Better Sooner More Convenient Primary Care - New Zealand Doctor

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Community pharmacy Community pharmacies face problems at times when dispensing prescriptions for newly discharged patients, as they try to reconcile the information on the prescription with previous medications dispensed, and without the benefit of a discharge summary providing information on what changes to regular medication have been made and why. Given the importance of a strong retail trade for the viability of pharmacy businesses, it may be that there is no pharmacy within some IFHCs. Developing the ability to send electronic prescriptions from primary care, with the ability to home deliver to frail elderly and those with transport issues, would provide more convenient care. Communications Technologies With its vast distances, small population and geographic isolation, the West Coast is ideally placed to benefit from investment in improved telecommunications technologies. The availability of telecommunications network capability (bandwidth) along the West Coast has historically limited the ability to benefit from some technologies, however this has recently been overcome with the availability of a direct fibre optic link between Hokitika, Greymouth and Westport and potentially Reefton in the future (one of the first business to business uses of this service is an upgrade of West Coast DHBs wide area network, interconnecting Buller Health with Grey Base Hospital from December 2009). The current Telepaeds network links videoconferencing between Greymouth, Westport, Hokitika, Reefton, Christchurch and over 100 other locations in New Zealand. It is currently mainly used for clinical conferences, educational sessions, and management meetings and to a lesser extent for remote patient consultations, eg. methadone clinics, surgical follow-up clinics. The new fibre optic link will enhance its usefulness, particularly in regards to linking into aspects of the hospital IT system such as PACS to review radiology images. Medical telemetry can support remote clinical support, remote consultations and remote diagnosis, potentially integrated with videoconferencing. An example of this is the CISCO Health Presence System, which is being trialed as a standalone medical telemetry and video conferencing unit linking Buller Health (ED and Outpatients) with Grey Base Hospital for remote diagnosis and outpatient consultations. This system is large, fixed, not well linked in with other DHB IT and telemedicine systems. As part of the Canterbury initiative, Dr Mike Sullivan and Bronwyn Petrie are reviewing the current clinical telemedicine capability on the West Coast, the range of potential clinical applications, and potential linkages with Canterbury. Of particular interest will be the ability to „store and forward‟ patient information, (eg. photos, ECG, spirometry etc) so that this can be reviewed at a later time by both the original clinician and a remote specialist. Their report is due in March 2010 and will inform development of the Telemedicine aspects of this plan. Business case appendices V12 AC 25Feb2010 Page 132
4 Objectives: To implement communications and information technology that facilitates integrated care for patients. To improve information flow between primary care, community nursing and allied health clinicians by all using the same electronic patient medical record. To improve information flows between primary and secondary care by establishing mechanisms for primary/community clinicians to view the hospital based electronic clinical medical record and vice versa. Adopt electronic prescribing. To increase the use of telemedicine for both outpatient appointments, and for seeking management advice from a distance (either real time or „store and forward‟). To enable and empower people in the community to obtain, process and understand the health information they need to make appropriate decisions about their health. To prepare local IT systems so that 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 New Zealanders and their treatment providers, and electronic prescribing 5 Benefits and gains Output measures Indicator Baseline Target – Yr 1 Year 2 Year 3 High Definition Videoconferencing interconnects all West Coast IFHCs Shared Medical Telemetry System Medical Practices move to a shared Med Tech 32 Database system Standard Definition only CISCO Health Presence being trialled in Buller All West Coast DHB Practices share same system but independent practices maintain their own All videoconferenc e-ing equipment replaced with high definition equipment Options for an integrated medical telemetry network explored Move to shared Med Tech database explored in detail. Logistics of moving iSOFT Community Nursing Addition Videoconferencing equipment deployed in IFHCs Move to shared Medical Telemetry system. Move to shared Med Tech database and move iSOFT Community Nursing functions to Med Tech Business case appendices V12 AC 25Feb2010 Page 133
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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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Appendix Nine: Referred services 1.
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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
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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
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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
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Page 191 and 192: A key possibility is that land at t
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Page 195 and 196: 7 Westland IFHC Facilities options
Page 197 and 198: Year two Substantive-IFHC in Greymo
Page 199 and 200: 12 Costs Capital costs Greymouth IF
Page 201: utilize MedTech, but via their own
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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