National Health IT Board director responds to criticism

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Graeme Osborne, a director of the National Health IT Board has responded to an open letter from HealthLink CEO Tom Bowden that was highly critical of the board’s technology policies

By Randal Jackson | Wellington | Thursday, 19 July, 2012 | 3 Comments

National Health IT Board director Graeme Osborne has responded to an open letter from HealthLink CEO Tom Bowden that was highly critical of the board’s technology policies. Bowden has called for an overhaul of health IT.

Bowden’s views were covered in a Computerworld article earlier this month

Osborne has posted his reply on the board’s website (healthitboard.health.nz).

“This letter is in response to your letter of 27 June 2012 with the title ‘Health IT Issues’ sent to the Chair of the National Health Board and the Director of the National Health IT Board.

Dr Murray Horn has asked me to respond on behalf of both boards. We always welcome input to and feedback about the National Health IT Plan. In this letter I have addressed each of the main points you made. However, there were a number of inaccuracies in the statements made in your letter which I have also addressed in this response. Please feel free to contact me directly to discuss any further issues you have with the IT plan.

As you are aware, there are also a number of forums you can engage in to discuss health IT matters. Please note, in the future we would appreciate the courtesy of receiving your correspondence before it is released to the media.

Nelson Marlborough DHB Tender for an e-Referrals Solution
I am not able to comment on any aspect of the procurement process used by Nelson
Marlborough DHB (NMDHB) in mid-2011 as this was a commercial process between the DHB and the vendors involved. I can confirm that on becoming aware of the procurement process the National Health IT Board highlighted to the NMDHB the requirement in the National Health IT Plan for DHBs to implement a regional e-referrals solution. This action along with dialogue between the South Island DHB Chief Executives resulted in the decision by NMDHB to cease the procurement process underway for an e-referrals IT solution, as was their right under the terms of their procurement process. NMDHB then engaged in the regional e-referrals implementation project led by the South Island IT Alliance.

The South Island IT Alliance has now chosen the e-referrals solution developed in partnership between Canterbury District Health Board and Pegasus as the South Island regional solution.

By the time the decision was made in 2012 this option had developed significantly and been implemented in over 50 GP practices across Christchurch. While I am not aware of all the reasons why this decision by the South Island IT Alliance was taken, the fact that the solution was fully owned by the Canterbury health system and had gained significant support from the GPs using the solution were important aspects of the decision. In terms of the pricing in the NMDHB tender results, I am informed that the price that you refer to covered a roll-out for the whole of the South Island, not just the Nelson Marlborough district.

I can understand the frustration for vendors who expend time and energy on responding to a tender process that is concluded without a result. The National Health IT Board has gained strong support from DHBs to work together on national and regional IT projects, so vendors should question IT tenders that only relate to a local solution for one DHB.
Vendors are welcome to contact the Health IT Cluster or the National Health IT Board for advice on this or other matters related to the scope or priority of health IT projects.

Sector successes
In your letter you made a number of comments about current health IT projects in progress across the sector. The board is very pleased with the progress on all the projects identified in your letter. They all have direct links to the Minister of Health’s priorities for the sector:

· The GP2GP solution is now available nationally and up-take is growing – the number of transfers between GPs by consumers, over the past three months, is as follows: April - 69, May - 383 and June – 1100, which represents a very pleasing take-up rate. GP2GP
was co-designed with GPs and is a simple and effective tool which was completed for a
modest investment. Many other countries, including Australia and the UK, have tried to
complete this type of project without success.

· The Community e-Prescription service has completed a successful trial. National roll-out will occur in 2013 once all IT vendors have made the required changes to their software and after an operational funding model has been agreed by the sector.

· The concept of a ‘shared care’ solution to support life stages or where a virtual clinical
team is required is a key part of the National Health IT Plan. The national ‘shared care’
trial for patients with long-term conditions has attracted over 150 patients and engaged
more than 100 clinicians in the Auckland Region. This health IT solution, developed with
clinicians and consumers, supports GPs, nurses, specialists and allied health people to
work together in a virtual team to better support a patient over an extended recovery or
on-going care period. Patients also have access to this shared information over a secure
internet connection. Currently, 20 people are taking up this option on a trial basis. ‘Shared care’ solutions for aged care and maternity are also under development across
the sector.

Corrections to your statements
Your letter contains a number of inaccurate statements that we would like to correct:

Nelson-Marlborough DHB electronic referrals tender
· You state that the National Health IT Board gave Nelson-Marlborough DHB a directive in relation to the tender. This is incorrect.

GP2GP
· You refer to GP2GP being in a ‘fledgling state’. Based on the information above this is
clearly incorrect. GP2GP is a simple and effective tool which was completed for a modest investment.

National Health IT Board approach
· You say the board ‘appears to want to run and manage IT projects rather than encourage innovation’. This is incorrect – the board does not run or manage IT projects.
Working with clinicians, consumers, health executives and IT vendors, the board has set
a clear direction, developed value propositions and identified priorities for the sector. It
has supported the creation of an environment where leaders can make regional and
national investment decisions and implement proven health IT solutions that meet required standards.

· The board also has a monitoring and reporting role to ensure the plan and the overall
eHealth Vision is achieved. In fact, the Minister of Health has directed that any health IT
investment over $500k must be endorsed by the National Health IT Board.

