Nelson Marlborough joins South Island shared electronic medical record

Clinicians at Nelson Marlborough District Health Board now have access to diagnostic test results and other clinical documents stored the South Island’s shared Eclair clinical data repository, following the recent implementation of the Health Connect South clinical information portal. The go live of the system at NMDHB means that all five South Island DHBs are now using the same shared electronic medical record, and work is continuing on the roll out of electronic sign-off and requesting of diagnostic tests across the South Island using Sysmex Eclair.

The following article was written by Kate McDonald and published in Pulse+IT on 13 January 2017.

South Island connects as Nelson Marlborough gears up for go-live

Nelson Marlborough District Health Board (NMDHB) is gearing up to go live with the Health Connect South clinical information portal next month in what is a major milestone for the South Island, with all five southern region DHBs connecting to the same shared electronic medical record for secondary care.

And when the primary care portal HealthOne is rolled out in Nelson Marlborough by the middle of the year, the South Island will have what is in effect a shared electronic health record for its entire population, in what could prove a model for the New Zealand government’s plans for a single, national EHR.

Adopting Health Connect South, which is based on Orion Health’s Consult technology, is expected to be easier for NMDHB clinical staff than for those moving from paper, as Nelson Hospital has used Orion’s Concerto clinical workstation for a decade and staff have had access to Health Connect South in read-only mode for six or so months as clinical documents are migrated across.

However, for NMDHB clinical director of information systems Bev Nicolls, the real fun begins when the other capabilities underpinned by Health Connect South, such as eLab and radiology sign-off and requesting, come online.

Allied to the roll-out of Health Connect South will be the activation of HealthOne, formerly known as the electronic shared care record view (eSCRV). Both Health Connect South and HealthOne originated as a partnership between primary health organisation Pegasus Health and Canterbury DHB, driven by those organisations’ desire for joined-up healthcare and precipitated by the 2011 earthquake.

The systems have both since been adopted by South Canterbury and West Coast DHBs, with Southern DHB following with Health Connect South and then HealthOne in the second half of last year. Dr Nicolls said Health Connect South is due to go live at Nelson Marlborough on February 13, with HealthOne capability activated at the same time but in effect rolling out gradually between March and June to local primary care providers.

As a practising GP, Dr Nicolls will be able to access Health Connect South through HealthOne on his desktop to check on test results and referrals status without having to play the age-old phone tag that is the bane of the existence of most GPs.

While many healthcare organisations are implementing large, proprietary EMRs, the South Island instead has worked on the concept of taking information from disparate sources and presenting it to clinicians through a portal.

Health Connect South provides access to clinical documentation and templates, results held in TestSafe South, which uses Sysmex’s Eclair clinical data repository, InterRAI assessments for older people and to HealthOne itself, where hospital clinicians can see the patient’s diagnoses and medications, uploaded by GPs and pharmacists.

It is by no means comprehensive just yet, Dr Nicolls said, and there are important privacy elements to work through, particularly for HealthOne, but for the first time, clinicians will be able to access up-to-date information on any South Island patient presenting at any ED or GP surgery in the region. The obvious question is then whether it could be rolled out for all New Zealanders.

“It is a good model but not the ultimate – currently it doesn’t have a comprehensive, single list of medicines or single diagnostic list,” Dr Nicolls said. “HealthOne hasn’t got there yet but step one is that you now know there are five different lists of medications for that patient. You can’t jump there in a single leap.”

There have already been benefits to using Health Connect South before it goes live in Nelson Marlborough despite it currently being view-only, Dr Nicolls said. He believes the surgical disciplines and specialist areas such as oncology will benefit in particular.

“We have had Health Connect South accessible in non-functional mode for probably about six to eight months so it has been the Canterbury version,” he said. “That has been particularly useful for the tertiary referrals for radiation oncologists, as we use Canterbury clinicians.

“Nelson Marlborough Oncology has hugely benefited and therefore oncology patients have benefited because oncology team coordination nurses have been able to see exactly what has gone on and where it has gone on and have access to all the information they need.

“That aspect has been fantastic, and is a microcosm of what will become available now. As we have migrated documents into Health Connect South, they will also become visible to other clinicians. If someone turns up in ED in Christchurch, they may well be able to see our discharge summary documents. There has been a steady benefit that has pre-empted the go-live for us, for patients and clinicians.”

And by being able to access primary care records in HealthOne through Health Connect South, hospital clinicians will have access to a far wider range of information than ever before. “Hospital doctors will get the GP suite of information and we’ve been working on that for 20 years so it’s really valuable,” he said.

“They can validate an allergy, know what medications their patients are on, and there is a plan to show what immunisations they’ve had. Every clinician will have that holistic view.

“For the GPs, we spend quite a lot of time calling the hospitals, which are only recently rolling out a centralised referral centre. If I refer a patient I often end up phoning a surgical secretary to see if they’ve received it and if I get an answering machine I randomly phone another surgical secretary.

“With HealthOne, I’ll be able to see that the patient has an appointment booked already or know it is pending, ready for triage. That immediacy is there. We sometimes sporadically get copied inpatient and outpatient blood test results – now we will be able to go straight in and look at someone’s PSA, for instance, if we haven’t received a result.”

In future, it is possible that patients will have access to the HealthOne portal, something that former Canterbury DHB chief medical officer Nigel Millar is quite keen on. Dr Nicolls is too, having pioneered the use of the Medtech ManageMyHealth patient portal at his general practice in the Nelson suburb of Stoke.

“Canterbury have been looking at the concept of a patient portal so logically Health One is a platform for people, including patients, to look at a specific patient’s record,” he said. “Nigel Millar has been very clear that the patient will be basically another user of HealthOne.”

For Health Connect South, Nelson Marlborough is currently going through user acceptance testing, with super-users from different departments at Nelson Hospital and Wairau Hospital in Blenheim having gone through testing cycles since early December. User acceptance testing is also taking place at walk-in centres such as Murchison Hospital and the older persons’ mental health facility at Alexandra.

For the GP roll-out, Dr Nicolls said it was technically possible from late February once the dust settles on Health Connect South, but in reality it will probably be between March and June. “It is an opt-off system so there has to be a lot of media to tell people about it,” he said.

More than anything, what Dr Nicolls and his colleagues who have worked on Health Connect South, including emergency department clinical director Tom Morton and paediatrician Peter McIlroy, are looking forward to are the future capabilities provided by the platform in the hospital setting.

“We are proudly independent here but we are now really keen to work as a wider South Island team to really leverage this stuff,” he said. “The second it launches we can then launch eLab and radiology sign-off and requesting and begin wider implementation of our ‘Paper-lite’ journey that we have been hanging out for for 18 months.

“These projects are quite advanced but we have just been waiting for the tools to come in. I think a lot is going to change in a year.”


More information

Eclair eOrders and Results sign off

Eclair Clinical Data Repository