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OFF ICIAL MAGAZINE OF HEALTH INFORMATICS NEW ZEALAND MAY 2021 | ISSUE 1 | $9.50 Digi tal Heal th CONNECT NZ
Improving patient flow through ED
DIGI TAL TRANSFORMAT ION? Or Disruption.
What’s up with nHIP?
BorderNET PROTECT ING AOTEAROA NEW ZEALAND
+ EMR VIRTUAL GO-LIVE + INNOVATION SHOWCASE
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YO U R H i N Z B O A R D
M E M B E R S Board Chai r Becky George Clinical Informatician & doctoral student Board Deputy Chai r John Ashley Director Digital Strategy & Solutions Atlantis Healthcare Board Member Alex Kemp Chief Allied Professions Officer Whanganui DHB Board Member Deb Boyd CEO Auckland Eye Board Member Elizabeth Berryman CEO & Founder chnnl limited Board Member Karen Blake Head of Clinical Informatics healthAlliance Board Member Karen Day
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IN THIS ISSUE
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Edi tor CONNEC T + eHealthNews Rebecca McBeth | email@example.com Des igner CONNEC T Leanne Lassman | firstname.lastname@example.org
08 What ’ s up wi th nH I P ?
A Ministry of Health team is working in partnership with consumers and their whānau, and the sector, to deliver the national health information platform (nHIP) programme. An update from Deputy Director- General of Data & Digital, Shayne Hunter. 10 BorderNET : Protec t ing New Zealand
Sec tor Engagement Manager Nic Quilty | email@example.com GM Marke t ing
Kylie Williams | firstname.lastname@example.org Sales & Marke t ing Execut i ve Brit Owens | email@example.com Finance & Admini s t rat ion Manager Gloria Holliday | firstname.lastname@example.org Health Informatics New Zealand Incorporated PO Box 300125, Albany Auckland 0752 New Zealand hinz.org.nz
In its response to Covid-19, New Zealand has become a world leader in operating a fully digital, integrated national border system. CONNECT editor Rebecca McBeth reports.
16 Trans form or be di srupted
ISSN 2744-4945 (Print) ISSN 2744-4953 (Online)
Spark Health CEO Will Reedy shares his opinion on the future of health and wellness in post-covid New Zealand.
Digital Health CONNECT is the official magazine of Health Informatics New Zealand (HiNZ).
20 Pat ient f low through a busy ED CONNECT editor Rebecca McBeth visits Christchurch Hospital’s new emergency department to see the impact of technology on patient flow and clinical practice. 24 St rong foundat ions for smar ter care After international borders closed, MercyAscot forged ahead with a virtual go-live of their new EMR without the vendor on site. CONNECT editor Rebecca McBeth intervi ewed their EMR project team to find out more.
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From the editor’s desk
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F R O M T H E E D I T O R ’ S D E S K
What a year it has been!
One area where we have seen significant progress over the past 12 months has been around systems that keep our communities safe from Covid-19. Minister of Health Andrew Little said in March that in responding to the Covid-19 pandemic, the health system had achieved greater transformation of digital services in a matter of weeks than it had in many years. Our cover article explores the data and digital health systems that have been deployed at the border and in our Managed Isolation and Quarantine Facilities to automate processes and digitally link people with their Covid-19 test requests and results, as well as share that data nationally. I also visited Christchurch Hospital where I discovered how they are using patient flow technologies to keep patients moving through the emergency department and hospital, then back out into the community. Hospital capacity has been a hot topic in recent months and the entire health system is straining under the pressure of the increasing number, age and acuity of patients coming through their doors. As pointed out in the article, digital tools cannot fix a full hospital, but they can provide better visibility of likely issues and pain points, allowing staff to problem-solve early. Minister Little recently announced sweeping reform of the health and disability system, which he says will encourage innovation and integration and ensure patient information is shared across the country. While the reforms have been broadly welcomed, the devil will be in the detail when it comes to implementation and strong leadership will be fundamental to realising the vision. A new structure alone will not fix the barriers preventing digital transformation of the health system, but recognition of technology as a key enabler of the reforms and an area “long overdue for attention” are good first steps. We have chosen Digital Health CONNECT as the name of this new magazine because an important role of Health Informatics NZ (HiNZ) is to connect many diverse professional groups and individuals, making it easier for you to share ideas and collaborate. CONNECT will be published five times a year, and we intend to showcase some of the amazing innovations and technologies being used to transform the health and disability sector and improve equity and outcomes across New Zealand.
Rebecca McBeth editor
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e H E A LT H N E WS
CONTENT HUB BEING CREATED
Health Navigator Charitable Trust, KidsHealth NZ and HealthInfo Canterbury are creating a national, as-a-service, health content hub. The partners are calling on others to join them in creating the hub, which will act as a central repository for trusted, New Zealand focused, high-quality health content and self- care resources for all New Zealanders. The hub will enable seamless sharing and updating of information across platforms, so that organisations can repurpose the content for their specific needs and audiences.
