Rebecca McBeth

Hutt Valley District Health Board (DHB) is using robots to process the 24,000 e-referrals it receives every year. Hutt Valley DHB is based in Lower Hutt, and covers an area including Upper Hutt, Wainuiomata and Eastbourne, located in the Wellington region of New Zealand. The DHB, along with Wairarapa and Capital and Coast DHBs, has recently embarked on a project to automate the Mental Health Intake Assessment process. Former chief information officer at Hutt Valley Shayne Hunter spoke at the HiNZ 2018 conference in Wellington last November about the e-referrals automation project. He said this was previously an end to end process of manually registering and processing all e-referrals, estimated to require more than 4600 hours annually or the equivalent of 2-2.5 full time clinical administrators. “We embarked on a project to try and make that robotic,” he explained. During a 3-month pilot period, the robotic process automation attempted 681 e-referral registrations had an 83 percent success rate, saving an estimated 71 hours in staff time. For e-referral processing there were 900 attempts and a 75 percent success rate, saving 56 hours. He said there were problems with the data coming in, such as missing data, which means human interpretation is still sometimes needed. “It doesn’t have to be start to finish robotically, it can co-exist with humans in the process,” said Hunter. “We took the person from referrals and they’ve now become a virtual workforce manager to help automate other processes.” A plan to use robots to speed up basic clinical coding, so coders can spend more time on difficult coding scenarios, has been paused due to the high level of complexity. However, the Mental Health Intake Assessment project is moving ahead and the DHBs are hoping to be able to automate 100 percent of the process. Hunter added that the DHB is also looking at embedding AI to interpret the content where there is missing data. This article first appeared on eHealthNews.nz.

Southern District Health Board (DHB) in New Zealand has kicked off its Digital Health Maturity Models project with the Ministry of Health. Southern and Mid Central DHBs were chosen by the Ministry last year to pilot three HIMSS Analytics maturity assessments: the electronic medical record adoption model (EMRAM), outpatient EMRAM (O-EMRAM) and the continuity-of-care maturity model (CCMM). Southern DHB business solutions manager Jack Devereux says the CCMM assessment project started in late February and involves filling out questionnaires based on five care settings: acute, secondary, primary, home support and residential care. For each of these settings there are three stakeholder groups – governance, clinical and information technology. Each of these has 250 questions to answer and around three weeks to respond. The HIMSS website says CCMM focuses on the capabilities needed in order to “seamlessly coordinate patient care across a continuum of care sites and providers”. On March 27, a training workshop with HIMSS, the Ministry, Mid-Central staff and DHB representatives from each region will introduce the assessments nationally. The following training days are an opportunity for the CCMM surveys to be reviewed and discussed with the Southern DHB stakeholder groups. Preliminary findings from all three assessments will be presented back on day four of the workshop. “That’s just a starting point, as the idea around the training is to identify people who can assess progress on an ongoing basis as we look to implement some of the actions identified,” Devereux says. HIMSS EMRAM scores hospitals internationally on their adoption and use of electronic medical records on a scale from 0–7, and O-EMRAM is used to evaluate services provided outside of a hospital or acute care environment. Devereux says the EMRAM and O-EMRAM surveys will be completed predominantly by the information services team, with pharmacy and clinical directors potentially being involved. He says the DHB is focused on implementing electronic health records as part of its digital transformation strategy. “We want to use this opportunity to inform our actions over the next few years as we head towards a new digital hospital being built here,” says Devereux. Mid-Central DHB will be next to assess its digital maturity. Ministry of Health group manager digital strategy and investment Darren Douglass said last year that the success of the pilot programmes will inform whether the assessments are rolled out nationally. This article first appeared on eHealthNews.nz.

