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GP 2 GP A case study in practical inter-operability Patients First 01 September 2011 GP 2 GP A case study in practical inter-operability Patients First 01 September 2011 Andrew. [email protected] org. nz andre. [email protected] org. nz

Coverage Patients First GP 2 GP – what it is Modules Workflow What it Coverage Patients First GP 2 GP – what it is Modules Workflow What it is not Lessons Next Steps 2

Doctors Use Electronic Patient Medical Records in Their Practice, 2006 and 2009* Percent * Doctors Use Electronic Patient Medical Records in Their Practice, 2006 and 2009* Percent * 2006: “Do you currently use electronic patient medical records in your practice? ” * 2009: “Do you use electronic patient medical records in your practice (not including billing systems)? ” Source: 2006 and 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 3

Practices with Advanced Electronic Health Information Capacity Percent reporting at least 9 of 14 Practices with Advanced Electronic Health Information Capacity Percent reporting at least 9 of 14 clinical IT functions* * Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test results, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test results, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests or preventive care. Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 4

Patients First Programme Quality powered by information Originally qi 4 gp – now primary Patients First Programme Quality powered by information Originally qi 4 gp – now primary care focussed Partnership with the RNZCGP and the NHITB Broader governance including HQSC, Mo. H BSMC Team and Pharmaceutical Society e. Continuum of Care projects (GP 2 GP, e. DS, NZe. PS) Leadership, HQMNZ, PMS Requirements Synergy with e. Medicines Programme and PPP 5

GP 2 GP - What is it? Electronic transfer of a patient’s full medical GP 2 GP - 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 HL 7 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 6

Modules Demographics Encounters 3 3 Regular Medications (Profile) 3 Medication History Problems Alerts/Allergies Warnings Modules Demographics Encounters 3 3 Regular Medications (Profile) 3 Medication History Problems Alerts/Allergies Warnings Procedures Vitals Family History Soc History Payers 3 3 3 2 3 3 3 7

Modules Immunisations Diagnostic Reports Advance Directives Functional Status Medical Equipment Care Plans Correspondence Treatment Modules Immunisations Diagnostic Reports Advance Directives Functional Status Medical Equipment Care Plans Correspondence Treatment Plan 3 3 3 2 2 3 3 2 Diagnostic Requests (Orders) 2 Additional Demographics Encryption Module 3 8

Step One: GP 2 GP Workflow Dr Anderton @ Old Practice Step 8: Final Step One: GP 2 GP Workflow Dr Anderton @ Old Practice Step 8: Final Acknowledgement HL 7/CDA Construct Step Two: Extracts Patient File data from system in preparation for CDA Construct Mr Burnett, patient, enrols at new practice and gives authority to Request the file from Old Practice Step Three: CDA build, HL 7 wrapper, Visual check, Places in Out Box HL 7/CDA De. Construct Step Four: Out Box Validates document, Encrypts & Certificates Transmits to Msg Service Out Box Dr Evans @ New Practice Step Six: In Box Step Seven: Strip HL 7 Populate PMS with Visual check structured data, Deconstruct CDA, Acknowledge transfer. Provide data to PMS for action 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 9

GP 2 GP – What it isn’t? A partial export of a patients file GP 2 GP – 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… 10

Health System Benefits Initial inter-operability dataset for development into a standard Common GP 2 Health System Benefits Initial inter-operability dataset for development into a standard Common GP 2 GP CDA Document for inclusion in the central library of sector CDA documents Universal translator (Babel Fish) between systems GP 2 GP Standard, foundation for other e-Initiatives e. DS, NZe. PS Obligation between health system vendors to inter-operate Hosted test environment with current versions of participating PMS software for self accreditation Non-GP 2 GP functions eg. export to PDF or memory stick, unencrypted, at patient request. 11

GP 2 GP – What it isn’t? A partial export of a patients file GP 2 GP – 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… 12

GP 2 GP – leveraged project What the project leveraged § PPP test environment GP 2 GP – leveraged project What the project leveraged § PPP test environment and resources § The Toolkit (developed once, used by all) § PCIMG as the advisory group 13

Scope – original, inherited, adapted Content, structure and transport Removed connected health from the Scope – original, inherited, adapted Content, structure and transport Removed connected health from the scope – agnostic to transport mechanism as long as secure/encrypted Reviewed content – not rich enough, added to – became 25 elements 14

GP 2 GP mon th 7 7 8 8 8 day 11 15 5 GP 2 GP mon th 7 7 8 8 8 day 11 15 5 8 9 11 15 22 Total Msg Senders s 2 3 1 4 2 3 1 2 2 6 1 1 1 2 2 4 25 transfers Available General Release now: • My. Practice • Housten Gradual rollout • Version 20 for General Release • End of September Available from October • Intrahealth (Profile for Windows)

Lessons from implementation Clinical view = transport of whole record, not as selected by Lessons from implementation Clinical view = transport of whole record, not as selected by GP Will shine the spotlight on quality of notes and clinical coding High codified and structured DB of some PMS’ meant difficult to deconstruct/reconstruct fields to highest common denominator 16

How would it look? Karori Medical Centre Island Bay Medical Centre GP 2 e How would it look? Karori Medical Centre Island Bay Medical Centre GP 2 e GP arg h isc e. D rral Refe e HL 7 PMS CDA e. Prescribe e. L e. Ra ab diol ora tor ogy y Wellington Hospital NZe. PS Prescription Broker Pacific Radiology Aotea Pathology 17

 Richard Medlicott and Sandra Hicks, Chair PCIM/Steering Group, Clinical, sensible Without diminishing the Richard Medlicott and Sandra Hicks, Chair PCIM/Steering Group, Clinical, sensible Without diminishing the value of any of the wider team involved in the project, there advice and keeping us honest to the original intent. The Team , was a core team that were predominantly responsible for the key decisions and direction throughout the project. Andre Bredenkamp Project Manager, chief cat herder, master of South African change management Peter Sergent, Medtech Architect, HL 7 Guru, CDA, Standards and Pinot Protocol David Hay, Datamodel and Toolkit Architect, CDA & CCD(oops) Guru and HL 7 Standards Ashwin Patel, My Practice, Standards, Clinical, “What’s the right thing” Edwin Ng, Healthlink, Standards compliance and messaging architect Peter Jordon, Toolkit developer and always happy to venture an opinion Tiffany Lang, Houston, Project Manager, always a cheerful word to be had Thusantha de Silva, My Practice, a very patient and logical developer 18 James Penfold, Intrahealth, a constant voice of reason