NEW REPORT ENVISIONS NZ AS GLOBAL LEADER IN DIGITAL HEALTH
An NZHIT report, Hauora, Mauri Ora: Enabling a Healthier Aotearoa New Zealand, was launched by Minister of Health Andrew Little in Parliament on 7 April 2021. “Lifting our performance in health and health outcomes and access to health is going to be delivered, in part, on the back of much improved use of data and digital processes,” he told attendees. The report makes five recommendations to “make New Zealand a world-class digital health technology exemplar.” These are to create a national Digital Health Innovation Network; a more effective Supplier Engagement Framework; and a national Digital Health Academy. Also, to focus on engaging and empowering consumers and promotion of New Zealand’s digital health industry offshore.
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AMBULANCE CARE SUMMARIES VIEWED ELECTRONICALLY IN SOUTH ISLAND HOSPITALS
Ambulance care summaries are being viewed more than 18,000 times a month by hospital staff working across the South Island. An integration between Orion Health’s Health Connect South and the St John and Wellington Free Ambulance systems means clinicians at four of the South Island’s DHBs can view all Ambulance Care Summaries for a patient within their clinical portal. St John staff were previously having to print the summaries in EDs and any information needed for the hospital record had to be manually re-entered into the hospital’s system. Christchurch Hospital ED physician James Weaver says the summaries are now available immediately for ED staff to view and the process saves considerable time for St John ambulance officers.
RUSH OF COMPANIES JOIN MEDTECH MARKETPLACE
More than 30 partners have signed up for Medtech’s FHIR API Integration Program. Called ALEX (Application Layer EXchange), the program uses Microsoft’s Azure FHIR software to enable secure integration into the Medtech 32 and Medtech Evolution patient management systems. Medtech has 80-85 percent of the PMS market in New Zealand (around 870 practices) and most use at least one third party application, such as a patient portal or telehealth platform. The providers of these systems can now join the Medtech marketplace, by agreeing to adhere to a code of conduct, in order to sell their services to GPs.
Read more bit.ly/DHC1-eHN4
Read more bit.ly/DHC1-eHN3
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HEALTH SYSTEM REFORM
The government has announced sweeping reforms of New Zealand’s health and disability system, scrapping all 20 DHBs and replacing them with a “truly national health service”. In announcing the reforms, Minister of Health Andrew Little said New Zealand needs a smarter health system and to deliver on its promise to provide people with better access to services, closer to home, using digital options. A new Crown entity, Health New Zealand, will “be able to plan for things like IT systems that talk to each other”, he said. “With appropriate safeguards in place, you should be able to turn up anywhere in the health system and know that the health professional seeing you has access to relevant health information about you,” said the Minister. Lloyd McCann, a member of the expert review panel that worked on the Health and Disability System Review, described the plan as, “bold and ambitious, but absolutely the right direction of travel”.
He said data and digital will be a key enabler of the reforms and
interoperability and standardisation will drive the necessary information sharing at a regional and national level. Tony Wai, board member of NZHIT, said the industry body welcomes news of the reforms as there is an, “understanding that there needs to be more interoperability and standards of delivery that can be more agile, and services needs to be provided in a more consumer-centric way.” The new structure is expected to be in place around July 2022.
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M I N I S T R Y O F H E A LT H
NATIONAL HEALTH INFORMATION PLATFORM ENABLING INNOVATION
A Ministry of Health team is and the sector, to deliver the national health information platform (nHIP) programme. working in partnership with consumers and their whānau, nHIP is not a new system — it is an ecosystem of data and digital services that enable a whole new way for a person’s health information to be accessible and updated. It is an exciting and ground-breaking change and will transform the way people interact with health services and use their health information. There will be investment in new technology, and in working with the health sector on enabling the technology services people use to interact with and share information. The nHIP programme will support sector uptake and innovation.
participation for people who have not traditionally accessed these services — including Māori, Pacific and people who are categorised as high needs because of age, geography and/or socioeconomic circumstance. The programme identifies and supports new and innovative ways people can access health care through digital means. The digital enablement programme is closely linked to the nHIP programme. The latter will provide data and digital services that enable a whole new way for a person’s health information to be accessible including enabling innovations to work reliably, and consistently across Aotearoa. While they are currently separate pieces of work, they are aligned in their objectives, with digital enablement intended to become a key workstream of nHIP.
leading to improved decision making and releasing time to care. It will include access for providers and consumers to health information such as demographics, enrolled practice, community service card entitlements, prescribed and dispensed medicines, Covid-19 immunisation status, and summary primary care data (GP only) through multiple consumer and provider channels. As part of tranche one, consumers will have the ability to update information held in the NHI , such as their contact details. Tranche one will also deliver technology enablers such as digital identity and interoperability services.
