Rebecca McBeth

In New Zealand, fourteen percent of general practicioners with a portal are offering patients online access to their medical notes. Latest figures from the Ministry of Health show that 610 practices out of 970 across the country offer a patient portal. Of those, 86 practices offer Open Notes, up from just 50 in the first quarter of 2017–2018. Ministry of Health chief medical officer Andrew Simpson says the Ministry encourages general practices to give patients access to their clinical notes. “Having access to their health information empowers people to be more involved in their healthcare,” he said. “On a practical level portals can help them understand their health condition better, and remind them of their care plan and their medications.” The Ministry figures show that four PHOs have all practices offering a portal and around 800,000 people are registered with a patient portal across the country. Twenty-one practices now also offer video-conference consults. “Primary health organisations are starting to see that patient portals are enabling practices to remain sustainable by doing more consultations online, leaving face-to-face consultations for those people who really needed them,” said Simpson. Bryan MacLeod is GP owner of a rural practice, the Coromandel Family Health Centre, and has been offering patients online access to their medical notes for about five years. MacLeod believes that by giving patients access to their medical notes, they are more informed about their care and can share this information with family members or other health professionals if they wish. “The more open we are about what we do and share information that belongs to the patient the better,” he said. “I haven’t seen a downside to it.” MacLeod is keen to start offering video consults and is considering having a separate room set up at the practice for this purpose, but believes the greatest value will be in connecting patients from his practice with tertiary care services. Broadcaster Toni Street has used a patient portal for the past three years and finds it hugely helpful in managing her autoimmune disease. She has also a different portal page for each of her three children. “I noticed about six months ago that I could read the [medical] notes and thought that’s really great because it means you have got a lot of accountability on the doctor’s part as well,” she said. This article appeared on eHealthNews.nz.

New Zealand’s Ministry of Health is going to Cabinet this June to get approval to develop a detailed business case for a national Health Information Platform. The Ministry has moved away from the idea of building a single Electronic Health Record, towards developing a national HIP that will enable data about a single patient to be shared, said deputy director data and digital Shayne Hunter. Hunter was a keynote speaker at the Emerging Tech in Health conference in Christchurch on May 21. “We are moving beyond the agenda of ‘we will drive for a single EHR in a physical sense’,” he told attendees. Rather, the Ministry is focusing on joining up data services to provide information about a patient via a national Health Information Platform (nHIP). “This is intended to be not just a technical platform, but a range of other components to enable us to support better information sharing across the sector,” he said. The plan to build a national EHR was expected to take three to five years when first announced by government at the HiNZ 2015 conference. An indicative business case was developed and presented to the Cabinet Committee on State Sector Reform and Expenditure Control in July 2017.  The committee requested further information on the costs and benefits of an EHR and these were expected to go back to Cabinet for approval in December 2017, but the Ministry has since re-focused its efforts on building a business case for a nHIP. Ministry group manager digital strategy and investment Darren Douglass said that interoperability is core to the new platform, which will “have the ability to assemble a virtual electronic record on an ‘as required’ basis from multiple trusted sources, and provide access to data and services”. The nHIP will be a key enabler for real-time clinical decision support, empowering patients to self-manage their health and wellbeing and data driven healthcare, he explained. The Ministry is planning a phased approach to implementation with investment in tranches and avoiding ‘lock in’ to a single technology solution.   Hunter, who took up his new role in March this year, said the Ministry’s vision is that “data, digital services and technology power the health and wellbeing of New Zealanders”. He argued that in order to move from an episodic model of care to a wellbeing model, “we need to get patients really and truly engaged”. This includes the need for social license to use patient data to inform decisions about the system. He said the current way of doing things in health is not sustainable and “we all have to own that problem going forward”. Over the past year, an extra 588 staff were employed in the health system at a cost of $27 million, but what exciting things could be done with a $27 million investment in digital and data? he asked. Hunter said that many of the issues health is struggling with are shared across government departments, such as how to invest in modern technologies under current procurement rules. He also said there is a lack of leadership and those who want to lead and make change within their organisations can find themselves hitting barriers. “I seek to step up to that,” he said. This article first appeared on eHealthNews.nz.

