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Aligning Health Service And ICT Trends


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Zoran Bolevich and Chris Mules
Ministry of Health

Published in: Health & Medicine
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Aligning Health Service And ICT Trends

  1. 1. A coherent future: aligning health service and ICT trends HINZ Seminar April 2009
  2. 2. Presentation outline <ul><li>Why the health system needs to re-orient </li></ul><ul><li>Long Term System Framework and emerging models of care </li></ul><ul><li>Role of ICT in re-orienting the health system </li></ul><ul><li>Ministry of Health’s priority areas in health ICT </li></ul><ul><li>Critical enablers for faster progress </li></ul><ul><li>Work currently under way </li></ul>
  3. 3. The New Zealand health system is experiencing a number of pressures, which will intensify <ul><li>Current pressures </li></ul><ul><li>Workforce shortages at all levels </li></ul><ul><li>Service failures </li></ul><ul><li>Cost growth </li></ul><ul><li>Safety and quality </li></ul><ul><li>Health Targets </li></ul><ul><li>Inequity of access </li></ul><ul><li>Decisions in the national interest </li></ul><ul><li>Pressures will intensify in the future: </li></ul><ul><li>Population growth, redistribution and ageing; </li></ul><ul><li>Increasing risk and prevalence of long term conditions; </li></ul><ul><li>Health inequalities; </li></ul><ul><li>Managing within an affordable funding path; </li></ul><ul><li>Effective utilisation of the available workforce; </li></ul><ul><li>Effective application of technological advances; and </li></ul><ul><li>Rising consumer expectations </li></ul><ul><li>Other drivers: </li></ul><ul><li>Not a system: evaluation of the health reforms </li></ul><ul><li>Develop system leadership, innovation spread and strategic planning: Ministry review </li></ul><ul><li>Lack of collaboration across DHB boundaries: Health & Disability Commissioner reports </li></ul><ul><li>Productivity imperative </li></ul><ul><li>Safety & quality agenda </li></ul>
  4. 4. Long Term System Framework as the system response <ul><li>The challenges - and the solutions - are complex and inter-linked </li></ul><ul><li>LTSF is a Ministry-led response </li></ul><ul><li>Focus on system performance, responsiveness and sustainability </li></ul><ul><li>A structured, co-ordinated, multi-year work programme </li></ul><ul><li>The new Minister is supportive, with adjustments to reflect the new Government’s policy priorities </li></ul><ul><li>Areas of close linkage with Ministerial Review Group </li></ul>
  5. 5. Current LTSF focus <ul><li>Vulnerable services </li></ul><ul><li>assessment and mitigation of service failure risks </li></ul><ul><li>focus on next 18 months while longer term service planning develops </li></ul><ul><li>Clinical networks </li></ul><ul><li>a structure to support clinical engagement and leadership, performance and quality </li></ul><ul><li>government policy priority </li></ul><ul><li>networks at regional and national levels </li></ul><ul><li>build on NZ experience with cancer and mental health </li></ul><ul><li>immediate national priorities: cardiac surgery, genetics, maternal fetal medicine, paediatric subspecialties </li></ul><ul><li>draft policy framework being developed for discussion with Ministerial Group </li></ul>
  6. 6. Current LTSF focus cont’d <ul><li>Service planning </li></ul><ul><li>defining district, regional and national level responsibilities </li></ul><ul><li>developing planning methodologies, tools and capabilities </li></ul><ul><li>strong fit with networks and decision making </li></ul><ul><li>supporting emerging DHB regional service planning, and existing national tertiary planning </li></ul><ul><li>Decision making </li></ul><ul><li>what key decisions will need to be made in the system over the next 5-10 years? </li></ul><ul><ul><li>equity of access, affordability, vulnerability, quality & safety, new technologies and services, workforce, ICT </li></ul></ul><ul><li>accountability and decision structures currently decentralised to individual DHBs </li></ul><ul><li>most of the key future decisions will need to be made across DHB boundaries </li></ul><ul><li>likely rebalancing of decisions towards regions, and to the centre </li></ul><ul><li>important role for clinical leadership at regional and national levels </li></ul><ul><li>linkage with shared services for backroom functions, and aggregation of P & F </li></ul><ul><li>options being explored with the Ministerial Group </li></ul>
