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Health It in New Zealand Vs US: A Comparison

Posted on October 24, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

I’d been corresponding with a PR person for a story I’m doing on ambulatory exoskeletons. She dug me up on Twitter, figured I dabbled in a few things health IT and asked if I would be interested in a recently published report on how health IT influences New Zealand’s healthcare. Now, unbeknownst to her, I also have an abiding interest in all things Kiwi, having lived in Wellington for a brief bit of time, so I was curious to know what this report contained.

The press release introducing the report started with an endorsement from John D. Halamka, so that was a huge plus in its favor. It outlined things that New Zealand has done right:
– It has a population the size of Colorado, and ranks 23rd among OECD countries (Organization for Economic Cooperation and Development, basically all of Europe, Aus and NZ, US, Canada, Mexico and industrialized nations in Asia) but is ranked number 1 or number 2 in several healthcare categories, including overall quality care delivery (92%), EMR use by doctors (97%), use of computerized patient care reminders (92%)
– Demographically similar to the US in terms of urban/rural population split (86:14 NZ, 81:19 US), Information and Communication Technology development index, has lower physician, nurse and dentist density per 10,000 (NZ: 87,4,10 resply, US: 27, 98, 16 resply) but spends far less than the US on healthcare (NZ spends 9.8 percent of its GDP, US spends about 16 percent of its GDP)

There are far too many of these interesting compare and contrast stats for me to do justice to them in this little space, so I’ll suggest you read the report in its entirety (Do not look at Table 5 if you want to avoid serious heartburn). There are some interesting case studies towards the end of the report and plenty to keep you busy reading for quite some time.

For me, the most interesting part of the report dealt with how far NZ health infrastructure has come since its national medical IT policy was implemented in 2005. New Zealand, as the report states, has a single layer of national government, low population size, making it easier to implement a standard health IT policy. However, it’s also interesting what they’ve been able to achieve infrastructurally, which is the establishment of the National Health Index, the Health Practitioner Index and a Medical Warnings System.

To those of us who associate indices with performance, the National Health “Index” seems clunkily named, and is not a measure of how healthy Kiwis are. New Zealand’s NHI is really a kind of health ID assigned to each patient who uses the country’s health and disability support services. The report says children born in New Zealand are automatically assigned an NHI at birth and about 95 percent of the population have their NHI. Where the NHI comes handy is in tracking of patient medical records. Whether a patient moves from hospital to community to private care or any combination you can think of, all EMR documentation generated along the way reference the unique NHI for the patient. The same concept applies to Health Practitioner Index, which is again a unique ID identifying every medical practitioner in a myriad of medical professions.

The Medical Warnings System is probably the most interesting piece of the New Zealand health infrastructure. It is a system containing details of all significant medical conditions associated with the patient. A flag against the NHI tells health workers that the patient has, say, a significant medical condition, or is allergic to some medicines.

Put together, this report paints us a picture of where we could take US healthcare over the next few years – from a logical way to collect patient data under one ID to a comprehensive electronics warnings system that takes the guesswork out of care. (One could argue that the American SSN serves pretty much the same purpose, but we certainly don’t have a system where records are organized by SSN, or used by health workers to communicate with one another.)

Establishing A National HIE On One Platform May Be A Good Idea

Posted on March 21, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

When you read this statement from HIT vendor Orion Health, it sounds oh-so-simple: why not establish an entire county’s HIE network on a single connecting platform?  Given the country’s already high EMR adoption rate — about 80 percent of GPs had one, as of March 2010 — New Zealand’s already part-way there.  Just knit offices up together and you’re ready to go.

Orion, of course has its own technology in mind, naturally. But whatever vendor you use, they may be onto something. I’ll pause here to say that the following proposal could incite a riot at a HIMSS floor full of competing vendors, but hey, ideas are harmless, aren’t they?

What if CMS decided that it would pay incentives not just to meaningfully, sensitively, insightfully install EMRs, but to connect them to an overall HIE?  And to take the thought into more controversial territory, what if it had a vendor or two of choice which doctors and hospitals had to use if they wanted the dough?

As we all know, the value of EMR installations isn’t just in automating, error checking and (hopefully) streamlining workflow in practices. The data is infinitely more valuable when it can be aggregated, shared, cross-checked and mined for best practices.

What are the odds of that, however, if you have an outbreak of regional and state projects using technology from a multitude of vendors?  You can talk standards all you want, but true interoperability isn’t going to happen anytime soon this way.  National connectivity?  Well, give me a couple of decades and let’s see how far that’s gotten.

On the other hand,  if CMS signed contracts with HIE technology vendors, and demanded that they give preferred pricing to those work with them, you’d see a rash of connectivity unrivaled since the invention of the telephone.  Before you scream that this just isn’t fair, doesn’t this kind of thing happen every day in, say, military contracting?

I know, I know, this may not be practical. But you can’t argue that It’d be interesting to see how the HIE and EMR market gelled if CMS took a strong lead.