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Broadband-Enabled Health Care for New Zealand
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Broadband-Enabled Health Care for New Zealand

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Murray Milner

Murray Milner
Chair, National Health IT Board
(3/11/10, Civic 2, 2.00)

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  • The Connected Health Programme will provide a foundation for this health system infrastructure. This project will establish an environment for the safe sharing of health information by delivering standards, frameworks and core network components to create a foundation for an interconnected health network where health applications will be able to interoperate – across ultra-fast broadband. The Connected Health Programme is designed to enable the very diverse communication needs of the sector to be addressed through a combination of both technical standards and a competitive commercial model. This model will allow health organisations to choose telecommunication services and products from a variety of accredited telecommunication service providers. Services and products are categorised by standards into “tiers” that can always interoperate with each other – at the network, services and applications layers. These standardised products will be marketed as Connected Health certified products by the telecommunications industry. This competitive model should enable the fast and ultra-fast broadband capability to be delivered into the health sector at affordable prices. This mechanism provides heath purchasers with the opportunity to ‘mix and match’ certified products from various suppliers but with the confidence they will all work together in combination as a seamless, integrated health connectivity environment. The suppliers to the health sector will be accredited to ensure minimum standards of secure connectivity are maintained throughout the health sector. These accredited providers will also be retail service providers in terms of the utilisation of the fibre-optic based broadband capability and their accreditation will automatically ensure the provision of universal connectivity across the health sector – allowing the benefits of the Government’s ultra-fast broadband initiatives to apply to all heath organisations using broadband-enabled applications and services.
  • The Connected Health Programme will provide a foundation for this health system infrastructure. This project will establish an environment for the safe sharing of health information by delivering standards, frameworks and core network components to create a foundation for an interconnected health network where health applications will be able to interoperate – across ultra-fast broadband. The Connected Health Programme is designed to enable the very diverse communication needs of the sector to be addressed through a combination of both technical standards and a competitive commercial model. This model will allow health organisations to choose telecommunication services and products from a variety of accredited telecommunication service providers. Services and products are categorised by standards into “tiers” that can always interoperate with each other – at the network, services and applications layers. These standardised products will be marketed as Connected Health certified products by the telecommunications industry. This competitive model should enable the fast and ultra-fast broadband capability to be delivered into the health sector at affordable prices. This mechanism provides heath purchasers with the opportunity to ‘mix and match’ certified products from various suppliers but with the confidence they will all work together in combination as a seamless, integrated health connectivity environment. The suppliers to the health sector will be accredited to ensure minimum standards of secure connectivity are maintained throughout the health sector. These accredited providers will also be retail service providers in terms of the utilisation of the fibre-optic based broadband capability and their accreditation will automatically ensure the provision of universal connectivity across the health sector – allowing the benefits of the Government’s ultra-fast broadband initiatives to apply to all heath organisations using broadband-enabled applications and services.
  • The Connected Health Programme will provide a foundation for this health system infrastructure. This project will establish an environment for the safe sharing of health information by delivering standards, frameworks and core network components to create a foundation for an interconnected health network where health applications will be able to interoperate – across ultra-fast broadband. The Connected Health Programme is designed to enable the very diverse communication needs of the sector to be addressed through a combination of both technical standards and a competitive commercial model. This model will allow health organisations to choose telecommunication services and products from a variety of accredited telecommunication service providers. Services and products are categorised by standards into “tiers” that can always interoperate with each other – at the network, services and applications layers. These standardised products will be marketed as Connected Health certified products by the telecommunications industry. This competitive model should enable the fast and ultra-fast broadband capability to be delivered into the health sector at affordable prices. This mechanism provides heath purchasers with the opportunity to ‘mix and match’ certified products from various suppliers but with the confidence they will all work together in combination as a seamless, integrated health connectivity environment. The suppliers to the health sector will be accredited to ensure minimum standards of secure connectivity are maintained throughout the health sector. These accredited providers will also be retail service providers in terms of the utilisation of the fibre-optic based broadband capability and their accreditation will automatically ensure the provision of universal connectivity across the health sector – allowing the benefits of the Government’s ultra-fast broadband initiatives to apply to all heath organisations using broadband-enabled applications and services.
