HINZ Nov 2012 HL7 Workshop Towards 2014

PREPARED BY

Standards and interoperabilityTowards 2014

Alastair_Kenworthy@moh.govt.nz

7 November 2012

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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National priorities 2012-14

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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Realising the 2014 vision

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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Repository-based information sharing

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GP2GP

Currently about 4000 medical records transfers per month

About 50% of GPs are users

Files over 5 MB have to be sent the old fashioned way (a future upgrade will allow files to be sent in pieces)

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The solution space

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Connected care

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Pharmacy clinical integration

eRx via NZePSeReferral via (eg) ERMS

Pharmacy desktop Dispensing system Assessment tool

Shared care system

Assess eligibilityCentrally register

Create medications plan

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SHARED CARE

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Emergency care

Common ED solution based on hospital PAS and CWS

Ambulance sends ePRF (as a kind of referral, but also an event summary) to hospital ED

Ambulance accesses primary care info and previous discharge summaries

Presenting complaint, diagnoses etc are SNOMED coded

eDS shared via R-CDR

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Discharge and follow ups

Discharge Rx via NZePS

eDS shared via R-CDR

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My List of Medicines

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My List of Meds – a repository-based application

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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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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 (Mar 12)

XDS (August 13)

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CRISP (Central DHBs)

Regional PACS archive

Regional CDR

Regional PAS

Regional clinical workstation

Regional ED solution

Regional RIS

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South Island initiatives

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)

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South Island SPaCE programme

Support 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)

Lab information standards review –

NZPOCS overhaul

HL7 v2.4 messaging implementation

Judicious coding

Message integrity between sender and receiver

Lab test orders and results

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Baltimore Fire 1904 …

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Baltimore FHIR 2012 (HL7 WG)