Evolving a Connected Healthcare System

• Abstract
• Introduction
• Developing an Integrated IT Capability
• Building the Health Care Sector’s "Core" Information and Technology Capability
• Rewarding Innovation
• Conclusion
• References

Abstract
The strategy "Evolving a Connected Healthcare System" sets out an evolutionary approach for building towards the ultimate goal of electronic health records and a fully integrated health information system. Retaining an overall vision and building towards it is preferable to a big bang approach which is fraught with risks in design, delivery and ability to implement in timeframes that match business need. All the information and the technology components of the new system must work effectively together when and wherever they are required, even though they may often have been conceived in different parts of the health system.

The emphasis is on collaboration. By working in partnership, everyone involved - government, local health care delivery entities and information technology (IT) suppliers - will have a higher chance of achieving the seamless system that supports new models of the provision of health care services.

The ability to develop a fully integrated IT capability across New Zealand’s entire healthcare sector in a co-ordinated fashion requires that everyone involved is aware of their roles in the process and the expectations of each part of the sector. There is in place a national framework for planning and co-ordinating information and technology work, based on the delineation of local, regional and national roles in IT terms.

A number of initiatives are underway to continue to build the health care sector’s "core" information and technology capability. Most of these have derived from the Top 10 recommendations identified in the 2001 WAVE Report ("Working to Add Value through E-information"). They are a mix of policy and infrastructure projects, supporting national improvements in areas such as the collection of ethnicity information, the privacy and security of health information, information and technology standards, upgrading the National Health Index (NHI), developing a Health Practitioner Index (HPI) and developing a data warehouse of GMS (general medical services) claims.

The swift development of a national IT strategy for New Zealand will require innovation as well as collaboration, particularly in the application of computer technology in the health care provider setting. The recently launched Innovation Awards highlight successful application of IT innovations within health care provider organisations and thus, showcase the health care sector’s innovative information management capabilities and promote knowledge-sharing.

Great progress as been made to date in IM systems and IT capability in the New Zealand health care sector. The sector must continue in a collaborative fashion to build on this foundation to support population-based health care and patient focused delivery of care and services.


Introduction
The strategy "Evolving a Connected Healthcare System" places the emphasis on the journey rather than the destination. While the ultimate goal of electronic health records and a fully integrated health information system is hard to dispute, to reach the end point while retaining health sector commitment, a health care information and technology strategy must deliver the goods within a timeframe that is tolerable to the stakeholders.

Further, the approach must be evolutionary rather than one of incremental steps. Retaining an overall vision and building towards it is preferable to a big bang approach which is fraught with risks in design, delivery and ability to implement in timeframes that match business need. And in doing this, we must ensure that all the information and the technology components of the new system work effectively together when and wherever they are required, even though they may often have been conceived in different parts of the health system.

By working in partnership, everyone involved - government, local health care delivery entities and information technology (IT) suppliers - will have a much better chance of achieving a seamless system that supports new models of the provision of health care services, such as the development and expansion of Primary Health Organisations (PHOs). This approach may also have its difficulties as collaboration comes at a price however the return in the longer term will be greater.


Developing an Integrated IT Capability
To develop a fully integrated IT capability across New Zealand’s entire health care sector in a co-ordinated fashion, everyone involved must be aware of their roles in the process and the expectations of each part of the sector. The national framework for planning and co-ordinating the development is based on the delineation of local, regional and national roles in IT terms.

The National Information Systems Strategic Planning (NISSP) framework^{[ 1 ]} , which was developed with the sector, outlines the division of local, regional and national roles in IT terms and forms the basis of the national framework for planning and co-ordinating information and technology work. This NISSP Framework has already been subscribed to by District Health Boards (DHBs) and the Ministry of Health and, in time, will also form links to incorporate primary care as primary care becomes more formal in its planning approach to information technology. The Ministry of Health has re-focused its efforts around this model as evidenced by the formation of a " Technology Shared Services Group", that enables the national HealthPAC (Health Payments Agreements and Compliance) agency and NZHIS (the New Zealand Health Information Service) to concentrate on improving transaction (claims and contracts) processing and the provision of information for the sector.


