FAQ for the NHI

NEW ZEALAND HEALTH INFORMATION SERVICE

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NHI Frequently Asked Questions
Contents:

Background information on the NHI

Management of data held on the NHI

Benefits

What are the benefits of having an NHI number?

Security and privacy

Obtaining more information about the NHI

Where can I find out more about my NHI number?

Background information on the NHI

— What is the NHI?

New Zealand health professionals have been using a form of the National Health Index (NHI) number for more than 20 years. It is used in hospitals, by family doctors, and by midwives. Most people now receive their own unique NHI number at birth. About 95 percent of New Zealand citizens have their own unique NHI number.

The NHI is not your health record, it is simply a unique combination of letters and numbers which helps identify who you are. This number is used by authorised health workers to help identify you so that you don’t have to keep repeating the same information over and over again. It can also speak for you when you cannot.

The NHI is a unique number that is assigned to each person using health and disability support services. The NHI is an index of information associated with that unique number. The Health Information Privacy Code 1994 places restrictions on the creation and use of unique identifiers such as the NHI number.

The NHI holds the following information: name (including alternative names such as maiden names), NHI number, address, date of birth, sex, New Zealand resident status, ethnicity, and if appropriate, date of death, or flags indicating any medical warnings or donor information. Clinical information is not recorded on the NHI.

Thus, individual patients can be positively and uniquely identified for the purposes of treatment and care, and for maintaining medical records. This means that healthcare providers can be sure that they are talking about the same person, thereby reducing the chance of making a clinical decision based on wrong information. This certainty is increasingly important as patients become more mobile, when care occurs in both the primary and secondary sectors, and where emphasis is on ‘shared’ care.

The NHI and the NHI number are central to the vision of safe and secure sharing of information among health and disability support services. An NHI number is fundamental for services to link information and get a better understanding of each person’s needs.

The complexity of hospital care has led to the development of independent clinical information systems, such as pharmacy, laboratory, and admission/discharge/transfer. Important information relating to an individual patient is often held in more than one place. The NHI number allows all this information to be brought together.

— Do I have an NHI number?

About 95 percent of New Zealanders have their own unique NHI number. Health and disability support services need the NHI number, and will assign one to you if you do not already have one. This is permitted under the Health Information Privacy Code 1994. Under this Code the health and disability support services must tell you if they are collecting information and if they will be using it to register you on the NHI or update information already associated with your NHI number.

— How did I get my NHI number?

Since almost 95 percent of New Zealanders have a unique NHI number, the majority of new numbers are given to newborn babies. If for some reason a person does not have an NHI number but must go to a health services provider, an NHI number will be assigned.

— What does an NHI number look like?

An NHI number is actually a string of seven characters — the first three are letters and the last four are numbers. These characters are assigned randomly by computer. An example of an NHI number is ABC1234. If you have been in hospital you may have seen an NHI number on your clinical notes or on the hospital identity bracelet.

— What is the Medical Warnings System (MWS)?

Associated with the NHI is a separate database called the MWS or Medical Warnings System. The MWS can only be accessed through the NHI.

The MWS is designed to warn healthcare providers of any known risk factors that may be important when making clinical decisions about individual patient care. The MWS may have information on known medical warnings, such as drug allergies or previous admissions to hospital. It may also indicate a person’s wishes regarding organ donation, and give information on next of kin or other contacts.

The MWS allows data from other sources to be available where it could be important. It is not designed to be a replacement for a healthcare provider’s own clinical information system. The MWS also has various levels of security controls to ensure only authorised people have access to this information.

— Who can access the MWS?

The MWS is currently available through most hospitals’ link to the NHI. It is also available to the Centre for Adverse Reactions Monitoring (CARM). CARM provides a form on which healthcare providers can report adverse reactions by their patients to drugs and vaccines. CARM then uses this information to update the MWS so that other healthcare providers will be aware of the risk. As GPs gain access to the NHI and MWS this information will become available to them also.

— Is there a link between the MWS and MedicAlert?

The MWS has no direct links with the MedicAlert Foundation, although this information may be entered on the MWS independently when a person with a MedicAlert bracelet visits a hospital.

— What is the NHI used for?

The NHI number is used by authorised users to:

obtain information from a hospital’s internal systems, by allowing online access to information such as diagnostic results, previous clinical events, or planned future events such as elective surgical bookings
access information from the MWS, such as medical warnings, medical alerts, and previous secondary care events
access information from the National Immunisation Register, such as immunisation status.

