eHealthNews.nz editor Rebecca McBeth

Digital health was a big winner at the 2020 Hi-Tech Awards with Emergency Q and Precision Driven Health scooping three awards between them.

DHB ICT staff have also been recognised as finalists in this years CIO Awards.

Emergency Q, a Kaupapa Maori software company that built a digital platform to reduce overcrowding in hospital Emergency Departments, won The Callaghan Innovation Maori Company of the Year Award and the Kiwibank Most Innovative Hi-Tech Service Award.

Precision Driven Health won the Visa Hi-Tech Solution for the Public Good award for the partnership’s freely accessible surgical risk calculator, nzRISK. 

Emergency Q chief executive Morris Pita says that since 2017, more than 40,000 patients have used the platform to leave ED a few minutes after arrival and receive treatment in primary care for primary care problems.

“These two awards are a fantastic reflection of the  sustained hard work and innovation of our team whose daily focus is to identify ways to help whanau in need find the primary care services they require in a way that frees up our busy hospital ED nurses and doctors to focus on patients with higher levels of acuity,” he says. 
 
The company was contracted by the Ministry of Business, Innovation and Employment this year to add Covid-19 specific screens to its free patient app.  

These new screens direct people to Covid-19 testing centres, support services such as foodbanks and mental health services.

Precision Driven Health’s nzRISK tool is one of the first applications of machine learning in health in New Zealand and delivers multi-level impacts, including improved surgical outcomes through more accurate risk assessment and immediate cost savings for hospitals. 
 
PDH chief executive Kevin Ross says the award comes at a time when the world is seeing the value of data in health, and in good data science. 

“The nzRISK project is one of our favourites because it demonstrates true collaboration across healthcare, industry and academia, with major contributions from Auckland District Health Board and Orion Health,” Ross says.

The Hi Tech Awards judges commented that PDH is a great example of a public-private partnership created to develop freely available, innovative solutions to improve public health outcomes in New Zealand.  

The finalists of the 2020 CIO Awards have been announced with Counties Manukau Health a finalist for the Best ICT Team Culture. 

The award, "recognises outstanding team culture within an organisation's ICT team where fostering team culture, retaining and nurturing a diverse IT staff has created a competitive advantage for the entire organisation". 

Stella Ward, chief digital officer at Canterbury and West Coast DHBs is also a finalist for CIO of the year. Ward recently resigned from her role at the DHBs amongst an exodus of senior executives from the organisation.

If you would like to provide feedback on this news story, please contact the editor Rebecca McBeth.

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eHealthNews.nz editor Rebecca McBeth

eHealthNews.nz is encouraging readers to show their appreciation for some of the unsung heroes of the health system’s response to Covid-19 – IT staff and teams.

Ministry of Health deputy director general Shayne Hunter is the first to says thanks on behalf of the Ministry, “to the many people and organisations who have stepped up big time, in what can be described only as extraordinary circumstances.

He says, “people who work in the areas of ICT, data and digital have been vital to stopping the spread of COVID-19 and keeping New Zealanders safe and working”.

Examples include; enabling people to work remotely and access health services through virtual consultations; accelerating the move by the sector to the cloud and Microsoft and AWS platforms; developing apps and other tools to enable new ways of working; providing or enabling access to timely data and information; removing paper from key processes; and much more.

Hunter says, “it has been humbling to see people coming together so quickly, and in ways we haven’t seen before, to solve problems and deliver new services, and maintain business continuity.

“The hours worked and the effort has been huge.

“Our challenge now, as we start to think about the move to lower alert levels, is to take on board what we’ve learned, lock in and harness the great things we’ve achieved together and build on this,” he says.

National Telehealth Leadership Group chair Ruth Large agrees that IT teams need a vote of thanks, saying “it has been the IT staff pulling the all-nighters to keep the health system running”.

If you have an individual or team you would like to thank, send your message to editor@hinz.org.nz along with a short description (100 words or less) of the hard work you’ve appreciated over the past couple of months.

These messages of support will be published on eHealthNews.nz and some individuals will be invited to participate in a webinar to share their stories and answer questions about their work.

Read Shayne Hunter’s full message of appreciation here.

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For more information and resources about COVID-19 go to https://www.hinz.org.nz/page/covid19

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eHealthNews.nz editor Rebecca McBeth

In our second round-up of news from health providers across New Zealand during Covid-19, eHealthNews.nz focuses on how they are using data and digital services to provide care in the community.

Government funds eMental health tools

The Government is funding the use of three eMental health tools for Kiwis wanting to look after their mental wellbeing as a result of change and uncertainty from COVID-19.

The tools are: the Mentemia app developed by former All Black Sir John Kirwan; a self-management platform from Melon Health; and an e-therapy programme called Staying on Track.

