Part 3: Progress under the strategic steps
3.1
In this Part, we examine the progress the Ministry has made with the sector in using the 4 strategic steps to improve on information management and information technology.
3.2
We conclude that there has been progress under all of the strategic steps and we discuss the main benefits noticed by District Health Boards and Primary Health Organisations. Much of the progress so far has been capability-building towards realisation of longer-term benefits.
Progress on certain initiatives under strategic step 1
3.3
Strategic step 1 involved supporting the priorities reflected in the WAVE Report through work on certain initiatives. We looked at the progress on 7 national initiatives and 1 DHB initiative that were central to enhancing the management and use of health information.
3.4
The national initiatives were:
- setting up HISO;
- preparing ethnicity data protocols;
- setting up the Health Practitioner Index;
- upgrading the National Health Index;
- setting up the National Immunisation Register;
- enhancing the Health Intranet; and
- the Privacy, Authentication, and Security Project.
3.5
The DHB initiative was to improve on DHBs’ ability to exchange electronic discharges and referrals. The 8 initiatives are described further in Figure 1.
3.6
The progress made on these initiatives has included:
- introducing standards;
- upgrading the National Health Index and introducing the Health Practitioner Index;
- building a secure network for exchanging information;
- introducing the National Immunisation Register to track immunisations; and
- improving the ability of DHBs to electronically exchange hospital discharge summaries and referrals with other health providers.
Introduction of standards by the Health Information Standards Organisation
3.7
So far, HISO has endorsed 2 sets of standards, driven or participated in the creation of 3 other sets, and started a wider standards-setting programme.
3.8
The first standards endorsed by HISO were a set of protocols written by the Ministry to facilitate a standardised approach to collecting, recording, and using ethnicity data in the sector. Ethnicity data can be used to improve decision-making to reduce health inequalities for ethnic groups. HISO endorsed the ethnicity data protocols in December 2003, and the Ministry issued them in February 2004.
3.9
The Ministry provided the initial training on the ethnicity data protocols for some DHBs and Primary Health Organisations through a series of Train the Trainer workshops in November 2004. Those trained at the workshops are expected to pass on the training to collectors, recorders, and users of ethnicity data. The Ministry plans to provide ongoing training to the other DHBs and Primary Health Organisations.
3.10
All Primary Health Organisations are required to collect information on the ethnicity of their patients. DHBs and Primary Health Organisations have agreed on a national target – accurately stated ethnicity data for 95% of the enrolled population of a Primary Health Organisation. Not all Primary Health Organisations meet the target yet but progress is being made. For example, in 2003, 10.6% of the records in the National Health Index database had no ethnicity stated or the ethnicity recorded as “other”. In 2005 the figure had decreased to 6.9%.
3.11
To gauge the effectiveness of the protocols, the Ministry is designing a framework to assess the quality of ethnicity data sent to national collections. This will include providing feedback to DHBs, Primary Health Organisations, and the Ministry’s Executive Team. HISO is also surveying the sector to gauge how well the protocols are used, and what training is needed to support their implementation.
3.12
As well as endorsing the ethnicity data protocols, HISO has:
- endorsed international standards for electronic messages containing health information as standards for health messaging in New Zealand;
- driven the preparation of, and endorsed, standards for data to be held in a new database of health practitioners (the Health Practitioner Index);
- driven the preparation of, and approved, standards for ordering and reporting the results of pathology tests; and
- participated in the joint preparation and publication of a set of standards for primary care practice management systems with Standards New Zealand.
3.13
HISO has a full work programme ahead, including work on standards for electronic hospital discharge summaries and referrals, and a set of standards for interactive communication between general practitioners’ practice management systems and external services. Notably, in December 2004, HISO organised a summit attracting representatives from throughout the sector as part of work to facilitate setting standards for electronic hospital discharge summaries and referrals.
Upgrading the National Health Index and introducing the Health Practitioner Index
3.14
Patient care is complex and patients typically receive health services from a wide variety of health practitioners in different settings. Important information relating to individual patients is often held in a number of independent clinical information systems, such as those operated by general practitioners, pharmacies, laboratories, and hospitals.
