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Introduction
It is with great pleasure that we present the first edition of Health Care and Informatics Review OnlineTM. This quarterly series is effectively a re-launch of the journal Healthcare Review - OnlineTM which has been published regularly and distributed via the Internet since 1996. The focus of Health Care Review OnlineTM was to review and offer information on major themes in health services policy, planning and its implementation, facilitating the dissemination of experience from one national setting to another.
The name change to Health Care and Informatics Review OnlineTM and the re-launch of the Journal reflects an expansion in scope, starting with this edition, that brings a particular focus onto clinical informatics.
Health Care and Informatics Review OnlineTM aims to create awareness and generate interest in clinical informatics. The Journal will focus on review articles that communicate the learning experience of the use of clinical informatics in real world settings. It provides contributing authors with the opportunity to outline their informatics related work and the experience related to that work, with the purpose of communicating and sharing the learning experience.
Health Care and Informatics Review OnlineTM is published with the support of the New Zealand Ministry of Health. The Ministry supports and encourages continual improvement of care and services in the health and disability sector and recognises the role that Health Care and Informatics Review OnlineTM can play to promote the sharing of experience, the dissemination of information and the advancement of discussion in the important area of clinical informatics.
The health sector in New Zealand has experienced many changes over recent years both structurally and technologically. The current round of health reform in New Zealand is building a new way of delivering health care - developing a system that focuses on wellness rather than illness, on promotion of collective responsibility for population health and on co-ordination of individual patient’s treatment. Emphasis is on collaboration and an incremental approach to system development.
In this edition "Building the Health System of the Future: IT and IM as building blocks", we consider the roles of information management (IM) and information technology (IT) in developing such a health system.
Health care has been described as perhaps the ultimate information worker environment[ 1 ] . Gathering, interpreting, acting upon and disseminating accurate and timely information is at the very core of medical practice. The increasing requirement for access to and dissemination of the "right" information, in the midst of today’s high-tech computing and communications environment, make IT and IM significant tools for enhancing health care delivery.
We open with a Guest Editorial from Dr Peter Davis, Professor of Public Health, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand. Dr Davis offers an initial interpretation of the papers included in the edition, with an emphasis on the parts of the overall picture that each paper informs. Such a guest editorial from a member of the Journal’s Editorial Board will be a standard feature in each edition of this Journal.
We are pleased to have the opportunity to present two papers based on material presented at the recent Health Informatics New Zealand (HINZ) conference held in Auckland, New Zealand, August 2003. Both papers highlight the critical roles of IM and IT in building the health system of the future and discuss how these tools can be most effectively deployed.
The HINZ conference, jointly organised by four professional health-related groups - HINZ, the NZ Health IT Cluster, the NZ Institute of Health Management and the NZHL7 Users Group - and the Ministry of Health, showcased the best of what New Zealand has to offer in terms of product innovation but, even more importantly, in terms of IT initiatives that demonstrate collaboration between different parts of the health sector.
The combination of academics, health care managers, health care providers, government ministries and competing IT vendors that attended the HINZ conference makes events such as this a rare and precious occasion, largely because of logistical issues associated with bringing these disparate health professional groups and the IT industry together. Conferences such as HINZ play an important role in revealing the capabilities of IT to an audience that has front-line experience of the health care system and is in a position to apply the reality challenge.
In the first of two papers based on presentations at HINZ, "Evolving a Connected Healthcare System", Mike Rillstone, Chief Advisor, Health Sector Information & Technology, New Zealand Ministry of Health reviews the strategy which sets out an evolutionary approach for building towards the ultimate goal of electronic health records and a fully integrated health information system. He emphasises the need for collaboration and for an incremental approach while retaining an overall vision, combined with the absolute requirement for all information and technology components of the new system to work together effectively even when they may have been conceived in different parts of the health system.
