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Digital health initiatives support continuity of care

Evidence demonstrating the advantages provided by many digital health systems and processes has grown to such an extent that they may almost be considered part of an expected standard of care. Patients can access their health portal via a smart phone app to schedule appointments or request repeat prescriptions. Shared care records allow care providers to share documentation of activities and note management recommendations. Secure transfer of prescription information reduces the risk of errors, and will soon render handwritten paper prescriptions or medication charts obsolete. The expansion of professional roles for pharmacists, particularly in community pharmacy and general practice settings, has placed greater importance on the documentation of what the pharmacist has identified and their advice for ongoing management. While many digital health initiatives are developing within pharmacists’ common practice settings of community pharmacies, hospitals and general practices, a question exists of what ‘pharmacist care’ information is being proactively shared. The New Zealand Government’s revised Health Strategy published in 2016 includes a key theme of a ‘Smart System’. This theme focuses on the need for a health system that innovates, improves, monitors and evaluates what we are doing, and the sharing and standardisation of ‘better ways of doing things’. Health portals are supporting patients to access and maintain their medical records, schedule appointments, view lab results and request repeat prescriptions. As at June 2017, just over 400 000 New Zealanders have registered for portal access via a smartphone application or secure web login. Systems are also being utilised to collect health data, and share information through eReferrals and shared care plans that aim to smooth a patient’s journey, and offer a greater role in setting their own health goals, supported by the multidisciplinary team. The pharmacy profession has been at the forefront of many of the ‘eHealth’ initiatives being implemented by the Ministry of Health. The New Zealand Electronic Prescribing Service (NZePS) provides a secure exchange of prescription information between prescribing and dispensing systems, although still requiring a physical barcoded paper prescription. This has been expanded further in hospital care where ‘electronic prescribing and administration’ (ePA) systems cover the entire hospital medicines cycle, including prescribing, review and dispensing of medication orders, and administration of medicines. A range of quality and safety benefits are provided by these systems, including the reduction of errors of interpretation or transcription of prescription information, real-time decision support, and integration with other management systems such as electronic discharge summaries and e-medicines reconciliation. However, in many respects, these electronic systems appear to be developed and implemented with a focus on how they meet the needs of the particular care setting, as opposed to any over-arching need for how to best support the patient and their health needs (and information) as they move between their home and various care settings. Patients expect health professionals involved in their care to know about them and their health needs. Yet pharmacists are still required to conduct medicines reconciliations, when a single shared medication record could automatically document all prescribed and overthe-counter medicines that make up a patient’s treatment regimen. Pharmacists in many areas of the country can view electronic discharge and medicines reconciliation summaries for patients, which can support medication counselling and provide clarity when treatment has been changed. Some hospitals also employ a discharge liaison pharmacist specifically to facilitate the transition of care (and some will soon gain their pharmacist prescriber authorisation). However, the knowledge of the ward pharmacist, who has contributed to the specialised care of a patient during their acute hospital stay, is seldom passed on to their community pharmacist who will provide the ongoing care and support to keep the patient living well (and the reverse also being true). Some regions still question the need for pharmacists to view these records, while other regions not only permit