Health information strategy for New Zealand

The health information strategy signposts the direction for health information services to meet national health information requirements for the 1990s and beyond. The Department of Health is involved in the essential business of funding and monitoring the health sector, providing policy advice and managing resources. The New Zealand Health Information Service will provide the data and analysis from both electronic and manual based systems to support the 'business' of health. Information systems must meet the needs of users. This requires consistency between the information strategy and the direction and goals of the organisation it is designed to service. The approach to health information is consistent with and supports the overall strategy and direction for the development of health services in New Zealand. The development and implementation of the New Zealand Health Information Strategy has been and continues to be an exciting and daunting challenge. All health professionals, managers and the public want high quality, relevant and timely information. The task now is to harness the information technology to support the health sector by providing the vital information.     

Australia and New Zealand's contribution to Pacific Island health worker brain drain

Objective: The paper aims to quantify Australia and New Zealand's contribution to the brain drain of Pacific Island health workers and to contribute firm evidence to the ongoing, highly‐contested health professional migration issue. Methods: The study uses the Australian and New Zealand 2006 census data to examine the number of Pacific Island born health professionals living in Australia and New Zealand and uses World Health Organization data to compare it against the numbers of health workers in Pacific Island countries. Results: Six hundred and fifty‐two Pacific Island born doctors and 3,467 Pacific Island born nurses and midwives are working in Australia and New Zealand, more than half of whom are from Fiji with significant numbers from Papua New Guinea, Samoa and Tonga as well. There are almost as many Fiji‐born doctors in Australia and New Zealand as there are in Fiji. There are more Samoa, Tonga and Fiji‐born nurses and midwives in Australia and New Zealand than in the domestic workforce. Conclusions: Migration of Pacific Island health professionals to Australia and New Zealand is very high and contributes to the shortage of health workers in Pacific Island countries. Implications: Australia and New Zealand are encouraged to actively address the issue in collaboration with Pacific Island partners with a number of solutions proposed.     

Advancing practice: Using nutrition information and technology to improve health—the nutrition informatics global challenge

Aims: The unique combination of technology, information and nutrition has been utilised in health care for decades. As technology and effective use of health data evolve, the field of ‘nutrition informatics’ is positioned to advance best practices of nutrition care delivered by registered dietitians and dietetic technicians registered. The present paper reviews the opportunities. Methods: A narrative review was constructed with reference to the literature. Results: Evolution of the use of digital health care in the USA is on an aggressive timeline because of regulations, which provide financial incentives to eligible professionals and hospitals who can prove ‘meaningful use’ of certified health‐care technology. While adoption and use of electronic health records has occurred at the international level for decades, only recently have American adoption rates increased. Health‐care providers are adjusting to rapid cultural changes, which support the interoperability of health data. The dietetics profession must move in tandem with this transition to digital care. This requires implementation and development of nutrition standards, vocabularies and quality measures, which support exchange of pertinent nutrition data critical to patient care and wellbeing. All dietetic professionals need to appreciate the paradigm shift in health care. Conclusions: Dietitians who are involved with informatics will help with this transition through their work with systems implementations, understanding competencies necessary for successful integration of digital nutrition and using electronic nutrition data for research.     

Using critical incident interviews to identify the mental health knowledge,skills and attitudes of entry‐level dietitians

Aim: This paper aims to explore new graduates' experience working with clients with mental health issues using critical incident interviews. Methods: The qualitative research techniques were based on phenomenology. A purposive sample of 19 new graduate dietitians was drawn from a range of work settings and locations throughout Australia. Data were gathered using 30‐minute critical incident interviews. Audiotaped data were transcribed, coded to identify common themes, compared for congruence and then categorised into knowledge, skills and attitudes. Results: New graduates encountered a range of situations involving a variety of mental health, wellbeing, dietetic and clinical issues. Common themes revealed that graduates felt under‐prepared to deal with these situations. Themes also highlighted the mental health knowledge, skills and attitudes required for entry‐level dietitians, which then informed the review of the National Competency Standards for Entry‐Level Dietitians. Conclusion: New graduates encounter a variety of mental health and wellbeing issues in their everyday practice and therefore require training to address these situations competently.     

