Achieving Integration - a Primary Care View Andrew Terris

Achieving integration – a Primary Care ViewSYSMEX Conference 2012Andrew.Terris@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 Primary Care 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-BanderAndrew 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, ProCarePresident, 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 Primary Care 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

• Integration• BSMCCurrent Sector Context• Primary options for acute care (incl increasedcommunity access to diagnostics)• Shared Care• New models of care• IFHCs and IFHNs• Pharmacy Services Agreement• Reducing avoidable (re)admissions• Information sharing

Information sharing for?• Patient Care and Safety• Supporting clinical delivery• Population Health analysis• Predictive Risk Modelling• Shared Care• Accountability• Funding• Other?

Eco-system (points of integration)

Main trends in integration• Summary Record• Shared Care (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 Care?Shared ViewShared CarePopulation base broad Complex patient (5%)Opt Off (with Opt On view) Opt OnView onlyView and contributeBroad data setsCare Planning Focus

Who is doing what? (a subset view)• Northern Region – Testsafe and CDR review• Northern Region – National Shared CareProject• 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 Care

eSCRV Privacy – OverviewGP opt offRoll basedfilter

eSCRV Privacy – Access Matrix

Integration - Vendor Responses• ORION – Concerto variations (access betweensecondary and primary – DHB and regiondriven)• Medtech – Manage My Health• Healthlink – Care 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