New Zealand’s Ministry of Health will provide access to two core national systems - the National Health Index (NHI) and Health Practitioner Index (HPI) – using FHIR interfaces. Group manager digital strategy and investment Darren Douglass said that by improving access to these core data sets as FHIR resources, the Ministry expects to make it easier for healthcare organisations and vendors to use them within their health applications. The staged release of NHI and HPI production FHIR APIs (Application Programming Interfaces) is planned from mid-2020.     “New Zealand has adopted the HL7 FHIR (Health Level 7, Fast Healthcare Interoperability Resources) standard for exchanging healthcare information electronically as a core component of our interoperability architecture and standards, along with SNOMED CT and other health terminology services,” said Douglass. The NHI is a unique identifier assigned to every person in New Zealand and the HPI identifies health professionals. “These two foundational data sets are already widely used across the NZ health sector so it made sense to provide access to these first,” he said.   HL7NZ chair emeritus David Hay is working with the Ministry on the project and says there are big gains to be had by opening up health data to multiple players. Existing players like GP and hospital system suppliers generally already have access, but the interfaces are not that standardised or widely used, he explained. “My vision is that we have an eco-system where smaller specialist systems can be created that nevertheless utilise these core national systems,” said Hay. “This is a critical first step on the road to allowing that and I’m really delighted the Ministry is making this step and putting funding behind getting this working.” Hay is assisting with the design and community engagement as a large part of FHIR is the community of people who can assist with both the design of the interfaces and implementation of them. Initial work has been on the NHI interface with a draft design due to be completed before a HL7 FHIR and SNOMED CT Implementation Workshop in Auckland on June 19, where it will be tested by the community. Hay said by involving the FHIR community in the process, it ensures changes to the design are made early on in the process rather than needing expensive re-working at a later date. Once the necessary security and privacy protections are in place, Hay hopes to see other data sets exposed in the same way, such as prescribing data. “FHIR is emerging internationally as the next generation of interoperability standards,” he said. “New Zealand has the potential of becoming leaders in some of this space because we are relatively small, we have national systems already in place and we’re willing to give things a try.” Douglass said the changes are part of the wider Digital Health Strategic Framework objective of accessible trusted information. Some read-only APIs are planned for earlier release to add and update functionality and guides for testing and implementation will be released in advance of each production release. This article first appeared on eHealthNews.nz.

Pinnacle Ventures has launched a pharmacogenomics programme to enable genetic testing to drive personalised prescribing decisions. The innovation arm of Pinnacle Midlands Health Network, a not-for-profit primary health care management company in New Zealand, is also working on embedding biomarker information into electronic health records and linking it to a clinical-decision support prescribing tool that can help prescribers by providing direct access to international pathways and guidelines. Pharmacogenetics involves prescriptions being tailored to a person’s genetic make-up, as people metabolise drugs in different ways, which can have a significant impact on a drug’s effectiveness. Ventures plans to do about 5,000 pharmacogenetic tests over the next 12 months, says chief executive John Macaskill-Smith. Some will be self-funded because individuals are struggling with their medications and others will be fully funded by Ventures, targeting specific groups within the Midlands population. Macaskill-Smith says it is a simple test that covers 65–70 per cent of medications frequently prescribed in New Zealand. “The New Zealand health system is under strain but using testing like this you could reduce the trial and error of prescribing and prevent adverse reactions to medications,” he said. Ethnicity plays a big part in how a person metabolises drugs, but the clinical trials that prescribing information are based on very rarely involve Māori or Pasifika test subjects. Macaskill-Smith said Ventures is partnering with key kiwi groups, Auckland University and Otago University medical schools and Callaghan Innovation to support research and develop a better understanding of how unique New Zealand populations respond to different medications. People who have a pharmacogenetic test can choose to consent to contributing their non-identifiable demographic information to researchers. Embedding the biomarker information into EHRs ensures a patient’s results are used for both current and future prescribing decisions, he said. Macaskill-Smith says a lot of direct-to-consumer online genetic-testing tools involve people essentially “giving away their DNA” as there are no protections or consent processes for how the testing company might use it. “You can lose ownership and visibility of where your DNA has gone. We are saying your DNA is yours and you should have control over it, so we are trying to promote safe and informed use of your genetic information by embedding it back into your own EHR,” he said. “Seeing an individual’s health record shift away from being largely about providers recording notes around their activity to actually becoming a blueprint for an individual’s health and wellness information is incredibly exciting. “This is the real health revolution that is about to occur, and including and using your DNA is core to this.” A virtual training package to help primary care providers respond to this genetic information is also being offered. The US Food and Drug Administration requires pharmaceutical companies to publish biomarker information in relation to how people with different genetic make-ups might respond to specific medications. Many health providers in the US use pharmacogenomics as a key tool in treating their patients, and other places, such as Canada and the European Union, are heading in this direction. The New Zealand government does not require this information to be published, but international curators have emerged and can be used to access individual drug information and treatment pathways to inform how doses should be altered according to people’s genetic make-up. This article first appeared on eHealthNews.nz.

