majority of general practices will be able to use the GP2GP system, if indeed they don’t already have this capacity installed in their practice today.

HealthLink’s secure messaging service, which is widely deployed throughout New Zealand, is being used to encrypt and transfer the patient records between practices as Clinical Document Architecture (CDA) messages. The CDA format allows the data contained within the message to be intelligently processed and imported by the ‘recipient’ clinical software, with information filed into the correct parts of the patient’s electronic record at their new practice.

Practices using GP2GP can eliminate the need to print off and compile entire patient records, and post them or pass them along to the patient to transfer to their new general practice. Under such workflows, the recipient general practice would either have to scan the record or file it along with their existing paper archives, in addition to entering all relevant patient demographics into their clinical system, an extra step that record transfers conducted using GP2GP can obviate.

While a simple idea conceptually and an obvious area for workflow improvement, variations in the four general practice clinical software products used throughout NZ and a previous lack of defined standards in this area meant that a significant amount of work needed to be undertaken before the vendors could deliver the GP2GP functionality.

In a guest editorial for Pulse+IT written at the conclusion of his company’s development work for GP2GP [Issue 24, pp8], Derek Gower of Houston Medical summarised the undertaking as follows:

“Over a 12-month period the vendors completed development, met for Connectathons, exchanged sample messages and found and squashed bugs. As funding was provided through a fixed price contract, the project was delivered on budget. Although the same could not be said for the delivery date, a six-month project rapidly became 12! The vendors put aside their normal competitive behaviour, as we all realised we had something to learn and something to share and if it was not a success we were all the joint losers.”

Adoption, uptake and looking to the future

The GP2GP system has been live since the start of this year following some controlled testing in the latter half of 2011. However, according to Andrew Terris, Patients First program director, the majority of electronic patient record transfers have occurred since Medtech Global made its GP2GP functionality available to practices.

“Medtech have only just come out with Release 20, which happened about three months ago,” Mr Terris says. “Given that Medtech have about 80 per cent market share, we’ve only really seen the numbers go up fairly rapidly in the last three months. Month-on-month transfers have pretty much doubled and we’re now seeing an exponential growth of usage.”

Patients First also reported the following statistics for the GP2GP initiative for the period January 1, 2012 to August 31, 2012:

  • 8710 patient files have been sent using GP2GP, with 4277 of these sent in August alone.
  • 585 practices have used GP2GP, with 324 having sent patient records.
  • 542 practices have received patient records via GP2GP.
  • 289 practices have sent more than one patient record and 181 have sent more than 10 patient records.

“We’re pretty pleased with these figures and the feedback has largely been positive; the uptake speaks to that as well,” Mr Terris says. “It’s still version 1, so there’s still a few teething problems that we need to work through but we think it’s being adopted pretty rapidly and the GPs we’ve spoken to that are using it report that it is saving them a lot of time.”

He went on to explain the variations in the numbers of reports sent and the number of computer generated acknowledgements returned to the originating practice, as shown in the diagram below.

“Some files are being sent to practices that have not yet upgraded to the relevant version of their PMS that is GP2GP-enabled. Where this is the case, the item appears at the receiving practice’s PMS inbox with a human readable version in the message; they just cannot import the structured data. As you see from the stats, the ‘tail’ is being picked up quite quickly.”

As part of the GP2GP project, a toolkit was developed that enables any structured information to be transported securely in CDA format between any of the general practice clinical systems. This toolkit (codenamed the Babel Fish) has already been leveraged for electronic transfer of prescriptions and eDischarge initiatives, and also for modelling summary records for use throughout the health sector.

“A useful bi-product of GP2GP is the rich dataset that’s been created, which is being taken into some of the HISO standards and is starting to evolve with the summary record work. For example, one of the things that emerged from the Christchurch earthquake was a realisation that they didn’t have a useful combined summary note that was able to be used across primary, secondary and pharmacy. So they’ve taken a dataset that has used quite a lot of GP2GP for its clinical content, and are now presenting that in a unified view.”

Posted in New Zealand eHealth

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