This document discusses New Zealand's priorities and initiatives for improving health information standards and interoperability between 2014-2017. The key priorities include expanding the national eMedicines program, developing regional information platforms, and implementing national clinical solutions. The goals are to achieve person-centered integrated care through shared health records, standardized messaging, and clinicians and consumers working collaboratively with technology. Challenges include connecting primary and secondary care systems and ensuring paperless hospitals and medication management across settings of care.
Standards and interoperability towards 2014 and the New Zealand e-health visionAlastair Kenworthy
Standards and interoperability towards 2014 and the New Zealand national e-health vision - the not so unexpected journey towards core personal health information being available at all points of care
Insta Health solutions is a leader in providing hospital and clinics management solutions for the emerging markets of India, Middle East, Africa and Middle East. With over 200 hospitals and clinics using the system in both cloud and local server installations, it has built good reputation as a very easy to use and implement system.
Electronic Medical Records in Canada, Work OrgJasjot Singh
This document reports on a case study of electronic medical record (EMR) implementation in Canada. It defines medical records and EMRs, outlines the benefits of EMR use such as increased access and reduced costs. It describes Canada's EMR certification process and progress across provinces/territories. Different EMR modules are identified and implementation across Canada is discussed. Recommendations are provided for adoption and the organizational approach, including physician committees and super users. The future of continuous patient supervision is briefly outlined before concluding.
This document discusses information technology (IT) implementation in healthcare. It describes how IT is used to store, retrieve, and transmit health information electronically. Key applications of health IT include electronic medical records, computerized provider order entry, clinical decision support systems, and picture archiving systems. The document also outlines various technologies used in health IT like barcoding, radio-frequency identification, and automated dispensing machines that help improve patient care and safety.
This document provides an outline for a presentation on electronic medical records (EMRs). It begins with defining the components of an EMR, including labs, admissions/discharge/transfer data, orders, radiology, notes, and billing. It then discusses the history and adoption of EMRs from the 1960s to present. The document reviews studies showing the effectiveness of EMRs in improving quality of care and achieving treatment standards. It also outlines how EMR data is structured in databases and data warehouses and describes common health data standards like ICD, CPT, LOINC, SNOMED, and HL7. The presentation covers meaningful use incentives and provides examples of using EMR data for research studies.
mMD.net is an electronic health record and practice management software with features including health information exchange, a patient portal, mobile access, and integration with other systems. It uses a services-oriented architecture and can automatically share patient medical records between providers to facilitate referrals and consultations.
This document discusses plans to develop an electronic health record (eHR) system in Hong Kong called CMS III & eHR. The goals are to improve integrated care, support evidence-based practice, and facilitate information sharing across public and private healthcare settings. Challenges include high patient volumes, an aging population, and currently using paper records. Opportunities include increasing public awareness and more capabilities in the existing CMS system. CMS III will improve quality, efficiency and management. The vision is for a system that supports care delivery, improves outcomes, and facilitates community-wide data sharing. Development will be government-led through a multi-phase process with public-private partnerships.
Standards and interoperability towards 2014 and the New Zealand e-health visionAlastair Kenworthy
Standards and interoperability towards 2014 and the New Zealand national e-health vision - the not so unexpected journey towards core personal health information being available at all points of care
Insta Health solutions is a leader in providing hospital and clinics management solutions for the emerging markets of India, Middle East, Africa and Middle East. With over 200 hospitals and clinics using the system in both cloud and local server installations, it has built good reputation as a very easy to use and implement system.
Electronic Medical Records in Canada, Work OrgJasjot Singh
This document reports on a case study of electronic medical record (EMR) implementation in Canada. It defines medical records and EMRs, outlines the benefits of EMR use such as increased access and reduced costs. It describes Canada's EMR certification process and progress across provinces/territories. Different EMR modules are identified and implementation across Canada is discussed. Recommendations are provided for adoption and the organizational approach, including physician committees and super users. The future of continuous patient supervision is briefly outlined before concluding.
