A Waikato team that built an app during strike action to enable nurses and managers to make faster, safer decisions has won the 2025 HiNZ Accenture Catalyst Award.

The Integrated Operations Centre (IOC) team at Health New Zealand Waikato built the industrial action app to allow nurses and managers to see staffing levels in real time.

The inaugural award celebrates individuals and teams who are helping the health workforce get future-ready for digital transformation. 

The Waikato team were announced as the winner at Digital Health Week on November 25 at Te Pae in Christchurch.

The judges said they were particularly impressed with the speed and scale of the initiative, and the measurable impact it had.

Ahmed Ahsan Saeed, production and planning manager at the Waikato IOC, said the team were thrilled to win the Catalyst Award which showed team work at its best.

“This is a great moment for the team and a real boost to keep building simple tools that make a real difference,” he said.

Will Reedy, managing director health at Accenture Aotearoa, sat on the judging panel and said Accenture was proud to support an award that is focused on making a clear digital health impact for people, whānau and communities.

“The range of applications this year shows just how diverse and people-driven digital innovation in New Zealand health has become,” he said. 

“We saw entries from hospital clinicians, allied health teams, pharmacists, community providers, researchers, educators, and emerging start-ups. All are using technology in different ways, but all focused on the same goal: empowering the workforce to deliver better care.”

Accenture’s sponsorship supports the $5,000 prize to sustain or scale the initiative and the winner also gets an opportunity to present their work at a HiNZ event, including a complimentary pass.

Saeed says the funding will help the team build a reusable Rapid Response App Framework and extend it to their on-premise databases so districts across Health NZ can deploy fast, reliable digital solutions when they need them most.

“The investment strengthens our ability to respond rapidly and consistently to future challenges, while giving our frontline teams more time to focus on patient care,” he says.

The other two finalists in the 2025 award were:

• Rincy Varghese from Health New Zealand Counties Manukau, who developed an innovative electronic elective surgical booklet co-designed by clinicians that replaces traditional paper-based forms, streamlines workflows, enhances transparency, accelerates patient care and makes prioritisation fairer
• Whakarongorau NZ Telehealth Services created a national system letting Healthline clinicians instantly book GP telehealth appointments for callers, improving access—especially for rural and underserved communities
  

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HealthOne, the South Island's shared electronic health record (SEHR), will expand to the lower North Island by the end of 2025. 

The expansion will initially connect general practices, community pharmacies, hospital and ambulance services to the existing South Island database. 

The project is being driven by three PHO networks; Tū Ora Compass Health, Te Awakairangi Health Network, and Health Hawke’s Bay. 

Scheduled to begin by the end of 2025, it will reach over 80 general practices across the three PHO networks, which collectively support more than 600,000 enrolled patients. 

HealthOne enables clinicians to securely view a patient’s medical history, including test results, allergies, medications, GP summaries, and hospital records. This streamlined access supports safer, faster, and more informed clinical decision-making. 

"We are extending the existing HealthOne record to the lower North Island, so the records from all of their enrolled patients will feed through," says Rachael Page, HealthOne general manager.  

"We are not having a North and a South, we are building on the single HealthOne record." 

Page says the platform has operated for around 13 years, with consistent monthly usage that matches presentations to healthcare facilities throughout the region. 

HealthOne connects to the South Island’s single hospital clinical portal, Health Connect South, and will begin integration with the regional portals covering the lower North Island as part of the expansion. 

She explains that many top of the South Island patients are transferred to Wellington's tertiary hospital, while Canterbury also receives numerous North Island patients at its leading tertiary hospital. 

"Just that one use case demonstrates the need for a shared record," she says. 

While the first phase is to onboard general practice, community pharmacy, emergency services and hospitals in the region, the intention is to bring on other organisations over time as they request it. 

A dedicated project team is being established to lead this initiative, and the PHOs are collaborating closely with others across Te Ikaroa Central Region to support a broader implementation of HealthOne. 

“Accessing patient information in the North Island has long been a challenge due to the variety of software systems and access limitations,” says Matthew Lord, chief information officer for Tū Ora and Health Hawke’s Bay. 

“Given HealthOne’s proven success in Te Waipounamu (South Island), it makes perfect sense to bring this solution to our region. 

“HealthOne not only meets but enhances our privacy and security standards, with robust, automated auditing of all access to patient records,” he says.  

Darren Douglass, acting chief information technology officer for Health New Zealand | Te Whatu Ora says the move is a significant and positive step forward for the health system. 

“Health New Zealand welcomes the rollout, which will enable clinicians to securely access the health information they need to provide safer, faster, and better-informed care for people in the areas covered,” says Douglass. 

HealthOne is a SEHR, which is separate to, but will ultimately integrate with, the Shared Digital Health Record (SDHR) national patient data service being developed by Health NZ.  

Originally due to go-live in June 2025, the SDHR has been delayed until this December and will initially enhance and increase covering of existing regional SEHRs, such as HealthOne, Your Health Summary and TestSafe, by providing access to national data collections. 

Health NZ says that following integration, users including general practice, will be able to access information about patients who live outside the region their SEHR system currently covers. Data sharing is not expected to begin until early to mid-2026. 

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Peter Jordan attend the recent HL7 International Work Group Meeting in Madrid in May and the FHIR DevDays Conference in Amsterdam in June. 

The HL7® FHIR® standard was at the forefront of these recent events, after all it is now being used in nearly 100 countries, but it is only part of a complex landscape involving many organisations and jurisdictions. 

This was the first HL7 International meeting outside of the USA since the pandemic and attracted a truly global audience with an emphasis on HL7 standards development whereas the focus of DevDays – although similarly international in terms of participation - was principally dedicated to the evolution and implementation of HL7 FHIR.  Both events were full of positive energy and underpinned by worldwide challenges in improving healthcare outcomes via interoperability standards. 

Growing co-operation

It was hugely encouraging to see the growing co-operation between the various international standards development organisations (SDOs). This was evident in the positive outcomes from the joint 2-day openEHR & HL7: Converge or Collide symposium that preceded DevDays. These included agreement on creating and publishing openEHR Archetypes for domain/clinical analysis as part of HL7's development process which, it is suggested, might lead HISO to consider the (re)endorsement of openEHR for clinical information modelling within New Zealand 

Both events were attended by representatives of the Terminology Standards Organisations – notably SNOMED International and Regenstreif (LOINC®) – who presented work on the new LOINC Ontology and NUVA (Unified Nomenclature of Vaccines) extensions for SNOMED CT®. The collaborations are highly significant for New Zealand in providing a more consistent, manageable and implementable approach for the use of clinical terminology in our digital healthcare systems and, of course, by Generative AI. 

The International Patient Summary probably provides the best example of multiple SDO involvement and significant progress was made towards publishing version 2 of the related FHIR IPS Implementation Guide. There were also deep discussions about aligning national base and core FHIR implementation guides with IPS to facilitate a truly international framework for patient summaries, including local IPS derivations such as the New Zealand Patient Summary. 

A new release 

The principal goal of HL7 International at present is to ballot, refine and publish Release 6 (R6) of the HL7 FHIR Specification. This will contain ‘normative’ and stable resources only with the remainder moved out to separate Implementation Guides, along with HL7 Approved ‘Additional Resources’.  

This should provide both a definitive answer to those doubting FHIR’s maturity level and a means of extending the scope of FHIR without requiring regular version updates. There are potentially significant challenges for implementers in moving from existing versions to R6; however, these are being addressed, in plain sight, by the FHIR Core Team and common tooling community. 

The role of AI  

There were numerous presentations and discussions about AI and, notably, the role that it might play in standards development and implementation with a view to providing clear and trustworthy outcomes.  

Many products are already incorporating AI into their FHIR-based solutions, such as generating FHIR resources and completing FHIR questionnaires using voice recognition. However, the general feeling is that we have not yet scratched the surface of its full potential, but we should be aware that, ultimately, AI is a tool (although, potentially, a game-changing one) and its effectiveness depends on how it is used. 

A changing world 

The current geo-political landscape also generated a good deal of discussion. Although, thankfully, New Zealand is a long way removed from many of these issues, there is relevance in concerns such aas the location of cloud-based data and services, including AI-based solutions. How comfortable are we with the potential for overseas governments to access Kiwi data that is stored on their territory?  

Overseas regulatory regimes also impact local suppliers who operate in those markets as well as providing exemplars for the potential effectiveness of applying similar methods here to support the conformant, consistent and equitable use of information standards.  