Developing the electronic health record: what about patient safety?

This paper examines the development of electronic health records within the National Health Service (NHS) by an analysis of a series of pilot projects funded by the Electronic Record Development and Implementation Project (ERDIP), one aspect of the work of the NHS Information Authority (NHSIA) (As of 1 April 2005, the NHSIA ceased to operate. Much of its work is continued by Connecting for Health and the Health and Social Care Information Centre.) The focus of the analysis is on the extent to which identifying and correcting error within health records was explored through these projects. The inherent potential for error and resultant impact on patient safety is highlighted, by considering the context of the record, the content of the record and the process of change from paper-based or piecemeal electronic health records to integrated electronic health records. While the process of change highlights issues of data security and access, it is the variability in starting points for different organizations that possibly poses most risk to patient safety. Issues relating to the content of the record can to some extent be minimized by the effective use of technology, but the tension between coding and qualitative data requires further consideration in terms of its impact on patient safety. This paper concludes that the development of electronic health records has to be viewed within the context of governance and patient safety, and the implications articulated.     

Florida doctors seeing Medicaid patients show broad interest in federal incentives for adopting electronic health records

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 aims to expand the use of electronic health records by offering financial incentives to physicians to fully adopt and implement them. We surveyed Florida physicians who deliver care to Medicaid participants to identify their interest in participating in the incentive program. More than 60 percent of all respondents expressed interest in applying for the incentives; of those already using electronic health record systems, 86 percent intend to apply for funding. This relatively high proportion of physicians creates the potential to reach the overall policy goals of the law. Among those not planning to seek incentives, common barriers--especially among nonusers of electronic health records--were "costs involved" (69 percent), "need more information about incentive program" (42 percent), and uncertainty about what system to purchase (42 percent). We suggest that these findings hold implications for the Regional Extension Centers working to help physicians achieve the federal meaningful-use criteria that are a condition of receiving the incentives. In particular, the centers should focus on providing physicians with information about costs of electronic health record systems.     

The SF‐36v2 and SF‐12v2 health surveys in New Zealand: norms,scoring coefficients and cross‐country comparisons

Objective : To provide New Zealand population norms for version 2 of the SF‐36 and SF‐12 health surveys and report scoring coefficients that enable the construction of Physical and Mental Component Summary scores from New Zealand SF‐36v2 and SF‐12v2 data. Approach : Norms for the SF‐36v2 and scoring coefficients for the Physical and Mental Component Summary scores are estimated using 2006/07 New Zealand Health Survey data, which included 12,488 adults (aged 15 years and over). Norms for the SF‐12v2 are derived from 2008 New Zealand General Social Survey data, including 8,721 adults. Comparisons are made between New Zealand norms for versions 1 and 2 of the SF‐36 instrument. In addition, New Zealand SF‐36v2 and SF‐12v2 norms and the scoring coefficients are compared with those for the United States and South Australia. Conclusion : Differences between: 1) New Zealand population norms for the SF‐36 versions 1 and 2; and 2) SF‐36v2 and SF‐12v2 population norms for New Zealand and those for the United States and South Australia highlight the importance of using version‐specific and country‐specific population norms. Implications: The analysis reported here allows for the appropriate use of the SF‐36v2 and SF‐12v2 instruments in New Zealand.     

