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
Standardised and Flexible Health Data Management with an Archetype Driven EHR...David Moner Cano
The semantically interoperable Electronic Health Record is one of the most challenging research fields in health informatics. Reaching this objective, the use of EHR standards that formally describe health data structures cannot be waived. CEN EN13606 is one of the most promising approaches to solve this problem since it covers the technical needs for semantic interoperability and, at the same time, it incorporates a mechanism (archetype model) for clinical domain experts’ participation in building an EHR system. In this paper we present EHRflex, a generic system based on archetypes. It empowers the clinician and allows him to manage his own EHR system in a simple and generic way, assuring that the user works with underlying standardized data structures. They can be exchanged with other people and systems when needed. EHRflex introduces EHR standards into the clinical routine delivering a technical platform which works directly on archetype based data.
Publication:
Anton Brass, David Moner, Claudia Hildebrand, Montserrat Robles. "Standardized and flexible health data Management with an archetype driven EHR system (EHRflex)". Seamless care – Safe care: The Challenges of Interoperability and Patient Safety in Health Care. Proceedings of the EFMI Special Topic Conference, pp. 212-218. IOS Press BV, Amsterdam. ISBN: 978-1-60750-562-4, 2010.
The document discusses New Zealand's priorities for health IT standards and interoperability between 2014-2017. The goals are person-centered, integrated care enabled by clinicians, consumers, and IT working together. National priorities include electronic prescribing, records, and shared care plans across primary and secondary care. Regional information platforms aim to provide access to referrals, test results, discharge summaries and shared care records. The document outlines several initiatives and challenges around implementing electronic medical records, medication management systems, and enabling information sharing across care settings.
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.
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.
Standardised and Flexible Health Data Management with an Archetype Driven EHR...David Moner Cano
The semantically interoperable Electronic Health Record is one of the most challenging research fields in health informatics. Reaching this objective, the use of EHR standards that formally describe health data structures cannot be waived. CEN EN13606 is one of the most promising approaches to solve this problem since it covers the technical needs for semantic interoperability and, at the same time, it incorporates a mechanism (archetype model) for clinical domain experts’ participation in building an EHR system. In this paper we present EHRflex, a generic system based on archetypes. It empowers the clinician and allows him to manage his own EHR system in a simple and generic way, assuring that the user works with underlying standardized data structures. They can be exchanged with other people and systems when needed. EHRflex introduces EHR standards into the clinical routine delivering a technical platform which works directly on archetype based data.
Publication:
Anton Brass, David Moner, Claudia Hildebrand, Montserrat Robles. "Standardized and flexible health data Management with an archetype driven EHR system (EHRflex)". Seamless care – Safe care: The Challenges of Interoperability and Patient Safety in Health Care. Proceedings of the EFMI Special Topic Conference, pp. 212-218. IOS Press BV, Amsterdam. ISBN: 978-1-60750-562-4, 2010.
The document discusses New Zealand's priorities for health IT standards and interoperability between 2014-2017. The goals are person-centered, integrated care enabled by clinicians, consumers, and IT working together. National priorities include electronic prescribing, records, and shared care plans across primary and secondary care. Regional information platforms aim to provide access to referrals, test results, discharge summaries and shared care records. The document outlines several initiatives and challenges around implementing electronic medical records, medication management systems, and enabling information sharing across care settings.
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.
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 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.
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.
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.
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.
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.
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.
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
eHealth Governance in a Local Organisation. The Experience from Pompidou Hospital. Degoulet P. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
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)
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.
Health Care Data Sets and their purpose
UHDDS, UACDS, MDS, OASIS, DEEDS and EMDS.
Explain the standardization data collection efforts.
Explain the five type of standards that need to be in place to implement the Nationwide Health Information Network (NHIN).
Standard Development Organizations
Evolving and Emerging Health Information Standards
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.
A Prototype Knowledge Base and SMART App to Facilitate Organization of Patien...Allison McCoy
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.
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)
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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
eHealth Governance in a Local Organisation. The Experience from Pompidou Hospital. Degoulet P. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
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)
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.
Health Care Data Sets and their purpose
UHDDS, UACDS, MDS, OASIS, DEEDS and EMDS.
Explain the standardization data collection efforts.
Explain the five type of standards that need to be in place to implement the Nationwide Health Information Network (NHIN).
Standard Development Organizations
Evolving and Emerging Health Information Standards
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.
A Prototype Knowledge Base and SMART App to Facilitate Organization of Patien...Allison McCoy
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.
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)
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.
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.
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.
Patient portals and personal health apps in New ZealandAlastair Kenworthy
Trusted personal health apps will have access to patient portals for the secure exchange of information recorded about the person and their health care.
Standards update to the New Zealand e-health national vendor forum July 2014Alastair Kenworthy
The document outlines several New Zealand health IT standards that are being developed or reviewed, including standards for pathology observation codes, clinical messaging, maternity care data, ambulance care summaries, clinical document metadata, lightweight web forms, and medication and discharge data. Development timelines range from August 2014 for public comments on some standards to October 2014 for first drafts of other standards to be ready. Contact information is provided for the national health IT standards organization.
SNOMED terminology is being introduced for clinical coding in emergency care in New Zealand. This includes emergency departments and ambulance, with SNOMED reference sets used to code clinical impressions, diagnoses, medicines and procedures. There is a challenge for software developers to build a RESTful SNOMED code finder web service and to use this in new clinical workstation solutions. Terminology services such as this are essential alongside rich data services such as FHIR services.
There is a snow theme, and a movie identification quiz.