They are being funded by the initial $500m Covid-19 response health package, announced prior to the lockdown.

Health Minister David Clark says the online tools give people practical ways to support their mental wellbeing.

The Mentemia app was originally aimed to be released just to workplaces but extra funding from the Ministry of Health means it will be available free to Kiwis throughout the Covid-19 response.

The Ministry is also working with Mentemia to create content and tools specifically to support front line health workers and government employees in essential services.

Plunket delivers virtual visits during lockdown

Plunket is delivering its Well Child services via telehealth during lockdown with Plunket nurses supporting families either via phone or video conference.

The organisation had been planning to introduce virtual consultations, but this was fast tracked due to Covid-19.

PlunketLine also continues to provide 24/7 support and the care provider is running Facebook Live chats.

All whanau enrolled with Plunket have access to online parenting education programmes, virtual community groups and other forms of parenting support.

Allied health goes virtual

Active+ allied health professionals are offering virtual appointments during lockdown.

Active+ director and physiotherapist Andy Schmidt says physios are providing rehabilitation exercise programmes to support those injured and rehabilitating at home with video-based exercises and reporting.

“We have also launched a number of free to air exercise programmes via social media,” he says.

During a consultation, physios ask a series of questions and get the patient to carry out movements and actions on camera, so they can make an assessment. They can then give advice on managing the injury, prescribe exercises and arrange further appointments.

Schmidt says physio clinics are seeing about 25-30 percent of the appointments they normally would via telehealth. ACC claims are reduced by about 70 percent and some people may not realise what can be done via telehealth, but those using the virtual service are positive about it.

The organisation also has occupational therapists, psychologists, dieticians and social workers providing telehealth in the community.

The Southerly tackles mental health in Gore

The Gore district is using a new curated mental health and wellbeing content service within the community as part of its Covid-19 response. 

Developed by HealthTRx, the evidence-based content service guides people with practical steps to strengthen their own and others’ mental health and wellbeing and supports people to stay well and resilient as the nation transitions through Alert Levels. 

Project management lead Penny Marlowe says, "we know the pandemic has placed the mental health of New Zealanders at heightened and unprecedented risk. 

"We are already seeing the challenging effects of isolation in lockdown, stress, anxiety and more. Research tells us these effects may well be long-lasting," she says. 

Health Care Home practices embrace telehealth

General practices transitioned a predicted ten-year process to telehealth services over the course of a weekend, the Health Care Home Collaborative says.

As part of its response to the Covid-19 Pandemic, the Collaborative moved fast to open telehealth and clinical triage resources support to all primary health organisations and practices prior to the RNZCGP college directive to conduct all initial patient consultations via telehealth.

Nicky Hart, chief executive of Feilding Health Care says, “we need to acknowledge that General Practice may never look the same, which when condensed brings its own hurdles, but also opens the way for a new and exciting landscape to benefit both practice teams and patient outcomes”.

If you would like to provide feedback on this news story, please contact the editor Rebecca McBeth.

Read more news:

Contact tracing app weeks away
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For more information and resources about COVID-19 go to https://www.hinz.org.nz/page/covid19

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Picture: Doctors from Counties Manukau Health using the one of the new devices. 

eHealthNews.nz editor Rebecca McBeth

Counties Manukau Health has introduced more than 500 Windows 10 tablet devices for clinicians to use in hospital patient care and on community home visits.

The project started rolling out in September 2018 and now has more than 500 large and small screen devices used across the organisation, including 90 of the Microsoft Surface Go.

The Surface Go uses secure facial recognition for fast login and is installed with the organisation’s top 15 clinical apps, including Clinical Portal, eReferrals, eRadiology, ePrescribing and eVitals.

Health informatics and medical administration fellow Brian Yow says the mobile devices empower staff by allowing them to do things such as remotely view results and sign-off letters, as well as facilitate patient care by showing X-rays and ordering tests at the bedside.

Clinical director of information systems Tina Sun says “having clinically relevant information readily available at the bedside improves efficiency and allows us to release time back to clinicians to focus on patient care”.

A time-and-motion study of more than 500 hours pre- and post-roll-out of the devices showed clinicians were able to save an average of 30 minutes per shift after the devices were introduced.

Yow says the productivity gains offset the device costs in a few months and the tablets last for several years, which brings significant improvements for patient care and clinical efficiency.

Deputy chief information officer Megan Milmine says they have found it is best to assign the tablets to individuals to ensure maximum use and personal responsibility for keeping them safe and charged.

Access to the clinical systems relies on clinical staff being on the hospital network; however, there is some ability to securely view patient information from home via Citrix.

