Health Information Standards in New Zealand

• Abstract
• Introduction
• The Health Information Standards Organisation
• Health Information Standards Organisation Membership
• Health Information Standards Organisation Terms of Reference
• Health Information Standards Organisation Structure
• From Present to Future: a Draft National Health Information Standards Plan for New Zealand
• Next Steps
• References

Abstract
The Health Information Standards Organisation (HISO) Ministerial Committee was established in June 2003, linking policy makers, providers and funders from throughout the health and disability sector. The requirement for a health information standards organisation for New Zealand was identified in the Working to Add Value to E-Information (WAVE) project, published in October 2001.

From Present to Future: a National Health Information Standards Plan for New Zealand was developed, in consultation with representatives from the health and disability sector at the request of the Ministry of Health and has been presented as the proposed work programme for HISO.

HISO holds a key co-ordination role, leading the development and implementation of information management (IM) and information technology (IT) standards for the health and disability sector, effectively placing the building blocks for current and future health IM and IT developments. It has an interest 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 particular, HISO is responsible for those requirements stemming from the WAVE report "From Strategy to Reality", which makes 79 recommendations towards improving the quality of New Zealand health information management and ultimately the quality of health care throughout the country.

HISO offers an excellent opportunity to make a real difference in developing a better information management environment in the health and disability sector.


Introduction

Perceiving that sound information systems are crucial to improving the health status of New Zealanders and to the efficient and effective operation of the health and disability sector, the government announced in late 2002 the formation of a New Zealand Health Information Standards Organisation (HISO).

With a role incorporating identifying, developing, publishing, promoting and monitoring New Zealand’s health information standards, HISO would be charged with putting in place the building blocks for current and future health information management (IM) and information technology (IT) developments. In particular HISO would be responsible for those requirements stemming from the Working to Add Value to E-Information (WAVE) report The WAVE Report "From Strategy to Reality" published the findings of a team drawn from the Ministry of Health, District Health Boards, primary care providers and other players in the New Zealand health sector to survey and analyse the current state of health information management in New Zealand. The report, published in October 2001, made 79 recommendations towards improving the quality of New Zealand health information management and ultimately the quality of health care throughout the country. The "Top 10" priorities selected by the Advisory board are shown in figure 1.

Figure 1: Top ten priorities from the WAVE report

The Health Information Standards Organisation
The WAVE Plan anticipated the establishment of the HISO, which would report to the Minister of Health. The HISO would take on a key co-ordination role, leading the development and implementation of information management (IM) and information technology (IT) standards for the health and disability sector. It would have an interest in ensuring that relevant and prioritised standards were identified for development and that these were implemented effectively for the overall benefit of the sector.

In June 2003, the current Minister of Health, Hon Annette King, announced 10 appointments to the Health Information Standards Organisation Ministerial Committee.

This new committee, which first met in late June 2003, links policy makers, providers and funders from throughout the health and disability sector. It offers an excellent opportunity to make a real difference in developing a better information management environment in the health and disability sector.

The committee members have been drawn from across the health and disability sector and include representatives of DHBs, professional and industry organisations, the government sector and the community. Current members include sector representatives from the Accident Compensation Corporation, the Independent Practitioners’ Association Council, the Royal New Zealand College of General Practitioners, the New Zealand Nurses Council, Ministry of Health, DHB NZ chairs, DHB CEOs, NZ Pharmacy Guild and a chairperson with a background in various parts of the health sector.

The HISO is to receive seed funding from the Ministry of Health for the first year and then it is intended that ongoing funding will be drawn from the various contributing health and disability sector organisations.


Health Information Standards Organisation Membership
The current HISO Ministerial Committee members are:

Chairperson: Paul Cressey
Paul Cressey, a pharmacist, is Managing Director of East Health Services Ltd and Deputy Chairman of the Counties Manukau DHB. Additionally he is member of the WAVE Advisory Board, Chair of the Health Intranet Governance Board and a member of the Injury Surveillance Ministerial Advisory Panel. He has an in-depth experience in pharmacy, primary care, and has held various committee roles with the Independent Practitioners Association Council.

Chai Chuah, District Health Boards Chief Executives Group
Chai Chuah is currently CEO of the Hutt Valley DHB. Previously, Chai worked for Canterbury Health Ltd in a number of roles including Acting Chief Executive, Chief Operations Officer and Chief Financial Officer. He also has 10 years’ experience with Coopers & Lybrand, consulting in management and accounting. Mr Chuah holds a commerce degree from Canterbury and is a long-standing member of the Institute of Chartered Accountants.

Dr Tim Gardner, Royal New Zealand College of General Practitioners
Dr Tim Gardner is currently working as a solo practitioner at the Dunedin Outram Medical Centre, a fully computerised practice that is affiliated to Southlink Health. Tim has been a doctor for 20 years. He has held positions in several Christchurch hospitals and has been a Paediatric Registrar at Dunedin Hospital. He has taught in the Department of General Practice in Dunedin and in 1997 was awarded New Medical Council accreditation as a teacher in 7th Year. Other positions held include membership of the Executive Otago Division of the NZMA and the Otago Division of the RNZGP Executive. He has been a member of the RNZCGP Information Committee and the WONCA Classification Committee since 1994 and 1995, respectively.