3.15
Since the WAVE Report was published, the Ministry has made progress with 2 key databases for identifying patients and health practitioners – the National Health Index and the Health Practitioner Index. The databases enable patients to be accurately identified for treatment purposes and information relevant to an individual patient’s care to be shared between health practitioners in a controlled way.
3.16
In upgrading the National Health Index and setting up the Health Practitioner Index, the Ministry has undertaken assessments to make sure that individual privacy is protected in assigning and using these identifiers, consistent with the provisions of the Privacy Act 1993.
National Health Index
3.17
The National Health Index is a database of information associated with a unique identifying number (an NHI number) that should be assigned to each person using health and disability services in New Zealand. Health practitioners have been using NHI numbers for more than 20 years.
3.18
The National Health Index does not record information about an individual’s health. Details on record include the person’s name, address, date of birth, sex, New Zealand resident status, and ethnicity. All the information associated with the NHI number is designed to accurately identify individuals receiving treatment and link them with their medical records.
3.19
Problems have occurred, and the National Health Index has been upgraded in some areas from time to time. In March 2003, the Ministry began a programme to upgrade the National Health Index and address issues such as:
- patients being registered more than once on the National Health Index and having duplicate NHI numbers;
- no online primary care access; and
- limited public awareness about the National Health Index and its purpose.
3.20
The upgrade has included:
- a 12-month programme to resolve duplication, which identified more than 125,000 duplicate NHI numbers within the 7 million records;
- the addition of new information to help identify individuals, such as place of birth, address history, and ethnicity history1;
- an improved online search engine to enable more accurate searching for individuals on the National Health Index;
- web-based application, known as NOAH (NHI Online Access for Health), allowing read-only access to the National Health Index from the computer of an authorised provider (for example, a general practitioner);
- new software for more efficient management of the National Health Index through linking and unlinking records;
- a training programme for National Health Index users delivered to some DHBs and Primary Health Organisations at the same time as the training in ethnicity data protocols through a series of Train the Trainer workshops; and
- a public awareness campaign, including a brochure and poster approved by a consumer advisory group and distributed to all general practitioner and hospital waiting areas, material for Primary Health Organisations, and information on the Ministry’s website.
3.21
As well as these improvements to the National Health Index, DHBs and Primary Health Organisations have agreed on a national target that 70% of a Primary Health Organisation’s enrolled population have an NHI number. Counties Manukau DHB has achieved a 90% target.
Health Practitioner Index
3.22
A national database of health practitioners’ details has been a priority for the sector for more than 2 decades. In response, the Ministry has recently set up the Health Practitioner Index.
3.23
The Health Practitioner Index is a national system for holding information about health practitioners and non-practitioners (for example, hospital admission clerks and medical centre practice managers) who handle health information. It will hold information such as the practitioner’s identifying number, name, practising status, qualifications, and scope of practice. The Health Practitioner Index will also hold details of organisations providing health services, and the location of facilities from which services are provided.
3.24
The Health Practitioner Index is a tool to enable appropriate linking of health sector people with each other and with health information, and for controlling which practitioners are authorised to access which information. For example, when the Health Practitioner Index is fully set up, a doctor involved in the care of a particular patient might be able to access certain information about that patient’s care, but another type of health professional such as a physiotherapist may not have the authority to see the same information.
3.25
Initial work on the Health Practitioner Index is complete. It is being progressively populated with data and made available to DHBs and other organisations within the sector.
Building a secure network for sharing information
3.26
The Ministry has been working on a Health Intranet to facilitate secure, interactive exchange of information between health providers, and to help with the delivery of integrated health services.
3.27
The Health Intranet originated in South Auckland around 1998. It was a network connecting local general practitioners and hospital clinicians, and let them access Ministry systems such as the National Health Index. It was expanded and went “live” in November 1999. The first users included the 4 largest DHBs, and general practitioner groups in South Auckland and Christchurch.