Milmine says this means on-call staff can securely review patients under their care from any setting, even at home, often saving the need to go into hospital, saving them time and improving their work-life balance.

She says the digital mobility project is about releasing time to care and involved a lot of work on infrastructure to ensure there is a fast and reliable wi-fi connection for clinicians on the move.

CM Health has also introduced other devices such as iPads for nurses doing eVitals and workstations on wheels.

“We have been on quite a journey to arrive at what we think is the right device mix, and we continue to scan the market for new ideas and devices. We do a full survey on any new devices trialled to ensure we choose those that meet the majority of people’s needs,” says Milmine.

If you would like to provide feedback on this news story please contact the editor Rebecca McBeth.

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eHealthNews.nz editor Rebecca McBeth

Tracy Voice

Tracy Voice took up the new role of chief digital officer for three DHBs – Capital & Coast, Hutt Valley and Wairarapa – at the end of July.

Voice was previously chief information officer at the Ministry for Primary Industries in Wellington.

CCDHB corporate services general manager Thomas Davis says, “Tracy’s achievements at MPI include creating and implementing an information technology strategy, introducing new digital and technology solutions at the New Zealand border and overseeing the merger of Ministry of Agriculture and Forestry and the Ministry of Fisheries technology systems.” 

Nick Baty

Nick Baty is joining Computer Concepts Limited as a principal consultant – security in mid-September. The purpose of this new role is to develop CCL’s cybersecurity practice, undertake security ‘thought leadership’ and mentoring, and fulfil security consultancy engagements. 

Baty was formerly the Ministry of Health’s chief security advisor (IT). Within this role, Nick was responsible for driving and leading an increase in the cybersecurity maturity of New Zealand’s health and disability sector agencies.

Some of Baty’s key achievements at the Ministry include developing and delivering an all-of-health-sector cybersecurity event response plan, facilitating a successful cybersecurity ‘bootcamp’ for health sector CIO equivalents and their teams during the HINZ Conference 2018, and developing and delivering advice to the health sector regarding improving the cybersecurity of fax machine and e-mail solutions.

Gabe Rijpma

Gabe Rijpma has been appointed chief executive officer at Aceso Health. Gabe is a 20-year veteran of Microsoft and previously ran the Microsoft Health business across the Asia and Pacific regions for the past 12 years from both Singapore and New Zealand.

His role will be to provide leadership and direction for Aceso as it continues to build and deliver projects for health systems and health providers across the Australia and New Zealand markets, with eyes firmly on Asia.

“My long-standing career at Microsoft has been nothing short of incredible. I have personally grown so much, lived and worked across three continents and worked with the most incredible group of passionate people in helping drive digital health forward with customers and partners alike,” he says. 

“I am incredibly proud of the team I am joining, they are just doing incredible work with customers in taking modern digital technologies and applying them to improve health by helping customers turn data into insight and action, as well as lay foundations to better integrate and deliver on interoperability in our health system.”

Kerry Macaskill-Smith

Kerry Macaskill-Smith has been appointed medical director for Pinnacle Ventures – the innovation arm of the Pinnacle Group.

She provides clinical oversight for all the Ventures projects, with a particular focus on implementing pharmacogenomics in New Zealand and supporting digital health solutions like the new cloud-based PMS system Indici and telehealth. 

She says she is passionate about systems that work well for everyone involved and believes “we have to change the way we are doing things if we want to have a functioning primary care system in the future”.

Macaskill-Smith says another key area for Ventures is making better use of the clinician data and she is actively involved in the READ to SNOMED reference group. 

Continuing to work part-time as a GP in one of New Zealand’s first Health Care Home sites keeps her connected to the reality of primary care in New Zealand.

Rommel Anthony

Rommel Anthony has joined the Ministry of Health’s Data and Digital team as the medication management digital services lead.  

Rommel was previously head of ICT planning and architecture at Capital & Coast, Hutt Valley and Wairarapa DHBs and has a strong background in health technology, including working previously at the Ministry and a number of health ICT vendors. 

The Ministry’s deputy director-general Data and Digital Shayne Hunter says Rommel will be working in an innovative area that is benefitting patients, prescribers and pharmacists by using technology to improve the way medications are managed. 

Mark Cox

Mark Cox has set up a consulting company called HealthIT Consulting to assist local and international software businesses enter new health IT markets.

Cox's previous roles include business head Asia Pacific ICNet with Baxter Healthcare Corporation and director of business development at Sysmex NZ. He is also a founder and former board member of industry body NZ Health IT.

Cox says HealthIT Consulting will assist international companies that are looking for cost effective ways of exploring and entering the New Zealand, Australian or South East Asian health IT market.

Trevor Delany

Trevor Delany became chief digital officer at Southern Cross Hospitals in June 2019.