New Zealand’s Northland District Health Board (DHB) is trialling an oral telehealth service for children and adolescents with plans to expand it to adult services over time. The DHB is piloting the use of Zoom video conferencing technology and a specialised intraoral camera to allow dentists at Whangarei Hospital to do examinations and consultations on children at remote locations. The first trial involved an oral health therapist operating the camera at Kaitaia District Hospital. The therapist sees the images live so is able to adjust the camera as needed and on instructions from the dentist. Previously, the dentist would have travelled to Kaitaia and seen the patients in person. Oral health therapist Kirstie Culpan said by having teledentists, children can have their consults on time. If needed, they can also be placed on the general anaesthetic waitlist as soon as possible. Northland DHB telehealth and mobility programme Manager Roy Davidson said, “The live clinical quality imaging provided by the specialised intraoral camera is the key technical component that makes these clinics possible.” He said the telehealth setup has at times proved to be a positive distraction in the clinic as children are generally interested in the technology. The service is targeting children and adolescents initially but will expand to adult services in time. A second pilot clinic was held on April 5 linking to Kerikeri, and an assessment will now be undertaken and a decision made on scale and timing of rolling out the service. “At this stage, there appears to be strong potential to link up the oral health locations throughout Northland, including the mobile dental clinics,” Davidson said. “Linking the more rural mobile dental clinics would provide a significant improvement to access of care for those families unable to travel to centres.” He said the telehealth service also provides support and peer contact engagement from dentists to dental and oral health therapists who are working in the community service. “Telehealth enables assessment in real time and discussion with whānau members who are with the patient and is a collaborative tool, enabling knowledge up skilling for the clinical teams involved,” Davidson said. “Telehealth reduces travel for clinicians, reduces travel for families and provides faster access to specialist dental care.” This article first appeared on eHealthNews.nz.

New Zealand’s Northland District Health Board (DHB) is trialling an oral telehealth service for children and adolescents with plans to expand it to adult services over time. The DHB is piloting the use of Zoom video conferencing technology and a specialised intraoral camera to allow dentists at Whangarei Hospital to do examinations and consultations on children at remote locations. The first trial involved an oral health therapist operating the camera at Kaitaia District Hospital. The therapist sees the images live so is able to adjust the camera as needed and on instructions from the dentist. Previously, the dentist would have travelled to Kaitaia and seen the patients in person. Oral health therapist Kirstie Culpan says that by having teledentists, children can have their consults on time. If needed, they can also be placed on the general anaesthetic waitlist as soon as possible. Northland DHB telehealth and mobility programme manager Roy Davidson said, “The live clinical quality imaging provided by the specialised intraoral camera is the key technical component that makes these clinics possible.” He says the telehealth setup has at times proved to be a positive distraction in the clinic as children are generally interested in the technology. The service is targeting children and adolescents initially but will expand to adult services in time. A second pilot clinic was held on April 5 linking to Kerikeri, and an assessment will now be undertaken and a decision made on scale and timing of rolling out the service. “At this stage, there appears to be strong potential to link up the oral health locations throughout Northland, including the mobile dental clinics,” said Davidson. “Linking the more rural mobile dental clinics would provide a significant improvement to access of care for those families unable to travel to centres.” He says the telehealth service also provides support and peer contact engagement from dentists to dental and oral health therapists who are working in the community service. “Telehealth enables assessment in real time and discussion with whānau members who are with the patient and is a collaborative tool, enabling knowledge up skilling for the clinical teams involved,” Davidson said. “Telehealth reduces travel for clinicians, reduces travel for families and provides faster access to specialist dental care.” This article first appeared on eHealthNews.nz.

