1 www.moh.govt.nz Debbie Chin_ Deputy Director-General by pengtt

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									             E-health and the E-citizen
              Implementing e-govt through
            developing e-health communities


                  Debbie Chin, Deputy Director-General, Corporate & Information, MoH
                         Peter Aagaard, Senior Advisor, Corporate & Information, MoH
                                                  Tony Cooke, CIO, Hutt Valley DHB



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                  Presentation outline

         • Ministry of Health’s strategic context
              – Debbie Chin
         • Implementing e-health
              – Peter Aagaard
         • A DHB perspective
              – Tony Cooke




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                   A day in the life…
                  157       babies are born
                  73        people die
                  105,000   prescriptions are filled
                  50,000    people take a cholesterol-lowering drug
                  50,000    people take one of the new antidepressants, eg: Prozac
                  40,000    laboratory tests are analysed
                  1,167     people are admitted to our hospitals
                  4,000     outpatients visit hospitals for care
                  432       people have elective surgical operations
                  1,960     people are seen in Emergency Departments
                  27        people are admitted to hospital with asthma
                  50,000    people visit their GP
                  21        people have heart attacks
                  19        people are diagnosed with diabetes
                  637       children are immunised
                  2,124     children and adolescents have a dental check up
                  3,000     new claims received by ACC


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                     Overview of the health sector
                                                 Minster of Health
             Annual output                 Reporting
             plan                                                           Ministerial accountability


                             Ministry       of                       21 District
                             Health (MoH)          Crown Funding     Health
   Private                    Policy advice        Agreement         Boards
                              Funding                                                       Reporting
                              Monitoring
                              Ministerial
                             services               Reporting

                  Service
                  Agreements                                            Internal
                                                                        Service
                        Reporting                   Service             Agreements                       ACC
                                                    Agreements


             Private and NGO Providers                      District Health Boards Provider Arm




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                  MoH IM units                                        Chief Advisor
                                                                        IM Policy
                                                                         Security
                       Deputy Director                                Health Intranet
                   Corporate & Information                              Standards
                                                                         E-health
                   HealthPAC                CA HSIT
                                              Strategy &
                                             Development
  DHBs             Operational             Sector Strategy
                                              • Think-tank
                   Delivery                   • Linkages
                                             & Visionaries

                                     MoH
                       IMAT
                        Managing              NZHIS
                                               Reporting

                     Technology
                    Sector-wide “Common      Information
                                            Monitoring and Analysis
                    Interest Management”
                    development
                    • Project Management
                                                    • Audit
                                              Gathering
                                                 • Compliance
                                                • Performance
                                                                         Sector
                                           & Dissemination
                         • Knowledge
                       Support
                         Management
                        • Development




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                  Implementing e-govt through e-
                  health

                             E-citizen
                             E-patient
                             E-community
                              E-health
                           MoH, DHBs, ACC       E-government
             E-commerce   GPs, NGOs,Hospitals




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                  Implementing e-govt through
                  e-health – vision & mission
             e-government                     e-health

   • Vision: New Zealand is a        • Vision: Ministry of Health
     world leader in e-government      continues to be recognised as
                                       world leader in e-health
   • Mission: By 2004 the Internet
     will be the dominant means of   • Mission: Grow information
     enabling ready access to          systems that support better
     government information,           health outcomes, improve the
     services and processes.           delivery of care, and the
                                       sharing of information.



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                   Implementing e-govt through
                   e-health - goals
                     e-Government                            e-health
•   Better services – more convenient and       •   Ensure the integrated delivery of safe,
    reliable, with lower compliance costs,          high-quality services and support that are
    higher quality and value                        centred on the needs of individuals,
•   Cost effectiveness and efficiency –             families, whanau and communities.
    cheaper, better information and services    •   Develop policy and plan services that
    for customers, and better value for             meet the needs of New Zealanders on the
    taxpayers.                                      basis of evidence.
•   Improved reputation – building an image     •   Allow communities and groups within the
    of New Zealand as a modern nation, an           community, such as Maori, to be
    attractive location for people and              involved in decision-making in the sector.
    business.                                   •   Allow individuals to participate in
•   Greater participation by people in              decisions about their own care and
    government – making it easier for those         support.
    who wish to contribute.                     •   Support ongoing knowledge development
•   Leadership – supporting the knowledge           programmes and strategic planning.
    society through public sector innovation.


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                    Information’s strategic role

    “The ability to exchange high-quality information
        between partners in health care processes will be
        vital for a health system focused on achieving better
        health outcomes.”


    “Better access to timely and relevant clinical information
      can improve clinical decision-making and, therefore,
      health outcomes for individual patients.”
                                        The New Zealand Health Strategy, 2000




           WAVE – Working to Add Value through E-information
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                  Primary Health Care Strategy
    • People have diverse health needs, and use a number of
      services provided by different providers in various
      settings.

