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EHR Strategy for New Zealand
1. Health Informatics New Zealand
www.hinz.org.nz
Health Information Strategy for New Zealand
Electronic Health Records
Purpose
• Share the thinking on shared health information that has evolved from
HISACs work on further defining HIS-NZ Action Zones
• Stimulate debate and identify key issues
1
2. Health Informatics New Zealand
www.hinz.org.nz
Context
• Built on HIS-NZ and Wave
• Views expressed to us by the sector have been taken into
consideration
• International examples have been considered from a NZ perspective
Key Direction from HIS-NZ
• Information should be available at varying levels of detail according to
the decisions that need to be made, with the richest information locally
• No central / single electronic health record nationwide
• Electronic health records are distributed but can be linked and referenced
• Health event summaries are the starting point for shared information
• Make accessible key event summaries to support safe delivery of care / integrated
care
• Common standards and information anchors that allow disparate
systems to share information
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3. Health Informatics New Zealand
www.hinz.org.nz
The Health Information Hierarchy (HIH)
National
National
Views
Views
Relevant views of
information above.
Po
it y
Appropriate views /
un
pu
District / /Regional
District Regional
subsets of the
mm
lat
Views
Views
information below.
ion
Co
Capture, use,
and share Local Views
Local Views
information
locally at the
point of care.
Individual
Standards
Standards
Indicators
Indicators
Health Outcomes
Health Outcomes
Basic Principles
1. Data collection is integrated into every day work practices.
2. Detailed data is used and maintained locally at the point of care
National
National
Views
(enter once and use many times).Views
Relevant views
it y
of information
P
P
Po
Appropriate views /
un
District / /Regional above.
p
p
pu
District Regional
3. Appropriateofinformation
subsets the views orViews
subsets flow
upwards through groups
mm
l
l
lat
information below. Views
i
i
i
Co
on
that regularly use the information / ensure its accuracy.
Capture,
4. Relevantuse, and of information Local Views given level are available to
views held Views
Local at any
share
the levels below, and to individuals / communities / populations.
information
locally.
Individual
5. Information flows are governedStandards
by agreed principles and processes.
Standards
Indicators
Indicators
Health Outcomes
Health Outcomes
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4. Health Informatics New Zealand
www.hinz.org.nz
A ‘Collections’ Type Example – Chronic Care Information
National CCM Systems
National
National
Views
Views
DHB CCM Systems Relevant views
it y
of information
P
P
Po
Appropriate views /
un
District / /Regional above.
p
p
pu
subsets of the District Regional
mm
l
l
lat
Views
Views
information below.
i
i
i
Co
on
PHO CCM Systems
Capture,
use, and Local Views
Local Views
share The full data set is used
information
PMS Systems locally delivering care
locally.
e.g. Chronic Obstructive Individual
Pulmonary Disease (COPD) Standards
Standards
Standards COPD Data Set and Business
Indicator Set Rules (coding, extraction etc.)
Indicators
Indicators
Indicators
Health Outcomes
Health Outcomes
Health Outcomes
Increase early recognition and Slow the rate of progression
response to individuals with and reduce the incidence of
chronic care avoidable complications.
A Health Event Summary Example – definitions
Appropriate views or extracts
Lo
ng
itu
d
(h inal
ist
or view
y)
NHI# AB1654
Date 7-Sep
s
Name John Blogg
Description words go here which describe what
happened to the final model of
change
NHI# AB1654
NHI# AB1654 Date 7-Sep
Date 7-Sep Name John Blogg
Name John Blogg Description words go here which describe what
Description words go here which describe what happened to the final model of
NHI# AB1654 happened to the final model of change
Date 7-Sep change
Name John Blogg
Description words go here which describe what
happened to the final model of
change
NHI# AB1654
Date 7-Sep
Name John Blogg
Description words go here which describe what
happened to the final model of
change
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Description words go here which describe what
happened to the final model of
Point in time view
change
(e.g. health status
summary)
NHI#
Date
AB1654
7-Sep
NHI#
Date
AB1654
7-Sep
NHI#
Date
AB1654
7-Sep Health
Name John Blogg
Description words go here which describe what
Name John Blogg
Description words go here which describe what
Name John Blogg
Description words go here which describe what
(clinically relevant subsets
Event
happened to the final model of happened to the final model of happened to the final model of
change change change
from an encounter / contact)
Summaries
Electronic
Medical Electronic
Records Health
Record
(detailed) (rich subset)
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5. Health Informatics New Zealand
www.hinz.org.nz
HES Scenario: Stu’s throat
Stu is on holiday and visits a GP complaining of sore and swollen throat
GP inspects Stu’s throat and glands and suspects Stu has tonsillitis
GP checks Stu’s HES records to ascertain whether prior history of tonsillitis. None found
GP takes a swab of Stu’s tonsils and books an appointment to meet again next day
The swab is couriered to community Lab, matched to patient via HES. Test results returned to GP
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Health
Event
Description words go here which describe what Description words go here which describe what Description words go here which describe what Description words go here which describe what
