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Welcome to the December edition of Health Care and Informatics Review Online. We present an interesting range of papers, with something of a focus on "exploiting" opportunities in New Zealand data collections.
The edition opens with a paper from Jim Warren, Professor of Health Informatics The University of Auckland, Auckland, New Zealand. In "General Practice EMRs: What they can tell us, and how", Warren considers the tremendous resource that exists in locally-held electronic medical records (EMRs) in General Practice systems. He rightly describes the data held in the Practice Management Systems (PMSs) of General Practitioners as "one of New Zealand’s great health data collections".
Warren identifies and reviews three specific opportunities: evidence-based treatment of hypertension; attaining persistence of chronic disease related prescribing and medication adherence in the community and; improved management of high users of Emergency Department services.
The paper presents a compelling argument for the benefits that would ensure from the development of domain-specific reporting tools to more readily and reliably exploit the potential of General Practice EMRs.
Also focusing in the primary care arena, Steve Creed, Senior Policy Analyst, Outcomes Performance Systems, Health and Disability Systems Strategy Directorate, Ministry of Health, New Zealand presents "The primary health care information environment in New Zealand". Creed describes the approach taken to identifying the current information environment in primary health care. He notes that the Ministry of Health led Key Directions project team responsible for the development of "Primary Health Care Strategy: Key Directions for the Information Environment" has found that the primary health care information environment in New Zealand is not fit for its purpose.
In broad terms, the finding was that the current health environment must be changed from the current patchwork of fragmented systems that are designed to support episodic events which make it difficult to co-ordinate patient care and to dependably identify and subsequently deliver appropriate care to individuals and populations.
Importantly, Creed describes a development path for investment in an information environment that is:
- organised around the needs of people
- flexible enough to meet local preferences
- dependable and maintains high-quality standards
- empowering for all its users.
"What constitutes clinical data?" is presented by Annie Fogarty, Clinical Nurse Director in Acute Care, Counties Manukau District Health Board, Counties Manukau, New Zealand. It outlines the development of a computerised Clinically Integrated System (CIS) Model as a method of collecting and utilising clinical data at the point of patient care delivery.
Multiple complexities that emerged in relation to the collection, analysis and presentation of clinical data during this development process necessitated a broadening of the definition of what constitutes clinical data. An initial perception of clinical data in purely statistical terms had to be widened to include evidence-based practice, clinical redesign, and outcome management.
Importantly, this expanded definition ultimately led to the interlinkage of care delivery, organisational efficiency, interdisciplinary teams, financial, patient and patient’s family. This, in turn, led to the production of new information enabling collective insights, which simultaneously embedded desired changes into clinical practice while developing innovations that benefited the patient.
In "The life of a surgical house officer - why isn’t IT helping us? Endless opportunities", Manoj Patel, PGY3 House Officer, Auckland, considers IT opportunities from the perspective of a busy House Officer in a New Zealand public hospital. Using the approach of "following" a House Officer through a typical day, Patel highlights the many challenges facing a House Officer, many of which relate to information and its availability. The paper offers an important "coal-face" perspective; despite the considerable investment and IT advances that have taken place, it seems that little impact has been made on the house officer’s information requirements. The paper presents a challenge for those developing IT solutions to consider the needs of House Officers in the development and enhancement of IT solutions.
