Sharing Health Information: Toward better, safer care · 2017-03-06 · 2 Sharing Health Information: Toward better, safer care 2013 From the Chair Better, safer health care, closer

Sharing Health Information: Toward better, safer care

2013

Citation: Ministry of Health. 2013. Sharing Health Information: Toward better, safer care. Wellington: Ministry of Health.

Published in November 2013 by the Ministry of Health PO Box 5013, Wellington 6145, New Zealand

ISBN 978-0-478-39381-1 (print) ISBN 978-0-478-39382-8 (online)

HP 5542

This document is available at: www.health.govt.nz and www.ithealthboard.health.nz

1Sharing Health Information: Toward better, safer care 2013

ContentsFrom the Chair 2

Patient portals making life easier for New Zealanders 4

Secure electronic system speeds up transfer of patient medical records 6

Patients benefit from electronic sharing of records 7

Electronic referrals a boost for patient safety 8

Emergency department staff have better access to patients’ medical information 9

Anywhere, anytime – 24/7 access to X-rays 11

Electronic prescription service improving link between GPs and pharmacists 12

Shared care plan helps manage long-term conditions 14

Connected Health 16

2 Sharing Health Information: Toward better, safer care 2013

From the ChairBetter, safer health care, closer to homeClinicians throughout New Zealand are increasingly able to access information about their patients when they need it via a range of secure electronic portals and shared medical records. This gives health professionals a fuller picture than previously to decide on the best possible treatment for patients, and is contributing to improvements in the quality and safety of health care.

As well, more and more patients can now access their health information via online patient portals. This supports self-directed care, with patients able to log in to book medical appointments with their GPs, request repeat prescriptions from their list of medicines, check when an immunisation is due and ask questions of their doctor or nurse.

Much of this innovation is a result of the National Health IT Plan since 2010, making sure information technology systems across the country can share information electronically, securely and reliably.

This booklet provides examples of how information technology is improving and, in some cases, changing the lives of New Zealanders.

Having shared access to patients’ health information means health professionals in primary care – such as GPs, pharmacists and community nurses – can work more closely and effectively in multi-disciplinary teams with doctors, nurses and specialists in hospitals. This is proving especially valuable for emergency department staff. For instance, in many hospitals the ED staff have electronic access to parts of GP records – enabling them to see what medicine a person is on and their medical conditions.

Electronic ‘shared care’ plans are also making a difference for many New Zealanders. These are developed with input from health professionals and might typically include a patient’s health goals, treatment plan and follow-up care. Tomoavao Wichman from South Auckland says having a shared care plan for his long-term conditions means that ‘when I wake up in the morning, I know what I’m going to do – the light at the end of the tunnel is getting brighter’.

You can read more about electronic sharing of health information at www.health.govt.nz/sharedhealthinfo

IT advances mean New Zealanders will be able to receive treatment closer to home – using the services that are available in their community. For example, videoconferencing is already allowing some doctors to carry out ‘virtual’ ward rounds, which then means people can go home from hospital sooner because they can be supported by a virtual care team or monitored by a specialist via a videoconference.

Many GPs are now sending patient referrals and prescriptions and receiving discharge information electronically. This means information can be shared securely and quickly, and will result in fewer errors as information is easier to read and less likely to be misplaced. Electronic referrals, or eReferrals, help clinicians manage the transition of patients through the health system. In most hospitals, referrals are sent directly from the GP to the hospital over a secure electronic network. The GP gets immediate confirmation that the referral has been received, and patients can be booked in for an appointment more quickly.

http://www.health.govt.nz/sharedhealthinfo


At the heart of all of these changes is the need to ensure people’s private health information is managed properly, so it is stored securely and accessed only by people with authority to do so. The IT Health Board has been working closely with a range of health and public sector experts and organisations to make sure the right security standards are in place and are being used. In addition, the IT Health Board’s Consumer Panel has produced a document outlining the principles for protecting privacy and requirements to strengthen confidence and trust in how personal health information is used. A key aspect involves people being able to choose not to share some of their information if they wish.

High quality information that clinicians and consumers can rely on is being delivered over a secure private network, and this network is called Connected Health. Wherever this brand is displayed, people can feel confident that

the health service or system they are using is working to common standards to ensure the safe and secure sharing of health information.

The IT Health Board was established in 2010 to guide the health and disability sector’s investment in information technology systems on behalf of the Ministry of Health. The IT Health Board works closely with a wide range of senior health leaders, consumer and clinician representatives, IT vendors, and organisations critical to the success of initiatives like the ones described in this booklet, such as DHBs, PHOs and general practices.

