NHI Promotion - National Health Information Priority Action Zones - Health Information Strategy Advisory Committee

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NHI Promotion
This document is an initial HISAC view of the ‘NHI Promotion’ Action Zone of the Health Information Strategy for New Zealand 2005 (HIS-NZ). Its purpose is to stimulate discussion and responses from health and disability sector practitioners, providers and funders, about the issues and opportunities associated with the improved use of existing and emerging information technologies and information management systems in the health and disability sector.

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Background
This Initial View is a HISAC informed ‘Straw Man’ and it does not claim to represent the final direction of the Action Zone. It is a starting point for the sector informed Preliminary Scope and Approach currently being prepared, by proactive engagement with the sector, for each Action Zone.

This Initial View focuses on the promotion of the National Health Index (NHI) to uniquely identify individuals in the health and disability sector.This will assist in achieving the HIS-NZ goal of improving information sharing across the sector.

HISAC sees the NHI Promotion Action Zone being delivered by:

Continuing to improve the quality of data in the NHI System.
On-going promotion of the NHI Number, its benefits and use, to the public of New Zealand.
Extending online access to the NHI System to more health and disability sector practitioners.
Ensuring that electronic health records and health transactions use the NHI Number as the patient identifier.
Ensuring that national, regional and local health information collections use the NHI Number to allow aggregation of information on population health status and outcomes, in a manner that allows either identifiable or non identifiable access as appropriate.

A view of NHI Promotion in the future
Vision: Make the NHI the single lifetime identifier for individuals in the health and disability sector.
Strategy: Embed the NHI in local, regional and national systems to enable an individual’s and population’s health information to be easily viewed, collated and analysed securely and effectively.

Introduction
The NHI System is a national register of demographic data of individuals, each identified by a unique NHI Number. It is managed by the New Zealand Health Information Service (NZHIS) and its information is updated through Primary Health Organisation (PHO) enrolment processes and online access from District Health Board (DHB) hospitals. The NHI is a fundamental building block that ensures individuals in the health sector are accurately identified.

General practice and some other organisations have online viewing access of NHI information while DHBs have the ability to create NHI Numbers and modify individuals’ demographic data.
This HISAC Initial View describes the NHI and sets out the features of the NHI Promotion Action Zone as part of the process towards turning the HIS-NZ into reality.

Diagram Representing the Funcation of NHI

Diagram Representing the Funcation of NHI

What happens today
The National Health Index was first introduced into the NZ health sector in 1979 when it was called the National Master Patient Index (NMPI). From that time on, patients who entered the public hospital system or who were born in hospital were assigned the national patient number. More recently, with the enrolment of individuals with Primary Health Organisations (PHOs), the NHI number has been used as the registration number and a lot of demographic information has been brought up-to-date. In 2004 a comprehensive clean-up of the national health index was undertaken. This project removed many duplicates and validated data against the mortality register to identify deceased patients. There were still more numbers in the system than expected, however further investigation found that about 800,000 people had gone overseas and had not yet returned (so they will still be potentially valid numbers).

There are issues where some health sector organisations such as pharmacies are omitted from the legislation that allows them to use and update the NHI in their systems. The NHI number is now used as the primary identifier in many systems and this enables patient information to be transferred securely and reliably between organisations, for example, a discharge summary can be sent electronically from a hospital to a general practice, and the GP can then index the information against the correct patient in their system. Using an NHI Number to identify health information is recognised as an accurate way of ensuring that the right information is associated with the right individual. Using an individual’s name cannot be relied on, due to variables in the way individuals’ names and details are recorded.

What could be improved
HISAC has identified the following areas where the NHI Promotion Action Zone should result in the NHI becoming more useful across the health and disability sector:

Improved awareness of the purpose, benefits and importance of the NHI System and the NHI Number.
Improved data capture processes to increase the accuracy of individuals’ demographic data contained within the NHI System.
Reduction in the creation of duplicate NHI Numbers.
Improved management of existing duplicate NHI Numbers.
Increased number of authorised stakeholders in the sector who can access and update individuals’ demographic data in the NHI System.
Increased use of the NHI Number as a unique identifier for the appropriate and secure exchange of individuals’ health information between health organisations.
Standardised processes to release encrypted NHI Numbers where appropriate.
Improved use of local, regional and national health information for population health analysis, outcomes evaluation, service delivery planning, policy development and research.
Interfaces between the GPs’ practice management systems and the NHI System, so that at the time of contact with General Practice, individuals’ demographic data is automatically synchronised with the NHI System.

NHI Promotion action
NHI Promotion will build on the significant progress made to date and focus on further improving and promoting the use and accuracy of the NHI in three key areas as:

The unique identifier for patients when receiving health care.
The unique identifier for each patient’s health events and health records.
An enabler for information analyses

The Ministry of Health has embarked on a systems and process development programme to address these areas as part of its National Systems Development Programme. Any access to or use of the NHI System, the NHI Number and the associated demographic data will continue to be governed by the appropriate privacy and security requirements.

NHI Promotion features
NHI Promotion could include these features:

Continuous quality improvement of the accuracy and completeness of information on the NHI System.
Training material will be made available to health organisations to help them use correct processes and standards for accessing, updating and creating NHI Numbers.
An expanded group of community providers and health workers will have improved access to the NHI System.
All health practitioners and organisations will routinely use NHI Numbers on all patient transactions.
Practitioners and patients will recognise safety and quality advantages in the use of the NHI Number as a unique identifier for the sharing and exchange of individuals’ health information.
Better use of local, regional and national data for population health analysis, outcomes evaluation, service delivery planning, policy development and research; as appropriate and within agreed security and privacy constraints.
Individuals will be made fully aware of the purpose and benefits of the NHI System in the delivery of their health care.
Individuals will be encouraged to identify their own personal NHI Number and will be advised as to how they can ensure their own demographic data on the NHI System is kept up to date.

NHI Promotion benefits
Individuals and patients in care will benefit from NHI Promotion through:

Enabling the correct patient information to be presented to clinicians involved in the patient’s care – thus ensuring better clinical quality and safety standards and avoiding unnecessary mistakes.
Improved interactions within the wider health care system – previous records and records from different systems can be presented in a more comprehensive view of the patient’s medical history at the point of care.
Increased awareness of the importance of the NHI in their care.

Health practitioners and organisations will benefit from NHI Promotion through:

Ability to index patient information together to provide a more comprehensive view of the patient’s history.
Reduced administrative overhead of dealing with patient information and patients do not always have to be asked for the same information.
Having increased confidence that the NHI System is more accurate and complete.

Organisations that fund the health and disability sector and are responsible for the delivery of health care will benefit from NHI Promotion through:

Improved ability to use patient event information for population health analysis, outcomes evaluation, service delivery planning, policy development and research; as appropriate and within agreed security and privacy conditions.

What happens next
Responsibility for implementing the Health Information Strategy for New Zealand lies with the whole health and disability sector under the leadership of HISAC. HISAC is working closely with sector representatives to prepare more detailed descriptions of the current problems and health practitioners’ priorities for improvements. If you would like to discuss the NHI Promotion initiative, please contact HISAC through enquiries@HISAC.govt.nz or write to:

The Action Zone Development Leader
HISAC Office
PO Box 5013
Wellington

Relevant documents
Initial Views (PDF, 229 KB)
Preliminary Scope and Approach (PDF, 1 MB)
Road Map (PDF, 47 KB)

Page last updated: 22 May 2009