In his new role, Delany is focused on advancing patient-centric services and facilities with modern digital and IT capabilities.

He says Southern Cross Hospitals is an organisation inherently focused on making lives better.

“It’s a role that aligns perfectly with my passion for people and making positive impact through digital ways and means,” says Delany.

He was previously head of information technology & services for BP New Zealand.

Jude Keys

Medtech Global has welcomed Jude Keys onto its team as its new national account manager.

Keys has spent 15 years at Auckland’s ProCare Health PHO in various roles, including executive officer, business services manager and enhanced practice services manager.

She initially trained as a nurse and specialised in paediatrics and says she is passionate about primary healthcare and making the job easier and better for all concerned.

“It’s really exciting and I’m looking forward to building and maintaining customer relationships for Medtech,” Keys says.

If you would like to provide feedback on this news story please contact the editor Rebecca McBeth.

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Picture: The Health and Disability System Review website.

eHealthNews.nz editor Rebecca McBeth

Data and digital is a specific workstream of the Health and Disability System Review and is being considered as part of the wider scope of the process, expert review panel member Lloyd McCann says.

Health Minister David Clark announced the wide-ranging review in May 2018. It is led by chair Heather Simpson and will provide an interim report by August 2019 and a final report by 31 March 2020.

McCann says there is a dual approach to data and digital within the review: it is being focused on within a specific workstream and considered as part of the wider scope of the panel’s work.

“The panel’s view is that data and digital are a critical enabler for the health system, but does not operate in isolation from the rest of the health system,” he says.

Some common themes have emerged from the engagement process with the sector to date.

“It’s very difficult to make an argument against data and digital being a critical enabler for the sector and we need to continue to enhance the capability within this area so the health system can deliver equitable outcomes for people,” McCann tells eHealthNews.nz.

There are some contentious issues including levels of investment in data and digital solutions as well as capacity and capability within the data and digital domain.

A key area being looked at is data and how it can be used to underpin clinical care and decision making.

“To enable data to flow you need to address issues like interoperability and standards. Providers, funders, industry partners have indicated that they have an appetite to get some outcomes in this area,” he says.

The interim report due out in August will signal the panel’s direction of travel, but no firm recommendations, which will come in phase two.

He says it is key to ensure that whatever recommendations are put forward and implemented within the data and digital domain do not drive further inequity in the system.

“We will be coming back to the sector to test what solutions look like to drive this area forward,” he says.

The review also presents an opportunity to look at adopting more ‘digital first’ services.

“One of the shifts people are saying will become increasingly important is the move from data and digital solutions operating as an enabler to becoming more prevalent as service delivery models in their own right,” he says.

McCann’s skills and expertise mean he is focusing on the data and digital workstream as well as contributing to all the others, as are his fellow panel members. The panel is supported by a review secretariat.

McCann says the review has had broad engagement with a range of health stakeholders and received submissions from many interested organisations and individuals. It has also engaged with industry partners via NZ Health IT.

“We are coming off the back of quite a number of reviews either specific to health or related to health, so it has been very pleasantly surprising that people have still engaged, and we’ve received a good number and wide variety of submissions to date,” he says.

If you would like to provide feedback on this news story please contact the editor Rebecca McBeth.

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eHealthNews.nz editor Rebecca McBeth

MidCentral DHB has published one of the country’s first district-wide digital health strategies.

Called Te Awa, the five-year strategy is collectively endorsed by the DHB, Central PHO, Manawhenua Hauora, the Clinical Council and the Consumer Council in the region and was developed after extensive district engagement and consultation.

An introductory message says that developing and using digital technology “will help us to improve access to services, to address and minimise health inequality, to improve the quality and safety of our services, and to increase the control people in our district have over their own health”.

The strategy has four guiding principles, which are; people-powered; one district; information sharing; and being a good digital health steward.

The objectives of the strategy are to digitise the consumer, families and whānau experience with improved access to information and to digitise end-to-end processes, allowing the smooth flow of information between services and across organisational boundaries.

It aims for better interconnected communications and collaboration, as well as better use of data for planning and decision making. Also, inclusive information management and stable and secure ICT services.

Steve Miller, chief digital officer MidCentral DHB, says Te Awa is a people/ whānau – centred strategy with a focus on wellness, which makes interagency collaboration key to its success.

“With over 60 percent of a person’s heath being attributed to various social determinates, it’s important we collectively engage in collaborative co-design as a system to enable quality living, healthy lives and well communities,” he explains.

The strategy has seven strategic portfolios with multi-year funding pathways, allowing a more agile delivery method for the projects within them.

