The health sector will be cautious about any future moves to standardisation in IT, says the chair of the government’s Wave health IT advisory board, David Caygill.
Caygill was commenting on Wave’s (Working to Add Value through E-Information) final report, which was released at the end of October. It makes a total of 79 recommendations, covering knowledge management, electronic health records, data architecture, privacy, systems infrastructure, investment and organisational design.
A new body will be set up, the NZ Health Information Standards Organisation, to help formulate standards where appropriate, and decide how firm standards will be in health IT. Until that body — also chaired by Caygill — has completed its deliberations, there will be no lifting of the moratorium on major health IT developments imposed earlier this year, says Health Minister Annette King.
Health organisations are likely still to be left with considerable latitude in what solutions they select. This trend was already signalled in one major respect by the Wave working party’s declining to favour one major communications network — either the NZ Health Information Systems network or the rival Healthlink — over the other.
“I don’t think the answer is as crisp as ‘you shall use HL7 [an international messaging standard for the health sector]’,” Caygill says. “The standards we prescribe might be more intangible than that.” They could simply indicate, in the messaging case, what information fields should be included in a message.
There may be a need for tighter standard in some areas, he acknowledges. But the question needs to be looked at and analysed carefully first in each of the workstreams into which the deliberations and recommendations were divided. He hopes to “have gained some momentum” before the general election in 12 months’ time.
Health department chief executive Karen Poutasi and Wave programme director David Moore have acknowledged that after a promising start, when New Zealand almost led the world in health IT, we have slipped a long way behind leading nations, through lack of coordination.
Out of the 79 recommendations, the advisory board has set 10 priorities which are:
- setting up NZHISO
- collecting reliable ethnicity data in association with health
- implementing a national index of health providers (the NPI)
- remedying difficulties with the National Health Index — inaccuracies and inconsistent use — so this can provide a reliable master index to all data relating to one patient. Primary health providers such as GPs, should have access to the NHI
- gathering primary care information
- remedying problems with laboratory and pharmacy data — again giving primary providers access
- “cleaning up” messaging standards
- establishing summaries of “health events” in patients’ lives, with data dictionaries and comprehensive use of electronic discharges form hospital and referrals
- creating a health portal
- developing standards for data interchange, security and network infrastructure.