The European Health Data Space is a health specific ecosystem comprised of rules, common standards and practices, infrastructures and a governance framework that, among its aims, is to empower individuals through increased digital access to and control of their electronic personal health data, at national level and EU-wide. A ‘space’ worth watching. 

Collaboration is key 

Both globally and locally, collaboration remains the key to driving exponential improvements in digital health and, consequently, healthcare outcomes.  

In my view, there is also no effective substitute for in-person participation at international meetings where everyone is together in one place and time zone, dedicated to achieving consensus-based solutions based on common goals and experiences.  

Our healthcare systems all share the same supply and demand related challenges: New Zealand must learn from the experiences of others, particularly regarding the percentage of overall healthcare spending that should be allocated to digital health. In this respect we are neither unique nor alone! 

 

Disclaimer: The opinions expressed in this article are purely personal and do not represent the views of my clients, HL7 New Zealand, HL7 International or generative AI. All related travelling and accommodation expenses were self-funded. 

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NEWS - eHealthNews.nz editor Rebecca McBeth 

The go-live of the Shared Digital Health Record (SDHR) in June will enhance and increase coverage of existing regional shared electronic health records (SEHRs) and will not include implementation for general practice.

The SDHR is a data service designed to securely share patient data across the healthcare system, eventually enabling healthcare providers nationwide to access and update core health information including allergies, adverse reactions, conditions, encounters, and observations.

The project has a budget of $4 million through to the go-live of a Minimum Viable Product (MVP) at the end of June 2025.

There are several existing SEHRs, including HealthOne in the South Island, and TestSafe, Your Health Summary and the SEHR in the North Island.

An update from Health New Zealand | Te Whatu Ora says the SHDR will initially increase both the coverage and breadth of information available through these systems, with a focus on building on what is already working well in different regions.

It has also confirmed there will be no go-live for general practices when the MVP goes live in June, acknowledging that practices need "a reasonable lead-in time" to prepare for implementation.

"We understand that general practices have a number of questions about the SDHR data service, including timeframes, general practice requirements, privacy and consent considerations, how it will work with existing SEHRs, what data will be shared and who will view it," the update says.

“Health NZ is working with stakeholders to answer these questions and confirm timeframes as soon as possible.”

In the first phase, Health NZ is collaborating with primary care providers who opt in to collect and share read-only versions of data held in their practice management systems (PMSs).

“Our intention is that Health NZ will manage the relationship with PMS vendors and make data available to SEHR services,” the update says.

Health NZ says patient privacy and data security remain central to the SDHR and it will provide a simple opt-out process consumers who prefer not to share their information.

"Any current privacy/confidentiality notifications about patient data in primary care systems will be observed,” it says. 

Access to patient information will be monitored and audited, and people will be able to request details of who is accessing their records

The SDHR will be a Fast Healthcare Interoperability Resources FHIR - based data service and application programming interfaces (APIs) will be made available on the Digital Services Hub later this year. 

Middleware NZ has been awarded the contract to provide FHIR expertise, architecture, development, testing and project management capability.

The SDHR data service will also include data from national collections such as immunisations and the National Health Index.

Future development is subject to funding and will expand access to other parts of the health system, including first responders, hospitals, and specialist services.

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New Zealand is ranked in the top-five countries for healthcare interoperability in a new global report, ahead of Australia, the United Kingdom and Singapore.

Experts say it is welcome to see New Zealand recognised globally as a leader in this space, but are concerned about the impact of recent data and digital budget and staff cuts on the country’s ability to maintain momentum.

The international research, released by research firm Black Book, ranks the digital interoperability performance of 18 high-income countries and found that New Zealand achieved a national interoperability rate of 90.3%, placing it fifth behind Estonia, Finland, Denmark and Sweden.

It says New Zealand, Sweden and Singapore have, “achieved high interoperability through national strategies that prioritise data standards, patient-centred platforms, and public-private collaboration. 

“New Zealand's Health Information Standards Organisation (HISO) and Singapore's national electronic health record system were specifically highlighted in surveys for their responsiveness and efficiency in clinical workflows,” the research says.

It cites the delivery of Hira tranche one as a major milestone in New Zealand’s interoperability journey, however Hira has since been paused due to a funding cut.

Health New Zealand | Te Whatu Ora former director strategy and investment Darren Douglass wrote to the Minister of Health in May 2024 about the impact of pausing or shutting down Hira services.

The letter says, “the immediate operational impacts will be reduced access for consumers and clinicians to summary health data, continued lack of data standards adoption and systems interoperability”.

Heath Tolley, group manager integration, data and digital, says that Health NZ has made significant strides over the past few years in enhancing its digital and data services, particularly in regards to interoperability. 

“We have worked collaboratively with the wider health sector on the adoption of national standards through HISO, and we are proud of the progress made through programs like Hira and the NZCDI (core data for interoperability), as well as our primary care initiatives such as GP2GP and, more recently, the Shared Digital Health Record, (SDHR)” he says.

Tolley says there is still work to do, recognising that Hira has been paused, but says the delivery of Tranche One established critical technology foundations such as the; Digital Service Hub; New Zealand Terminology Service; and National Events Management Service.

Tolley says the SDHR builds on the work of Hira and delivery continues on other services such as Immunisation API to support vaccine information and a Cervical Screening API to give primary care access to patients' screening histories.

“We believe that these initiatives will continue to drive positive outcomes for New Zealand's healthcare system, ensuring that we maintain our high standards and continue to innovate in the face of challenges.”

Scott Arrol, chief executive of Health Informatics New Zealand (HiNZ) says it is great to see New Zealand performing well globally on interoperability and shows the benefits of the widespread adoption of both international and local standards, such as the National Health Index (NHI).

However, he cautioned against complacency, noting the potential impact of recent budget and staffing cuts in New Zealand’s data and digital sector.

“It is encouraging to see that we are ahead of the curve, but without sustained investment and focus, there is a real risk we will fall behind. We need to keep our foot on the pedal to stay competitive,” he says.

The Black Book report says that the success of countries like New Zealand, “is powered in part by interoperability-focused technology vendors delivering the infrastructure for real-time, standardised health data exchange”.

It mentions InterSystems and Orion Health as being active in New Zealand and supporting the rollout of enterprise-level platforms that enable the integration of patient data across hospitals, clinics, pharmacies, and labs.

Niru Rajakumar, chief executive of McCrae Tech Hospitals, which was divested from Orion Health in a recent buyout of the company, says maintaining a global edge requires ongoing commitment, warning that “good is not good enough anymore”. 

“Striving for world-class interoperability is how we move from potential to performance and ultimately deliver a more connected, equitable, and person-centred health system,” he says

Peter Jordan, HL7 New Zealand secretary, says the top-five ranking surprised him a little and while New Zealand has a lot of technical interoperability, the country still has a way to go. 

“We have always had a big advantage in the key building blocks – notably the NHI and Health Provider Index (HPI) – plus the endorsement of international standards, notably FHIR and SNOMED CT, by HISO,” he tells eHealthNews. 

While New Zealand has also built a “fair amount” of key, modern infrastructure using these standards and APIs, “there is little doubt that the reduction in resources allocated to digital health has slowed progress over the past year,” says Jordan.

The Black Book rankings are based on data collected between 2020 and 2025 from over two million healthcare professionals and stakeholders about how effectively their national health systems enabled the secure and standardised sharing of patient data across healthcare settings. 

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Awanui Labs and Medtech Global have collaborated to enable real time reporting of patient lab results, streamlining workflows and increasing visibility at general practices.

Awanui Labs is the largest community lab provider in the country, sending more than 465,000 electronic messages every day, including more than 100,000 to GPs.

The organisation has worked with Medtech to develop an ALEX® API to deliver patient results directly to referrers using Medtech Evolution.

Sixty-four sites are now live with the new functionality, electronically receiving their patient’s test results - including blood, urine, histology and cytology - in real time as they are reported by the laboratories. 

This replaces the legacy ‘store and forward’ system currently deployed for most practices.

Bhavesh Daya, Awanui service delivery manager, says the new integration is all about improving patient care.   

“We view this integration as a foundational piece of work which will allow both Medtech and ourselves to deliver improved services to practices and ultimately improved care for the patient,” he says.

Increased visibility in tracking results helps streamline communication between labs and GPs, reducing delays and unnecessary calls, ensuring faster issue resolution and fewer miscommunications regarding result delivery.

“There is no longer an issue with sending messages, then waiting a few hours, then sometimes getting an acknowledgement or sometimes not, and then a call from a practice saying we have not received any results in the last two days,” Daya explains. 