  • About SJUNET: Commenced 1998 Public Private Partnership Originally connected 7 counties Now the backbone of national healthcare services Upgraded to fibre up to 1Gbps SJUNET-based applications: Medical Messaging: E-prescriptions, results, secure email VC: Consultations, rounds, supervision, education Telephony Services: IP Telephony File Transfers: Teleradiology, telepathology, admin Web Services: Quality registries, archives, databases App Sharing: Remote access to key systems

Broadband-Enabled Health Care for New Zealand Presentation Transcript

  • 1. Broadband-Enabled Health Care for New Zealand 11/05/10 Murray Milner, Chair National Health IT Board
  • 2.
    • Government Ultra-fast Broadband initiatives
    • Challenges in health service delivery
    • National Health IT Plan – vision & shared care
    • Foundations for safe sharing of information
    • The Connected Health Approach
    • Capitalising on Broadband in health
    • Broadband enabled innovations – some examples from overseas
    • Conclusions
    Topics for Today
  • 3. Government’s Vision & Initiatives for Ultra-Fast Broadband
    • Ultra-fast broadband (i.e. enabling speeds of more than 100Mbps downstream) to be available to 75% of all New Zealanders – focusing initially on business, education and health “users”
      • Supplemented by much-improved broadband (better than 5Mbps downstream) to the remaining 25% of New Zealanders living in the more rural parts of the country
    • Two faster broadband initiatives
      • the Ultra-fast Broadband Initiative – $1.5-billion fund aimed at 33 urban centres, covering 75% of the population. (Crown Fibre Holdings)
      • the Rural Broadband Initiative – $300 million to connect up schools, hospitals and health provider sites in rural areas
        • This initiative will focus on rural schools, but also provides for fibre cable to be deployed to rural hospitals or health care provider sites if they meet certain criteria - including their significance to local communities.
  • 4. Health as a Priority
    • In August 09 Cabinet agreed that to take advantage of the UFB investments for health, the Ministry will work on behalf on clinicians and consumers to ensure that:
      • the priorities for the health sector are understood and that services are, as much as possible, able to be implemented in areas of high need
      • “ use of Faster Broadband and the potential for technology enabled improvements in healthcare are a part of every new Integrated Family Health Centre proposal ”
  • 5. Challenges in Health Service Delivery
    • Workforce shortages
    • Lack of specialists
    • Increase of chronic diseases
    • Inequalities in service provision and health outcomes
      • The urban/rural divide
    To address issues, the MRG Report (July 2009) made recommendations including those to enhance sustainability and the consumer experience – reducing waste and bureaucracy, improving safety and quality; and enhancing clinical and financial viability
  • 6. Rural Health ICT Challenges
    • Technology ‘speed’ and coverage
    • Need for good hospital discharge information (E.g. can’t pop out to the Chemist if script is needed)
    • Access to ICT support services
    • Isolation from peers and specialists – support, training, advice
    • Referring patients to specialists or hospital – patient travel
  • 7. The eHealth Vision
    • “ To achieve high quality health care and improve patient safety, by 2014 New Zealanders will have a core set of personal health information available electronically to them and their treatment providers regardless of the setting as they access health services.” National Health IT Plan, July 2010, available at www.ithealthboard.health.nz
  • 8. eHealth Principles
    • This vision is enabled by three principles
    • Ensure the community understands and supports appropriate use of, and access to, electronically stored personal health information
    • Clinicians are integral to the development and ongoing use of personal health information solutions
    • The health workers, support carers and the Family are integral to the ongoing care of the person
    • Electronic information will be person- centred
    Community Family and Support Carers Clinicians and health workers Patient/ Consumer
  • 9. Phase 1 Workstreams Personal Health Information Work Streams 1. Quality Information for Primary Health Care 2. Continuum of Care 3. Safe Medications Management 4. Clinical Support 5. Patient Administration Supporting Information Work Streams 6. Population Health 7. Business Support 8. Safe Sharing Foundations Information Infrastructure
    • Applications
    • Clinical
    • Administrative
    Model of Care Broadband fits here
  • 10. Future History Care Plan Decision Support Phase 2 Shared Care Models Core Health Information Supports Multi-disciplined care Does not replace a Personal Health Record Vitals E-events
  • 11.
