Better Sooner More Convenient Primary Care - New Zealand Doctor

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Appendix Fourteen: IFHCs – Information Technology 1. Aspirational statement: Appropriate information and communication technology is in place that best progresses and supports the new models of care for West Coasters. 2 Project overview One of the key elements of the West Coast Integrated Family Health Centre (IFHC) project is the electronic integration of health services, supporting an integrated model of service delivery across a range of geographically isolated service delivery locations. This plan proposes the development of an integrated health information strategy for all health providers on the West Coast, with the aim of ensuring that the right level of access to clinical information is available at each point of care encountered by patients, and that all appropriate clinical information follows the patient from carer to carer as they travel through a patient centred network of care, all in a way that minimises waste and duplication and whist safeguarding patient privacy. This plan will put the West Coast in a good position to adopt national initiatives as they become available, eg. a core set of personal health information available electronically to <strong>New</strong> <strong>Zealand</strong>ers and their treatment providers, and electronic prescribing. 3 Current situation / Problem definition Within primary/community care All but one of the West Coast‟s General Practices use the same patient management system (PMS) MedTech 32. Those practices that are owned by the West Coast District Health Board use the West Coast DHB PrISM system, which provides a single shared patient administration system but which has been configured in a way that restricts integration because of patient privacy concerns. A number of other services are available over the PrISM system (access to hospital health information systems on Health Views [such as discharge summaries, PACS radiology images, laboratory results], access to the DHB‟s library resources and online clinical databases, secure email, DHB intranet access). Two of the privately owned GP practices also Business case appendices V12 AC 25Feb2010 Page 130
utilize MedTech, but via their own separate installations, whilst the other privately owned practice uses a product called Profile. Most other primary health and community service organisations maintain their own independent systems, with the exception of Rata Te Awhina Trust (a Māori Health NGO), which uses the DHBs PrISM system and MedTech. The majority of non general practice services that are currently owned by the DHB, such as community nursing and allied health, use DHB‟s iSOFT patient information system, but aren‟t using its electronic patient notes capacity. Therefore, while GPs, rural and practice nurses use MedTech for their consultation notes, most other community based nurses and allied health providers who are caring simultaneously for the same patients keep paper based clinical records: this can lead to duplication and lack of coordination and consistency of care, with resulting confusion for patients. In the Buller region a recent change to all these providers using MedTech has proved very successful. Information flows between primary and secondary care Two of the key integration points between primary/community and secondary services are the referral and discharge processes. The objective is to ensure that all relevant information is made available to the receiving provider when there is a transfer of a patient‟s care (either a referral to a provider or a discharge back to the original referrer). Currently while referrals from the general practices are written in their practice management system, they are then printed out and faxed to the hospital rather than electronically transmitted. Discharge letters are sent and received electronically. DHB owned practices can use PrISM to access HealthViews for patient information as described above. Many patients arrive at the Emergency Department (ED) without a referral from their general practice: care would be safer if ED and admitting senior medical officers (SMOs) could access the patient's general practice records, particularly their problem list, regular medication list and allergies. Currently ED clinical notes are hand written and not always easy to read, which may lead to lack of appropriate follow-up by GPs/nurses or even an inpatient ward if the patient is admitted into hospital from their ED visit. Laboratory and radiology All West Coast radiological images and reports are accessible via the central iSOFT system at the DHB. All except one of the current general practices uses the hospital laboratory for lab investigations, and all results are stored in iSOFT. This means that all radiological investigations and most laboratory results are all stored in a central system, accessible by those who can access HealthViews in iSoft. Business case appendices V12 AC 25Feb2010 Page 131
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Business Case Better, Sooner, More
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1 Caveats/status This business case
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Current situation By three years Wa
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staffed on a capacity model - in wh
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support from DHBs, specialist clini
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10.4 Key milestones................