“Now we know that the result is getting delivered and we know it is being imported, and so we get a faster response.”

Practice experience

Before going live, the integration was piloted with five Medtech sites for seven weeks, sending 22,000 results over that time.

Northcare Accident and Medical joined the pilot in June and account manager Nastassja Aneck-Hahn says it has streamlined workflows at the practice.

“We love all the new technology integrated into Medtech so we are keen to test any new features available and see how they can improve our efficiency,” she says.

“The labs integration is real time and we run an urgent care service so one doctor commented that it has greatly assisted them with efficiency and visibility with patient reports, especially high alert reports.”

In the past all lab reports would land in an inbox which had to be “sifted through” by a nurse, so this has greatly reduced time and effort for them.

It has also removed underlying issues around duplicate or mismatched results, or inaccurately addressed reports.

“This has really made things faster and easier for the nurses and doctors. It means we never have to go looking for things because it is stuck somewhere in the system,” says Aneck-Hahn.

Looking to the future

Medtech’s general manager integration and infrastructure Lawrence Peterson says the new ALEX® API aims to solve the complexity of tracking medical reports by providing real-time visibility.

The historic ‘store and forward’ process involved an intermediary, which added delays and uncertainty. Now, labs are immediately notified if a report fails to deliver and troubleshooting can start straight away.

Peterson says this integration sets the foundation for further enhancements. 

One potential development is notifying doctors of urgent results in real-time, or even prompting follow-up tests based on initial findings. 

“In the future, we hope to move past the acknowledgement of receipt, to a receipt and read of the report,” he says, adding that this would streamline processes further, reducing the need for repeat tests and improving patient care.

Daya agrees, saying real time notification of urgent or critical results within Medtech could finally replace faxing.  

 “This is a foundational piece of work for us to build on to to deliver better services,” he says.  

“We now have a dedicated ‘channel’ for Medtech practices that we can specifically customise to introduce new functionality.  Once we further progress this rollout, we will be workshopping some potential future enhancements with the Medtech team.”

He adds that development of this API was a simple and straight forward process and he looks forward to continuing to collaborate. 

“We had excellent engagement from the Medtech team, they were responsive to our requirements and understood that our customers needed to see continuity in our results,” Daya says. 

Peterson says the partnership going forward is strong.

“The future is really exciting in this space," he says.

Hear more about Medtech ALEX and the integration with Awanui Labs at Digital Health Week 2024, visit booth 116 to meet the Medtech team.

Image 1 - Awanui Labs team

Image 2 - Bhavesh Daya, Awanui service delivery manager

If you would like to provide feedback on the above feature article, please contact the editor Rebecca McBeth.

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Medtech Global, supplier of practice management systems (PMS) to more than 80 percent of Kiwi general practices, has worked with New Zealand’s leading aged care software provider, VCare, to allow information to seamlessly flow from primary to aged care.

A new integration between the largest providers of primary care and aged care software in New Zealand is releasing clinical time to care for the country’s growing elderly population.

Medtech and VCare have collaborated via the Medtech ALEX® platform to allow aged care staff to view what GPs have entered about residents in Medtech Evolution in their own system.

GPs with patients in aged care facilities currently have to enter patient information into two different systems, their own PMS and the facility’s platform.

This copying and pasting of progress notes is an inefficient use of their time and can be a source of errors.

An integration with Medtech Evolution via Medtech’s ALEX® platform removes this duplication by pulling consultation notes and a summary of the patient’s health record – including medical warnings, diagnostic reports and recent observations –from Medtech into VCare.

Information only needs to be entered once, driving efficiency and providing one source of truth about the resident.

Users say this means clinicians and carers spend less time in front of a screen, and have more time to spend with patients.

Solving a problem

Alex Cauble-Chantrenne, Medtech clinical integrations programme manager, has a background in aged care software and feels it is a care setting that is overlooked.

She says VCare wanted to solve a data matching problem that both GPs and their aged care customers had identified between Medtech and their system.

“That is what ALEX® is about: finding solutions to the problems and closing gaps in patient care,” says Cauble-Chantrenne.

“Time is precious, in primary care in particular, so it is really heartwarming when we can save GPs some time because they simply do not get enough of it,” she says.

“This not only reduces the burden on clinicians, but is better for patients as caregivers have relevant up-to-date information at their fingertips.”

VCare provides software to retirement villages, rest homes, nursing homes, hospitals, and the disability sector, all the way from a rural five-bed home to the largest aged residential care providers in the country.

Chief executive Chris Graham says this means the potential savings for facilities that have GPs using Medtech is significant.

They can choose to pull information from Medtech on demand, or have scheduled updates where any relevant information on their residents is pulled through.

“One of the challenges is that a facility can have lots of different GPs looking after different patients from several different practices,” he says.

“Following this integration, they can just pull the relevant information into their local system, as long as the GP has given consent.

“Budgets are tight: you have to maximise the value of patient-facing time, so reducing this duplication of effort with data means there is more of that time for patients.”

Graham says the integration work is one way at this stage, but they plan to be able to push information from VCare back into Medtech.

“There is a massive number of New Zealand elder citizens in long term care facilities at various levels: some are very independent, but they are still receiving care services, and there are still GPs involved. This is about removing barriers to handling that information so there is one unified record, one source of truth,” says Graham.

Following a successful pilot, the integration will be made available to multiple sites.

Saving time & reducing risk 

Elizabeth Knox Home and Hospital is the largest care home on one site in New Zealand.

Currently home to 215 residents, they are in the process of adding another 68 beds with the new Totara Home opening this July and 80 percent of all Knox beds are hospital-level. 

Acting quality and operations manager Margaret Brown says the Knox Home facility uses many VCare functions including admissions, discharges, transfers, care plans, observations, progress notes, and billing.  

Elizabeth Knox also has its own medical practice with five doctors on site using Medtech Evolution. 

Brown was concerned about the use of two different systems because they needed an integrated clinical record and this involved GPs having to copy and paste notes from Medtech into VCare, which carried risk and was time consuming. 

Knox started piloting the new integration at the beginning of this year and VCare now regularly uploads anything new from Medtech in relation to residents. 

“I was impressed with the user interface for the uploaded notes as it is very clear,” she says. 

“It releases time to care and the benefits were immediate, without needing a complex change management process.” 

Brown explains that if a patient comes to them from a Medtech practice they can pull through a summary of their health information on admission, which again reduces risk and the need for duplication of work. 

Knox medical director, Jock Carnachan says it saves GPs valuable time as they just need to write their consultation notes once into Evolution. When the nurses click on the icon in VCare any new information is uploaded, or it sends a message that there are no new updates.

The inclusion of diagnostic reports such as radiology and lab reports is particularly useful for Knox Home team members, he says. 

Playing well together

Graham says VCare’s philosophy is focused on interoperability, essentially ‘playing well with others’.

“We like to talk to other systems and we like them to talk to us,” he explains.

He says that using the ALEX® platform was straightforward and the interface is very robust.

“It was an easy vendor partnership, so we are looking forward to lots more going on in this space,” says Graham.

When a partner comes to Medtech with a problem they want to solve, the ALEX® team sets them up with a 'sandbox environment' to experiment in.

Cauble-Chantrenne says they also get a non-commercial instance of Evolution to see what the Medtech system looks like and how it works.

“This ensures that when we have a partner like VCare building out an integration, they can see where that information is flowing into or out of Medtech,” she says.

“The most exciting thing is when they find other things that they can do and we work with them on a path forward.

“At Medtech we are looking to interoperate as much as possible to build out this healthy ecosystem within aged care and communicate between disparate systems,” says Cauble-Chantrenne.

“We are very lucky to have some really great partners on our ALEX® platform and VCare has been wonderful to work with.”


Image – An Elizabeth Knox team member chatting with a resident using VCare Anyware on a mobile device

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Empowering frontline professionals to seamlessly match patient needs with health services.

Leading Health Technology Company Healthpoint is set to launch the inclusion of SNOMED Clinical Terminology into their health and social services directory API. The move will enable applications and users of the Healthpoint API to use standardised clinical terminology, reducing the chance of misinterpreting a clinical need, and ensuring greater accuracy when connecting people to the correct service the first time. The use of SNOMED CT within the Healthpoint API can assist in processes such as: health promotion, patient journey mapping, referrals, and appointment bookings.

