Achieving Integration - a Primary Care View Andrew Terris
Achieving Integration - a Primary Care View Andrew Terris
Achieving Integration - a Primary Care View Andrew Terris
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<strong>Achieving</strong> integration – a <strong>Primary</strong> <strong>Care</strong> <strong>View</strong>SYSMEX Conference 2012<strong>Andrew</strong>.<strong>Terris</strong>@patientsfirst.org.nz12 October 2012
Coverage• The advent of increased focus on qualitymeasures, review and refresh of HISOstandards and emergence of a more clinicallyrich dataset is putting increasing demands onthe need for information.• What does this mean for information systemsover the next year and• how can the sector use this to bestadvantage?
The Current healthenvironment…business as usual
Patients First Is• The National <strong>Primary</strong> <strong>Care</strong> Quality andInformation Programme• Multi-disciplinary• Focus on integration and measuresBetter health through better systems and betterinformation
GovernanceNamesDr Harry PertDr Bev O’KeefeConsumer RepFiona ThomsonHelen Morgan-Bander<strong>Andrew</strong> StensonShelley FrostGraeme OsborneTony CookeElizabeth PlantJanice WilsonRichard HamblinSam CliffeRon HootonKaren Crisp[DHB?]RolePresident, RNZCGPChair, GPNZ, member NHBMatu IhakaCEO, GPNZCEO, RNZCGPGroup Manager, Business Performance, RNZCGPDeputy Chair, GPNZ, member HQSCDirector, NHITBNHITBPresident, New Zealand Pharmaceutical SocietyCEO, Health Quality and Safety Commission (HQSC)Director, Measurement and evaluation, HQSCMinistry of Health BSMCCEO, Pro<strong>Care</strong>President, Pharmacy GuildTBC
Patients First Model6
Where we have come fromIn the last 2 years, Patients First has delivered or is well down the path of delivery on: GP2GP Clinical Pathway tool evaluation PMS Requirements Health Quality Measures Library SMM <strong>Primary</strong> <strong>Care</strong> PMS Toolkit (universal translator) PMS Certification/validation eDischarge (framework)• Sector engagement and teamwork• Community ePrescription Service• Building strong relationships pan sector
Health Quality Measures NZ
How does HQMNZ compare?Feature HQMNZ NQMC (USA) ACHS(OZ ) NHSIC(UK)Definitionstandard Find measures SubmitmeasuresComment onmeasureFollowmeasuresdevelopmentCollaborativeapproachWhole ofhealth coverageOn-sitereporting ofdata(Potential)
Creating a Better eco-system• We have a measurementsframework for a commonlanguage of measurements inhealth• We have a defined standard forclinical information• We can share information in astructured way• We have the start of a universaltranslator for systems to sharedata• We have a PMS certificationframework to balance a clinicalvoice in requirements11
• <strong>Integration</strong>• BSMCCurrent Sector Context• <strong>Primary</strong> options for acute care (incl increasedcommunity access to diagnostics)• Shared <strong>Care</strong>• New models of care• IFHCs and IFHNs• Pharmacy Services Agreement• Reducing avoidable (re)admissions• Information sharing
Information sharing for?• Patient <strong>Care</strong> and Safety• Supporting clinical delivery• Population Health analysis• Predictive Risk Modelling• Shared <strong>Care</strong>• Accountability• Funding• Other?
Eco-system (points of integration)
Main trends in integration• Summary Record• Shared <strong>Care</strong> (Case Management)• Standards (RSD, ePharmacy, Status Summary Record,Interoperability Reference Architecture)• Pharmacy information for supporting LTC and careprovision• PPP - aggregate information currently, somediscussion re patient level data for analysis• Maternity/Child integration of care• HQSC driving more quality reporting (HQSI, Atlas ofvariation)
Standards for reaching the e-healthvision
What is Shared <strong>Care</strong>?Shared <strong>View</strong>Shared <strong>Care</strong>Population base broad Complex patient (5%)Opt Off (with Opt On view) Opt On<strong>View</strong> only<strong>View</strong> and contributeBroad data sets<strong>Care</strong> Planning Focus
Who is doing what? (a subset view)• Northern Region – Testsafe and CDR review• Northern Region – National Shared <strong>Care</strong>Project• Midland region – call centre, central triage,patient access to record and booking• Mid Central – A/H and emergency access toinformation. Ambulance paramedic and callcentre triage• Canterbury: eSCRV, Collaborative <strong>Care</strong>
eSCRV Privacy – OverviewGP opt offRoll basedfilter
eSCRV Privacy – Access Matrix
<strong>Integration</strong> - Vendor Responses• ORION – Concerto variations (access betweensecondary and primary – DHB and regiondriven)• Medtech – Manage My Health• Healthlink – <strong>Care</strong> Insight (real-time “pull” ofdata from regional eco-system for up-to-datesnapshot of summary data)• HSAGlobal – CCMS (Case management for atrisk/LTCcohort)
Summary reflections• Patient identifiable data is sacrosanct• Need to share and match data to identifyfrequent fliers• Trend to opt off model for CDR/summary record• Who gets access to what information in a sharedcare context• Greater degree of community access todiagnostics and focus on referral protocols withcorresponding test/orders
Summary reflections• Desire (from a quality perspective) to shareinformation for learning and quality improvement(place higher demand on timeliness and detail ofdata)• Greater demand from clinical community forinformation flow to support effective patient care• Ministry of Health looking for increased focus oninformation for measuring effective primary careintegration• Advent of structured information flowhighlighting coding quality issues
Questions