quality powered by information

Coverage

• 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 PPP3

Where we have come from

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

In the last 18 months, Patients First has delivered or is well down the path of delivery on:

Fit with Health IT Plan

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Ackoff – path to wisdom

6

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• Training• Professional developmentPractitioner

• Aiming for Excellence• CornerstonePractice

• BSMC, IFHC• Must share common languageNetwork

• National Standards• Health TargetsNational

Building on Strengths 2Quality at four levels & the opportunity of networks

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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Export

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Steps:•Process Request (Send)•Encrypted CDA document created

component><section><templateId root=" 2.16.840.1.113883.2.18.7.2.1/><code code="46240-8" codeSystem="2.16.840.1.113883.6.1"/><title>Encounters</title><text><table><thead><tr><th>Encounter</th></tr></thead><tbody><tr><td><content ID="enc1">Checkup Examination</content></td></tr><tr><td><content ID="enc2">Further examination</content></td></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"/></participantRole></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">

<value xsi:type="CE" code="32398004" codeSystem="2.16.840.1.113883.6.96" displayName="Bronchitis"/>

</observation></entryRelationship></encounter></entry></section></component>

component><section><templateId root=" 2.16.840.1.113883.2.18.7.2.1/><code code="46240-8" codeSystem="2.16.840.1.113883.6.1"/><title>Encounters</title><text><table><thead><tr><th>Encounter</th></tr></thead><tbody><tr><td><content ID="enc1">Checkup Examination</content></td></tr><tr><td><content ID="enc2">Further examination</content></td></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"/></participantRole></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">

<value xsi:type="CE" code="32398004" codeSystem="2.16.840.1.113883.6.96" displayName="Bronchitis"/>

</observation></entryRelationship></encounter></entry></section></component>

Import

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Steps:1 - PMS:

• Import message into mail • Create Acknowledgement• Match Patient• Match Practitioner• Create Task• Present Mail to Practitioner

Steps:2 - Practitioner:

• Confirm patient match• Present items to import Problem list,

Medications and alerts• Present items that exist in Problem list,

Medications and Alerts• Select items to import• Import selected items and all encounters

excluding duplicates• Complete Task• View file in human readable form• Print File

Screenshots

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• New Menu item:

• Tools/Patient/Export to GP

• Upon selection display the following

screen:

Step Four:Out Box Validates document, Encrypts & CertificatesTransmits to Msg Service

GP2GP Workflow

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HL7/CDA Construct

Step Two:Extracts Patient File data from system in preparation for CDA Construct

Step Three:CDA build, HL7 wrapper,Visual check,Places in Out Box

Step Five:File arrives in In BoxCertificate checkedFile decrypted and validated, ready for import

Messaging Service

Messaging Service:Store and forward,Validates address,Routes message

Step Six:Strip HL7Visual checkDeconstruct CDA,Provide data to PMS for action

Step Seven:Populate PMS with structured data,Acknowledge transfer.

Dr Evans @ New Practice

Out Box In Box

HL7/CDA De-

Construct

Dr Anderton @ Old Practice

Step One:Mr Burnett, patient, enrols at new practice and gives authority to Request the file from Old Practice

Step 8:Final Acknowledgement

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 ServiceNZePS

NZePS Schematic

Rx

Rx

Rx

Rx

Simpl Health Information Exchange (Broker)

Simpl Health InformationExchange Portal

DispensingSystem

Software

PrescribingSystem

Software

Patient / Dr

Consultation

Data Repository& Access Services

Sim

pl H

IE A

dapt

er

Clinicians without systems

Internet Browser

Pharmacists

Simpl HIE Adapter

Simpl HIE Adapter

Sim

pl H

IE A

dapt

er

NZePS Workflow

GP Software(HIE Enabled)

Patient Patient

Pharmacy Software

(HIE Enabled)

HIEThe ePrescription is Stored, encrypted

and stored in the HIE repository

HIE Scenario DiagramProcesses 1- 3

Create Prescription, Dispense, and Record

5Pharmacy software

retrieves the ePrescription

6Pharmacist sends the Dispensed

ePrescription

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.

The paper script is

handed to the patient

1

GP Creates the e-Prescription

2

3The patient gives the

paper script to the

pharmacist

4The pharmacist

scans bar code on the paper script

(the ‘SCID’)

Adapter Performs:Encryption

Authentication / Authorisation

Comms/TransportSCID Generation

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 FishA universal translator

Imagine

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HL7

CDAPMS

GP2GP

eReferral

ePrescribeeRadiologyeLaboratory

Island BayMedical Centre

Karori Medical Centre

WellingtonHospital

eDischargeWellington

Hospital

NZePSPrescription

Broker

Pacific Radiology

Aotea Pathology

Health Quality Measures NZ

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www.patientsfirst.org.nz/hqml

Acknowledgements

Patients First - Governance• RNZCGP, GPNZ, National Health IT Board, Ministry of Health , Health Quality and Safety Commission, Pharmaceutical Society of New

Zealand

Expert Advisory Group - HQML• 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– Sapere, RNZCGP, GPNZ, PPP, Wellington School of Medicine, Compass Health, Karo Data Management

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Collaborative and Cross-secto

r

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