Ken Leech, Independent Practitioners Association Council
Ken Leech, Information Systems Manager for ProCare Health Limited, has been an information systems professional for over 25 years, with more than four years’ experience in the primary health care sector. He chairs the IPAC Information Management Forum. His previous experience includes working as a project manager and consultant for various British and North American organisations. His last role prior to ProCare was with Azimuth Consulting Limited.

Sandy Grey, New Zealand Nurses Council
Sandy Grey, an independent midwife practitioner with 17 years’ experience, currently works in a group of eight midwives in West Auckland. She has been National President of the New Zealand College of Midwives (NZCOM) since 1997 and has been involved in various sector groups including the technical group for the development of a national perinatal database and the RHA National Referral Guidelines project. She has been the NZCOM representative in the Section 88 negotiations. She regularly participates in the NZCOM Standards Review Process and holds an Advanced Diploma of Nursing.

Debbie Chin, Ministry of Health
Prior to taking up the position of Deputy Director-General of Corporate and Information, New Zealand Ministry of Health, Debbie Chin was a partner of KPMG. She combines her professional background in accountancy and financial management with significant local and central government consultancy experience with a specific interest in health. She spent four years on secondment to the Department of Prime Minister and Cabinet providing advice to the Prime Minister on Health, ACC and Local Government. She subsequently became a committee member of the National Health Committee and was jointly responsible for a report on Working Towards Improved Maori Health Outcomes.

As member of the WAVE Advisory Board Debbie was responsible for providing support to the Board. She was appointed to the Ministerial Committee on the establishment of HISO and the State Services Commissioner’s e-government interoperability Framework Committee. Debbie is also convenor of the Health Intranet Governance Body and a member of the Australian National Health Information Management Group that reports through to Australasian Health Ministers. Debbie has also been a member of the institute of Chartered Accountants’ National Public Sector Committee.

David Rankin, Accident Compensation Corporation
David Rankin is General Manager, Healthwise, ACC, where he has worked since 1998. This position has responsibility for purchasing health services for treatment of the 1.5 million claims by New Zealanders for injuries each year. David holds a Master’s degree in Health Administration and a Master’s degree in Public Health, both from Loma Linda University, California. He gained a Diploma in Obstetrics from the University of Auckland in 1985 and an MBChB from the University of Otago in 1982.

Julian Inch, DHBNZ Board
Julian Inch is the CEO of DHBNZ. His experience in the health sector includes roles with the Ministry of Health, health funders and health providers. Julian has held management positions in strategy, policy and funding teams where health information is used.

Murray Burns, Pharmacy Representative
Murray is currently Chief Executive of the Pharmacy Guild of New Zealand. He has 20 years’ experience in public sector roles including Chief Executive Officer of the Central Regional Health Authority, General Manager of the Works and Development Services Corporation (NZ) Ltd, General Manager of the Corporate Services and Company Secretary, Works and Development Services Corporation (NZ) Ltd. He was chair of the former Health Benefits Ltd. He also holds directorships for Lumley Investments (NZ) Ltd, Pharmaceutical Services Ltd, Manawatu Community Pharmacy Group Ltd and PrimeNet Ltd.

Helmut Modlik, Maori Representative
Helmut Modlik’s iwi affiliations include Ngati Toa, Ngati Tama and Te Ati Awa. He has comprehensive experience working with Maori organisations including Nga Ika a Tangaroa Ltd, Te Hiku o Te Ika Ltd and Poutama Trust. He has been the Acting Manager Maori Health Policy, Ministry of Health, Programme Manager at the Ministry of Health overseeing the formation of PHOs and Change Manager for the Health Funding Authority. He is currently a Director of Arrus Noble Developments, a consultancy firm specialising in the provision of economic and business development services, and is a member of the Capital and Coast DHB and PHARMAC Boards.


Health Information Standards Organisation Terms of Reference
The terms of reference for the HISO have been set out by the Minister of Health under nine major headings:

1. Strategic oversight - To develop an integrated, sector-wide strategic perspective of the relationship of health care initiatives to relevant standards.
2. Prioritisation - To develop a co-ordinated view of the relative importance of the various health information standards in New Zealand.
3. Quality Assurance - To review the existing health care sector standards, plans and activities and to subsequently confirm appropriate sector-wide plans.
4. Championing of emergent standards - To review the existing health care sector developments where standards, eg, for activities such as electronic referrals and discharges, are being developed and tested, and to support these endeavours.
5. Standards development - To facilitate the development of sector-wide standards where these are required but where such moves are not already underway.
6. Development funding options - To recommend how specific standards’ developments should be funded.
7. Endorsement - To agree on a suitable set of existing health information standards.
8. Advocacy - To promote the adoption of standards endorsed by the HISO.
9. Monitoring - To review the progress of standards developments and the implementation of standards.