“We are seeking to take a more ‘learn and adapt’ approach to accelerate value delivery and better manage risk by breaking initiatives into smaller three-monthly cycles,” Miller says.

The portfolios are; consumers, families and whānau-centred; workforce management; innovation; data and analytics; knowledge management; business management; infrastructure and IT services.

Miller says the strategy seeks to rationalise a large number of existing suppliers and applications and to develop a co-investment partnership approach with industry to accelerate the district’s digital transformation.

MidCentral DHB has been chosen by the Ministry of Health to pilot four HIMSS digital maturity assessments from August this year. Miller says the results will help determine the organisation’s areas of focus to get the best results.

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eHealthNews.nz editor Rebecca McBeth

Three early adopter sites are working to implement the allied health data set standard for district health boards.

The standard was published by the Ministry of Health in March last year and defines the minimum data set to be captured by allied health staff in DHBs to record patient-related clinical activity.

The early adopter sites, Waitemata, Canterbury and Nelson Marlborough DHBs, are starting with a gap analysis to determine what information is not being collected and how much work and resourcing would be required to bridge that gap.

Chair of the working group that developed the standard, Rebecca George, says the biggest gaps usually lie within inpatient systems.

George, who is the clinical lead for allied health informatics at Canterbury DHB, says implementation will ensure that information about AH staff interventions in hospitals is properly recorded in the systems.

The aim is for the early adopter sites to provide a model of how this integration can be rolled out across DHBs and how this can be applied in other contexts.

“We have got some early adopting sites who have taken this on board and are actively integrating it into their systems and engaging in discussions about how to do that in the rest of the country,” she tells eHealthNews.nz.

The clinically driven nature of the standard means it is a learning curve for staff to take this on board and implement it in their sites, adds George.

“For allied health clinical leads, it supports the continued and deeper engagement with their information services and CIOs, which is good,” she says.

This year, the standard team will be working closely with the Health Information Standards Organisation, which she says is very supportive of the standard and the way it is being driven by clinical leadership and staff.

“We will be looking to work with HISO to continue supporting the implementation and review the work of the early adopters and progress made, and be engaging with professional groups that are keen to be included and haven’t so far been,” George says.

Five professions are included in the standard at this stage: occupational therapy, physiotherapy, social work, speech and language therapy, and dietetics/nutrition.

The next review of the standard will involve an alteration to include more professional groups.

George says the new data standard was created because of inconsistencies in the data collected by AH professionals and lack of visibility of the data.

“We hope to soon have a working group meeting to discuss and explore the idea of a single repository for AH data collected nationally and the end goal is to make use of the analytics and outcomes,” she explains.

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Picture: Philips chief medical officer – EMR Luiz Arnoldo Haertel

eHealthNews.nz editor Rebecca McBeth

New Zealand health providers have the skills and digital maturity to reap the benefits of full end-to-end electronic medical record systems, says Philips chief medical officer – EMR Dr Luiz Arnoldo Haertel.

Haertel  is a keynote speaker at the HiNZ Conference 2018 in Wellington from November 21–23 on EMR: The processing agent of the healthcare industry revolution.

He tells eHealthNews.nz that New Zealand has so far taken a “best-of-breed” (BoB) approach to EMR adoption rather than “best-of-suite” (BoS).

“If a health ecosystem has a large number of BoB systems in place that are transactionally interfaced to each other, the consequence is that there is significant rework, redundant efforts, maintenance difficulty to keep data well aligned, as well as overlap in the solutions,” he says.

“It is more often than not complicating communication across source systems, rather than simplifying, to make sense of data associated with clinical or nonclinical workflows.”

He argues that a full, comprehensive BoS EMR system is able to cover all workflows of a hospital which reduces maintenance and complexity, simplifies the user experience, upholds visibility across the patient’s care continuum and enables the health organisation to control the costs of running their business.

Philips’ research on New Zealand’s EMR systems shows that they have grown organically as new technologies emerged and that no true end-to-end EMR systems have been adopted.

“There are organisations who have amalgamated large numbers of best-of-breed systems and done well to orchestrate them as best as possible to help them optimise care,” says Haertel.

“The innovative mindset in New Zealand around health informatics does mean that there are some organisations very well enabled, given their skill-set and maturity, to be able to rationalise their ecosystems to full end-to-end EMR suites.”

He says New Zealand has a unique opportunity in linking more data across the continuity of care settings, as there is less integration across primary care, in-home care and other settings than in countries such as Australia.

“There is great potential for New Zealand healthcare organisations to connect data from every area of the ecosystem and take on an enterprise versus department-by-department approach that reduces complexity and improves care,” explains Haertel.

He says any EMR solution must be tailored to the needs and provide benefits to the health system and improvements to the quality of care for patients.