Kate Rhind CEO of Healthpoint emphasises, “SNOMED CT’s introduction is a game-changer for New Zealand’s health sector. It’s a crucial keystone for digital modernisation, allowing us to leverage data for better patient outcomes and a more efficient healthcare system”

The Healthpoint API - healthpointapi.com is built using HL7^® FHIR^® (Fast Healthcare Interoperability Resources) standard for healthcare data exchange. Healthpoint designed the API so New Zealand-based organisations and other applications can access ‘real-time’ comprehensive health and social services content held within the Healthpoint directory.

Chair of HL7NZ, John Carter says “Integrating SNOMED CT into Healthpoint’s FHIR®-based API offers an even greater level of interoperability than using either of these open standards on their own and ensures the Healthpoint information can be easily shared and specifically targeted to the right service or clinician.”

An advantage of SNOMED CT is that reference sets and language reference sets can be created that are relevant to the country or region you are in. Healthpoint is working with the SNOMED National Release Centre at Health New Zealand – Te Whatu Ora, to validate mapping from existing Healthpoint categorisations, and provide patient-friendly concepts in English and Te Reo Māori.

Providing patient-friendly terminology in Healthpoint and the Healthpoint API could benefit health organisations and patients nationwide. Imagine a doctor using “fracture of humerus” and a patient using “broken arm.” SNOMED enables the use of synonyms but provides a single code, ensuring everyone is referencing the same concept.

With this upgrade a person will be able to search the Healthpoint directory using patient friendly terms in either English or Te Reo Māori and get results for relevant specialists or services. For example, for “Cervical Screening” or “Whakamātautau waha kōpū.” At the same time an application can query the Healthpoint API by the SNOMED code for this concept and return the same list of services.

And how this concept is represented in SNOMED:

In the rollout, Healthpoint will enable the “category,” “type” and “specialty” elements on the FHIR Healthcare service base resource and allow users to query the API using these elements.

Healthpoint will rollout SNOMED CT to the production version Healthpoint API on the evening of Friday 19th of April 2024.

Source: Healthpoint media release

Sector updates are provided by organisations to eHealthNews.nz and have not necessarily been edited or checked for accuracy. Any queries should be directed to the organisation issuing the release.

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Over 130 people are gathering in Auckland today to take part in a symposium and ‘Connectathon’ being run by Health New Zealand | Te Whatu Ora, Health Information Standards Organisation (HISO) and HL7 New Zealand. The event, which is fully subscribed, is running in parallel to a companion event in Australia.

Gerard Keenan, Programme Director of the Hira Programme at Health New Zealand says the symposium and Connectathon are for health software developers, service designers, clinicians and everyone else working for an interoperable and unified health system.

“At today’s symposium, digital health leaders in New Zealand, Australia and the Pacific are talking about the importance of using the same standards when using and exchanging health information."

Alastair Kenworthy, Group Manager Data and Digital Standards at Health New Zealand says standardisation with FHIR^®, SNOMED-CT and the International Patient Summary is critical for the digital health ecosystem being built.

“Our experts will explore models for increased collaboration across the Pacific region and focus on improved health equity through digital transformation. We’re very pleased to welcome participants from the Tihi Hauora workshop at last year’s Digital Health Week and visitors from the Cook Islands.”

The Connectathon runs on the following two days – 21 and 22 March. HL7 New Zealand Chair and Health New Zealand interoperability expert John Carter says New Zealand’s Connectathon will continue the work that began at the “IPS-athon” held at HiNZ Digital Health Week 2023, to adapt the International Patient Summary (IPS) to our unique cultural and health system settings and build a New Zealand Patient Summary.

“Besides the patient summary track, participants from government and industry can choose other topics such as developing product integrations with Hira application programming interfaces (APIs) or developing interactive applications with FHIR questionnaires. There’s also an education track that will explore the FHIR New Zealand base implementation guide.”

Outcomes from the Connectathon will be featured on Health New Zealand’s Hira webpages.

Future Connectathons are also being planned, and details will be available over coming months.

Explanation of terms

• The FHIR (Fast Healthcare Interoperability Resources) standard is a set of rules and specifications for exchanging electronic healthcare data. It is designed to be flexible and adaptable for use in various settings and with different healthcare information systems.
• SNOMED CT is a clinical terminology standard, which puts a code and name to all health conditions, situations and interventions.
• APIs enable two or more computer programs to communicate with each other using a set of definitions and protocols.
  

Source: Health New Zealand media release

Sector updates are provided by organisations to eHealthNews.nz and have not necessarily been edited or checked for accuracy. Any queries should be directed to the organisation issuing the release.

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Medtech Global has developed a real-time API connection to deliver radiology reports directly to doctors' inboxes, eliminating the need for store-and-forward and reducing errors.

The new integration is being used by Kiwi GPs to improve their clinic workflow and speed up the patient journey.

Radiology reports in New Zealand are currently sent from radiology providers via encrypted store-and-forward messaging, with files picked up every 1-2 hours and brought down to view by the GP when the clinic connects.

The current distribution system can sometimes result in reports going to the wrong place due to an incorrect address, or missed acknowledgements to say whether a file has been imported successfully, or rejected.

A personal drive
Medtech’s general manager integration and infrastructure, Lawrence Peterson, is passionate about improving the system for sending and checking diagnostic reports after a failure resulted in a missed diagnosis for a member of his family.

"My personal experience is my "why" and drives me to find solutions for primary care interoperability problems like this one,” he says

“Doctors are busy and do not have time to find lost reports, or try to track them down with radiology, they just want to know that their report is getting to the right place.

“That is the real power behind this integration, it ensures accuracy and saves doctors’ time.”

Medtech worked with private radiology company Horizon Radiology, part of the Integral Diagnostics group in NZ, to implement the Zed Technologies real-time integration for managing medical imaging using its ALEX^® platform, which enables event driven data sharing using FHIR^® APIs .

The system verifies patient and doctor information before sending reports, ensuring accuracy and reducing the risk of reports going to the wrong place.

“It's real time delivery straight into the doctor's Medtech inbox,” Peterson says.

“And before it is sent the system verifies that the patient and the requesting doctor exist at the practice so they get the right recipient every time.”

The branded PDF radiology reports also contain a single sign-on link for easy access to patient results within their patient management system, without having to log in to another system to view the relevant images.

A simpler solution
Samir Ranchhod, chief digital officer at Tamaki Health, says the primary care group is always looking for ways to simplify the workflow of GPs.

The integration was piloted at Tamaki’s Sylvia Park clinic, which is co located with Horizon Radiology, and they are now looking to scale it out across the group.

“We piloted this because we believed it would benefit the workflow of the clinic, and also the patient journey,” he says.

Normally, when a patient is sent to radiology, they return to the clinic and the doctor will then need to access third party software to search for the patient and find the scan.

“There is always a delay in the way that the GPs deal with the patient,” explains Ranchhod.

GPs using the new integration now get reports directly into their Medtech PMS in the same way they get a lab test, along with a link to view the image.

“It is very quick and efficient because doctors are able to work inside the PMS,” says Ranchhod.
“That speeds up the patient journey, but also the workflow for the doctors.”

Future integrations
Peterson says there is no change to the Evolution workflow, so there is no learning curve or change management for GPs, just real-time, rich imaging available right in the PMS.

Any Medtech user who sends a patient to Horizon Radiology can now benefit from this integration, and Integral Diagnostics NZ will look to deploy the Zed Technologies integration across all of their diagnostic imaging services in New Zealand including Astra Radiology, SRG Radiology and Trinity MRI, over the coming months.

Ross Wright, chief executive of Zed Technologies, says the organisation exists to make sure that radiology scans and reports are available when and where they are needed.

“Finding new ways to reduce error or friction in accessing results is a win for both radiology providers and referring doctors. Thanks to Horizon Radiology and Medtech for making this such a smooth project,” he says.

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Te Rūnanga o Toa Rangatira is looking towards data, technology and innovation to augment their services and ensure “any door is the right door”, says tumu whakarae (chief executive) Helmut Modlik.

“Our mantra is ‘any door is the right door’ requiring connection with our mauri ora ecosystem, so people have seamless access to whatever kind of help they need,” he says.

Te Rūnanga is the mandated iwi authority for Ngāti Toa Rangatira and has a holistic vision of health, “which is about doing everything we can conceive to enhance the overall wellbeing, prosperity and mana of our community”, Modlik says.

The authority is starting its journey from having an ecosystem of ad hoc applications, spreadsheets and informal processes and tools, towards standardised platforms that fit across the scope of their entire mauri ora service delivery.

It operates a number of ‘health services’ - five GP clinics, maternity, youth, and mental health and addiction services – but does not see these as distinct from others that feed into a person’s wellbeing such as food, housing and employment support services.

