Health Informatics New Zealand Conference, Christchurch
Thank you for inviting me here today to open the 2015 Health Informatics New Zealand conference – the most important fixture on the health IT calendar.
It’s great to be in the South Island – the first time in 14 years the conference has been held here.
I’d like to acknowledge Liz Schoff, HiNZ chair, and David Meates, chief executive of Canterbury DHB.
Attending the HINZ conference in Auckland last year was one of my first speeches as a Minister of Health. I am pleased to be part of your conference again this year. You have chosen a highly relevant and important theme - Collaborate: Share. Solve. Achieve. Measure.
Minister of Health and Sport & Recreation
I have to say, not only is it a great time to be the Health Minister but it is also a pretty good time to be the Sport and Recreation Minister with the Rugby World Cup underway in the UK.
IT is a significant strategic investment for Government, both from a health and broader social sector investment perspective.
It has a crucial role to play in making the health system more sustainable, improving productivity and efficiency and health outcomes. IT also has a role to play in supporting Government’s wider cross-government interests.
Developing a clear vision for the future of IT investment in health has been one of my key priorities in my first year as Minister alongside my other priorities of childhood obesity, improving clinical and financial performance and refreshing the New Zealand Health Strategy.
I’d like to start with an update on the sector. I believe our health sector is in good shape. The feedback I’ve been getting on my travels around the country is that although there are still challenges, we’re heading in the right direction.
My first year overseeing health has required swift, clear decisions to deal with some long standing issues – such as HBL and Southern DHB.
Just yesterday I launched the Childhood Obesity Plan. Ten per cent of New Zealand kids are obese. Ten per cent of all New Zealand children aged between 2 – 14 years are obese. That’s around 79,000 kiwi kids.
Childhood obesity is a serious issue which means some of our kids could end up living shorter lives than their parents.
Delivering better health services is a top priority for this Government. In the tightest of budgets we obtained $400 million extra to grow health services this year. Health received the largest share of new funding in Budget 2015 - $15.9 billion.
We’re investing around $1.7 billion over the next four years for new initiatives and to meet cost pressures and population growth. This includes more funding for elective surgery, palliative care, and free doctors’ visits for children aged under 13.
New Zealand Health Strategy update
You will all be aware that the New Zealand Health Strategy is being updated. The last strategy was developed in 2000, and much has changed since then. The updated strategy will set a road map for the health sector for future years.
IT and eHealth solutions, are already transforming the way people interact with the health system and receive care, and the way health professionals work.
It is absolutely a key enabler of the updated health strategy, as we strive for a more effective and productive health system, and we must get it right.
E-Health solutions offer better, safer, more efficient healthcare. They are also an important enabler of new models of care and providing care closer to home.
It is clear clinicians and health providers want better access to health information across the system, where and when they need it. They want IT systems that are well-designed, easy to use and closely aligned with clinical workflows.
Decision support tools must be available at the point of care, and health providers need to know that care being provided to their patients is being coordinated appropriately.
Systems like this will support clinicians to deliver consistently high-quality care and will make the most of their valuable time, not to mention the valuable time of their patients.
The importance of collaboration
It is fitting that the theme of this conference is collaboration. For information sharing and integrated services to work well it takes a team approach. They need to be developed and implemented with strong leadership from clinicians, working in partnership with patients and vendors.
Over the past five years the IT Board has been working with the sector to increase levels of regional and national collaboration on key projects. Progress has been slowly building and we now have a platform on which to take the next steps.
Over the next few years I expect to see people working much more collaboratively across health boundaries to gain benefits for the whole health system.
IT solutions must support timely, quality patient care – and improve productivity. They should enable clinicians to spend more time with patients, and less time battling with administrative issues that can suck up time and energy. Even within existing systems we could make better use of the information that is available to make better decisions for patients.
A good example of this is patient portals. New Zealanders want access to their health information so they can work with their care team. They don’t want to have to tell their story over and over again.
I am encouraged by the adoption of patient and provider portals. Over 90,000 patients from 260 practices have access to a portal.
Portals enable consumers to play a greater part in managing their own health.
They are also the first significant IT project freeing up general practices to spend more time with patients.
Practices with a large number of patients using portals are noticing time savings for doctors, nurses and administrative staff.
However, the goal for eHealth is national adoption – partial adoption of solutions such as patient portals is not good enough. We need the benefits of digital systems to be widely available.
To get us there as quickly as possible, I have been working closely with the National Health IT Board on accelerating the adoption of key eHealth solutions.
Setting a clear path for the future of eHealth
As I travelled around meeting clinical leaders, patients and IT providers it became clear that our eHealth system was complicated, fragmented and not as user friendly as it could be.
As I walk around hospitals I kept seeing examples of where individual clinicians have designed a stand-alone information system or programmes to use in their own unit – we end up with 20 different systems.
In my view it intuitively makes sense to have a more uniform It environment with fewer systems, fewer vendors more standardisation and greater functionality.
