quality powered by information coverage the evolution qi4gp to patients first who and what we are? a...
TRANSCRIPT
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
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7
• 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
8
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
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