E-scripts first stage in record sharing

By Holly Ryan

Plan to share patients’ medical data between healthcare providers makes successful start with electronic prescription service

SimplHealth chief Jodi Mitchell says IT can help with the sharing of information to make things faster, save money and improve patient outcomes. Photo / Richard Robinson
SimplHealth chief Jodi Mitchell says IT can help with the sharing of information to make things faster, save money and improve patient outcomes. Photo / Richard Robinson

A plan to modernise the sharing of patient records nationwide between healthcare providers has passed an early check-up with an initial roll-out for prescriptions set to be completed in six months.

Health software company SimplHealth, which won the contract to supply the national New Zealand ePrescription Service (NZePS) in 2011, says the roll-out has been a success.

SimplHealth chief executive Jodi Mitchell says the firm is excited about the opportunity.

"We were really happy to get the contract and we think it's going pretty well so far," Mitchell says.

The ePrescription service is one of the initial phases of the 2010 National Health IT Plan to allow for more eHealth records and collaborative sharing of information between health care professionals.

Approved for roll-out in 2010, the programme allows medical information including medications and prescription data, to be collected and stored in one complete record, making it easier for health professionals to deal with patients.

According to Minister for Health Tony Ryall, the Government has been working for "a long time" to try and bring the health IT sector into a more modern space.

"I think the real action is going to happen in the next 18 months because that's when the integration starts fully and it will be available on a much wider scale than it is now," Ryall says.

"But it's taken a long time to make sure we have all the privacy staff, and all the vendors on side as well as having the clinicians feeling comfortable with where we are going."

According to Mitchell, the benefits of the service include prescriptions being generated electronically, preventing transcription errors, as well as saving time and allowing doctors to be able to check whether patients have filled their prescriptions.

With upwards of twenty million scripts produced annually, Mitchell says the margin for error under the previous system was far too high.

National Health IT Board director Graeme Osborne says SimplHealth were well ahead of other contenders for the contract, having already implemented a similar system in Australia.

"SimplHealth have successfully created a really smart solution and already had it operational in Australia, and so that really put them ahead of the game in terms of that procurement process. And of course we were very pleased that a New Zealand company was in that position," Osborne says.

The roll-out for the initial stage of the programme began in July last year. Osborne says the programme is well on track to hit its key targets, with 30 per cent of pharmacies and 15 per cent of GPs using the systems so far, although the ePrescription service is expected to take a further six months to be implemented nationwide.

The programme will initially be focused on pharmacies and doctors, but Osborne says further expansion under the Health IT Plan will extend the programme to what he hopes will include a full medical information file being available to all health care professionals caring for a patient, making it easier and faster for all parties.

Mitchell says she hopes the plan will address some of the healthcare issues that providers face daily in the sector.

"Issues around healthcare in New Zealand and worldwide are really the sustainability of public health systems, focused on affordability, efficiency and workforce," Mitchell says.

"One of the biggest areas I believe that can help that efficiency is the use of IT to facilitate the sharing of information, to make things a lot quicker, to save money and to improve patient outcomes - which is the ultimate goal."

According to Osborne, one of the main focuses of the National Health IT plan is to ensure the process is as secure as possible, and that the prescription data is completely private.

"The data is entirely encrypted through the system, which absolutely can not be hacked into," Osborne says.

"We take this area really seriously. The way we describe it, is that the relationship between the consumer and their health provider is paramount," he says.

"So we really encourage consumers to have rich conversations with their providers about what information they are happy to have shared and if they have got any concerns."

Osborne says the move is a step in the right direction from previous paper records where information could be accessed without any knowledge.

The minister for health agrees with Osborne, saying the programme is safer in a number of aspects as people's medications are known to healthcare professionals without the individual having to personally keep track of their medications.

Ryall also notes that the majority of people he has spoken to assume that is the way the system operates already.

"If you talk to ordinary people and you tell them that for the first time their hospital is going to be able to look at their primary care record, and will be able to look at their hospital records, they tend to look at you somewhat awry and say, 'Well haven't you been doing that for 20 years', so now we're trying to standardise inter-operability."

SimplHealth was set up 25 years ago but according to Mitchell, the company has focused a lot more in the last 17 years on healthcare, in particular over the past two years.

Patient privacy concerns with introduction of IT plan

The increasing introduction of regional schemes under the National Health IT Board, is raising the issue of privacy and security around personal information, in particular the sharing of personal and medical information.

The National Health IT Plan, which was published in 2010, includes a number of regional and national strategies to improve collaboration between health-care organisations as well as implementation of a number of eHealth schemes.

Medical records for thousands of Wellington residents have been added to the National Health IT Board's online repository. But a member of the public spoken to by the Herald argues that this has been done without their knowledge or consent. The individual, who wished to remain anonymous, said the strategy being implemented under the Government's National Health IT Plan, was in breach of the Privacy Commission's regulations which state that the public must be informed before any of their personal or medical details are shared, something he does not believe has been completed to an adequate standard.

He says approval for the programme occurs when an individual signs up to a GP.

The programme being referred to is the Wellington shared care record, which has so far been implemented in Christchurch, Wellington and from Wairarapa through to Hamilton, with Auckland next on the list.

In a letter to the member of the public, Compass Health chief executive Martin Hefford notes that the company, which has the contract to implement the system, had conducted stringent screening processes and seminars, and a campaign to inform the public about the programme, and that personally informing patients would take an enormous amount of funding and would not improve awareness enough to justify the extra funds.

"You ask why practices did not inform patients directly - for instance by letter. The answer is experience to date is that increase in awareness does not justify the additional expense," Hefford said.

Hefford noted the awareness campaign had so far cost around $30,000, and that he felt the campaign had been adequate.

"In introducing the eSCR [shared care record], GPs and Compass Health have had to weigh up two duties of care: one to patient confidentiality and the doctor patient relationship, and the other to ensuring all members of a health team treating an individual have access to the information needed to treat that person safely."

In an email to the senior policy adviser on health, at the office of the Privacy Commissioner, the member of the public outlined his concerns, asking:

"Can you confirm that if someone had access to a user name and password, they could sit at a computer anywhere in the world and download/copy dozens of patients' files uninterrupted? According to Compass, there is no restriction on the number of files one can access during a session (no red alert)?" to which the policy adviser replied, "As to your question, yes, that is my understanding".

The Ministry of Health stated that the process had gone through stringent security checks and through the Privacy Commissioner before its implementation, and that the ministry was confident that the process was as secure as possible.

This was backed up by Hefford in the letter, stating that although no system had cast iron security, they were the accountable entity, if any aspects of the programme did not stand up to scrutiny.

- NZ Herald

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