    • It is important that there is coordination of care between
      these services, so that the best possible total package
      of care is provided to the patient without unnecessary
      duplication.

    • Accurate and useful information about enrolled
      populations and their health needs is critical to quality
      as well as to the successful adoption of a population
      health focus in primary health care…

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                  NZ international position
         The Australian National Electronic Health Records Taskforce report
            states that the decision by New Zealand


         • “to invest in and promote key items of health
           information management infrastructure has
           positioned it as a world leader in the field,
           particularly in the primary care sector.” [1]

             [1]   A Health Information Network for Australia: National Electronic
             Health Records Taskforce. July 2000. Australian Department of Health
             and Aged Care. p43




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                  Health electronic claims
                              Note: Excludes ACC claims

             Service        Annual volume of       Percent of
                                claims          electronic claims
             Immunisation            142,800           95

             Pharmacy              41,538,000          97

             Maternity               414,000           34

             GMS                    6,808,000          97

             Labs                  17,602,800         100

             Total                 66,505,600

            Plus 8,000 agreements & 6,000 section 88 notices

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                  Embedding knowledge




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                  Selecting the agreement terms




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                  Adding the services




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                  So, good progress..but….
   "In terms of standards and infrastructure,
   New Zealand is ahead of the UK and
   NZHIS has been used as a model for other
   countries, including Singapore." 1

   1http://computerworld.co.nz/webhome.nsf/UNID/43BBCFFAB259B170CC2
   56C8B00731CBB!opendocument




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                  Improving quality
                  – an international challenge
         • In the US (To Err is Human, IOM Report)
              – Up to 88,000 death pa. caused by medical errors: ahead of
                motor vehicles and AIDS
              – Hospital errors exceed $8.8 billion per year


         • In NZ (Peter Davis, National Survey)
              – 4.5% of all hospital admissions associated with highly
                preventable adverse events
              – Adverse events increase average hospital stays by 9 days




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                  How to get there…




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                    Integrated care – changing the
                    information landscape
                       Disease management
         Multiple      Well person programmes        Population
                                                    Management

                                      Whanau care         Needs Analysis
     Patient

                      ‘Traditional’
                          Care
                                                    Team-based – eg MH



         Individual              Provider           Multiple


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                    Improving connectivity
 “The ability of government organisations to share
 information and integrate information and
 business processes by use of common standards”
                                 Def. of interoperability. E-gif v1.0, p7


                  • Right information
                  • Right time
                  • Right person
                  • Right format
                  • Right place


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                      Strategic change management
                  •   Define a goal and a path
                  •   Increase strategic IM capacity (HSIT)
                  •   Establish sustainable structures (HISO)
                  •   Develop sector IM Standards Plan
                  •   Improve communication & coordination
                  •   Undertake IT infrastructure work
                  •   Provide e-health capability
                  •   Develop e-health applications



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                   (1): The WAVE forward…

                                                        Short-Term
                                                      Improvements
                                                   < 24 Months

  WAVE Report
                                                          Incremental
                                                        Improvements
Strategic IT Sector Framework
                                                   2 – 3 years


                                                     Strategic Change
                                                      and Innovation
                                                   > 3 years


           WAVE early Opportunity Identification
                                                         WAVE
                                                   Longer Term Strategic Change




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                  (1): Bridging the Concept
                  Reality Gap
                                     1.   Leap across it- Hope grand vision will carry
                                          across
                                     2.   Narrow the Gap- by moving the concept
                           Concept
                                          closer to reality

Reality
                                     3.   Fill the Gap - The reality can be moved
              Acceptance
                 Gap                      closer to the concept by a series of
                                          interlocking “Smart” projects -
                                          stabilising foundations and building in
                                          an integrated way




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                  (2): MoH Capability                                  Chief Advisor
                                                                         IM Policy
                                                                          Security
                        Deputy Director                                Health Intranet
                    Corporate & Information                              Standards
                                                                          E-health
                   HealthPAC                 CA HSIT
                                               Strategy &
                                              Development

                    Operational             Sector Strategy
                                               • Think-tank
  DHBs              Delivery                   • Linkages
                                              & Visionaries

                                      MoH
                        IMAT
                         Managing              NZHIS
                                                Reporting

                     Technology
                    Sector-wide “Common       Information
                                             Monitoring and Analysis
                     Interest Management”
                    development
                     • Project Management
                                                     • Audit
                                               Gathering
                                                  • Compliance
                                                 • Performance
                                                                          Sector
                                            & Dissemination
                          • Knowledge
                       Support
                          Management
                         • Development