  7. 7. Current focus cont’d <ul><li>Engaging the community and health professionals </li></ul><ul><ul><li>communications strategy to build awareness of challenges and trends </li></ul></ul><ul><ul><li>provide context for specific change proposals </li></ul></ul><ul><ul><li>provide opportunity to shape the future system </li></ul></ul><ul><ul><li>being scoped in discussion with National Health Committee </li></ul></ul>
  8. 8. Longer term work programme <ul><li>Seven response areas identified for co-ordinated response through the LTSF : </li></ul><ul><li>long term service planning </li></ul><ul><li>quality, safety and innovation </li></ul><ul><li>new models of care </li></ul><ul><li>performance </li></ul><ul><li>leadership and decision making </li></ul><ul><li>workforce </li></ul><ul><li>information systems </li></ul><ul><li>Key elements of the LTSF work programme from 09/10 will be defined through Ministry SOI process and with DHB CEOs </li></ul>
  9. 9. New models of care <ul><li>Review of trends in models of care and service configuration: </li></ul><ul><li>Acute secondary and tertiary inpatient services will consolidate into a smaller number of centres </li></ul><ul><li>Smaller district hospitals will use clustering, regional services and networks to expand their critical mass </li></ul><ul><li>Services will shift between professional groups </li></ul><ul><li>Services will shift between settings: from tertiary to secondary, from there to primary and community, and into the home </li></ul><ul><li>Primary care will have greater role in prevention, delivery of traditionally secondary services, and improved access to specialist diagnostic testing </li></ul><ul><li>Increase in integration and self management will be enabled by information technology </li></ul><ul><li>What will the cost impacts be? </li></ul><ul><li>How will change be managed? </li></ul><ul><li>What does this mean for ICT development? </li></ul>
  10. 10. Direction from the new Government <ul><li>“ It will be critical to re-orient the health service in a way that fosters quality, is patient-centred and provider-friendly.” </li></ul><ul><li>Hon Tony Ryall </li></ul><ul><li>Minister of Health </li></ul><ul><li>February 2009 </li></ul>
  11. 11. Goal of a nationwide Health ICT effort <ul><li>Develop a sustainable and effective information management and technology environment… </li></ul><ul><li>that stimulates, enables and supports… </li></ul><ul><li>re-orienting the health system in a way that </li></ul><ul><ul><li>fosters quality </li></ul></ul><ul><ul><li>is person-centred </li></ul></ul><ul><ul><li>is provider-friendly </li></ul></ul><ul><ul><li>increases productivity of the system as a whole </li></ul></ul>
  12. 12. Person-centred <ul><li>Services organised around the needs of each person and family/whānau </li></ul><ul><li>Information systems and processes centred on the person </li></ul><ul><li>The right care can be provided by the right professional/provider at the right place and the right time </li></ul><ul><li>Person/citizen is a participant (‘co-producer’) in the health care process </li></ul>
  13. 13. Provider friendly <ul><li>Simple, automated processes, where ‘compliance costs’ for providers are minimised </li></ul><ul><li>Providers only required to collect and report information that really matters </li></ul><ul><li>Clinical delivery tasks are made easier and safer through the use of supportive technologies (such as clinical decision support systems) </li></ul><ul><li>Clinical networking is made easy </li></ul>
  14. 14. Information Management Principles (NIHI, 2008) <ul><li>Health information should be recorded in a form that allows all relevant actors to be able to trust that information where appropriate </li></ul><ul><li>Health information must always identify source and method of derivation </li></ul><ul><li>Health information should be encoded to international standards wherever practical </li></ul><ul><li>Primacy of patient safety </li></ul><ul><li>All individual health information will be made available to all clinicians engaged in care of a patient (subject to audit trails) </li></ul>
