Transcript Quality powered by information

quality powered by information
Coverage
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The evolution qi4gp to Patients First
Who and what we are?
A quality programme enabled by information
Putting the strategy in context
A bit of show and tell
– GP2GP
– Community ePrescription Service
– Health Quality Measures NZ
• Making systems work for patients and General Practice
• Where to next?
• Questions
Patients First Programme
Quality powered by information
• Originally qi4gp – now broader primary care focussed
• Quality powered by information (not separate focus areas)
• Partnership with GPNZ, 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
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Where we have come from
In the last 18 months, Patients First has delivered or is well down the path of delivery on:
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GP2GP
Clinical Pathway tool evaluation
PMS Requirements
Health Quality Measures Library
SMM Primary Care
PMS Toolkit development
Sector engagement and teamwork
Community ePrescription Service
Transfer of Care (Electronic Discharge)
PMS Certification/validation
Fit with Health IT Plan
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Ackoff – path to wisdom
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Building on Strengths 2
Quality at four levels & the opportunity of networks
Practitioner
• Training
• Professional development
Practice
• Aiming for Excellence
• Cornerstone
Network
• BSMC, IFHC
• Must share common language
National
• National Standards
• Health Targets
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Context of Measures
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Show and Tell
Don’t tell me. Show me!
GP2GP
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
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</tr>
</tbody>
</table>
</text>
<entry>
<encounter classCode="ENC" moodCode="EVN">
<templateId root="2.16.840.1.113883.2.18.7.2.1.1"/>
<id root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
<code code="GENRL" codeSystem="2.16.840.1.113883.2.18.18" displayName="General">
<originalText>
<reference value="enc1"/>
</originalText>
</code>
<effectiveTime value="20000407"/>
</encounter>
</entry>
<entry>
<<id root="14d4a520-7aae-11db-9fe1-0800200c9a66"/>
<!—E.g ACC claim number -->
<code code="ACC" codeSystem="2.16.840.1.113883.2.18.19" displayName="ACC"/>
•Process Request (Send)
</participantRole>
•Encrypted CDA document created
</participant>
<performer>
<!—can have multiple performers -->
<assignedEntity>
<id root="2.1.840.1.113883.2.18.3.1" extension="12ABCD"/>
<assignedPerson>
<name>Mary Allen</name>
</assignedPerson>
</assignedEntity>
</performer>
<entryRelationship
typeCode="RSON">
<observation
classCode="COND" moodCode="EVN">
Export
Steps:
<value xsi:type="CE" code="32398004" codeSystem="2.16.840.1.113883.6.96"
displayName="Bronchitis"/>
</observation>
</entryRelationship>
</encounter>
</entry>
</section>
</component>
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</tr>
</tbody>
</table>
</text>
<entry>
<encounter classCode="ENC" moodCode="EVN">
<templateId root="2.16.840.1.113883.2.18.7.2.1.1"/>
<id root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
<code code="GENRL" codeSystem="2.16.840.1.113883.2.18.18" displayName="General">
<originalText>
<reference value="enc1"/>
</originalText>
</code>
<effectiveTime value="20000407"/>
</encounter>
</entry>
<entry>
<<id root="14d4a520-7aae-11db-9fe1-0800200c9a66"/>
<!—E.g ACC claim number -->
<code code="ACC" codeSystem="2.16.840.1.113883.2.18.19" displayName="ACC"/>
1 - PMS:
</participantRole>
• Import message into mail
</participant>
<performer>• Create Acknowledgement
<!—can have
• multiple
Matchperformers
Patient -->
<assignedEntity
>
• Match Practitioner
2 - Practitioner:
<id root="2.1.840.1.113883.2.18.3.1
" extension="12ABCD"/>
• Create Task
<assignedPerson>
• Confirm patient match
• Present Mail to Practitioner
<name>Mary Allen</name>
• Present items to import Problem list,
</assignedPerson>
Medications and alerts
</assignedEntity>
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Present items that exist in Problem list,
</performer>
Medications
and Alerts
<entryRelationship
typeCode="RSON">
• Select items to import
<observation
• Import selected items
and all encounters
classCode="COND" moodCode="EVN">
Import
Steps:
Steps:
excluding duplicates
• Complete Task
<value xsi:type="CE" code="32398004" codeSystem="2.16.840.1.113883.6.96"
• View file in human readable form
displayName="Bronchitis"/>
• Print File
</observation>
</entryRelationship>
</encounter>
</entry>
</section>
</component>
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Screenshots
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Step One:
Mr Burnett, patient,
enrols at new
practice and gives
authority to
