THE H EALTH M ANAGEMENT S YSTEM C OLLABORATIVE Collaborating for the Nation’s Health … the 7 (10) DHBs

What this is not about … Justifying an EHR A heavy technical presentation Reiterating the issues experienced in other places The view from a CEO of a DHB What we’ve done to date What this is about …

Justifying an EHR

A heavy technical presentation

Reiterating the issues experienced in other places

The view from a CEO of a DHB

What we’ve done to date

Health is Facing Unprecedented Issues Significant increase in acutes Significant increase in chronic conditions Workface issues 16000-20000 new nurses by 2025 GP shortages Medical staff shortages Increasing sub-specialisation

Significant increase in acutes

Significant increase in chronic conditions

Workface issues

16000-20000 new nurses by 2025

GP shortages

Medical staff shortages

Increasing sub-specialisation

Issues for Health Patient safety and care Ageing population Ageing staff Pace of clinical technology advance Increasing public expectation and political focus Financial pressures

Patient safety and care

Ageing population

Ageing staff

Pace of clinical technology advance

Increasing public expectation and political focus

Financial pressures

Issues for Health “ New Zealand is striving to … more efficient management of chronic conditions, the big clinical challenge of an ageing society …” “ ... to rationalise the hospital sector to assure its clinical viability” “… a need to improve efficiency incentives and information” “ hospital spending could be cut further, perhaps dramatically, by greater use of community services” “ Another concern is the sustainability of the health care service delivery model in the face of rising demands and looming health workforce shortages ” (OECD Economic Surveys : New Zealand 2009)

Issues for Health “ It is becoming generally accepted that continuing to deliver health care to New Zealanders using today’s model of care will, at best, become increasingly challenging and may, in due course, cease to be viable” (National Institute of Health Innovation 2008) “ We are reaching the limits of what we can achieve for chronic condition outcomes with a fragmented system” (NZ Ministry of Health 2008)

… But there are some potential glimmers of hope: Underutilised skills and resources GPs, community pharmacists, nurse practitioners community providers Devolution of secondary services to primary care Long term approach to workforce issues – many and varied “ The need for innovation in health care” (Ryall 2008) No Easy Answers

… But there are some potential glimmers of hope:

Underutilised skills and resources

GPs, community pharmacists, nurse practitioners

community providers

Devolution of secondary services to primary care

Long term approach to workforce issues – many and varied

“ The need for innovation in health care” (Ryall 2008)

No Easy Answers “ When physicians use health information technology to its full potential, the result is fewer deaths, fewer complications, and lower health care costs” (Amarasingham, M.D; Powe, M.D)

And very few of which can be enabled by current ICT systems All of which represent major service transformation

“ ICT diffusion could help the clinical revolution by: i) managing fast-changing medical best practice in a centralised database made available to all doctors..” ii) allowing shared electronic records of patient information, so as to allow new models of patient-centred delivery that minimise error and duplication” (OECD Economic Surveys : New Zealand 2009)

There is an even bigger picture Health is a key component of individual, societal and national success “ Health costs will impact national competitiveness” (OECD) The challenge for health is no less than national success An efficient and effective ability to exchange of information is only a part of the answer – but it is an essential part

Health Management System Collaborative Vision is to establish an individual-centric health information management service by “ wrapping the Health Management System around the individual” ...... rather than the provider.

“ Individual decision making by 21 DHBs may be too fragmented to make rational and coherent capital allocation plans; more regional and national collaboration is called for.” (OECD Economic Surveys : New Zealand 2009)

HMSC Vision - Key Attributes The system will: be supportive of users & evidence based enable vastly improved shared access to an individual’s health information by all the clinicians involved in their care as well as by the individuals themselves. allow people to be fully informed about their health & have improved ownership & participation in their own care significantly expand the traditional view of a Patient Administration System (PAS) and Clinical Support Systems to be more integrated, more interactive, wider in scope and much richer in functionality make the patient electronic record easily available across the continuum of care .

