Auckland PHO Switch it on! hareholder Meeting 7 th June, 2016
Auckland PHO Welcome: Dr Carmel Built, Chair on behalf of the Board
Auckland PHO Welcome Dr Yaw Moh and Jonathan Murray National Hauroa Coalition Introduction to Mōhio
Introduction for
What is Mōhio? Mōhio is a real-time web based platform that integrates General Practice and PHO.
What is Mōhio? Patient prompts system Electronic forms Electronic referrals Live budgets Live data extraction Range of reports and dashboards Financial Clinical and health target Appointment scanner DHB compliance reporting
Why Mōhio? Replaces: DrInfo PREDICT CVD Advanced Forms Patient Dashboard Karo Reports* Manual claims/referrals to PHO Single platform Shared data (no differing reports) Live or daily reports Developed by PHOs
MōhioExpress Electronic platform for delivery of services: Programme promotion and identification Very fast sits outside of PMS system Record items back into PMS
MōhioForms For referrals and claiming Integrated: Pulls existing General Practice and primary health data Live: General practice and community teams access the forms live. Demand management (live budgets) and eligibility checks. Claim, invoice, clinical note and reporting all completed from form. Rules engine: Very flexible rules and adaptable. Currently ~50 DHB contracts and our FFP built in. Clinical: Guideline based care prompts and pathways
RocketM Data collection and integration engine: Allows remote collection and querying of any data source Focused on individual client/patient data Real time system Centralised web interface control at NHC Secure Imports from other DHB/MoH sources such as NIR for accurate Childhood Immunisation information
Mōhio Appointment Scanning Sample Medical Practice 1/08/2015 Live checking of Appointment Book for patients eligible for a service Designed so client/patients don t walk in the door without teams ready to delivery services Live report available to our General Practices to review each day e.g. National Health Targets, New Born Enrolment NHI Patient Name DOB Due ABC1235 MICKEY MOUSE 20/04/2015 CVD, Smoking Brief Advice
Mōhio Live Reporting Live Mōhio reports available listing all patients due Health Target Activities NHI level data Excel report (easy sorting/filter) Ideal for recall activities Includes phone numbers and other contact details Single click on the patient s NHI to open their MedTech record
Mōhio Clinical Reporting Strong suite of clinical reporting available: Detailed Diabetic Patient Report Available Supports your diabetic patients, improving DAR rates, internal audits Influenza 65+ patient list Childhood Immunisation patient lists LTC and CVD Triple Therapy Identification list
Mōhio Live Dashboards Sample Practice
Auckland PHO The National Enrolment Service Introduction to the NES
The NES is a new IT initiative that will enable PHOs and General Practice to achieve more accurate, integrated, real time information on patient enrolment, eligibility, and identity.
What is the National Enrolment Service? (NES) The NES will be a single source of truth for all national enrolment data. What this means NES will provide the capability to support practices by assisting in patient identification. NES will integrate directly with the Practice Management Systems via a secure web-based service that links to Ministry of Health national identity and enrolment systems, providing relevant data for payment and reporting purposes. Enrolment and identity data will be updated in NES on a daily basis, allowing a real time view of national enrolment data.
How NES will help PHOs and General Practice A monthly snapshot of the NES practice data will produce information on identity, and enrolment to allow for CBF (capitation based funding) payment allocation on a monthly basis. The current quarterly process is inefficient in the allocation of funding and creates a financial risk for practices and PHOs. NES will see the end of the inefficient retrospective quarterly submission of enrolment registers.
In Summary the Benefits of NES are: A centralised register with real time patient enrolment status enabling more timely payment calculation for enrolled patients, Validated NHI and up to date patient demographics, supporting accurate identification of patients and clinical safety, Validated addresses using e-sam service, supporting accurate Geocoding and assignment of deprivation-based funding Nightly register updates to NES Web services integration with PMS, creating a seamless experience for the user when interacting with national services Processing and payment cycle reduced from 3 months to 1 month
What your PHOs role is with NES implementation. Auckland PHO will provide comprehensive support to each general practice to assist with the preparation for NES over the transition period. Important steps for NES Set Up 1. Data Cleansing Auckland PHO is working with Karo Data Management to cross match the patient information data held in the practice PMS system against the data held by the NHI. Reports will be sent to practices where there is a mismatch between the two data sets. 2. All practices will need their PMS version to be upgraded to the latest version to enable integration with NES web services, including Enrolment and Identity. For Medtech practices this will be MT32 v22.2.