At the same time, work has begun on a digital enablement programme. A key part of this programme is to provide support for innovative digital health services and technology to district health boards (DHBs) and other providers. This includes working with the sector to leverage what is currently working well, and to support ongoing innovation. Further work is underway providing funding and support to the primary and community care sector around digitally-enabled health services that aim to improve access and
First tranche of work being planned
Soundproof telehealth pods for the community are an example of innovation being supported by the digital enablement programme. Telehealth pods are being considered by several DHBs, including Waitematā, which is testing them at North Shore Hospital.
The national Health Information Platform programme business case is being considered by government for potential inclusion in the 2021 Budget, and work is also under way on a business case to release funding specifically for tranche one of the programme. Tranche one will focus on quality and timely information sharing between service providers,
Dr Robyn Whittaker is clinical director for Waitematā DHB’s
Institute for Innovation and Improvement (i3). She says telehealth and especially video appointments work best when both the patient and clinician use a quiet and comfortable space that is well lit and has reliable and easy-to-use technology. “It can be challenging for patients and clinicians to access appropriate spaces, equipment and internet coverage to make or receive a telehealth call. The telehealth pod is a private soundproof space, with telehealth technology installed and ready to go. “They can be installed easily on site and located in community centres such as libraries, marae and churches to improve patient access to telehealth in a comfortable environment closer to home.” The DHB is trialling a telehealth pod in the outpatients clinic at North Shore Hospital. “There are dual screens so clinicians can see patient notes alongside the video call, a good camera, and good sound and lighting. The initial feedback from clinicians and patients has been very positive.” She says the DHB’s aim is to locate the pods in the community for whānau to use, so people don’t have to worry
about having a digital device, data plans, or finding a private space.
innovation. This means providers will be able to learn from existing projects such as the development of telehealth pods, and not have to start from the beginning. More information about nHIP and the digital enablement programme will be available on the Ministry of Health’s website, health.govt.nz/our-work/ digital-health.
“Our project manager Tim Alvis is currently talking with community and iwi organisations in Helensville and Wellsford about where a telehealth pod might work best for them.”
Robyn says, in time, the pods could have multiple uses.
“For example, people could access their patient portals using the computer; we could have blood pressure monitors and scales, so people can have measurements taken at the same time. The possibilities are huge.”
Sharing what has been learnt
Shayne Hunter deputy director-general data and digital Ministry of Health New Zealand
A key part of the digital enablement work is to keep the sector updated on what others are doing and to share
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F E AT U R E
BorderNET PROTECT ING AOTEAROA NEW ZEALAND
IN ITS RESPONSE TO COVID- 19, NEW ZEALAND HAS BECOME A WORLD LEADER IN OPERATING A FULLY DIGITAL, INTEGRATED NATIONAL BORDER SYSTEM. CONNECT EDITOR REBECCA MCBETH REPORTS.
A s the early days of the Ardern announced that from midnight 9 April 2020, everyone entering New Zealand would have to go through 14 days of managed isolation in a dedicated facility. Since then, 32 hotels nationwide have been transformed into Managed Isolation and Quarantine Facilities (MIQF). The system has capacity for 4,500 Covid-19 pandemic were sweeping across the globe, Prime Minister Jacinda returnees to be moving through these new facilities at any one time and more than 130,000 people have completed an isolation stay. Each of these individuals requires regular health checks and testing for Covid-19 before they can be released and a centralised data set is published daily by the Ministry of Health. A border net Getting this system up and running has been a massive task, which comes under the Covid-19 All-of-Government (AoG) Response Group. It requires integrated modern data and digital systems to underpin the end-to-end process and putting these in place has been the focus of the Ministry of Health’s data and digital team. Successful roll-outs of national software solutions in something as complex as a health system are known around the world to be particularly difficult to execute. However, a unifying goal, government funding and a sense of urgency has allowed the Ministry, its
AoG partners such as the Ministry of Business Innovation and Employment, health professionals and software vendors, to work together in a new way and achieve in mere months what previously would have taken many years, if ever achieved at all. The ecosystem is called BorderNET,
(Border System for Notifiable Exposure and Travel Related
Infectious Diseases) which records and links people’s arrival into the country through to their managed isolation stay, Covid-19 testing requests and results and national reporting. Key to this are the National Border Solution (NBS), which is an extension of another newly developed system called the National Contact Tracing Solution; and the Border Clinical Management System (BCMS). There is also a national clinical data repository for all Covid-19 test reports and a national register to record and track border worker testing status. Most recently, the Ministry has rolled out a Covid-19 Immunisation Register to record vaccinations against the virus. A unique identifier As a plane wings its way to New Zealand, the first of these new systems kicks in with the NBS pulling information from the Advanced Passenger Processing (APP) system. The solution is looking to get a reliable match for each of the passenger’s National Health Index number: a unique identifier which holds peoples’ name and address, date of birth, gender and ethnicity. While little known outside health circles, this number has been in use since 1993 and is the envy of many
Dr Lara Hopley specialist anaesthetist
clinical advisor digital innovations Waitematā District Health Board
Michael Dreyer GM national digital services Ministry of Health New Zealand
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or they were calling to find out their result, sending busy staff off looking for the answer. Keeping guests informed automatically saves staff time and resource and greatly reduces guests’ anxiety in what can be a stressful situation, Hopley says. Social license People’s private health information is being held in these new national systems. Tight security and privacy are key to retaining what is called ‘social license’ to collect, store and use this information for the public good. Issues that might be insignificant to some people cause concern for others and can lead to a loss of trust, so the Ministry has worked closely with the Privacy Commission on the design of the new systems. The app used in MIQF initially
Each facility now has its own dashboard giving a quick overview of all the guests and key information such as their current Covid-19 status, whether they are confined to their room and what tasks need to be completed that day. The BCMS also records daily health checks and can send a referral to the team of GPs who are responsible for the guests’ clinical care. These GPs use the system for making notes, allocating tasks to nurses and electronic prescribing. When a guest is due for a test, staff use a new app to digitally link the test order, the guest, and the specimen through barcode scanning. Removing paper from the process significantly reduces the time taken to process tests in the lab and the possibility of labelling errors, which were previously occurring up to 20 percent of the time.
