Sandra Hicks IPAC

1. Health Informatics New Zealand
www.hinz.org.nz
Sharing health
records
A general practice and
patient perspective
Sandra Hicks, IPAC, December 2006
• Local general practice and patient
perspective
• Pointers from the UK
• What should we do in New Zealand?
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2. Health Informatics New Zealand
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Sharing Electronic Health
Records
• What
• When
• Why
• Who
But not
• How or
• Where
General Practice
• A typical general practice?
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3. Health Informatics New Zealand
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Halswellhealth
Halswellhealth – the partners
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4. Health Informatics New Zealand
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The surgery
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5. Health Informatics New Zealand
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The records
Demographics
The patients
• 9261 enrolled patients
• 4305 male
• 4955 female
• 6% Maori
• 1.5% Pacific Island
• 2.6% Asian
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Demographics
The Staff
• 4 partners, soon to be 5
• 3 associate doctors
• 1 GP registrar
• 5 practice nurses (& often a student nurse)
• 5 receptionists
• 2 administrators
• 1 practice manager
• 1 podiatrist
The practice manager is the only full-timer, although
all the partners work at least 40 hours per week
in the practice
Shared Electronic
Health Records
• Why?
– Rapid access to clinical information
• e.g. allergies, medication lists, past surgery
– Prevent duplication of labs, Xrays etc
• Test and Xray results available electronically
– Reduced administration time chasing missing
notes, results, referral letters etc.
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7. Health Informatics New Zealand
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Shared Electronic
Health Records
• Why not?
– Privacy
– Security
– Takes more time – particularly in general
practice
• Generating health summaries
• Recording (in a standardised way) the
reasons for prescriptions
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8. Health Informatics New Zealand
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Shared Electronic
Health Records
• What do the patients think?
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9. Health Informatics New Zealand
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Patient Questionnaire
Sharing Your Health Records
• At the moment your health record is held in many
different places, although mostly with your GP
(general practitioner). But obviously some information
relating to you can also be held at the hospital, with
GPs in other cities, physios, the laboratory (blood
tests), and at the local after hours surgery or other
places that you may have visited.
• This could cause problems as each place may not have
a complete record of your health experiences when
looking after you. Things such as your medications,
allergies, any previous operations and recent blood
test or X-ray results may not be available to the
person that you are seeing.
Patient Questionnaire cont
• Health Information New Zealand (HINZ), a
government initiative, along with the Ministry of
Health, ACC and other organisations are looking at
developing an electronic health record where at
least some parts of your record would be available
to other health professionals.
• I have been asked to speak at a HINZ seminar
about what GPs think about sharing health
records electronically. I am particularly keen to
ensure that I advocate accurately on your (i.e.
patients’) behalf when giving this presentation.
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10. Health Informatics New Zealand
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Patient Questionnaire cont
• To help me I would like to know what you think
about sharing your health records with other
health professionals. I have designed some
questions and would like your help. Please be really
honest in your response to these questions.
• On a scale of 1 to 5 please indicate how happy you
would be to have the following pieces of your
health record available centrally to all health
professionals who can access a secure electronic
health network.
Very happy Do not want this ever
1 2 3 4 5
Patient Survey – 100
surveys, return rate of 90%
Age and Sex of respondents
40
number of respondent
35
30
25 female
20 male
15 not stated
10
5
0
<25 25-40 40-60 60+
age
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years at the practice
50
average number of
40 years =17.25 (7 people
did not respond to this
30 question)
years
20
10
0
1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89
respondents
What would you be happy to share?
• The list of medicines that you are taking
• A list of medicines that you are allergic to
• A list of current and previous health problems
(e.g. asthma, diabetes, hysterectomy, knee
reconstruction etc)
• The records from hospital admissions
• Summaries of hospital admissions (like the
discharge letter that goes to your GP)
• The records from your general practitioner
• Summaries of problems for which you have seen
your general practitioner.
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What would you be happy to share?
• What about lab results – at the moment these are
held by the person who requested them, and at
each of the three laboratories (Southern
Community, Medlab and Canterbury Health
Laboratories).
• How comfortable would you be to have all the
laboratory results go into a central laboratory
repository which could be looked up by other
health professionals who were treating you?
Sharing health record
patient degree of com fort (scale 1 to
2.5
2
1.5
1
0.5
0
h o s p ita l
M e d ica tio n s
s u m m a rie s
s u m m a rie s
L a b re s u lts
p ro b le m lis t
A lle rg ie s
re co rd s
G P re co rd s
d is c h a rg e
G P event
h o s p ita l
L is t o f
parts of the record
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Anything else?
• Is there anything (other than already
indicated above) that you would NOT
want available? (You may list
examples that don’t apply to you
personally, but that you think should
be kept private.)
Information that respondents
would not want shared
Mental health issues that may be circumstantial
rather than inherent. Could be misconstrued or
perhaps viewed unfavourably.
Hospital admission for surgery would be fine to be
accessed by others. However not hospital
admissions such as intoxication. I wouldn't like all
people having access to as it doesn't affect my
health and creates an area to be judged
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14. Health Informatics New Zealand
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Information that respondents
would not want shared
There may be some discussions you
prefer to be kept private - perhaps the
option of that being on the Central
Register?