The Palmerston North-based Health Hub Project in New Zealand is aiming to reduce health inequities and increase access to care with the help of artificial intelligence, machine learning and blockchain. Project co-founder David Hill is a GP at the Health Hub Project in Palmerston North, which runs four general practices with around 9000 patients. Hill says clinically trained people are a diminishing resource in healthcare and the system cannot rely on that to ensure its sustainability in the future, therefore technology needs to be used to “balance that inequity of supply and demand”. “The whole point of what we are doing is trying to make sure that we use IT in a way that allows or permits greater equity of access to patients and starts to reduce the reliance on the ever-dwindling resource of healthcare workers,” he says. “Also, to advance the value proposition that we give to patients.” The first stage of the Health Hub Project is developing a New Zealand-focused model of risk stratification to identify those patients who are most at risk and in need of services. “We want to look at a much more integrated model of risk stratification, so it’s not just clinical but psychosocial factors like housing and education as well,” explains Hill. He says these factors are drivers of poor health, which impact Māori and Pasifika people disproportionally, and the model could help differentiate other drivers. He is also working with researchers at Massey University to develop a social exclusion measurement for New Zealand, which will be incorporated into the risk stratification. The project’s aim is to create a database of patient information and to use AI and machine learning to develop the risk stratification score and enable researchers to look at the impact of health interventions. Hill says the database will start with the 9000 patients at the Health Hub Project practice. Patients will have access via an app to their own data, and be able to input it, as well as choose how it is shared with researchers. The organisation is working with a small team of New Zealand-based software architects to design, develop and implement into practice a secure application, using blockchain technology. “The nice thing about blockchain is it allows you to identify each block of data and anonymise it,” he says. The data will be housed in a data warehouse and the primary use will be for the direct care of that patient. “So, when a patient phones for an appointment, we know their risk stratification score and that allows us to allocate appropriate resource for the patient when they come in,” he says. The current thinking is that if patients want an expanded analysis that includes comparing their diagnosis with larger populations, they would have to opt in to sharing their information anonymously for research purposes. Hill says they are talking to a number of potential investors locally and internationally about the data analysis tool and app to progress the development of the software. This article first appeared on eHealthNews.nz.

A patient-flow system implemented at MidCentral District Health Board (DHB) in New Zealand is helping to streamline patient journeys through Palmerston North Hospital and allowing clinical staff to view important patient information at the bedside. The MIYA patient flow system, from Alcidion, is live in 17 wards and the emergency department at Palmerston North Hospital and one ward at the Horowhenua Health Centre. Alcidion is an Australian-based provider of Clinical Decision Support Systems, including Patient Flow Software, EDIS, Mobile EMR and Outpatient Solutions. MIYA gives real-time updates of bed management and patient flow throughout the hospital and health centre, showing a patient’s progress from the time they arrive to the time they are discharged, as well as an overview of hospital occupancy. Charge nurse Sarah Donnelly says, “The mobile technology is a godsend on ward rounds and has helped improved patient flow in and out of the ward, making discharges more evident and timely. I love it and wouldn’t be without it now”. The system was tested on two wards for three weeks in early November 2018 before being rolled out to all clinical areas later that month. Acute care and hospital operations service manager Carrie Naylor-Williams says the next phase of the implementation involves looking at how to use the data being collected by the system on a day-to-day basis. The hospital also plans to go live with MIYA in theatres before the end of this year. The data can be used to predict future demand, so staff know what to expect on different days and can plan accordingly. It’s also used to forecast operations for surgical patients. “We can see the cohort of patients currently admitted and what their predicted length of stay is and therefore what surgeries we can do. It will give us greater understanding to be able to manage the capacity of the hospital,” says Naylor-Williams. Bed management and capacity planning was previously done on paper and whiteboards and experienced staff getting a “general feel” for how things were looking, she explained. “We want to put be able to put a science to it and not be dependent on someone with experience being able to do it, but anybody can look at the board and see what the day’s like,” says Naylor-Williams. MIYA pulls data from the hospital’s clinical portal, so clinicians can securely view a current patient’s history, including admissions, demographics and results, on mobile devices at the bedside. The software platform has successfully integrated with five clinical information systems at Midcentral DHB, including WebPas, CareStream Radiology, Clinical portal and Pathology to provide clinical staff with detailed patient information displayed on the ward’s journey board. Naylor Williams says this means doctors can discuss results with patients face to face and make immediate decisions while on their ward rounds. They can also quickly view immediate bed availability in suitable wards. A version of this article first appeared on eHealthNews.nz.