3.28
In 1999, the New Zealand Health Information Service established a governance body, the Health Intranet – now Health Network – Governance Board (Governance Board). As of April 2003 (the latest figures available), there were 131 users of the Health Intranet, including all 21 DHBs, some general practitioners, and a range of other health providers.
3.29
In May 2003, the Governance Board approved a connection enabling access to the Health Intranet from a separate secure messaging system used by most general practitioners.
3.30
Primary Health Organisations also use the Health Intranet to share funding information with the Ministry.
3.31
The Governance Board is responsible for policies and procedures, and ongoing review and management of security, communication, and user authentication standards.
3.32
In 2002, the Ministry commissioned Standards New Zealand to prepare and publish a Health Network Code of Practice on exchanging electronic health information over a secure network. The Governance Board subsequently adopted this code of practice, and prepared security policies for users and standards for service providers.
3.33
Health sector users of applications such as Health Payments, Agreements and Compliance (part of the Ministry), and Accident Compensation Corporation claims systems, which can be accessed through the Health Intranet and other network connections, must have a digital certificate. This is an electronic “passport” that establishes a user’s credentials and is used for security purposes. For example, a digital certificate is used to verify that a user sending a message is who they claim to be. More than 3000 digital certificates have been issued, covering a large proportion of the sector. Digital certificates are available free to those wishing to join the Health Intranet, and the Ministry is looking at ways of expanding the use of digital certificates.
3.34
The Ministry is also using a Privacy, Authentication, and Security Project to prepare a set of codes of practice, guidelines, and standards that are fundamental to ensuring appropriate safeguards continue to apply to the electronic exchange of health information. This will consolidate and build on existing safeguards such as the Health Network Code of Practice, and the Governance Board’s policies and standards.
Building capability to track immunisations
3.35
In 1995, the national Immunisation Strategy proposed a national immunisation system that would address some of the reasons for poor immunisation coverage. A subsequent report by the National Health Committee in 1999 recommended a package of measures to improve immunisation coverage, including setting up a database of immunisations.
3.36
The National Immunisation Register was introduced in July 2004 as part of a national immunisation project to provide accurate data on a child’s immunisation status, and information on local, regional, and national immunisation coverage. The register was initially used to track Meningococcal B vaccinations and is now being expanded to record other childhood vaccinations. Using the register, general practitioners receive information on the immunisation status of patients direct to their desktop computers. The National Health Index number is included on the register.
Building capability for electronic exchange of hospital discharge summaries and referrals
3.37
Our survey showed that the majority of DHBs have given high to medium priority to improving their information management and information technology since the WAVE Report was published. Priorities have included the capability of hospitals to electronically notify general practitioners of patient discharges, and for practitioners to electronically refer patients for treatment.
3.38
The sector uses a Referral, Status Report, and Discharge Summary system for exchanging these types of electronic messages. The number of messages exchanged using this system grew from around 80,000 a month to 150,000 a month between July 2004 and September 2005. DHBs are the main users of the delivery system for electronic discharge summaries, and use is also growing among accident and medical centres, general practitioners, and specialist practitioners.
3.39
Some DHBs have been using this system for several years to electronically send hospital discharge summaries. Some are extending their existing capability. For example, Counties Manukau DHB notifies general practitioners within 40 minutes of their patients being discharged. Other DHBs cannot yet send hospital discharge summaries electronically, but several are introducing the service, or plan to in the next few years with their new clinical information and patient management systems.
3.40
Referrals are more complex, and no DHB has in place yet a fully-functioning referrals management system capable of connecting to the messaging system. Several DHBs have systems planned and expect to implement them soon.
Progress on sector planning frameworks under strategic step 2
3.41
Strategic step 2 involved preparing and implementing planning frameworks to co-ordinate and align the sector’s improvements in information management and information technology.
3.42
The Ministry has sought to co-ordinate and align DHBs’ plans for information management and information technology.