Defining remote health

OBJECTIVE: To develop a definition of the discipline of Remote Health. DESIGN: A broad literature search using key words and an Internet search of industry-recognised web sites were carried out. RESULTS: Fifty-five relevant citations and nine web sites were reviewed, covering Australia, Canada, New Zealand, the United Kingdom and United States. The papers offered a variety of definitions of geographical and practice-based approaches to 'remoteness', and definitions of 'remote and rural health'. CONCLUSIONS: None of the single current definitions in the literature adequately reflect all of the characteristics of Remote Health in Australia. A definition is offered: Remote Health is an emerging discipline with distinct sociological, historical and practice characteristics. Its practice in Australia is characterised by geographical, professional and, often, social isolation of practitioners; a strong multidisciplinary approach; overlapping and changing roles of team members; a relatively high degree of GP substitution; and practitioners requiring public health, emergency and extended clinical skills. These skills and remote health systems, need to be suited to working in a cross-cultural context; serving small, dispersed and often highly mobile populations; serving populations with relatively high health needs; and a physical environment of climatic extremes.     

Follow-up methods for retrospective cohort studies in New Zealand

OBJECTIVES: To define a general methodology for maximising the success of follow-up processes for retrospective cohort studies in New Zealand, and to illustrate an approach to developing country-specific follow-up methodologies. METHODS: We recently conducted a cohort study of mortality and cancer incidence in New Zealand professional fire fighters. A number of methods were used to trace vital status, including matching with records of the New Zealand Health Information Service (NZHIS), pension records of Work and Income New Zealand (WINZ), and electronic electoral rolls. Non-electronic methods included use of paper electoral rolls and the records of the Registrar of Births Deaths and Marriages. RESULTS: 95% of the theoretical person-years of follow-up of the cohort were traced using these methods. In terms of numbers of cohort members traced to end of follow-up, the most useful tracing methods were fire fighter employment records, the NZHIS, WINZ, and the electronic electoral rolls. CONCLUSIONS: The follow-up process used for the cohort study was highly successful. On the basis of this experience, we propose a generic, but flexible, model for follow-up of retrospective cohort studies in New Zealand. Similar models could be constructed for other countries. IMPLICATIONS: Successful follow-up of cohort studies is possible in New Zealand using established methods. This should encourage the use of cohort studies for the investigation of epidemiological issues. Similar models for follow-up processes could be constructed for other countries.     

Follow-up methods for retrospective cohort studies in New Zealand

Objectives: To define a general methodology for maximising the success of follow-up processes for retrospective cohort studies in New Zealand, and to illustrate an approach to developing country-specific follow-up methodologies.
Methods: We recently conducted a cohort study of mortality and cancer incidence in New Zealand professional fire fighters. A number of methods were used to trace vital status, including matching with records of the New Zealand Health Information Service (NZHIS), pension records of Work and Income New Zealand (WINZ), and electronic electoral rolls. Non-electronic methods included use of paper electoral rolls and the records of the Registrar of Births Deaths and Marriages.
Results: 95% of the theoretical person-years of follow-up of the cohort were traced using these methods. In terms of numbers of cohort members traced to end of follow-up, the most useful tracing methods were fire fighter employment records, the NZHIS, WINZ, and the electronic electoral rolls.
Conclusions: The follow-up process used for the cohort study was highly successful. On the basis of this experience, we propose a generic, but flexible, model for follow-up of retrospective cohort studies in New Zealand. Similar models could be constructed for other countries.
Implications: Successful follow-up of cohort studies is possible in New Zealand using established methods. This should encourage the use of cohort studies for the investigation of epidemiological issues. Similar models for follow-up processes could be constructed for other countries.     

Health policy responses to rising rates of multi‐morbid chronic illness in Australia and New Zealand

Objective: To examine current health policy in Australia and New Zealand and assess the extent to which the policies equip these countries to meet the challenges associated with increasing rates of multi‐morbid chronic illnesses. Method: We examined reports from agencies holding data relating to chronic illness in both countries, looking at prevalence trends and the frequency of multiple morbidities being recorded. We undertook content analysis of health policy documents from Australian and New Zealand government agencies. Results: The majority of people with chronic illness have multiple morbidities. Multi‐morbid chronic illnesses significantly effect the health of people in both Australia and New Zealand and place substantial demands on the health systems of those countries. These consequences are both predicted to increase dramatically in the near future. Despite this, neither country explicitly acknowledges multi‐morbidity as a major factor in their policies addressing chronic illness. Conclusion and Implication: In addition to considering policy responses to chronic illness, policy makers should explicitly consider policies shaped to address the needs of people with multi‐morbid chronic illness.     