  15. 15. Information Management Principles cont’d <ul><li>Health information of all individuals will be shared in privacy-protected form to support healthcare quality improvement </li></ul><ul><li>Statutory adherence </li></ul><ul><li>People can access their own health information </li></ul><ul><li>People can contribute to their own health record </li></ul><ul><li>People can define additional access rights on their health information for other people (e.g. family members) </li></ul><ul><li>People can review who has accessed their health information and have a clear and effective means of directing queries concerning such access </li></ul>
  16. 16. Current state evidence (NZ) <ul><li>‘ Connected Health’ quantitative survey (2008, to be published) found: </li></ul><ul><ul><li>79% of surveyed clinicians agreed that better access to electronic healthcare information held by other organisations could improve the way they provide health services </li></ul></ul><ul><ul><li>48% of surveyed clinicians were unable to find the electronic information they needed from other organisations at least once a day </li></ul></ul><ul><ul><li>Among DHB employed clinicians, this number rises to 75% </li></ul></ul><ul><ul><ul><li>nearly 15% report they are unable to find this information more than 10 times every day </li></ul></ul></ul>
  17. 17. Current state evidence (NZ) cont’d <ul><li>‘ Connected Health’ quantitative survey also found: </li></ul><ul><ul><li>Surveyed clinicians wanted electronic access to: </li></ul></ul><ul><ul><ul><li>Patient medication information 68% </li></ul></ul></ul><ul><ul><ul><li>Diagnostic test results 66% </li></ul></ul></ul><ul><ul><ul><li>Discharge summaries 61% </li></ul></ul></ul><ul><ul><ul><li>Clinical guidelines 57% </li></ul></ul></ul><ul><ul><li>Wanted day-to-day tasks handled electronically: </li></ul></ul><ul><ul><ul><li>Diagnostic test results 47% </li></ul></ul></ul><ul><ul><ul><li>Discharge summaries 44% </li></ul></ul></ul><ul><ul><ul><li>Patient medication information 42% </li></ul></ul></ul><ul><ul><ul><li>Patient referrals 34% </li></ul></ul></ul><ul><ul><li>85% of clinicians strongly agreed that having improved e-access to health information would </li></ul></ul><ul><ul><ul><li>Improve coordination of care between practitioners </li></ul></ul></ul><ul><ul><ul><li>Help achieve better outcomes for health organisations </li></ul></ul></ul>
  18. 18. Emerging evidence in favour of EHR outcomes <ul><li>Amarasigham, R. et al. (2009). Clinical information technologies and inpatient outcomes. Archives of Internal Medicine, 169, 2: </li></ul><ul><li>In hospitals where more doctors used computerised data, there were 16% fewer medical complications than in hospitals where less computerised data was used </li></ul><ul><li>More computerised hospitals also tended to have lower costs because medical complications can add dramatically to the cost of hospitalisation </li></ul><ul><li>The Commonwealth Fund (In-the–Literature, January 2009): </li></ul><ul><li>31% of primary care physicians with high IT capability and 28% of those with medium IT capacity reported their ability to provide quality medical care had improved over the past five years </li></ul><ul><li>By contrast, just 22% of those with low IT capability reported similar views </li></ul>
  19. 19. Ministry of Health priority areas <ul><li>Provide better information for the public </li></ul><ul><ul><li>Provide on-line directories of providers and guidance on service options </li></ul></ul><ul><ul><li>Improve the use of national data collections </li></ul></ul><ul><ul><li>Foster development of personal health ‘portals’ </li></ul></ul><ul><li>Ensure smarter investment in information technology </li></ul><ul><ul><li>Provide a national ‘blueprint’ for health information systems </li></ul></ul><ul><ul><li>Develop a common decision-making process </li></ul></ul><ul><ul><li>Accelerate progress through collaboration and sharing </li></ul></ul><ul><li>Strengthen the national health information infrastructure </li></ul><ul><ul><li>Strengthen identity management (NHI, HPI) </li></ul></ul><ul><ul><li>Provide a ‘core clinical record’ capability for safety and continuity of care </li></ul></ul><ul><ul><li>Provide facilities for finding and sharing information nationally </li></ul></ul><ul><li>Simplify agreement, payment and reporting systems </li></ul><ul><ul><li>Rationalise service agreements </li></ul></ul><ul><ul><li>Automate administrative and payment processes </li></ul></ul><ul><ul><li>Make performance monitoring and reporting meaningful </li></ul></ul>