System architecture
· You state that the design of the health eco-system is a ‘rigid, hierarchical model’. In fact, the whole premise of the National Health IT Plan is that we build on existing regional and national capability that has been proven to deliver quality results. It is fundamentally a decentralised model, within which clinicians and consumers co-design and co-produce health IT solutions. For example Test Safe in use across the Auckland metro area and in the process of extending to the Northland district is an example of a proven IT solution developed for clinicians by clinicians. It is a clinical data repository providing clinicians with access to medical results, radiography reports, medications and clinical documents in a similar way to the eShared Care Record View currently under early adoption in Canterbury.

· The systems architecture that enables the IT Plan is a standards-based, federated
architecture that has gained strong sector support and has attracted international
interest. The board has worked with IT professionals from across the sector, supported
by local and international experts, to develop this architecture.

Interoperability standards
· You say interoperability standards are not being mandated. The board ensures that
standards are independently developed and then works directly with IT vendors to
ensure the standards are incorporated into their systems before they are implemented in
the sector. By following this approach standards are ‘effectively mandated’.

· A good example of this approach is the GP2GP solution that only works because the
four vendors of GP practice management systems are required to use the GP2GP
standard. It is our experience that simply mandating standards is not enough. Your
comparison with North America is interesting. In both the USA and Canada the adoption
of IT solutions in primary healthcare has been very slow. The current approach being
applied in the USA based on mandating standards linked to incentive payments is in
response to this slow take-up. In New Zealand we have had over 95% of GPs using IT
solutions for over five years, so we are ahead of these countries on this measure. The
board believes we need to focus on supporting clinical integration and consumer
engagement as set out in the IT Plan.

Investment Approach
· You imply in your letter that the National Health IT Board supports a supply-side
investment model; this is not correct. The board recognised from an early stage that
supply-side approaches being used in the United Kingdom, Canada and Australia were
not achieving the desired results.

In New Zealand the National IT Board has focused primarily on the demand-side by promoting to healthcare organisations and clinicians the business and clinical value propositions enabled by investment in IT. This has been supported by a focus on reducing the barriers to the take up of health IT solutions.

This approach has seen a reduction in spending locally by individual DHBs and an increase in regional and national investment. Primary care and Non-Government Organisations have responded to the clear vision and plan set by the board and started to increase their investment in health IT solutions. The board’s limited innovation funding is targeted on supporting clinical leaders who are increasing the use of health IT solutions in their clinical practice, or to support the evaluation of an existing solution.

· In your letter you set out a desired investment environment based on five areas. The
board supports your view that all these areas are important. It is the board’s assessment
that four of the areas are already present, while one – ‘any available funding is tagged
for the purchasing of services that meet highest priority national health targets’ – is
under active development within the Ministry of Health, as part of a renewed focus on
clinical integration.

National Health IT Board approach
The National IT Plan requires IT professionals and IT vendors to work closely with clinicians and consumers to ensure health IT solutions are effective and support the relationship between the patient and their clinician; and that the information collected and accessed is of high quality and can be trusted. The goal of the plan is to enable ‘person centred, integrated care’, which is already resulting in a reduced number of IT systems that are used across the sector and a commitment that the systems will work well together.

National solutions are favoured where a foundation system is required, such as the National Health Index or the National Immunisation Register, or where cohorts of patients need to have a set of information collected in order to improve care for all: for example, maternity, oncology and cardiac health.

Regional solutions are selected to support patient flows from community settings, through specialists, into secondary and tertiary hospitals and back into the community such as e-referrals and e-medications.

Further information on health information standards, the HISO work programme, case studies and other supporting information about the solution architecture are available on the National Health IT Board web site – www.ithealthboard.health.nz

Summary
The National Health IT plan is achieving economies of scale and creating a sustainable
information platform to better enable the operation of the sector; supporting improved
productivity for clinicians; and, supporting improved safety and confidence for people, patients and their families by allowing access to a more complete set of health information.

I hope this clarifies the issues you have raised.

Yours sincerely
Graeme Osborne
Director, National Health IT Board
Director, Information Group,
Ministry of Health

Comments

Fair points I actually think there is a serious attempt being made to engage consumers. Everywhere I look on the multiple governance groups in health IT projects, I see designated consumer representatives.

Check out http://www.ithealthboard.health.nz/advisory-groups/consumers
Posted by Anonomous if blank at 20:57:50 on July 19, 2012

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Fair points but... I still think that almost everyone is missing the point to some extent. The focus should not be on clinicians or vendors but on the citizen who should be central to everything the sector does. There's still too much 'please the clinicians' thinking happening in the health sector. The days of the doctors being demi-gods are gone. I'd also think that most primary care isn't delivered by doctors but by nurses and specialist carers.
Posted by Anonymous at 20:01:40 on July 19, 2012

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Fair points but... It would be nice if patients did drive care expectations, but most patients barely ask doctors for information, let alone state that they expect to be able to call for information/access their files online/receive their physio plan with a link to videos of exercises. If care is really to be focused on the patient/citizen, there needs to be some unified way to tell the health sector what we want (not just a single demographic groups there are now like Grey Power - what they want with IT and Health will probably be very different to what Gen Y want).

When it comes to IT you have to win over the clinicians to get the system adopted.

This sounds like a good start - at least with the e-referrals and interoperability work going on, I know there's a chance my GP will receive my notes and test results from my specialist.
Posted by Anonymous at 14:43:48 on July 23, 2012

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