This document discusses information technology (IT) implementation in healthcare. It describes how IT is used to store, retrieve, and transmit health information electronically. Key applications of health IT include electronic medical records, computerized provider order entry, clinical decision support systems, and picture archiving systems. The document also outlines various technologies used in health IT like barcoding, radio-frequency identification, and automated dispensing machines that help improve patient care and safety.
This document provides an outline for a presentation on electronic medical records (EMRs). It begins with defining the components of an EMR, including labs, admissions/discharge/transfer data, orders, radiology, notes, and billing. It then discusses the history and adoption of EMRs from the 1960s to present. The document reviews studies showing the effectiveness of EMRs in improving quality of care and achieving treatment standards. It also outlines how EMR data is structured in databases and data warehouses and describes common health data standards like ICD, CPT, LOINC, SNOMED, and HL7. The presentation covers meaningful use incentives and provides examples of using EMR data for research studies.
mMD.net is an electronic health record and practice management software with features including health information exchange, a patient portal, mobile access, and integration with other systems. It uses a services-oriented architecture and can automatically share patient medical records between providers to facilitate referrals and consultations.
This document discusses plans to develop an electronic health record (eHR) system in Hong Kong called CMS III & eHR. The goals are to improve integrated care, support evidence-based practice, and facilitate information sharing across public and private healthcare settings. Challenges include high patient volumes, an aging population, and currently using paper records. Opportunities include increasing public awareness and more capabilities in the existing CMS system. CMS III will improve quality, efficiency and management. The vision is for a system that supports care delivery, improves outcomes, and facilitates community-wide data sharing. Development will be government-led through a multi-phase process with public-private partnerships.
eHealth Governance in a Local Organisation. The Experience from Pompidou Hospital. Degoulet P. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
This document provides an overview of health information technology (IT) applications in hospitals. It discusses enterprise-wide hospital IT systems like electronic health records and computerized physician order entry. It also covers departmental IT systems and how they integrate. A key focus is on clinical decision support systems and their potential to improve patient care through functions like alerts, reminders, and access to evidence-based knowledge sources. The document notes both benefits of health IT, like reducing errors, but also risks such as alert fatigue and potential workarounds or unintended consequences of implementation.
This document discusses health information systems, including electronic medical records (EMRs), electronic health records (EHRs), and radiology information systems (RIS). It provides an overview of Bumrungrad Hospital's implementation of a new information system and discusses some of the challenges they faced. Key topics covered include the differences between EMRs and EHRs, challenges of implementing EMRs such as high costs and ensuring confidentiality, and how RIS is used to store and distribute radiological data and manage patient workflow in radiology departments.
This document discusses telehealth and telemedicine initiatives in geriatrics in Hong Kong. It describes Hong Kong's electronic patient record system, community health call center, and use of telemedicine in geriatric care. The call center aims to provide telephone support for high-risk elderly patients, improve links to primary care, reduce emergency department visits and hospitalizations, and improve access to healthcare advice. Telemedicine allows for remote consultations, exchange of medical images and videos, and online patient education and assessments to help address issues of patient isolation, frailty, and limited healthcare resources.
Graeme Osborne
Director, National Health IT Board
Peter Gow
Chair, National Information Clinical Leadership Group
Ernie Newman
Chair, NHITB Consumer Panel
Barry Vryenhoek
Chief Executive, healthAlliance New Zealand Ltd
(Thursday, 9.45, Keynote)
The document discusses an open-source electronic health record (EHR) system called Oscar and describes its architecture and features. It provides examples of how Oscar has been used in radiotherapy settings and primary care clinics. The document also discusses a personal health record (PHR) module called MyOSCAR that is integrated with Oscar. MyOSCAR allows patients to access and share their health records. Two pilot studies are summarized that examine the use of MyOSCAR for blood pressure management and collecting drug safety data from patients. The studies found high completion rates of tasks in MyOSCAR and positive feedback from patients wishing to continue using the application.