Perhaps genetic records
Irrelevant information that would not
be applicable to care from another
provider
Abortion
Any private personal issues
Lab Results not to be shared
I cannot think of anything but if
something pops up I would mention it
STD's etc may be best kept as an
optional choice
anything that doesn't directly relate
Specific STI's, TOPs etc which may be
requested by Insurance companies from
a GP and they may feel compelled to
divulge info when the individual went
elsewhere specifically so that the family
Dr would not have info
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15. Health Informatics New Zealand
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Access to Records
Would you be happy for the following groups of people to have access
to your records?
• your general practitioner
• practice nurses
• after hours doctors
• other general practitioners
• hospital doctors (includes emergency department, outpatient
clinics, specialists, doctors on the ward if you are an inpatient)
• hospital nurses (includes emergency department, outpatient
clinics, specialist nurses, nurses on the ward if you are an
inpatient)
• Physiotherapists
• Chiropractors
• Plunket nurses
• mental health workers
• Family Planning doctors and nurses
• Vision and Hearing Testers
• Dentists
• Pharmacists
• Alternative medicine practitioners
• Yourself
• Your family/whanau
Allow Access Part 1
100
90
80
70
60 Yes
50
40 No
30
20
10
0
after hours
own general
other general
practice nurse
hospital doctors
hospital nurses
physiotherapists
chiropractors
practitioner
practitioners
doctors
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Allow Access Part 2
90
80
70
60
50 Yes
40 No
30
20
10
0
Plunket mental `Family Vision and Dentists Pharmacists Alternative Yourself Your family/
nurses health Planning Hearing medicine whanau
workers doctors and Testers practitioners
nurses
Holding Records
Who do you think should hold your records?
Please tick as many as you wish.
• the different professionals you see (as
now)
• your general practitioner
• Yourself
• the Ministry of Health
• a secure electronic site where they can be
accessed as required
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17. Health Informatics New Zealand
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Holding the health record
90
80
70
60
50 Yes
40 No
30
20
10
0
yourself
professionals
your general
the Ministry
electronic
a secure
practitioner
of Health
individual
site
health
Other comments
Survey is quick decision making. A longer time for
thought would have been appreciated as there are
important considerations to be answered
especially with consideration to lower echelon
access and all info available to specific
professionals when they would only require
specific info
my main concern would be security of electronic
and physical storing of files
only if absolutely secure
as much information available as possible
An electronic site is fine if our nation continues in
safety - if it fell into bad hands it could be
dangerous and used against people with
disability/hereditary illness etc.
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18. Health Informatics New Zealand
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Other comments
I understand this to mean my GP is the 'main'
holder of the records with other professionals
having access to them
Health practitioners who do have access should
hold this information as confidential and not be
able to discuss this with other
peoples/professionals without consent (possibly in
writing)
I would like it to be secure, i.e. that those people
who happen to work within the healthcare
industry but don't have a direct input into the
patient's care aren't accessing for general
interest rather than for individual care
Don't mind other professionals having access as
necessary
Other comments
I think that the more info a medical practitioner
can have about you the better they would be able
to treat you correctly
It will be great to have a secure electronic site
which all medical practitioners can view including
person viewing their own records e.g. id no
required, but no access to other members of the
public
I feel that it is useful for health professionals
that adhere to a strict confidentiality code to
have records but do have some issues with such a
wide variance of people holding the records
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19. Health Informatics New Zealand
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Hippocratic Oath
• What I may see or hear in the course of
the treatment or even outside of the
treatment in regard to the life of men,
which on no account one must spread
abroad, I will keep to myself, holding such
things shameful to be spoken about.
(Classical version)
• I will respect the privacy of my patients,
for their problems are not disclosed to me
that the world may know. (Modern version)
Recent developments in
the UK
• Much money being spent on improving IT systems
• NHS Connecting for Health
– NHS Care Records Service
– Choose and Book, electronic booking service
– Electronic Transmission of Prescriptions
– National Network (N3) – broadband connectivity and IT
infrastructure
– Contact – central email and directory service for the
NHS
– PACS Picture Archiving and Communications Systems
– IT supporting GPs, including QMAS, QoF and GP to GP
record transfer
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20. Health Informatics New Zealand
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Pre-requisites for Shared
Electronic Health Records
• In general practice
– Ability to electronically transfer notes
between general practices
– Excellent search tools
– Smart decision support tools
– Training in the use of the technology
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21. Health Informatics New Zealand
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Pre-requisites for Shared
Electronic Health Records
• In the hospital
– Clinical notes on the computer
– Electronic referrals and discharges
Pre-requisites for Shared
Electronic Health Records
• In general
– Dialogue with the people of New Zealand
as to what they want
– Solving the privacy and security issues
– A national approach which constructively
involves all the stakeholders
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Recommendations
• Ask the patients
• Develop a system that allows for individualised
permissions
• The shared electronic health record should be
accessible to patients
• Ensure that the pre-requisites have been dealt
with
• Have a national approach with decision-making
which involves all stakeholders
• Don’t forget the Hippocratic Oath
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