Introducing Information System Strategic Plans using a common framework
3.43
A national Information System Strategic Plan (ISSP) framework has been prepared by the Ministry and agreed collectively with the DHBs’ Chief Information Officers. Under the framework, published in April 2003, the objectives of ISSPs produced by all DHBs are to:
- link implementation of systems to business objectives;
- schedule implementation of systems to match business priorities and budgets; and
- make better strategic use of information management capabilities.
3.44
Using the framework, ISSPs are to be prepared and updated in parallel with annual plans, and are to be approved by the Ministry. In August to September 2004, the Ministry commissioned a review of DHBs’ first ISSPs by an independent consultant with knowledge of health information management and DHB information technology planning. This review concluded positively on the ISSPs for all DHBs, indicating they were making progress in better planning for improvements to their information systems. Figure 6 summarises the conclusions from the review, the most common areas of strength and areas where ISSPs could be improved.
Figure 6
The Ministry of Health’s analysis of District Health Boards’ first Information System Strategic Plans
| Conclusion from review | No. of DHB ISSPs* |
|---|---|
| Good/excellent basis on which to build an annual Information System strategic planning cycle | 8 |
| Useful document in guiding developments at DHBs | 5 |
| Excellent basis for further alignment and development in the coming year | 3 |
| Clear programme of development for hospital provider services/DHB | 2 |
| Sets out a clear strategic path for the development of Information Systems in the DHB | 1 |
| Areas of strength in DHB ISSPs | No. of DHB ISSPs* |
| Analysis of the strategic environment | 18 |
| Consistency between District Annual Plans and ISSPs | 14 |
| Commitment to regional collaboration | 14 |
| Management principles to guide developments | 13 |
| Coverage of needs of primary care | 7 |
| Areas where DHB ISSPs could be improved | No. of DHB ISSPs* |
| Governance arrangements for information systems, particularly obtaining and sustaining executive and clinician support | 15 |
| Work to support national systems, for example, the National Health Index upgrade and the Health Practitioner Index | 11 |
Focus on information systems associated with primary care organisations
|
11 |
| Information on how an ISSP is to be funded | 11 |
| Rationale for project selection | 10 |
* Out of a total of 21 DHBs.
Indicators of progress included in DHB annual plans
3.45
Since they were established in 2001-02, every DHB has had to prepare an annual plan setting out priorities for delivering health services to meet the needs of the populations they serve. These annual plans include objectives and key performance indicators agreed with the Ministry.
3.46
In 2003-04 and 2004-05, the annual plans included a common set of key performance indicators on progress made to implement some of the recommendations of the WAVE Report. DHBs were to report every 6 months against these indicators. Figure 7 summarises our analysis of the main activities reported by DHBs against the key performance indicators.
Figure 7
Progress reported by District Health Boards against key performance indicators
| 2003-04 and 2004-05 | |
|---|---|
| Key performance indicator | A qualitative report on progress towards improving online access to clinical knowledge bases and clinical guidelines or protocols. |
| Reported activities | Almost all DHBs reported that hospital clinicians had access to clinical knowledge databases, guidelines and protocols to varying extents, mostly through local intranets and Internet connections. Some DHBs reported that they had, or were in the process of extending, access to primary sector clinical staff . |
| Key performance indicator | A qualitative report on progress made towards implementing an electronic referral letter and hospital discharge summary notification functionality between hospital and general practitioners. |
| Reported activities | DHBs are at different stages in their ability to send hospital discharge summaries electronically. Some have been able to do this for several years or are extending existing capability. Several are introducing the service or plan to in the next few years with their new clinical information and patient management systems. Referrals are more complex, and no DHB yet has in place a fully functioning electronic referrals management system. Several DHBs have electronic referral systems under way and expect to implement them soon. |
| 2004-05 | |
| Key performance indicator | A qualitative report on progress towards increasing the number of general practitioners using electronic prescribing. |
| Reported activities | Many DHBs reported that their practices had the capability to generate and send prescriptions electronically using Practice Management Systems. While many practices generated prescriptions electronically, none sent them electronically. Some DHBs reported legislative constraints such as prescriptions requiring a signature. |
| Key performance indicator | A qualitative report on progress towards increasing the number of general practitioners using electronic laboratory test ordering and receiving electronic laboratory results. |
| Reported activities | Most DHBs reported that all or most of their practices received laboratory results electronically, sometimes downloaded directly to practice management systems. Few DHBs reported practices ordering laboratory tests electronically, although some noted that practice management systems had this functionality and they were looking into using it by setting up electronic ordering systems. Some DHBs also noted that standards for laboratory test coding were required. |
