The Rise and Rise of the Virtual Health Record


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Tom Bowden
(Friday, 10.30, General 2)
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Provision of immediate access to accurate, pertinent, satisfactorily comprehensive clinical information in a dependable and cost-effective manner has long been an elusive goal. Attempts to implement shared record systems (both summary record systems and comprehensive record systems) have proved extraordinarily challenging. However, the Virtual Health Record (VHR) is an entirely new approach to patient information sharing. It is based upon linked regional implementations of a new technology. The methodology commences with a consensus building process amongst providers to determine what information is shared and how it is to be shared? VHR lends itself to an incremental approach to implementation.
Now being implemented in its second and third regions, the Virtual Health Record system is gradually being expanded as the technology and support systems are bedded in and the clinicians across each region learn to trust one another and work closely together to deliver a highly functional and reliable method of communication.
The Virtual Health Record is proving to be a viable method for sharing information across the healthcare ecosystem.

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  • I also see a lot of time being spent trying to use technology to re-engineer the health sector , particularly bey devising clever ways in ewhich records can be readily shared across multiple disparate providers. My feeling is that we should be focused on routine automation of existing processes and very careful inching forward as we head into the brave new world of shared records, we should always remember that public trust is a currency that is extremely hard to create and maintain , yet awfully easy to squander and once expended is lost, probably for ever. I’d also point out that the e vidence is
  • In the IT field however we continue to do well. This has come about because we have had a very strong link between health care strategy and a strong commitment from the private sector to work with government to implement systems and services in support of that strategy.
  • This time we look at the number of parties the average practice communicates with. It has grown from 3 in 2000 to 58 today.
  • Which GPs have seen this patient?
  • The Rise and Rise of the Virtual Health Record