An antibiotic prescribing app developed at Capital and Coast District Health Board (DHB) has improved doctors’ adherence to prescribing guidelines. Developed by the DHB’s Infection Services with computer science students from the Victoria University of Wellington, the Empiric app gives prescribers easy mobile access to antibiotic guidelines and assists with clinical decision making. Empiric prescribing is when a doctor chooses an antibiotic before knowing exactly what micro-organisms are involved, so they prescribe according to the symptoms. Between 35–50 per cent of hospital inpatients are on antibiotics at any one time. Most large DHBs will have their own empiric antibiotic prescribing guidelines, which are often used by the smaller local DHBs. Previously these guidelines were either in a booklet or on a website, which meant doctors had to either carry a paper copy or find a computer terminal to look them up. Infection Services clinical leader Dr Michelle Balm says that while adherence to the guidelines was good, there was room for improvement. “We wanted to make it a lot easier for prescribers to make good clinical decisions about antibiotics use as close to bedside as possible,” Balm said. Empiric is automatically downloaded on to all the DHB smartphones that are given to junior doctors in place of the traditional pager. Figures show all junior doctors are using it weekly and most on a daily basis, and adherence to the guidelines has increased since the app was introduced. Doctors report that it increases confidence around prescribing. The app is also free to download on the Apple and Android app stores and has been downloaded 700 times outside the DHB. Balm says that while there are regional differences, the prescribing guidelines are broadly applicable across New Zealand, and that the DHB made Empiric freely available for anyone to use, “in the interest of transparency and to try and get a national discussion going on this topic”. Empiric takes prescribers through a set of questions to produce a personalised – rather than generic – prescription recommendation. Features include options for when a patient has an allergy and where there is a risk of multi-drug resistant organism. This article first appeared on eHealthNews.nz.

An implementation plan for a nationally consistent Electronic Oral Health Record (EOHR) will be presented to the country’s 20 district health board (DHB) chief executives by the middle of this year. Professional services organisation TAS is leading the implementation on behalf of the DHBs after recently signing a contract with the Ministry of Health. Chair of the EOHR programme board Robin Whyman is clinical director oral health at Hawkes Bay DHB. He says the programme started around 2015–16 because staff operating oral health services recognised that, while nearly all DHBs are using the same clinical system, differences in local implementations mean they are unable to get nationally consistent information out of it. “When trying to get information for a national picture of what’s going on in oral health and around service quality improvements, we were struggling to compare things and be confident we were interpreting things in the same way,” he added. All but two small DHBs are using Titanium Solutions and the remaining are paper based. A number of Māori health providers contracted to the DHBs are also using the software. The Titanium system contains critical information about the status of patients and treatments provided to nearly all children up to the age of 12 and some adults. However, each DHB has made its own decisions with the vendor, resulting in boards being on different versions of the software and two slightly different code sets for treatments being used. A Request for Proposal for a national EOHR system was released in November 2016, but the EOHR Programme Board recommended not to award a contract. Instead the programme team is working with Titanium to make improvements and move towards a nationally consistent system. “One of the early pieces of work is to work with the sector to allow a nationally agreed code set for the system,” Whyman says. “By having a consistent coding set and interpretation we believe we will start to have conversations about quality improvement, looking at outcomes of treatment and oral health status and how that’s linked to interventions put in place.” He hopes to have a national coding set in place and in use by mid-2019. Whyman says the board is also looking to develop regional groupings of DHBs using the same instance of the software. These will evolve over the next couple of years. “Part of the work of TAS is to work with the sector on the best way to do that,” he says. An implementation plan that’s “achievable within the resources of the DHBs” will be presented to the 20 DHB chief executives by the middle of this year for approval, he says. A TAS statement says a nationally consistent EOHR is expected to help improve New Zealanders’ oral health through improved capture and quality of oral health information. It says the programme of work underway will see DHBs implementing consistent business, system and information management processes. It will also enable DHBs to benefit from national economies of scale and achieve efficiency benefits. This article first appeared on eHealthNews.nz.