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Annual government health funding pe
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Ambulatory Sensitive Hospitalisatio
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The base populations of the three d
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Māori/Pacific Not Māori/Pacific D
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4.7 West Coast region service deliv
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5 Future model of care 5.1 The desi
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support them. Help with understandi
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LEVERS VISION Better, sooner, more
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providing the majority of care). Th
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The Community Health System Deliver
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To better integrate the support pro
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5.5 Enablers A key aspect of this b
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Two rounds of meetings with front l
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While doctor-nurse substitution has
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Nick Goodwin, Kings Fund 14 , in hi
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Quality domains Each new initiative
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Preventative Acute LTC management R
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Preventative Acute LTC management R
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The core services are provided or p
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Total required FTEs for the Grey IF
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7 Governance, Ownership & Managemen
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Option D: PHO/DHB jointly owned Pri
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The IFHS will need the ability to b
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Of note, a large proportion of the
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The DHB delegates decision making o
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Limited integration of community se
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10.4 Key milestones The table below
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Expanded pharmacy roles Improving a
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Devolved community based services w
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Appendices Appendix One: Health Equ
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ongoing GP shortage creating an env
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10. What are the unintended consequ
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It is common for people with an acu
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Outcome measures Indicator Baseline
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determine ratio of nurses and GPs t
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C. Extended role for pharmacists:
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11 Engagement Working group who dev
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Appendix B: Acutely unwell adult pa
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4 Objectives to implement nur
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Review Buller after hours arrangeme
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Year three Community education camp
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13 Costs Budget considerations:
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established. This group now oversee
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Output measures Tobacco control / s
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Improving immunisation coverage - h
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Year three Continued joint plan
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extending health promotion activiti
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Immunisation Coverage Funder Provid
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The Community Health System Deliver
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Clinical care Practice self managem
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and increases in the numbers of pat
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Ambulatory Sensitive Hospitalisatio
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% CVD on lipid lowering drugs, beta
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Health navigators/ kaiawhina: chan
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Committee‟s objectives 41 of prov
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- lack of consistency of care betwe
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qualifications and skills. Where ca
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6 Deliverables / activities Impleme
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“With an aging population and an
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Differences between revenue generat
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Appendix Seven: Integration - Healt
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It is expected that HealthPathways
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Year two implement the process to
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Low uptake by primary and secondary
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Appendix Eight: Improved access to
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to easily access by telephone). Oth
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Year One - July 2010 to June 2011 T
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LECG 50 evaluated whether “the im
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Page 151 and 152: them by technical errors or lack of
Page 153 and 154: Identify patients that would benefi
Page 155 and 156: • Provision of patient specific m
Page 157 and 158: 12 Organisational accountabilities
Page 159 and 160: emain under the care and management
Page 161 and 162: Service user pathways in an optimal
Page 163 and 164: Model for shared care pathways deve
Page 165 and 166: Implementation plan: to June 30 Dev
Page 167 and 168: Year two Review progress, outcome m
Page 169 and 170: 10 Risk analysis Risk Probability I
Page 171 and 172: Appendix Eleven: Frail older people
Page 173 and 174: ehab and treatment programmes that
Page 175 and 176: Year one: Maintain and continue the
Page 177 and 178: Māori have a higher incidence of m
Page 179 and 180: 11 Organisational accountabilities
Page 181 and 182: There are often vacancies for allie
Page 183 and 184: 6 Deliverables / activities Program
Page 185 and 186: Professional development: Provide
Page 187 and 188: Mainstream arguments are concerned
Page 189 and 190: Appendix Thirteen: IFHCs - Faciliti
Page 191 and 192: A key possibility is that land at t
Page 193 and 194: This option is effectively a Greenf
Page 195 and 196: 7 Westland IFHC Facilities options
Page 197 and 198: Year two Substantive-IFHC in Greymo
Page 199: 12 Costs Capital costs Greymouth IF
Page 203 and 204: 4 Objectives: To implement c
Page 205 and 206: Security An individual‟s health i
Page 207 and 208: 8 Effect on inequalities The increa
Page 209: Appendix Fifteen: Project advisory
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