A few years ago Pinnacle started down the bold path to search for a new practice management system (PMS) option for its members. We had a vision based on many discussions with practices of what a more sustainable and viable health ecosystem looked like, and a core part of this was moving control back to patients and clinicians. This meant recognising to support the health needs of a patient and their clinical teams data needed to flow more freely across the system. The result is indiciTM - a cloud-based system, specifically tailored to user needs and able to support the Health Care Home (HCH) model, but also traditional GP services.
After the initial design work with Pinnacle, Valentia have taken indiciTM to the country and its been tested against all the other current New Zealand PMS systems, and a number of international options. In Wellington, Wairarapa, MidCentral and Auckland (alongside the testing done by Pinnacle) indiciTM has come out the preferred system.
The development journey has been a tough one. While the New Zealand health system claimed to be standards based it soon became apparent that some of the incumbents had not adhered to the standards, creating short cuts and back room agreements to cut costs. Some national systems have also struggled with integration.
There are also no standards or rules around data migration and some of the major systems have provided no assistance in the migration of patient data. Even today there remains many documents that are suffering from proprietary storage arrangements, something that needs more transparency and monitoring by the sector.
Valentia have built the only truly cloud-based health information system. Moving from a local app on a local server to a browser-based system brings many changes with it. While it enables almost seamless integration between systems across the sector, like any web-based tool it brings with it some of the challenges of online working.
For some of the sites we've onboarded so far it's been a real journey exploring the best configuration of hardware, what kind of internet connections are best and how to get the best performance out of the new configuration.
Any change is hard. Many practices have only ever known one product, so it's a big shift. indiciTM is also designed to automate and create more efficient workflows. For some practices this has been unexpected and really run up against existing workflows or even roles that team members play.
The challenges of change tend to generate a range of stories for people. There are things which cause pain and feel hard at the time. But later these same stories re-emerge with a new twist, once people have the chance to reflect from the other side of the change process. Often what starts as a real 'bug bear' becomes the greatest or most useful thing.
But look, it's still a new product and we know it's not bug free - but then neither are those that are many decades old.
In November 2018 Medtech initiated a legal claim against Valentia and the Pinnacle Group, which both parties immediately rejected wholeheartedly.
Pinnacle has not copied any of Medtech's software. We strongly believe indiciTM is a major step forward - using modern software, being fully cloud/browser based with a SNOMED native coding system - there was no interest or need to copy any other system (especially a non-web based, interbase, read code based system).
We've been working through the response to the Medtech claim. While this process is ongoing, we would like to make it clear it has had no bearing on practice onboarding nationally or the continuing development pathway for indiciTM - work continues exactly as scheduled.
There are now 12 practices running on indiciTM across the Midlands region, including a presence in all four localities. There are six practices confirmed to come onboard between now and August 2019, with discussions happening in many more practices across the network. In addition, the school clinics in Waikato have indiciTM in over 30 sites, and the regional smoking service providers also use indiciTM.
Our onboarding process is customised to meet the needs of each new client, but there are learnings our team take away each and every time that help us refine the process overall. We're proud to be able to offer an expert team to guide practices through such a major change to the way they operate.
Our onboarding programme includes a four-week programme of support for practices from their 'go live' date, including clinical support from GPs and nurses. We focus our training prior to go-live on what is required to operate - getting the basics locked in place. By week three the deeper questions around the capabilities of the system, or tasks that are slightly out of the ordinary start to emerge, so the team now ensures they are still on the ground to support through this phase, and into business as usual.
We also schedule time to come back to work with key staff after the basics have been embedded -there is so much more indiciTM can offer. These 'mastery' sessions are held about a month after the onboarding process is complete and are a time to explore some of the extra functions outside of what is needed for day to day operation.
There are already practices live in Palmerston North, Wellington and Nelson with many more scheduled to go live by the end of the year.
All shared health records accessed by primary and secondary providers across for the 880,000 people in the Wellington region (including all lab results, prescribing information and shared care plans) are now in the indiciTM shared electronic health record (SEHR). We're hopeful a recent agreement in the Midlands Alliance Leadership Team (with all Midlands DHBs) will see a similar result here. Unlike existing SEHRs in place in midlands, the indiciTM SEHR is agnostic and works with all PMS systems that allow a data hook and API to be put in place.
Hospice in Auckland has now shifted to indiciTM and there is a range of other community providers looking at onboarding in the second half of the year, including M?ori health providers, physios and non-government organisations.
St John and the national telehealth service run by HML are also using indiciTM systems to support their clinical care, meaning once there is clinical governance sign off there will be seamless integration between their systems and indiciTM.
With a growing national footprint for indiciTM we know it's time to make sure the product support and ongoing customer care programmes are in place.
In conjunction with our software partner Valentia and infrastructure partner Stratus Cloud/Platform Plus, we are establishing a virtual helpdesk to offer nationwide support for indiciTM. Through this virtual helpdesk Valentia is offering 24 hours support, with the help of their people based in Pakistan.
We've also expanded the help function within indiciTM, with release notes and user manuals now available.
Somewhere along the way we've all experienced early adoption, and the pain that inevitably comes alongside it. That mobile phone that could receive texts but not send them, that Fitbit watch strap that kept breaking... These products all had their flaws, but people kept with them because of the big picture, believing in what the device would do once the hiccups and disappointments were overcome.
indiciTM has been completely designed from scratch; after talking to hundreds of New Zealand frontline GPs, nurses, medical centre assistants, nurse practitioners, patient access centre staff, allied health staff and patients. It uses new technology and new workflows... and that newness has come with teething troubles for those who have been first.
It's rewarding to hear some of those people who experienced the early, slightly unpolished and let's be honest kind of problematic versions of indiciTM now being the ones who will loudly say "it's not perfect, but there's no way I'll ever go back to the old way of working". We hear from community-based health practitioners who think indiciTM is brilliant - they love the mobility and ability to work from the same record with other clinicians.
We want to take the opportunity to thank our practices and NGO colleagues who took the leap of faith with us. They not only experienced the trials of a 'newbie' product, but also became part of our learning curve on how to onboard a practice. On both counts the feedback they've provided has been key to improving indiciTM, and the onboarding process, into being ready for everyone.
We also want to say a big thanks to Valentia, indiciTM is their product, driven by an excellent partnership and team spirit.
The indiciTM team, are now concentrating on addressing the last remaining issues raised by the "early adopter" practices. This work should be complete by June. This will solidify and stabilise the PMS into a more mature product, capable of running all aspects of 'business as usual' for a practice.
From there... its onto new development opportunities, with a raft of ideas being worked up to keep taking indiciTM forwards, cementing it's position as the innovator in the PMS marketplace. It will never be over, and it will never be perfect. Every day the question is "so what's next?"
indiciTM is a real alternative option for practices, it's not the only option and we will continue to support all systems that Pinnacle practices choose to use.
If your practice is considering the change to indiciTM then get in touch with our commercialisation manager Will Hughes.