| 2005-06 | |
| Key performance indicator | A qualitative report on progress towards implementation of the 12 Health Information Strategy for New Zealand 2005 Action Zones (see paragraphs 3.51 and 3.52) that the DHB’s ISSP has scheduled for the 2005-06 year. |
| Reported activities | DHBs are to report on these measures quarterly. |
Progress on sector stewardship arrangements under strategic step 3
3.47
A number of stewardship groups have been set up within the sector to make sure that the sector’s information management and information technology activities are appropriately overseen and guided by the interests of sector stakeholders. Some of the main Ministry, DHB, primary care/practitioner, and industry groups, and their purposes, are shown in Figure 8. The Figure includes national and regional groups to co-ordinate capital investment in information systems.
3.48
There are many groups that need to work together effectively for the stewardship arrangements to function as they were intended to. We note that the stewardship arrangements are still evolving as the various groups mature and become more effective in linking and working together. For example, the DHB New Zealand Information Group was set up to provide better links between the DHB Chief Information Officer forum and the DHB Chief Executive Officer group.
Figure 8
Overview of sector stewardship arrangements
| Ministerial Committee | |
|---|---|
| Health Information Strategy Action Committee | Provides, governance, oversight, and leadership of the sector
in implementing the Health Information Strategy for New
Zealand 2005. Three sub-committees responsible for infrastructure (including privacy, authentication, and security); health information standards (including continuing work on standards under the name of HISO); and national data collections. |
| Ministry of Health groups | |
| Information Liaison Group | Manages changes to the administration, payment and information support systems that the Ministry provides for DHBs under a national agreement. Provides input to the Ministry’s short-term information projects. Supported by regional DHB analyst sub-groups. |
| National Capital Committee | Advises on capital investment within the sector. The Minister must approve all information system investments more than $3 million. Supported by Regional Capital Groups, which must support investments more than $500,000. The Director-General of Health must approve investments between $500,000 and $3 million. |
| Ministry-Accident Compensation Corporation Information Group | Facilitates collaboration between the Ministry and the Accident Compensation Corporation on improvement and investment activity within the health and disability sector. |
| The Primary Care Practice Management System (PMS) Vendor Forum | Provides liaison between the Ministry and the sector for changes in primary care systems. |
| Health Network Governance Board | Sets standards and oversees the operation of the Health Intranet network. |
| District Health Board groups | |
| DHB New Zealand’s DHB CEO–Ministry Deputy Director-General Group | Co-ordinates collaborative discussion between DHBs and the Ministry on national issues and policy decisions. |
| DHB New Zealand’s Information Group | Provides oversight and advice for DHB Chief Executive Officers on information. Directs the efforts of Chief Information Officers and other relevant groups. Streamlines information efforts and investment. Provides a mechanism for external groups to engage with DHBs collectively. |
| DHB Chief Information Officer Forum | Advises the DHB New Zealand Information Group on information strategy. |
| Privacy Officers Forum | Promotes a uniform approach to implementing Privacy legislation. |
| The National Service Improvement Group | Provides guidance for DHBs on national service improvement initiatives. |
| Primary care/practitioner groups | |
| The Independent Practitioner Association Council (IPAC) | Provides input to information management and technology issues on behalf of IPAC membership (IPAs and Primary Health Organisations). |
| Strategic Information Group | Seeks to build relationships and promote primary care engagement in information management activity. |
| The Primary Care Information Managers Group | An informal group including general practice and Primary Health Organisation managers for trouble-shooting primary care information management issues, sharing knowledge, and improving sector relationships. |
| The Royal New Zealand College of General Practitioners Information Technology Working Party | Meets periodically to identify key practice management system and medical communication issues from a general practitioner and general practice perspective. |
| Industry groups | |
| New Zealand Health IT Cluster Incorporated | To represent the interest of the New Zealand Healthcare Technology industry in uniting with hospitals and health providers, research, development and manufacturing groups. |
| Health Informatics NZ (HINZ) | A national, not-for-profi t organisation whose focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. |
| NZ Health Level 7 User Group (NZHUG) | A national forum dedicated to the achievement of interoperability in health services information systems. It is focused on the evolving HL7 International Standard, but not limited to it. |
Progress on refreshing and implementing the sector’s strategy for information management and information technology under strategic step 4
3.49
The Ministry told us the sector is about 5 years along a 20-year path to reach fully integrated health information management and information technology capability (see Figure 9).
