Transcript 8 - General Practice New Zealand

GP2GP
A case study in practical inter-operability
Patients First
01 September 2011
[email protected]
[email protected]
Coverage
 Patients First
 GP2GP – what it is
 Modules
 Workflow
 What it is not
 Lessons
 Next Steps
2
Doctors Use Electronic Patient Medical Records
in Their Practice, 2006 and 2009*
Percent
100
98 99
2006
92
97
96
2009
95
89
79
72
75
50
46
42
37
28
25
23
0
NET
NZ
UK
AUS
GER
US
CAN
* 2006: “Do you currently use electronic patient medical records in your practice?”
* 2009: “Do you use electronic patient medical records in your practice (not including billing systems)?”
Source: 2006 and 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 3
Practices with Advanced Electronic Health Information Capacity
Percent reporting at least 9 of 14 clinical IT functions*
100
92
91
89
75
66
54
50
49
36
26
19
25
15
14
FR
CAN
0
NZ
AUS
UK
ITA
NET
SWE
GER
US
NOR
* 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.
Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
4
Patients First Programme
Quality powered by information
 Originally qi4gp – now primary care focussed
 Partnership with the RNZCGP and the NHITB
 Broader governance including HQSC, MoH BSMC Team
and Pharmaceutical Society
 eContinuum of Care projects (GP2GP, eDS, NZePS)
 Leadership, HQMNZ, PMS Requirements
 Synergy with eMedicines Programme and PPP
5
GP2GP - What is it?
 Electronic transfer of a patient’s full medical record (in
structured format) from GP to another GP using any PMS
 The “techie” bit
 PMS converts patient information into CDA format within an
HL7 compliant message
 transmitted via a secure, encrypted link to the new GP
 receiving GP sees file in “inbox” and imports
 PMS translates CDA message and populates relevant fields
in patient record of PMS
6
Modules
Demographics
Encounters
3
3
Regular Medications (Profile)
3
Medication History
Problems
Alerts/Allergies
Warnings
Procedures
Vitals
Family History
Soc History
Payers
3
3
3
2
3
3
3
3
3
7
Modules
Immunisations
Diagnostic Reports
Advance Directives
Functional Status
Medical Equipment
Care Plans
Correspondence
Treatment Plan
3
3
3
2
2
3
3
2
Diagnostic Requests (Orders)
2
Additional Demographics
Encryption Module
3
8
Step One:
GP2GP Workflow
Dr Anderton @
Old Practice
Step 8:
Final Acknowledgement
HL7/CDA
Construct
Step Two:
Extracts Patient File
data from system in
preparation for CDA
Construct
Mr Burnett, patient,
enrols at new
practice and gives
authority to
Request the file
from Old Practice
Step Three:
CDA build,
HL7 wrapper,
Visual check,
Places in Out Box
HL7/CDA
DeConstruct
Step Four:
Out Box Validates document,
Encrypts & Certificates
Transmits to Msg Service
Out Box
Dr Evans @
New Practice
Step Six:
In Box
Strip HL7
Visual check
Deconstruct CDA,
Provide data to PMS
for action
Step Seven:
Populate PMS with
structured data,
Acknowledge
transfer.
Step Five:
Messaging Service:
Store and forward,
Validates address,
Routes message
Messaging Service
File arrives in In Box
Certificate checked
File decrypted and validated,
ready for import
9
GP2GP – What it isn’t?
 A partial export of a patients file for whatever reason
 A bulk export or migration of patients files
 A data repository for statistical or other analysis and reporting
 A mechanism to share patients records with other “interested”
parties.
 An HPI or NHI lookup
 Export to paper or other medium to hand to a patient
 Complicated
 Perfect…
10
Health System Benefits
 Initial inter-operability dataset for development into a standard
 Common GP2GP CDA Document for inclusion in the central library
of sector CDA documents
 Universal translator (Babel Fish) between systems
 GP2GP Standard, foundation for other e-Initiatives eDS, NZePS
 Obligation between health system vendors to inter-operate
 Hosted test environment with current versions of participating PMS
software for self accreditation
 Non-GP2GP functions eg. export to PDF or memory stick,
unencrypted, at patient request.
11
GP2GP – What it isn’t?
 A partial export of a patients file for whatever reason
 A bulk export or migration of patients files
 A data repository for statistical or other analysis and reporting
 A mechanism to share patients records with other “interested”
parties.
 An HPI or NHI lookup
 Export to paper or other medium to hand to a patient
 Complicated
 Perfect…
12
GP2GP – leveraged project
What the project leveraged
 PPP test environment and resources
 The Toolkit (developed once, used by all)
 PCIMG as the advisory group
13
Scope – original, inherited,
adapted
 Content, structure and transport
 Removed connected health from the scope –
agnostic to transport mechanism as long as
secure/encrypted
 Reviewed content – not rich enough, added to –
became 25 elements
14
GP2GP
mon
th
7
7
8
8
8
8
8
8
day
11
15
5
8
9
11
15
22
Total
Msg
Senders
s
2
3
1
4
2
3
1
2
2
6
1
1
1
2
2
4
25 transfers
Available General Release
now:
• MyPractice
• Housten
Gradual rollout
• Version 20 for General
Release
• End of September
Available from October
• Intrahealth (Profile for
Windows)
Lessons from implementation
 Clinical view = transport of whole record, not as
selected by GP
 Will shine the spotlight on quality of notes and
clinical coding
 High codified and structured DB of some PMS’
meant difficult to deconstruct/reconstruct fields to
highest common denominator
16
How would it look?
Karori Medical
Centre
Island Bay
Medical Centre
Wellington
Hospital
HL7
PMS
CDA
Wellington
Hospital
NZePS
Prescription
Broker
Pacific
Radiology
Aotea
Pathology
17
 Richard
Medlicott
Chair PCIM/Steering Group, Clinical, sensible
Without diminishing
theand
valueSandra
of any of Hicks,
the
wider team
involved us
in the
project,
advice
and keeping
honest
to thethere
original intent.
was a core team that were predominantly
responsible for the key decisions and
direction throughout the project.
The Team
,
 Andre Bredenkamp Project Manager, chief cat herder, master of South African change
management
 Peter Sergent, Medtech Architect, HL7 Guru, CDA, Standards and Pinot Protocol
 David Hay, Datamodel and Toolkit Architect, CDA & CCD(oops) Guru and HL7 Standards
 Ashwin Patel, My Practice, Standards, Clinical, “What’s the right thing”
 Edwin Ng, Healthlink, Standards compliance and messaging architect
 Peter Jordon, Toolkit developer and always happy to venture an opinion
 Tiffany Lang, Houston, Project Manager, always a cheerful word to be had
 Thusantha de Silva, My Practice, a very patient and logical developer
18

James Penfold, Intrahealth, a constant voice of reason