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quality powered by information

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

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quality powered by information

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  1. quality powered by information

  2. 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

  3. Patients First ProgrammeQuality 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 PPP

  4. Where we have come from In the last 18 months, Patients First has delivered or is well down the path of delivery on: • 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

  5. Fit with Health IT Plan

  6. Ackoff – path to wisdom

  7. Building on Strengths 2 Qualityat four levels & the opportunity of networks

  8. Context of Measures

  9. Show and Tell Don’t tell me. Show me!

  10. GP2GP

  11. 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

  12. 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"> <templateIdroot="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 --> <codecode="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> <entryRelationshiptypeCode="RSON"> <observationclassCode="COND"moodCode="EVN"> <valuexsi:type="CE" code="32398004"codeSystem="2.16.840.1.113883.6.96"displayName="Bronchitis"/> </observation> </entryRelationship> </encounter> </entry> </section> </component> Export • Steps: • Process Request (Send) • Encrypted CDA document created

  13. 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"> <templateIdroot="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 --> <codecode="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> <entryRelationshiptypeCode="RSON"> <observationclassCode="COND"moodCode="EVN"> <valuexsi:type="CE" code="32398004"codeSystem="2.16.840.1.113883.6.96"displayName="Bronchitis"/> </observation> </entryRelationship> </encounter> </entry> </section> </component> Import • 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

  14. Screenshots • New Menu item: • Tools/Patient/Export to GP • Upon selection display the following screen:

  15. GP2GP Workflow Step One: Mr Burnett, patient, enrols at new practice and gives authority to Request the file from Old Practice Dr Anderton @ Old Practice Step 8: Final Acknowledgement Dr Evans @ New Practice HL7/CDA De-Construct HL7/CDA Construct Step Four: Out Box Validates document, Encrypts & Certificates Transmits to Msg Service Step Six: Strip HL7 Visual check Deconstruct CDA, Provide data to PMS for action Step Seven: Populate PMS with structured data, Acknowledge transfer. 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 Out Box In Box Step Five: File arrives in In Box Certificate checked File decrypted and validated, ready for import Messaging Service: Store and forward, Validates address, Routes message Messaging Service

  16. 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…

  17. Community ePrescription ServiceNZePS

  18. NZePS Schematic

  19. NZePS Workflow

  20. What does an eScript look like?

  21. 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…

  22. Babel Fish A universal translator

  23. Imagine Karori Medical Centre Island Bay Medical Centre Wellington Hospital GP2GP eDischarge HL7 Wellington Hospital eReferral CDA PMS NZePS Prescription Broker ePrescribe eRadiology Pacific Radiology eLaboratory Aotea Pathology

  24. Health Quality Measures NZ

  25. www.patientsfirst.org.nz/hqml

  26. 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 Collaborative and Cross-sector

  27. 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

  28. PMS Certification

  29. 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

  30. 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

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