Graeme Osborne Director, National Health IT Board Peter Gow Chair, National Information Clinical Leadership Group Ernie Newman Chair, NHITB Consumer Panel Barry Vryenhoek Chief Executive, healthAlliance New Zealand Ltd (Thursday, 9.45, Keynote)

1. Enabling Person-Centred, Integrated Care
HINZ Conference, Auckland
Thursday, 24 November 2011
Graeme Osborne
Director, National Health IT Board

2. Enabling an Integrated Healthcare Model
eHealth Vision
To achieve high quality health care and improve patient safety, by 2014 New Zealanders
will have a core set of personal health information available electronically to them and
their treatment providers regardless of the setting as they access health services.

3. National Health IT Board
Priority Programmes for 2011/12
eMedicines Programme Regional Information Platform (DHBs)
1. Community E-prescribing 1. Clinical Data Repositories/ Clinical
Workstation
2. Inpatient e-prescribing
2. Patient Administration Systems
3. Medicines reconciliation, medication
3. Imaging/PACS
management and administration
4. Clinical support – Labs/Pharms
4. Universal List of Medicines
5. Continuum of care:
5. NZ Medicines Formulary • eReferrals and eDischarges
National Solutions Integrated Care Initiatives
1. Oncology 1. Shared Care
• Long Term Conditions
2. Cardiac Health • Maternity
3. InterRAI for Aged Care • Emergency View (Canterbury)
4. Health Identity 2. Primary Care
• BSMC Initiatives
5. Connected Health • Patients First Initiatives (eg. GP to GP)
*Supported by ICT Infrastructure / Back Office - Finance & Supply-Chain, Data Centres.

4. Roses and Brickbats
1. South Island Concerto/Imaging solution
– Regional implementation, Vendor engagement, Delivery
2. Shared Care – Long Term Conditions
– Clinical leadership, focus on patient experience, working with clinicians on process
change, real-time evaluation (NIHI)
3. Northern Region - Health Alliance
– The effort to make shared services work in practice, professionalism, delivering for all
members of the region
4. Central Region Information Systems Plan
– Regional IT plan, Utilising the best within the region, Board and CEO commitment to
a 4 year joint capital expenditure programme
National Clinical Leadership Group, Health IT Cluster, National Institute for Health Innovation

5. Roses and Brickbats
1. Reliance on individuals (many on contract)
2. Vendors (and others) who forget that clinician and patient
experience is about clinical quality and process integrity
3. Our inability to learn from other industries eg. core competence
4. People who use complexity as a reason to not look outside their
part of the sector

6. Already in operation
NZ Population Under development
Planned for the future
4,412,636 as at Monday, 12 Sep 2011 at 01:28:35 pm
Core Health Information - Health Identity, demographics, allergies and alerts, register of health information
Long Term Conditions - Shared Care Record
Comprehensive Clinical Assessment (InterRAI)
Maternity - Shared Record of Care
Well Child - Shared Record of Care
Mental Health - Shared Record of Care
Common Clinical Results (Laboratory results, Medications, Referrals, Discharges and other clinical documents)
TeleHealth - In-home monitoring
Four Regional IT Platforms
Continuum of Care
National minimum
Nat. immunisation
Maternity, Pharms
warehouses etc.
B4 Schools
Clinical Information Clinical Information
Cancer
register
register
dataset
dataset
Patient Portal Imaging/Picture Archive
Patient Administration Clinical Systems Support
and billing
Patient Administration
Connected Health
Primary/Integrated Specialist/Tertiary/ Public Health
Home Settings
Family Health Centres Secondary Hospital

7. Priorities towards 2014
1. Medication Safety Programme (jointly with National Health Board
and the Health Quality and Safety Commission):
– Wide adoption of e-medications management solutions across the sector
(hospital and community)
2. Engaging Consumers:
– Compelling consumer engagement model to attract take-up of on-line access to
personal health information via health portals
3. Develop IT Leaders and Teams:
– Set expectations and monitor IT professional capability
4. Funding of health IT innovation and national solutions
And, four words:
Standardisation, Integration and Operating Model