“A solution can be strong on paper, but if it does not fit the practical needs of the clinician it will be rejected,” he says.

To read more about the HiNZ Conference click here >>

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Picture: Minister of Health Dr David Clark

eHealthNews.nz editor Rebecca McBeth

Work on developing a national financial management and procurement IT system for DHBs has been suspended following the release of an independent review of the project.

Late last year, the Ministry of Health commissioned Deloitte to review the National Oracle Solution programme to inform its advice to the Government after New Zealand Health Partnerships, which is leading the design and build, asked for a further $22.8 million for the project.

More than $100 million has already been spent on the solution since 2012 “with little to show for it”, says Health Minister David Clark, adding that the Deloitte report is a window into a troubled project.

“Deloitte’s report makes clear that the project was not set up to deliver its expected benefits for DHBs. This underlines that there was an urgent need for the Ministry to intervene when it did," he says in a statement.

Clark says work on the programme has been suspended while his officials review a plan from NZHP to develop a highly detailed business case for work on this area.

"I'm expecting advice on this in coming weeks. I'm not in a position at this point to offer a view on the future of the programme," he says.

The NOS, based on Oracle business applications, is intended to replace all DHBs’ current finance and procurement systems.

The original business case, approved in 2012, envisaged significant savings from the centralisation of these operations and deployment was expected in 2014.

However, since then costs have significantly increased, timelines have been delayed, scope has reduced and the delivery approach has changed.

“These challenges have eroded confidence and trust amongst stakeholders over the ability to successfully implement NOS,” the Deloitte report says.

All DHBs have approved the latest revised timeline and their portion of the additional $22.8 million funding.

But the review says substantial additional investment would be required as this extra cost does not cover DHB implementation and change management costs, Pharmac change costs, ongoing support and maintenance or future roll-out waves.

The report recommends that the Wave 1 of the Oracle applications on HealthBIS infrastructure go live at the first four DHBs, but with increased support and oversight.

The process by which the Ministry of Health commissioned Deloitte to review the project has also been reviewed by Audit New Zealand.

Questions of a conflict of interest was raised in Parliament around Deloitte’s purchase in 2013 of IT company Asparona, which had worked on the NOS programme.

The Audit NZ review found that the Ministry followed the Government’s procurement procedures, but recommends that it significantly improve its awareness of conflict of interest in procurement processes.

“I’m advised the Ministry has accepted Audit New Zealand’s findings and has acted to address them,” Clark says.

This article was updated on Wednesday 5 September.

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Picture: A Waikato DHB staff member edits a form from the generic XML toolkit.

eHealthNews.nz reporter Sam Sachdeva

The Waikato DHB's mental health and addictions service 10-year transition to an electronic record system shows a “big bang” approach is not always the best solution, one of the people behind the transition says.

The DHB’s mental health and addictions service team has been paperless since the end of 2015. It has now created 2.6 million electronic forms and 6.5 million unstructured documents from scanning.

Waikato DHB system implementation analyst Paul Docherty says the transition to an electronic record had “almost an accidental start” after the introduction of the Clinical Workstation access point for clinicians.

When the Ministry of Health introduced new outcome reporting requirements in 2005, the DHB chose to use a generic XML form toolkit to collect the information instead of a one-off application.

As more reporting requirements were introduced, Docherty says the DHB implemented greater electronic collection of information, allowing clinicians to bypass the use of paper forms.

Geographical requirements meant some organisations such as Auckland DHB chose a “big bang” implementation with back scanning of paper records, while Waikato DHB was able to more gradually transition due to a lack of similarly strong drivers, he explains.

Docherty says the gradual process meant clinicians were never confronted with dramatic changes, allowing an upskilling for some nurses who claimed to have never previously turned on a computer.

“Saying ‘Move the mouse across the screen’ resulted in the mouse being physically picked up and physically moved across the screen,” Docherty tells eHealthNews.nz.

The use of XML forms ensured the data was collected in a structured format, allowing more valuable information to be provided to clinicians and making it easier to produce audits for information not systematically collected.

The DHB went fully paperless in December 2015, with some documents unable to be turned into electronic forms, such as those that require the signature of a patient, scanned instead.

Docherty says it has received approval from Archives NZ to dispose of the paper copies after holding them for an archive period, shortened from three months to one month.

Docherty says the electronic record is useful for the “highly mobile patient group” who use the DHB’s mental health and addiction services, ensuring clinicians who see them at any site can view their details.

It has also made it easier for the DHB to carry out clinical audits and performance reporting for the Ministry.

Docherty says the DHB has been asked to find mobile solutions, and there are “a few challenges on the horizon”, including the possible development of a universal recovery plan which can be accessed and updated by the patient, DHB staff, GPs and NGOs.