Important steps for NES Set Up 3. Each practice will need to complete and sign the Connected Health Information Services Provider Request Form. This is required to ensure that all employees are aware that access to Connected Health Information Services (e.g. NHI look up) and use of any information obtained using the Services is subject to the provisions of the Privacy Act 1993 and the Health Information Privacy Code 1994. 4. Connected Health Information Services includes a number of services already in place such as: National Health Index (NHI),eSpatial Address Management (esam), GP2GP and access to other information services such as NIR data. The two new Connected Health Information Services are NZePS and NES.
Next steps Once the Provider Request Forms are completed Auckland PHO will submit them to the MoH and the PHO staff will contact you to advise you of the next steps. The PHO will be working with Karo and their contracted staff to provide training and ongoing support to the PHO and Practices throughout this transition process The current quarterly process will continue until adequate testing has been done to confirm we have achieved specific quality targets for use and accuracy.
Auckland PHO Are we there yet? Changes and Improvements are a journey. Auckland PHO Update
The Past The future Siloed services Disconnected Poor communication Fragmented Provider focused Integrated services Patient centric, care closer to home Shared accountability & transparency Improved capacity and capability Connected providers Improved relationships
National MoH Restructured Refresh of NZ Health Strategy More emphasis on vulnerable populations, end of life care, technology and children (obesity) Primary Care Funding Working Group Changes to the Medicines Act
Regional - ADHB supporting Primary Care Alliance Leadership Team activities Enhanced POAC ferronjet, venesection, specialist wound care Better hospital discharge processes Referrals to Rapid Response
Where does Auckland PHO fit?
ADHB/WDHB Alliance CMDHB Alliance Metro Auckland Clinical Governance Lead by CMDHB on behalf of the other DHBs Auckland Regional After Hours, Regional Work Programme, Safety In Practice, Data Sharing Work Streams and Service Alliances ADHB Procare Auckland PHO AH+ NHC WDHB Procare Waitemata PHO ETHC post-box thru Procare NHC post-box thru WPHO CMDHB East Health Procare NHC AH+ ETHC Community Care Auckland (CCA) PHOs in Auckland
Metro Auckland Clinical Governance Forum Report
Auckland PHO Focus Ensuring healthcare and access equity to vulnerable populations Improving Practice business systems, capability & capacity Enhanced Primary Care Growing number of practices and the number of patients Achieving health targets/ipif Advancing IT capability
Access and Equity Primary Care needs investment to deliver what we aspire to Funding envelope for Primary Care 2016_17 1%! VLCA being reviewed Auckland PHO experienced drop in quintile 5 numbers from last census = drop in funding
Enhanced Primary Care Enhanced primary care whatever can be provided in primary care settings should be Lean Approach GPs and Practice Nurses working to top of their scope DHBs and PHOs supporting approach in different areas of NZ
Achieving Health Targets - from 01/07/16 Now called Value and High Performance - System Level Measures/Contributory Measures Ambulatory Sensitive Hospitalisation rates for 0 4 year olds 1. LMC registration rate 2. New born enrolment rate 3. Referral rate from LMC to Well Child Services 4. Immunisation 5. Enrolment to oral health services
Achieving Health Targets Now called Value and High Performance - System Level Measures/Contributory Measures Acute hospital bed days per capita Length of stay Frequent readmissions Poly pharmacy Influenza vax in the elderly CVD Risk assessment Smoking rates
Achieving Health Targets Now called Value and High Performance - System Level Measures/Contributory Measures Patient experience of care Patient Portal uptake and use DHB inpatient care survey Uptake of Primary Care patient experience survey Sentinel events Access to diagnostics Admissions for drug reactions
Achieving Health Targets Now called Value and High Performance - System Level Measures/Contributory Measures Amendable mortality Cancer screening and treatment timeliness Cardio-vascualar risk management Other chronic disorder management Injuries (self harm) prevention Smoking rates