Health Information Standards Organisation Structure
HISO’s structure is shown in figure 2.

Figure 2: HISO struture

From Present to Future: a Draft National Health Information Standards Plan for New Zealand
From Present to Future: a National Health Information Standards Plan for New Zealand was developed, in consultation with representatives from the health and disability sector, at the request of the Ministry of Health and has been presented as the proposed work programme for HISO.

The Plan was published in June 2003 and is available on the website of the Ministry of Health.^{[ 2]}

The purpose of a National Health Information Standards Plan is to ensure that accurate health information is uniformly collected, collated and made appropriately available throughout the health and disability sector in New Zealand. This will have major benefits in many areas of operation, including strategic planning, business processes and clinical practice, and will lead to improvements in the health status of all New Zealanders.

The plan will provide a foundation from which to systematically but rapidly advance the New Zealand information standards agenda as well as a framework for describing health and disability sector priorities; standards development processes; governance issues and practice; development and implementation planning; and a work programme for the HISO. To succeed, it must be a practical, sector-based plan, to ensure that all relevant interested parties and institutions support and implement the plan.

The Draft National Health Information Standards Plan, provides the framework and the guiding principles for the development and national application of health information standards and management. It outlines the roles and responsibilities of organisations and personnel in the sector and the processes by which national health information standards could be achieved.

The Draft Plan addresses the importance of standards, the current status of standards settings in New Zealand, and e-government initiatives. The Plan presents a proposed framework and process for standards development and implementation and reviews types of standards and their different management. In addition the Plan makes proposals for standards development processes and for HISO’s relationship with the sector and the role of Working Groups. The following recommendations are made for consideration:

Recommendation 1
The framework and guiding principles described in this plan be adopted by HISO and the sector as the approach to national standards development for the sector.

Recommendation 2
That the sector responsibilities for liaison with the Australian standards groups be determined as soon as possible to ensure appropriate two-way linkages between New Zealand and Australian health sector standards efforts to maximise leverage.

Recommendation 3
A Programme Manager-Standards be appointed to the Ministry of Health with responsibility for driving and maintaining the standards programme including formal quarterly updates.

Recommendation 4
Priority be given to formalising the standards plan work programme and advancing the high priority actions identified.

Priority Initiatives
The Draft Plan summarises a number of business process/transaction and information areas where there is a requirement for standards to be adopted or enhanced that will need to be prioritised.

• A national data dictionary
  • A central repository of confirmed and pending standards for the New Zealand health and disability sector
• Population-based funding data
  • A population database to support capitation-based funding
• Well child data, including immunisation and meningococcal information
  • A central register of all immunisations
• Discharge summaries
  • Electronic capture and distribution of discharge summaries
• Laboratory information, including orders, results reporting and results repositories
  • Electronic capture and distribution of laboratory orders and reports
• Privacy, authentication and security
  • The development of privacy, authentication and security frameworks and standards to support e-health transactions
• Ethnicity
  • Improving the collection and storage of ethnicity data
• Pharmacy data
  • Enhance the current national pharmacy data warehouse
• NHI data
  • Improvement of data quality in all NHI fields, reducing duplication and improving access for all providers
• A health provider index
  • An authoritative source of health practitioner information including an identifier for all health professionals
• Vendors’ systems, in particular general practice management systems
  • A sector wide liaison and change management framework, standards and accreditation framework for primary care practice management system vendors
• Clinical audit
  • A standard code set to handle clinical audit for accreditation and benchmarking
• Referral summaries
  • Electronic capture and distribution of referral summaries
• Chronic disease state management
  • The development of datasets and HL7 messages for chronic diseases such as diabetes
• Primary care data
  • Collection of quality data on provision of primary care
• Disability support services /health of older people
  • The rollout of the responsibility of DSS to DHBs will require information collection
• Claims
  • Standardisation of electronic claiming from different agencies, eg, ACC, HPAC, medical insurance
• Best practice, evidence-based guidelines
  • The development of a knowledge architecture and standards to support the use of evidence based guidelines
• Outpatients
  • The agreement of a national minimum dataset and coding standard for outpatients data
• Emergency department
  • Agreement of a national minimum data set and coding standard for emergency department data
• Radiology images
  • Agreement on a national standard for radiology images such as the implementation of DICOM messaging and storage
• Prescribing
  • Development of a coding standard for GP prescriptions, the implementation of electronic prescribing, the implementation of a drug formulary in GP Practice Management Systems, and incorporating the Pharmac Drug Schedule into PMS systems
• PHO data
  • The agreement of a national minimum data set and coding standard for PHO data

Next Steps
It is now five months since HISO first met. The chairman of HISO, Paul Cressey has indicated that HISO will "open for business" early in December 2003.

This journal will report on "HISO - Open for Business" in early 2004.


References
1. Ministry of Health. From Strategy to Reality: the WAVE Project. October 2001
2. Ministry of Health.From Present to Future: A Draft National Health Information Standards Plan for New Zealand. June 2003.