Transcript Main Heading

IT in The Future of Aged Care
Andrea Pettett
NZ Health IT Cluster
13 Sept 2006
www.healthit.org.nz
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Agenda
•About the NZ Health IT Cluster
•Overview of 2006 Projects
•HIS-NZ
•Relevance to the Aged Care Sector
•The Microsoft Collaborative Health Showcase
•Demonstration Highlights
•The Microsoft Video
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www.healthit.org.nz
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The NZ Health IT Cluster
Vision :
“Uniting organisations to position New Zealand
as a world leader in the supply and use of
innovative health technology”.
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The NZ Health IT Cluster
•Formed in 2002
•An Alliance of Health IT vendors, Infrastructure
companies, Government, Universities, Health
providers
•Objectives are to build collaborative
relationships in the sector, initiate/undertake ehealth projects, build member capability to grow
their business in their chosen market
•Is commercially focused
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Overview Of 2006 Projects
•E-Laboratory : Clinical Data Repository Options 2006
•E-Pharmacy : Perspectives and Implementation
Considerations 2006
•Microsoft Collaborative Health Showcase
•Business Development Forums
•Export Network to Health Informatics Conference
Sydney August 2006
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Health Information Strategy for NZ
• HIS-NZ published in 2005
• Envisages Electronic Health Records distributed at
local, regional, and national levels
• Focus is on the communication and connectivity
required to use and share distributed information
• 12 Priority Areas = 12 Action Zones
• HIS-NZ sets benchmark targets over 3-5 years
• Recommends the establishment of a Governance
group to provide oversight for the implementation
• HISAC established late 2005
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The Action Zones
1. National Network Strategy
2. NHI promotion
3. Health Provider Index (HPI) implementation
4. E-Pharmacy
5. E-Labs
6. Hospital Discharge Summaries
7. Chronic Care and Disease management
8. Electronic Referrals
9. National Outpatients Collection
10.National Primary and Community care collection
11.National System Access
12.Anchoring Framework
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Health Provider Index
•Due to go live October 2006
•Comprises 3 indices
– Health Provider number
– Health Organisation number
– Health Facility number
•Fully operational 2007
•All claiming to be electronic by 2010
•Electronic claiming likely by July 2008
•Will require NHI and HPI numbers
•THIS INCLUDES AGED CARE PROVIDERS!
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Collaborative Health Showcase Project Development Plan
10 May
05
Initiation &
Proposal
Phase
Development
Phase &
Presentation
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30 June
05
14 July
05
Deliverables, plan &
funding finalised
Kick-off
31 Oct
31 Dec 05
Feb 06
Release 1
Ambulatory &
community
Releases 2 & 3
Family physician,
Tertiary
MSHUG & HIMSS
Commitment in
principle to
showcase
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Presentation
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Microsoft Collaborative Health Showcase
Proposal to develop an Integrated Health System
(Microsoft oriented) aligned to health priorities and
market needs to demonstrate:
a low cost, standards based, multi-vendor Services
Oriented Architecture
integrating 6 products, 1 mobile carrier and a
systems integrator
across GP, community/ ambulatory and tertiary care
settings
To be promoted internationally by Microsoft as an
exemplar of their Collaborative Health strategy
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Role of the Cluster
•Governance
•Coordination & single point of contact
•Contracting with Microsoft, project participants,
NZTE & FRST
•Funding conduit
•Marketing initiatives
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The Contracting Framework
•The Cluster formed a limited liability company
•NDA’s signed by all parties expressing interest
•Letter of Intent agreed with Microsoft & signed
by the Cluster and participants
•Development Agreement with Microsoft
•Services Agreement with participants with
mirrored obligations
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Collaborative Projects
Collaborative projects are challenging but achievable!
