HiNZ 2015: National child health IT platform scores early wins

The introduction of an IT platform by the Midlands Health Network that can track a child's health milestones from birth to six has been able to identify over 6000 kids in the Waikato who have missed oral health checks over the last year, potentially saving the district health board millions in the cost of anaesthetising children for tooth extractions.

Midlands Health Network's service manager for child health Bronwen Warren told the Health Informatics New Zealand (HiNZ) conference in Christchurch yesterday that the National Child Health Information Platform (NCHIP) that has been rolled out in the Waikato had also scored some early wins in linking up newborns with GPs, identifying newborns who had missed metabolic screening tests and ensuring children are immunised as close to the schedule as possible.

NCHIP has been built by Orion Health in association with the Best Practice Advocacy Centre and is set to roll out in Tairawhiti next month, followed by Taranaki in January and the Lakes region in March. The gradual roll-out is part of plans for a national system that will eventually cover all children up to the age of 18.

NCHIP is a shared data repository, with access available to six different provider groups involved in the care of a child up to the age of six, including the national immunisation register, lead maternity care (LMC) midwives, Well Child/Tamariki Ora providers, hearing and vision teams, oral health providers and GPs. GPs can access the system through an icon on their desktop if they are using Medtech32.

It also involves a Child Health Coordination Service (CHCS) based in Hamilton. All Waikato newborns are now being registered on NCHIP at the same time they are registered for the national immunisation register, and are then followed up to ensure they are immunised at six weeks, three months and five months.

The system also provides a shared view of the 27 other milestones a child should complete by the time they are six, such as Well Child checks, hearing and vision checks and B4school checks. Children who have not been enrolled in a general practice are also followed up.

The system also includes an eReferral function from the LMC to the GP and the Well Child provider, but the plan is to include more referral capability.

While there are plans over time to add more information from other service providers and the data of all children up to the age of 18, at present it is designed to ensure that no child falls through the cracks.

Ms Warren gave the example of a GP who contacted the service recently looking for contact details for the family of a seven-month-old child who had missed an immunisation at five months. There were three known addresses for the mother but she could not be contacted at any of them.

As the service has partnered with the Ministry of Social Development and the Ministry of Education, each agency is able to contact the others to see if they have any information about a particular child. One had a phone number at a fourth address, and the mother was able to be contacted.

“She was reminded that the baby was due for another immunisation and that child was taken to the general practice that afternoon and immunised,” Ms Warren said.

While individual stories are powerful, Ms Warren said the new platform had been able to support providers across the board. For instance, it has been able to connect more than 300 newborns with their family's GP, at a rate of about 10 to 12 per week.

“We have noticed that modern mothers will opt to not register their child at their family GP but at the general practice that is nearest to their work,” she said. “We've had a number of conversations with general practice and the families in order to correct that.”

It has also identified more than 60 newborns for whom there were no metabolic screening results, and more than 6000 children who had missed out on dental checks, she said.

“We did a cross-match from our data to [the oral health service's] data, and we found them 6000 children. Currently in the Waikato, the DHB is spending $2.5 million per year to anaesthetise young children and take their teeth out. We are really hopeful that we can reduce that number.”

The system is about to roll out to Tairawhiti, where it is being interfaced with the national Maternity Clinical Information System (MCIS) as well as the Titanium electronic record software used by oral health providers.

Ms Warren said NCHIP was also being aligned with Midland PHO's mobile immunisation service, B4school check and school clinics. “At the moment they are very siloed – different data systems, different staff doing a discrete role – so we are looking at how we can integrate that and essentially walk the talk that we are speaking to our providers about.”

Data from 27,000 children aged nought to six was uploaded in May, and Ms Warren said next year the plan was to add the six- to 18-year-olds. “There are fewer milestones for the age bracket but the Ministry is talking about contributory measures around health targets,” she said. “I have a few ideas on that.”

Public health nurses and clinicians in hospital accident and emergency departments can also access the information as long as they have the child's NHI number. Ms Warren said this would support things like opportunistic immunisations.

And while only clinicians have access at the moment, Ms Warren said there were long-term plans to provide access to the system to parents through patient portals, although that would prove a challenge in terms of integration, she said.

Posted in New Zealand eHealth

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