Tom Bowden HealthLink (Friday, 10.30, General 2) See video at http://www.slideshare.net/secret/7EmESReifPHGa8 Provision of immediate access to accurate, pertinent, satisfactorily comprehensive clinical information in a dependable and cost-effective manner has long been an elusive goal. Attempts to implement shared record systems (both summary record systems and comprehensive record systems) have proved extraordinarily challenging. However, the Virtual Health Record (VHR) is an entirely new approach to patient information sharing. It is based upon linked regional implementations of a new technology. The methodology commences with a consensus building process amongst providers to determine what information is shared and how it is to be shared? VHR lends itself to an incremental approach to implementation. Now being implemented in its second and third regions, the Virtual Health Record system is gradually being expanded as the technology and support systems are bedded in and the clinicians across each region learn to trust one another and work closely together to deliver a highly functional and reliable method of communication. The Virtual Health Record is proving to be a viable method for sharing information across the healthcare ecosystem.

1. The Rise and Rise of the
Virtual Health Record
Tom Bowden
HealthLink

2. Late Breaking News on the relentless
search for practical ways to share a
Patient’s health information
• Tom Bowden, CEO HealthLink Ltd,
Tuesday 11th October 2011

3. Today’s Agenda...
• Pressure on Health Systems
• The Holy Grail of Health System Efficiency
• Attempts to date
• Alternative Approaches
• The Virtual Health Record (case study)

4. New Zealand, like most other
developed countries sets great store
by its advanced health system

5. However there is one problem with
health systems; they are very
expensive and everyone is feeling
the pinch

6. 6
International Comparison of Spending on Health, 1980–2008
Average spending on health Total expenditures on health
per capita ($US PPP) as percent of GDP
8000 16
United States
Norway 14
7000
Switzerland
Canada
Netherlands 12
6000
Germany
France
5000 Denmark 10
Australia
Sweden
4000 United Kingdom 8
New Zealand
United States
3000 6 France
Switzerland
Germany
Canada
2000 4 Netherlands
New Zealand
Denmark
1000 2 Sweden
United Kingdom
Norway
Australia
0 0 1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
6
Source: OECD Health Data 2010 (June 2010).

7. Average Annual Growth Rate of
Real Health Care Spending per Capita, 1996–2006
5.0% 4.8%
4.3%
4.1%
3.9%
4.0%
3.7%
3.6%
3.3%
3.0%
3.0%
2.5%
2.0%
1.6%
1.0%
0.0%
New United Australia* OECD Canada United Netherlands France Switzerland Germany
Zealand Kingdom Median States
*1995-2005
47 Source: OECD Health Data 2008, “June 2008.”

8. Athens

9. London

10. Washington

11. OK so what the *(%#@! has
that got to do with health IT?
Healthcare is costing us too
much, a situation that has to
change!

12. A short history lesson...

13. Game
Changing
event!
The State and
Published
Pattern of
HEALTH 2005
Information
Technology
Adoption

14. “Innovations in information technology
(IT) have improved efficiency and quality
in many industries. Healthcare has not
been one of them.”
“If most (US) hospitals and doctors’
offices adopted HIT, the potential
efficiency savings for both inpatient and
outpatient care could average over $77
billion per year.”

15. And so began the search for the
holy grail...

17. “If I live in Bradford and fall ill in Birmingham
then I want the doctor treating me to have
access to the information he needs to treat
me”. ....” Rt Hon Tony Blair 1999
almost at that instant, the world’s largest non-
military IT project, a £13 billion National
Programme for Information Technology
(NPfIT) took flight.
13 years later....

18. Knowledge to Cure Cholera
Dr John Snow
Noted 500 deaths from
Cholera occurred within
10 days.
Traced to a single water
pump in Broad Street

19. NHS told to abandon delayed IT project
“£12.7bn computer scheme to
create patient record system is
to be scrapped after years of
delays”
The Guardian 22nd September 2011

20. What went wrong?…
“The
Devil is
in the
Detail”
Professor Trisha Greenhalgh
University College, London
May 2010

21. 1. Most patients seen in unscheduled care either have conditions
for which the data on the SCR are irrelevant or they are able to
provide these data themselves.
2. Clinical staff are generally suspicious of the completeness and
accuracy of information they are getting from a shared
record. This is creating an apparent reluctance to refer to it.
3. The cost of developing and maintaining a national shared
record system to a minimum standard of quality and safety is
prohibitive.
4. The public have continuing concerns over the privacy of their
information and sharing of personal medical data without
explicit consent has eroded public trust in the healthcare
system.
University College London (Greenhalgh et al).