    • Patient-centric – owned by the patient
    • Shared with relevant health providers
    • Dynamically kept up to date by clinical team
    • Available to any health practitioner under emergency “break glass” with audit
  • 12. Foundations for Shared Care
    • The current availability of broadband services does not meet the needs of future health care delivery
    • There needs to be consistently good broadband connectivity throughout all parts of the health sector
    • Enabling safe sharing of all types of information across all entities throughout the sector
    • Enabling a collaborative model of integrated care, often with the sharing of rich media information in real-time
      • Requires the increased use of ultra-fast broadband capability, to improve the performance of the connectivity
      • Requires that connectivity be universally available across all parts of the sector
      • Requires that safeguards associated with universal and robust identity management are in place
    • The ultra-fast broadband initiative combined with the National Health Board’s Connected Health Programme will deliver the capability the sector needs for the future
    • The health sector will need to be willing and able to make both the financial investment in technology required, and the clinical and business process changes needed, to realise these opportunities
  • 13. Connected Health Approach
    • Purpose
      • Connected Health is establishing an environment for the safe sharing of health information
    • What is it?
      • Connected Health is a standards-based, commercial model for the delivery of universal connectivity across the New Zealand health sector
      • The Connected Health Network is a 'network of networks' delivered by multiple telecommunication service providers on a competitive basis, using industry standard, commodity capability
    • What is the Programme delivering?
      • The foundation components of an interconnected health network, including
        • A common connectivity framework
        • Network connectivity standards (approved by Health Informatics Standards Organisation)
        • Core network components
          • Three managed points of interconnection
          • A uniform addressing scheme
        • An accreditation and certification process for suppliers (telecommunication service providers)
        • Governance and management oversight
  • 14. Connected Health Approach (cont.)
    • What will be different?
      • Improved reliability, safety, and security of transferring health information
        • Only products or services certified against approved network connectivity standards will be allowed to connect to the network
      • Increase competition
        • Health IT suppliers will be required to disaggregate services and products and certify them against common (HISO-approved) network connectivity standards, thereby levelling the competitive field and allowing new vendors to enter the market
        • Increased competition between health IT suppliers, increasing innovation and encouraging value for money
        • Health organisations across the sector will have a greater choice of standardised offerings, from multiple IT suppliers
      • Build foundation components
        • A foundation for the safe sharing of electronic health information throughout the sector and with the public at large
  • 15. Connected Health Network
  • 16. Connected Health Status
    • Architectural Framework, UNI, NNI specifications all published as HISO standards Sept 2010.
    • POI implementation by Datacraft underway. Ready for testing end Oct, live early Dec.
    • Accreditation of existing Health Network providers and Vivid Networks complete Sept.
    • Certification of supplier UNI and NNI products started Sept, to complete Oct 2010.
    • FX, Gen-i, and TCL connect to POIs for testing end Oct.
    • Ministry migrated to certified connection (Healthzone) by end Nov.