Murray Milner Chair, IT Health Board


Patient portals making life easier for New Zealanders Wellington novelist Blair Polly spends his days immersed in murder and mayhem but when he needs to attend to more routine things, like renewing a prescription for medicine or asking his GP a question, he turns to technology.

He’s one of the many patients around New Zealand now able to access their health information via a secure online portal to manage aspects of their own health care and talk to their GPs.

‘It’s really good,’ he says. ‘I’m pretty computer literate so I haven’t had any problems but anyone with average computer skills would be able to use this. If you can navigate around Facebook or Trade Me, you’ll be fine with a patient portal.’

Vendors and clinicians have been working together to give patients direct electronic access to their own information, and a number of portals are being rolled out in practices around the country. Patients can log in to these to make appointments, check the list of medicines they’re taking, view records and medical alerts. They can renew prescriptions and ask their GP questions electronically.

Wellington writer Blair Polly, who uses a patient portal.

Blair Polly’s GP, Richard Medlicott, offers his patients at Wellington’s Island Bay Medical Centre access to their own health information through a portal called ManageMyHealth. He says the portal helps to connect patients and doctors, provides a useful service and


saves the practice time (and money) by doing electronically tasks that usually required a phone call.

Blair Polly, who has Type 2 diabetes, has been using the portal since July 2009, mostly for repeat prescription requests and to communicate directly with his doctor.

‘I can just log on, see all of my medications and tick the ones that need renewing, press “send” and then pick up the script from my doctor’s office,’ he says. ‘If I need to ask my GP a question, I can just send a message instead of having to phone his office, leave a message and wait for him to ring me back. This is a lot easier.’

He gets an alert in his email inbox when a new message has been posted on the system.

‘I’ll click on a tab, and it will open up my lab results, and there might be a comment from the doctor that relates to the results.’

Meanwhile, Auckland GP David Thompson says a secure online patient portal used by his practice is proving a godsend.

‘It’s easy to use, gives patients a lot more control over their health care, frees our staff from a number of administrative tasks, and we’re also seeing some clinical benefits,’ he says.

The Torbay Medical Centre began offering an electronic patient portal, ManageMyHealth, two and a half years ago. David Thompson says 250 patients currently use it and it will be offered to all 10,000 people on the practice’s books.

‘It’s really good. People can make appointments online, request repeat prescriptions, check their lab test results and send us messages.’

He says the practice is noticing improvements in the management of some health conditions.

‘It’s easy to use, gives patients a lot more control over their health care, frees our staff from a number of administrative tasks, and we’re also seeing some clinical benefits.’


Secure electronic system speeds up transfer of patient medical records

Wellington GP Chris Masters now receives all the information he needs about new patients before they even turn up for their first appointments.

Transferring medical records between general practices can be a lengthy process but now all GPs in New Zealand can use a secure electronic system called GP2GP, which has made the whole process faster and easier.

Previously, when patients changed doctors, their medical records would have to be printed out or photocopied, mailed to the new practice and then re-entered into the electronic patient or practice management system.

GP2GP allows different practice management systems to ‘talk’ to each other, meaning patient records can now be transferred immediately and securely at the touch of a button.

GP2GP is now being used by more than 80 percent of general practices, with nearly 18,000 files sent in June 2013.

‘Registering new people into the practice is so much easier with GP2GP,’ says Chris Masters. ‘It means we can catch up on screening and any tests a patient might be due for much more quickly. I also know in advance if a patient is likely to need more of my attention; if they’re a diabetic, for instance.’

He says GP2GP is very easy to use.

Thousands of patient files are transferred securely via GP2GP.

As well as having access to their own health portal, the process of transferring a patient’s information to a new GP is now much easier.


Patients benefit from electronic sharing of records The 2011 Canterbury earthquake was a sharp reminder for health professionals of the need for accurate patient information at the point of care.

Dr Nigel Millar, Chief Medical Officer at Canterbury District Health Board (CDHB), says it was difficult to access up-to-date paper-based patient information in the period immediately after the quake.

‘Services were so disrupted, with many general practices and pharmacies closed or not operating fully,’ he says. ‘A lot of people couldn’t get to see their family doctor after the earthquake.

‘People were coming to the hospital’s emergency department without a referral, for example, and there was no quick way to check their medical history.’