Figure 9
Path to integrated health information management and information technology
3.50
The Ministry recognises that the sector, as well as increasing its technical capability, must continue to enhance the capability of its people, business processes, and culture. The Ministry has designed a new health information strategy to achieve this.
The Health Information Strategy for New Zealand 2005 provides a framework for consolidated sector action
3.51
The Health Information Strategy for New Zealand 2005 was compiled by a sector steering committee supported by the Ministry, and published in August 2005. The strategy takes stock of the sector’s information management and information technology capability, and provides a framework for consolidating action to continue to improve it.
3.52
In our view, the Health Information Strategy for New Zealand 2005 builds on the WAVE Report by setting 12 information management and information technology priorities (known as “Action Zones”) for the sector to focus on in implementation planning in the next 3 to 5 years. The Action Zones reflect many of the priorities in the WAVE Report (see Figure 10) and others that have become more prominent since the report was published. The strategy outlines how these priorities will continue to be addressed.
Figure 10
The Health Information Strategy for New Zealand 2005 Action Zones and priorities from the WAVE Report
| Action Zone* | Description | WAVE Report priority taken forward |
|---|---|---|
| National network strategy | To improve the quality and speed of sector communications | Make integrated care work by developing standards for data exchange, security and network infrastructure |
| National Health Index promotion | To improve National Health Index data quality and accessibility, helping more parts of the sector to connect together using the index as an identifier | Fix up the National Health Index |
| National Provider Index implementation | To implement identifiers that can be used for consistently referencing practitioners, agencies and facilities in the health and disability sector, supporting communication of health information and collaboration in a secure and trusted manner | Implement the National** Provider Index |
| e-Pharmacy | To enable prescribing clinicians to monitor and track the dispensing of medications they prescribe and ultimately prescribe medications electronically | Fix up pharmacy and laboratory data |
| e-Labs | To enable diagnostic tests to be electronically ordered, and then monitored and tracked from the point of ordering to reviewing results | |
| Hospital discharge summaries | To expand the network of providers that hospitals send summaries to (for example, to residential care providers), and extend summaries to include outpatient visits and ultimately community services | Sort out Health Event Summaries |
| Electronic referrals | To agree a standard minimum data set for referrals between providers | |
| National primary and community care collection | To improve the available national and regional information on effectiveness and use of primary and community care services | Gather primary care information |
| National system access | To improve access to national data collections on the activity and effectiveness of health and disability services and the well-being of New Zealanders | Launch health portal |
| Chronic care and disease management | To increase the capability for information systems to provide decision support for the management of chronic conditions at local, regional, and national levels, initially focusing on diabetes and cardiovascular disease | These Action Zones build on other areas highlighted in the WAVE Report |
| National outpatient collection | To put in place a national collection system for hospital outpatient data | |
| Anchoring framework | To prepare a framework for a national data dictionary, providing a common language for sharing and analysing information electronically (for example, comparing the relative effectiveness of different treatment patterns for cardiovascular disease) |
* From the Health Information Strategy for New Zealand 2005.