New Zealand’s largest primary health organisation (PHO), ProCare, has selected Indici after a year-long practice management system (PMS) review. ProCare chief executive Steve Boomer says, “The ProCare PMS review steering group and ProCare Board have reached agreement that Indici is the system best suited to our needs. “However, we cannot recommend this as a preferred system until we have reached a suitable commercial agreement with Valentia Technologies, Indici’s parent company.” Indici was developed by Valentia in conjunction with Ventures, the commercial and innovation arm of Pinnacle Primary Health Network. The cloud-based mobile PMS supports the Health Care Home model of general practice, which is being adopted by PHOs across the country, and involves improving access to care by offering telehealth options for patients. Seven vendors started in the review process and were narrowed down to Indici and US-based Epic in mid-2018. Tū Ora Compass Health, Te Awakairangi Health Network and Central PHO have also committed to rolling out Indici. Valentia president technical services Ahmed Javad says the review was an extremely thorough and well-managed evaluation process. "We are looking forward to completing contractual arrangements and then embarking upon an exciting transformation journey with ProCare member practices," he says. Boomer says the PHO’s members were updated on progress at the end of last year, and are “encouraged to get in touch with us to discuss any specific needs they may have with their PMS”. “We thank the steering group, made up of GPs, practice nurses and managers from our network, for their dedication to the 12-month review process,” he says. “There were many different perspectives provided by steering group members based on their own PMS experiences, all of which contributed to robust discussion and debate before reaching consensus.” Practices in the region predominantly use Medtech or MyPractice systems currently. An industry expert, who asked not to be named, says the decision is a major accomplishment for Indici. He predicted a steady flow of GPs changing systems.  “Practically the change burden around a practice migrating from one PMS to another is a non-trivial undertaking,” he says. This article first appeared on eHealthNews.nz.

Northland District Health Board (DHB), which is based in Whangarei and covering the northernmost part of the North Island in New Zealand, has launched a web-based interactive version of the Health Needs Assessment (HNA). DHBs must produce an HNA report every 5–7 years as a way of monitoring the health and wellbeing of the population, as well as their need for health services. The reports are typically published as lengthy paper-based or PDF documents. Former Northland DHB clinician Juliet Rumball-Smith was instrumental in driving the development of an online HNA, which is intended to make the data easier to access and understand by anyone. Research associate Edith Bennett and data scientist Shameer Sathar at Northland DHB’s Health Intelligence Hub built the tool in-house using open-source software such as Python and Django. “There’s a lot of data already published, but it’s quite hard to access or understand, so we thought why not create an application where people can access information themselves and with interpretation already there,” Bennett says. “We can also update it as data becomes available, such as the Census 2018 data which will be published soon.” A survey completed with stakeholders before the new tool was published found that 86 per cent of respondents said the web-based format improved their ability to access the data. Sathar says future plans include making the tool more mobile compatible. “We’re also hoping to use it beyond the HNA by having forecasting and projections data available,” says Bennett. “Our real aim is to get a one-stop-shop for people to go to look for population health data specific to Northland.”   A version of this article first appeared on eHealthnews.nz.  

A national group is being formed to start work on linking the country’s four regional clinical portals, with approval from the district health boards’ (DHBs) chief information officers. The group is being led by Stella Ward, chief digital officer at Canterbury DHB. If successful, the project would allow any clinician involved in a patient’s care to view that person’s computerised health data from anywhere across New Zealand. Waitemata DHB clinical adviser digital innovations Lara Hopley is a key driver of the project and says clinicians are very keen to be able to see patients’ data from other regions as they often move around the country. An information paper, Connecting the Regional Clinical Portal to improve patient safety and quality of care, went to the National DHB IS Leadership Forum in November and was noted. The idea was also raised at a recent meeting of clinical IT leads from around the country, who were supportive. The paper says, “safety and clinical care would be improved if the clinician was aware of the other records, and could seamlessly view, from within their local Clinical Portal, all the available nationally stored computer information about their patient”. New Zealand’s 20 DHBs are grouped into four regions that each have a shared view of their region’s patient information via Clinical Portal 8 from Orion Health. Of the 20 DHBs, three are not yet using their regional shared portal, but all have imminent plans to move on to one. The southern region has all five South Island DHBs using Health Connect South and the Midlands region has five DHBs using the e-space Midland Clinical Portal. The central North Island has five DHBs already using the Regional Health Informatics Programme portal and Capital and Coast DHB has plans to join. Two Northern DHBs are using the Northern Regional Shared Clinical Portal and Auckland and Northland are due to join in 2020. Hopley says the details of exactly what data will be shared and how to technically achieve the sharing still need to be worked out but she would like it to start as a read-only “portal into other portals”, meaning they would have a tab to access one of the other three portals and land on their dynamic patient summary screen. “Access to the latest documents is likely to give 80–90 per cent of the information you need while assessing a patient,” she added. “It’s a rich data set and we don’t want information overload, but we are skilled clinicians at filtering out the signal from the noise.” Ultimately, the aim would be to have more integrated sharing of all the data with documents and results from other areas, and the end clinicians not needing to tab into a different portal, she says. Issues around auditing also need to be agreed, but Hopley says DHBs already have robust internal auditing processes in place and could extend these to monitor staff looking at other portals. She suggests starting with a proof of concept to prove the value, allowing paediatricians in the Midlands area to access the Northern Regional portal, as a lot of children go up to Starship Hospital for treatment. “As we are already supplying them with access via CareConnect’s TestSafe portal, we are not really changing what they can see, we are just making it easier,” explains Hopley. “This would prove the value and allow a blueprint for how we can do this as a minimum viable product, allowing each region to then understand the cost and prioritise accordingly.” Auckland DHB chief digital officer Shayne Tong says, “in Auckland metro a big number of our population come from outside the region so linking up the portals nationally would be beneficial”. ADHB recently approved a business case to move on to the Northern Regional Clinical Portal. The project is underway and ADHB has an estimated go-live date of February 2020, followed closely by Northland DHB. “Our doctors and clinicians move around DHBs so to have that one-stop-shop for the region is pretty incredible and being able to link nationally too is a real benefit,” says Tong.   This article first appeared on eHealthNews.nz. 

