Clinicians set the challenge at HINZ

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

The head of New Zealand’s National Health IT Board, Graeme Osborne, and Bill Pascal of the Canadian Medical Association are two of the headline speakers at the 11th annual HINZ Conference and Exhibition, being held in Rotorua in November. New Zealand’s premier event for health IT will see clinicians throw down a challenge to vendors to move ideas into clinical practice.

Health Informatics into Clinical Practice is the theme of this year’s HINZ conference and it is an apt one considering the real effect health IT is now having on healthcare delivery globally. Health IT is not only becoming embedded in clinicians’ every day workflow, but its effects on consumers and patients is also becoming more noticeable.

Consumer feedback on the NZ National Health IT Board’s National Health IT Plan is therefore a timely part of the presentation that board director Graeme Osborne will deliver at HINZ 2012. In addition to details on the 2012 version of the plan, Mr Osborne will release the findings of the board’s research into what consumers think of it.

“[Consumers] are saying it all sounds really good but what does it mean for us?” Mr Osborne says. “Who is going to hold it, what is it going to look like? There are still quite a lot of New Zealanders who ask us is there one big database that is going to be sitting in Wellington?”

Mr Osborne will present a tree diagram the board has constructed to help consumers and the healthcare industry in NZ as a whole understand how their health information hangs together. He will illustrate the diagram with several examples, including how the country’s electronic medications reconciliation (eMR) program, which aims to allow clinicians to view an accurate list of patient medications, allergies and adverse drug reactions and compare this with prescribed medicines and documented allergies, is working. The eMR project is currently underway at Counties Manukau, Waitemata and Taranaki DHBs and is expected to go live in Auckland and one other DHB this year.

Also at speaking at the conference is Bill Pascal, chief technology officer for the Canadian Medical Association. He has spent the last 20 years assessing how innovation can help transform healthcare delivery and was one of the authors of the first national health IT strategy for Canada. In particular, he will share his views on how technology is opening up a new era that will completely change healthcare.

Other keynote speakers at HINZ 2012 include Australia’s Emma Hossack, who will discuss privacy and health IT; Claudia Pagliari of the Centre for Population Health Sciences at the University of Edinburgh Medical School, who will discuss the value of telehealth; Marie Shroff, New Zealand’s Privacy Commissioner; and NZ’s Associate Minister of Health, Jo Goodhew.

Clinicians’ challenge

One of the highlights of HINZ 2012 is the Clinicians’ Challenge, an annual competition to find potential technology solutions to solve an important and recurring problem that health professionals face in their daily practice.

HINZ asked clinicians to put forward day-to-day work-related challenges that they would like health IT vendors to help answer. A judging panel has chosen three of the challenges to present at the conference, covering the topics of improving the effective delivery of healthcare in a rural environment, supporting integrated care and self care, and testing the best ways to utilise new e-pad technology to improve productivity within hospitals.

The first challenge is from a rural GP who would like to streamline the process for issuing the standing orders for nurses and physicians’ assistants that allow them to prescribe certain medications for routine and simple conditions. The submitting clinician describes the process as cumbersome, and would like vendors to meet the challenge of creating a database of drugs that could be supplied and administered under standing orders, as well as a software program that could be embedded within a practice management system or on a stand-alone secure website linked to the PMS. The idea would be to enable a standing order to be generated and edited on an online template by selecting each element from drop-down menu.

The second challenge asks vendors to develop an IT system to streamline nephrology referrals from primary and secondary care. The idea is to help to identify and refer patients with chronic kidney disease (CKD) who are at high risk of developing end stage renal disease (ESRD). The clinician envisages that the system will use an established risk prediction model for progression to ESRD in patients with moderate to severe CKD.

The third challenge is a fascinating one. It asks the vendor community to come up with a way of improving ward round note-taking via mobile devices in real time. According to the submission, taking notes that automatically link to the hospital’s electronic medical record can be time-consuming and interrupt team efficiency, as one person has to type the note into the device using a portable keyboard or touch screen.

According to the submission, the clinician is advocating “the development of a system based on ‘operational transformation’ technology as seen in commercial products like Google Wave and Etherpad”. These products “allow several simultaneous users to edit a ward round or admission note in real time, for instance one recording the history while another records examination findings and a third corrects errors. The system should also allow for easy template-based content creation, freeform graphic insertion, and be based on open web HTML5 technologies to be compatible with a broad range of tablets, phones and traditional computers.”

The Clinicians’ Challenge, which is supported by HINZ, the New Zealand Health IT Cluster and the National IT Health Board, will involve three selected vendors and the three clinicians who put forward the challenge to give a five-minute presentation to the judges at HINZ. The winners are expected to finish their proposal by September 1, 2013, and to present their findings at next year’s HINZ conference. Winners will be judged on innovation, feasibility, potential health benefits and the effective use of health workers.

Scientific papers

NZ’s National Shared Care Plan program initially involved eight general practices in greater Auckland and several disease specialties, along with pharmacists and community care services.The technology underpinning the program is HSAGlobal’s Collaborative Care Management Solution (CCMS), a web-based electronic health record and clinical case management solution that is integrated with My Practice, Medtech32 and secondary care systems to support care planning and co-ordination.

Not surprisingly, this project has raised a great deal of interest in New Zealand and beyond. At HINZ 2012, PhD student Helen Gu of the University of Auckland will deliver a paper reporting on the experiences and lessons learned to date from the staged implementation of IT-enabled shared care planning. The paper will outline some observations of the trial and highlight the need for further development in technology and in governance frameworks, including medico-legal, clinical workflows and funding models.

Primary care information architect at Patients First and eHealth standards specialist Peter Jordan will discuss the challenges of implementing the HL7 CDA standard in practical applications. He will examine the development and use of common data models and the NZ CDA Toolkit to generate and consume CDA documents from practice management systems.

Sheree East, director of nursing with Canterbury’s Nurse Maude community nursing service, will discuss the results of a 12-month trial of using Microsoft Dynamics CRM as a fully electronic clinical documentation system in the community setting.

The HINZ Conference and Exhibition will be held at the Energy Events Centre in Rotorua from November 7 to 9. Register online at

Posted in New Zealand eHealth

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