The system will:

be supportive of users & evidence based

enable vastly improved shared access to an individual’s health information by all the clinicians involved in their care as well as by the individuals themselves.

allow people to be fully informed about their health & have improved ownership & participation in their own care

significantly expand the traditional view of a Patient Administration System (PAS) and Clinical Support Systems to be more integrated, more interactive, wider in scope and much richer in functionality

make the patient electronic record easily available across the continuum of care .

A major transformation… source: MoH

HMS must enable the transformation Pre-Requisites Current Legacy systems High cost for integration Low level of integration between primary and secondary Lack of standardisation Provider focused – transactional episodes of care Multiple sources of “same” information Future Single integrated health record Patients access & contribute to their record Role based access for health professionals Information gathered as an integrated part of the care process Capability for electronic communication between individuals & clinicians Standardised care pathways & standardised information Self care strongly supported by system & professionals Clinician led Focus on Primary, Community and individual End to end process Optimum total cost of ownership Commitment to change (policy & service delivery) Sufficient resources Population view for planning and decision making

Legacy systems

High cost for integration

Low level of integration between primary and secondary

Lack of standardisation

Provider focused – transactional episodes of care

Multiple sources of “same” information

Single integrated health record

Patients access & contribute to their record

Role based access for health professionals

Information gathered as an integrated part of the care process

Capability for electronic communication between individuals & clinicians

Standardised care pathways & standardised information

Self care strongly supported by system & professionals

Clinician led

Focus on Primary, Community and individual

End to end process

Optimum total cost of ownership

Commitment to change (policy & service delivery)

Sufficient resources

Population view for planning and decision making

HMSC - Procurement Drivers * - MidCentral, Wairarapa & Whanganui Time Frame Driver 2007/08 NMDHB & SCDHB - scope was for wider patient-centric vision than “traditional” hospital provider based PMS. Reluctance to “catch up to the back of the pack”. Issued RFI 2008 Central Region DHBs* Group – issued same RFI with same patient-centric vision (and had agreed on a common hosting approach.) 2008 NDHB commences planning for replacement of PMS and achieving wider vision for Northland. Dec 2008 HMSC formed, creating scale needed to attract new solutions / vendor thinking. Aggressive timeline for RFI and RFP

RFI Process: Evaluation & Education Time Frame Activity Dec 2008 Three Auckland DHBs express interest, request reference in RFI document. RFI for the 7, potentially 10 - issued. Represents ≡ 60% of population. Jan – Feb 2009 Initial emphasis - Evaluating responses to meet aggressive timeline March 2009+ Primary emphasis now on “being informed”, i.e. harvesting salient points from the responses learning through evaluation and socialising the results developing preferences re: services, potential solution and implementation planning the procurement roadmap as an enablement stream clinical engagement

Primary emphasis now on “being informed”, i.e.

harvesting salient points from the responses

learning through evaluation and socialising the results

developing preferences re: services, potential solution and implementation

planning the procurement roadmap as an enablement stream

clinical engagement

Strong Clinical Engagement Has been - and will be - a cornerstone of this activity: Early consultation; e.g. in NMDHB/SCDHB General Practice SMOs Pharmacists Community providers Response overwhelmingly encouraging

Has been - and will be - a cornerstone of this activity:

Early consultation; e.g. in NMDHB/SCDHB

General Practice

SMOs

Pharmacists

Community providers

Response overwhelmingly encouraging

Strong Clinical Engagement Each DHB: 1st Tier Evaluation Panel comprised of: DHB health professionals Administrator / managers IT staff Primary sector representatives (GPs, administrators) RFI evaluation teams range in size from 9 to 30. In total there are 111 evaluators - 56% are health professionals. Evaluator Type No. of Evaluators % of all evaluators GPs 10 9% Primary Care Nurses 4 4% Primary Sector Health Professionals 14 13% Doctors 25 23% Nurses 17 15% Allied Health 6 5% DHB Health Professionals 48 43% All Health Professionals 62 56%