2014 and beyond - interoperability for the New Zealand national e-health prog...Alastair Kenworthy
This document discusses various initiatives related to improving clinical coding, data sharing, and patient portals in New Zealand. It mentions coding emergency room visits and procedures, sharing ambulance reports and discharge summaries, developing portals for patient self-care and viewing clinical records, and standardizing coding of laboratory results to facilitate sharing of clinical information across systems. Overall it aims to improve transfer of care between providers and access to comprehensive patient data through various interoperability and clinical coding projects.
Standards and architecture update to the New Zealand national e-health vendor forum
- New HL7 CDA standards
- Clinical data repository record locator service
This document provides an update on standards and initiatives from the PCIM Group & National Vendor Forum in April 2013. It discusses priority workstreams around the New Zealand Health Data Set and continuum of care. It also outlines the status of various projects, including equipment specifications moving to final stages and other projects beginning development or review.
New Zealand Health Sector Architects Update on Interoperability February 2013Alastair Kenworthy
Update to the New Zealand health sector architects forum from the interoperability working group. We have enjoyed a summer of CDA, with a number of new implementation guides coming about. This year also looks bright for XDS-enabled regional CDRs.
Standards update to New Zealand national e-health vendor forumAlastair Kenworthy
New Zealand is developing a raft of new HL7 CDA based standards in pursuit of the national e-health vision for 2014 - this has proven an unexpectedly long journey, but we hope a rewarding one
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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. HINZ Nov 2012
Privacy breaches
Disruptive innovation
Fabula, syuzhet, syzygy
2014
trees
data as an actor
personalised medicine
2
3. In the news
Novopay a $30m horror show
‘… such rush-jobs are all too common … [the
government] may be setting the stage for future
horrors with its stated policy of getting a national
patient-record system in place by 2014’
Sunday Star Times, 25/11/12
4. 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
4
6. National priorities to 2014
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
6
7. Top priorities for the next twelve months
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
7
8. GP2GP
50% of GPs are users
5500 transfers alongside 36,000 e-referrals per month
Files over 5 MB have to be sent the old fashioned way
5500 (Nov)
8
12. Emergency care
Ambulance accesses primary
care info and any discharge
summary
Ambulance shares ePRF (as an
event summary, but also a kind
of referral) with hospital ED
Common ED solution based
on hospital PAS and CWS eDS shared
via R-CDR
12
13. Discharge summary
SNOMED coded presenting complaint,
diagnoses, procedures
Continually updated during hospital stay
Discharge Rx via NZePS
eDS shared
via R-CDR
13
16. 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
16
24. Clinical integration
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)
Shared Care Systems for patients
with long term conditions
24
25. SPaCE programme
Supporting 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
25
26. Orders and results
Community lab and radiology test ordering solutions are appearing
(with decision support and order tracking functions)
Laboratory information standards review –
NZPOCS overhaul
HL7 v2.4 messaging implementation
Judicious coding
Message integrity between sender and receiver
26
30. From: Bob Dolin
Sent: Tuesday, November 29, 2011 12:55 PM
To: Rishel,Wes; Pratt, Douglas (H USA); robert worden;
Structured Documents WG
Subject: RE: CDA or greenCDA
Hi Wes,
What is CCDA?
Thanks,
Bob
30
We look at the standards and interoperability agenda, towards reaching the New Zealand health sector’s objective of shared personal health information by 2014National Health IT Board prioritiesClinical integration and the interoperability frontlineThe standards agenda
Be regional‘electrified health records’
Current headlines in Nov 2012Novopay a $30m horror showJackson scrambling to finish The Hobbit – one day out from premiereHowever, the first headline wrongly susposes the 2014 vision to be predicated on a national rollout of some monolithic system
This is the e-health destination as described by NHITBWith a further theme of sustainability in the health system
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
These are the National Health IT Board priority programmes for 2012-14 – the windowpanes Underpinned 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.
GP2GP has been a success storyGP2GP 2.0 is in planning
Interconnected 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.The essential LTC Services a pharmacy must provide include, dispensing of pharmaceuticals, medicine reconciliation, synchronisation of medicines, reminder services (e.g. email, phone call) for collection of pharmaceuticals, regular screening of adherence to medicine regime, and regular engagement with the patient’s multidisciplinary care team.
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
Having a SNOMED CT coded eDS would be like Xmas to GPsGlobal general practice reference set has ~3500 concepts (July 2013)Locally, all clinical systems SNOMED enabled from x date – 2015? 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 NZePSDischarge summary is a living document, continually updated from admission to discharge, and visible to all parties hospital and community through the hospital stay (this cannot be achieved very easily with a messaging model)
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.To progress from one stage of adoption to the next, a hospital must have implemented everything at the preceding levelScores go to 4 decimal places, depending on achievements at higher levels (which makes big jumps possible)
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 excellenceCentral Region is Region Central
There is plenty of locked-up clinical data that DHBs would like to make available via the R-CDRXDS seems to offer a robust way of doing this – we hope cost effectiveHIE community policy?
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)
SPaCE programme likely to have chosen a vendor by Xmas
What standards do we need to reach the 2014 goal?Of these, HISO 10040 is an interim standard (awaiting trial implementation)Transfer of Care Standard is scheduled to be released for public comment in the first half of 2013, ePharms (necessary for the NZePS) after thatThe Comprehensive Care Assessment Document will be a standardised interRAI extractWe will also have refreshed health identity standards
The diagram shows the CDA solar system, with the blue planets representing sets of templates and document types we use locally, deriving from international specifications (green)We are strongly internationally influenced, reusing wherever the fit to requirements is better than we could hope to achieve by ourselvesThe Continuity of Care Record (CCR) – although not itself CDA – is the origin of our conceptual data model for information exchangeThe other document types shown are: Consolidated CDA (CCDA) developed by the US’s ONC for Health IT; Continuity of Care Document (CCD); local GP2GP; local e-discharge summary (eDS); local e-prescription document; local transfer of care – generic referral/discharge document