Standards at the heart of healthcare

Every year the nearly five million New Zealanders will inevitably require some form of healthcare – from a visit to a GP or hospital stays and surgery to treatment for conditions like asthma or diabetes. Getting a vaccination or screening test is preventative healthcare. Behind these services lie millions of individual health records to ensure consistency across providers and services. Now, with the spotlight on the provision of global health response to the COVID-19 pandemic, consistency and recognisability across countries is even more important.

And that’s where standards have a critical role to play now and into the immediate future.

The Ministry of Health has worked with Standards New Zealand to establish a national mirror committee for the ISO/TC 215 Health informatics technical committee of the International Organisation for Standardisation (ISO). The group’s convenor and Ministry of Health’s Chief Standards Advisor leading the adoption and development of data and digital standards, Alastair Kenworthy, spoke to us about how standards are being used in the fight against COVID-19 and other wide-reaching initiatives.

Standards use has a massive scope

‘Standards used within health have a massive scope. Standards underpin the safe capture and transfer of vast amounts of data, from basic information about the individual and their interaction with the health system, to complex diagnostic and treatment data used in patient care.’

‘In health we provide a vast range of services that impact almost every New Zealander in some way. The diversity of the different organisations and the systems they operate can make it challenging to offer consumers a joined-up experience. People shouldn’t have to retell their health story at every encounter. The health system should be easy to navigate, and digital options need to be available.’

‘My focus is on standards for data and interoperability that ensure that high quality information is captured at source and follows the person. The ISO International Patient Summary, HL7 FHIR and SNOMED CT are the principal standards on the sector’s interoperability roadmap, and my job is to see them adopted.’

Helping to tackle the pandemic

Standards have had a role to play beyond general health care. Alastair was involved in the development of the New Zealand COVID Tracer contact tracing app and the QR codes that all New Zealanders will be familiar with.

‘There were a number of key decisions behind the selection of the QR code and questions about standards had to be answered quickly. We left no stone unturned in considering the nature, content and dimensions of the QR code, and its accessibility on older model smartphones. Linked to the New Zealand Business Number, the GS1 Global Location Number was the ideal choice as the standard location identifier embedded in the QR code. Using QR codes to keep a touch-free personal diary and support contact tracing in a privacy-preserving way has been a real success.’

‘As we look to the next step of COVID-19 response we’re now planning the development of digital vaccination certificates. This is where standards really help as rather than having to find a solution by ourselves, we look to international committees and the knowledge of experts across the world for the best model to adopt.’

Developing a widely recognised and agreed vaccination certificate and associated policy is currently work in progress with the Ministry of Health. The project is part of the wider standards work that Alastair leads to ensure that consumers’ digital experience with the health system and their own digital records is world class.

Made to meet New Zealander’s needs

To continuously improve the digital experience for consumers, Alastair’s role requires keeping up to date on 50 published ISO standards, as well as the products of health-specific standards organisations HL7 International and SNOMED International.

‘With SNOMED CT, we have a worldwide standardised code system of 300,000 concepts, covering every aspect of healthcare. Having a comprehensive system of terminology that is both narrative and machine-readable at the same time supports fully digital health records that are accessible by consumers, giving them confidence and control over their data.’

‘New Zealand, represented by the Ministry of Health, is a founder member of SNOMED International where I work with other national representatives to see the product developed and implemented by members. I also enjoy my work with the Global Digital Health Partnership to implement common standards for interoperability between member countries. One thing that is clear is that New Zealand has some distinct needs such as provision for Māori and Te Reo. We’re a bit like Belgium, Canada and Switzerland in that our country has multilingual needs. This has seen us publish a SNOMED subset of 200 consumer-friendly terms for common health conditions in New Zealand English and Te Reo.’

‘HISO – the health sector’s kaitiaki (steward) for data and digital standards – runs an open development process and presently we have out for public comment a draft set of protocols for recording Māori descent and iwi affiliation data. This is work we’ve done with Statistics New Zealand and the Data Iwi Leaders Group. We rely on partnerships like this to engage the experts and to ensure the purpose and effect of every standard.’

‘Data standards are the hidden building blocks behind interoperability. With an increasing national and now even international lens on secure and consistent health data access, standards are the only way we’ll be able to make sure we’re all on the same page speaking the same language, so that terminology or missing information doesn’t stop a person getting the services they need.’

Helping you access standards

Standards are at the heart of quality healthcare and make it easier to compare health services, exchange information, aggregate data and safeguard the privacy of an individual’s health. By implementing standards, government and industry make a proactive commitment to the principles of quality, transparency, accountability and safety.

There are a range of existing health and data standards available on our website or talk to us if you’d like to learn more about developing new standards.