2. quality powered by information

3. 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

4. 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 PPP 3

5. 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:

6. Fit with Health IT Plan 5

7. Ackoff – path to wisdom 6

8. 7 Training Professional development Practitioner Aiming for Excellence Cornerstone Practice BSMC, IFHC Must share common language Network National Standards Health Targets National Building on Strengths 2 Quality at four levels & the opportunity of networks

9. Context of Measures 8

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

11. GP2GP

12. 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 11

13. Export 12 Steps: Process Request (Send) Encrypted CDA document created component> Encounters Encounter Checkup Examination Further examination Mary Allen

14. component> Encounters Encounter Checkup Examination Further examination Mary Allen Import 13 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

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

16. Step Four: Out Box Validates document, Encrypts & Certificates Transmits to Msg Service GP2GP Workflow 15 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 Box Certificate checked File decrypted and validated, ready for import Messaging Service Messaging Service: Store and forward, Validates address, Routes message Step Six: Strip HL7 Visual check Deconstruct CDA, Provide data to PMS for action Step Seven: Populate PMS with structured data, Acknowledge transfer. Dr Evans @ New Practice Out BoxIn 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

17. 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… 16

18. Community ePrescription Service NZePS

19. NZePS Schematic

20. NZePS Workflow

21. What does an eScript look like?

22. 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… 21

23. Babel Fish A universal translator

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

25. Health Quality Measures NZ

26. 25 www.patientsfirst.org.nz/hqml

27. 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 26 Collaborative and Cross-sector

28. 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 27

29. PMS Certification

30. 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 29

31. 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