Sustainable Personalised Healthcare: New Zealand Initiatives Showcased At Global E-Health Forum
|Wednesday, 07 December 2011|
New Zealand, famed for its pristine landscapes, healthy lifestyle and innovations, is also making significant strides in eHealth, as witnessed at the Global E-Health Forum held in Hamburg from 11-13 October. Chai Chuah, National Director of the New Zealand government’s National Health Board, spoke to around 200 delegates from more than 30 countries about challenges and opportunities in sustainable personalised healthcare.
Chai Chuah is National Director of the National Health Board Business Unit of the New Zealand Ministry of Health. The NHB Business Unit is central to the new model for planning and funding of health services and changes that will have an emphasis on:
• Stronger clinical leadership • Improving quality and safety
• Higher service performance • Improved regional and national decision making, and
• Reducing administrative cost and waste
In his presentation to the Forum, Chai Chuah explained how his country has developed health informatics to drive efficiencies: “New Zealand is committed to protect and improve it’s health system on a sustainable basis and realises that new approaches are required to increase quality cost effectively. We are currently focusing on more clinically led innovative models of care, greater involvement of patients and consumers in designing our future health services, and greater integration of investment in IT, workforce and infrastructure,” he explained.
With a small, geographically dispersed population and remote locations, New Zealand has strong incentives to develop and implement new approaches to healthcare delivery using innovative health technologies. New Zealand’s health system is largely funded through taxation and delivered by a mix of public and private providers. Hospital services are generally provided by public district health boards, while primary and community care is mainly delivered by private providers receiving funding assistance from government.
Over the last 60 years, the increase in funding for health services has outpaced GDP growth. Historically, New Zealand was one of the first countries to introduce (over 20 years ago) a unique patient identifier and has extended the system to include a similar identifier for all health practitioners and organisations. By the end of the last century, there was effectively a 100% uptake of clinical support systems in primary practice.
Particularly respected is New Zealand’s effective integration of care. Health is viewed as a series of continuums:
(a) from patient to primary medicine, community and ancillary care, to the secondary and tertiary sectors;
Key areas of focus where New Zealand providers are attracting major international attention include:
• The use of Shared Care Plans for patients with long term conditions by a patient’s clinical team, ancillary service providers and patients and families. Using a summary care record drawn largely from existing data sources, the care team asynchronously accesses and updates the Care Plan, which is accessible to the patient and nominated family members.
• The integration of primary and secondary services, utilising clinical pathways developed and agreed between specialist and GP communities, involving triaging patients at primary level, and resulting in reductions in referral rates and hospital admissions. This integrated approach is aligned with funding and reward frameworks.
• Regionally held Clinical Data Repositories (CDRs) that record all patient interactions in relation to such aspects as laboratory results, Picture Archiving and Communication System (PACS) and, increasingly, medication history. These CDRs are accessed and updated by primary and secondary providers.
• The application of ‘lean thinking’ principles to improve workflow within hospital environments while taking an integrated view of the patient’s journey.
• At national level, datasets of all patient interactions, national screening programmes, morbidity and mortality data, providing a rich population health research and policy development resource.
From 1994-2008, at an estimated cost of £15m, New Zealand has achieved particular progress in three key areas, namely: (1) a “high level of computerisation, such as laboratory tests, discharge summaries, and outpatients’ letters sent to general practitioners electronically; (2) remote access to laboratory and other reports from any public sector hospital in the country; and (3) patients’ remote access to their GP records”1.
This focus on innovation has resulted in New Zealand’s health sector being recognised internationally as a provider of high quality and cost effective services. For example, a 2009 Commonwealth Fund survey ranks New Zealand first for advanced electronic health information capacity among primary care physicians and second for use of electronic medical records. 2Additionally, a 2010 Commonwealth Fund study ranks New Zealand first in overall quality of care, coordinated care and patient-centred care. 3This is despite the fact that the average spend on health per head of population in New Zealand is about 16% less than in the UK.
New Zealand GPs have the second-highest rate of electronic patient record use, second only to Denmark.
Practice management software is currently estimated to be used in 95 percent of New Zealand general practices.
In New Zealand, 90 percent of primary care physicians and 100 percent of laboratories communicate via secure health data networks every day.
82 percent of New Zealand physicians report that they receive information back for almost all patient referrals to other doctors and/or specialists in comparison to 75 percent in United Kingdom and 37 percent in United States.
New Zealand has a fully specified National Health Index (NHI) system for patients since 1992.
New Zealand’s health expenditure per capita ranks as one of the most cost efficient in OECD country – at US$2,983, it is close to one-third of United States’ health expenditure per capita.
Key eHealth initiatives include opening up online access between hospitals and primary care for emergency care, the roll out of nationwide eReferrals and eDischarges,early work in transferring records between GPs, and eMedication in hospitals and primary care.
Challenges and opportunities with respect to this latest personalised healthcare initiative include:
1. To provide sufficient evidence of sustainable impact on health and fiscal outcomes.
2. To ensure there is integration with other key government health improvement priorities (such as improvement in medication management).
3. To move beyond “another good IT application looking for a problem to solve”.
4. To switch the drive and ownership of this initiative from the clinician to consumers.
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