军队人员健康档案基本数据集与数据元标准研究

军队人员健康档案基本数据集与数据元标准是军队人员电子化健康档案标准的核心。国家卫生部卫生信息标委会于2011年8月组织完成了我国城乡居民健康档案基本数据集、数据元及值域代码标准的编制工作,同年将其正式颁布为我国卫生行业标准,并开发了基于基本数据集与数据元标准的区域健康档案信息平台。本文参照我国居民健康档案基本数据集与数据元标准,基于军队人员健康档案基础框架和特殊属性,阐述我军健康档案基本数据集与数据元标准体系。     

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Integration of electronic health records (EHRs) in the national health care systems of low‐ and middle‐income countries (LMICs) is vital for achieving the United Nations Sustainable Development Goal of ensuring healthy lives and promoting well‐being for all people of all ages. National EHR systems are increasing, but mostly in developed countries. Besides, there is limited research evidence on successful strategies for ensuring integration of national EHRs in the health care systems of LMICs. To fill this evidence gap, a comprehensive survey of literature was conducted using scientific electronic databases—PubMed, SCOPUS, Web of Science, and Global Health—and consultations with international experts. The review highlights the lack of evidence on strategies for integrating EHR systems, although there was ample evidence on implementation challenges and relevance of EHRs to vertical disease programs such as HIV. The findings describe the narrow focus of EHR implementation, the prominence of vertical disease programs in EHR adoption, testing of theoretical and conceptual models for EHR implementation and success, and strategies for EHR implementation. The review findings are further amplified through examples of EHR implementation in Sierra Leone, Malawi, and India. Unless evidence‐based strategies are identified and applied, integration of national EHRs in the health care systems of LMICs is difficult.     

EHR in the UK: shedding some light from a manager's perspective

Much has been written recently about the National Health Service electronic health record initiative which, from outside the United Kingdom, may sound to some like the envy of the world. The National Health Service Connecting for Health is the body which now oversees the National Programme for Information Technology, which is responsible for delivering England's electronic health record or National Care Record Service. Questions have been raised as to whether the reported progress toward this admirable goal is an example of spin or reality. A health information management professional from the United States, who has been working inside the UK eye of the storm, sheds some light from a health information management perspective.     

Comparison of nutrition knowledge among health professionals,patients with eating disorders and the general population

Aim: To investigate and compare the level of nutrition knowledge of health professionals, patients with eating disorders and individuals without an eating disorder as controls. Methods: Participants were recruited online through an Australian and New Zealand professional eating disorder organisation and community eating disorder organisations and a university in Australia. Assessment was conducted online using the General Nutrition Knowledge Questionnaire and SCOFF. Demographic data were also collected. Results: Dietitians had greater nutrition knowledge than all other health professionals, except medical doctors. Psychologists and dietitians had similar knowledge for choosing everyday foods. Dietitians had greater nutrition knowledge than eating disorder patients and controls in all areas of nutrition knowledge, while other health professionals had similar knowledge to patients. Patients with eating disorders had greater knowledge of sources of nutrients than controls. Conclusions: Australian health professionals exhibited higher levels of nutrition knowledge than health professionals in previous studies in other countries. However, non‐dietitian health professionals had similar levels of knowledge to individuals with eating disorders. Training and continuing education in nutrition is needed so health professionals can confidently identify when a patient has misleading information about nutrition and either correct the misinformation or refer the patient on to a qualified dietitian.     

Digital disruption of dietetics: are we ready?

