Presented by Corrine Gower Victoria University of Wellington Megan Peterson Arohanui Hospice

1. Take one Palliative Care Data Standard, a
course of NZ Universal List of Medicines, the
New Zealand Formulary and the NZePS.
Avoid allergies: Integrate well!
Corinne Gower
Victoria University of Wellington and Houston Medical
Megan Peterson
Arohanui Hospice, Palmerston North
HINZ Presentation, Thursday 28th November 2013

2. Overview of presentation
• Introduction
• End Users Overview (Megan)
– Palliative Care Dataset
– Prescribing Solution
• Implementers Overview (Corinne)
– Palliative Care Dataset
– Prescribing Solution
• Lessons Learned
• Questions

3. Introduction
• Common themes
– Output requirements were specified
– Input and workflow had to be determined
collaboratively.
• Points of difference
– Palliative Care DS: Design and development phase
was the major phase. No third party product
integration.
– Prescribing: UAT phase was the major phase.
Extensive third party product integration.

5. Our Region

6. Palliative Care Data Definitions
Standard
HISO 10039.1 and HISO 10039.2
•Provides a basis of a common language for
recording information about service contacts
that can be shared and compared between
stakeholders, and for understanding palliative
care in NZ.

7. Data Issues
Pre Implementation
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Multiple data entry screens
No definitions for fields
Non compulsory data entry
Lack of user understanding
Incomplete and inconsistent data output
Data could not be relied upon

8. Implementation
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Resourcing
Change Management
Communication
Education of users
Challenges to work flow and
business processes

9. End User Recommendations
• Scope the project well.
• Strong working relationship with vendor and
external stakeholders.
• Determine impact on end to end business
processes (eg. referral management).
• Education sessions should including context
and constant reviewing of the data.
(Take with wine, repeat as required!)

10. Prescribing information workflow and
objectives
Workflow
• Prescription Creation
– Medication selection
– Interaction checking – allergies and drug-drug interaction
– Regular Medication recording
• Output – paper and electronic
– Correspondence – information sharing
• Incoming dispensing messages.
Objectives
• Reduce preventable medication errors
• Facilitate greater use of generic (non-trade/brand) drugs.

11. Solution Components
NZF
NZULM
Houston Medical
VIP.net
Patient Health Information
Management System
(Hospice)
NZePS
Dispensing System
(Pharmacy)

12. Clinician Requirements
• Doses: A list of doses associated with each medicine. Doses should
be easy to maintain.
• Medication readability:
– ‘paracetamol 500mg tablet’
– ‘paracet 500mg+pseudoeph HCl 30mg (&) chlorpheniramine mal
2mg+paracetamol 500mg+pseudoeph 30mg tabs’,
• Secondary use of prescribing information in correspondence
• Drug Allergy alerts: Recognition of existing drug allergy alerts
• Form/Strength: Option to prescribe either by form (1 tablets, 5 ml)
or by strength (10 mg).
– A pick list of administrative units is confined to units associated with
the medication in the NZULM.
• Supply: Need to request pharmacist to determine supply quantity.
– Administration Unit of ‘QS’

13. Prescribing Functionality Evaluation
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NZF interaction checking is working well
Improved prescription generation
Prescribing data now makes greater clinical sense
Fewer scripts returned or queried by the pharmacy
because supply details have been overlooked
• Some optional fields, such as medication route, are being
omitted because they do not read well on the prescription.
• Increased generic prescribing
– System default and generic/trade cross matching
• No improvements in dose consistency
– Latin/non-Latin frequency and timing instructions.

14. Implementer Challenges
• Relationship Management: Huge overhead when piloting
• Challenge of justifying benefits: Having to sell government
strategy, Connected Health licenses. Documents and
implementation specifications have limited value in
communicating change drivers and benefits directly to
information system end users.
• Technical Complexity: Huge. With integration to third party
products you have to know where the boundaries are.
Medicines are included in the NZULM that are not yet
available.
• Collaboration: Need for regular site visits
• Expectations: Structured data entry is extremely difficult.

15. Community ePrescribing
Recommendations
• More work is needed to understand the
potential impact to clinician’s workflow when
a standard or specifications are developed.
• Need to ensure there is a clear path to convert
data (such as allergies) from old to new
system.
• Useful to have supporting documentation or
web based information, such as case studies,
to support implementation.

16. Lessons Learned
• Scope everything thoroughly
• Set realistic timeframes and adequately
resource the project
• Understand clinician workflow
• Engage clinicians, nurses and allied staff
• The perfect system does not exist

17. The importance of recognition –
What an achievement!
Thanks to:
Arohanui Clinicians
Houston Medical
Developers
Patients First Team
(Peter Jordan)
NZULM (Craig
Mabon)
NZF (Chris Hilder)

18. Questions