Modlik says they often work with whānau in a range of areas, but disconnected systems and lack of consistency meant they cannot see the whole picture of what they are delivering through their data.

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Te Rūnanga o Toa Rangatira chose Noted as their key digital platform and went live in February to support a transitional housing and support service for men who have come out of prison.

“These men need a wide range of support, so this initial service implementation will provide insight into much of what we are going to encounter,” Modlik explains.

“We are working with the community to have a seamless journey, not only of service provision and support, but related data and information.”

Te Rūnanga o Toa Rangatira has also adopted the South Island regional Electronic Referral Management System (ERMS) to manage referrals in and out of the organisation.

“Our vision is to create an integrated ecosystem of comprehensive support. As people move through that integrated ecosystem, we need to have information available, such as referrals,” Modlik says.

The mauri ora approach increases the scope of what Te Rūnanga are looking to achieve with data.

“The data that we think is relevant to a person's wellbeing, or their mauri ora, is beyond the strictly physiological data,” Modlik says.

“There is also the heightened view we have around the mana and the dignity of the person and what is going on for them.”

“You can't identify root cause and come back with an optimal response, unless you have timely insights to the relevant spectrum of contributing factors.”

The community they serve has a disproportionately complex set of multifactorial comorbidities, so it is “never going to be realistic for us to expect our teams to be across an ever growing pool of data”, he explains.

“Our vision is that we will be able to utilise emerging tools for decision support, and that is occurring in a holistic frame.”

Modlik says the frame of thinking about people holistically excludes the fragmented siloed thinking and approach which characterises much of the rest of the health and social service system.

“We are best placed to accumulate evidence for what is possible when you integrate and pursue the vision we were describing. It is just the beginning, but we are optimistic.”

Picture: Helmut Modlik speaking at the Tihi Hauora Matihiko

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The first API (application programming interface) standards for the health sector are now available. The standards were developed by Health New Zealand | Te Whatu Ora Data and Digital, working with the health IT sector and others.

Hira Programme Director Gerard Keenan says the release of the standards is a significant step forward in promoting interoperability, data exchange, and innovation within the healthcare ecosystem.

“These are a technical guide to providing and deploying a modern API service. They are the baseline for the sector to use to provide a more consistent and reliable approach for the delivery of health information services.

He says the standards were reviewed by the newly formed technical standards community, using developer collaboration platform GitHub.

“This was a new approach to the review of standards; supporting and promoting participation from the sector. The level of sector engagement and contribution was really encouraging.

“Feedback is very important when technical standards are developed to ensure they are fit for purpose and easy to understand. Listening and being open to different opinions and viewpoints supports shared knowledge and collaboration.”

The next step is for the standards to be endorsed by HISO – the Health Information Standards Organisation.

The two standards just released cover guidance and expectations for:

• API design and development (for FHIR and non-FHIR API specifications)
• API security.
  

These standards will:

• Enhance interoperability by establishing a common framework for seamless communication and data exchange among diverse healthcare systems and applications.
• Prioritise data consistency, ensuring information is accurately and uniformly exchanged across various health platforms.
• Support innovation – developers, healthcare providers, and stakeholders can leverage these APIs to create robust and integrated solutions that improve patient care and overall healthcare delivery.
• Support improved patient care through better access to health data, streamlined workflows, and more efficient communication among healthcare providers.
• Foster collaboration and higher adoption by working with the digital health community and healthcare professionals to keep standards relevant.
  

Get involved!
Input from the sector is invaluable in shaping the future of healthcare interoperability. To be part of the ongoing development of API standards, please visit the https://apistandards.digital.health.nz website. This link will be available via the Health New Zealand Data and Digital Standards webpages, and when launched, the Hira Marketplace website.

Source: Health New Zealand | Te Whatu Ora media release

Sector updates are provided by organisations to eHealthNews.nz and have not necessarily been edited or checked for accuracy. Any queries should be directed to the organisation issuing the release.

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The interoperable Eclair FHIR API by Sysmex has been added to the Diabetes in Pregnancy Registry (DiPR) in New Zealand to enable reliable follow-up care and improved outcomes for pregnant women with diabetes.

Managed by the Counties Manukau Diabetes Service at Middlemore hospital, the DiPR is a web-based system designed to monitor women with pre-existing diabetes or those who develop diabetes during pregnancy.

The registry went live with the Eclair FHIR-API in early October last year as a solution to enhance the rate of blood testing for HbA1c among pregnant women – a vital measure for monitoring blood sugar levels during their 3-month and 12-month checkups with their GP. This ensures that appropriate care is provided to pregnant women during and following childbirth.

Through the FHIR-API, electronic orders for HbA1c testing can now be placed directly on Awanui’s Eclair system. Using the Eclair eOrders module, Awanui’s Eclair system manages laboratory testing requests across multiple primary care facilities throughout New Zealand.

When triggered by specific conditions in the registry’s practice management system, Enigma, the API creates an order without the need for a user interface, carrying complete information including the unique identifier for the individual (NHI), the healthcare provider requesting the test (HPI-CPN) and their practice facility.

GPs can track their patients’ most recent HbA1c screening result in their practice management system, forwarded from the DiPR via the HealthLink messaging service, allowing timely follow-up with the individual for efficient monitoring and care.

Currently, the registry is used by Te Whatu Ora Counties Manukau, with plans to roll out the system regionally in the near future.

Learn more about the Eclair FHIR API solution here.

Source: Sysmex New Zealand media release

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I started working on FHIR (Fast Healthcare Interoperability Resources) because I believe in better health outcomes and that healthcare has broken processes. As well as being a technical standard, FHIR is a name for a community of people dedicated to solving the challenge of sharing healthcare information, and who participate in an open fashion.

Together we have produced a technical specification that describes how to exchange healthcare information. That API has become transformative and is taking over the world of healthcare.

Open Solutions
Interoperability is not a technical problem, it is about building community knowledge and building community answers at every level.

FHIR is an open community, anybody can join. You do not have to pay or register, you can just be part of the community by spending your time on FHIR. This frees up the community to focus on solving problems.

One of my mantras is that interoperability is a the team sport: people contribute to open knowledge to drive change, and it’s why FHIR being an open community is so important. One outcome of that is that open knowledge lifts the baseline, forcing everybody to get better.

The ultimate goal of FHIR is to make the platform public property, so that commercial organisations make money by providing services, not by owning the platform.

If we can solve community problems in an open way, we share the technical base at multiple levels. This solves another key problem with healthcare, which is scale.

Making interoperability worthwhile
The accepted definition of interoperability is the ability of two or more systems to exchange data and make use of the data, so it is a very data centric view of the world. But what if we automate our existing processes, and they are not very good?

You can easily create worse processes with digital, so the real challenge with interoperability is to make it worthwhile.

I prefer to use this definition of clinical interoperability; ‘the ability of two or more clinical teams to transfer patients and provide seamless care’.

The idea is not to automate existing bad practices, but to build new ones that allow us to transform healthcare outcomes.

Institutions tend to keep records and share them for institutional purposes, rather than to serve the patients their families. This means the systems serve our institutions, they do not serve us – where us is either the individuals providing care, the individuals receiving care, or their families.

Our call in the FHIR community is to refocus not on interoperability that automates our existing walls and features, but on processes that break down the walls and allow us to create new kinds of workflows, as it is through those new kinds of workflows that change happens.

For example, using FHIR to provide access to fluid patient summaries that are widely available to create virtual workflows. Virtual Emergency Departments and early discharge services that keep people connected through FHIR and interoperability to hospital systems are truly transformative.

Join the community
In my experience, interoperability happens slowly and gradually and then suddenly you realise that you now totally depend on it.

We set out to disrupt healthcare by significantly reducing the cost of data exchange, principally through making it scalable, easy and natural to use. But of all the things we did, it is the open community that truly changed the game.

I encourage you to join our community and build interoperability that serves clinical health outcomes and helps to build a public treasure that we all benefit from.

This View is a summary of Grieve's presentation at Digital Health Week 2023, if you attended the conference you can access his and all other presentations online.  

If you want to contact eHealthNews.nz regarding this View, please contact the editor Rebecca McBeth.

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Registrations are open for a Connectathon being run by Te Whatu Ora, HISO and HL7NZ in Auckland from 20-22 March 2024. The Connectathon will run in parallel to a companion event in Australia.

The March event follows the success of the “IPS-athon”, focused on the International Patient Summary (IPS), at Digital Health Week 2023. The Connectathon will continue work on adapting the IPS to our unique cultural and health system settings to build a New Zealand Patient Summary (NZPS). The NZPS will enable consumers to tell their health story in digital form and vastly improves continuity of care.