This document provides definitions and explanations of common buzzwords and acronyms used in the healthcare IT industry. Some key terms include EMR/EHR for electronic medical records/health records, PHI for protected health information governed by HIPAA privacy rules, ICD-10 for the medical coding system replacing ICD-9, cloud computing, quality reporting metrics, data breaches of protected health information, precision medicine tailored to a patient's genome, EHR meaningful use incentives, pay for performance replacing fee-for-service, accountable care organizations, and healthcare reform through the Affordable Care Act.
How to move Forward the Implementation of the EU Interoperability Recommendation to Establish Trust and user Acceptance Part 1: Perspective of a Member State. Rossing N. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
A Prototype Knowledge Base and SMART App to Facilitate Organization of Patien...Allison McCoy
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This document discusses using an electronic medical record (EMR) to support clinical research. It outlines how EMR data can be used throughout the research process, including determining study feasibility, including data in grant applications, patient recruitment, study interventions, data collection, and assessing study outcomes. While EMRs provide rich clinical data and can streamline aspects of research, the data was primarily collected for clinical care so requires validation for research purposes. Fully integrating research workflows into EMRs remains a challenge.
An electronic early warning score system was proposed to address the shortcomings of a manual paper-based system. The electronic system would calculate scores based on recorded vital sign observations and trigger alerts and escalation pathways for deteriorating patients. The system could be deployed on mobile devices at bedsides or fixed iPads to facilitate real-time data entry and alerts. It leverages an existing electronic medical record platform already in use in New Zealand to provide an integrated, feasible solution.
Health Informatics - Transforming healthcare delivery in Hong Kong. Presented by Dr Ngai-Tseung Cheung, Head of Information Technology and Health Informatics/Chief Medical Informatics Officer, Hong Kong Hospital Authority, at HINZ 2014, 11 November 2014, 9.15am, Plenary Room
Ehip5 caring through sharing next steps dirk colaertimec.archive
This document discusses next steps for expanding an eHealth information platform called eHIP. It proposes integrating more clinical applications and collaborators, applying web 2.0 collaboration tools, and experimenting with decision support and clinical workflow services. The goal is to demonstrate how eHIP can enable different phases of eHealth like information sharing, collaboration, decision support, and disease management programs. It also discusses connecting separate electronic health record initiatives through eHIP and establishing eHIP as a sustained clinical data and service platform to support interconnected healthcare providers.
Big Data Analytics for Treatment Pathways John CaiJohn Cai
This document discusses using real-world big data analytics to understand treatment pathways. It begins by explaining the need for real-world evidence from real-world data to assess effectiveness and outcomes beyond randomized clinical trials. It then describes the volume, variety, and velocity characteristics of real-world big data from sources like claims, EMRs, surveys, and devices. Technical challenges of reconstructing complex patient journeys are discussed. Hadoop and MapReduce are presented as a potential solution by breaking the work into mappers that extract patient data and reducers that organize it into timelines. Examples are given of how this could enable cost, pathway, and outcomes analyses to better inform decision making.
We have successful terminologies for medicines but medical devices have much greater variety and are inherently harder to describe. We need international standards for device terminology and identification on both the clinical side and for the supply chain.
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This document provides an overview of health information technology (IT) applications in hospitals. It discusses enterprise-wide hospital IT systems like electronic health records and computerized physician order entry. It also covers departmental IT systems and how they integrate. A key focus is on clinical decision support systems and their potential to improve patient care through functions like alerts, reminders, and access to evidence-based knowledge sources. The document notes both benefits of health IT, like reducing errors, but also risks such as alert fatigue and potential workarounds or unintended consequences of implementation.
