State of EHR in New Zealand

Koray Atalag MD, PhD, FACHIk.atalag@auckland.ac.nz

About

National Institute for Health Innovation (NIHI)The University of AucklandPrivate Bag 92019, AucklandNew Zealand

Koray Atalag, MD, PhD, FACHI

Medical Doctor, PhD Information SystemsFellow of Australasian College of Health Informatics

Chair openEHR New ZealandopenEHR Localisation Program LeaderHL7 New Zealand Board MemberHealth Informatics New Zealand Executive MemberISO TC215 Working Group Member

New Zealand Quick Facts

• Population: 4.5million – (~20% Maori & Pacific)– <30 million sheep >60 million cattle!

• GDP (PPP) per Capita: USD 28,800• Good healthcare, low cost• High IT adoption, good integration• Single health identifier ~20 years• National eHealth strategy and plan

– National Health IT Board

NZ Health System• Publicly funded (~77% from taxation)• Ministry of Health and National Health Board• 20 District Health Boards (DHB)

– receive public funding, develop regional strategies, operate hospitals and oversee primary care

• 60 Primary Health Organisations– groups of practices funded by capitation & fee-for-service

• Accident Compensation Corporation– national accident insurance (employer + employee contributions)

• Pharmac– Government-funded purchaser of pharmaceuticals

• Private Healthcare Sector– providing health insurance and healthcare services, primarily in the area of

elective surgery, to about 20% of New Zealanders.

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

0

1000

2000

3000

4000

5000

6000

7000

8000

9000US ($8,233)

NOR ($5,388)

SWIZ ($5,270)

NETH ($5,056)

DEN ($4,464)

CAN ($4,445)

GER ($4,338)

FR ($3,974)

SWE ($3,758)

AUS ($3,670)*

UK ($3,433)

JPN ($3,035)*

NZ ($3,022)

Source: OECD Health Data 2012.

Average Health Care Spending per Capita, 1980–2010Adjusted for Differences in Cost of Living

5

Dollars ($US)

THECOMMONWEALTH

FUND* 2009

Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

    AUS CAN GER NETH NZ UK US

OVERALL RANKING (2010) 3 6 4 1 5 2 7

Quality Care 4 7 5 2 1 3 6

Effective Care 2 7 6 3 5 1 4

Safe Care 6 5 3 1 4 2 7

Coordinated Care 4 5 7 2 1 3 6

Patient-Centered Care 2 5 3 6 1 7 4

Access 6.5 5 3 1 4 2 6.5

Cost-Related Problem 6 3.5 3.5 2 5 1 7

Timeliness of Care 6 7 2 1 3 4 5

Efficiency 2 6 5 3 4 1 7

Equity 4 5 3 1 6 2 7

Long, Healthy, Productive Lives 1 2 3 4 5 6 7

Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290

Country Rankings

1.00–2.33

2.34–4.66

4.67–7.00

Exhibit ES-1. Overall Ranking

7Pharmaceutical Spending per Capita, 2010Adjusted for Differences in Cost of Living

US CAN GER FR JPN* AUS* SWIZ OECD Median

NETH SWE NOR UK** DEN NZ0

100

200

300

400

500

600

700

800

900

1,000 983

741

640 634 630

541510 508 481 474

395 369331

285

* 2009.** 2008.Source: OECD Health Data 2012.

THECOMMONWEALTH

FUND

Dollars ($US)

9

NETH NOR NZ UK AUS SWE GER US FR CAN SWIZ0

20

40

60

80

100 99 97 97 96 95 94

72

46

68

37

98 98 97 9792

8882

69 67

56

41

2009 2012

Source: 2009 and 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Percent

Doctors’ Use of Electronic Medical Recordsin Their Practice, 2009 and 2012

11

NZ SWE NET SWIZ NOR FRA UK US AUS GER CAN0

20

40

60

80

100

55 52 49 4945

39 3831

2722

14

Percent

Doctor Can Electronically Exchange Patient Summaries and Test Results with Doctors Outside their Practice

Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

eHealth VisionTo achieve high quality health care and improve patient safety, by 2014 New Zealanders will have a core set of personal health information available electronically to them and their treatment providers regardless of the setting as they access health services.

