The document discusses several electronic health record projects in Auckland, New Zealand. It describes the Chronic Care Management project, which supports structured care for patients with chronic illnesses through electronic tools. It also outlines the TestSafe project, which aims to give clinicians access to all laboratory test results for their patients across multiple healthcare organizations. Finally, it discusses plans for the ARMHIT project to create a single shared mental health record across three Auckland District Health Boards.

1. Health Informatics New Zealand
www.hinz.org.nz
Electronic Health Records:
The Thin End of the Wedge
Phil Brimacombe
Chief Information Officer
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2. Health Informatics New Zealand
www.hinz.org.nz
Agenda
Auckland Region DHBs EHR direction
CCM: a completed EHR project
TestSafe: an EHR project in progress
ARMHIT: an EHR project coming up
Auckland DHBs EHR direction
Driven by the RISSP
Improving health outcomes through information
exchange
Information systems will contribute to the development
of new processes for improved clinical effectiveness
and efficiency
Information systems will support the priority
development of Primary Health Care. The emphasis will
be on supporting new models of healthcare in
preference to automating current processes
A number of projects building towards CDR, CWS, HES
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3. Health Informatics New Zealand
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Auckland DHBs EHR direction
CDR: Develop and publish a regional Clinical Data
Repository architecture that will allow logical integration of
patient records and clinical images. Implement in stages to
enable delivery of Key Projects such as Chronic Care
Management, Mental Health, and Community, Ambulatory
and Disability systems.
CWS: Extend the scope and use of the Concerto clinical
workstation to provide secure and seamless access to
clinical information. Ensure access at point of care including
mobile and bedside.
HES: Implement a regional repository of all clinical Health
Event Summaries (including discharge summaries) across
Primary, Community, outpatient, and inpatient care. Allow
clinicians and patients to access relevant information.
Why have a CDR?
Data for patient care is in different places inside the enterprise
– PiMS, CMS, Éclair, PACS, Specialty databases
Some key clinical data unavailable at point of care
– Alerts/Allergies, problem lists, current medications
Communication between systems not standardised
– Expensive to create, support, maintain extend
‘Enterprise’ are separate entities
– Counties Manukau, Waitemata & ADHB
Many specialist systems collecting data that needs to be generally
available (at least in summary)
– Lab, Cardiology
Some fundamental processes not computerised
– Internal Referrals, handover of care
External entities needing/supplying data increasing
– GP, PHO, NGO, Patient, Labs
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4. Health Informatics New Zealand
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Clinical Data Repository Requirements
Standardise the presentation of patient information
to clinicians
– Right data for the right patient to the right person at the right
time
– ALL key data available to clinician at point of care,
regardless of where it is stored
Store the same type of information in the same place
– Store common information once only
– Store data of the same type in the same repository
Facilitate retrieval of stored information by other
systems
– Need to make it simple to update and communicate data
between components
Clinical Data Repository
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5. Health Informatics New Zealand
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CCM: a completed EHR project
Supports delivery of structured care to patients with chronic illness
(Diabetes, CVD, CHF, COPD)
High need patients
Empowered primary care
– Secondary outreach/training
– Electronic decision support
– Regular reporting on progress
GP enrols patients according to clinical criteria
4 free practice visits per annum
6 hours nursing time per annum
Structured data is collected at each visit
Data sent to DHB Server where it is validated and saved
Reporting on aggregated data
Secondary care access to the data
Empowered Patients
– Patient held care plans
CCM HES primary -> secondary
GP/Nurse creates CCM message (HES) and send to DHB system for
analysis/reporting
Hospital Clinician (ED) can access report automatically generated from
that HES (and others) when patient attends ED
HES sent to ED Clinician
GP/Nurse sees
repository can access
patient
HES report
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6. Health Informatics New Zealand
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GP selects CCM in Medtech
GP completes TIM CVD form
Lab Results
Auto-populate
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7. Health Informatics New Zealand
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GP completes TIM diabetes form
GP receives ECDS advice – click “Actions”
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8. Health Informatics New Zealand
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Actions recommended by Predict
Reporting & Feedback to GP
Reports generated monthly from DHB data
Each GP receives their data compared to a
similar cohort of aggregated, anonymised
GPs
Communication via PHO
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9. Health Informatics New Zealand
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EC Whiteboard: Dr selects patient
EC Dynamic Patient View – click icon
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10. Health Informatics New Zealand
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Dr is presented with CCM Summary
CCM Benefits
Patient gets regular, free visits to the GP
Specialist training to GPs & nurses
Standardised templates, decision support and other