other countries that have struggled to implement a single national identifier in health. The NHI has proved absolutely crucial to linking all the new data and processes together at the border, says GM of national digital services at the Ministry of Health, Michael Dreyer. A match is found for around 80 percent of passengers and if they are new to the country, they can be assigned an NHI before they land. Border staff then know who people are and can complete initial health checks before allowing them into the country. From there, the border solution takes the new cohort of people and maps them into managed isolation hotels. This drives information into the Border Clinical Management System, automatically creating a guest’s testing schedule and set of tasks, letting MIQF staff know when swabs need to be done, when that task has been completed and what the results are. Clinical lead for the BCMS Lara Hopley says, “this means people don’t have to repeat themselves continually. As guests touch down in the country, the system knows who they are and can verify their identity via their NHI.” Managing isolation Dreyer describes setting up 32 hotels as Managed Isolation and Quarantine Facilities as a “complex logistical exercise” and says technology has been critical to enabling a consistent, efficient and effective process nationwide. hinz.org. z/p ge/JOIN
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“PEOPLE DON’T HAVE TO REPEAT THEMSELVES CONTINUALLY. AS GUESTS TOUCH DOWN IN THE COUNTRY, THE SYSTEM KNOWS WHO THEY ARE AND CAN VERIFY THEIR IDENTITY VIA THEIR NHI.” – LARA HOPLEY
The BCMS automatically orders the lab test and once the result is ready it is sent back to the system and into the national clinical data repository, which feeds the government’s daily Covid-19 case updates. The BCMS holds every guest’s mobile phone number and texts them when there is a negative result. If a result is positive, they get a phone call. Test results were previously being handed to guests on slips of paper
had the guest’s image stored on it to allow nursing staff to positively identify people, but some guests were concerned about how these might be passed on or used by other agencies and the use of pictures was dropped. As part of the All of Government response, the Ministry of Health works with other government agencies, DHBs, defence staff and police. Dreyer says bringing together an aggregate workforce means you want to avoid a
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situation where information is passing around on paper, or in emails or excel spreadsheets. “By putting in place a handful of integrated systems with strong security and tightly managed access
to information, we could ensure clinical data was only available to certain people and there’s less risk around leakage or loss of personal information,” he says. “Having an overall national view also allows us to make policy planning decisions and focus resources on areas where they need to be.” Adapting and adjusting National systems mean the Ministry of Health team can more easily adapt and make operational changes as the situation and science on Covid-19 evolves. PREMIUM TO CONT I NUE READ I NG TH I S PAGE JO I N HiNZ TODAY FROM $1 7 PER MONTH WI TH NO M I N I MUM TERM . OR $1 9 8 PER YEAR .