The event will be held at Cliftons, Queen St, Auckland and will take place in two parts:

• Symposium, 20 March: Digital health leaders in New Zealand, Australia and the Pacific will share the importance of standardisation with FHIR®, SNOMED and IPS to the digital health ecosystem we’re building. Our experts will explore models for increased collaboration across the region and focus on improved health equity through digital transformation.
• Connectathon, 21-22 March: Participants will choose from several topic-focused tracks – either to further develop and prove the NZPS FHIR specification, develop product integrations with our marketplace APIs or develop interactive applications with FHIR questionnaires. There is also an education track that will explore the FHIR NZ base.
  

This event is for health software developers, service designers, clinicians and anyone interested in the digitalisation of our health system. All skill levels and job roles are welcome at this hands-on, participatory, and technical digital health event. Expert track leads will help guide each participant to the tracks that match their professional interests and skill level.

Attendees can choose from one of the following options:

• Day one (Symposium only)
• Days two and three (Connectathon only)
• Days one to three (Symposium & Connectathon)
  

Registration is free. Future Connectathons are also being planned, and details will be available over coming months.

Source: Te Whatu Ora media release

Sector updates are provided by organisations to eHealthNews.nz and have not necessarily been edited or checked for accuracy. Any queries should be directed to the organisation issuing the release.

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The National Event Management Service (NEMS) has been successfully piloted and is expected to be in production in March 2024.

NEMS is an event broker system enabling notification of data changes from one system to multiple other systems, such as a patient’s change of address or their presentation to an emergency department.

Gerard Keenan, director Hira programme and technology enablers, says NEMS will give healthcare providers much better visibility of what is happening to patients outside of their direct healthcare setting.

Information is also fed directly into subscriber systems, reducing the need for manual updates.

The pilot tested the connection between various systems, by notifying a small group of health sector subscribers of a death. The publisher was the Health Identity Platform and notifications were based on death information from the National Health Index..

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This was successfully completed in December 2023 and from April 2024 it is planned to extend to areas other than deaths, as well as onboarding new subscribers to the death event.

Keenan says each day there are over 700,000 data changes in the health system and the new service will enable the right data to get to the right people at the right time.

Currently information is captured in one healthcare information system – such as a hospital’s patient administration system - but not all healthcare providers that need this information are alerted because of a lack of interoperability.

“With NEMS, the update is made once, in one system (the publishing system) and then communicated to the other systems (subscriber systems). Information systems subscribe to events, which they get when there has been a change in a person’s information linked to their National Health Index (NHI) number,” Keenan explains.

Solace is the publish-subscribe message broker being used for NEMS.

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InterSystems, a creative data technology provider, has become an early user of the Hira Programme’s application programming interfaces (APIs) developed by Health New Zealand – Te Whatu Ora using the HL7^® FHIR^® health data sharing standard.

APIs enable two or more computer programs to communicate with each other using a set of definitions and protocols. The Hira Programme is driving the move to using FHIR-based APIs for interoperability to enable New Zealanders to access their health information securely wherever it is stored.

Patient administration
Brian Biggs, customer relations and sales director for InterSystems New Zealand, says the company found out that new API functionality was being developed by Te Whatu Ora when his team started the discovery phase of a major patient administration system project.

InterSystems is delivering the patient administration system for Te Toka Tumai Auckland, part of Te Whatu Ora. Serving multiple facilities, including Auckland City Hospital, Starship Children’s Hospital and several community organisations, the system is due to go live in mid-2024.

“Our long-term goal was always to use the National Health Index API, but in any project of this scale, it can be a risk relying on technology that doesn’t quite exist yet,” says Biggs.

“So, we started to work with Te Whatu Ora data and digital identity team, who were developing the NHI API, with a view to InterSystems being early adopters.

“Together, we took the theory and started to discuss how certain scenarios would be handled – for example, how we would work with patients – and put it in the real world.”

Biggs gives the example of managing the identity of a person only known by one name (a mononym) rather than a first name and a surname.

“Currently, the legacy NHI needs a first name and a last name. So, we needed to determine what would happen with the new service when someone had a mononym. The specification said to treat any single name as a mononym. Many systems, including ours, need at least a surname – but treating a single surname as a mononym may have impacts, including with patient identification, in downstream systems.

“These were the types of conversations we were having. We were very excited by the level of engagement we had with the Te Whatu Ora team – they were very pragmatic, open and collaborative.”

Benefits
Biggs says using the FHIR-based APIs has several benefits for Te Toka Tumai Auckland’s new patient administration system, including the ability to reconcile data within the wider information systems environment.

The FHIR (Fast Healthcare Interoperability Resources) standard is a set of rules and specifications for exchanging electronic healthcare data. It is designed to be flexible and adaptable for use in various settings and with different healthcare information systems.

“We will know when a patient’s data was last accessed from the NHI, for example, and FHIR enables us to access other relevant information,” he says. “As well as demographic information, data is retrieved from the National Enrolment Service on the individual GP and GP practice a patient is enrolled with. Data is shared using Health Provider Index identifiers for the individual (HPI-CPN) and the facility (HPI-Fac).

“FHIR enables us to do multiple things at the same time. Whereas historically, you could just do one thing and then another, now you can pull them together into a bundle. Using FHIR resources, we can intuitively and seamlessly provide access to different services in the background without the user having to be aware of the complexities involved.”

The increased reliability and consistency of data will make a big difference to hospital administrators, says Biggs. And, because the patient administration system is the backbone of Te Toka Tumai Auckland’s healthcare information systems, there will be other benefits.

“The system will also benefit patients because the data that other healthcare information systems hold about them will be more up-to-date and reliable.”

Working with Te Whatu Ora
Biggs says the InterSystems team appreciates the opportunity to work with Te Whatu Ora and run the NHI API through real-life scenarios.

“The team at Te Whatu Ora has been genuinely wanting our feedback, and being able to be an early adopter will pay longer-term dividends. It is great for the project, but more importantly, great for the sector.”

Te Whatu Ora Hira Programme industry engagement director Russell Craig says the programme is very pleased with the outcomes of the partnership.

“InterSystems is in the vanguard of those adopting modern FHIR APIs as part of the digital transformation of our health system – transformation being enabled by Hira and other strategic initiatives such as the National Data Platform.

“As Hira continues to build Te Whatu Ora API-management capabilities and releases more FHIR APIs into production, we are looking forward to many more health digital service suppliers following in InterSystems’ footsteps.”

This feature appeared in the Hira Programme update in December 2023.

Picture 2: Brian Biggs, customer relations and sales director for InterSystems New Zealand
Picture 3: Te Whatu Ora Hira Programme industry engagement director Russell Craig

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Medtech is ensuring the responsible and reliable transfer of primary care data and improving the performance of its practice management system (PMS) by working only with Certified Partners from 2024.

Medtech distributes and supports more than 80 percent of the practice management systems across New Zealand.

Historically, a number of third-party applications have connected into the Medtech PMS to provide bespoke digital services or enable sharing and extracting of patient data.

The problem
Medtech’s general manager integration and infrastructure, Lawrence Peterson, has identified a number of issues including a user’s PMS not working, slowing down or not upgrading properly, and errors created due to data being inserted into the wrong place in the wrong format.

“On average one to two sites per month come to us for help with their Medtech PMS, and when we have investigated, we have identified an underlying trigger or process from a non-Medtech application has caused the problem” he explains.

In order to stop these problems occurring, Medtech has implemented a Certified Partners Programme and has reached out to all systems interacting with the Medtech database inviting them to join.

As part of that process Medtech looks at what the partner is doing and why and ensures it is not interfering with the business operations of the Medtech users.

“We have had a lot of success and are now working with a number of partners where we know what they are doing and what data they are taking and the purpose of that,” explains Peterson.

However, the team also came across some bad practices in the market, with tools that are not fit for purpose extracting large amounts of data without a clear purpose, which in one case was being stored in a staging server outside of New Zealand.

“We have come across a tool that was taking things like doctors bank account details and secret passwords for secure messaging agents, lots of really sensitive stuff and we shut that down,” Peterson says.

“When patients lose trust in the system that is holding their health data, they also lose trust in their doctors and that is harmful.”

The solution
A Medtech upgrade in early 2024 will cleanse the database, removing all non-certified applications, tables, queries, stored procedures, and triggers running on the Medtech system.

Further development releases will strengthen the security through encryption at rest and change in the security architecture in line with the Health Information Security Framework (HISF).