Following discussions with the Health IT Board I commissioned an independent report on the benefits of a single electronic health record. This review has recently completed by Deloittes and will be on the Ministry of Health website in the coming days.
The benefits of an electronic health records
Deloitte’s found that there is growing international support for adopting a Hybrid/Best of Suite strategy for Electronic Health Records, where a ‘single’ EHR is introduced to join up information held in a smaller number of Electronic Medical Record systems.
There are five key findings in the report:
- Quality and productivity benefits are available by rationalising the systems used by secondary care facilities;
- Creating a ‘Single’ EHR, that physically consolidates health information in one place, will improve decision support and care coordination especially for complex patients with multiple long-term conditions;
- Primary Care needs to be connected real-time with the ‘Single’ EHR;
- Implement Closed Loop Medicine Management, as this is the area that offers the highest benefits in terms of patient safety and quality;
- Develop Consumer Portal access. This leverages the ability to serve up information from a physical repository in real-time, through digital channels to consumers. Consumer engagement around their health and wellness is key to implementing a preventative or primary care led strategy.
We have laid much of the groundwork by linking up our health information systems and securely sharing a considerable amount of patient information.
However, we are entering a new and vital phase. We need a platform that lets us consistently and widely share information and integrate services across hospitals and communities.
We need this platform in place so we can hit the ‘go’ button and really deliver the same high quality health services to all New Zealanders, no matter who they are or where they live.
The next steps
Based on the advice I have received, including the findings of the Deloitte report, I have asked the Health IT Board to establish a work plan under my direction.
Firstly, DHBs need to complete the foundation eHealth investments set out in the National Health IT Plan. This includes the completion of the foundation programmes already underway.
For example, we need to complete the replacement of the legacy PAS systems, have common clinical workstations in all public hospitals and fully joined up eMedication systems.
Secondly, over the next 12 months we need to complete the design-thinking and investment plans for a Hybrid/Best of Suite approach.
A single national electronic health record system
A national electronic health record is a critical tool for providing the best care, whether in hospital or in the community.
It will provide information via a patient portal and enable clinicians to view comprehensive patient information in one place. It will include a person’s allergies and alerts, medications and diagnostics, and will have clinical decision support tools.
It will also incorporate data from all the current population screening programmes and accommodate any new screening requirements.
This information can be securely accessed, and updated by those providing care to an individual.
The record will be able to be accessed via portals and apps running on a variety of devices.
In a digital hospital, all patient information is linked up into a standard electronic medical record and can be accessed from anywhere in the hospital.
This means a nurse taking a patient’s vital signs can send them electronically straight to a central database, where they can be securely accessed by everyone caring for that patient.
So that we do it once, and do it right, a blueprint of a digital hospital will be developed for the sector, and will be available by November 2016.
A national whole-of-person IT prevention platform will capture information relating to current and future population screening and prevention programmes.
As with the other systems just mentioned, it will have privacy and security features designed in from the start, building off the connected health security model.
As with the electronic medical record, this prevention information will form part of the national electronic health record. We have the ideal opportunity to make a smart investment in this area as the current prevention systems are at the end of their life and need replacing.
The need for greater information sharing across Government agencies
A person’s health is strongly influenced by wider social factors – such as housing, education, employment and socio-economic status.
It is important the health information we collect about individuals and populations is shared with the broader social sector to inform future social investments, evaluate the impact of programmes and ensure the services provided by other sectors contribute to improving the health of all New Zealanders.
This level of information sharing can be challenging for health professionals. For many it goes against the grain of what we believe to be patient privacy. We need to find a new way to balance privacy with security and greater outcomes as we move ahead in this increasingly digital and integrated world.
We need to make better use of the data we already have available to help recognise the most high risk families. We need to be able to know if they are being immunised, accessing primary care, as well as if they’re in education or involved with the justice system.
My vision for the future of eHealth
These are big goals and to achieve them we need to improve the way we implement eHealth IT solutions.
In the next 10 years clinicians, health providers and consumers will be using a range of devices to access health information wherever they are in the system.
The New Zealand health system will also be using eHealth solutions to deliver effective healthcare in the most productive manner possible.
We need to make sure the right investments are made today to achieve these outcomes.
It is very important that DHBs and vendors fully commit to these plans – there is no room for slowing down the implementation of government priorities. We need to improve our ability to work together to implement the national expectations.
As part of the work programme I have also asked the Ministry to identify the levers I have as the Minister to help accelerate our progress and incentivise greater collaboration.
When it is done well, DHB Chairs are committed to a new way of operating, CEOs are prepared to invest and CMOs and IT professionals lead the implementation – a real team effort. This is what I want to see.
I think everyone in this room would agree that we want a health system that provides safe, equitable, high-quality care for New Zealanders.
I look forward to hearing about the discussions that will take place during this conference.
I urge you to use it as an opportunity to consider how you collectively put in place eHealth solutions that will significantly and positively change the way the health sector operates, today and in the future.