Standards and InteroperabilityTowards 2014

alastair_kenworthy@moh.govt.nz

27 November 2012

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HINZ Nov 2012

Privacy breaches

Disruptive innovation

Fabula, syuzhet, syzygy

2014

trees data as an actorpersonalised medicine

CLAUDIA?

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

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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

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This tree represents the solution space

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National priorities to 2014

eMedicines programme Pharmacy clinical integration eMR, ePA NZULM, NZ Formulary

Regional information platforms eReferral and eDS CDRs, CWS, ED solution PACS LIS, pharmacy PAS

National solutions Cancer information Cardiac health Comprehensive clinical assessment Health identity platform FMIS, procurement, supply chain

Clinical integration LTC shared care Maternity and well child Patient portal View of primary health info Urgent and unplanned care

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Top priorities for the next twelve months

Offered by IFHCs Personal health info Appointments Repeat prescriptions Email consultations

Common regional CWS and CDR

Accessible both hospital and community

Inter-regional view

Patients with LTCs and high needs

Multidisciplinary input

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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)

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The continuum of care

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Pharmacy clinical integration

eRx via NZePS eReferral via (eg) ERMS

Pharmacy desktop Dispensing system

Assessment tool Shared care system

Assess eligibilityCentrally register

Create medications plan

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The strategy

SHARED CARE

PHARMACY

SERVICES

AGREEMENT

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Emergency care

Common ED solution based on hospital PAS and CWS

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

eDS shared via R-CDR

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Discharge summary

eDS shared via R-CDR

SNOMED coded presenting complaint, diagnoses, procedures

Continually updated during hospital stay

Discharge Rx via NZePS

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My List of MedicineseRx

My Listof Meds

eDS shared via R-CDR

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My List of Medicines

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Going for Gold programmeeMR and ePA in all wardsShared medications lists

Transition to eMR and ePA

Standardised paper based eMRand medications charts

eMR system separate to ePA Outdated pharmacy systems Shelves versus drawers versus robots Medical oncology ePA

CHALLENGES

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End-to-end medications management

Community

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Hospital

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Paperless hospitals

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Comprehensive clinical assessments

Home care assessment Long term care assessment

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Comprehensive clinical assessments

PDF (current)

CDA + PDFCDA level 3 (March 12)

XDS (August 13)

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Regional information platforms

Regional PACS archive

Regional CWS

Regional CDR

Regional PAS

Regional ED solution

Regional RIS

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Regional ePharmacy

…

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Regional CDRs (and national too)

4 DHB regions plus 5th nationally10, 20, … repositories?One registry?

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Regional CDRs

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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

TestSafe+ eSCRV North?

eSCRV+ TestSafe South

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SPaCE programme

Supporting Patients and Clinicians Electronically

Integrate primary care and hospital workflow

Incrementally replace eight systems across five DHBs

Streamline the patient journey

Go well beyond replacing the incumbent systems

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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

Orders and results

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CDA HL7 v2

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New standards development …

… An unexpected(-ly long) journey …

2010 Midland ‘core clinical dataset’

GP2GP

HISO 10040 HIEs

HISO 10041 – 2013 Q1/2

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HISO standards for 2014

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From: Bob DolinSent: Tuesday, November 29, 2011 12:55 PMTo: Rishel,Wes; Pratt, Douglas (H USA); robert worden; Structured Documents WGSubject: RE: CDA or greenCDA

Hi Wes,

What is CCDA?

Thanks,

Bob

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Our family of CDA-based standards

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