Telehealth is increasingly being used to connect clinicians within and between New Zealand’s hospitals and to reach into people’s homes, a new survey revealed. The Telehealth Leadership Group’s most recent stocktake questionnaire was sent to all 20 District Health Boards (DHBs) in October 2018. Telehealth Leadership Group programme lead Patricia Kerr says the group is still doing a detailed analysis of results, but initial findings show there has been a general increase in the use of telehealth within DHBs since the last survey in 2014, as well as between DHBs. Also, there are more telehealth services going directly from clinics into people’s homes and a wider range of technologies being used. “There’s not only an increase in the volume of use, but also in the number of clinical services using telehealth,” she said. The number of DHBs with telehealth programme managers has increased and more DHBs are also providing telehealth training to staff. The examples of excellence identified previously – Auckland, Northland, Waikato and Canterbury – have continued to grow and others have emerged. “There are more pockets of excellence, where individuals are taking up use of telehealth because they can see it delivers benefits for their service delivery,” Kerr said. Telehealth is increasingly being used for multidisciplinary meetings with streaming of pathology and radiology images, allowing clinicians who previously could not attend to participate and reducing travel times. New Zealand Telehealth Resource Centre telehealth advisor mobile health Andrew Panckhurst says improved interoperability between providers of video conferencing services has made it easier for people using a variety of different platforms to link up. New entrants to the video conferencing market are often open and interoperable by nature, and better connectivity has also boosted growth. Ministry of Health sector portfolio manager data and digital services Judy Eves says that “virtual meeting rooms”, a concept that was not widely used in the 2014 survey, now enables people to easily join video conferences from a laptop or mobile device. The increased use of telehealth supports the Ministry’s goal of more cost-effective care delivered closer to people’s homes. “There are huge cost and time benefits for both patients and clinicians,” she said. Telehealth also improves access to education and training. “We’re hoping to use the results of the survey to promote communications and share areas of excellence that are happening and further support the uptake of telehealth,” explained Eves. The Telehealth Leadership Group is a clinically led independent group, supported by the Ministry of Health. The group plans to survey GPs and Primary Health Organisations (PHOs) on their use of telehealth later this year. This article first appeared on eHealthNews.nz.

Unsigned prescriptions are now legal when created with an electronic system that is integrated with the New Zealand e-Prescription Service (NZePS). The Director General of Health Ashley Bloomfield has approved a waiver for unsigned prescriptions to be recognised as legal prescriptions when strict criteria are met, including the use of an electronic system that is integrated with NZePS. Ministry of Health Group Manager of Digital Strategy and Investment Darren Douglass said the Ministry is working with partners across the health system on pilot implementations to “ensure that processes fully comply with the legislation and maintain patient safety and confidentiality." “The Ministry recognises the opportunity to move to a paperless system in the future, and the waiver for unsigned prescriptions is one step in that direction,” he said. The ePS allows prescribers to generate a barcoded prescription to give their patients to present at a pharmacy. The barcode is scanned, and all the prescription information is made available electronically. Royal NZ College of General Practitioners Medical Director Richard Medlicott envisions a paperless future where repeat prescriptions ordered via a patient portal app could be sent to people’s phones as a barcode to present to a pharmacy for scanning. However, he acknowledges that uptake of the service by GPs has been slow. Rollout began in 2013, and all community pharmacies have access, of which 75 percent are now scanning barcoded prescriptions but only 150 general practices are using the service. Medlicott said early on there were some sector leaders arguing that because GPs had to pay for ePS, it was not worth it. With a practice population of 12,000 to 13,000 patients, Medlicott pays $120 a month and estimates savings of around $1,500 a month. Not having to do triplicate controlled-drug forms is a particular timesaver. “It’s really easy, it will save you money, it will decrease fraudulent scripts and you can see whether medications are being dispensed or not,” he said. “It’s a no-brainer. There’s this idea that GPs are business-savvy, but they just see the cost and not the benefit.” Pharmacy Guild CEO Andrew Gaudin says the NZePS reduces a pharmacy’s administrative workload and increases efficiencies in the dispensary, allowing pharmacists to spend more time with patients. “As uptake of the service by general practice has been slow, pharmacies are not yet able to fully utilise the benefits the NZePS system could deliver,” he said. “Currently only 14 per cent of general practices are generating electronic prescriptions. It would be great to see this number increase.” Ministry of Health figures show that more than 1.2 million e-prescriptions have been generated by GPs in the past six months. This article first appeared on eHealthnews.nz.  