Next year, third parties will need to use either ALEX^® or Medicly to facilitate data extraction from the PMS.

Medtech ALEX^® enables event driven data sharing using FHIR^® APIs for things like patient health summaries. Third parties who access patient information are governed by a Medtech Partner Programme Code of Conduct.

Medicly is a secure data exchange that provides the mechanism for safe and secure bulk data extraction for population health and health research, often for primary health organisations (PHOs).

Medtech chief executive Geoffrey Sayer says the upcoming change is about improving security, permissions and informed consent around the Medtech product.

“We all have an obligation under HISF and when you keep putting different agents on to a practice’s software, you invite vulnerability,” he explains.

Sayer believes that too often in health the attitude is that because an organisation is paying for a person’s healthcare, they should by default get access to the data resulting from that. However, the Health Information Privacy Code states that any data extracted must have a clear purpose and be consented to on that basis.

Medicly puts rules in place and provides governance around meeting the Privacy Code while still allowing the really important population health related extractions to occur.

This means that if a patient has denied consent for their medical record to be shared, their data will be excluded from any extraction, something which is not always being implemented now.

Medicly is built on Eightwire’s Data Exchange platform that processes over 3.5 billion records every month in the social, healthcare and law enforcement sectors and has achieved SOC 2 certification.

General manager Andy Ellis says they partnered with Medtech to make an existing process more robust, scalable and secure.

“Medicly simplifies and secures the data exchange process, providing governance across data extraction and auditability for ensuring the patient and their data is protected,” he explains.

“We act as an intermediary to ensure the right controls and consents are in place, but we do not have access to the data and no other parties can see or access it either.

“This ensures patient privacy is protected. There is no bending the rules with our system, but organisations can still access the important analytics they need to guide improvements to the health system.”

The Medicly platform can deliver 4000 records per second and by managing the process through a secure data exchange, it also gives time back to data analysts to do the important work of pulling out insights, rather than fixing data errors and system crashes, Ellis says.

The future
The Medtech team has been communicating with PHOs, practices and vendors about the 2024 deadline when uncertified applications will no longer work, to ensure valuable tools are retained by using one of the two certified pipelines into the system.

“We are locking bad practices out, to make sure the data is safe and secure and only used for the purposes that it is consented for,” Peterson says.

“This is to ensure accuracy and security of the data and ensuring that applications are not interfering with the performance and the warranty of the Medtech software.”

Peterson believes practices are largely unaware of the magnitude of the data that is being taken in some cases and when they become aware and asked if they are happy with it, the answer is a “resounding no”.

“Population health data informs a lot of very important work, and we are certainly not trying to stop that happening: this is about how the data is taken, and what data is taken,” he explains.

Sayer says trust is at the heart of a doctor patient relationship and the use of Medicly means the movement of data is properly consented.

“It is critical that we address these issues of patient consent and data governance before the new world of Artificial Intelligence comes into play,” he says.

Ellis agrees, saying this partnership to enable secure access to primary healthcare data is laying the foundations for the use of emerging technologies.

“To adopt those, you need to have scalable and secure data sharing in place across Aotearoa. This creates opportunities for speeding up delivery of current and future data and digital projects to benefit clinicians and patients.”

To find out more about the Medtech Partnership Programme see our website: https://medtechglobal.com/nz/our-partners/

Or contact the Partnerships Team on
partners@medtechglobal.com

Picture: Jason Gleason, Eightwire chief executive, Andy Ellis, GM Medicly, Lawrence Peterson Medtech GM integration and infrastructure, Alex Cauble-Chantrenne, product manager clinical integration Medtech (left to right)

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Integration with the NZ ePrescription Service (NZePS) is now a minimum requirement for all prescribing and dispensing systems operating in New Zealand as the country moves towards a “truly paperless” prescribing process.

A Medicines Data Repository (MDR) has also been commissioned to provide a single source of truth for prescribed and dispensed medicines information for New Zealanders, based on real-time information received directly from the NZePS.

Vidhya Makam, Te Whatu Ora programme lead Digital Medicines portfolio, says a number of projects are working towards the goal of making the prescribing process “truly paperless”, including working with IT suppliers to ensure they are NZePS-compliant.

In June this year the Te Whatu Ora Whānau, Consumer and Clinician Digital Council endorsed integration with NZePS and MDR as a digital minimum requirement for prescribing or dispensing systems operating in New Zealand.

There are 14 prescribing systems that are already integrated, including all practice management systems used by GPs.

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It also includes both Elekta, which provides specialist oncology solution Mosaiq and the Incisive prescribing system used mainly by private specialists.

Both pharmacy systems used in New Zealand are also integrated, so even if a script is not sent via NZePS, the dispensed details are still sent through to the service and can be captured in the MDR.

“This creates a single source of truth of a patient’s medication history that can be integrated with our clinical systems, so the information is available to clinicians wherever they are in the country,” Makam says.

“It will also feed into the medication summary for the patient so that as a consumer you will be able to see what was prescribed or dispensed and what repeats you have available.”

In December 2022, changes were made to allow signature exempt prescriptions for controlled drugs to be made through NZePS.

To enable this, the team has introduced the ability to send immutable script images to NZePS and enable the script and the script image to be directed to a patient’s chosen pharmacy. NZePS-integrated systems are now rolling out these changes.

When fully implemented, a patient will not have to carry a paper copy of the script to a pharmacy if they have nominated a pharmacy to the prescriber.

Per month 1.9 million scripts are being sent using NZePS out of a total of 2.7 million scripts.

Makam says the current work is targeting that remaining 30 percent of scripts to make them NZePS-compliant.

In 2020, a temporary signature exemption was put in place that allowed non-NZePS scripts to be sent electronically as part of the pandemic response. This waiver has been consistently extended, but is currently set to expire in October 2024.

The Digital Medicines portfolio team will be speaking at Digital Health Week NZ 2023 in Hamilton this November.

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Rotorua Area Primary Health Services (RAPHS) has increased its newborn enrolment coverage by 26 percent over the past year after integrating its shared care view for Rotorua Hospital with the National Enrolment Service (NES).

Chief executive Kirsten Stone says non-enrolled patients are high users of hospital services, and support for whānau with newborn children is a priority to initiate access to care, health, and wellbeing services right from birth.

RAPHS was close to the bottom of the national league table for newborn enrolment at the end of 2022, but is now ranked fifth. Stone says this is a direct result of collaboration between primary and secondary care providers and use of information to drive improvement.

The primary health service provides a shared care view to Rotorua Hospital ED called PatientWise. This started in 2010 as a way to look up a patient’s GP and has developed over time to include clinical information such as demographic details, problem codes and medications.

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Hospital users can now also see clinical encounter notes from the GP’s practice management system over the past 90 days, and there is functionality for secure messaging with the usual GP.

Until recently, only information on RAPHS enrolled patients was available, but an integration with the NES, which provides up to date national enrolment and identity data for people enrolled with any practice nationally, means hospital clinicians can identify those patients who live locally, but who are not enrolled with a GP.

A new referral pathway into the RAPHS Koiora team, which includes community nursing, clinical pharmacy, mental health and social care; allows the hospital to refer these patients without a GP and especially those with complex health and social needs, to RAPHS for follow up care including support to enrolment.

Stone says this process has significantly increased enrolment with general practice, particularly for priority patient groups.

“Our focus on supported enrolment has lifted enrolment for Māori by 3 percent and Pasifika by 4 percent over the last year, even though practice books have largely been closed during this period,” she says.

In parallel RAPHS has a clinical service for transitional care post hospital admission.

“This is for those who are not well served by the system: that do not have a GP, or practice books might have been closed so there is not any follow-up care. We have the hospital and the primary care team working together to make sure those really vulnerable cases do not fall between the cracks.

“Even before Covid-19, the unenrolled population were identified as high users of health services or hospital services, and there has been a whole range of initiatives looking at that,” Stone says.

“The Covid period and emergency housing initiative put massive extra pressure on the health sector in Rotorua by introducing around 5000 people into quite a small system, and not all of them had a GP. With practices under stress with national workforce shortages, GPs also have less capacity to take on these new patients.

“This approach is joining the circle to ensure the technology, the information, and service providers are working together.”

Data scientist Justin Sherborne says the web-based tool PatientWise was built in-house and is also being used by the local out of hours care provider and some pharmacists.

He says the integrated nature of the tool makes it easier for clinicians to identify non-enrolled patients as they already use it to see the patient’s primary care clinical information.

If a hospital clinician looks up a patient it sends an automatic notification to the GP, which Sherborne says they love as they then know they patient has presented at hospital.