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                   (3): Standards – enabling
                   connections                                               B
                                Governance
                                    HISO
                                                         Messaging (HL7)
                                                            Subsidy claims
              Software                                       Immunisation
                                      Data                  PHO registers
             Accreditation          Person - NHI
                                   Provider - HPI
                                    Facility - HPI
                              Services provided - NFG
                                     Date/time
                                  Diagnosis - ICD
                                        Cost
                                      Outputs
  A                Privacy                              Security
                  HIPC 1994                     Health Network Code
                                                     of Practice

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                  (3) Health Information
                  Standards Organisation
                  MOH    ACC     DHB       Clinical   Primary   External     Pvte   Comm




                                       NZHISO Committee

                    WG 1         WG 2
                     eg.          eg.
                   e-health     Security                                         MoH
                                                  MoH
                  standards    standards
                                               Secretariat                     and other
                                                Support                         sector
                                                                   Liaison      groups
                       HISO/Sector
                     funded working
                         groups
                                                Standards NZ
                                              & other standards
                                                organisations




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                  (4) NZ Health Information
                  Standards Plan - content
         • NZ standards history
         • Why standards are necessary
         • Review of existing standards / proposed initiatives
         • Australian situation
         • Framework for standards development and
           implementation in NZ
         • Process for standards development and
           implementation in NZ
         • Prioritised Programme of implementation actions



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                  (5) Communication
        •   Quarterly Health e-Newsletter
        •   DHB CIO, CFO, CEO, SIG forums
        •   Conferences and presentations
        •   DHB Information Liaison Group - DHB/MoH information
            initiatives and services
        •   MoU developed between MoH & ACC
        •   Linkages with Health Information and Technology Cluster
        •   Health Informatics NZ participation
        •   Examples of excellence studies



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                   (5) Coordination
         • Common DHB ISSP frameworks
         • Transparent investment criteria
         • DHB IM Indicators established for 03/04
              – Electronic referrals & discharges
              – Access to knowledge-bases like Cochrane
         • DAP guidelines
              –   Ethnicity data quality improvement
              –   NHI data quality improvement
              –   MHINC data quality improvement
              –   Outpatient information



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                  (6) Info-structure programme
              • Upgrade of National Health Index (Patient id)
                  –   New search engine
                  –   Change history
                  –   New fields to support population register use
                  –   New geo-coding software
                  –   New architecture population register access
                  –   Better management of data quality
              • Health Practitioner Index (Provider id)
                  – Single identity for practitioners
                  – E-Lookup for practitioners
                  – Linkage to digital security


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                  (7) E-capability
        • Broadband - PROBE
        • PAS - Authentication agreement &
          development project (ACC & E-govt)
        • E-government LEGO project
        • MoH ‘gateway’ - HADIE
        • Telecom Next Generation Internet
        • ProClaim - electronic claiming & data
          processing
        • E-procurement

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                  (8) E-health applications
         •   Capitated Based Funding - PHOs
         •   Electronic laboratory ordering programme
         •   Electronic transfer of lab. data to NCR
         •   National immunisation register
         •   Pharmaceutical special authorities
         •   DSS devolution projects
         •   Maternity section 88 changes
         •   Redeveloped Cancer & Mortality systems


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                  Conclusion
      • Significant progress in increasing e-govt through
        e-health
         – Developing a plan and an implementation
           approach
         – Improving capacity
         – Health Information Standards Plan & Oversight
         – Communication & Coordination
         – Info-structure programme & e-capability
         – E-health applications


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                  A DHB perspective




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                  District Health Boards
         • Key issues
              – Fragmented health care delivery services
              – Allocating best use of resources
              – Patient is not a reliable transport mechanism
                for their own health information
              – Reliance on paper based medical records
              – Health information is “sensitive”
              – Monitoring patient outcomes


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                  E-Health in Action
         • DHBs as users of e-health
              – National Health Index
              – Access to HealthPAC services
              – Healthlink services
                  • Electronic transfer of lab results
                  • Electronic transfer of discharge summaries
              – Web sites
              – On-line access to patient information


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                  Gaps in E-Health
         • Health Practitioner Index
         • Broadband network access (schools, GPs)
         • Community based electronic clinical record
              – Immunisation
              – Upcoming appointments
         • Electronic referrals
         • Order processing



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                  Opportunities for E-health
      • Do away with the paper!
           – Measure outcomes
           – Allocate resources
      • Allow providers to talk to each other securely
           – Information follows the patient
           – Authorised access dependant on role
      • Nivarna: Electronic Patient Records
           – Accessible in more than one place at one time
           – Delivers relevant data at the point of care
           – Legible, timely, accurate, complete


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                  Thank you


       Implementing e-govt through
       developing e-health communities




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