Request the file
from Old Practice
GP2GP Workflow
Dr Anderton @
Old Practice
Step 8:
Final Acknowledgement
HL7/CDA
Construct
Step Two:
Step Three:
Extracts Patient File data
from system in
preparation for CDA
Construct
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
In Box
Step Six:
Step Seven:
Strip HL7
Visual check
Deconstruct CDA,
Provide data to PMS for
action
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
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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…
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Community ePrescription Service
NZePS
NZePS Schematic
Data Repository
& Access Services
Rx
Rx
Simpl Health Information Exchange
(Broker)
Simpl HIE Adapter
Rx
Pharmacists
Dispensing
System
Software
Simpl HIE Adapter
Patient
Prescribing
/ Dr
System
Consultation Software
Simpl HIE Adapter
Simpl HIE Adapter
Simpl Health Information
Exchange Portal
Rx
Internet Clinicians without
systems
Browser
NZePS Workflow
HIE Scenario Diagram
Processes 1- 3
Create Prescription, Dispense, and Record
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Patient
1
The paper
script is
handed to
the patient
Pr
oc
es
s1
–C
re a
te
N
ew
oc
Pr
e-P
re s
GP Software
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(HIE Enabled)
GP Creates the
e-Prescription
cr i
pti
es
s2
on
is
–D
pe
ns
e
re s
e-P
p
cr i
4
n
tio
The pharmacist
scans bar code on
the paper script
(the ‘SCID’)
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(HIE Enabled)
Pharmacy
software
retrieves the
ePrescription
HIE
The ePrescription is
Stored, encrypted
and stored in the HIE
repository
Patient
Pharmacy
Software
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Adapter Performs:
Encryption
Authentication /
Authorisation
Comms/Transport
SCID Generation
The patient
gives the
paper script
to the
pharmacist
Pharmacist
sends the
Dispensed
ePrescription
oc
Pr
es
s3
–
c
Re
o rd
Dis
p
s
en
eD
eta
ils
In a totally HIE enabled
environment, the GP
prints the prescription,
and his software sends
an ePrescription to the
HIE Gateway. The
Patient takes the paper
prescription to the
Pharmacy where it is
scanned and the SCID
barcode retrieves the
ePrescription from HIE
and allows the
Pharmacy to act on it,
dispensing the
medicine. The Dispense
items are recorded in
HIE.
What does an eScript look like?
NZePS– What it isn’t?
• It does not fix Pharmacy claiming or special authorities
• It does not fix poor prescribing practices
• A data repository for statistical or other analysis and reporting
• A formulary
• It is not a new drugs list or schedule replacement
• It is not replacement for a signed prescription
• Complicated
• Perfect…
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Babel Fish
A universal translator
Imagine
Karori Medical
Centre
Island Bay
Medical Centre
Wellington
Hospital
HL7
PMS
CDA
Wellington
Hospital
NZePS
Prescription
Broker
Pacific
Radiology
Aotea
Pathology
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Health Quality Measures NZ
www.patientsfirst.org.nz/hqml
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Acknowledgements
Patients First - Governance
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RNZCGP, GPNZ, National Health IT Board, Ministry of Health , Health Quality and Safety Commission,
Pharmaceutical Society of New Zealand
Expert Advisory Group - HQML
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NZ Health Quality and Safety Commission
Capital and Coast DHB
DHBNZ
Compass Health
Pegasus Health
University of Otago – Wellington School of Medicine
Karo Data Management
Ministry of Health
RNZCGP
GPNZ
Pharmaceutical Society of New Zealand
New Zealand Nurses Organisation
Project Team - HQML
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Sapere, RNZCGP, GPNZ, PPP, Wellington School of Medicine, Compass Health, Karo Data Management
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Why HQML?
• Consistent way of defining measures
• Platform and process for existing and new
measures
• Multi-discipline
• Robust process – including a multi-disciplinary
expert advisory group
• Clinically led and quality focussed
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PMS Certification
Desired Outcome
For The Sector:
– provide a credible, independent and accurate
appraisal of PMS systems
– to help inform purchasing decisions and,
• for Vendors
– the process will enable them to have a clearer
understanding as to the requirements and
priorities of the market
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In Summary
• We have a defined standard for clinical
information
• We can share information in a structured way
• We have the start of a universal translator for
systems to share data
• We have a PMS certification framework to
balance a clinical voice in requirements
• We have a measurements framework to get
consistent way of measuring in health