At last the “E” word is out in NZ! We have a national EHR project…Now what?

Dear all, it has been a while…A lot has happened since my last post which was from Medinfo 2015 conference in Sao Paulo. Well it was a blast (and I mean it!) for openEHR. Being a sponsor of the event and having our own booth it was a new milestone for our international community. You can check out the various activities and presentations from this link.

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R>L: David Ingram (Emeritus Prof. UCL, openEHR President of Board of Governors; unbeatable Ed Hammond – father of HL7; Japanese colleagues (Dr Hiroshi Mizushima, Chief Senior Researcher of Center for Public Health Informatics in National Institute of Public Health and Shinji Kobayashi now joint-lead of openEHR Localisation Program; and myself)

The Brazilian national EHR project is strongly underpinned by openEHR and it was eminent during the whole event.

Before the conference I spent a whole week in Manaus, the capital of Amazonas state located in the middle of vast jungle! We are working with the State University of Amazonas (UEA) on a care integration project with some concrete telehealth and mobile technology demonstrators. We will be using openEHR for eliciting information requirements and for creating a core record structure.

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Amazonas Project team meeting at a great venue: Samsung Ocean Lab

Now back to down under, our precious little big cute country…Yes at the recent HINZ 2015 conference the Minister has formally announced the national EHR project. Rumor has it that this particular acronym was a real tabu in the previous administration and I think it was a wise decision. Now that NZ has achieved a lot in the health IT space I think we can confidently say “we can do it mate!” and with classical Kiwi twist: in whooping 3 years and without major investment (that’s my guess!). The recent independent review report provides a great overview of where we are at the moment pointing out in good detail strengths and weaknesses of our current system. However can you believe there is no mention about standards – as I always try keyword searching in such documents: openEHR: none (well not a big surprise), FHIR: none (now that’s a surprise) and HL7: none (well wasn’t expecting that!). OK governments and their contractors a bit scared of interoperability standards but hey there’s the terminology standards: ICD and SNOMED: none! That is a bit odd and most probably deliberate.

Well I’m not going to bore you with more details – the full report is here.

My take on this is that the hospitals in NZ will need to step up and get decent EMRs and we will also have a single national EHR that will aggregate person centric data from various systems. Unlike many other nations our primary care health IT is in much better off than hospitals for various reasons and this report rightfully makes it clear there’s a lot to gain to lift the game in the secondary care sector. Nevertheless they prescribe one or two vendor products in this space (it doesn’t leave much to imagination who these could be 😉

Now final words: I firmly believe openEHR is well placed at the two opposite ends of the interoperability game (as opposed to what is commonly known as the middle-out approach in the HIE centric virtual EHR architectures).

  1. Bottom-up: working with clinicians and other stakeholders to elicit our national clinical information requirements, most probably providing input for FHIR profiling for Health Information Exchange.
  2. Top-level: the national EHR backbone should be openEHR based. We already have many national programs running scalable industry solutions – see this recent whitepaper for adoption patterns. Clearly there is no other standards based alternative. Of course we can also adopt a monolithic solution’s model and hope for the best…Now that’s a real danger.

This can happen while big-guys take on the hospitals and deploy their fully integrated EMRs. I say this often and I’ll say again: no matter which approach choose we will have to do our homework: define our clinical information requirements! It is utterly naive to expect a single vendor or government to do it for us. And that’s what openEHR is about. Stay tuned…

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