Canterbury DHB had been thinking about developing a new electronic system to share patient records, but this work was accelerated by the effects of the earthquake. That new system, called the electronic Shared Care Record View (eSCRV) has proved so successful it will be rolled out to all other DHBs in the South Island.

Electronic health information held at Canterbury hospitals and pharmacies, and relevant information from close to 90 percent of Canterbury general practices, are available through eSCRV. Clinicians are only authorised to look at information relevant to their part in a patient’s care. People who do not want to share their information in this way can easily ‘opt off’ the system with a phone call or by talking to their GP.

Shared Care Record View gathers information for each person into a single record, and clinicians are able to see different parts of that record according to their care role.

The system was developed jointly by the DHB, Orion Health and Pegasus Health, with input from GPs, pharmacists and Nurse Maude community nurses.

‘Shared Care Record View means health professionals can access patient records securely at the point of care, leading to faster, safer and better informed diagnoses and treatment, and shorter waiting and treatment times,’ says Dr Millar. ‘It’s quicker and easier to get the information we need about our patients.

‘If someone turns up at Christchurch Hospital’s emergency department, for example, we’ll be able to see their relevant medical history, such as any recent or chronic illnesses, allergies and the medicines they are taking.’

Dr Nigel Millar, Canterbury DHB.

Patients have better access to their health information and so do the clinicians looking after them, thanks to a new system called electronic

Shared Care Record View (eSCRV).


GPs are not only accessing patient information online, they are sending it electronically as well.

Electronic referrals a boost for patient safety Christchurch GP David Kerr says a new system of electronically referring patients for treatment will mean better and more accurate care.

Sixteen DHBs are now using eReferrals, and the other four are introducing them. By 2014, all DHBs will have an eReferrals system. More than 40,000 eReferrrals are being sent around New Zealand each month.

eReferrals help clinicians manage patients as they move through the health system, from general practice to hospital and between other health providers, without relying on pieces of paper being correctly faxed or posted and arriving at the right destinations.

When a patient needs to be referred to a hospital clinician for further assessment or treatment,

the general practitioner (GP) can complete an eReferral form and send it at the touch of a button while the patient is present.

Dr Kerr says there is less chance of an electronic referral being lost or illegible.

Electronic referrals can be sent and accessed securely and quickly, and can be tracked. The eReferral forms have been designed to provide the information clinicians need, such as the patient’s unique National Health Index number, their test results and list of medications.

‘Better quality information in a referral means clinicians can make better decisions about priorities and treatment options,’ he says. ‘It reduces the time patients have to wait as their referrals are less likely to be sent back for further information.’

Electronic referrals are improving the transition of patients through the health system.


Emergency department staff have better access to patients’ medical information A new medical record-sharing system is giving authorised hospital emergency department staff in four DHBs electronic access to GP records to help with patient care.

There is more than one way of sharing patient information, and a system up and running at Hawke’s Bay, Tairawhiti, Northland and Nelson Marlborough DHBs is giving health professionals

access to patient information at the time they need it.

Dr Mark Barlow, a consultant emergency physician at Hawke’s Bay DHB, says that thanks to Care Insight, emergency staff now have much fuller health information on which to base treatment.

‘We have signs in the emergency department saying that, as part of your stay, we may ask your GP for health information. Doctor-patient

Emergency department staff need the right information at the right time to provide the best possible care for patients.

There is more than one way of sharing patient information, and a system being used by four DHBs is also proving successful.


confidentiality is preserved as we don’t get the full patient notes, so we don’t know everything you’ve said to your GP over the years, we just see a list of medications and current scripts and medical conditions.’

Hawke’s Bay DHB Information Services Manager Gina McEwen says the system is available at any time but is mostly used after hours.

‘When a patient turns up in ED and the clinician needs more information, they tell the patient they can access part of their record from their GP’s system and then ask their consent. An icon in our patient management system is used to look up specific information. Care Insight returns information very promptly and indicates if information is held in more than one practice and what the primary enrolled practice is.’

Dr Barlow says the real safety benefits lie with patients who have allergies to medication or who run the risk of drugs reacting with each other. Having electronic access to information can also help determine the likely medications involved when a patient has had an overdose and has a reduced level of consciousness.

‘One of the big advantages is when the patients can’t tell us what’s going on and it saves us a lot of time ringing around GPs and pharmacists or waiting until the next day for information.’

This means there is no delay in providing the best possible treatment based on accurate information.

The system was developed by HealthLink and DrInfo in collaboration with Health Hawke’s Bay. GPs are notified when their patient is checked

at the emergency department, and a record is requested. GPs keep full control of patient data since Care Insight runs securely on the practice’s server and the medical record itself never leaves the practice.

