Investigating the Potential to Improve the Free Flow of Healthcare Information – a survey of New Zealand clinicians and health providers HINZ Conference 2009 Ross McKenna October 2009

Agenda Background and Purpose of Paper Approach and Methodology Findings Conclusions Questions

Background and Purpose of Paper

Approach and Methodology

Findings

Conclusions

Questions

Background and Purpose Person- centered Health information needs to follow patients across care settings – not constrained by organisation boundaries Implementation of ICT in health requires collaborative effort and clinical input Increasing pressure on budgets and more technology options – setting priorities is difficult Sector ICT decisions made in lots of places across the sector Broad agreement on high level requirements (E.g. HISNZ 2005) but limited statistically significant evidence of specific sector ICT needs Needed evidence based analysis of ICT needs of the New Zealand Health sector to: Provide more detail to assist targeting and prioritising effort and spend – Connected Health Measure success and progress of ICT investments Research conducted by UMR under contract from MoH Provides ‘independent’ evidence of current Sector requirements – Clinicians and ICT Decision makers, DHB and non-DHB An informed, evidential starting point for communication between clinicians, purchasers, technical and vendors

Person- centered Health information needs to follow patients across care settings – not constrained by organisation boundaries

Implementation of ICT in health requires collaborative effort and clinical input

Increasing pressure on budgets and more technology options – setting priorities is difficult

Sector ICT decisions made in lots of places across the sector

Broad agreement on high level requirements (E.g. HISNZ 2005) but limited statistically significant evidence of specific sector ICT needs

Needed evidence based analysis of ICT needs of the New Zealand Health sector to:

Provide more detail to assist targeting and prioritising effort and spend – Connected Health

Measure success and progress of ICT investments

Research conducted by UMR under contract from MoH

Provides ‘independent’ evidence of current Sector requirements – Clinicians and ICT Decision makers, DHB and non-DHB

An informed, evidential starting point for communication between clinicians, purchasers, technical and vendors

Research Approach and Methodology Depth interviews with opinion leaders (n=8) Explore key issues Ideas for question-lines Depth interviews with key segments (n=103) Issues, barriers and drivers Decision making and influences Develop Questionnaires Issues, barriers and drivers Clinicians and Decision makers Detailed sector surveys undertaken (n=2,454) Sent to 7,000 individuals in 5,000 orgs DHB /non-DHB Clinicians/ ICT Decision makers 32% Response, 90% by mail - “It’s about time someone asked us” Margin of error = 2.3% non-DHB Clinicians, 3.4% ICT Decision makers, 7.9% DHB clinicians

Survey findings Diversity of the Health sector 19% Clinicians and 25% specialists work in more than one DHB area Wide variation in numbers of patients seen/treated per day per clinician 34% sector organisations part of a larger group 34% sole private practices 17% not-for-profit 25% GPs work from multiple locations Strong agreement across the Sector (94% DHB & 80% Non-DHB clinicians) that improved ICT would help to enhance service delivery - but limited perception of value for money. Generally consistent view of top 4 priority information types needed electronically Test results Medication information Discharge summaries Referrals High level of technology capability in the sector 93% Clinicians have internet access and use email . 80% Clinicians like to keep up with the latest technology

Diversity of the Health sector

19% Clinicians and 25% specialists work in more than one DHB area

Wide variation in numbers of patients seen/treated per day per clinician

34% sector organisations part of a larger group

34% sole private practices

17% not-for-profit

25% GPs work from multiple locations

Strong agreement across the Sector (94% DHB & 80% Non-DHB clinicians) that improved ICT would help to enhance service delivery - but limited perception of value for money.

Generally consistent view of top 4 priority information types needed electronically

High level of technology capability in the sector

93% Clinicians have internet access and use email .

80% Clinicians like to keep up with the latest technology

Survey findings - continued 51% Non-DHB clinicians and 72% DHB clinicians reported that at least once a day they could not find the patient electronic information they required to optimally treat their patients Email Communications Most email use in the sector is for administrative communications. 51% Non-DHB clinicians use email for communicating with patients and 42% for sending/receiving referrals. . However, Fax is the ‘safe’ default technology – 95% non-DHB organisations. Urban GPs use email to communicate with patients more than rural Improving their organisations use of ICT was a priority for 74% ICT decision-makers Recognition of increasing importance of ICT to healthcare But there are challenges to be overcome… Privacy and security concerns Funding/resources inadequate Incompatible ICT (PMS) systems Need support from Ministry and DHBs Lack of Standards Barriers to increased use of ICT

51% Non-DHB clinicians and 72% DHB clinicians reported that at least once a day they could not find the patient electronic information they required to optimally treat their patients

Email Communications

Most email use in the sector is for administrative communications.

51% Non-DHB clinicians use email for communicating with patients and 42% for sending/receiving referrals. . However, Fax is the ‘safe’ default technology – 95% non-DHB organisations.

Urban GPs use email to communicate with patients more than rural

Improving their organisations use of ICT was

a priority for 74% ICT decision-makers

Recognition of increasing importance of ICT to healthcare

But there are challenges to be overcome…

What driving ICT investment in Health?

Conclusions General agreement that better access to “electronic” information leads to better care quality, efficiency and coordination of care delivery Availability of technology for use does not always = productive use of that technology for healthcare ICT flexibility and interoperability is needed to support diverse “business” models Must meet individual provider unique needs but also support business processes that span multi-provider More information should be accessible “electronically” – Big 4 types of valuable information consistently requested. Factors influencing clinicians need for “electronic” information Current availability/use of technology Patients treated per day What is stopping it? = Technology issues, funding needed, privacy/security, lack of standards. More external coordination and guidance is needed (GP and Aged Care particularly) - from “DHBs and the Ministry of Health” Need for agreement from all collaborators slows ICT purchasing cycles Plenty of opportunities for ICT to support information exchange in the sector but needs: Common direction - MoH, DHB, supported by Funders Collaboration - Clinical, ICT decision makers, other providers, vendors Connection to business and model of care

General agreement that better access to “electronic” information leads to better care quality, efficiency and coordination of care delivery

Availability of technology for use does not always = productive use of that technology for healthcare

ICT flexibility and interoperability is needed to support diverse “business” models

Must meet individual provider unique needs but also support business processes that span multi-provider

More information should be accessible “electronically” – Big 4 types of valuable information consistently requested.

Factors influencing clinicians need for “electronic” information

Current availability/use of technology

Patients treated per day

What is stopping it? = Technology issues, funding needed, privacy/security, lack of standards.

More external coordination and guidance is needed (GP and Aged Care particularly) - from “DHBs and the Ministry of Health”

Need for agreement from all collaborators slows ICT purchasing cycles

Plenty of opportunities for ICT to support information exchange in the sector but needs:

Common direction - MoH, DHB, supported by Funders

Collaboration - Clinical, ICT decision makers, other providers, vendors

Connection to business and model of care

QUESTIONS? UMR Research findings will be available from the Ministry of Health Website

UMR Research findings will be available from the Ministry of Health Website