Electronic Health Records and Electronic Case Records in 2012 It’s not as hard as we think!

Agenda The problem we’re trying to solve Examples of EHR and ECR in 2012: Patient care in a primary care setting Provision of long term care Medical incident from an Ambulance Services perspective Patient care in a secondary care setting Information Architecture Making it happen . . .

The problem we’re trying to solve

Examples of EHR and ECR in 2012:

Patient care in a primary care setting

Provision of long term care

Medical incident from an Ambulance Services perspective

Patient care in a secondary care setting

Information Architecture

Making it happen . . .

The problem we’re trying to solve Quality information is necessary to deliver the optimum health service but the information required is often held elsewhere (and is not immediately available) and : Patients worry about misuse of their health information and that the data is unsafe If data was provided, there is a concern that practitioners would get more information than they need and there are particular concerns regarding access to mental health and sexual health data Some concerns that releasing information would result in less control of patient management and/or increased scrutiny of clinical decisions etc . Therefore, discussion about EHRs and ECRs tends to stop at the “patient privacy barrier” and progress has been minimal This paper describes what an EHR/ECR capability might look like if these concerns were addressed

Quality information is necessary to deliver the optimum health service but the information required is often held elsewhere (and is not immediately available) and :

Patients worry about misuse of their health information and that the data is unsafe

If data was provided, there is a concern that practitioners would get more information than they need and there are particular concerns regarding access to mental health and sexual health data

Some concerns that releasing information would result in less control of patient management and/or increased scrutiny of clinical decisions etc .

Therefore, discussion about EHRs and ECRs tends to stop at the “patient privacy barrier” and progress has been minimal

This paper describes what an EHR/ECR capability might look like if these concerns were addressed

Scenario 1 – Primary Care Practice Management System and online notifications of external health events operate side by side at the GP/Nurse’s desktop Data displayed from multiple sources as one virtual record (bloods, medications etc.) Identifies other health providers involved in a patient’s care Electronic Support for Clinical Decisions Moderated online access by patients to their data

Practice Management System and online notifications of external health events operate side by side at the GP/Nurse’s desktop

Data displayed from multiple sources as one virtual record (bloods, medications etc.)

Identifies other health providers involved in a patient’s care

Electronic Support for Clinical Decisions

Moderated online access by patients to their data

Scenario 2 – Long Term Care Specialists can access key data from PMS – medications, allergies etc. All providers involved see the same (appropriate) data to ensure continuity of care Management of tests and reviews (scheduling and reporting) Electronic Case Records provide a vertical slice of data – ad hoc enquiry for other information

Specialists can access key data from PMS – medications, allergies etc.

All providers involved see the same (appropriate) data to ensure continuity of care

Management of tests and reviews (scheduling and reporting)

Electronic Case Records provide a vertical slice of data – ad hoc enquiry for other information

Scenario 3 – Ambulance Services “ Break glass” access to critical patient data where patient consent is not possible Observations and baselines etc. automatically transmitted to the hospital

“ Break glass” access to critical patient data where patient consent is not possible

Observations and baselines etc. automatically transmitted to the hospital

Scenario 4 – Secondary Care Access to all patient history (sexual and mental health by exception) Medical warnings and alerts, pharmaceutical use and laboratory test results Summary by default – drill down to detail where required Contact information provided if more clinical detail needed

Access to all patient history (sexual and mental health by exception)

Medical warnings and alerts, pharmaceutical use and laboratory test results

Summary by default – drill down to detail where required

Contact information provided if more clinical detail needed

Information Architecture Point of Care Health Event Summaries Health Event Records Clinical Record – Patient B Health Event Summaries Health Event Record = “ minimum (clinical) data set” for that type of event Health Event Summary = transactional record of event Health Event Records Clinical Record – Patient A

The Heath Event Summary Index Record Identifier Unique Serial Number Definition Event type, security indicator Patient Identity NHI, public interest flag Health Worker Identity HPI (Worker, Organisation and Facility) Date/Time Inputs (repeating) Serial number of records created in the same transaction Outputs (repeating) Serial number of services or interactions that resulted from this transaction Audit (repeating) HPI (Worker) and date/time of access

Information Architecture District, Community and National Repositories Connected Health Networks DHB Health Event Summary Index Health Event Records PHO

Information Architecture National Collections etc Ad hoc report Communicable Disease Register Rheumatic Fever Register Cancer Register National Immunisation Register Integrated Diabetes Management DHB .. Health Event Summary Index Integrated Cardio Vascular Disease Management Report Specification DHB 2 DHB 1 DHB n Data Extract(s)

Information Architecture Point of Care Enquiry DHB .. Health Event Summary Index DHB 2 DHB 1 DHB n Data Extract(s) User HES1 HES2 HER1 HES3 HER2 Connected Health Networks

Making it happen . . . Technology is not a barrier Health Information Strategy for NZ sets the direction Work already underway including: Authentication and security Connected Health Networks Online Forms Server Common data dictionary Code sets and data standards Still work to be done in the policy, legislation and regulation space

Technology is not a barrier

Health Information Strategy for NZ sets the direction

Work already underway including:

Authentication and security

Connected Health Networks

Online Forms Server

Common data dictionary

Code sets and data standards

Still work to be done in the policy, legislation and regulation space

Thank you for listening I’m keen to continue the discussion. You can contact me at: Doug Neilson Information Strategist PO Box 12 698 Thorndon Wellington 6144 Phone 027 446 7224 eMail [email_address]

I’m keen to continue the discussion. You can contact me at:

Doug Neilson

Information Strategist

PO Box 12 698

Thorndon

Wellington 6144

Phone 027 446 7224

eMail [email_address]