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Graeme Osborne
Director, National Health IT Board
Peter Gow
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Ernie Newman
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Barry Vryenhoek
Chief Executive, healthAlliance New Zealand Ltd
(Thursday, 9.45, Keynote)
The document discusses an open-source electronic health record (EHR) system called Oscar and describes its architecture and features. It provides examples of how Oscar has been used in radiotherapy settings and primary care clinics. The document also discusses a personal health record (PHR) module called MyOSCAR that is integrated with Oscar. MyOSCAR allows patients to access and share their health records. Two pilot studies are summarized that examine the use of MyOSCAR for blood pressure management and collecting drug safety data from patients. The studies found high completion rates of tasks in MyOSCAR and positive feedback from patients wishing to continue using the application.
This document provides definitions and explanations of common buzzwords and acronyms used in the healthcare IT industry. Some key terms include EMR/EHR for electronic medical records/health records, PHI for protected health information governed by HIPAA privacy rules, ICD-10 for the medical coding system replacing ICD-9, cloud computing, quality reporting metrics, data breaches of protected health information, precision medicine tailored to a patient's genome, EHR meaningful use incentives, pay for performance replacing fee-for-service, accountable care organizations, and healthcare reform through the Affordable Care Act.
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Increasing use of electronic health records requires comprehensive patient-centered views of clinical data. We describe a prototype knowledge base and SMART app that facilitates organization of patient medications by clinical problems, comprising a preliminary step in building such patient-centered views. The knowledge base includes 7,164,444 distinct problem-medication links, generated from RxNorm, SNOMED CT, and NDF-RT within the UMLS Metathesaurus. In an evaluation of the knowledge base applied to 5000 de-identified patient records, 22.4% of medications linked to an entry in the patient’s active problem list, compared to 32.6% of medications manually linked by providers; 46.5% of total links were unique to the knowledge base, not added by providers. Expert review of a random patient subset estimated a sensitivity of 37.1% and specificity of 98.9%. The SMART API successfully utilized the knowledge base to generate problem-medication links for test patients. Future work is necessary to improve knowledge base sensitivity and efficiency.
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An electronic early warning score system was proposed to address the shortcomings of a manual paper-based system. The electronic system would calculate scores based on recorded vital sign observations and trigger alerts and escalation pathways for deteriorating patients. The system could be deployed on mobile devices at bedsides or fixed iPads to facilitate real-time data entry and alerts. It leverages an existing electronic medical record platform already in use in New Zealand to provide an integrated, feasible solution.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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2. The destination is …
Person-centred, integrated health care
Clinicians, consumers and IT people working in co-production
Providers having the confidence to invest in new solutions
2
3. National priorities 2012-14
eMedicines programme Regional information platforms
Pharmacy clinical integration eReferral and eDS
eMR, ePA CDRs, CWS, ED solution
NZULM, NZ Formulary PACS
LIS, pharmacy
PAS
National solutions Clinical integration
Cancer information LTC shared care
Cardiac health Maternity and well child
Comprehensive clinical assessment Patient portal
Health identity platform View of primary health info
FMIS, procurement, supply chain Urgent and unplanned care
3
4. Realising the 2014 vision
Offered by IFHCs CWS
Common regional
Patients with LTCs and
Personal health info
and CDR
high needs
Appointments hospital
Accessible both
Multidisciplinary input
Repeat prescriptions
and community
Email consultations
Inter-regional view
4
6. GP2GP
Currently about 4000 medical records transfers per month
About 50% of GPs are users
Files over 5 MB have to be sent the old fashioned way (a future upgrade
will allow files to be sent in pieces)
6
11. Emergency care
Ambulance sends ePRF (as a kind
of referral, but also an event
summary) to hospital ED
Ambulance accesses primary
care info and previous discharge
summaries
Presenting complaint, diagnoses
etc are SNOMED coded
Common ED solution based
on hospital PAS and CWS eDS shared
via R-CDR
11
14. My List of Meds – a repository-based application
14
15. eMR and ePA in all wards
Going for Gold programme Shared medications lists
Transition to eMR and ePA
Standardised paper based eMR
and medications charts
CHALLENGES eMR system separate to ePA
Outdated pharmacy systems
Shelves versus drawers versus robots
Medical oncology ePA
15
20. CRISP (Central DHBs)
Regional PACS archive
Regional CDR
Regional PAS
Regional clinical workstation
Regional ED solution
Regional RIS
20
21. South Island initiatives
eSCRV sources information from GPs,
pharmacy, community nursing and
hospitals
ERMS is the regional electronic request
management system (8,000 referrals
per month)
Health Pathways has 400+ treatment
plans and pathways (74,000 page views
per month)
21
22. South Island SPaCE programme
Support patients and Integrate primary care and
clinicians electronically hospital workflow
Incrementally replace eight Streamline the patient
systems across five DHBs journey
Go well beyond replacing
the incumbent systems
22
24. Lab test orders and results
Community lab and radiology test ordering solutions are appearing
(with decision support and order tracking functions)
Lab information standards review –
NZPOCS overhaul
HL7 v2.4 messaging implementation
Judicious coding
Message integrity between sender and receiver
24
This slide set presents a state of the nation in the pursuit of New Zealand’s eHealth directives, and in particular progress towards the 2014 vision.