** Now the Health Practitioner Index.
3.53
The Health Information Strategy for New Zealand 2005 proposes an evolutionary approach to setting up an electronic health record distributed at local, regional, and national levels, with the most detailed information about a patient kept locally. It focuses on the communication and connectivity required for the sector to use and share this information effectively to deliver better health outcomes.
3.54
Parts of the sector with less capability will need support while the more capable parts of the sector continue to evolve. To this end, the Health Information Strategy for New Zealand 2005 sets broad benchmarks for improving on information-sharing capability in different parts of the sector.
The Health Information Strategy Action Committee will provide governance, oversight, and leadership
3.55
The Health Information Strategy for New Zealand 2005 recognises that clear governance will be needed to keep the strategy on track. It proposes that a governance group be established to fulfil this function.
3.56
The Minister for Health has done this by revising the role of HISO in August 2005 and renaming it the Health Information Strategy Action Committee.
3.57
The role of the Health Information Strategy Action Committee is to provide governance, oversight, and leadership of the sector in implementing the Health Information Strategy for New Zealand 2005. In doing so, among other tasks, the Health Information Strategy Action Committee has the task of ensuring sector ownership and responsibility for the strategy, ensuring transparency and co-ordination of implementation, and reviewing and auditing progress.
3.58
The Health Information Strategy Action Committee has 3 sub-committees responsible for:
- infrastructure (including privacy, authentication, and security);
- health information standards (including continuing work on standards under the name of HISO); and
- national data collections.
Main benefits noticed by District Health Boards and Primary Health Organisations
3.59
Through our survey, we asked DHBs and Primary Health Organisations to what extent the strategic steps taken by the Ministry had helped with improvements to their information management and information technology. We also asked them about the extent to which specific initiatives had improved their use of information.
District Health Boards – co-ordination has improved, although there is room for further improvement
3.60
Most DHBs believed that the strategic steps taken by the Ministry had helped with their information management and information technology to some extent. Over all DHBs, sector stewardship arrangements have been slightly more beneficial than sector planning frameworks (see Figure 11). Most DHBs believed that the strategic steps, especially sector stewardship arrangements, had improved co-ordination (see Figure 12), although most (16 out of 21) also believed that DHB information management and information technology enhancements could be better co-ordinated.
Figure 11
Usefulness of sector stewardship arrangements and sector planning frameworks
DHBs believe that sector stewardship arrangements have been slightly more beneficial than sector planning frameworks
Figure 12
Usefulness of the strategic steps
Most DHBs believe that the strategic steps have improved co-ordination, especially sector stewardship arrangements
3.61
As an indication of improved co-ordination at DHB level, 14 out of 21 Information System Strategic Plans indicated a commitment to regional collaboration. Three DHBs – Auckland, Counties Manukau, and Waitemata – have formed the Auckland Alliance, which has produced a regional Information System Strategic Plan. There are also other examples of collaboration emerging; for example, between West Coast, Southland, and Otago DHBs, who have formed SouthernALLIANCE.
3.62
To help promote co-ordination, DHBs are required to demonstrate that they have considered collaboration when investing in information system enhancements. For capital expenditure on information systems worth more than $500,000, a regional capital expenditure group must support the business case.
3.63
Our survey showed that the strategic steps taken by the Ministry had fewer benefits for Primary Health Organisations. Most of the Primary Health Organisations that responded believed there had been hardly any benefit to their information management and information technology from the strategic steps. Most Primary Health Organisations did not believe that the strategic steps had improved co-ordination, and most (94%) believed that enhancements were not adequately co-ordinated for them.
Specific initiatives have yielded some early benefits, but the benefits of others are yet to be seen
3.64
About two-thirds of DHBs (13 out of 20) and slightly more than half (53%) of the Primary Health Organisations that responded to our survey believed that electronic information use in patient treatment had improved because of the initiatives we examined.
3.65
We asked DHBs (see Figure 13) and Primary Health Organisations (see Figure 14) about the extent to which each initiative had improved their use of information.
