‘Query Based Exchange’
– Accurate, Complete Patient Information, As and When Needed
All around the world there is a concerted effort being made to improve the way in which patient information is managed. While there is widespread agreement that improved information management will lift healthcare delivery quality and lower costs, there is much less agreement as to how this can best be achieved. The dilemmas surrounding this issue are especially relevant to New Zealand which is at the forefront of the global drive to find better ways of managing patient information. New Zealand is a world leader in this field because of its early adoption of a primary-care led healthcare model and highly evolved structure of primary-care networks.
Fig 1. New Zealand has consistently ranked first in Commonwealth Fund Surveys of Practice Automation and IT Capability
A challenge of leadership is that you have to be first to solve any problems that arise, especially if you wish to continue moving forward. Today a key problem confronting people and organisations wishing to improve their management of patient information arises because of unanswered strategic questions over whether and how the sector should share a patient’s records. The pitched battle between those parties wishing to create substantial patient databases and those who want a distributed record sharing model in which patient records are queried on an “as needed” basis has continued unabated for some years. But simmering tensions should now begin to ease, as a successful approach comes to the fore.
The answer to the question; whether, and if so, how, to share patient records? has been debated back and forth across the New Zealand health sector for the past five years and no clear winner has yet emerged. But there are glimpses of a clear direction ahead and that is excellent news for us all. The keenly fought philosophical battle has been waged between proponents of a “longitudinal patient record” that can be accessed by multiple parties and their opponents who wish to access information from primary care records as the main source of information; querying primary care and other systems on an ‘as needed’ basis. The National Health IT Board and a number of District Health Boards have been backing the patient database model and the current National health IT plan is clearly based upon assembling regional repositories of patient data. However technology is catching up with customer needs and the ‘Query Based Exchange’ camp is now finally able to prove that its model has what it takes to deliver high quality patient care and has some significant advantages over creation and maintenance of regional patient record repositories.
‘Query Based Exchange’ is creating the ability to instantly access patient information. Last week in the Hawkes Bay, emergency staff at the Hawkes Bay hospital used Query Based Exchange to access 122 patient records to assist in the provision of care to Emergency Department patients. The system used at Hawkes Bay DHB is used to provide an emergency care summary from each general practice and pharmacy attended by the patient over the previous six months. The Hawkes Bay system is being used to get a quick snapshot of a patient’s condition, including recent medical history, prescriptions issued, pathology results, allergies and medical warnings. Queries to pharmacy systems show which medicines local pharmacies have dispensed for the patient. This information is accessed online, in a matter of seconds, directly from the GP and Pharmacies’ electronic records. It can only be accessed with the patient’s permission and only by a registered healthcare professional who has been trained to use the system.
The Hawkes Bay DHB’s ‘Query Based Exchange’ system has been extremely well received.
“Often patients presenting to our emergency department have no recollection or limited recollection of what medications they are on, or of any changes to their medication. Sometimes they are too unwell to give us information and this provides significant difficulties, especially after-hours when the general medical practitioners’ offices and pharmacies are closed. And so we really have little idea of what medical problems exist or what medicines a patient is using. Query Based Exchange has significantly improved our access to information about this kind of patient. We are able to access a list of current medications and prescriptions and a list of recent and past medical problems on many patients presenting to the emergency department. This enables us to have more information to make the right decisions about patient management.”
Dr Mark Barlow, Consultant Emergency Physician, Emergency Department, Hawke's Bay Hospital
Based upon what has been achieved in the Hawkes Bay, a further four health regions have implemented or are in the throes of implementing a ‘Query Based Exchange’ system so that unscheduled care provision can be better informed via online access to up to the minute GP and pharmacy records.
Once the ability exists to reliably query a patient’s records from both primary care and pharmacy, one of the major reasons for establishing regional patient record databases disappears altogether, hopefully, so too will the privacy and reliability problems that have slowed up patient record sharing. A range of problems has continued to hamper development of patient databases and repositories, amongst them; concerns over the completeness and accuracy of information, worries that privacy might be compromised and the sheer cost of ensuring all systems are able to exchange information that will accurately and reliably correlate into a unified patient record.
There are already a number of regional repositories in New Zealand, however these repositories are proving to be cumbersome to access, expensive to operate and are dogged by security and privacy concerns. As a consequence they are getting very little day-to-day usage. If, as many predict, ‘Query Based Exchange’ continues to develop and cement itself as the preferred option for information sharing, then the ambitions for regional repositories will scaled back and they will be used as data warehouses for holding secondary care records, thereby providing a useful mechanism for secondary care providers to access and share information generated within their hospital and public health systems and to provide carefully managed access to primary care providers, on a ‘need to know’ basis. The main mechanism for information sharing will be ‘Query Based Exchange’.
Internationally, ‘Query Based Exchange’ is gaining favour as a strategy for sharing patient information. The US Department for Health and Human Services has named Query Based Exchange as its preferred method for enabling information sharing during unscheduled care.
The successful uptake of ‘Query Based Exchange’ will also be a victory for health information privacy, particularly the sanctity and integrity of primary care records. A robust ‘Query Based Exchange’ framework will provide continued assurance that information shared between patient and GP will always remain confidential and only be released by the GP in the certain knowledge that the patient has given his or her express consent to do so.
Disclaimer: Tom Bowden is CEO of HealthLink Ltd, a company that provides the Query Based Exchange solution “CareInsight”.
Here is a link to a video about the system at Hawkes Bay DHB
5 April 2013