resources empower nurses in care delivery
Regular feedback to the GP
Data repository for reporting
Data available to secondary care clinician at point of
care
Main benefit is improved patient care
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11. Health Informatics New Zealand
www.hinz.org.nz
TestSafe: an EHR project in progress
Before TestSafe – ‘Regional Éclair’
All results from Auckland DHB laboratories
– Excluding: A+ Mental Health and Sexual Health
All results performed by Community
Laboratories requested by DHB clinicians
– where the requesting GP has indicated ‘copy to’ a
DHB
– Approximately 15% of all Community based
laboratory tests were routed to the Regional Éclair
repository
Before TestSafe - Issues
Move Return to
(Change GP) Daily Activities Discharged
Present at Present at Return to
GP (new) Emergency GP
ISSUES
ISSUES ISSUES •Repeated , tests, staff time
•Access to previous •Acute situation, getting results from
records tests repeated Hospital
•Phone calls / delays •Delay in care while •Delay in care while tests
/ repeated tests tests are performed are re-done, or results sent
from Hospital
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12. Health Informatics New Zealand
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TestSafe - Vision
Move Return to
(Change GP) Daily Activities Discharged
Present at Present at Return to
GP (new) Emergency GP
ACCESS RELEVANT RESULTS
Project Overview
Project: All results funded by Auckland DHBs
Auckland DHB Diagnostic
Éclair Medlab LIS
Hospital Lab Results ++ Community Lab Results
Stage 1: Business Case Complete Dec 04
Stage 2: Privacy Assessment
DHB based access to community Live June 06
results
Stage 3: Primary Care Test Orderer access Work In Progress
to hospital results
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13. Health Informatics New Zealand
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TestSafe Stage 2: Privacy Process
1. Developed TestSafe Privacy Framework
– Incorporated existing DHB privacy policy
– DHB based consultation
Expert reference group
Primary Care liaison officers
– Crown Solicitors Legal / Ethical opinion
2. Wider Sector Consultation,10 months to Apr 06
– Resulting in Privacy Framework updates
Stage 2: Privacy Process
Sector Consultation
– DHB PHO Management Groups
– DHB Clinical Boards
– DHB Community Boards
– Consumer focus group
– Meetings with interested organisations e.g. Womens groups
Regional Privacy Advisory Group (RPAG) established
Aug 05
Medical Protection Society Review (early 06)
ProCare Privacy Committee review (early 06)
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Stage 2: Privacy Approach
Patient Choice
– Core aspect of the privacy solution
– More information >>
Patient Awareness
– Test Orderer assistance required
Direct mail used a primary means of communication with Test
Orderers
Implementation pack provided
– Help line, website, communication materials
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Stage 2: Privacy Approach
DHB Policy
– Employment contracts, training, disciplinary procedure
Security Audit
– TestSafe Service Coordinator employed
– Additional patient record monitoring of access to
Community results patient records
Role Based security
– Additional controls recommended by RPAG for existing
DHB based users
– Currently being implemented
Stage 3: Primary Care Access
Current State
– Orion Concerto for ‘portal’ services
– Each DHB has own Concerto instance
Technical Issues
– User Authentication
– User – Patient relationship authentication
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Stage 3: Primary Care Access
Separate Concerto for Primary Care access
planned
Possible use of PHO-Patient registers to verify
patient relationship
– ‘Break Glass’ override available
‘Copy To’ feature included
id Component View
ADHB GP
CMDHB GP External Concerto Web Eclair (Test
Safe)
DHB Application
WDHB GP
DHB Concerto
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Stage 3: Primary Care Access
Sample timeline
Nov Dec Jan Feb Mar Apr May June
Vendor engagement
Detailed design
Configuration and Testing
Privacy and security approval
Access available ☺
ARMHIT: an EHR project coming up
Clients, their families and clinicians are
provided with a computer system that
supports a recovery-based approach to
mental health care
Phase 1
A single shared Mental Health client record across the
three Auckland DHBs
Phase 2
NGOs, GPs and clients use the system to participate in
shared care
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18. Health Informatics New Zealand
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ARMHIT Specific flow
ARMHIT Phase 1 Benefits
Improved clinical effectiveness and reduced clinical risk
Information on clients who access services regionally
Access to crisis team services
Population health management capability
Capture of national KPI data
Consistency of use of clinical guidelines
Integrated care between DHB community and inpatient
Information to primary care through the HES
Capture information on client priority for psychiatric input
Monitor that accreditation requirements are being met
Performance related reporting
Information on Maori clinical and cultural service delivery
Information on staffing skill mix
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Conclusion
There is no conclusion, building an EHR is a
never ending journey
– E referrals
– Medication record
– Community & disability
– Diabetes retinal screening
Health Event Summaries the key to information
exchange
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20. Health Informatics New Zealand
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Patient Choice
1. Call to: “0800 LAB PLUS”
– Hours 7:00 am to 7:00 pm, Monday to Friday
– Patient specifies a date (range) during which
the test was ordered
– All access to view the test result is removed
from the RRR
2. “Prevent TestSafe Sharing” flag on
laboratory order forms
– Implemented as a new ‘test’ in GP PMSs
<< Return
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