Whānau Tahi

Connected health – is it plugged in?

Connected health and digital health have been buzzwords for the Government’s health IT strategy for years. The New Zealand Health Strategy articulates a future vision for the New Zealand health system, featuring investment in digital technology. This vision is further developed in Digital Health 2020, a strategy document detailing specific actions to improve health connectivity.

But years into the rollout what is being achieved?

Pharmacy Today reporter Jonathan Chilton-Towle attempts to untangle the patchwork of online services currently available.

Pukekohe South Pharmacy pharmacist Marie Tsai has woven a small part of the patchwork quilt of health IT in south Auckland.

The young pharmacist was a runner- up in the Pharmacy Awards for her efforts in getting the pharmacy business connected to Shared Care patient information sharing system along with the GPs next door.

Managed by Whānau Tahi, Shared Care allows pharmacists and other healthcare professionals to set themselves up as a patient’s “care provider” which gives them access to the patient’s file, including information such as their diagnoses and prescribed medication. Using the system, Miss Tsai can update the file so the patient’s other care providers can see when medication is dispensed. She is also able to see the patient’s care plan – which sets out a patient’s personal goals – and this gives her a way to relate to the patient, by giving them medicines information in a way that speaks to the health outcomes they want to achieve.

It also helps avoid drug interactions.

Using Shared Care for half a year, Miss Tsai has managed to load most of her regular patients into the system. But there are gaps. Many GPs and pharmacies do not use Shared Care or a similar system, meaning those who do, can’t access patient information about people who come in from clinics not using it.

Miss Tsai and the GPs implemented the connection together, rather than feeling guided by any greater strategy, and she is adamant that getting this type of initiative implemented at a PHO or DHB level would result in far greater uptake.

Her pharmacy also uses TestSafe, a database for everyone living in the northern region DHB areas, which gives users access to information, including patient test results, e-referrals and medicines information.

However, there is no linkability between TestSafe and Shared Care, and pharmacists are not privy to GP records and will not be updated when a patient is discharged from hospital. “It’s [Shared Care] useful if people use it,” Miss Tsai says.

All around New Zealand, pharmacists like Miss Tsai are collaborating with other care providers to improve their information-sharing processes.

A major tool to be added to this toolbox may be a national electronic health record (EHR), which will give health professionals access to patient information.

The datasets for the EHR are yet to be decided, but the preferred model will initially contain a core set of data, including demographics, diagnoses, medications, immunisations, allergies and alerts.

Ministry of Health acting chief technology and digital services manager Darren Douglass says the ministry is still considering business cases for the record.

“The National Electronic Health Record Business Case project team will continue to engage across the sector in regard to how any future national EHR will work with existing solution,” he says.

“The method of how other systems would align with a national EHR is still under discussion; however, it is our expectation that existing systems and investments would be used.

“At this stage, the preferred national EHR approach would be one that connects with other systems,” Mr Douglass says.

Shared Care, the system used by Marie Tsai in Pukekohe is owned by Whānau Tahi, which in turn is owned by West Auckland health and social services provider Waipareira Trust. Whānau Tahi managing director Ray Noonan says almost every community pharmacy in New Zealand will have access to Whānau Tahi service but how deeply they engage with it is up to them.

In fact, some pharmacies may not be aware they can access the platform already.

Instead of taking a centralised route, Whānau Tahi creates a system focused around connecting each patient to all the services they might need, not only in health but also social and justice. This involves sharing patient data and creating a joint care plan involving staff across all these services, within existing privacy constraints. With one or two exceptions, Mr Noonan does not believe lack of linkability between different electronic record services is a problem, as most enable data to be interchanged.

“Where that becomes a problem is more so where a legacy provider is trying to hold users to ransom.” Whānau Tahi does not want to “get territorial” around client data, and Mr Noonan questions whether providers that do will remain open for much longer. Mr Noonan does see several DHB’s taking leadership in the connected health space, pointing to Counties Manukau DHB’s widespread adoption of the Whānau Tahi platform.

The implementation of a single EHR connecting all providers is unrealistic and would dampen innovation, he says. “In my view, it’s based on a tech assumption from five to 10 years ago,” Mr Noonan says.

Mr Douglass does not agree with this view. “We do not agree with claims that a national EHR would stifle innovation. Far from it, allowing access to information in a far more robust and predictable manner will create the opportunity for better collaboration and innovation,” he says. The South Island has already implemented a centralised data-sharing network.

All five southern DHBs use the clinical information portal, Health Connect South, which provides an electronic record for hospital care. South Island primary healthcare providers can link into this database using another system called HealthOne. Created by Orion Health, Health Connect South pulls information from disparate sources, allows users to update or add information and presents it in a single patient view. The Nelson Marlborough DHB became the last South Island DHB to link into the shared record in February. At the time, Canterbury Community Pharmacy Group clinical leader Gareth Frew said being able to remotely view patients' records was a huge help for Medicines Use Reviews and Medicines Therapy Assessments. "I think it potentially saves lives," Mr Frew said.

The system is generally easy to use and performs well, although Mr Frew believes it could have better integration with pharmacy dispensing software, such as Toniq. Having access to records of people from across the South Island is also very important during disaster situations and makes it easier to dispense emergency supplies of medicine to displaced people, he says. Patient portals, secure online sites where patients can access their health information and interact with health professionals, including requesting repeat prescriptions, form another strand of the connected health tapestry.

Medplus Family Medical Centre in Takapuna, Auckland, has had the Health365 patient portal in place for about four years and nearly 70 per cent of its 10,000 patients are currently signed up. GP Heidi MacRae praised the system for streamlining appointment-making and the repeat prescribing process. “That represents a huge saving in receptionist time, and my patients report an improvement in convenience,” Dr MacRae says. “Looking at test results remains the most popular feature of the portal and has empowered many of our patients to take a greater interest in their health issues.” With nearly half of all practices offering portals, the number of registrations across the country is rising. There were 233,839 registrations between June 2016 and June this year, taking the total patient portal users to 407,049 as of early September.

Mr Douglass believes health is complex, and individual health organisations will need to implement digital technologies in a way that responds to their specific priorities and environment while remaining aligned with the sector. “The New Zealand Health Strategy articulates a clear and compelling future vision for the New Zealand health system,” he says.

“Far from being chaotic, this is a pragmatic and necessary approach. The acceleration to shared systems and cloud services aligned to national standards is reducing variation and complexity in the sector, and the current work on a health technology vision and digital health strategy will further strengthen progress towards the vision.”

Delivery is proceeding in line with the investment plans of the ministry and individual DHBs, he says.

Published in Pharmacy Today

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