Digital health is transforming the delivery of health care around the world to meet the growing challenges presented by ageing populations with multiple chronic conditions. Digital health technologies can support the delivery of personalised nutrition care through the standardised Nutrition Care Process (NCP) by using personal data and technology‐supported delivery modalities. The digital disruption of traditional dietetic services is occurring worldwide, supporting responsive and high‐quality nutrition care. These disruptive technologies include integrated electronic and personal health records, mobile apps, wearables, artificial intelligence and machine learning, conversation agents, chatbots, and social robots. Here, we outline how digital health is disrupting the traditional model of nutrition care delivery and outline the potential for dietitians to not only embrace digital disruption, but also take ownership in shaping it, aiming to enhance patient care. An overview is provided of digital health concepts and disruptive technologies according to the four steps in the NCP: nutrition assessment, diagnosis, intervention, and monitoring and evaluation. It is imperative that dietitians stay abreast of these technological developments and be the leaders of the disruption, not simply subject to it. By doing so, dietitians now, as well as in the future, will maximise their impact and continue to champion evidence‐based nutrition practice.     

Eating environment in the aged‐care residential setting in New Zealand: Promoters and barriers to achieving optimum nutrition. Observations of the foodservice,menu and meals

Aim: To investigate the foodservice, menu and meals in the aged‐care residential setting to identify promoters and barriers to achieving optimum nutrition. Method: An observational study conducted by the University of Otago Dietetic Training Programme. Rest home dietitians around New Zealand identified a final convenience sample of 50 facilities. Ten final‐year student dietitians each spent two days in their designated rest homes, administering a 19‐item questionnaire to ascertain practices relating to staffing, dining environment, menu, meals, snacks, feeding assistance, fluids, special diets, nutrition care, medications, nutrition policy and access to sunlight. Observations describing foodservice and meal‐related activities only are reported in this paper. Results: Most rest homes had the ability to provide for the needs of residents. Ninety per cent of facilities offered menu cycles of at least four weeks long. Potential barriers to meeting needs were inadequate amounts of protein‐rich food for numbers served and lack of perceived choice in menus and meal service. Lack of foodservice staff training and poor uptake of training opportunities contributed to these barriers. Conclusions: This is the first such study conducted in New Zealand. Results should be of interest to the Ministry of Health and district health boards that are charged with the responsibility to ensure that meals in long‐term care facilities meet the nutritional needs of this potentially vulnerable population. Shortcomings identified in the present study require a multidisciplinary approach that should include district health boards, auditing agencies, aged‐care organisations, training providers and dietitians.     

Children overdue for immunisation: a question of coverage or reporting? An audit of the Australian Immunisation Register

Objective : Vaccinations in Australia are reportable to the Australian Immunisation Register (AIR). Following major immunisation policy initiatives, the New South Wales (NSW) Public Health Network undertook an audit to estimate true immunisation coverage of NSW children at one year of age, and explore reasons associated with under‐reporting. Methods : Cross‐sectional survey examining AIR immunisation records of a stratified random sample of 491 NSW children aged 12≤15 months at 30 September 2017 who were >30 days overdue for immunisation. Survey data were analysed using population weights. Results : Estimated true coverage of fully vaccinated one‐year‐old children in NSW is 96.2% (CI:95.9‐96.4), 2.1% higher than AIR reported coverage of 94.1%. Of the children reported as overdue on AIR, 34.9% (CI:30.9‐38.9) were actually fully vaccinated. No significant association was found between under‐reporting and socioeconomic status, rurality or reported local coverage level. Data errors in AIR uploading (at provider level) and duplicate records contributed to incorrect AIR coverage recording. Conclusions : Despite incentives to record childhood vaccinations on AIR, under‐reporting continues to be an important contributor to underestimation of true coverage in NSW. Implications for public health : More reliable transmission of encounters to AIR at provider level and removal of duplicates would improve accuracy of reported coverage.     

