Diabetes in New Zealand

Get Checked Programme System Upgrade - Questions and Answers

What IT systems are being upgraded?

There are two main components in this IT upgrade:

The Microsoft Access database initially used for “Get Checked” has been upgraded already, and has been available for over 18 months for PHOs to use.

This provides PHOs with an option for collecting clinical information from their practice PMS systems to support quality improvement and a wider range of clinical services.
The PMS systems are also now being upgraded to ensure that the information presented to users is consistent with the NZGG Guidelines on the “Management of type 2 diabetes” and the “Assessment and Management of CVD Risk”.

Privacy requirements

Do these PMS upgrades comply with the Health Information Privacy Code?

These PMS upgrades, and the PHO diabetes/CVD database that may be used by PHOs, are upgrades of the existing “Get Checked” IT systems.

No information is passed from the practice to their PHO (MSO if appropriate) without specific action by the practice to set up / select this.

And no identifiable patient data goes anywhere outside the PHO unless the PHO provides a password and username.

There are specific reports for District Health Boards, but these all use aggregate non-identifiable indicators. PHOs run these reports, and either forward a printed copy or an e-mail version (the PHO database generates an Adobe “pdf” file).

The patient explanation and consent is covered by the recommended provisions for people enrolling with PHOs. This information is used by PHOs to improve the quality of care for people in their enrolled population, and is also consistent with the aims of the PHO Performance Programme.

What is this upgrade for?

The PMS systems are being upgraded to provide options for practices and PHOs that are consistent with the 2003 NZGG Guidelines above.

Some PHOs and practices and PHOs may choose to use this upgrade for “Get Checked”, for diabetes reviews more often than annually, and for quality improvement initiatives for CVD risk assessment (in people without diabetes). However these are all options for practices to choose.

It is also an option for PHOs to collect, feedback to practices, and manage the diabetes/CVD information for the PHO Performance Program.

What are the objectives of the "Get Checked" programme?

These are included in the contracts with PHOs, and the service specifications included in the National Service Specifications maintained by DHBs and the Ministry of Health.

They are:

To systematically screen for the risk factors and complications of diabetes to promote early detection and intervention
To agree on an updated treatment plan for each person with diabetes
To update the information in the diabetes register used as a basis for clinical audit and planning improvements to diabetes services in the area
To prescribe treatment and refer for specialist or other care if appropriate.

The contracts for “Get Checked” are agreed with PHOs by DHBs, and funding for this is from the population-based funding allocated to each DHB. The IT upgrades allow considerable flexibility in prices and invoicing to accommodate different DHB and PHO contracts.

PMS upgrades and practice IT requirements

Why are the PMS systems being upgraded?

The PMS systems are being upgraded to ensure that the wider range of information (as specified in the New Zealand Guidelines Group Guidelines for the management of cardiovascular disease (CVD) and type 2 diabetes) can be displayed to the GP or nurse user.

This is clearly the most important requirement for supporting any systematic review – annually or more often – to provide the best advice for a patient (with or without electronic decision support).

Practices who update their PMS systems should notice more flexibility in the options for cardiovascular risk assessment (CVRA). They should also be able to view a more, consistent interface for annual or more frequent reviews of cardiovascular risk management - regardless whether the patient has diabetes or not for people at high risk.

They may also appreciate more robust claiming, and accounting for each patient with a free annual check.

No information is passed from the practice without each practice allowing this, and information is only passed from the practice to the PHO mailbox that the practice enters.

What long term conditions and reviews are supported?

The PHO database supports existing and updated PMS systems for “Get Checked” (so that not all practices have to upgrade PMS systems at once).

Practices will also be able to choose to forward cardiovascular risk assessment and management reviews, or more frequent diabetes reviews (to support Care Plus or other projects). The system is designed to ensure that in future PHOs and DHBs may include other long term conditions.

Do the PMS system upgrades work with other options for cardiovascular risk assessment and electronic decision support?

The PMS upgrades are an option which practices, PHOs, and DHBs can consider. All the providers of these systems have been provided with the implementation guides and the specification for the core data to promote inter-operability.

Which PMS systems are being upgraded?

MedTech 32 (this will use an Advanced Form but will be available without charge to all users), Intrahealth Profile (for Windows and Mac), Houston VIP 2000, MedCen, NextGen and MyPractice.

Will practices need broadband?

A secure electronic message system is required for existing and upgraded systems. Broadband is not required for upgraded PMS systems forwarding information to PHOs.

However if PHOs wish to provide practices with a username and password for directly running practice benchmarking and reports about payments to practices then broadband is strongly recommended.

Will practices need a specific IT message service?

No, the upgraded system will work with any secure electronic message service that can reliably transfer a file from one outbox folder to an inbox folder. All interfaces are open (i.e. via a file directory) using message specifications which are available to any vendor.

However in practical applications the message system must be able to read the header in each file, and recognize the EDI address to which the message must be delivered. The message specification is not proprietary, and test messages will be provided for all message transfer systems that request them.

What do people with a username and password need to log on for reports?

A secure connection to their server (a digital certificate or a service that includes these) and either Microsoft Internet Explorer or Mozilla Firefox.

How flexible are the reports?

There are a limited range of basic reports, but all reports are in specific “libraries” of reports and can be designed with “Crystal Reports”. Alternatively PHO users with appropriate password and access rights may export all data from the PHO database to spreadsheets or other applications for analysis.

PHO database upgrades

What is the PHO Diabetes/CVD Database?