The system is a success, with patients benefiting from faster diagnosis and treatment. Clinical pharmacists find the system is a real time saver, says Mark Barlow. Clinical pharmacists traditionally spend much of their time phoning GPs and community pharmacies to obtain an accurate list of a patient’s current medications and doses. Being able to access this information electronically will free up their time significantly.

‘One of the big advantages is when the patients can’t tell us what’s going on and it saves us a lot of time ringing around GPs and pharmacists or waiting until the next day for information.’


It is not just written health information that can be shared – clinicians across New Zealand can now share patient X-ray images as well.

Anywhere, anytime – 24/7 access to X-rays Picture this: your 12-year-old son broke his leg a month ago and is getting around on crutches. You decide to go ahead with the out-of-town family holiday you’ve been planning – but while away, your son trips and hurts his leg. You take him to the local hospital’s emergency department.

It’s 9 pm, but they’re able to go online to look at X-rays of his leg taken back at home before they decide on the best course of treatment or order a new set of images for comparison.

Clincians now have online access to radiology images held by DHBs in New Zealand. For example, the ‘go-live’ of a new, shared radiology archive in the central region means clinicians in six DHBs – Capital & Coast, Hutt Valley, Wairarapa, MidCentral, Whanganui and Hawke’s Bay – can retrieve images stored in the new Picture Archiving and Communication System (PACS).

Similar archives are being used in other regions as well.

Dr Murray Milner, the Chair of the Central Region Governance group and IT Health Board, says the new system provides secure entry to an archive of images taken and stored anywhere in the region.

‘Clinicians will be able to consult their colleagues while viewing the same set of images, regardless of their location,’ he says.

Dr Milner says the flexibility of time and location, coupled with access to a regional archive of images, will benefit patients.

‘It will be very helpful for patients who have to travel to other hospitals in the region for health care or for out-of-town people turning up at any emergency department in the region. The go-live of the PACS archive is an exciting development for the central region.’

Central region clinicians now have secure access to an archive of radiology images taken and stored anywhere in the region.


Electronic prescription service improving link between GPs and pharmacistsAbout 20 million new prescriptions are written in New Zealand each year for 60 million medicines – and a new electronic system is helping ensure they are legible and contain all the information GPs and pharmacists need.

The New Zealand electronic prescription service (NZePS) is being rolled out across all general

practices and community pharmacies around New Zealand and will strengthen the links between the two systems.

GPs using NZePS can send prescriptions electronically to pharmacies and will be able to see if their patients’ medicines have been dispensed or collected. When a patient takes a paper copy of the prescription to be filled, the pharmacist can scan a barcode printed on it to access the information. Prescription details will

Pharmacist Antony Wentworth helps a customer.

Information is also being shared with pharmacists, and electronic prescribing is giving them greater certainty about the medicines they’re dispensing.


no longer have to be entered by hand into the pharmacy’s system.

The doctor can provide additional information in the secure electronic message to the pharmacist, reducing the need for follow-up phone calls.

NZePS is expected to speed up the time spent on processing prescriptions help GPs identify and follow up with patients who haven’t filled their prescriptions, and give the health system more information about prescribing and dispensing patterns.

Auckland pharmacist Antony Wentworth has been using NZePS at the Orewa Care Chemist for three months and says it has

already reduced the amount of time being spent on prescriptions.

‘It’s good, and it has a lot of potential to improve things even further as it develops,’ he says. ‘We’re going to be able to spend more time with our clients instead of administration, and that’s going to be a big benefit.’

Once NZePS is being used by all general practices and community pharmacies, it will

be introduced for hospital discharge and outpatient prescriptions, as well as prescriptions from a range of other community-based prescribers. ‘The ePrescription service represents the beginnings of a shared care record between community

pharmacy and general practice,’ says Lee Hohaia, Chief Executive of the Pharmacy Guild.

‘With the ePrescription service, not only will the system be more efficient for community pharmacy, but prescribers will also be able to tell when patients have collected their scripts or have only collected part of their prescription. This will result in more targeted communication between prescribers and their patients and the general practice and community pharmacy. This has to be a good thing and result in a positive outcome for patients.’

Graeme Osborne, Director of the IT Health Board, says NZePS means prescriptions will be accurate, accessible and traceable.

‘It’s a 21st century solution that makes innovative use of information technology to the benefit of patients, clinicians and health managers,’ he says.

