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There’s light at the end of the tunnel
North Island by Deprivation Index 
NZ Census 2006
North Island by Deprivation Index 
NZ Census 2006
Northland by Deprivation Index 
NZ Census 2006
Northland by Deprivation Index 
NZ Census 2006
Whangarei City by Deprivation Index 
NZ Census 2006
 One DHB and 2 PHOs who are not in 
competition- in fact share most “back office” 
functions 
 Good alliancing relations...
 Northland Primary Information Governance 
Group 
 Established December 2007 
 Chaired by Ken Leech 
 Wide representat...
Pronounce things like: 
 Acute glomerulonephritis 
 Necrotising fasciitis 
 Phenoxymethyl penicillin 
And calculate the...
Patient DashBoard
 Auckland PHO 
 Central PHO 
 Compass/WIPA 
 East Health 
 Hauraki PHO 
 Health Hawkes Bay 
 Manaia PHO 
 Nelson B...
• Alan Davis 
• Northland District Health Board 
• Northern Regional Alliance
• Northland 
• Primary Care/DHB initiative 
• Driver = security/primary access 
• 9 month development phase 
• Roll-out in...
E-transmission 
E-triage
Service Median time to triage completed 
(June 2013) 
Cardiology 0.21 days 
Respiratory 0.5 days 
Ophthalmology 0.96 days ...
Clinic type % referrals managed with non contact 
outcomes 
Haematology 53% 
Oncology 69% 
Renal 59% 
Paediatrics 24% 
Gen...
•People move their mindset at a certain speed 
• Be modular and iterative 
• Reflect on changes at each step 
• Be prepare...
• Phase 1 – referral generation and transmission 
• All about primary care 
• Goal is security of the message 
• Keep it s...
1. Increase access to specialist services 
2. Provide Specialist Services within Primary care 
3. Provide chronic disease ...
To provide a seamless and reliable 
telehealth service which looks and feels like 
clinical care
Telehealth as a key enabler: 
•Increase availability of and access to 
services in primary and community 
settings 
•Impro...
 30 VSL end points at NDHB 
 15 of these are Telehealth 
◦ Kaitaia Outpatients (2 clinic rooms) 
◦ Bay of Islands Hospit...
 Engagement with Primary Care 
 Outpatient Clinics 
 ICU -> District Hospital ED 
 Dargaville Mobile Telehealth 
 Reg...
6 of the major specialities are now doing 
telehealth clinics on a regular basis
 Overwhelmingly positive 
 Before and after impressions 
Consensus: Great if it means don’t have 
to travel, take time o...
 Increased specialist presence and reduced patient and 
clinician travel 
 Can reduce patient waiting lists 
 Increase ...
 Health Link Tool- used to make e-referrals to 
private specialists and NGOs. 
 NGOs will include- Green Prescriptions, ...
 • Sport Northland 
 • Hospice 
 • Arthritis Foundation 
 • Alzheimer’s society 
 • Cancer Society 
 • Northable 
 ...
 Gives a view of classifications, medications, 
allergies, immunisations to external providers 
 Currently being accesse...
 Largest Practice in Kerikeri has given access 
to district nurses to become users of their 
version of MedTech 
 Kaipar...
 A component of the Care Connect Tool 
 Trial started in the Hokianga and Bush Road 
Medical Centre to allow 2 way messa...
 MedTech Manage My Health and My Practice 
Health 365. 
 Access if via a secure website- same level of 
security as inte...
 Patient Portal have an option to allow patients 
to read their notes from the time they enrol 
onto the portal 
 Eviden...
53 
13,564 the majority of patients who viewed at least one visit note 
reported; 
77-85% understood their health conditio...
and what we tend to do in Northland 
“…start very simple and then just begin with it. And let 
things happen organically a...
Kenealy et al. Diabetes Care 
2010
 Changes will be evolutionary not 
revolutionary 
 Pace of change will be dictated by what 
providers can cope with and ...
 His proposed definition of “patient-centred care” is this: 
The experience of transparency, individualisation, 
recognit...
“I can plan my care with people who work together to 
understand me and my carer(s), allow me control, and 
bring together...
“The patient is always a person. 
The person is sometimes a 
patient. 
The person is more than an 
individual. 
The person...
 Maori Providers 
 Whanau Ora Providers 
 Other Health Providers: pharmacists, dental, 
Plunket, DHB community services...
 Providers involved for 5 hours per year, 
patients for the other 8755 hours 
 Patients, families and communities have 
...
“ All changes and new concepts that we initiate 
in order to make the healthcare sector more 
person- centred must include...
 Who is your customer? 
 What do you want for yourself if you’re 
needing a health IT system that best manages 
your car...
“Good will is easy. It gets complicated when 
it’s about money and income.”
He aha te mea nui o te 
ao? 
