The sector is committed to implementing a National Enrolment Service (previously known as e-enrolment) in 2015.
The National Enrolment Service (NES) will be a single source of truth for all national enrolment data, and will provide the capability to support practices by assisting in patient identification and eligibility assessments. NES will integrate directly with the Practice Management Systems via a secure web-based service that links to the Ministry of Health national identity and payment systems, providing relevant data for payment and reporting purposes.
Nationally, up to 35,000 patient changes occur between Practices each month. This is in addition to around 6,000 patients enrolling for the first time. The current manual enrolment process is inefficient, processes are duplicated and prone to error in relation to data and patient information. This leads to inaccuracies in the allocation of funding and creates a financial risk for practices and PHOs when enrolment audits reveal data errors and result in funds being recovered.
The health sector is increasingly using electronic systems for the exchange of information. The Health IT Plan sets out a vision that all New Zealanders will have a core set of personal health information available to them and their healthcare providers electronically. The NES is an important component of this plan.
Benefits of NES include:
- A national register with real time patient enrolment details which will facilitate more accurate and timely sharing of data between core services in the health sector
- A single source of truth for enrolment data to ensure accuracy of Capitation Based Funding calculations
- Validated NHIs, up-to-date patient demographics and enrolment data, supporting accurate identification of patients and contributes to clinical safety
- Validated addresses using eSAM service, supporting accurate assignment of deprivation-based funding
- Reducing processing and payment cycles from 3 months to 1 month and reducing financial liability
- Updated enrolment business rules supported by NES technology will provide real time information and accurate details
- Improved eligibility assessment guidance will support practices to make decisions about patient eligibility for publicly funded services
- Web services integration with PMSs will create a seamless experience for the user when interacting with national services.
Key NES Services
From 1 July 2015, a core set of Ministry hosted NES services have been operating. Practices are able to access and utilise these services once the PMS versions, with the new integration capability, are available and implemented at the practice. This will happen in a managed rollout from August 2015.
Patient Identity Information
When a patient presents at a practice, users will be able to search and view the NHI records for the patient from within the PMS and compare them to the local record. Depending which system has the most recent accurate detail, either the NHI or the local PMS record can be updated to ensure both systems are synchronised.
For a patient who wishes to enrol in the NZ Health system for the first time, and has no current record, the ability to create a new NHI is being introduced. This will happen in real time as part of the enrolment process and will immediately synchronise the NHI service with local records for that patient. This will eliminate the need for the current manual process and calls to the Help Desk.
Training and information resources for using the NHI functions will be available for all PHOs and practices.
National Enrolment Service
The purpose of NES is to capture practice enrolment register details and changes on a daily basis. This will ensure discharge summaries, lab results etc are sent to the practice where the patient is enrolled.
For payment purposes, funding calculations will be based on a monthly snapshot rather than three-monthly register submissions. This will allow for payment calculations and processing at monthly intervals.
Eligibility refers to a patient’s eligibility to receive publicly-funded health services. When a patient enrols, users will be able to search to determine whether the patient is a verified NZ Citizen by birth i.e. if a patient was born in New Zealand before 2006 they are deemed eligible. This will be the first eligibility assessment available. Additional eligibility assessment information will be added over time.
What NES is not
NES is not:
- A patient portal for electronic enrolment
- Via the internet using PC or mobile device
- Via kiosk or tablet at the practice
- An external web forms based enrolment server
- Requiring integration with all PMS vendors
- A replacement for current paper enrolment forms
- No current replacement for Audit and Compliance purposes is available
- An updated enrolment form will be provided to reflect changes regarding privacy and use of patient information as a result of NES
Enrolment Business Rules and Requirements
As we progress to the NES there is an opportunity to amendmend enrolment business rules and requirements which are having less-than-optimal impacts on patients and providers. Currently these business rules are being worked through the PHO Service Agreement Amendment Protocol (PSAAP) Group.
The proposed new metrics to be implemented when we have transitioned to NES are:
|Enrolment status updated||Daily||Quarterly|
|Enrolment register calculated (NES snapshot)||MonthlyFirst day of month||Quarterly|
|Capitation Based Funding (CBF) Payment||Monthly15th of the month||Monthly|
NES makes it possible to capture all changes to patient enrolments within practices and their respective PHO’s (including patient transfers and date of last consultation) on a daily basis.
Other business rules in regards to patient stand-down and pre-enrolments etc, as well as all business rules relating to the current register submission process, are being reviewed at PSAAP. Additional information will follow once these are finalised.
Implementation to NES
All web-based NES services integrated within the PMSs will be available for use by practices once they have applied the appropriate PMS vendor upgrade release and have enabled the service.
From August 2015 there will be a transition period while practices adopt the NES during which time the current CBF quarterly registers will still be required for all payments processing. The practices who are ready will have their registers entered into NES in parallel with the current CBF system to allow for variance and quality checking.
During this parallel run, PHOs will still be paid their capitation funding via the quarterly CBF system. This will manage the financial risk through a controlled transition environment over a six to twelve month period. Exception reporting will be fed back so that PHOs and Practices have a window of opportunity to fine tune any data inaccuracies over that time before they are paid via the monthly NES process.
More information can be found at: www.health.govt.nz/nes