    • Health Network integration completed early Dec – the new Connected Health Network ‘goes live’
  • 17. Connected Health & UFB Architecture UFB = Government Ultra-fast broadband initiatives. Diagram courtesy of Crown Fibre Holdings Protected ring Optional drop diversity Layer 2 Backhaul Central Office Central Office Point of Interconnect Service Providers Connected Health Network Cabinet Cabinet Cabinet
  • 18. UFB and Connected Health Linkages
    • UFB aligned to CH common connectivity framework for an interconnected health network
    • UFB products will be certified to CH standards in conjunction with Retail TSPs
    • CH standards for UNI and NNI have been reviewed by Crown Fibre; experts from IEEE & MEF have also been consulted
    • CH will play valuable role in governance and oversight
    • The uniform addressing scheme will drive benefits
    • CH framework provides a smooth migration path from legacy products to new UFB based products
  • 19. The Potential of Broadband
    • Broadband has the potential to improve New Zealand health care delivery by:
      • Providing video-based services to assist in removing distance as an issue in patients gaining access to health care
      • Providing video and other rich media web based services to support clinical education and clinical peer support (especially in rural settings)
      • Extending hospital-based services to allow for the wider exchange of high-resolution images and other rich media content between health providers in near real-time
      • Enabling the provision of a model of shared care where many clinicians across all care settings can deliver against integrated care plans for patients,
      • Providing high bandwidth links that allow health providers and hospitals to give patients, whänau and communities access to more valuable health care services (e.g. including real time video) from their homes and support self-care, education and treatment for long-term conditions
  • 20. SJUNET, Sweden
    • Applications include:
    • Messaging for E-prescriptions, results, secure mail
    • VC for consultations, supervision
    • File Transfer e.g. Tele-radiology
    • Web access to registries, archives, databases
    • Remote access
    • Backbone of national healthcare in Sweden
    • 1Gbps fibre
    • PPP model, open access
    Sources: Pyramid Research, Swedish Association of Local Authorities and Regions, Carelink, CFH analysis Courtesy of Crown Fibre Holdings
  • 21. IDA Experience Centre Singapore
    • Fibre for remote consultation, x-ray and diagnostics
    Courtesy of Crown Fibre Holdings
  • 22. Health Sites a Priority for UFB
    • Government policy to prioritise UFB to health sites
    • Target completion by 31 Dec 2015 for urban sites
    • Health providers:
      • 14 categories registered under the Health Care Competency Act
      • ~10,000 entities in urban New Zealand
      • ~100,000 health workers in urban New Zealand
    • Crown Fibre Holdings can direct prioritisation of Local Fibre rollout
    • Complemented by Rural Broadband Initiative for Rural New Zealand
    • Committed demand from Health assists priority delivery of service across all parts of New Zealand
  • 23. Establishing Demand in Health
    • Limited information is currently available on specifically where the gaps in the ability to support ultra-fast broadband exist across the health system
      • Sites with no Fibre
      • High bandwidth sites
    • National Health Board and DHBs working with MED and CFH to populate the Broadband Demand Map with health sites – see www.broadbandmap.govt.nz
    • Health providers can self-register on the Map
    • The Broadband Demand Map will help identify priorities for the health sector in terms of geographic coverage
    Visit the Crown Fibre Holdings Booth for more information
  • 24. Conclusion
    • Government is investing in Ultra-fast Broadband (Ultra-fast Broadband and the Rural Broadband Initiative) – health is a priority
    • IT Health Plan is building a shared care model to support increased self and collaborative care in any setting – Phase 1 is removing the barriers to sharing information, allowing for ultra-fast broadband to play an increasing part in high-value health applications
    • Government Ultra-fast broadband initiatives will deliver the improved performance for rich media health applications
    • Connected Health Approach fosters competition (value for money), choice, and a secure, reliable ‘network of private networks’ for the safe transfer of information
    • NHB/IT Health Board is supporting MED and CFH to identify where improvements in broadband availability and speed will be of most benefit
    • To benefit, health providers should choose Connected Health certified networking products and register on the Broadband Demand Map
    • Broadband-enabled innovations have the potential to help overcome the challenges of improved sustainable health service delivery in the future