Information will be recorded electronically Personal health information will be available, with appropriate access, across providers People will be more involved in the collection and use of their personal health information Providers will have clearly defined roles when collecting, using and sharing health information Optimise resources (time, facilities and equipment) and focus on the quality healthcare.

National Health IT PlanEnabling an Integrated Healthcare Model

National Health IT Board Programmes

eMedications Programme

1. Community E-prescribing Service

2. Inpatient e-prescribing

3. Medicines reconciliation, medication management and administration

4. Universal List of Medicines

5. NZ Formulary

National Systems

1. Health Identity (new NHI)

2. Connected Health Network

3. InterRAI for Aged Care

4. Oncology

5. Cardiology

Regional Information Platform (DHBs)

1. Clinical Data Repositories/ Workstation

2. Patient Administration Systems

3. Imaging/PACS

4. Clinical support – Labs/Pharms

5. Continuum of care: eReferrals/eDischarges

Integrated Care Initiatives

1. Shared Care - Maternity

2. Shared Care - Long-Term Conditions

3. Care/Clinical Pathways

4. Primary Care

5. Well child

National Health Index (NHI)

• Unique health identifier used >20 years• All NZ-born children receive NHI at birth• Information stored centrally:

• name and address• date of birth• sex & ethnicity

• Statistical search algorithms, adaptive• NZ has strict privacy and security laws• System also includes:

– Medical Warning System– Health Provider Index (Organisation, person, facility)

(GP) Practice Management Systems

• 4 major vendors; one >90% market• Very comprehensive EHR, all GPs really use it• Integrated w/ Labs, ePrescribing, Discharges,

secure messaging• Warnings & Reminders, patient recalls• Advanced decision support modules

– PREDICT CVD risk prediction tool ~400,000 pts.– Also provides clinician advice & patient guides

MedTech PMS Screenshots

PREDICT CVD Decision Support System

Hospitals

• Patient Admin Systems; ADT, billing etc.• LIS, RIS, PACS + clinical systems• Clinical Workstation – integrated view

– Orion Health’s Concerto Product– Rhapsody integration engine (Orion)

• Orion is rolling out integrated Hospital Information System in most of NZ– (Orion bought Microsoft’s Amalga HIS)

Clinical Workstation

Shared Care

Shared care is about caring for patients with high needs in collaboration with other healthcare professionals.

Central to shared care is the patient care plan. All team members can access and contribute to the care plan and communicate with each other to provide the best care for the patient.

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24

Shared Care System (HSA Global CCMS)

Community Pharmacy

Emergency DepartmentsOutpatients

Inpatients

HOME-BASED SERVICES

Patient’s homeGeneral Practice

HML

St John

COMMUNITY SERVICES

Community-based Secondary Services -

Falls prevention

District nursing

Private/ public Allied Health

FAMILY MEMBERS

CENTRAL SERVICES

DHB Planning and Funding LTC Meds Contract Mgrs

Aged Care Providers

Hospice

Palliative care

11 April 2023 25

CCMS Care Planning

26

Seismic Innovation!

• NZULM includes:– approval status and restrictions for use in NZ– subsidy info and any conditions that apply.

• SNOMED based terminology• NZ Formulary

– clinically validated medicines information and guidance on best practice

– Used for decision support

New Zealand Universal List of Medicines (NZULM) and Formulary

NZ ePrescription Service

HISO standards development

HISO 10040 Health Information Exchange

10040.1R-CDRs

XDS

10040.2 CCR

SNOMED CTArchetypes

10040.3Documents

CDA

Usage of the Content Model

Creating CDA Payload

LocalisationContent definition is language independent

Exploiting Content Model for Secondary Use

Single Content Model

CDA

FHIR

HL7 v2/3

EHR Extract

UML

XSD/XMI

PDF

Mindmap

PAYLOAD

System A

Data Source A

MapTo

Content Model

System B

Data Source B

Native openEHR Repository

Secondary Use

MapTo

Content Model

Automated Transforms

No Mapping

Shared Health Information Platform (SHIP)

Questions?k.atalag@auckland.ac.nz