This is the e-health destination as described by NHITBWith a further theme of sustainability in the health system
These are the National Health IT Board priority programmes for 2012-14Underpinned by work on infrastructure,connectivity, ICT organisational capability, standards
IFHCs will be able to offer access to a patient portal that presents a core set of personal health information and has functions like booking an appointment, requesting a repeat prescription and having email interaction with practitioners. Examples of nascent IFHCs include Midland Health Network, Canterbury Initiative, Island Bay medical centre, and Wairarapa and MidCentral PHOs.For patients with high needs around long term conditions, shared care systems will be in place enabling the involvement of a multi-disciplinary team. The frontline is now the community pharmacy, where we can expect to see shared care plans created for patients with high needs.Hospitals will have a clinical workstation and clinical data repository – common within the region, accessible by the community workforce as well as in the hospital. The R-CDR needs to present an inter-regional view.
We need the new standard to drive the repository-based information sharing described by the National Health IT Plan.Solution scope options for NHITB/healthAlliance pioneering work on R-CDRsAn important use case is shared care system access to repository-held records, such as test results, discharge summaries and My List of MedicinesThere is also the ‘after hours’ use caseThere is an interesting comparison with the implementation of Australia’s PCEHR, which has the following features:Single national XDS registry (XCA not required)Registry and repositories implement XDS and ATNAPatient privacy consents (non BPPC) based on Practitioner-Role-Organisation and Organisation-Patient-Document relationships (with opt-outs)Eight CDA document types in circulation – a mix of levels 1, 2 and 3Registry vendor supportive of PIXV3 (though not implemented)
What have we solved so far?
Different branches of the tree represent the different kinds of solution that will exist in the environment – from shared care systems at the top, for people with high needs, through systems that lubricate the wheels of healthcare in the community and the hospital, test results, reports and other objective health information in CDRs, and – at the base of the tree – demographics, allergies and alerts, enrolments/registrations
Connected care solutions are in development that will enable information flows between all of the following: community pharmacy, general practice, community nursing, residential care, ambulance, ED
Community pharmacy referrals and assessmentsNZePS developed but not rolled outCCMS introduced as shared care solution Pharmacy Services Agreement for long term conditions New processes to support –Referrals into pharmacies Eligibility assessments by pharmaciesEnrolments for LTCSCreation of medications plansCommunication of medications plansOngoing clinical management by the pharmacistShared information within the care teamNZePS v2 has been successfully tested by the NZePS broker, one pharmacy vendor and three GP vendors, and paves the way for version two to be implemented in all pharmacy and GP systems as a precursor to national rollout. Work is underway on preparation for the rollout.