    1. 1. The Rise and Rise of the Virtual Health Record Tom Bowden HealthLink
    2. 2. Late Breaking News on the relentless search for practical ways to share a Patient’s health information• Tom Bowden, CEO HealthLink Ltd, Tuesday 11th October 2011
    3. 3. Today’s Agenda...• Pressure on Health Systems• The Holy Grail of Health System Efficiency• Attempts to date• Alternative Approaches• The Virtual Health Record (case study)
    4. 4. New Zealand, like most otherdeveloped countries sets great store by its advanced health system
    5. 5. However there is one problem with health systems; they are very expensive and everyone is feeling the pinch
    6. 6. 6 International Comparison of Spending on Health, 1980–2008 Average spending on health Total expenditures on health per capita ($US PPP) as percent of GDP8000 16 United States Norway 147000 Switzerland Canada Netherlands 126000 Germany France5000 Denmark 10 Australia Sweden4000 United Kingdom 8 New Zealand United States3000 6 France Switzerland Germany Canada2000 4 Netherlands New Zealand Denmark1000 2 Sweden United Kingdom Norway Australia 0 0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 6 Source: OECD Health Data 2010 (June 2010).
    7. 7. Average Annual Growth Rate of Real Health Care Spending per Capita, 1996–20065.0% 4.8% 4.3% 4.1% 3.9%4.0% 3.7% 3.6% 3.3% 3.0%3.0% 2.5%2.0% 1.6%1.0%0.0% New United Australia* OECD Canada United Netherlands France Switzerland Germany Zealand Kingdom Median States *1995-2005 47 Source: OECD Health Data 2008, “June 2008.”
    8. 8. Athens
    9. 9. London
    10. 10. Washington
    11. 11. OK so what the *(%#@! hasthat got to do with health IT?Healthcare is costing us toomuch, a situation that has tochange!
    12. 12. A short history lesson...
    13. 13. Game Changing event!The State and PublishedPattern ofHEALTH 2005InformationTechnologyAdoption
    14. 14. “Innovations in information technology(IT) have improved efficiency and qualityin many industries. Healthcare has notbeen one of them.” “If most (US) hospitals and doctors’offices adopted HIT, the potentialefficiency savings for both inpatient andoutpatient care could average over $77billion per year.”
    15. 15. And so began the search for the holy grail...
    16. 16. “If I live in Bradford and fall ill in Birmingham then I want the doctor treating me to have access to the information he needs to treat me”. ....” Rt Hon Tony Blair 1999 almost at that instant, the world’s largest non- military IT project, a £13 billion National Programme for Information Technology (NPfIT) took flight. 13 years later....
    17. 17. Knowledge to Cure CholeraDr John SnowNoted 500 deaths fromCholera occurred within10 days.Traced to a single waterpump in Broad Street
    18. 18. NHS told to abandon delayed IT project“£12.7bn computer scheme to create patient record system is to be scrapped after years of delays”The Guardian 22nd September 2011
    19. 19. What went wrong?… “The Devil is in the Detail”Professor Trisha GreenhalghUniversity College, London May 2010
    20. 20. 1. Most patients seen in unscheduled care either have conditions for which the data on the SCR are irrelevant or they are able to provide these data themselves.2. Clinical staff are generally suspicious of the completeness and accuracy of information they are getting from a shared record. This is creating an apparent reluctance to refer to it.3. The cost of developing and maintaining a national shared record system to a minimum standard of quality and safety is prohibitive.4. The public have continuing concerns over the privacy of their information and sharing of personal medical data without explicit consent has eroded public trust in the healthcare system.University College London (Greenhalgh et al).
    21. 21. Starting From A Good Place
    22. 22. Quality of Care from Doctor Percent rated care received in past 12 months from regular doctor as very good/excellent 100 84 76 79 74 74 75 67 69 59 54 49 50 43 25 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USBase: Has regular doctor/place of care. 24Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
    23. 23. Physician Satisfaction100 Satisfied 75 Very satisfied 54 54 66 54 49 50 59 54 68 49 36 25 34 35 35 30 22 27 21 18 15 12 0 8 5 NZ NOR NET UK SWE ITA CAN FR US AUS GERSource: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
    24. 24. Practices with Advanced Health Information Capacity Percent reporting at least 9 of 14 clinical IT functions* 100 92 91 89 75 66 54 49 50 36 26 25 19 15 14 0 NZ AUS UK ITA NET SWE GER US NOR FR CAN* Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access testresults, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with testresults, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests orpreventive care. 26Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
    25. 25. Electronic Partners6050 1 0 040 % E30 M R20 U S E10 0 Aug-99 Aug-00 Aug-01 Aug-02 Aug-03 Aug-04 Aug-05 Aug-06 Aug-07 Aug-08 Aug-09 Aug-10
    26. 26. Three New Zealand Alternatives• Share for Care – Opt In• Shared Care Record View –Opt Out• Care Insight – Virtual Health Record
    27. 27. West Coast Region- Share for Care
    28. 28. What information is included?• Long-term health problems• Long-term medications• Recent health issues (last 6 months)• Recent medications (last six months)• Allergies• Immunisation record• Hospital discharge summaries• Test resultsWhat information is not included?• Consultation notes• Information you do not want shared
    29. 29. • The shared care record view (eSCRV) system will allow doctors, nurses and pharmacists to get a patients medical record on the spot.• Project spokesman Dr Nigel Millar, chief medical officer from the Canterbury District Health Board (CDHB), said the system would provide an "up-to- date summary" of a patients history.Christchurch Press Feb 22 2011
    30. 30. The Virtual Health Record
    31. 31. Case Study - Hawkes Bay DHBDRAFT • Covers all of the region’s general practices, will include pharmacies • Pilot Commenced in March 2011 • Now Going for Clinical Council Approval • Privacy Impact Assessment underway • In daily use
    32. 32. Benefits• Quick to implement• Low cost• Privacy- friendly• No intermediate systems
    33. 33. VHR Use Cases• A and E querying all of the medical centres, after-hours clinics to obtain current information about a patient it is treating.• A local accident and emergency provider checking on GP records to see what medications a patient is using• A general practice querying local pharmacies to ascertain whether a patient has been dispensed the medicines that he or she has been prescribed• A surgeon on a hospital ward looking for more information about a patient’s medical history, prior to an operation
    34. 34. Actual Examples• An elderly patient shows up at ED without a referral. Care Insight is used to find out what medicines he she uses.• A person arrives acting suspiciously/behaving erratically, Care Insight used to ascertain whether they are a drug seeker.
    35. 35. The Care Insight systemPatient Presents at ED or A&M Clinic Which GPs have seen this patient? May I see these current summaries? Gather Patient Summaries Deliver set of summaries Message to each practice with a record of which records have been viewed The viewer initiates a structured ‘self-referral’ into the hospital CDR
    36. 36. What do the users think of theVirtual Health Record/ Care Insight?
    37. 37. “ Having access to the patients recent prescriptions and the date they were generated is very helpful in terms of clarifying patients history and in terms of confirming the medications that they are currently on. The list of previous medical conditions/diagnoses is also helpful, particularly in patients with dementia or who are unable to recall their medical or surgical history. I think this is a valuable resource and it would be beneficial to have access extended to all consultants and registrars in ED.”Mark Barlow, Head of ED, Hawkes Bay DHB
    38. 38. Planned improvements• Redesign of the user interface• Educating the public about it• Continuous improvement of system management
    39. 39. Key Learnings• Very important to get a consensus from the region’s providers• Training ED and A and E staff is mission critical• The feedback loop to practices is very important• Take it slowly and get it right
    40. 40. Shared Health Records: The equivalent of climbing Mt Ama Dablam Where we will be by HINZ 2012Emergency Record Sharing Starts Here Base camp 1: New Zealanders you are here
    41. 41. “We didn’thave themoney, sowe had tothink” Sir Ernest Rutherford, - Father of Nuclear Physics and famous New Zealander
    42. 42. Thanks for your