breastscreen aotearoa an independent review - Ministry of Health

10. INFORMATION SYSTEMS IN BSA10.6.1 In 1996 when tenders were sought for the six Lead Providers ofmammography screening, specifications for developing a suitable informationsystem were left to each applicant to develop and cost. The outcome was that four ofthe Lead providers (BSC, BSCC, BSS and BSHC) entered into a contract with onesoftware company, and BSAN and BSM each contracted with a separate softwarecompany. As a result, there are three different and currently incompatiblecomputerised systems in the Lead Providers. The systems have to fill severaldifferent functions ranging from scheduling staff, generating invitations, andscheduling appointments, to recording results and providing the minimum data-set formonitoring. The Independent Monitoring Group is particularly concerned about theproblems that arise when a woman moves from one Lead Provider to another andappears on the records of both. They were also concerned by the slow developmentof fail-safe systems in BSM. In fact the facility for radiologists in sub-contracted sitesto enter their findings electronically rather than manually, was only finallyimplemented the day before I visited BSM in late February 2002. The IMG continuesto emphasise the need for a single information system for all Lead Providers,preferably integrated with a population register (see Section 5 above).10.6.2 As already seen, at monthly intervals the Lead Providers submit details of eachwoman screened to the New Zealand Health Information Service, (NZHIS), whichvalidates the NHI number of each woman and, after the NSU has resolved any querieswith the Lead Providers, adds the record to the BSA database. The nationalmonitoring data-set included on this database consists of items of informationrequired by the Independent Monitoring Group. Initially there were inevitableproblems with abstracting the relevant details in a consistent way from the threedifferent systems and each of the software companies had to make adjustments.However these problems are now largely resolved and fewer difficulties can beanticipated in the future.10.6.3 The need for a single national summary statistical database remains but thiscan be achieved without introducing a completely new software system to cover bothoperational needs of the Lead Providers and a statistical database. The current BSAdata-base already provides the statistical database, while the three separatecommercial software companies can continue to support the operational needs of theLead Providers, thus avoiding the inevitable turmoil and expense of changing fromone software system to a new one.The BSA database is building up a cumulative record of each woman's screeninghistory, and since it is held under NHI number has the additional advantage of beingclosely integrated with the NHI system and the NHI Population Register as itdevelops, (see 5.6 above). In future these systems could ensure that when a womanmoves from one Lead Provider region to another, details of her last screen and duedate of next screen could be abstracted from the BSA database and sent to her newLead Provider. There may be a need, however, for the new Lead Provider to be able toaccess more detailed information images of from her previous Lead Provider, and thiswill necessitate some modification of their systems.32