happened to the final model of happened to the final model of happened to the final model of happened to the final model of
change change change change
Summaries
SWAB +
Lab tests Lab results
GP ordered Lab GP
HES Scenario: Stu’s diagnosis and prescription
Stu returns to the GP 1 day after the tonsil swab was sent to lab for testing
GP checks lab results and sees microboligical confirmation that Stu’s tonsillitis is a bacterial infection
As Stu’s records show he is not allergic to penicillin, GP prescribes a treatment course of Amoxicillin
Stu presents a copy of his prescription at a pharmacy
Pharmacist confirms prescription is valid, checks allergies and current medications, and fills the prescription
Lab
results
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Health
Event
Description words go here which describe what Description words go here which describe what Description words go here which describe what Description words go here which describe what
happened to the final model of happened to the final model of happened to the final model of happened to the final model of
change change change change
Summaries
Medications
Prescribed Dispensed
GP Pharmacy Claim
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6. Health Informatics New Zealand
www.hinz.org.nz
HES Scenario – Stu’s Accident
Stu loses control of his mountain bike and has a serious crash
Ambulance paramedic finds Stu unconscious. Identifies him from Drivers License
Paramedic accesses HESs (emergency care view) and notes Stu is a diabetic
After further assessment, paramedic treats for diabetic shock, dresses wounds and take Stu to hospital
Hospital treats Stu including X-Ray, stitches and overnight observation, then discharges him
GP examines a week later and removes stitches
Diabetes!
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Health
Event
Description words go here which describe what Description words go here which describe what Description words go here which describe what Description words go here which describe what Description words go here which describe what
happened to the final model of happened to the final model of happened to the final model of happened to the final model of happened to the final model of
change change change change change
Summaries
Referral/ Discharge
Ambulance Discharge Hospital GP
HESs – Stu’s health system history
Health NHI#
Date
AB1654
7-Sep
NHI#
Date
AB1654
7-Sep
NHI#
Date
AB1654
7-Sep
NHI#
Date
AB1654
7-Sep
NHI#
Date
AB1654
7-Sep
NHI#
Date
AB1654
7-Sep NHI# AB1654
Date 7-Sep
Event
Name John Blogg Name John Blogg Name John Blogg Name John Blogg Name John Blogg Name John Blogg
Description words go here which describe what Description words go here which describe what Description words go here which describe what Description words go here which describe what Description words go here which describe what Name John Blogg
Description words go here which describe what
happened to the final model of happened to the final model of happened to the final model of happened to the final model of happened to the final model of happened to the final model of Description words go here which d
change change change change change change happened to the final m
change
Summaries
Ambulance Hospital GP GP Lab GP Pharmacy
Diagnose Diagnose Treat Diagnose Diagnose Prescribe Dispense
Treat Treat Discharge Treat Discharge Refer Discharge
Refer Refer Refer
Discharge
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7. Health Informatics New Zealand
www.hinz.org.nz
Lo
ng
itu
d
(h ina
ist l v Views
ory iew
) s
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Description words go here which describe what
happened to the final model of
change
(appropriate
NHI#
Date
AB1654
7-Sep
views or
Name John Blogg
Description words go here which describe what
happened to the final model of
change
extracts,
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Description words go here which describe what
Point in time view nationwide
(e.g. health status
happened to the final model of
access)
change
summary)
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Description words go here which describe what
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Description words go here which describe what
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Description words go here which describe what
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Description words go here which describe what
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Description words go here which describe what
NHI#
Date
Name
AB1654
7-Sep
John Blogg
Description words go here which describe what
Health
Pointer to
happened to the final model of happened to the final model of happened to the final model of happened to the final model of happened to the final model of happened to the final model of
change change change change change change
Event
more info
Summaries
(clinically
relevant
View,
Push, Pull
subsets from
an encounter /
contact)
Electronic
Medical Electronic
Records Health
(detailed)
Record
e.g. Home Care e.g. GPs e.g. Hospitals e.g. Specialists (rich
e.g. Labs, subset)
Pharmacies,
Radiology
e.g. Gym,
Coach,
‘My portal’
Possible Stepping Stones to HES – build from the bottom up
1. Identify priority ‘events’ with defined data sets
and supporting business rules.
2. Capture standardised event data sets in local
systems at implementation leads.
3. Provide HES from local systems at
implementation leads to information hubs with
local indexing / use.
4. Increase participants and implement other
event types.
5. Connect information hubs via a federated
architecture (e.g. PAS model, national index).
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