Submissions to the Australian and New Zealand Review of Food Labelling Law and Policy support traffic light nutrition labelling

Objective: Food labels to support healthier choices are an important potential intervention for improving population health by reducing obesity and diet‐related disease. This study examines the use of research evidence about traffic light nutrition labelling in submissions to the Review of Food Labelling Law and Policy conducted in Australia and New Zealand. Methods: Content analysis of final submissions to the Review and a literature review of documents reporting research evidence about traffic light labelling. Results: Sixty‐two submitters to the Review were categorised as ‘supporters’ of traffic light labelling and 29 as ‘opponents’. Supporters focused on studies showing traffic light labels were better than other systems at helping consumers identify healthier food options. Opponents cited evidence that traffic light labels were no better than other systems in this respect and noted a lack of evidence that they led to changes in food consumption. A literature review demonstrated that, as a group, submitters had drawn attention to most of the relevant research evidence on traffic light labelling. Both supporters and opponents were, however, selective in their use of evidence. Conclusions: The weight of evidence suggested that traffic light labelling has strengths in helping consumers to identify healthier food options. Further research would be valuable in informing the development of an interpretive front‐of‐pack labelling system. Implications: The findings have significant implications for the development of front‐of‐pack nutrition labelling currently being considered in Australia and New Zealand.     

SMART Platforms: Building the App Store for Biosurveillance

Objective

To enable public health departments to develop “apps” to run on electronic health records (EHRs) for (1) biosurveillance and case reporting and (2) delivering alerts to the point of care. We describe a novel health information technology platform with substitutable apps constructed around core services enabling EHRs to function as iPhone-like platforms.

Introduction

Health care information is a fundamental source of data for biosurveillance, yet configuring EHRs to report relevant data to health departments is technically challenging, labor intensive, and often requires custom solutions for each installation. Public health agencies wishing to deliver alerts to clinicians also must engage in an endless array of one-off systems integrations.Despite a $48B investment in HIT, and meaningful use criteria requiring reporting to biosurveillance systems, most vendor electronic health records are architected monolithically, making modification difficult for hospitals and physician practices. An alternative approach is to reimagine EHRs as iPhone-like platforms supporting substitutable apps-based functionality. Substitutability is the capability inherent in a system of replacing one application with another of similar functionality.

Methods

Substitutability requires that the purchaser of an app can replace one application with another without being technically expert, without requiring re-engineering other applications that they are using, and without having to consult or require assistance of any of the vendors of previously installed or currently installed applications. Apps necessarily compete with each other promoting progress and adaptability.The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project is funded by a $15M grant from Office of the National Coordinator of Health Information Technology’s Strategic Health IT Advanced Research Projects (SHARP) Program. All SMART standards are open and the core software is open source.The SMART project promotes substitutability through an application programming interface (API) that can be adopted as part of a “container” built around by a wide variety of HIT, providing readonly access to the underlying data model and a software development toolkit to readily create apps. SMART containers are HIT systems, that have implemented the SMART API or a portion of it. Containers marshal data sources and present them consistently across the SMART API. SMART applications consume the API and are substitutable.

Results

SMART provides a common platform supporting an “app store for biosurveillance” as an approach to enabling one stop shopping for public health departments—to create an app once, and distribute it everywhere.Further, such apps can be readily updated or created—for example, in the case of an emerging infection, an app may be designed to collect additional data at emergency department triage. Or a public health department may widely distribute an app, interoperable with any SMART-enabled EMR, that delivers contextualized alerts when patient electronic records are opened, or through background processes.SMART has sparked an ecosystem of apps developers and attracted existing health information technology platforms to adopt the SMART API—including, traditional, open source, and next generation EHRs, patient-facing platforms and health information exchanges. SMART-enabled platforms to date include the Cerner EMR, the WorldVista EHR, the OpenMRS EHR, the i2b2 analytic platform, and the Indivo X personal health record. The SMART team is working with the Mirth Corporation, to SMART-enable the HealthBridge and Redwood MedNet Health Information Exchanges. We have demonstrated that a single SMART app can run, unmodified, in all of these environments, as long as the underlying platform collects the required data types. Major EHR vendors are currently adapting the SMART API for their products.

Conclusions

The SMART system enables nimble customization of any electronic health record system to create either a reporting function (outgoing communication) or an alerting function (incoming communication) establishing a technology for a robust linkage between public health and clinical environments.