Healthy Connections

Categories: Engineering and science.

Connected Health is a model for healthcare delivery that uses technology to provide healthcare remotely. It “aims to maximise healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care,” according to its Wikipedia entry.

Its origins are in telehealth, remote care and disease and lifestyle management programmes, particularly in the United States and Europe.

In New Zealand, Connected Health has a champion in Murray Milner, the chair of the National Health IT (Information Technology) Board, who says Connected Health is a brand for safely sharing patient information between patients and doctors, and among doctors.

“We make sure that the information is available in electronic form.”

The Board’s vision of the “technologised” future of health has three elements: a unique identifier number for every person; the system of connectivity within the health system; and virtual cloud data storage.

These elements all support an inter-operable set of applications.

The unique identifier is a person’s National Health Index (NHI), introduced progressively from 1993. Everything about a patient is increasingly linked to this alphanumeric identifier of three letters and four numbers.

“The NHI is unique and dies with you. You can get an NHI even before you are born. For example, if a blood test is done on a baby in the womb it’ll be important to distinguish the mother’s blood from the baby’s – so the unborn child gets an NHI,” Dr Milner says.

The second element of the Connected Health brand is connectivity. Clinicians are connected through a series of accredited service providers (usually information and communication technology companies).

Dr Milner says the health environment is essentially a large intranet which forms a secure, virtual, private network.

The third feature is that all the information needs are managed within a virtual private cloud. Although there is not one single database, there has been much consolidation into several databases, which can all be accessed by authorised persons from a single device.

New Zealand’s 20 District Health Boards are now concentrating their clinical information into four primary data centres. Others, such as private providers, general practitioners and community practice groups, have defined protocols for sharing information and are increasingly consolidating their information into resilient data stores.

More technology will change behaviour. Issuing prescriptions is one example. Currently, a general practitioner gives a patient a word-processed prescription which the patient takes to a pharmacist who then dispenses the medication ordered.

In future the doctor will enter the prescription into a database against the name of the patient, who will then present a note to the pharmacist with a unique barcode. The pharmacist will access the patient’s record and dispense the medications ordered. This will reduce errors in dispensing and the pharmacist can directly connect to the general practitioner with any queries.

Such a system would also allow a doctor to renew routine prescriptions without seeing the patient, thus saving time and reducing costs.

Dr Milner says doctors and pharmacists accept Connected Health is “an appropriate way forward to deliver better more convenient care for New Zealanders”.

At a societal level, funding for the health system has increased steadily over recent years, generally rising faster than the rate of inflation. As the Treasury has pointed out, increases in the amount of money the Government has earmarked for its health budget have yet to be matched by any commensurate increases in the health of the population. More money does not necessarily equal better health, yet there is always pressure for more to be achieved with every dollar of expenditure.

“We are looking for efficiency gains,” Dr Milner says. The ageing of the New Zealand population generates pressure to use every dollar to maximum effect. So how much “gain” is the aim? “If we could get the increase in health expenditure back to just the level of CPI [consumer price index] increases – rather than around twice the CPI, as at present – and achieve the same level of care for an aging population, that would be a great outcome.”

So under a “technologised” health system, how would this differ from the present system – given that IT has been

playing an increasing role for many years now anyway?

“There’d be a massive difference,”

Dr Milner says. One of the big differences he foresees would be in productivity. Tasks which currently take minutes – such as renewing standard prescriptions – could be done in seconds.

“There’d be less manual labour and more electronic transfer and storage of information, which would be available

instantly to all those parties that needed it. (Doctors and specialists in triage treating a patient after an accident, for example, would be able to access their medical records instantly.

“For example, currently there are not enough renal specialists to support the increasing population of people requiring dialysis in Northland. One doctor working with specialist nurses using videoconferencing can deliver excellent dialysis services for patients scattered across Northland. This use of technology enables a scarce resource to be used in a highly efficient way.

“Every hospital used to have its own IT system, and they were all different. The National Health IT board has been busy getting the IT systems aligned, so that they can talk to each other, and can also talk to primary and community providers.

“Currently more than 90 per cent of the country’s GPs [general practitioners] use an electronic system for patient records, and about 70 per cent can now exchange patient information in electronic form between each other. Non-public providers like Southern Cross Insurance are also coming on board.

“They are keen to integrate and will pay to do so, because they can see the benefits to themselves and particularly to their patients.”

Dr Milner acknowledges that there may be some patient resistance, particularly to less face-to-face interaction with GPs, but points out there are also great benefits.

“Patients, especially those with chronic conditions, can self-manage more easily.

Shared care plans can be developed for the 100,000-plus people with multiple conditions. These shared care plans will involve nurses, the GP and various specialists. There is a lead manager – typically the GP – who provides oversight of the collaborative work plan for each patient.”

The role of the National Clinical IT Leadership panel’s role is pivotal to the IT system’s operation. “Changes in the system are all clinician led. This is not a set of managerial initiatives. Changes and new directions happen, if and only if, they come from the clinicians themselves. Each change must have a passionate clinician champion.”

Powerful new technologies can generate various reactions. One is to see new technology as an enabler of change:

the other to see it as a driver of change.

The first puts people in charge; the second makes the technology itself the hero and people have to adapt to its strategic imperative.

Mr Milner is a self-confessed IT enthusiast. Now a consultant in private practice, he worked for Telecom for 38 years, ending up as the Chief Technology Officer before coming on to the National Health IT Board as its chair.

“We see Connected Health as primarily an enabler for the better delivery of health outcomes, while at the same time driving for technological gains to improve the economic sustainability of the sector.

“Not everyone is happy with everything, but the introduction of technology is being managed carefully.

It’s not about the technology; it is very much about the careful implementation of change,” he says.