He is reluctant to offer advice to other DHBs planning to go paperless, but believes events like the HiNZ Conference 2018 provide an opportunity to tell his team’s story in a “non-threatening” way.

Paul Docherty will be presenting on Waikato DHB’s transition to paperless at the HiNZ conference 2018 to be held at Wellington TSB Arena from November 21–23.

To read more about the HiNZ Conference 2018 click here >>

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eHealthNews.nz editor Rebecca McBeth

Less than 0.2 percent of South Islanders have opted out of having a shared-care record since HealthOne went live in 2012.

The South Island’s electronic shared-care record view, HealthOne, stores health information including GP records, prescribed medications and test results.

HealthOne covers everybody living in the South Island, more than one million people, and only 1,150 patients have opted out.

The system collects data from secondary and primary care providers and makes it visible in a single shared patient record. Access to the record is available at the point of care for multiple providers including GPs, pharmacists, hospital clinicians and Nurse Maude staff.

The shared records are being accessed by healthcare providers more than 130,000 times a month and there are around 15,000 active users of the system.

If a patient does not want to have their information shared they request an opt-out. The person then receives a call or email to inform them about HealthOne, explain who can access their information and the implications of opting out. They are also offered a free visit with their GP to discuss their decision.

Only 1250 people across the South Island have opted out since HealthOne went live in Canterbury in late 2012 and, of those, 109 have opted back on to the system.

Patients can request to have parts of their information marked confidential, such as a prescribed medication or details of a consultation.

The South Island Alliance Programme Office says HealthOne is designed for use at the point of care and there is a process to ensure that information is only being accessed by clinicians caring for that patient and only in relation to a specific episode of care.

“Pro-active fortnightly audits are conducted that show users who have accessed outside the agreed timeframes of having an encounter with a patient and these are followed up for an explanation, initially through a letter that asks for an explanation of why the patient record was accessed, and their responses are reviewed,” a statement says.

“If their reasoning cannot be closed off by the Privacy Office then it is escalated to the user’s superior/governing body to progress according to their own privacy processes.”

HealthOne was commissioned by a partner alliance of the Canterbury DHB, Pegasus Health and Orion Health.

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eHealthNews.nz editor Rebecca McBeth

A new IT system for New Zealand’s blood banks means patient files are available digitally nationwide and allows for innovations such as smart fridges to be trialled.

The $8 million project by the New Zealand Blood Service took more than two years of planning before eTraceline went live at 37 blood bank sites over the weekend of 1–3 September 2017.

Previously, a system called eProgesa was used to track the donor and manufacturing services of NZBS, as well as blood banking.

However, this is not going to be developed further for blood banks and so NZBS made the decision to change to eTraceline, from the same vendor MAK-SYSTEM, which is specifically developed for blood banks.

NZBS chief information officer Tony Carpinter says eTraceline brings enhancements to the service straight away and allows for future developments such as smart fridges.

eTraceline Plus Team leader Kathy Clark says the new system means that wherever a clinician is in the country, they can view the same patient information held electronically on the system.

This is important as patients often move from more rural to main centres for procedures and their patient file holds records of all their tests, special requirements and history.

“It’s important that this information is accessible anywhere as it’s an important feature of New Zealand that we do have a national blood service that covers the whole country,” says Clark.

Carpinter says migrating all the patient files from eProgresa into the new system took around 18 months and was complicated by the fact that some patients appeared in different databases.

Benefits of the new system include electronic stock ordering, which was previously done via fax. An electronic dashboard at NZBS now shows incoming orders and their status so the service can ensure they are filled.

NZBS is also doing a “low-tech pilot” of a smart fridge at MercyAscot in June, says Carpinter.

Smart fridges are located in operating theatres, but under the control of the blood banks to ensure the right blood products are available at the point of need and therefore used more efficiently.

Clark says the eTraceline implementation was a huge change management task involving training and workshops, online help and a 24/7 helpline during go-live.

More than 560 staff who work in New Zealand’s blood banks were trained and the system has now become embedded into their day-to-day business, she says.

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PICTURE: Wellington Free Ambulance relationship and development manager and paramedic Vanessa Simpson using ePRF on a tablet.

eHealthNews editor Rebecca McBeth

With ambulance staff nationwide now using the same ePRF, paramedics can access patient information from previous call-outs, no matter where in the country they occurred.

All New Zealand ambulance staff are using a single electronic patient report form to record patient information after Wellington Free Ambulance went live with ePRF last month.

The ePRF allows frontline staff to enter patient details into a structured electronic form using a tablet device, rather than having to handwrite notes.

WFA went live with ePRF on 6 March. St John has been live with the system for more than two years following a nationwide roll-out over three months, starting in October 2015.