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The September Hira Update (first item in ‘News’ section) is now available. It has a snapshot of the latest Hira projects, and takes a closer look at the Hira connector plane build, and the responsible use of health information.

Hira will transform the way people interact with health services and use their health information. It will deliver:

• A New Zealand patient summary – an app/website allowing healthcare consumers/whānau to see their health information in one place and update some of it
• A platform allowing healthcare providers to access and update patient data held in different databases
• A secure, carefully controlled digital ecosystem enabling vendors to build apps for healthcare consumers, whānau and providers, to help people manage their own health
  

We welcome your feedback, input and questions about Hira – please email us on contact@hira.health.nz. Further information on the Hira Programme is also available on Te Whatu Ora website.

Source: Te Whatu Ora - Data & Digital media release

Sector updates are provided by organisations to eHealthNews.nz and have not necessarily been edited or checked for accuracy. Any queries should be directed to the organisation issuing the release.

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Innovative digital health companies were in the spotlight at the recent 2023 NZ Hi-Tech Awards.

Formus Labs won both the software and deep tech categories and Tend won the innovative Hi-Tech service award, with Orion Health highly commended in that category.

Formus was founded within the Auckland Bioengineering Institute and developed the world’s first AI-automated 3D planner for joint replacement surgeries.

Formus chief executive Ju Zhang says he and the team were incredibly honoured to receive two awards.

"I think our success comes from our enduring belief that our technology, based on decades of world-class research, will make a fundamental improvement to orthopaedic patients and surgeons," he says.

"The Hi-tech awards cap off a great first half of 2023 for Formus with a growing user base in Australia, international regulatory clearances, and growing exposure in the orthopaedic industry worldwide.

"We are looking forward to taking our technology to the US and Japan, providing surgical plans without the effort of planning to surgeons, unlocking scalability and insights for the tech ecosystems of our industry partners, and pushing the frontiers of orthopedics with our clinical champions," says Zhang.

Co-founder of digital first general practice provider Tend, Josh Robb, says the competition was fierce, with outstanding finalists in their innovation category.

“Our unique and innovative service, with a strong focus on promoting more equitable healthcare access and outcomes across Aotearoa, is what made us stand out from the rest,” he says.

“The judges were impressed by our ‘inside out’ approach and the dedication of our purpose-driven founders to leaving a positive health legacy for Aotearoa.”

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Fellow co-founder Mataroria Lyndon says it was humbling to see Tend’s technology and team's dedication and mahi being recognised.

“We will continue driving technological innovation in healthcare, and are committed to making a meaningful impact on the health and well-being of our communities,” he says.

Chief executive of Orion Health Brad Porter congratulated Tend as the winners and said it was great to see digital health so well represented at the awards.

“We were really proud to be highly commended for our work implementing our world-first Digital Front Door solution in Canada, supporting more than 15 million people with a unified digital tool to manage their own healthcare,” he says.

“These were two great examples of Kiwi tech making a difference to the healthcare experience for people around the world."

The NZ Hi-Tech Awards judges said the calibre of this year’s entrants was at an all-time high, with a record number of new companies entering the awards.

“A key theme that comes through is how many of our Kiwi companies are making technology with purpose that can really scale internationally,” said NZ Hi-Tech Trust chair David Downs.

Picture: Tend co-founders Josh Robb and Mataroria Lyndon at the Hi-Tech Awards - click to enlarge

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Te Whatu Ora is focused on "driving a rationalisation around fewer better national platforms and national services”, and moving from pilots to “innovation at scale”, Leigh Donoghue says.

The chief data and digital spoke at the MTANZ HealthTech Conference on June 26, where he said there has been massive structural underinvestment in data and digital health in New Zealand.

“One of the first tasks is to … deal with the underinvestment, and enable the organisation to think and operate in a very different way,” he told the audience.

“We will focus on fewer simpler platforms leveraging what we have rather than driving wider variation.”

Donoghue said when he started at Te Whatu Ora on May 1, 2023 there were 1600 data and digital projects in the pipeline, all developed with slightly different aims, affordability and investment priorities. This way of doing things created duplication and variation across the country.

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The new organisational structure meant a central team could reprioritise these projects, and channel investment in line with national priorities.

“We need fewer better platforms across the landscape. We cannot continue driving more pilots to build on to the complexity that exists today,” he said

“This will only work if we work in partnership, and big change requires big partnerships.”

Te Whatu Ora is working to simplify the number of touch points into the organisation and provide clear lines for engagement.

“We are moving to nationally-led more strategic approaches to relationships,” he said,

“This is not business as usual, and we would ask you to work with us, not around us, because there are deeply entrenched traditional ways of working and we need to come together to create this once in a generational shift.”

Donoghue said Te Whatu Ora will also be taking a much more focused approach to innovation and “move from pilots to innovation at scale". 

“There are some big opportunities for us in this space, but we want to make sure that we do not have uncontrolled innovation,” he explained.

The organisation is setting up better processes to shorten the cycle of innovation and allow for faster application.

“The innovation cycle of technology development is accelerating. We need to simplify our process and take steps to make the right innovations accessible more widely more quickly.”

He also said the national organisation needs to build new skills and strategic capability inhouse.

The inhouse team will be equity-led and focused on levelling the floor, simplifying the landscape, and leveraging what is has in order to accelerate delivery.

Donoghue said data and digital services need to evolve their approach to focus on “good, better great”, with great as the longer term ambition, but starting with a minimum viable product.

“We need to create capability and capacity for change. We have a health sector that is fully stretched at the moment, so freeing up capacity is critically important. It is not simply about saving money, but a focus for us will be how we free up clinical time.”

Donoghue said change at this scale is a multi-year journey. “This is the best part of a decade program of change,” he said.

Picture: Te Whatu Ora chief data and digital Leigh Donoghue speaking at the MTANZ HealthTech Conference

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The Te Whatu Ora Hira Programme has released a tender for an Event Notification Service (ENS) to improve health sector interoperability.

Hira has also released the medicines consumer view FHIR (fast healthcare interoperability resources) API to allow people to access more of their medicines information via their patient portal.

The ENS will let healthcare providers know when information relating to a patient has changed, such as their address, or when they have had an interaction with the system, such as being seen at the emergency department.

The tender is for an event notification service solution and a partner to deliver the solution, who may be the same or different providers. The notifications are IT system to IT system.

A Hira update says, “the service is a foundation of the Hira programme and will support the wider Hira interoperability and integration outcomes”.

The RFP says one of the major challenges in the health sector is the dynamic nature of data.

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In Aotearoa-New Zealand, over 700,000 healthcare-related data changes occur daily, but the lack of a universal ENS means health system applications cannot access these critical data updates.

This results in the development of scheduled polling for changes or the cumbersome task of uploading delta files to capture relevant updates.

The ENS aims to keep IT systems informed about changes occurring in data source systems through authorised subscriptions.

“This will improve the currency of data when it matters and increase the reach of consumer health data changes shared across the sector,” the RFP, which closes on June 14, says.

The medicines consumer view FHIR API provides access to the Medicines Data Repository, and is available for patient portal suppliers to access and integrate with.

“Traditionally, patient portals are linked to a person's enrolled GP and their practice, meaning only information about medicine prescribed from that practice is available through portals,” a Hira update says.

“With this API, the information available to authenticated consumers has been extended to include all prescribing and community dispensing data available, based on information sent to the New Zealand electronic prescription service (NZePS).”

People will need to be authenticated using their My Health Account digital identity before they can access the medicines consumer view.

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At this week’s World Health Assembly in Geneva, Netherlands presented a statement on behalf of the EU and members, Norway, UK, USA, Canada, Australia and New Zealand calling on WHO to do more to harmonise ICD-11 and SNOMED CT.

• The statement points to the significant number of countries that have moved beyond ICD to use higher granularity terminologies, in particular SNOMED CT, to support quality digital health information and interoperability
• Concerningly, this is not well-reflected in the WHO progress report on ICD-11
• WHO is asked to change course and engage with international standards organisations to enable global and national digital health strategies
  

The UK made its own supporting statement a few minutes later, calling for WHO recognition of SNOMED CT and the International Patient Summary (IPS)

WHO’s response acknowledged both SNOMED and IPS

Recording here https://www.who.int/about/governance/world-health-assembly/seventy-sixth-world-health-assembly WHA76 Committee B Seventh Meeting starting at 41 minutes

Sector updates are provided by organisations to eHealthNews.nz and have not necessarily been edited or checked for accuracy. Any queries should be directed to the organisation issuing the release.

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