National Enrolment Service Key Messages December 2015

National Enrolment Service Key Messages – December 2015

Introduction:

A commitment has been made by the sector to begin implementing a web-based National Enrolment Service (NES), previously known as e-enrolment in 2015. This document provides PHOs with a high level overview of NES, including guidance on what NES is, the services that will be available to general practices, and how PHOs can start to support their general practices to ensure that they are ready for implementation of NES.

NES will be a single source of truth for all national enrolment data. It will provide the capability to support practices by assisting in patient identification and enrolment processing, using a single national standard process. NES will integrate directly with Practice Management Systems (PMS) via a secure web-based service that links to the Ministry identity and enrolment databases. This new process will provide relevant data for payment and reporting purposes.

Nationally, up to 22,000 patient changes occur between practices each month, in addition to 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 places practices and PHOs at a financial risk with the recovery of funding following an enrolment audit because of errors in data. Using NES the enrolment data held nationally will be available in real time, allowing the generation of more accurate payment calculations and reporting to both PHOs and practices.

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 providers electronically. The NES is an important component of this plan.

NES will be hosted within the Ministry’s Connected Health Network to ensure reliability, safety, and security of information. However NES will be managed and operated by the sector, so the accuracy of the data inputted becomes paramount.

In summary NES will allow for:

Ø  a centralised register with real time patient enrolment status

Ø  single source of truth for enrolment data to ensure accuracy of capitation based funding (CBF) calculations

Ø  validated NHI and up to date patient demographics

Ø  validated addresses using eSAM service

Ø  web services integration with PMS

Ø  amended PHO enrolment business rules

Ø  Networks and PHOs will have secure access to their real time enrolment data, which will support their service development and delivery, and planning functions.

NES is not a:

Ø  patient portal for electronic enrolment

–  via the internet using PC or mobile device; or

–  on kiosk or Tablet at the practice

Ø  external web forms based enrolment server

–  requiring integration with all PMS vendors

Ø  replacement for current paper enrolment forms

–  No current replacement for Audit and Compliance is available

–  No widespread method of individual identification is available.

Key NES Services

From 1 July 2016 NES services will be rolled out to general practices. Once ‘live’ in a practice NES services will include:

Patient Identity Information

Ø  NHI Search and Get – users can search and view the NHI records for a patient from within the PMS, and update the PMS with the most recent demographic data for the patient.

Ø  NHI Create and Update – authorised users can create a new NHI using the patient identity service within the PMS, update systems and synchronise both the PMS and NES with the most recent demographic data for the patient. Training for this service will be required.

NES Masterfile

Ø  The NES Masterfile will allow for extraction of a national enrolment masterfile that contains the “single national source of truth” for all enrolment data. The purpose of NES is to capture enrolment register changes on a daily basis, which makes it possible to take a snapshot of NES on a monthly basis. This will allow payment processing at monthly intervals.

Other services will be added over time to the NES, and will integrate directly with PMS. This includes Births, Deaths and Marriages and Immigration New Zealand. Once these services are integrated it will provide greater enrichment of data, and NES will be able to provide eligibility assessments.

Enrolment Business Rules and Requirements

As we progress towards implementation of NES, there is an opportunity to make amendments to enrolment business rules and requirements that are having less-than-optimal impacts on patients and providers. Currently business rules are being signed off through the PHO Services Agreement Amendments Protocol group (PSAAP), however the new metrics to be implemented inside NES are:

NES will make it possible to capture all changes to patient enrolments within practices and their respective PHOs, including patient transfers, deaths, and date of last consultation, on a daily basis.

Other business rules in regards to patient stand-down, GMS fee for service claims, pre-enrolments, and all business rules relating to the current register submission process are being reviewed by PSAAP; more information will follow once these are finalised.

Implementation Plan for NES

NES will be rolled out to all practices nationally using a staged approach. This will require the Ministry, PHOs and Vendors to co-ordinate their efforts so that the impact on general practice is kept to a minimum. Once 98 percent of practices in all PHOs are successfully using NES there will be at least a six month transition period before NES is accepted as business as usual. All PHOs will still be required to submit their CBF registers quarterly via the normal process during this time.

During the transition period, CBF payments will be calculated using the existing payment calculation and the new NES based calculation so that a comparison can be made. Once the totals from the two calculations reach an agreed level of accuracy over two consecutive quarters, PSAAP will be in a position to agree that NES can be accepted as business as usual for all future CBF calculations. Exception reporting will be fed back to PHOs and practices during the transition period so they can fine tune any data inaccuracies.

Requirements for PHOs and Practices

PHOs will need to provide comprehensive support to each of their general practices in preparation for NES and during the subsequent implementation period.

1.  All practices will need their PMS version to be upgraded to allow for the capability of NES; this will be available via a new version release close to 1 July 2016. Practices will be notified by their software vendors when this is ready for installation, along with release notes.

2.  Practices need to be signed up to Connected Health if they are not already. Practices need Connected Health to be able to access NES web services. PHOs may need to undertake a stocktake of their practices who are not already signed up to Connected Health.

a)  Connected Health forms can be downloaded from the Ministry’s website at the following location: http://www.health.govt.nz/our-work/health-network/how-join-health-network or email

3.  All PHOs and practices are required to have a Health Provider Index Organisation ID Number allocated if they do not already have one. PHOs may need to undertake a stocktake of their practices who have not applied for these unique identifiers and assist with obtaining them as necessary.

HPI Organisation ID numbers can be obtained:

a)  by completing an Access Request form and submitting it to the Ministry of Health or

b)  Requests for HPI Org Ids should be sent to .

c)  If your PHO contracts directly with Individual Contracted Providers and pays their CBF payment separately from their practice entities then these providers will also need their own unique identifiers within NES called: Health Provider Index Common Person Number (CPNs). CPNs are assigned to all health practitioners via their registered authority eg Medical Council of New Zealand: 0800 286 801.

4.  PHOs will need to support practices to clean up any missing or inaccurate NHIs for enrolled patients. The Ministry Identity Management Team will be working with PHO data managers and Management Service Organisations to produce lists of patients with inaccurate NHI records and identify the nature of the inaccuracies. A strategy will be agreed between all parties to address these.

5.  Every user of NES needs to be set up with their own access rights at the appropriate level; ie practice owner, or administration, PHO etc. More information on this process will be provided during implementation.

NES Contact

Please direct any questions about NES to:

Alastair McLean
Project Manager
Primary Care
Community Health Service Improvement
Sector Capability and Implementation
Ministry of Health
DDI: (04) 816 3312
Mobile: 021 514 940

NES High Level Messages Page 4 of 4