Electronic health record could be five years away

Competing strategies push development into 'stage two'

A single electronic health record could still be five years away, despite mistakes that saw patients suffer serious consequences from referral failures.

Last week, Health and Disability Commissioner Ron Paterson reported on the three patients who had suffered when referrals between DHBs, to surgeons working for different district health boards, got lost in the system. The delays in treatment resulted in one patient losing an eye, another having a serious stroke and a third patient’s prostate cancer spreading to his bones.

Paterson’s report on the incidents emphasises the value of developing a “single Electronic Health Record” (EHR) to which everyone can refer.

However, Graeme Osborne, chair of the Health Information Strategy Advisory Committee, says the HISAC sees the development of an EHR as “the next phase”, once the problems around separate lines of referral among parties involved in a patient’s care have been sorted out.

The EHR, a concept mooted from as far back as the publication of the Ministry of Health’s WAVE report in 2001, will be re-examined next year, says Osborne. However, when it comes to a realistic timescale for implementation, Osborne would only commit to “less than five years”.

In his report on the stroke case, the commissioner said: “This case highlights the need for the development of a single electronic health record and record management system in New Zealand which could provide automatic electronic tracking of referrals and appointments, together with the capacity for all health providers (including GPs and patients) to view the progress of referrals in the system and appointments made.”

However, Osborne says, the mutual confidence of the various parties must be established first. It would also be necessary to ensure that the various separate electronic lines of communication were working properly before feeding them into a centralised, or partly centralised, EHR.

It might seem simpler, from a technical point of view, to have referrals sent to a central EHR, using a star-like communications structure, rather than maintaining multi-way links, says Osborne. “But this is not just a technical problem.”

“There are countries that are going for this star-like approach and they’re struggling to do it. It’s a more powerful model to get all the connections working first.”

Two different structures for a national Electronic Health Record are under discussion, says Osborne. One option involves putting every item of information about a patient and his or her treatment into one central record. But a possibly more manageable alternative would be to keep only “vital” information centrally — personal details and data on current treatments and medications, and how these might interact with proposed treatments. This second model would see less vital information kept separately, at different sites, and only be pointed to from the central record.

The HISAC has recently been reconstituted, and Health (and ICT) Minister David Cunliffe has told it to adopt more of a strategic role and be less involved in implementation matters.

However, the HISAC is presently trumpeting the success of the Hutt Valley DHB in implementing an electronic referrals system — for GPs sending referrals to the DHB — “based on standards published by an expert advisory committee in 2007”.

The HISAC is also working with a further eight DHBs that have active projects under way to implement electronic referrals systems.

“It’s true to say this has not progressed as fast as we’d hoped,” says Osborne. In view of the recently reported cases, the eight other boards might like to push electronic referral system development further up the priority queue, he suggests.

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