Now that Wellington is on board, the entire country is covered by the same electronic patient assessment information system and more than one million ePRFs have been completed nationwide over the past two and a half years.

WFA relationship and development manager Vanessa Simpson says having all ambulance services using the same system benefits patients, as paramedics can see what happened on previous call-outs, no matter where the patient is nationwide.

The Wellington roll-out went very smoothly, helped by the support and learning from St John’s previous go-lives.

More than 100 front-line staff have been trained, as well as volunteers and staff within the Patient Transfer Service.

Simpson says staff like the structured nature of the e-form, which includes drop-down boxes and provides safety alerts, such as if a medication dosage is outside recommended guidelines.

“It’s more timely patient information and it’s concise, accurate and legible,” says Simpson.

The ePRF is printed off in emergency departments and presented as an ambulance-care summary.

Simpson says the handover time in hospital has increased in the short-term as staff get used to the new system, but results from St John indicate that the electronic process will ultimately reduce handover times by around 10 minutes.

This will be further reduced when the electronic form can be pushed directly into a hospital’s clinical workstation.

The ePRF is also connected to the National Health Index.

Ambulance staff use a trusted source of information to find a patient’s NHI number, such as a hospital discharge letter, or can look the number up and pull down the patient’s date of birth and address into the electronic form.

When the ambulance services become trusted users of the NHI database, the system will be able to pull through some clinical information as well.

St John ePRF project manager Chris Laufale says plans are in place to start pushing ePRF information to district health boards and GPs electronically, and that within a year St John hopes to be able to pull clinical information down via the NHI.

The point at which ambulance staff can view clinical information, such as a patient’s previous ECG, and have discussions based on this information in a patient’s home is the “nirvana”, he says.

The ePRF system is provided by Valentia Technologies and tailored to reflect the needs of New Zealand’s ambulance services.

Laufale says the electronic system has improved clinical care, auditing processes and changed the way the service looks at resourcing, such as helicopter deployments.

St John was able to apply everything it had learned over the past few years to help ensure a smooth implementation in Wellington.

Simpson adds that the possibilities for understanding and improving the WFA service are “boundless” with so much data now being collected electronically.

“We will have so much information available at the push of a button, it’s going to really change things,” she says.

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eHealthNews editor Rebecca McBeth

PICTURE: SmartHealth was an online doctor service

Funding pressure and lack of uptake or reduced emergency department attendance means the online doctor service will not be continued and the procurement process investigated.

Waikato District Health Board is stopping its SmartHealth online doctor service at the end of this month due to the high cost and a lack of uptake and results.

The service is provided through HealthTap, a US-based technology provider. The DHB’s contract with HealthTap comes to an end on 13 May and will not be renewed.

SmartHealth included a free out-of-hours online doctor service, plus online outpatient consultations with a hospital specialist, both provided on patients’ mobile phones and smart devices through HealthTap. These will both cease from 30 April.

Interim chief executive Derek Wright says staff recommended to the board that they not renew the contract for a further year.

“While the Board did not take this decision lightly, when we are currently struggling to meet the current demand in our hospitals within our budget, they felt the $7.2 million cost of renewing the contract was not justified, particularly in our current financial situation,” says Wright.

“While HealthTap itself was a useful service and many of our patients who used it were very positive about the experience, we didn’t engage our clinicians effectively in how best to use the product in their area, and there were technical teething troubles early on.

“We had very ambitious targets for the rollout of this service but only 10,000 people signed up for SmartHealth, considerably fewer than expected. While the free out-of-hours doctors’ service has been popular with those who have used it, it has not resulted in fewer attendances at the hospital’s Emergency Department, which was one of our aims.”

The DHB had already begun its end-of-trial review of the HealthTap service, carried out by EY, which is due to be completed by the end of May, and the Office of the Auditor General is also investigating the HealthTap procurement process.

However, Wright says the board needed to make the decision prior to the end of the existing contract with HealthTap.

He says patients who had found the service helpful would be disappointed, but that the board is still committed to the principles of virtual healthcare because of its large rural and remote population.

“We may look at how we provide this kind of service in the future, and the reviews will certainly help guide us in that. We have learned lessons from how we rolled out this service and in future will involve our clinicians and community before we look at new ways of working,” Wright says.

People signed up to SmartHealth will be contacted by the DHB and advised of the decision and recommended options for accessing health information, out-of-hours care and hospital consultations in future.

The DHB says all patient data created by the doctor in HealthTap is owned by the DHB and has been sent to the board’s patient information system.

The HealthTap software was purchased by Waikato DHB in 2015 under the leadership of disgraced former chief executive Nigel Murray, who has since resigned.

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