The vision for the end of 2014 was for all New Zealanders to have electronic access to their core personal health information*. The reality is that it is still some time away. NURSING REVIEW gives you an update on where sharing electronic health records between patients, practices, pharmacies, hospitals, and other health professionals is up to.
Sharing patient records across health sectors
Health One (formerly known as eSCRV or electronic Shared Care Record View)
This is the recently renamed Canterbury and West Coast shared care record platform for health professionals to securely view relevant patient information shared by public hospitals, community pharmacies, and general practices. Trying to access information post-earthquakes prompted its development. Information available includes prescribed medications, medical diagnoses, test results, and allergies. First piloted in 2012, it has 118 general practices and 106 pharmacies contributing data, as well as hospital-held data, and it can be accessed by approximately 5000 doctors, nurses, and pharmacists working in primary, secondary, and community settings. (Uses Orion Health platform).
Shared Care Record (SCR)
This provider portal for practices in Wellington, Porirua, and the Kapiti Coast enables emergency departments and after-hours practices to view a summary of patients’ recent general practice records. Launched in April 2014 and led by Compass Health, it is also being implemented in MidCentral DHB region and is already live in Wairarapa. It now covers most Wellington and Wairarapa practices and patients. (Uses ManageMyHealth system.)
An information sharing portal being used to view patient information from GP practices by after-hours providers and emergency departments in Northland, Hawke's Bay, Tairawhiti, and Nelson-Marlborough DHB regions. (Developed by DrInfo and Healthlink).
The vision of the National Health IT Board's IT Plan was for all Kiwis to have an electronic portal to their personal health information by the end of this year. But it is up to general practices to invest in one of the software systems available and to decide what information or services are accessible. Dr Sadhana Maraj, the board's eHealth clinical lead, acknowledges implementing portals has been "challenging" for general practices because it involves changing the way they work with patients and is costly.
She said in recognition of those barriers, the previous Minister of Health in June agreed to fund up to $3 million to support the uptake of patient portals. She said this funding and the board's promotion strategy – including eHealth ambassadors and the recently released patient portal implementation guide – should help to increase the uptake. The IT Board says more than 37,000 patients from 96 general practices have registered for a patient portal but the number that have an active portal and the services they can access is not known.
Website-based portals allow patients to view health information made available by their GP and (commonly used by those overseas) to make appointments, request repeat prescriptions, send messages, and read lab results. Portals operate in a similar way to online personal banking.
This is being used largely in Central region, particularly in Compass practices in Wellington and Wairarapa, as well as by Midland Health Network. In July, it had been implemented in 71 practices out of 230 contracted practices. (Linked to practice management software MedTech).
The IT Board's July update says this patient portal had been implemented in nine practices with 37 GPs involved. (Linked to practice management software My Practice).
Mid this year, this portal system was to be trialled by the first of 17 Rotorua practices with access to Accession Patient. (Linked to Intrahealth practice management software).
Electronic shared care plans
An electronic Shared Care Plan allows a patient and their health professionals to not only securely access and send key health information but also collaboratively work together by electronic messaging to develop and monitor a patient-centred, coordinated care plan. The New Zealand focus has been on creating shared care plans for patients with long-term conditions and can include a patient’s daily or regularly reporting weight, blood sugar, etc. via their patient portal.
Shared Care Long Term Conditions Programme
Auckland's healthAlliance has been leading a shared care planning project for the three DHBs in Auckland since 2010 with the support of the National Health IT Board.
The largest component at present is Counties Manukau DHB's At Risk Individual (ARI) programme, which involves a care coordinator and a shared care plan and has 925 patients enrolled. The shared care platform has in all 99 practices involved, 13,531 patients enrolled (130 can access their shared care plan through a patient portal), and 1221 health professionals. (Uses NZ company HSA Global's Connected Care Management Solution software platform or CCMS).
Canterbury also has been offering electronic shared care planning since 2010. To date, ten pilot practices have created 480 long-term plans for patients with complex problems. In addition, 898 acute plans have been created across general practices and secondary care. The DHB says nearly all doctors and nurses in the region can read, write, or update acute plans, regardless of where they work. About 100 advanced care plans have been created and the CREST service (a short-term home-based rehabilitation programme) has created more than 3600 care plans readable by health professionals across the DHB. (Also uses HSA Global's CCMS).
Other electronic health record projects
Work began in 2010 on developing the Well Child providers' new electronic Plunket health record (ePHR) as part of its PlunketPlus information technology upgrade. It was first trialled in September 2013 and a pilot is to be underway in the New Year using tablets and the mobile ePHR app to record Well Child information by 28 nurses, two clinical leaders and a manager in Northland. Following the pilot, it is to be rolled out across the country. In 2010, Plunket said the long-term vision was for “clients to be able to access their child’s ePHR record through a secure patient portal and record their child's development milestones in an electronic version of the Plunket Book”.
National Health IT Plan.