He tangata! He tangata! 
He tangata!
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
News from the Coal Face: There’s light at the end of the tunnel
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News from the Coal Face: There’s light at the end of the tunnel

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News from the Coal Face: There’s light at the end of the tunnel. Presented by Dr Andrew Miller, General Practitioner, at HINZ 2014, 11 November 2014, 4.30pm, Marlborough Room

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News from the Coal Face: There’s light at the end of the tunnel

  1. 1. There’s light at the end of the tunnel
  2. 2. North Island by Deprivation Index NZ Census 2006
  3. 3. North Island by Deprivation Index NZ Census 2006
  4. 4. Northland by Deprivation Index NZ Census 2006
  5. 5. Northland by Deprivation Index NZ Census 2006
  6. 6. Whangarei City by Deprivation Index NZ Census 2006
  7. 7.  One DHB and 2 PHOs who are not in competition- in fact share most “back office” functions  Good alliancing relationships with Maori Providers  Highly functioning PHOs with good population health data, full time data analyst, highly effective IT team & practice facilitators  Makes implementation and provider change management relatively simple
  8. 8.  Northland Primary Information Governance Group  Established December 2007  Chaired by Ken Leech  Wide representation-both planning and funding so decisions made in one forum  Driver behind most primary IT developments in Northland
  9. 9. Pronounce things like:  Acute glomerulonephritis  Necrotising fasciitis  Phenoxymethyl penicillin And calculate the dose of multiple drugs from mg/kg/day and convert this into tablets and liquid forms
  10. 10. Patient DashBoard
  11. 11.  Auckland PHO  Central PHO  Compass/WIPA  East Health  Hauraki PHO  Health Hawkes Bay  Manaia PHO  Nelson Bays PHO  Pegasus  ProCare  South Canterbury DHB  Southern PHO  Te Tai Tokerau PHO  Waitemata PHO  Well Health  [West Coast PHO - soon]  Whanganui Regional Health Network  a number of individual practices and A&Ms
  12. 12. • Alan Davis • Northland District Health Board • Northern Regional Alliance
  13. 13. • Northland • Primary Care/DHB initiative • Driver = security/primary access • 9 month development phase • Roll-out initiated March 2009 • 100% electronic from 1st June 2013 • Auckland • Negotiation/Product development 2009 • Driver = security • Heavy secondary care involvement • Roll-out initiated 2012
  14. 14. E-transmission E-triage
  15. 15. Service Median time to triage completed (June 2013) Cardiology 0.21 days Respiratory 0.5 days Ophthalmology 0.96 days Paediatrics 1.67 days Renal 0.25 days Gynaecology 0.67 days Orthopaedics 9.15 days
  16. 16. Clinic type % referrals managed with non contact outcomes Haematology 53% Oncology 69% Renal 59% Paediatrics 24% General Medicine 59% Neurology 41% Respiratory 29% Liver 32%
  17. 17. •People move their mindset at a certain speed • Be modular and iterative • Reflect on changes at each step • Be prepared for unintended consequences • Involve everyone in the pathway
  18. 18. • Phase 1 – referral generation and transmission • All about primary care • Goal is security of the message • Keep it simple • Keep secondary care out of the room • Phase 2 – triage and response • Mainly about secondary care • Volumes will increase • e-Triage takes longer
  19. 19. 1. Increase access to specialist services 2. Provide Specialist Services within Primary care 3. Provide chronic disease management within a patient’s home 4. Facilitate communication for health administration and education
  20. 20. To provide a seamless and reliable telehealth service which looks and feels like clinical care
  21. 21. Telehealth as a key enabler: •Increase availability of and access to services in primary and community settings •Improve primary care access to specialist advice to support community-based care
  22. 22.  30 VSL end points at NDHB  15 of these are Telehealth ◦ Kaitaia Outpatients (2 clinic rooms) ◦ Bay of Islands Hospital ◦ Dargaville Hospital ◦ Child Health Centre (2 clinic rooms) ◦ Orthopaedics ◦ Whangarei Outpatients (2 clinic rooms) ◦ Renal (3 locations) ◦ Kamo, Kaikohe CMH ◦ ICU ◦ Te Roopu Kimiora (2 mobile locations)
  23. 23.  Engagement with Primary Care  Outpatient Clinics  ICU -> District Hospital ED  Dargaville Mobile Telehealth  Regional Cancer MDM  Mental Health – Kimiora  Standards and Guidelines
  24. 24. 6 of the major specialities are now doing telehealth clinics on a regular basis
  25. 25.  Overwhelmingly positive  Before and after impressions Consensus: Great if it means don’t have to travel, take time off work etc
  26. 26.  Increased specialist presence and reduced patient and clinician travel  Can reduce patient waiting lists  Increase access to education and support  Provide access to multi disciplinary teams  Improve cross team communications and management capability  Knowledge gain for remote location
  27. 27.  Health Link Tool- used to make e-referrals to private specialists and NGOs.  NGOs will include- Green Prescriptions, Alzheimer’s Society, Arthritis NZ etc  Doesn’t require the recipient provider to have a PMS  Will allow provider to send back an inbox message to our PMS
  28. 28.  • Sport Northland  • Hospice  • Arthritis Foundation  • Alzheimer’s society  • Cancer Society  • Northable  • Epilepsy Northland  • Stroke Foundation  • Parkinson’s Society  • Plunket  • Maori Providers  • Manaia PHO
  29. 29.  Gives a view of classifications, medications, allergies, immunisations to external providers  Currently being accessed by ED, WhiteCross, Mid/Far North afterhours GPs and the hospital pharmacists  Most used by hospital pharmacists
  30. 30.  Largest Practice in Kerikeri has given access to district nurses to become users of their version of MedTech  Kaipara Care- Dargaville is also sharing MedTech via Manage My Health with Te Ha (local Maori Provider), district nurses and the pharmacists.