NZePS is part of the national Medication Safety Programme run jointly by the National Health Board, IT Health Board and the Health Quality & Safety Commission New Zealand.

‘It’s a 21st century solution that makes innovative use of information technology to the benefit of patients, clinicians and health managers.’


Shared care plan helps manage long-term conditionsEveryday activities like digging the garden, growing his own vegetables and walking around the block have given 72-year-old Tomoavao (Tom) Wichman a new lease on life.

The turning point came when Tom and Mangere Family Doctors practice nurse Donna Snell created an electronic shared care plan based on Tom’s goals for the management of his long-term conditions.

Tom and Donna are part of the National Shared Care Plan – Long Term Conditions programme led by the IT Health Board and healthAlliance. The programme develops a comprehensive and coordinated electronic care plan for people with long-term conditions and the providers who support them.

A pilot of the programme in Auckland proved successful, and the region’s three DHBs are now rolling it out across the city. It has also been a hit in Canterbury, with more than 3500 people now enrolled on the region’s shared care initiative.

DHBs have realised the potential benefits of shared care planning for delivering services to their patients, and those without a system already in place are looking at options for electronic shared care plans.

Tomoavao Wichman is benefitting from an electronic shared care plan to help manage his long-term conditions.

Sharing information helps clinicians keep each other and their patients up to date with the latest relevant health information.


When patients set their goals, Donna asks questions based on the cues they give – ‘so you want to be able to kick a ball around with your grandchildren when you go on a church picnic?’

‘It’s about putting the ball back in their court; they need to own it – it’s not my heart or my diabetes. You need to use their words and make it really relevant and meaningful for them.’

Donna has developed shared care plans with about 40 of her patients, and emphasises that successes stem from relationships built on trust. She says electronic shared care plans have several standout features, with 24-hour access from anywhere in the world being a huge advantage.

‘Communication between primary and secondary care is open and out there, and patients really like the transparency. It’s up to date. You can see the list of medications they are on and if there have been any changes. Specialists can also look at what we’ve been discussing in the care plan so it adds a whole new dimension to secondary care’s understanding of the patient.’

Tom also appreciates not having to repeat his story, not having unnecessary tests and not being the ‘go-between’.

‘Donna is more like a coordinator. We talked about my medications, the different clinics I

go to and the specialists, and I told her I was worried about all the different drugs reacting together. She checked this out with the pharmacist and put it all in my record.’

‘Before, one of the specialists would tell me that the other specialist should have done this or that or prescribed this drug and I’d think “why can’t you just tell them?” Now all the specialists have

access to my plan, and they can tell each other things,’ says Tom.

For Tom though, the main benefit is more personal – he’s a changed man.

‘I’ve got diabetes, I’ve got cancer;

you name it, I’ve got it. When you’ve got these conditions, the light in the tunnel goes off. But when I talked to Donna and made a plan, the light started coming back on, it was fantastic. If you just sit back and say “that’s it for me, I’m a goner,” well, you will be. But if you plan to get up and go for a walk next week, well then you will, your mind will be ready,’ says Tom.

‘The problem was that I woke up, and whatever came along, I just did it, and you just end up chasing your tail. Now I’ve set up a plan for tomorrow, the week, the month, the year, and I’m always looking for things that will improve my health. When I wake up in the morning, I know what I’m going to do – the light at the end of the tunnel is getting brighter now.’

‘I’ve got diabetes, I’ve got cancer; you name it, I’ve got it. When you’ve got these conditions, the light in the tunnel goes off. But when I talked to Donna and made a plan, the light started coming back on, it was fantastic.’


Connected Health Wherever the Connected Health brand is displayed, people can feel confident that the systems and processes being used to collect and access information are secure and trustworthy.

The eHealth visionAn individual’s health information collected over his or her lifetime can be likened to a ‘tree’. Each tree will be different, as each person has a different life experience.

The tree has levels that build on each other:

• an individual’s core health information provides the ‘roots’

• an effective and secure system for sharing information represents the ‘trunk’

• common clinical information, connected care and a shared care plan represent the ‘branches’ of the tree.

This connecting of health information will support the development of ‘shared care’ plans and help achieve the eHealth vision of a core set of personal health information being available electronically by the end of 2014.

For more information about the information technology in the health sector, visit the IT Health Board’s website at: www.ithealthboard.health.nz

http://www.ithealthboard.health.nz/


Sharing Health Information: Toward better, safer care · 2017-03-06 · 2 Sharing Health Information: Toward better, safer care 2013 From the Chair Better, safer health care, closer

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