Until the end of last year, testing for Covid-19 in managed isolation was done on day three and 12 of a person’s stay. As new, more easily transmissible variants of the disease began to emerge, the government decided that people from anywhere other than Australia, Antarctica and some Pacific Islands must also have a test within 24 hours of entering a facility. Implementing that change nationally using manual or localised systems would have involved an enormous amount of extra work. However, the automation offered by a single system reduces the large manual overhead required to keep things moving. hinz.org.nz/page/JOIN
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The digital system saves at least ten minutes of administrative time per swab taken in the facility and about three minutes per swab registration in the labs. That time quickly adds up as there are up to 1200 swabs taken in MIQF every day. The labs also need capacity to significantly ramp up testing when there is a community outbreak of Covid-19. “It’s a challenge managing something at scale with a high volume of people and data,” explains Dreyer. “Early on, we could see the strain on the workforce where things were not automated, and we are now seeing the benefits of through-put and removing lag. “These staff have a tough job and it’s been heartwarming to see the sheer appreciation of people for the systems that have gone in and the difference it’s made to their work and the customer experience.” A new way of working The creation of BorderNET has been a huge collaborative effort and the sense of urgency led to a more agile approach to software development, with first versions of systems rapidly developed and used, then improved over time. “The number of hours people have put in to make this happen so quickly is phenomenal, but the real difference has been the nature of the collaboration across the country to co-design, use and iterate,” says Dreyer. “That’s been powerful as the systems end up being designed by the “THE NUMBER OF HOURS PEOPLE HAVE PUT IN TO MAKE THIS HAPPEN SO QUICKLY IS PHENOMENAL, BUT THE REAL DIFFERENCE HAS BEEN THE NATURE OF THE COLLABORATION ACROSS THE COUNTRY TO CO-DESIGN, USE AND ITERATE.” – MICHAEL DREYER
NATIONAL SYSTEMS ROLL-OUT
APR I L 2020 National Contact Tracing Solution goes live MAY 2020 National Clinical Data Repository for all Covid-19 tests goes live
MIQF FACILITIES PER REGION
users themselves, so we know they meet their requirements.” The National Border Solution is built on Salesforce, a cloud-based system which was chosen as the IT platform for the National Bowel Screening Programme in 2019. When Covid-19 arrived on our shores, that platform was repurposed in just seven days in April 2020 to create the National Contact Tracing Solution. Since then it has been through 21 iterations, including its expansion to support the border process. Using a cloud based technology means new systems can be configured and deployed immediately across the country, as long as there is an internet connection, says Dreyer. The agile development method is common in some industries, but the complexity of health and risk-averse nature of the system has meant that, until recently, it has not often been put into practice across the sector. “It’s been a great experience for the team in the Ministry and our vendors to be able to collaborate directly with the sector and end users across the country on something that is constantly evolving,” Dreyer says. “Where it makes sense to have a national system, that should be the operating model of the future.” ©
JULY 2020 National Border Solution goes live
OCTOBER 2020 National register to record and track border worker testing status introduced NOVEMBER 2020 Border Clinical Management System goes live in Auckland
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FEBRUARY 202 1 Covid-19 Immunisation Register used for first vaccinations Inventory management system for Covid-19 vaccines goes live hinz.org.nz/page/JOIN
MAY 202 1 National booking system for Covid-19 vaccinations due to launch
S P O N S O R E D A R T I C L E
THE FUTURE OF HEALTH AND WELLNESS IN POST-COVID NEW ZEALAND. WILL REEDY SHARES HIS VIEW. TRANSFORM OR BE DISRUPTED
T ake a trip with me back to 2018, a world where hopes were pinned on Harry and Meghan as the next power couple of the British Royal dynasty, Sophie Pascoe and Joelle King were decorated with multiple gold medals at the Commonwealth games and the leaders of North and South Korea put aside their differences for a short time to have a cup of tea. Hope seemed to be abundant. In that same year, I wrote an industry view on the potential threat to the health sector in the form of disruption caused by international organisations offering a digital health experience for every New Zealander via a consumer held record. At that stage, I had high hopes that by now we would have taken some collective steps to defend ourselves from this threat and take control of our own destiny. In early 2021, nearly two and a half years since I wrote this and now living in a Covid tinted world, I have been asked, if this level of threat has changed? Just as Harry and Meghan disrupted the plans of the Windsors, there
NZ health sector to meet these needs, the rate of transformation across the sector is still painfully slow. This is the perfect petri dish for someone to offer a solution (not necessarily the best fit for our communities) and push the sector to transform but in a way where we (collectively as health providers and NZ grown businesses that support the sector) have less control.
Digital transformation vs. digital disruption Digital transformation in any
industry is a whole scale change to the foundational components of a business from its operating model (how it delivers services) to its enabling infrastructure (technology, buildings etc). Health organisations that make a strategic commitment to digitally transform, do so in response to a significant number of ‘business’ challenges. For example, threat to sustainability, growing populations, chronic disease burden, ageing workforce, and growing inequity in healthcare within their communities. Essentially, digital transformation
Dr Will Reedy CEO Spark Health
IN EARLY 2021, A YEAR AFTER OUR FIRST LOCKDOWN, WE ARE YET TO MAKE SIGNIFICANT PROGRESS TO EMPOWER NEW ZEALANDERS BY PROVIDING MORE ACCESS AND CONTROL TO THEIR OWN HEALTH INFORMATION OR THROUGH TOOLS SUCH AS CONSUMER HELD RECORDS.