8. Priorities towards 2014
1. Medication Safety Programme (jointly with National Health Board
and the Health Quality and Safety Commission):
– Wide adoption of e-medications management solutions across the sector
(hospital and community)
2. Engaging Consumers:
– Compelling consumer engagement model to attract take-up of on-line access to
personal health information via health portals
3. Develop IT Leaders and Teams:
– Set expectations and monitor IT professional capability
4. Funding of health IT innovation and national solutions
And, four words:
Standardisation, Integration and Operating Model

9. National Health IT Plan
Enabling
Clinical
Person-Centred
Data
Integrated Care
Repository
Connected
Identity
Health

10. eHealth Strategy
Supporting Integrated Care
NICLG and NHITB
A productive partnership
promoting a positive plan
Peter J Gow
Associate Professor of Medicine
Chair, NICLG

12. The original plan

17. Purpose of NICLG
 To champion the development and implementation of the National
Health IT Plan.
 To provide input into the design of National Health IT Board
sponsored programmes/projects with a view to ensuring
appropriate
 planning principles
 design solutions
 clinical representation
 involvement in pilot projects, including their evaluation
 advice in implementation and roll out of projects.
 To ensure usability and uptake of programme/projects by
promoting engagement with clinicians through professional
contacts and networking structures, for feedback to the NHITB and
to project staff.
 To take a lead role in influencing health professionals and other
stakeholders to develop evidence based improvements in health
care processes across the continuum of the health sector.
 To act as an advisory group to the Health Information Standards
Organisation (HISO).

18. NATIONAL INFORMATION CLINICAL
LEADERSHIP GROUP AGENDA
1/11/11
Peter Gow * Ros Gellatly
Jim Vause * Denise Watene
Norma Campbell * David Kerr *
Peter Freeman Karolyn Kerr
Christine Roke Graeme Osborne
Vicky Noble * Sadhana Maraj
Objectives for the day Di Davis Kathy Farndon
Janet Gibson Amanda Ashcroft
Wendy Bremner Ernie Newman
Provide an update to relevant projects across the Shaun Costello Wendy Bremner
sector for clinicians to; Aaron Jackson * Culver Arran
Shaun Costello David Jones
1. Add input into the design of processes and IT
Sandra Hicks Shelly Frost
solutions to ensure strong linkages to clinical Andrew Bowers Jim Kriechbaum
processes and models of care. Tim Gardener Oliver Menzies
2. Champion the flow of information on new Allan Panting Inga Hunter *
Martin Wilson * Kim Bannister
processes and IT solutions to ensure clinicians Stella Ward * Richard Feltham
understand, support, implement and ultimately Bev Nicolls Elizabeth Plant
use them. Brenda Hynes Andrew Munro
Alan Merry

19. NICLG Agenda-Presentations
 E-Plunket, from Plunket
 The Health Identity Project, from the NHITB
 National Transfer of Care eDischarge Project, from
Patients First
 Assessment of Risk Tool (ART), from the NHITB
 National Implementation of Surgical Prioritisation
(responding to the report of the Office of the
Auditor General), from the National Health Board
 Towards a national clinician-led Acute Coronary
Syndrome (ACS) and secondary prevention
quality improvement system, from the National
Cardiac Network
 Report on the NHITB 2011/12 priorities and future
plans, from the NHITB.

