Changes in information technology systems in New Zealand general practice Rebecca Didham; MSc Susan Dovey; PhD, MPH Lynnette Barker; BSc

1. 1. Background Study design Results Implications Presentation summary

Structure of primary care in New Zealand District Health Boards (DHB) 21 New Zealand Government: Ministry of Health Non-aligned Practices Primary Health Organisation (PHO) 79 General Practices ~1250

Information technology in general practice: Nationwide survey 2003 Questionnaire posted to all general practices in New Zealand Practice profile Software, hardware and support systems Internet, electronic and general communication Research and education 938 responses were received from 1188 practices, giving a response rate of 80.0% Established a national base-line

Information technology in general practice: Random sample 2005 Questionnaire posted to 250 randomly selected general practices. Questionnaire posted to 250 randomly selected general practices. 121 responses (48.4%), due to shorter survey period 121 responses (48.4%), due to shorter survey period 91 of these respondents previously contributed to the 2003 IT census 91 of these respondents previously contributed to the 2003 IT census

General results (n = 91) Urban Rural or semi-rural 69.3% 30.7% 75.6% 24.4% Full time Equivalent GPs per practice: Range Average 0.5 to to Practice manager64.8%68.6%

Practice Hardware All practices have at least one computer (no change from 2003) The number of terminals ranged from 1 to 52 (1 to 50 in 2003), with an average of 8.8 per practice (7.7 in 2003) In 2003, the most commonly used operating system was Windows 98 (54.9%). In 2005 it is now Windows XP Professional (65.2%).

Practice software All but one practice used Patient Management System (PMS) software to record patient and clinical details.

Use of PMS Software  PMS used to store full clinical notes: 79.1% in 2003 (63.8% exclusively) 82.0% in 2005 (70.1% exclusively) Function Laboratory requests/results86.5%97.7% Prescriptions92.2%95.5% Screening/Disease registers98.9% Allergy information86.5%87.6% Vaccinations95.5% Investigation requests/resultsNot asked89.9% Referral lettersNot asked87.6% Hospital discharge lettersNot asked67.4%

Coding Consultation diagnoses were coded in 66.3% of practices (no change from 2003) Consultation diagnoses were coded in 66.3% of practices (no change from 2003) Inconsistent coding – real figure ~20% Inconsistent coding – real figure ~20% 91.2% use the Read Code system (a decrease from 98.2% in 2003) 91.2% use the Read Code system (a decrease from 98.2% in 2003) Those practices who stopped using Read Codes in 2005 now use ICD-9 or ICD-10 Those practices who stopped using Read Codes in 2005 now use ICD-9 or ICD-10

Internet and electronic communication Connected to the internet? Yes 79.1%Yes 90.0% Broadband 40.7% Broadband 61.5% Dial-up 74.7% Dial-up 38.5% % 86.2%

Issues surrounding IT in general practice in New Zealand COSTTIME  No specific government funding  Ever-increasing software and hardware needs  How do smaller practices fund this cost?  Time needed to upskill clinic staff  Extra time needed during consultation

IT in primary care medicine around the world Almost 100% rate of computerisation UK government provides total funding for IT Roll-out of IT strategies over several years No exact national figures Estimates of PMS use between 17% - 82% PMS software slowly becoming commonplace No exact national figures 17% used PMS for clinical notes in 2000 Canada Health Infoway – Electronic Health Records for 50% of the population by 2009

The way to the future… IT resources are still rapidly developing so decisions made now will almost inevitably have to be altered in the short-term future IT resources are still rapidly developing so decisions made now will almost inevitably have to be altered in the short-term future New Zealand continues to show strong advances in IT in general practice and is a good model of how technology can be successfully paired with clinical management New Zealand continues to show strong advances in IT in general practice and is a good model of how technology can be successfully paired with clinical management Issues for the future: Privacy, security of electronic data Issues for the future: Privacy, security of electronic data