remains a threat to the health sector of offshore disruption which is possibly growing as more technology developers will be seeking to focus on healthcare in response to the first global pandemic in the digital era. New Zealanders, like the rest of the world during the pandemic, have had a taste for what digital tools can enable in terms of empowering them to take more of an active role in their health care. While there remains an opportunity to digitally transform the
requires healthcare organisations to realise that the current operating model and enabling infrastructure aren’t meeting health needs in a sustainable way and that a digital ecosystem is a key enabler of change. As I traverse the sector now, there are only a handful of organisations that have started this journey. On the other hand, digital disruption as defined by Gartner, is an effect that changes the fundamental expectations and behaviours in a
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with a GP were registered to use a patient portal. This was an increase of 24 percent from the year before and prior to Covid-19 arriving on our shores. However, it should be noted that not all of those enrolled are using their patient portal frequently and not all of them have access to their record as this is dependent on the functionality turned on for them by their GP/GP practice. GPNZ Chair, Dr Jeff Lowe recently observed that while having a quarter of eligible patients registered nationally is an improvement, it is still a “pretty poor uptake” given that portals have been available for more than a decade. Consumer held records – the future is still waiting Back in 2018, there were an emerging number of vendors who were starting to provide consumer held records to enable individuals to manage their health and wellness. These vendors provide consumer held records that integrate and share information with provider systems leveraging modern interoperability standards. In other health systems around the world, Covid-19 has accelerated the adoption of modern interoperability standards to provide consumers with access to summaries of their care with providers across multiple care settings. These emerging vendors have also been joined by an explosion of new start-ups looking to provide consumers with better health and wellness experiences. A number of
culture, market, industry, or process that is caused by, or expressed through, digital capabilities, channels, or assets. In the context of health, digital disruption occurs when an organisation (usually a new organisation) looks to provide health and wellness services leveraging digital capabilities but importantly are not constrained by the existing business model or infrastructure.
Covid-19: has it been the catalyst for digital transformation?
Many in the sector believed that Covid-19 was the ‘crisis’ that would accelerate digital transformation, with an increased focus on providing improved digital experiences for New Zealanders to manage their own health and wellness. In early 2021, a year after our first lockdown, we are yet to make significant progress to empower New Zealanders by providing more access and control to their own health information or through tools such as consumer held records. If we take GP patient portals as a proxy for New Zealanders’ appetite to access a record of their care (admittedly a record curated by their GP versus a consumer held record where New Zealanders can create and augment their profile with information from other health providers) it is interesting to note the latest adoption numbers. In September 2020, a quarter of all New Zealanders (1.2 million) enrolled
SUCCESS WILL BE DEPENDENT ON THE LEVEL OF INVOLVEMENT OF A BROAD RANGE OF PATIENTS IN THE DESIGN OF CONSUMER HELD RECORDS, FROM THE OUTSET.
how they will best work together to complete a full health ‘picture’. A recent HIMMS article – A New Patient Journey Imperative: Covid-19 and the Acceleration of Digital Health encourages leaders within the health sector to have honest conversations about how we begin to give the healthcare system the opportunity to do what was intended all along – to make us all healthier. This requires us to: • Stand for equity in care delivery and wellness management for all our communities. • Enhance and democratise the patient journey with reasonable access to cost-effective, common sense, digital health tools and services. • Invest in solutions that optimise care delivery and more deeply connect people within and across our healthcare systems. • Drive evidence-based awareness of health innovations that impact public policy and support equity, patients, caregivers and thoughtful technology. • Encourage consumer and health vendors to facilitate the direct input of consumers and caregivers into the design and development of their tools and services. Embracing digital equity to improve health equity There is a risk that in a rush to enable digital access to health information we could widen the gap for those already impacted by limited access
to healthcare. Collectively, the sector needs to ensure that equity is a focus of our governance and decision making and a key objective of our business strategies. Success will be dependent on the level of involvement of a broad range of patients in the design of consumer held records, from the outset. Including the end users in shaping how information will be accessed, shared and regulated will be the key to empowering patients to improve their wellbeing. Through engaging in meaningful conversation across the sector and with our communities we will begin to deliver solutions that are of value, deliver real health outcomes and go some way to protect ourselves from outside disruption. ©
these are also leveraging platforms provided by global players such as Apple i.e. Apple Health Kit. In support of consumer health records, a number of Electronic Health Record (EHR) and Electronic Medical Records (EMR) vendors are working with Apple to provide standard integrations for consumers to access their information from health providers who use their EHR or EMR. Consumers are also generating personal data using wearables and other devices. Couple that with the rapid growth of other offshore digital health developments from mobile apps to make diagnoses from a photo, apps that can detect fluid behind an eardrum and AI that detects depression by monitoring speech patterns—powered by the roll out of 5G across the country—there will be growing pressure for an anchor point to capture this information and enable the patient to access and share it with their provider of choice. What do we do now? As leaders of health organisations, we need to focus on what we can do and prioritise getting the foundations in place for digital growth. While the health sector review has addressed the need to accelerate digital capabilities, we can’t wait until those actions are ‘rolled out’ to start thinking about the fundamentals of the operating model, infrastructure and strategies required to leverage the capabilities that digital tools offer, (including consumer held records) and
ABOUT THE AUTHOR As Spark Health CEO Dr Will Reedy works in the Business and Consumer Clusters (executive team) to focus on health and life sciences. Health and life sciences is the first true industry vertical capability established in Spark. Will continues to work as a doctor one day a week at Counties Manukau District Health Board.