  31. 31.  A component of the Care Connect Tool  Trial started in the Hokianga and Bush Road Medical Centre to allow 2 way messaging between general practice and hospital specialists  Possibly a more elegant solution than e-referral simple advice  Message can be initiated by secondary services  May lead to more comprehensive shared EHR
  32. 32.  MedTech Manage My Health and My Practice Health 365.  Access if via a secure website- same level of security as internet banking  Patients can be enrolled at whatever rate practices feel comfortable with
  33. 33.  Patient Portal have an option to allow patients to read their notes from the time they enrol onto the portal  Evidence strongly suggests that having Open Notes  Improves health literacy  Improves compliance  Strengthen doctor/patient relationships  Is well liked and accepted by doctors and patients  Does not increase patient complaints or doctors workload
  34. 34. 53 13,564 the majority of patients who viewed at least one visit note reported; 77-85% understood their health conditions better 76-83% remembered their plan of care better 70-72% thought able to take better care of themselves 69-80% better prepared for visits 60-78% would take medications better Ann Int Med 2012;157(7):461-470
  35. 35. and what we tend to do in Northland “…start very simple and then just begin with it. And let things happen organically and let it expand as the organization and the patients are ready for it. …There is no perfect system, everything’s gonna have flaws. ….You can think about it in a room for twelve months and not learn as much as you could in one week of actually doing it.”
  36. 36. Kenealy et al. Diabetes Care 2010
  37. 37.  Changes will be evolutionary not revolutionary  Pace of change will be dictated by what providers can cope with and wish to do  Underlying philosophy is to make care more patient centred and coordinated  However changes should also make our work more enjoyable and allow us to work to the top of our scopes  Using IT in “Stealth Mode”
  38. 38.  His proposed definition of “patient-centred care” is this: The experience of transparency, individualisation, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.  “ There needs to be a radical redesign to move the focus of health from a quality improvement health focus to a courageous pursuit of wellbeing  (1) “The needs of the patient come first.”(2) “Nothing about me without me.”(3) “Every patient is the only patient.”
  39. 39. “I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me”. “We are sick of falling through gaps. We are tired of organisational barriers and boundaries that delay or prevent our access to care. We do not accept being discharged from a service into a void. We want services to be seamless and care to be continuous”. National Voices UK
  40. 40. “The patient is always a person. The person is sometimes a patient. The person is more than an individual. The person is part of a context. The person exists because of their context”
  41. 41.  Maori Providers  Whanau Ora Providers  Other Health Providers: pharmacists, dental, Plunket, DHB community services etc  Whanau members  Government agencies: MSD, Housing NZ  NGOs  All these providers have the ability (and responsibility) to work in a collaborative model.
  42. 42.  Providers involved for 5 hours per year, patients for the other 8755 hours  Patients, families and communities have assets that should be used  Partnership of Equals- with patients not to patients  Informed and empowered patients are more likely to make healthy lifestyle choices.  On-line self help tools reduced consultation rates by ~20%.
  43. 43. “ All changes and new concepts that we initiate in order to make the healthcare sector more person- centred must include all stakeholders. We must make sure that everybody is on board or we are not likely to succeed” Jacqueline Bowman-Busato European Platform for Patients’ Organisations
  44. 44.  Who is your customer?  What do you want for yourself if you’re needing a health IT system that best manages your care in an integrated, person centred way  Make NZ’s health IT system the model the rest of the world aspires to.  Strive to make systems interoperable and share standards  “Above all else do no harm”- Hippocrates
  45. 45. “Good will is easy. It gets complicated when it’s about money and income.”
  46. 46. He aha te mea nui o te ao? He tangata! He tangata! He tangata!

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