17 of New Zealand’s district health boards (DHBs) are hosting some of their clinical and non-clinical data offsite using cloud services. The author asked all 20 DHBs what cloud services they are currently leveraging, their future plans and the barriers they see to cloud adoption. All but three (South Canterbury, Lakes and Tairāwhiti DHBs) are using or piloting cloud services already and all are considering or have definite plans to expand their use of cloud. Cloud services are supporting key hospital applications across the country, including patient administration systems, clinical portals, laboratory, picture archiving and communication, radiology, pharmacy, eReferrals and ICU systems. Some primary and community data is being hosted in the cloud via solutions such as the Indici patient management system and the Manage My Health patient portal. DHBs are also using cloud-based collaboration and communication tools, such as BoardBooks, Zoom Health (video conferencing) and Skype, eText and SafeNet, as well as hosting their corporate websites and intranet in the cloud. Webinar: Leveraging Cloud to Revolutionize Health IT and Transform Your EMR System Many boards see moving to the cloud as a key enabler for achieving their information strategy goals and expect a significant uptake over the next three years as they migrate clinical and non-clinical data from onsite infrastructure to Infrastructure as a Service. Some report that increasing mobility is driving uptake of cloud services, especially Software as a Service and Platform as a Service. All DHBs are at least exploring possibilities or have firm initiatives in place, such as Lakes DHB, which is moving to a “national infrastructure provider for computer services”. A response from healthAlliance, the shared-services agency for Waitemata, Auckland, Counties Manukau and Northland DHBs, says cloud services are a key part of the Northern Region’s combined technology strategy and that they are in the preliminary stages of adopting government-approved cloud-based solutions. “There is a desire within the region to harness the many benefits that cloud-based technologies can offer, balanced of course with a risk-based approach to security and privacy,” it says. MidCentral DHB has a new district-wide Digital Strategy and a key principle of this is to adopt cloud services first, where possible, for any new or existing initiatives for clinical and non-clinical services. Hawkes Bay DHB is developing a cloud infrastructure roadmap to increase the utilisation of private, regional and public cloud services, and South Canterbury DHB plans to use Microsoft Azure to host its Patientrack and electronic patient observation application. Other DHBs, such as Southern and South Canterbury, are also looking at leveraging the public cloud through use of Office 365 and other Microsoft services. Waikato DHB has around 22 cloud solutions, of which 11 are clinical. It “views cloud-based solutions as having the potential of providing considerable value through innovation, flexibility, speed to market and economic differentiators”. However, Waikato DHB’s executive director corporate services Maureen Chrystall says the cloud “is not a one-size fits all solution” and that “a bimodal strategy and decision process is required to ensure risks and impacts are managed and value is delivered”. The main barriers to cloud adoption cited by DHBs include data security, cost, legislation, legacy systems and resource capability.   A version of this article first appeared on eHealthNews.nz.