Specific initiatives have yielded some early benefits
3.66
Most DHBs and most of the Primary Health Organisations that responded to our survey believed that the National Health Index upgrade had noticeably improved information use and become a more reliable and useful patient identifier. Benefits cited by specific DHBs and Primary Health Organisations included increased access to the National Health Index, and improved assignment of NHI numbers through more reliable searching of the database, and therefore fewer duplicates.
3.67
National statistics show that the rate of creation of duplicate NHI numbers throughout all DHBs has reduced significantly since the beginning of 2003 (see Figure 15).
Figure 13
Extent to which initiatives have improved information use for District Health
Boards
Some initiatives have improved use of information noticeably more than others
Figure 14
Extent to which initiatives have improved information use for Primary Health
Organisations
Ethnicity data protocols and the National Health Index have improved the Primary Health Organisations’ use of information much more than other initiatives
Figure 15
Duplicate National Health Index numbers throughout District Health Boards
The rate of creation of duplicate National Health Index numbers throughout all District Health Boards has reduced significantly since the beginning of 2003
3.68
There was a noticeable drop in the duplication of NHI numbers in July 2003, at the beginning of the first full year that most Primary Health Organisations were operational. Around this time, the Ministry’s National Health Index contact centre updated its methods for helping practices identify whether patients had existing NHI numbers. The duplicate reduction exercise under the National Health Index upgrade programme was also ongoing.
3.69
Most DHBs believed that enhancing the Health Intranet and setting up the National Immunisation Register had noticeably improved their information use.
3.70
There are pockets where the Health Intranet has been set up as a vital tool for exchanging information. For example, in South Auckland where it originated, it is used by a small group of general practitioners to access Ministry services such as the National Health Index, hospital services such as cardiology and radiography (with electrocardiographs and X-rays available online), and other local services such as laboratory results.
3.71
Benefits of the Health Intranet cited by other DHBs included secure access to payment information and national frameworks, and improved connectivity.
3.72
Around half of the DHBs and most of the Primary Health Organisations that responded to our survey believed that the ethnicity data protocols issued by the Ministry had noticeably improved information use. Benefits cited by specific Primary Health Organisations included improved data collection. Around half of the DHBs also believed that extending their ability to electronically share discharges and referrals had noticeably improved their information use, and 8 reported that the number of hospital discharges they sent electronically had increased.
The benefits of some initiatives had yet to be seen, particularly by Primary Health Organisations
3.73
The benefits of other initiatives had not yet been seen by DHBs and Primary Health Organisations. Most DHBs and most of the Primary Health Organisations that responded believed that setting up HISO and the Health Practitioner Index, and the Privacy, Authentication, and Security Project had hardly improved their information use at all. For the Health Practitioner Index and the Privacy, Authentication, and Security Project, this was understandable as they had yet to reach most DHBs and Primary Health Organisations.
3.74
Most of the PHOs that responded to our survey had also yet to see noticeable benefits from the Health Intranet and extending electronic discharges and referrals. The National Immunisation Register had also not yet noticeably improved information use for most of the Primary Health Organisations that responded, although when we conducted our survey they were only just gaining access to it.
3.75
Notwithstanding the results of our survey, the Ministry told us that the sector was on the way to achieving improved health outcomes facilitated by information technology in primary care. We accept that that there were signs that the use of electronic information at primary care level is increasing. For example:
- the use of electronic messaging for exchanging hospital discharges summaries, patient status reports and referrals is growing (see paragraph 3.38);
- when using the National Immunisation Register, general practitioners receive information on the immunisation status of patients direct to their desktop computers (see paragraph 3.36);
- DHBs report that all or most of their practices receive laboratory results electronically, sometimes downloaded directly to practice management systems (see Figure 7); and
- in March 2005, the Accident Compensation Corporation launched an incentive package paying general practices to lodge claim forms using broadband Internet access. This has led to more practices subscribing to broadband and an increase in the proportion of claim forms lodged electronically to 71% in November 2005, up from 55% at about the same time in 2004.
1: Opening address by the Minister of Health at the launch of the WAVE Report, 29 October 2001.
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