20. NICLG Agenda-Breakout session
 e medications (Aaron Jackson)
 Partnership with HQSC
 A programme approach across four DHBs
 My “List of Medicines” paper tabled
 e referrals (David Kerr)
 National alignment with regional understanding
 Involve HISO to detail the definitions
 Shared care (Stella Ward/Matt Hector- Taylor)
 Brings together multiple service streams to meet needs
of people
 Helps providers to communicate, and work as a team
 e Discharge Summary(Peter Gow/Janet Gibson)
 Template headings decided (Advice to patient
paramount)
 Discussion on business rules around responsibility for
patients after discharge
 Incorporation of “request for clarification “

21. NICLG-learning points
 Involve team in problem identification
before seeking solutions
 Avoid polishing the solution before
engaging the sector
 Communication is not just about talking
and listening but requires understanding
and cooperation
 Actions speak louder than words
 Look on the NHIT Plan as a Quality
Improvement Programme
 Remember the five Ts (Don Berwick)

22. NHITB and NICLG-ensuring
excellence in e health everywhere
Where is your health system going?
Transformed
organisation with
high levels of
quality and safety-
Ambition to Improve Quality
-everywhere
Islands of excellence New islands
within sea of ordinary appear, others go,
quality and safety but no overall
real change
Ordinary
Quality

23. Champions at rugby (and Health IT
implementation-a team effort)

24. Supporting Integrated Care
Consumer Issues
1. Security and confidence are
crucial, but absolutely achievable

25. Consumer Issues
2. Health consumers – the public –
need to be led through knowledge.
From unawareness, through
understanding and acceptance, to
active encouragement and support

26. Consumer Issues
3. Change management issues,
including incentives, need to be
addressed early
Clinicians need to be supported
through the change.

27. Consumer Issues
4. Work needs to start soon on the
Patient Portal
The most visible sign to the public
that change is under way.

28. Consumer Issues
Progress to date has been
impressive…………..

29. Clinician
cats, computer
cats, and
consumer cats.

30. healthAlliance - Our Region
Some facts about healthAlliance:
• 500+ employees in 8 locations
• Serving a population base of 36.1% of New
Zealanders
• Our services support 26,500 DHB staff, 15,000
computers, 10 hospital sites, 94 community sites
and 266 dental sites
• 81,500 assets worth over $1.1B (NBV $60
million)

31. What we do:
Providing some Financial Services to Taranaki DHB

32. hA exists to provide:
• Efficient & effective delivery of transactional
activities
• Lower costs
• Improved quality & sustainability of service
• Elimination of inefficiencies
• Integrated & seamless processes
• Centres of excellence, expertise & staff
development
• Regional alignment & standardisation of activities
within customer DHBs
Resulting in the release of funding for front-line
services

33. Today
• Some regional systems but still high level of duplication
• 3 Teams – change process underway
• 3 networks – 8 local Data centres
• 3 Infrastructure strategies aligned to some degree
• 3 IT Service Management Systems
• Varied/fragmented management operating system
• (KPI, Risk, Finances, Project office, etc.)
• High level of duplication in core systems
• Patient Admin: 4 instances; 3 systems
• Clinical Workstation: 4 instances
• Finance: 2 instances; 2 systems etc

34. Regionally mandated 1 process, 1
system
 Clinical Leadership
 Freeing Clinicians for Quality
Engagement
 Getting Clinicians to
Agree & Align Regionally
To deliver outstanding shared services that enable healthcare
excellence for the Northern Region’s population.

35. Vendor Engagement
 Vendor Capability
 Software Quality & Release Lifecycles
 Procurement Processes
 Procurement Lead Times
 Contracting Complexity
To deliver outstanding shared services that enable healthcare
excellence for the Northern Region’s population.

36. Benefits: Total DHB IS Cost

37. Performance to date
To deliver outstanding shared services that enable healthcare
excellence for the Northern Region’s population.

38. Regional Actions
 Deliver National Health IT Plan and Health
Benefits Ltd Business Case through Northern
Region IS IP
 Regional Governance
 Regional Capital Plans
 Regional Processes
 Regional Common Systems
 One Network; Clinical Workstation;
Patient Administration System; ERP
 Regional IS Capability &
 Capacity Building
To deliver outstanding shared services that enable healthcare
excellence for the Northern Region’s population.