Last week at the Partners Connected Health Symposium 2011, I had the privilege of conducting an extended sit-down interview with George Arnold, program manager for Health of New Zealand Trade and Enterprise, which helps manage the health care system and its IT infrastructure.
His agency released a white paper for the U.S. HIT program, offering advice from New Zealand’s own experiences over the last decade. He made some general observations about what formed the bedrock for his country’s HIT program, part of which could serve as a roadmap for our own initiatives:
- They started with a master patient index as well as a master provider index. Here in the U.S., of course, giving each patient a unique identifier has strangely met with resistance.
- 97% of the physicians are using EHR systems; 99% of pharmacies are computerized.
- While it isn’t moving in the direction of Accountable Care Organizations (ACOs) like the U.S. health care system seems to be at this time, New Zealand is developing a new program called Shared Care, which strives to improve patient care coordination. It is driven by IT initiatives, and the fact that the primary care physician possesses a patient’s longitudinal care record — opening it up to more care providers will be the next step.
Arnold made some interesting observations regarding the construction of national HIT systems and how they can affect the quality of care while controlling costs, which of course is the over-arching principle motivating U.S. efforts:
On the EHR incentive program: “It’s bizarre to me — $44,000 for uptake, and it’s still a struggle to get people to take it up. Whereas, I think the average amount a [general practitioner] pays in New Zealand for systems maintenance or whatever is on the order of $3,000, it’s a totally different ballgame.”
On what motivates New Zealand physicians to adopt EHR systems: “One of the key drivers in doctor uptake was that we moved to a more capitated system of payment. So the doctor charges fees for service to patients directly, but most of his [government] compensation comes in the form of quarterly payments based on enrollment in that practice — on average, 1,500 to 2,000 patients…in order to get the capitation payment, you have to be able to prove that you have those patients enrolled. Given that each patient has an identifier, you can demonstrate it [with the EHR system]. It all kind of ties together. It all started out as a payment thing, but over time it grew into a richer system.”
On the differences between New Zealand’s government-driven health care model and ours: “The challenge [to HIT leaders] in the U.S. setting is that the models of care are so fragmented — they’re shaped to a degree by policy but not driven by them because it’s, in theory, a private sector model. I don’t think there’s a U.S. health system. That is what I am struggling with. You’ve got at least five of them: Veteran’s Affairs, Tricare, Medicare, Medicaid, and you’ve got a private insurance model. And each of these are different beasts.”