Each DHB: 1st Tier Evaluation Panel comprised of:

DHB health professionals

Administrator / managers

IT staff

Primary sector representatives (GPs, administrators)

GPs

Primary Care Nurses

Nurses

Allied Health

Strong Media & Industry Interest IT takes a back seat in shared health system evaluation Computerworld, 9 Apr 2009 DHB CEO backs collaboration on health software Computerworld, 3 Apr 2009 Better health services the goal The Nelson Mail, 7 Mar 2009 Health Collaborative reassures local vendors Computerworld, 7 Mar 2009 Patients to add to own health records Dominion Post, 3 Mar 2009 DHBs to develop shared records NZ Doctor, 25 Feb 2009 Health IT collaboration open to new members Computerworld, 21 Jan 2009

Want to Emphasise… Engagement and participation of the Ministry Through concept stages Representation on Project Governance Group Project Operational Steering Committee Observer/ex officio status Alignment “ The approach is consistent and complementary with Ministry thinking” (Alan Hesketh DDG Information MoH)

Engagement and participation of the Ministry

Through concept stages

Representation on

Project Governance Group

Project Operational Steering Committee

Observer/ex officio status

Alignment

“ The approach is consistent and complementary with Ministry thinking” (Alan Hesketh DDG Information MoH)

Want to Emphasise… No predetermination of solution architecture vendor software country of origin Genuine process to test market and invite solutions to the Collaborative’s needs

No predetermination of solution

architecture

vendor

software

country of origin

Genuine process to test market and invite solutions to the Collaborative’s needs

Challenges Are not technical, nor a function of size … for 4.5 million people - about the size of Manchester, or half the size of a large American HMO Are societal, ethical, professionally behavioural Are daunting, but not impossible

Are not technical, nor a function of size

… for 4.5 million people - about the size of Manchester, or half the size of a large American HMO

Are societal, ethical, professionally behavioural

Are daunting, but not impossible

Challenges - Privacy Clearly still to be resolved However… Much of the necessary exchange happens now, with paper or fax based records NZ has good privacy laws in place – High principle, low regulation Recognises role of technology in information availability and that controlled sharing is critical to the economy

Challenges - Privacy Much to learn from the “good” places - Canada “Privacy by Design” Privacy is an important consideration – it should not be seen as a barrier or an excuse to stay frozen in immobility Proceed carefully – but proceed

Much to learn from the “good” places - Canada “Privacy by Design”

Privacy is an important consideration – it should not be seen as a barrier or an excuse to stay frozen in immobility

Proceed carefully – but proceed

Challenges Existing New Zealand vendors feel threatened - or at least challenged No apology for that … NZ Health should not be behind the rest of the world Might have misread their customer’s need and vision? Instead - relish the opportunity… If vendors feel challenged, imagine what it feels like from here!

Instead of being challenged, we should seize an opportunity - for New Zealand, for the sector, for the vendors …but most of all for the health of the people of New Zealand, and the potential contribution to the country’s prosperity

Seven (ten) DHBs have recognised a need, and are collaborating to find the way forward This is unique in the history of ICT in New Zealand Health The drivers are compelling The challenges are significant In reality … there is no choice

Seven (ten) DHBs have recognised a need, and are collaborating to find the way forward

This is unique in the history of ICT in New Zealand Health

The drivers are compelling

The challenges are significant

In reality … there is no choice

Thank you

HMSC Governance Structure Chair – John Peters CEOs – Karen Roach, Julie Patterson, David Meates, Chris Fleming, Joy Cooper (Tracy Adamson), Stuart Wilson (for Murrray Georgel) Clinicians – CMAs Nigel Miller (CDHB) & Andre Nel (NMDHB) & Martin Wilson (Pegasus & CDHB) MoH – Alan Hesketh CIO – Nick Lanigan (NMDHB) Simpl – Bennett Medary OSC Chair - TBA