Paul Grundy, MD, MPH

May/2005

Trends in Healthcare for “an” IBM Business The New Zealand Experience

Health Care and a ROCKET Launches are both just to COMPLICATED TO MANAGE WITHOUT COMPUTER ASSISTANCE in the 21st Century .

As a result of these applications of information technology in primary care: immunization rates went from 73.7% to 98.5%. Control of diabetes improved – for patients with HbA1c

higher than 9 pre-enrolment was 64% and this was reduced to 7% post EMR enrolment

There was an 83% Improvement in lipid control with the elimination of wait time for statins for diabetes patients.

There was a reduction in acute DM admissions - this was running at 9% per year in 2000. By 2005, the growth rate was reduced to below 0% actually declining.

New Zealand FactsNew Zealand Facts

Used by 92% of all healthcare sector organizations in New Zealand.

All hospitals, radiology clinics, private laboratories

~1,800 general practices.

> 800 specialists, physiotherapists, other allied health workers

Over 3 million messages a month are exchanged,

95% of the communication in the primary health care sector.

New Zealand FactsNew Zealand Facts

Over 98% of GP offices are using one of nine Practice Management Systems

95% use their systems to electronically send and receive clinical messages such as laboratory results, radiology results, discharge letters, referrals, delivery of age-sex registers to their IPA/PHO, etc.

~ 99% of GPs now use the Internet on a regular basis from their offices - including communicating with their patients.

New Zealand Facts (cont’d)New Zealand Facts (cont’d)

Specialists use of computers range from 70-90% depending on their region.

GPs increasingly favor referring patients to specialists who are able to send information back to them electronically.

Driving ForcesDriving Forces

The development of IPA’s (Independent Practitioner Associations) encouraged the uptake of information technology in primary care in New Zealand. IPAs paid the costs for their member

GPs to access the HealthLink network as part of their membership services.

HealthLink facilitated change by offering an “electronic claiming only” service for claims submission free of charge for the first 6 months.

New Zealand’s critical success factorsNew Zealand’s critical success factors

A national health identifier NHI Early adoption of HL7 Development and acceptance of the 1993

Privacy Act and the 1994 Health Information Privacy Code along with “practical” implementation of these

Mandatory electronic claiming for GMS (government subsidies for GP care)

Collaboration with private and public organizations

Multi-vendor co-operation and understanding of the business opportunities

NZ critical success factors (cont’d)NZ critical success factors (cont’d)

HealthLink employs nurses to act in liaison roles with General Practice, and so provide direct contact with the GPs.

HealthLink provides a help desk that has become the GP’s first point of contact when requesting help with their EMRs

HealthLink has also stayed very close to the GP system providers

NZ critical success factors (cont’d)NZ critical success factors (cont’d)

Healthlink’s strategy has always been to work very closely with primary care physicians

to stay close to them and provided the infrastructure to support them.

HealthLink is intricately and comprehensively tied to the GPs

“like the parmesan in the spaghetti is how one observer described it”.

NZ critical success factors (cont’d)NZ critical success factors (cont’d)

HealthLink spend a lot of effort on demonstrator and beta testing sites.

They also work closely with the physician EMR vendors to debate projects thoroughly at all stages – before during and after implementation.

Many of the HealthLink initiatives were a result of demand of the primary care physicians

e.g. discharge summary from hospitals, radiology test results (DI), orders (still in progress), delivery of claiming data – i.e. responding to market needs

An interesting asideAn interesting aside

At one stage the New Zealand Government spent several millions of dollars on an alternative product “The Health Intranet of New Zealand”.

This failed at the point where they tried to connect the Intranet to General Practice computer systems.

The GPs were very unhappy to let government representative agents touch their computers – making the Health Intranet impossible to implement on the ground.

The government agents had no understanding of how General Practice works

In terms of standards and infrastructure, New Zealand is ahead and NZ-HIT has been used as a model for other countries, including Denmark and Singapore."

19 May 2004

A pediatric cardiology clinic in Auckland NZ supervises babies at home using ISDN videoconferencing  

May 2005

The New Zealand Health Care Experience

GP Uptake of I.T. in New Zealand

0

20

40

60

80

100

1994 1997 2000 2003

Year

Perc

enta

ge o

f GPs GP Computer

Use

EDI NetworkSubscriptions

Clinical Useof Internet

HealthLink increasingly used to assist with chronic disease managementHealthLink increasingly used to assist with chronic disease management

MedicalClaims

PharmacyClaims

LabData

Data Warehouse

ChronicDiseaseRegistry

HealthRisk

Indicators

Risk Stratification& Patient Assignment

INTERVENTIONS

CLINIC/”CENTER OF EXCELLENCE” REFERRALS

MAILINGS & PATIENT EDUCATION

HIGH RISK

LOW &MEDRISK

Automated Disease Management Model

Chronic Disease RegistrySystematic Evaluation of

“Gaps-In-Care” based

Risk AssessmentBased on:UtilizationPharmacy

Lab Scores

All Patient Data Stored onSame Platform

IDENTIFY & SCREENPRIORITIZE & ASSIGN

Automated Disease Management Model

Future State -- The portal is the Key

Workflow Applications

Knowledge Repositories

Information Model

Meta-KnowledgeRepository

CollaborativeKnowledge Authoring

Tools

PortalKnowledge-based Services

So Why Aren’t We There Yet?So Why Aren’t We There Yet?

IBM has not decided to go for it yet?

IBM has not figured out to turn it into the business yet?

IBM has not figured out how to fit the pieces together on the financial side

SO LETS FIGURE IT OUT TODAY

1) IBM finances the portal, translator and IT service to make it happen where we are the large employer, have other large employer friends and have plan support.

Create a EMR and PHR portal for providers and patients

2 IBM establishes the standards

3) IBM charges the payers large employers plans CMS and providers for the service.

Give ourselves a 1 year 18 month time line to build at least ten RHIOS and make a billion or 2.

sell the service to the plans and large employers in the USA and/or to the MOH in AP and EMEA.

Sell it to the docs all over the world at a per month cable fee of say $500 to $800.