Building the Health Care Sector’s "Core" Information and Technology Capability
In addition, a number of other new initiatives have been set in motion to continue to build the health care sector’s "core" information and technology capability. Most of these 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 that was commissioned by the New Zealand Ministry of Health^{[ 2 ]}). They are a mix of policy and infrastructure projects, supporting national improvements in such areas as the collection of ethnicity information, the privacy and security of health information, information and technology standards, upgrading the National Health Index (NHI), developing a Health Practitioner Index (HPI) and developing a data warehouse of GMS (general medical services) claims.

A number of "common" information and technology capabilities, ie, that address areas of development that are desired by the sector and built collaboratively, are under development in partnership with the DHBs and primary care groups; the recent Well Child, Meningococcal and Immunisation projects are good examples of national projects that are well-advanced.

The WAVE Top 10 programmes are underway and have been expanded to include more emphasis on those programmes that will benefit primary care and disability services. Since the inception of the WAVE project, the environment has changed, with the release of the Primary Care Strategy, the Disability Strategy and the development of PHOs, providing a context for the implementation of information technology.

The NHI Programme is underway, aimed at improving the quality and reach of the national identifier. The NHI upgrade programme includes aims of improvement of data quality and improved access to that data for primary care providers. A steering group has been established, a business plan and budget approved and the project execution plan is complete. Many individual sub-projects are underway, including a project to improve the quality of ethnicity data collection.

The HPI project will develop a national application containing core data, ie, reference data that is collected nationally and becomes a standard, on health practitioners and health care organisations and facilities. A business case and proof of concept have been completed and a Privacy Impact Assessment is available for comment.

The Special Authority process will be improved considerably by the ability to apply online for subsidies for approximately 100 drugs for which government approval is required for eligibility for a subsidy. The system will run through a secure network link to HealthPAC and will provide an immediate response to the doctor accepting or declining the application.

The Privacy, Authentication and Security (PAS) project is a joint project between the Ministry of Health and the Accident Compensation Corporation (ACC) and is the foundation for a connected health care system. The project supports consistent privacy and security practices across the sector and is now in the sector consultation phase.

The Health Information Standards Organisation (HISO) is now up and running with wide sector representation to ensure the appropriate development of standards.


Rewarding Innovation
The swift development of a national IT strategy for New Zealand will require innovation as well as collaboration, particularly in the application of computer technology in the health care provider setting. The HINZ and Ministry of Health sponsored Innovation Awards were launched recently with the purpose of finding the projects that have been innovative and have successfully applied these IT innovations within health care provider organisations.

These awards will be made annually and will showcase the health care sector’s innovative information management (IM) capabilities and will allow knowledge already developed to be shared. They have already proven very popular in their first year.

The 2003 winners included: Auckland DHB for their Clinically Integrated System; Electronic Medical Technologies for their online patient management system; Counties Manukau DHB for the Well Child and Diabetes system developed with Orion Systems Software; Hutt Valley DHB’s Regional Health Surveillance System; Otago DHB’s Electronic Prescribing project and ProCare Health for online, evidence-based guidelines.

In addition, a more transparent view on sector IT and IM innovations will be made possible through the online journal Health Care and Informatics Review Online, now sponsored by the Ministry of Health. The Ministry will also provide more support for IT/IM innovation through the health sector informatics research programmes; programme are to be initiated by the universities in conjunction with the NZ Health Information Technology Cluster, made up of a majority of health sector software and hardware vendors.


Conclusion
The New Zealand health care sector has made great progress in its IM systems and IT capability over recent years through both private and public investment. The sector must continue to build on this foundation in order to support population-based health care and patient focused delivery of care and services. All involved must continue to work towards improving the quality of decision-making, information portability and improving the manoeuvrability of sector resources ensuring that they can come together in appropriate forms in a timely manner. None of this can be readily achieved unless we also work on lowering provider compliance costs, continuing to support collaboration and improving consumers’ experience of the health care system.


References
1. Ministry of Health. Framework for DHB Strategic Information System Planning. April 2003.
2. Ministry of Health. From Strategy to Reality: the WAVE Project. October 2001.