Planned improvements to the country's medical warning system (MWS) could avoid some deaths and unnecessary misery for a significant number of people, Dr Sandy Dawson says.
In a recent interview when he was clinical director of the National Health Information Technology Board, Dr Dawson said people should not be worried about the state of the MWS, but "I certainly think we could do better".
The MWS is an alert service linked to patients' national health index (NHI) numbers, warning clinicians of known risk factors such as drug allergies or medical conditions.
• Have your medication allergies been properly recorded?
One of the limitations of the present system is that hospital doctors can access it, but general practitioners cannot.
GPs also cannot input data on their patients directly, although they can do so by contacting the Centre for Adverse Reactions Monitoring (Carm), based in Dunedin.
There are also instances where conditions and allergies may be noted at the hospital where a patient is treated, but that information is not passed on to the national system.
If that patient later requires treatment in another hospital, treating clinicians will not have access to that information and the patient may be in no condition to supply it verbally.
As part of the National Health IT Board's health identity programme, expected to be completed by the end of next year, it is envisaged clinicians' access to the information will be improved.
The health identity programme is being designed to integrate existing electronic systems so they can " talk" to each other, with the aim of ensuring the right health information is available when and where it is needed.
One of the issues with the existing systems is the significant number of duplicate patient NHI records, which can be risky if clinical decisions are based on incorrect information.
Dr Dawson said advances in technology meant ambulance crews, in future, could also have access to basic patient information.
He acknowledged the importance of patient privacy, but said that, as with bank records, access could be "very tightly protected".
It was much easier to audit electronic records than paper systems if there were concerns.
Medical assessor at Carm Dr Michael Tatley said it was a "no brainer" that all treating clinicians with the ability to prescribe should have the ability to "interrogate" the MWS and see if there was a problem or potential problem.
When an adverse reaction is reported to Carm, the centre is able to enter a danger (where the re-administration of the medicine is likely to be life-threatening) or a warning (where the medicine would be likely to cause a clinically significant reaction) against the patient's NHI record in the national database.
Although anyone can report an adverse reaction to Carm, involvement of health professionals is preferred.
The centre sends replies to those who report reactions, which include information about the cause, similar reactions and information to assist with future prescribing.
Dr Tatley said while this information about such drugs as penicillin was not adding to the science, it was important in helping to prevent the patient's becoming ill in future.
Dr Dawson said another issue with the existing system was how incidents were described and the sector had been working on ways to improve the consistency of that.
In the case of an allergy to a medication, clinicians needed to know the extent of a previous reaction because, in some circumstances, the doctor might consider the potential benefit of the drug outweighed the risk of harm.
Southern District Health Board's IT clinical leader, Dr Andrew Bowers, said the electronic prescribing system used in the recent successful pilot at Dunedin Hospital would alert a prescribing doctor to any allergies recorded on the hospital's system.
To then prescribe a medication that had previously produced an allergic reaction, the doctor would have to make a formal decision weighing the benefit against the risk of harm.
The doctor could not make such a prescription "by mistake".
That system would also highlight possible problems with drug interactions if patients were on other medications.
He agreed the efficiency of such systems depended on the accuracy of the information within them.
At this stage, it is not clear when, and how, the system used in the pilot might be extended to other hospitals throughout the country.