Hear more from Will Reedy. Listen to eHealthTALK NZ episode 3 – Patient portals and empowerment on Spotify, Buzzsprout, Apple and Google podcasts.
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F E AT U R E
WHAT IMPACT CAN TECHNOLOGY HAVE ON PATIENT FLOW THROUGH AN EMERGENCY DEPARTMENT? REBECCA MCBETH VISITED CHRISTCHURCH TO FIND OUT. GOING WITH THE FLOW
A midst the bustle of nurse Sally Yarwood accepts a call on the handsfree device dangling around her neck. As team leader in charge of ED’s north pod for this shift, she is being asked for bed space for an elderly patient. Using the tablet computer slung across her shoulder, she pulls up a map view of the ED showing every bed in the department, whether it is occupied and whether the patient has been seen. Christchurch Hospital’s new Emergency Department (ED), charge She assigns the new patient a space by pulling his information from the patient management system ‘ED at a Glance’ (EDaaG), lets the caller know, then assigns a nurse to the patient - all with a swipe or push of a button.
how long until a patient is likely to be admitted or discharged. Previously, this information was kept on hospital whiteboards, smattered with magnets and symbols. ED charge nurse manager Anne Esson describes these as being like honey pots, with staff swarming around like bees, trying to see or update information. With 375 people coming through the ED on one recent weekend day, having information at the fingertips and available across the organisation is critical to patient flow and experience. Yarwood explains: “I’m very mobile and can go around looking at different areas, dealing with lots of different problems and know exactly what is happening at a glance.” A quick change of tabs on her tablet computer and the charge nurse can view bed occupancy across
The South Island’s largest hospital building at 62,000 m 2
Opened in November 2020
Part of Christchurch Hospital which has 833 beds
Houses Christchurch hospital’s new emergency department, which is the busiest in Australasia, treating more than 83,000 patients a year
A fresh look Just 500 metres from the old ED, the airy corridors and digital screens adorning the bright white walls signal, we are in Canterbury DHB’s new acute services building, Waipapa. Calls over a general tannoy system are a thing of the past, as staff contact each other individually using voice recognition technology Vocera. “IT’S REALLY TRANSFORMATIONAL BECAUSE A LOT OF HOSPITALS HAVE DATA, BUT NOT A LOT HAVE TRANSLATED THAT INTO OPERATIONAL INFORMATION.” PREMIUM TO CONT I NUE READ I NG TH I S PAGE JO I N HiNZ TODAY FROM $1 7 PER MONTH WI TH NO M I N I MUM TERM . OR $1 9 8 PER YEAR . hinz.org.nz/page/JOIN the whole hospital, allowing her to be more proactive about moving people through. A bird’s eye view This whole-of-hospital system, FloView, was built by Canterbury
DHB’s IT team and helps Nicky Topp, nursing director daily operations, “use data to make decisions”. In front of a bank of computer screens displaying activity across the hospital in real-time, Topp explains that the system holds key information such as every patient’s individual needs, diet and expected discharge date. FloView feeds into the hospital’s kitchens and its most recent update includes information on ‘clinical criteria for discharge’, which allows for nurse-led discharges once a patient meets set criteria.
“Previously I had to walk around to find people or call their phones, now I can allocate and do it on the move and on one device,” Yarwood explains. The Waipapa ED has doubled in physical size and been divided into pods of 20 beds each, making it all the more important that staff are not tied to a central location. As patients present at the department, she can see at the touch of a button who is in the waiting room, where the next bed is coming up and
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PREMIUM TO CONT I NUE READ I NG TH I S PAGE JO I N HiNZ TODAY FROM $1 7 PER MONTH WI TH NO M I N I MUM TERM . OR $1 9 8 PER YEAR .
TOP Waipara and Christchurch Women’s Hospital. MIDDLE LEFT Charge nurse Sally Yarwood checks her tablet computer for available bed spaces. MIDDLE Voice enabled Vocera devices charging and awaiting use for the next shift. BOTTOM Nicky Topp, nursing director daily operations, shows real-time dashboards to Mick O’Donnell, senior communications advisor at Canterbury DHB.
“THIS ALLOWS US TO BE EXTREMELY AGILE AND PULL DIFFERENT LEVERS TO KEEP PATIENT FLOW GOING.”