23. Starting From A Good Place

24. Quality of Care from Doctor
Percent rated care received in past 12 months from regular doctor
as very good/excellent
100
84
76 79
74 74
75 67 69
59
54
49
50 43
25
0
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Base: Has regular doctor/place of care.
24
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

25. Physician Satisfaction
100
Satisfied
75 Very satisfied
54 54
66 54 49
50 59 54
68 49
36
25
34
35 35 30
22 27 21
18 15 12
0
8 5
NZ NOR NET UK SWE ITA CAN FR US AUS GER
Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

26. Practices with Advanced Health
Information Capacity
Percent reporting at least 9 of 14 clinical IT functions*
100 92 91 89
75 66
54
49
50
36
26
25 19 15 14
0
NZ AUS UK ITA NET SWE GER US NOR FR CAN
* Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test
results, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test
results, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests or
preventive care.
26
Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

27. Electronic Partners
60
50 1
0
0
40 %
E
30 M
R
20
U
S
E
10
0
Aug-99 Aug-00 Aug-01 Aug-02 Aug-03 Aug-04 Aug-05 Aug-06 Aug-07 Aug-08 Aug-09 Aug-10

28. Three New Zealand Alternatives
• Share for Care – Opt In
• Shared Care Record View –Opt Out
• Care Insight – Virtual Health Record

29. West Coast Region- Share for Care

30. What information is included?
• Long-term health problems
• Long-term medications
• Recent health issues (last 6 months)
• Recent medications (last six months)
• Allergies
• Immunisation record
• Hospital discharge summaries
• Test results
What information is not included?
• Consultation notes
• Information you do not want shared

31. • The shared care record view (eSCRV) system will
allow doctors, nurses and pharmacists to get a
patient's medical record on the spot.
• Project spokesman Dr Nigel Millar, chief medical
officer from the Canterbury District Health Board
(CDHB), said the system would provide an "up-to-
date summary" of a patient's history.
Christchurch Press Feb 22 2011

32. The Virtual Health Record

33. Case Study - Hawkes Bay DHB
DRAFT
• Covers all of the region’s
general practices, will
include pharmacies
• Pilot Commenced in
March 2011
• Now Going for Clinical
Council Approval
• Privacy Impact
Assessment underway
• In daily use

35. Benefits
• Quick to implement
• Low cost
• Privacy- friendly
• No intermediate systems

36. VHR Use Cases
• A and E querying all of the medical centres, after-hours
clinics to obtain current information about a patient it is
treating.
• A local accident and emergency provider checking on GP
records to see what medications a patient is using
• A general practice querying local pharmacies to ascertain
whether a patient has been dispensed the medicines that
he or she has been prescribed
• A surgeon on a hospital ward looking for more information
about a patient’s medical history, prior to an operation

37. Actual Examples
• An elderly patient shows up at ED without a
referral. Care Insight is used to find out what
medicines he she uses.
• A person arrives acting suspiciously/behaving
erratically, Care Insight used to ascertain
whether they are a drug seeker.

38. The Care Insight system
Patient Presents at ED or A&M Clinic
Which GPs have seen this patient?
May I see these current summaries?
Gather Patient Summaries
Deliver set of summaries
Message to each practice with a record
of which records have been viewed
The viewer initiates a structured ‘self-referral’
into the hospital CDR

40. What do the users think of the
Virtual Health Record/ Care Insight?

41. “ Having access to the patient's recent
prescriptions and the date they were generated is
very helpful in terms of clarifying patient's history
and in terms of confirming the medications that
they are currently on.
The list of previous medical conditions/diagnoses
is also helpful, particularly in patients with
dementia or who are unable to recall their
medical or surgical history.
I think this is a valuable resource and it would be
beneficial to have access extended to all
consultants and registrars in ED.”
Mark Barlow, Head of ED, Hawkes Bay DHB

42. Planned improvements
• Redesign of the user interface
• Educating the public about it
• Continuous improvement of system
management

43. Key Learnings
• Very important to get a consensus from the
region’s providers
• Training ED and A and E staff is mission critical
• The feedback loop to practices is very
important
• Take it slowly and get it right

44. Shared Health Records:
The equivalent of climbing Mt Ama Dablam Where we will be by HINZ 2012
Emergency Record Sharing Starts Here
Base camp 1: New Zealanders you are here

45. “We didn’t
have the
money, so
we had to
think”
Sir Ernest Rutherford,
- Father of Nuclear Physics
and famous New
Zealander

46. Thanks for your time
Tom.bowden@healthlink.net