PHOs have a choice about migrating their existing “Get Checked” data to the updated and reliable web-based PHO CVD/diabetes database, which has been available to PHOs for more than a year. This database is free to every PHO, and they are provided the option of installing the database software themselves or using a server shared with other PHOs in a management services organisation (MSO) or other regional collaboration.

Regardless of the option chosen, individual PHOs have a wide range of set-up options, and can assign usernames with passwords for secure internet access to their own data and reports.

The upgraded PHO database software provides more flexible options for improving data quality, improving payments and invoicing systems, and improved PHO and practice reports that can be designed using Crystal Reports (a common report designer) for a wide range of PHO quality improvement initiatives.

These initiatives may include clinical analysis to support the PHO Performance Programme requirements for diabetes, CVD, and potentially other priorities in future.

Additional details are available on the PHO Diabetes Database website.

What about using the existing Get Checked database or our own PHO IT system to collect and use the information from the upgraded PMS systems?

The upgraded PMS systems send a different set of information to the PHO, and the existing PHO “Get Checked” database cannot accept this. Present PHO management software almost certainly cannot accept it either, and would have to be enhanced and tested specifically.

Use of information

How should this data be used?

District Health Boards and PHOs should use this data to monitor the number of people accessing structured reviews, the quality of their care, and the impact of diabetes in their enrolled populations.

Sharing of PHO Information

No information is passed from the practice without each practice allowing this and the patient has provided consent, and information is only passed from the practice to the PHO mailbox that the practice enters.

How could the PMS information be used by other health programmes?

The PHO Diabetes/CVD database provides a far more comprehensive range of clinical and Age Sex Register (ASR) or ‘Patient Demographics’ (terms are used interchangeably) data for PHOs who wish to provide more detailed clinical support for their practices. It includes data and reports that can that can be linked to Care Plus and other PHO information, retinal screening, and hospital data for more actively managing quality improvement.

PHO performance programme

What is the PHO Performance Programme?

On 1 July 2007 the PHO Performance programme introduced an indicator which requires PHOs to prepare and submit a Diabetes / CVD Capability Assessment. The purpose of this is to identify the ability of individual PHOs to implement Cardiovascular Risk Assessment (CVRA) and diabetes services.

The PHO Performance Programme in conjunction with the Programme’s Advisory Group is also developing a parallel CVD / diabetes development plan, which will use the information provided in the Capability Assessment to introduce key evidence-based indicators in 2008 for diabetes and CVD.

How will the PHO Performance Programme use the PMS information?

To generate indicator information the PHO Performance Programme relies on PHO aggregate information provided by the PHO, which has been sourced from the member practice PMS applications.

All of the information needed for the indicators proposed for the PHO Performance Programme can be collected, and all the aggregate data can be provided, from the PHO database and the upgraded PMS systems. These upgrades also allow a wider set of quality improvement feedback to practices - in addition to the main indicators for the PHO Performance Program.

National Health Targets

What are the national health targets?

There are 10 national health targets that have been endorsed by the Ministry of Health and DHBs. These are being introduced in 2007/08:

Improving immunisation coverage
Improving oral health
Improving elective services
Reducing cancer waiting times
Reducing avoidable admissions
Improving diabetes services
Improving mental health services
Improving nutrition, increasing physical activity and reducing obesity
Reducing the harm caused by tobacco
Reducing the percentage of the health budget spent on the Ministry of Health

For more details see: http://www.moh.govt.nz/healthtargets

What is the target for diabetes?

There will be an increase in the percentage of people in all population groups estimated to have diabetes:

Accessing free annual checks.
On the PHO diabetes register who have satisfactory or better diabetes management.
On the PHO diabetes register who have had retinal screening in the past two years.

What is the current status on diabetes services?

Information from 2005 shows 56.8 percent of the total number of people estimated to have diagnosed diabetes had a free annual review.

73 percent of the total number of people who had a free annual review had satisfactory or better diabetes management, and 65.percent had reported retinal screening within the precious two years. These figures vary by ethnicity.

How does the Ministry collect and report diabetes data?

Diabetes information is collected by a GP or an appropriately trained nurse at the time of the Get Checked diabetes annual review and forwarded to the PHO register/database. Each PHO reports aggregate data to the Local Diabetes Team or equivalent for their DHB. The Local Diabetes Team (LDT) combines the data received from all PHOs in their area, which goes to the DHB, which then forwards it on to the Ministry of Health in DHB annual plans.

How can the quality of the information be improved?

These options have been reviewed by the Auditor-General. There are 5 specific recommendations for DHBs about data and data quality. These PMS upgrades all include nationally agreed data specifications, a consistent data schema for messages, and they all include better validation within PMS systems.

What is being done to meet the national health target for diabetes endorsed by DHBs and the Ministry of Health?

The Diabetes and Cardiovascular Disease Quality Improvement Plan will provide a collaborative framework for improving the health outcomes on which the national targets are based.

General project questions

Who is funding the upgrade?

The Ministry is funding the PMS and PHO system upgrades. The PHO database must be upgraded first in a system that must receive new messages from the PMS.

There is no charge for the PHO Diabetes/CVD database.

Is the field Message Control ID in the Message Header supposed to be a unique number identifying the acknowledgement, rather than the original message?

Yes. The field Message Control ID in the header is a unique message id to be generated by the sender of the message. This applies to all messages, including response messages.

For response messages, the message id of the corresponding request message is stored in the Originating Message ID field of the message body.

There are no restrictions as to what kind of format a message id should have. It is up to the sending endpoint to ensure that each generated message id is unique.

NB: Although not explicitly stated in the current version of the schema, the maximum length of the Originating Message ID field should be 20 (the same as for the Message Control ID field).

Page last updated: 6 November 2007