Community Pharmacy Services Agreement opens the door to the introduction of shared care services between GPs and pharmacists with patients with high needs
This is care without walls – the ambulance has access to the patient’s past event information, including recent discharge summaries, via the regional CDRAmbulance might send an ECG as an attachment to the ePRF – presently an ECG can be sent via email, with patient consentePRF includes details of interventions, making it both a referral and an event summaryAmbulance ePRF use case illustrates very well the difficulty of having multiple non-interoperable referral systemsePRF phased rollout from July 201320% of ambulance calls are for people discharged within the past week70% of ambulance calls are medical as opposed to injuriesAmbulance particularly interested in discharge diagnoses from ED and discharge dispositionePRF portal will be made available to Accident and Medical centres, possibly also ED as a first stepAmbulance officers record meds found in the patient’s home – could scan barcodesAmbulance arrival board in ED
A structured discharge summary will be importable into the GP PMS and shared care systems (which are accessible in the pharmacy), as well as being communicated via the R-CDR as an entry in the longitudinal recordDischarge Rx entered via SMT –Directed to the hospital dispensing systemOr to community pharmacies via the NZePS
The conceptis of a managed list following the patient, reviewed and updated by the care teamIncludes allergies and alertsSitsalongside prescribing and dispensing information
A shared, repository-based information resourcePresented natively via existing point-of-care applications, loosely coupled to the repositoryQuestions the South Island e-medications workshop set out to address: What datasets are involved? How does the repository work? What are the interfacing requirements client-side? What is the interface to the eDS? What is the interface to eSCVR?
The need in many DHBs to upgrade their pharmacy management systems, such as in Midland region where all DHB pharmacies will share a single application instanceHospitals will also adopt prioritisation standardsThere will be a national agreement on e-prescribing, which will provide DHBs with an off-the-shelf waiver under the Medicines Act to permit e-prescribingThis will all build on pilot work at Taranaki, Southern, Waitemata and Counties Manukau DHBsNational implementation will begin mid 2013, following a hardening exercise on the recommended solution‘Going for Platinum’DHBs implementing new/updated ePM systems for dispensing and pharmacy management – predominantly CSC ePharmacyCSC ePharmacy interfaces to MedChart for medication ordersAlso has interfaces to suppliers’ systems, FMIS, PyxisMidland has plans to create a single-instance regional solution:single instance of the back endlocal deployment of the client-side applicationmulti-tenanted, but with a common configurationintegration with district level PAS and FMIS
Hospital medications management is also topicalThis slide shows how My List of Meds relates to the hospital medications chart – used as an input to medicines reconciliation on admission, and updated out of the discharge summaryMedical oncology solutions will tend to be different to the ePA solution for the rest of the hospital, and will also cater to both inpatients and outpatientsA combined view will be presented somehow, in the portal if not the wider hospital ePA solution
EMR Adoption Model (EMRAM) for uptake of HIT within the hospital. There are 8 stages, with the topmost being a fully paperless environment. Below this, physician documentation / charting (structured templates), full CDSS and closed loop medication administration environment are fully implemented.Electronic Medical Record Adoption Model – a structured assessment developed by HIMSS Analytics to measure hospital progress towards full electronic system rollout.NHITB will coordinate EMRAM assessments that benchmark New Zealand hospitals against similarly sized hospitals globally. All hospitals in the US, along with most Canadian and European hospitals, have completed EMRAM assessments. DHBs are keen to participate, and results available to date indicate New Zealand hospitals compare well globally.
The first of three examples of the emerging class of interoperable shared care solutionsComprehensive care assessments with the sector’s interRAI application, hosted nationallyAssessments are created and stored in one system, but used in others – for care planning, by the GP, on admission to hospitalDeveloping this capability is an incremental taskCurrently, the application can present PDF-formatted assessment reports within an application sessionBuilding on this, CDA level 1 can be used to attach metadata to the report and it can be conveyed via web services to portal usersFinally, when an XDS infrastructure is in place, and we have a suitable set of templates, we can move to CDA level 3 content shared out of an XDS-enabled repository
Porous regional boundaries and centres of excellence