Rillstone highlights the need for a co-ordinated approach to the development of fully integrated IT capability across New Zealand’s entire healthcare sector, drawing attention to the national framework for planning and co-ordinating information and technology work, based on the delineation of local, regional and national roles in IT terms.
He goes on to review briefly a number of initiatives underway that continue to build the health care sector’s "core" information and technology capability, most of which have derived from the Top 10 recommendations identified in the 2001 WAVE Report ("Working to Add Value through E-information", a programme to develop a Health Information Management and Technology Plan commissioned by the New Zealand Ministry of Health).
Rillstone concludes by highlighting the progress made to date in IM systems and IT capability in the New Zealand health care sector and the need for the sector to continue to work collaboratively to build on this foundation to support population-based health care and patient-focused delivery of care and services.
In "The Health System of the Future", our second paper from HINZ, Phil Brimacombe, CIO, Counties Manukau DHB and Waitemata DHB, Auckland, New Zealand and Ian Rowe, IS Enterprise Architect, Counties Manukau DHB and Waitemata DHB, Auckland, New Zealand, propose practical models for making the health system of the future work. These models address both structure and information systems.
Employing concepts derived from many years’ experience at Counties Manukau District Health Board (DHB), Auckland, New Zealand, the paper proposes a guide by which all parties in the health sector might deploy information system tools that enable, support and drive new health strategies and thus achieve the gains in population health status that such strategies are designed to provide. Strong recommendation is made for broader uptake of proven, successful, practical methods and solutions.
In keeping with Rillstone, Brimacombe and Rowe emphasise the need for a co-ordinated and common approach to information systems investment and to information sharing technology. They note that experience in Counties Manukau DHB has demonstrated that collaboration and an incremental approach are critical success factors for achieving the New Zealand Health Strategy and making the Health System of the Future a reality for today.
"Health Information Standards in New Zealand: Part 1" is presented by Paul Cressey, Inaugural Chair, HISO Committee, Managing Director, East Health Services Ltd, and Deputy Chairman, Counties Manukau DHB, Auckland, New Zealand. Cressey summarises progress to date with the establishment of a Health Information Standards Organisation for New Zealand (HISO). HISO, established in June 2003, is intended to lead the development and implementation of IM and IT standards for the health and disability sector, effectively putting into place the building blocks for current and future health IM and IT developments. The organisation has a role in ensuring that relevant and prioritised standards are identified for development and that these are implemented effectively for the overall benefit of the sector.
In consultation with representatives from the health and disability sector at the request of the Ministry of Health, the publication From Present to Future: a National Health Information Standards Plan for New Zealand was developed, and has been presented as the proposed work programme for HISO.
In particular, HISO is responsible for requirements stemming from the WAVE report "From Strategy to Reality", which makes 79 recommendations aimed towards improving the quality of New Zealand health information management and, ultimately, the quality of health care throughout the country.
HISO will "open for business" early in December 2003. Health Care and Informatics Review OnlineTM will report on the organisation’s progress in "Health Information Standards in New Zealand: Part 2" to be published in early 2004.
Our final paper in this inaugural issue provides a specific example of the application of information management systems to improve health outcomes. In the paper "Clinical Information Systems in Oncology - Making a Difference to Patient Outcomes", Andrew Miller, Medical Head of Radiation Oncology, Palmerston North Hospital, Palmerston North, New Zealand, details the development of the Oncology Information System (OIS) from paper format to a modern unified electronic system, highlighting issues of choice, implementation and use. He discusses various patient outcomes and highlights the impact of electronic systems within oncology on these outcomes.
Using the example of changes implemented in one New Zealand centre, Miller clearly demonstrates that the OIS is more than just a paper substitute, highlighting that a clear advantage of the newer system is its capacity to re-use data and to quickly and repeatedly apply quality assurance to prospectively collected data.
Louise Kirkwood
Managing Editor
Health Care and Informatics Review Online
1. Crounse B. Global healthcare industry manager, Microsoft Corporation. Healthcare 2005.