– Getting the parties together & managing conflict
– Agreeing the contract terms & payments
What to do with shared IP
Warranties & indemnities
– Obtaining sufficient funding
For the project
For the Cluster
– Funding agreements & reporting requirements
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Overview of Patient Flow
Robert Zane
Presents at family
physician practice
Family
Physician
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Electronic referral to
regional diabetes
service
Electronic discharge
summary
Active management
of care plan
Presents at emergency
department
Community /
Ambulatory
Cardiac event
in a tertiary
setting
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Retrieve EMR
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Overview of Systems Collaborating
Health Collaboration Engine
Laboratory
System
Pharmacy
Family Physician
Practice
Management
System
Health
Services
Directory
Plug-andPlay
Infrastructure
Clinical
Decision
Support
System
Community
Clinic
Management
System
Patient and
Clinical
Management
System
Mobility
Network
Pharmacy
System
Pharmacy
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Highlight: Informed Decision Making for
Acute Events
Situation: Conscious patient presents at Emergency
Room with chest pain, electronic records retrieved and
analyzed, patient is transferred to Cardiac ICU
Care Setting: Hospital Emergency Room
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Highlight: Lab Outreach Orders and Results
Situation: Clinician orders diabetes screening tests online, is notified when results arrive and reconciles
results with orders in patient record
Care Setting: Community Based Diabetes Clinic
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The Technical Challenge
•Provide an integrated view of information from
disparate systems
•No lead system ie no single central database
•No superset of information/ no single record source
•The “plug and play” challenge from Microsoft
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“Plug and Play” Conceptual Model
Decision
Support
System 1
Clinical
Support
System 1
Event 1
CSA 1
Decision
Support
System n
Event 2
CSA 1
Event 1
CSA 2
Health Collaboration Engine
Clinical
Support
System 2
Message
Management
Services
Health
Services
Directory
Clinical
Support
System n
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Event n
CSA n
Patient
Mngt
System 1
Patient
Mngt
System 2
Patient
Mngt
System n
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CSA = Collaboration System Adaptor
Messaging approach
Message Envelope
Message Header
To:
From:
Type:
etc…
Clinical payloads are HL7 V3 compliant as
far as possible
Also use same format for Health Services
Directory non-clinical payloads
The payload is encrypted and not
accessible to the Collaboration Engine
Payload
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Collaboration System Adaptors
Collaborating
System
Adaptor
{
Data set receiver
Data Set
Producer
Unpack Clinical
Payload and
Transform to
native format
Transform from
native format and
pack Clinical
Payload
Decrypt Message
Encrypt Message
Receive Message via
Web Services
Send Message via Web
Services
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Adaptor
Health Collaboration
Engine
“Plug and Play”
Infrastructure
Provide
Message transport protocol
translation
Message protocol
implementation
Message content mapping
Encryption / decryption
Collaborating
System
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Health Services Directory
•A web service exposing directory services
•A database containing
Register of Health Users
Register of Service Providers
Register of messaging schemas
•A schema repository for all message schemas
•Is loosely coupled, so also uses Collaboration System Adaptors
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Highlight: Patient engagement in
community based care
Situation: Patient’s care plan identifies goal range for
blood glucose results. Patient submits blood glucose
results to Healthphone daily via mobile phone. Out of
range results trigger alerts to patient & clinician via text
message
Care setting: Community based diabetes clinic
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Current manual processes are costly:
Referral
Paper based referral
Key referral data
Manual confirmation to
referrer
Triage referral
Schedule
specialist
assessment
Schedule appointment
at mutually convenient
time
Phone/letter to patient
to confirm appointment
Reminder call/letter re
appointment
Patient
assessment
Request manual patient
notes
Complete assessment
form
Manually copy patient
details onto
assessment form
File hardcopy record
Order
lab tests
Complete admin
components of lab test
form
View
test
results
Admin receive test
results
Locate patient file
Select required tests on
form
Notify clinician of results
Fax/send form to lab
Match the order to the
results
Give patient a copy of
the form
Analyse the results
File test order for later
matching
(confirm receipt of lab
test order at lab)
(remind patient to have
tests)
File results into patient
record
Manually file patient
record
(match for billing
purposes)
Update manual patient
notes
File patient notes
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Equivalent processes in a non-computerized setting
And take time away from care:
...
...