  20. 20. Accelerating progress - critical enablers <ul><li>National health information architecture </li></ul><ul><li>National health information infrastructure </li></ul><ul><li>Shared services </li></ul><ul><li>Spreading innovations </li></ul><ul><li>Community dialogue on safe sharing of health information </li></ul><ul><li>Common decision making framework </li></ul>
  21. 21. National health information architecture <ul><li>An overarching architecture for the New Zealand health system – developed jointly with DHBs, PHOs, NGOs, private providers </li></ul><ul><li>Describes how business processes, systems, information components and technical standards will combine and work together </li></ul><ul><li>Provides a context for the development of enterprise architectures at organisational levels </li></ul><ul><li>Ensures alignment and re-usability of artefacts </li></ul><ul><li>Enables smarter IT investment decisions </li></ul><ul><li>It is supported by: </li></ul><ul><ul><li>A set of collaborative tools </li></ul></ul><ul><ul><li>A common repository </li></ul></ul><ul><ul><li>A joint governance mechanism </li></ul></ul>
  22. 22. Health System Architecture
  23. 23. National health information infrastructure <ul><li>Provide a nationwide coverage </li></ul><ul><li>Provide a platform for regional and local developments </li></ul><ul><li>Provide better information to the public </li></ul><ul><li>Support collaboration and clinical networking </li></ul><ul><li>Examples: </li></ul><ul><ul><li>National directories (NHI, HPI) </li></ul></ul><ul><ul><li>‘ Core clinical record’ (replacing the Medical Warning System)  clinicians to define ‘core clinical data set’ first </li></ul></ul><ul><ul><li>Data warehousing, analysis and reporting (focus on quality improvement) </li></ul></ul><ul><ul><ul><li>- includes public reporting of provider performance </li></ul></ul></ul><ul><ul><li>‘ Secure portal’ – collaborative on-line environment supporting communities of interest (eg, clinical networks) </li></ul></ul>
  24. 24. Safe sharing of health information <ul><li>A comprehensive stakeholder and community dialogue programme which will: </li></ul><ul><ul><li>inform / educate the community and the policy makers (two-way communication) </li></ul></ul><ul><ul><li>canvass a vision of a person-centred health information environment </li></ul></ul><ul><ul><li>enable the identification and debate of key issues </li></ul></ul><ul><ul><li>discuss approaches to difficult balancing decisions (eg, safety vs privacy; individual vs common good) </li></ul></ul><ul><ul><li>clarify the roles, rights and responsibilities of people and their health providers in respect of health information </li></ul></ul><ul><li>“ What should I as a New Zealander expect the health system to know about me in order to provide me the health services I need, safely?” </li></ul><ul><li>Appropriate community and clinical representation and leadership will be critical </li></ul>
  25. 25. Work in progress <ul><li>Directional content July 2009 and ongoing </li></ul><ul><ul><li>In conjunction with regional planning processes </li></ul></ul><ul><ul><li>Collaborative on-line space </li></ul></ul><ul><ul><li>National fora and sector-wide engagement </li></ul></ul><ul><li>Architecture July 2009 and ongoing </li></ul><ul><ul><li>In conjunction with DHB, PHO, IPA, NGO, clinical and governance experts </li></ul></ul><ul><ul><li>Shared on-line repository </li></ul></ul><ul><li>Infrastructure 2009-2011 </li></ul><ul><ul><li>Building on previous NSDP work </li></ul></ul><ul><ul><li>Refocusing and clinical leadership </li></ul></ul><ul><ul><li>Initial focus on eEvents (GP-to-GP, eReferrals, MWS) </li></ul></ul><ul><ul><li>Working with the Ministry of Economic Development on maximising benefits to health of the Government’s broadband investment strategy </li></ul></ul><ul><li>Safe sharing June - Dec 2009 </li></ul><ul><ul><li>Subject to Minister’s sign-off </li></ul></ul>