Unsigned prescriptions are now legal when created with an electronic system that is integrated with the New Zealand e-Prescription Service (NZePS). The Director General of Health Ashley Bloomfield has approved a waiver for unsigned prescriptions to be recognised as legal prescriptions when strict criteria are met, including the use of an electronic system that is integrated with NZePS. Ministry of Health Group Manager of Digital Strategy and Investment Darren Douglass says the Ministry is working with partners across the health system on pilot implementations to “ensure that processes fully comply with the legislation and maintain patient safety and confidentiality." “The Ministry recognises the opportunity to move to a paperless system in the future, and the waiver for unsigned prescriptions is one step in that direction,” he said. The ePS allows prescribers to generate a barcoded prescription to give their patients to present at a pharmacy. The barcode is scanned, and all the prescription information is made available electronically. Royal NZ College of General Practitioners Medical Director Richard Medlicott envisions a paperless future where repeat prescriptions ordered via a patient portal app could be sent to people’s phones as a barcode to present to a pharmacy for scanning. However, he acknowledges that uptake of the service by GPs has been slow. Rollout began in 2013, and all community pharmacies have access, of which 75 percent are now scanning barcoded prescriptions but only 150 general practices are using the service. Medlicott says that early on there were some sector leaders arguing that because GPs had to pay for ePS, it was not worth it. With a practice population of 12,000–13,000 patients, Medlicott pays $120 a month and estimates savings of around $1,500 a month. Not having to do triplicate controlled-drug forms is a particular timesaver. “It’s really easy, it will save you money, it will decrease fraudulent scripts and you can see whether medications are being dispensed or not,” he says. “It’s a no-brainer. There’s this idea that GPs are business-savvy, but they just see the cost and not the benefit.” Pharmacy Guild CEO Andrew Gaudin says the NZePS reduces a pharmacy’s administrative workload and increases efficiencies in the dispensary, allowing pharmacists to spend more time with patients. “As uptake of the service by general practice has been slow, pharmacies are not yet able to fully utilise the benefits the NZePS system could deliver,” he says. “Currently only 14 percent of general practices are generating electronic prescriptions. It would be great to see this number increase.” Ministry of Health figures show that more than 1.2 million e-prescriptions have been generated by GPs in the past six months. This article first appeared on eHealthnews.nz.

A group of Kiwi clinicians with a passion for technology driving changes in healthcare has created a Clinical Informatics Leadership Network. The new network is being supported logistically and financially by Health Informatics New Zealand and held its first meeting during the HiNZ 2018 conference in Wellington. It now has 74 members from a range of health professions such as medicine, nursing, allied health, midwifery and pharmacy. It provides an online forum for members to share expertise and ideas as well as national networking events. Network organiser Karen Blake is the regional manager for health informatics at shared services organisation healthAlliance and has worked as a midwife in both New Zealand and Australia. “There have been lots of failed IT projects in health and there’s enough evidence now to demonstrate that clinical leadership is absolutely fundamental to the success of these projects,” she says. “Our IT solutions need to be clinically led to solve clinical problems, as it’s not about solving more and more IT problems.” Similar networks have been set up in Australia and the UK, where NHS trusts routinely have a chief clinical information officer and there is a national CCIO for Health and Care. Fellow network organiser and clinical director information services and virtual healthcare at Waikato DHB Ruth Large says in New Zealand there are a variety of ways that DHB information services use a clinical reference point, but there is no consistent clinical IT role in DHB leadership models. “There has been a gap in terms of clinical leadership around the development of our digital technologies,” she says. Large says CILN members do not need to have IT qualifications or a role involving informatics, but an interest in using technology to drive change, efficiency and good patient outcomes. Large wants New Zealand to avoid the US experience where the wide implementation of electronic health records has seen many clinicians become disengaged, feeling they are entering patient data into computers to “feed the machine”, rather than for improved patient outcomes. “We need a cohesive and supportive voice for clinical IT, otherwise we are just going to get the technologies we are given,” Large says. This article first appeared on eHealthNews.nz.