— Is there any additional cost to the end user of the NHI?

No, there is no cost to the end users of the NHI.

— Are there any links to debt collection agencies?

No, there are no links to or associations with debt collection agencies.

Management of data held on the NHI

— Who looks after the NHI?

A part of the Ministry of Health called the New Zealand Health Information Service (NZHIS) acts as a custodian that looks after the NHI and MWS. NZHIS has stewardship and maintenance responsibility over these two systems. The goal of the NZHIS is to make accurate information readily available and accessible in a timely manner throughout the health sector to support the sector’s ongoing effort to improve the health status of New Zealanders.

— How is the NHI number used?

The NHI number is used by:

a hospital’s community health service, to co-ordinate and manage its visits (for example, for community health nursing or mental health contacts)
screening programmes, to co-ordinate and manage the programme; this includes tracking and contacting clients and potential clients, and managing clinical information
public heal
th units, to co-ordinate and manage patient-based public health services such as immunisation and school dental services.

The NHI number is used to uniquely identify health and disability support information in national databases that are accessible to approved health and disability support services. There are two databases:

The Medical Warnings System. The MWS is designed to warn health and disability support services of any known risk factors that may be important when making clinical decisions about individual patient care. This data can be accessed only through the NHI.
The National Immunisation Register. The NIR is designed to assist vaccinators to increase New Zealand’s immunisation coverage through timely access to immunisation histories.

The Ministry of Health uses a coded form of the NHI number to uniquely identify health and disability support events on statistical databases. The databases are used to:

produce statistical publications
meet international reporting requirements
assist with developing policy
facilitate research
support the planning of health and disability support services, including health needs assessment
assist with monitoring the performance of health and disability support services.

An encrypted form of the NHI number is used in statistical databases to help protect the privacy of individuals while enabling data from different places to be linked.

— Can I change my details on the NHI?

Yes, you can change your details on the NHI. The best approach is to check with your regular health professional that they have your correct details. If they have direct access to the NHI, ask them to update your details. If they do not have direct access, ask them to forward the new details to NZHIS.

Alternatively, you can contact the NZHIS’s Privacy Officer directly:

Privacy Officer
New Zealand Health Information Service
Ministry of Health
PO Box 5013
Wellington
telephone: (04) 816 3330
fax: (04) 816 2898
e-mail: information@moh.govt.nz

— Where is NHI information stored?

NHI information is stored in a database maintained by the New Zealand Health Information Service (NZHIS). The NZHIS is a group within the Ministry of Health responsible for the collection and dissemination of health-related data.

— How can we be sure the information on the NHI is up-to-date and accurate?

The best approach is to check with your regular health professional that they have your correct details. If they have direct access to the NHI, ask them to update your details. If they do not have direct access, ask them to forward the new details to NZHIS.

Alternatively, you can contact the NZHIS’s Privacy Officer directly:

Privacy Officer
New Zealand Health Information Service
Ministry of Health
PO Box 5013
Wellington
telephone: (04) 816 3330
fax: (04) 816 2898
e-mail: information@moh.govt.nz

— Who has access to the NHI?

Only health agencies that are involved in providing health services can access and use the information on the NHI. The New Zealand Health Information Service manages the NHI under the guidance of the Health Information Privacy Code 1994.

— How will possible duplicate NHI numbers be eliminated?

A 12-month intensive duplicate-resolution programme, which began in March 2003, has identified and linked many existing duplicates. The programme was based on using specialised software to trawl the NHI looking for potential duplicate numbers. More than 125,000 duplicate NHI numbers were identified and resolved during this period.

Duplicate reduction is performed by actively searching for duplicate records. Currently, a team of analysts use reporting tools to search through NHI numbers to identify possible copies. Reducing the number of duplicates will increase the quality of the NHI. Duplicate reduction has two aspects:

finding and linking existing duplicates, and
reducing the creation of new duplicates, including:
new data elements to improve the ability to uniquely identify individuals
training on searching the NHI to reduce the number of new registrations of individuals already existing on the NHI
increased monitoring to identify agencies that are creating duplicate NHI numbers
installing a new search engine to improve the ability to find an existing NHI number.

— Do I need an NHI number?