Decision
support
Read guidelines
Assess case against
guidelines
Recommend actions
Document analysis
and store
Approve and
supplement
recommended
treatment
Review and finalize
guideline findings
Plan
care
Prescribe
drugs
Convert guideline
recommendations to
treatment actions
Complete admin
components of
prescription form
Document treatment
actions
Select required drugs
on form
Manually schedule
treatment actions
Fax/send form to
pharmacy
Educate patient re
treatment actions
Prescribe drugs
Enter bring-ups in
manual file
Finalize care plan
actions
Patient
interaction
with care plan
Schedule regular
follow-up visits
Phone/write to patient
to remind re performing
tests etc
Respond to abnormal
results at scheduled
follow-ups or acute
events
Give patient a copy of
the prescription
File prescription order
for later matching
(confirm receipt of
prescription at
dispensing location)
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(remind patient to
collect prescription)
Update manual patient
notes
File patient notes
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www.healthit.org.nz
Equivalent processes in a non-computerized setting
‘Collaborative Health’ puts time…
Referral
Triage referral
Schedule
specialist
assessment
Schedule appointment
at mutually convenient
time
Patient
assessment
Complete assessment
form
Order
lab tests
Select required tests on
form
View
test
results
Analyse the results
Value-added clinical steps
Paper based referral
Key referral data
Manual confirmation to
referrer
Phone/letter to patient to
confirm appointment
Request manual patient
notes
Reminder call/letter re
appointment
Complete assessment
form
Complete admin
components of lab test
form
Fax/send form to lab
Manually copy patient
details onto assessment
form
Give patient copy of form
File hardcopy record
(confirm receipt of lab test
order at lab)
File test order for later
matching
Admin receive test results
Locate patient file
Notify clinician of results
13Match
Sept
2006
the order to the results
Analyse the results
File results into patient record
Manually file patient record
(match for billing purposes)
(remind patient to have
tests)
Update patient notes
File patient notes
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www.healthit.org.nz
Redundant (manual) steps
… where it adds value!
...
...
Decision
support
Assess case against
guidelines
Finalize care plan
actions
Recommend actions
Educate patient re
treatment actions
Review and finalize
guideline findings
...
Plan
care
Prescribe
drugs
Prescribe drugs
Patient
interaction
with care plan
Respond to
abnormal results
Value-added clinical steps
Read guidelines
Document analysis and
store
Approve and supplement
recommended treatment
Convert guideline
recommendations to
treatment actions
Complete admin
components of prescription
form
Document treatment
actions
Select drugs on form
Manually schedule
treatment actions
Educate patient re
treatment actions
Enter bring-ups in manual
file
Finalize care plan actions
Fax/send form to pharmacy
Give patient copy
prescription
File prescription order for
later matching
Schedule regular
follow-up visits
Phone/write to patient
to remind re
performing tests etc
13Respond
Septto abnormal
2006
results at scheduled
follow-ups or acute
events
(confirm receipt of
prescription at dispensing
location)
(remind patient to collect
prescription)
Update patient notes
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www.healthit.org.nz
File patient notes
Redundant (manual) steps
Why seamless/ collaborative?
•Reduced administration and “low value” time spent by
clinicians
•Reduction in errors, mismatched and lost results,
non-fulfilled prescriptions
•Complete information at point of care - in facility or
community
•Confident management of community-based
patients by exception
•Improved consistency and quality of care
•Improved clinical indicators/ outcomes
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What Have We Achieved?
•Pragmatic governance of a complex multi-vendor
collaboration project
•Federated, standards-based, patient oriented,
Electronic Health Record
•Use of “off the shelf” Microsoft technologies to reduce
cost and risk
•Aligned to support clinical priorities
•Delivery of “Plug and play” capability
•Patient engagement in their own care using
mobile devices
•The implementation project at the first
customer site is under way
•A measurements stream is in place
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Project Outcomes
•MSHUG presentation - San Diego Feb 2006
•HIMSS San Diego 2006 - the Showcase was
demonstrated on the Microsoft Stand
•All vendor applications have received considerable
international profile which will continue for 12 months
•The Health Collaboration Engine (HCE) will be
marketed internationally by Microsoft
•Simpl and Healthphone are now Microsoft international
partners
•The Microsoft Video (play)
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Upcoming Projects
•Information and Technology requirements to
deliver best practice Chronic Care
•“Aged Care showcase”
•Several others in the concept stage…
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