Achieving Health Targets Now called Value and High Performance - System Level Measures/Contributory Measures Number of babies who live in a smoke free household at 6 weeks postnatal Breast feeding rates Smoking at first registration with LMC & 2 weeks postnatal B4School checks rate LMC referral to PHO
Advancing IT capability Move to Mōhio Patient portals NES Involvement with Care Connect National Electronic Health Record
General Updates Health and Safety Act and what it means for Practices Vulnerable Children s Act background checks and interview questions Practice Administration Update Series July PHO GP Liaison Role
Social Media
Health Target Achievements 31 st March Indicator and place in NZ /36 PHOs Target Auckland PHO Performance # APHO who achieved target /25 CVD risk assessment 2nd 90% 92% 19 Diabetes Annual Review 90% 95% 9 Smoking Brief Advice 3rd 90% 92% 17 Immunisation 2 yrs 6th 95% 92% 11 Immunisation 8 mos 5th 95% 95% 11 Cervical Screening 2nd 80% 83% 9
CVD Risk assessment 90% Aotea Health 99% Auckland Central Medical 93% Avondale Family Doctor 95% Avondale Health Centre 90% Avondale Medical Centre 93% Blockhouse Bay Medical Centre 94% Calder Centre 90% Dominion Medical Centre 93% Donovan Street Medical Centre 92%
CVD Risk assessment 90% Gabriel Medical Practice 99% Glenavon Doctors Surgery 95% Marsden Medical Practice 91% Meadowbank Medical Centre 90% Mt Albert Medical Centre 93% Newmarket Medical Centre 94% Oneroa Accident and Medical Centre 90% Orakei Health Services 91% Ostend Medical Centre 91% Richmond Rd Medical Centre 92% Three Kings Family Medical Centre 97%
Smoking Brief Advice 90% Aotea Health 98% Auckland Central Medical Centre 95% Avondale Family Doctor 98% Avondale Health Centre 96% Avondale Medical Centre 95% Blockhouse Bay Medical Centre 92% Calder Centre 90% Dominion Medical Centre 95% Donovan Street Medical Centre 98%
Smoking Brief Advice 90% Glenavon Doctors Surgery 96% Oneroa Accident and Medical 94% Orakei Health Services 98% Ostend Medical Centre 93% Piritahi Hauora 96% Richmond Rd Medical Centre 93% Symonds Street Medical Centre 94% Three Kings Family Medical Centre 95%
Immunisation 2 yrs 95% Avondale Family Doctor 98% Avondale Health Centre 94% Avondale Medical Centre 97% Blockhouse Bay Medical Centre 92% Dominion Medical Centre 100% Donovan Street Medical Centre 95% Gabriel Medical Practice 97% Marsden Medical Practice 100% Meadowbank Medical Centre 100%
Immunisation 2 yrs 95% Piritahi Hauora 100% Richmond Road Medical Centre 93% Symonds Street Medical Centre 94% Three Kings Family Medical Centre 97%
Immunisation 8months 95% Auckland Central Medical Centre 100% Avondale Family Doctor 98% Avondale Health Centre 95% Avondale Medical Centre 97% Calder Centre 100% Dominion Medical Centre 100% Gabriel Medical Practice 100% Marsden Medical Practice 100%
Immunisation 8months 95% Mt Albert Medical Centre 100% Newmarket Medical Centre 100% Richmond Road Medical Centre 100% Three Kings Family Medical Centre 98%
Cervical Screening 80% Aotea Health 83% Avondale Family Doctor 86% Dominion Medical Centre 86% Gabriel Medical Practice 81% Newmarket Medical Centre 86% Ostend Medical Centre 84% Piritahi Hauora 82% Richmond Road Medical Centre 83% Three Kings Family Medical Centre 87%
Diabetes Annual Reviews 90% Aotea Health 97% Avondale Family Doctor 92% Dominion Medical Centre 92% Gabriel Medical Practice 95% Marsden Medical Practice 94% Newmarket Medical Centre 92% Oneroa Accident and Medical Centre 97% Ostend Medical Centre 93% Piritahi Hauora 95%
All 6 Targets Avondale Family Doctor Dominion Medical Centre
5 Targets Gabriel Medical Practice Three Kings Family Medical Centre
4 Targets Aotea Health Marsden Medical Practice Newmarket Medical Centre Ostend Medical Centre Piritahi Hauora Richmond Road Medical Centre
3 Targets Auckland Central Medical Avondale Health Centre Avondale Medical Centre Calder Centre Donovan Street Medical Centre Mount Albert Medical Centre Oneroa Accident and Medical Centre
2 Targets Blockhouse Bay Medical Centre Glenavon Doctors Surgery Meadowbank Medical Centre Orakei Health Services
0 and 1 Target 4 practices
The Future is already here It s just U ne ve n ly D istrib u ted William Gibson-Author