78 percent of the region’s inter-district flow and previously would struggle to send patients back to their local region. Giving regional providers insight into the status of those patients via FloView has been “slightly magical”, says Topp, as now they “pull their patients back”. Planning ahead With more than 300 patients arriving at ED most days, senior medical officer James Weaver says his job would be “very challenging” without the digital tools he has available. “We save a huge amount of time between Vocera and EDaaG in trying to find and communicate with people,” he explains. There is some automation in the system so when a bed request is sent, it comes out as a message over Vocera on that ward. Christchurch Hospital is also implementing an ‘in transit’ function for EDaaG to create something similar to an airport arrivals board, showing patients coming in by ambulance or being sent from their GP. And they are looking to use the wealth of data being collected to try and predict demand for inpatient beds and assign resources. Technology alone cannot fix patient flow issues as no amount of digital tools can fix a full hospital. “But the tools enable us better visibility of where’s there’s likely to be any problems so we can problem-solve early,” Weaver says. “Trying to measure improvements in flow is always difficult in a complex system like a large acute hospital, but we can’t imagine not having these technologies.” ©
Waiting for doctors or consultants to do their rounds and discharge patients can be time-consuming and unnecessary but solving this is an age- old problem for busy hospitals trying to manage patient beds. “We have tried for years to have nurse-led discharge, but it’s not been very successful,” Topp admits. The benefit of doing it electronically means all the necessary information is available in one place and is especially useful on weekends when staffing is lower. On a mission Topp’s mission is to ensure each patient is, “in the right place to get the right care by the right person”. As the age and acuity of patients
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attending hospital increases, its capacity to “hold on to patients” reduces and getting patients to where they need to be becomes all the more important if it wants to avoid the dreaded ‘gridlock’. PREMIUM TO CONT I NUE READ I NG TH I S PAGE JO I N HiNZ TODAY FROM $1 7 PER MONTH WI TH NO M I N I MUM TERM . OR $1 9 8 PER YEAR .
“There’s nothing simple about patients in hospital these days,” explains Topp, “and before we had no visibility of who was where and what they needed, so we were just guessing. “Now we know who’s coming in, what’s wrong with them and the best place for them to go, all live and minute by minute. “It’s really transformational because hinz.org.nz/page/JOIN a lot of hospitals have data, but not a lot have translated that into operational information”. “This allows us to be extremely agile and pull different levers to keep patient flow going.” As the main tertiary hospital for the South Island, Christchurch deals with
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S P O N S O R E D A R T I C L E
STRONG FOUNDATIONS FOR SMARTER CARE AFTER INTERNATIONAL BORDERS CLOSED, MERCYASCOT FORGED AHEAD WITH A VIRTUAL GO-LIVE OF THEIR NEW EMR WITHOUT THE VENDOR ON SITE. REBECCA MCBETH INTERVIEWED THEIR EMR PROJECT TEAM TO FIND OUT MORE.
A fully integrated Electronic Medical Record (EMR) is a fundamental enabler for Healthcare Holdings to achieve its vision of being a value- based care provider. The concept is a simple one: that providers should aim to deliver the best possible outcome for consumers in a cost-effective manner by moving towards value-based models of care. Sarah Gardner, general manager patient engagement and quality, MercyAscot and TrakCare project director, explains that data and digital solutions are key in order to quantify the delivery of services and measure health outcomes for patients. “To be a value-based provider, we need to have data-rich information from the start of our patients’ journeys through to the end,” she says. “It’s about using data to a drive great outcomes for our patients at every opportunity.”
“Horizon two is being a mature analytics organisation. Once you’ve got your data digitised and ready for action, my view is, the world is your oyster. It is then a matter of using it to get the best outcome in terms of value strategies to drive an improved patient outcome or deliver more cost-effective care,” he says. “Horizon three is the innovation horizon and the EMR is also foundational in being able to automate and utilise things like AI and machine learning, and embedding a culture of change across the organisation.” The art of the possible MercyAscot previously worked with the Northern DHBs on a plan to purchase an Electronic Medical Record for the region, which ultimately did not deliver a product. Gardner says that experience provided excellent insight and education into the “art of the
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Dr Lloyd McCann chief executive Mercy Radiology & Clinics head of digital health Healthcare Holdings
“THE EMR IS ABOUT MAKING REAL TIME DECISIONS WITH REAL TIME INFORMATION AND MAKING IT REALLY ACCESSIBLE WHEREVER YOU ARE IN THE ECOSYSTEM OF HEALTHCARE.”
A story of transformation For Lloyd McCann, chief executive Mercy Radiology & Clinics and head of digital health, Healthcare Holdings, the EMR is the foundation of the organisation’s digital transformation. The investment in the EMR and future initiatives to unlock value from the data it captures are key to continuing to be a leading provider of health care services in New Zealand. By embracing the concept of ‘healthy data’—which is accessible, useable and ready for action—the EMR is enabling MercyAscot to become a data driven organisation, says McCann.
possible” and convinced them of the benefits of a fully integrated and hosted EMR system. During a robust procurement process, InterSystems met the brief of requirements and “ultimately came up with the best price and product”, she says. McCann says the organisation considered going with a hybrid approach, but that brings the added risk and complexity of managing multiple vendors. “Having a simplified foundational layer helps with the innovation that will come downstream.”
Sarah Gardner general manager - patient engagement & quality MercyAscot EMR project director
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