Yes. Health and disability support services need the NHI number and will assign one to you if you do not already have one. This is permitted under the Health Information Privacy Code 1994.

Under this Code the health and disability support services must tell you if they are collecting information and will be using it to register you on the NHI or update information already associated with your NHI number.

— Can my NHI number be used for other purposes?

NHI numbers can only be used for the purpose they were created for. Please see the section above ‘How is the NHI number used?’ for more information on the uses of the NHI.

— How is the NHI accessed?

The NHI was originally developed for public hospitals and is accessed directly from the hospital's PMS using the standard NHI transactions. One of the ways the NHI can be accessed from a primary care provider’s computer is through the use of a web-based solution called NOAH (NHI Online Access for Health). All that is required is a web browser (such as Internet Explorer or Netscape version 4.0 and up), a digital certificate to ensure authorised access, and a Health Intranet connection.

With the release of NOAH, work has begun on building NOAH functionality into primary care Practice Management Systems (PMS)s. The first step to see this occur will be the development of a new NHI API (application programming interface) that will be easier to integrate into a PMS.

— How does the NHI merge information?

The NHI number ties together all patient documentation and internal patient systems in hospitals. The NHI number is on patient labels, which are used on most items of patient documentation, from pharmaceutical labels to discharge summaries. Usually, the hospital’s central patient management system, which manages admissions, discharges, and transfers of patients, is linked to other clinical systems such as the laboratory, the pharmacy, and dental and surgical booking by means of the NHI number.

Where regional services exist, such as centralised diagnostic services, health and disability support services may receive the diagnostic results electronically from an external source. The NHI number is used to ensure that the results are associated with the correct patient.

Benefits

— What are the benefits of having an NHI number?

For you to get the best care and support, your health professional must have the right information about you at the right time. Your NHI number identifies you and makes sure you are correctly matched with your health record. Other people may have a similar name to you, your name can be spelled wrong, or you may have changed your name by deed poll or by marriage. Having a unique number helps health workers avoid confusion.

Security and privacy

— Who has access to NHI information?

Access to the NHI is restricted to health professionals and agencies governed by the Health Information Privacy Code. Each organisation that has access to this information has to sign an access agreement, and every NHI transaction is logged. Details are recorded of who accessed the NHI and when, what they did, and which NHI number they looked at. An audit programme monitors whether access was justified and whether it was used for legitimate purposes.

— Who can change my information?

DHBs and NZHIS are current organisations able to change NHI details; they have full access and are able to change personal information such as alternative names and contact details, as well as update medical warnings. All NZHIS staff have to sign a confidentiality agreement before using the NHI. For most users, however, viewing the NHI is a read-only process, which allows them to search for NHI numbers and see the information but not change anything.

— Is my NHI number secure?

The Privacy Act 1993 protects personal information and gives you a measure of control over your personal information. The Health Information Privacy Code 1994 was approved by the Privacy Commissioner to take into account the special factors and characteristics of health and disability services and strengthen the focus on privacy. Your NHI number helps keep your health information private. Personal information with your NHI number included is more secure than the same information with your name and address on it.

— Is the NHI system secure?

All NHI messages are protected by 128-bit encryption as they travel over a ‘virtual private network’ (VPN) called the Health Intranet. The computer system is kept in a secure room, and the information is duplicated on another system in another building. Both systems have disaster recovery plans in place to ensure that the data held on the NHI is always kept secure and complete.

— How can I find out more about NHI privacy?

The NHI complies with all Privacy Act and Health Information Privacy Code requirements, which can be viewed online at www.privacy.org.nz/comply/hinfopc.html.

Obtaining more information about the NHI

— Where can I find out more about my NHI number?

You may approach your local health professional (for example, your general practitioner) to find out your NHI number and see the information that is held with it.

Often the general practice will be able to give you your NHI number straight away. They may also be able to access the NHI directly and advise you of the details held.

If the general practice does not have direct access, they can e-mail a request on your behalf to the NZHIS’s Privacy Officer, who will then send the information back to the practice. Here, NZHIS is treating the practice as a trusted third party to make it easier for you to safely receive the information. This is the preferred approach.

Alternatively, you can contact the NZHIS’s Privacy Officer directly:

Privacy Officer
New Zealand Health Information Service
Ministry of Health
PO Box 5013
Wellington
telephone: (04) 816 3330
fax: (04) 816 2898
e-mail: information@moh.govt.nz

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