How to really get what you
want, not necessarily what you
asked for
Cheryl McCullagh,
Director of Clinical Integration
The Sydney Children’s Hospitals Network Cheryl.mccullagh@health.nsw.gov.au
SCHN
Information Management and
Technology Strategy (IMTS)
IMTS Strategy 2012
The IMTS aims
Single patient view
Sustainability and accuracy
Access to information
Innovation
Principles
Solving network gaps
Automating and integrating processes
Westmead Randwick 2013 2014 2015 2016 2017 EMM Clin-docs EMR2 SurgiNet PathNet c/compass
Move off iPM to SCHN stack Voice Rec in ED PAS: add Facility ID PAS feed To CHW POW EMM FirstNet
EMR Strategic Roadmap 5 years
16 EIR SCH scanning Healthenet NEHR
Voice Rec. Doc.
EMR SCHN Backscanning Lanier END Endoscopy VR Lanier VR Lanier
Reports Lync MRD Scanning Coding Email wifi IT support PCs Printing BYOD
NAP forms CCIS CCIS TBA NAPforms EMR SCHN Mental Health CHOC Mental Health CHOC Rehab Referrals Clin-docs EMR2 FirstNet EMRP Oncology Billing App.
Branding
The shared
memory of our
patients health
history.
Good Brands
•
Identify the message
•
Contain the essence of the message
•
Simplicity, but with a back story
•
Flexibility to tell a short and long story
•
Longevity
•
Currency
•
Memorable
•
Personal
•
Credible
•
Honest
A fully integrated health record for all children:
safer care
better access
current complete records
reduced risk
reduced errors
accessible education
Clinicians
Researchers
Coding/counting
Space
Vendor relationships
Long term Takes work
Get as close to the business as you can Manage the polygamy or the affairs
Good vendors
Clear ROI
Maximise the workforce Make things easier
Honest
Share the blame Get dirty
Play well with others
Vision
Current road map leads to HIMSS 6
Still disconnected pieces of the EMR with little automation Roadmap 2 takes us all the way to an integrated care digitally enabled health service in the same timeline
Problem ?
SCHN has about half the technical infrastructure and functional software to create a digital health environment.
We want to maximise the current momentum to go all the way
• Pieces approach is not reaping efficiencies • SCHN wants to create a true “digital hospital” • A proactive strategy, can unify
SINGLE EMR 2015 2016 2017 Clin-docs EMR2 SurgiNet c/compass Cardiology documentation Outpatient documentation Patient and family apps FirstNet
MEMORY 2
Strategic Roadmap- 3 years
29 E-billing E-training Backscanning EMR apps VR Dragon VR Lanier
Infrastructure, register at birth, Tap on log on, Mobile capability, Full redundancy, BYOD, monitor and device connection
NAP forms Smart pumps Referrals Patient Portal EMRP Pharmacy Bar coding and e-imprest. EMM Cardiology
documentation check in Self
Self check in Patient and family apps Patient Portal E-Education Security and tracking
Security and tracking
Automated coding Spot registration Randwick Westmead
• User experience improvements
• Integration the smart theatres
• Improved patient identification
• Electronic consents process
• Virtual clinics
• Pharmacy automation and integration
• Single dose medication dispensing
• Redesign the workforce for the future
Complete eMR function and redesign
Review And Update
Document
Patients and Families
Needs
• Communication and safety
• real time understanding of waiting times
• Way finding
Possibilities
• Family portal • My problem list • On line education • Self check in • Self assessment• Referral and appointment tracking
• E-clinic
• Results
• Q and A on line
• Contribution to the record
• patient and family apps
In hospital
•
Phone services
•
Nurse call
•
Peer group meetings
•
Parent groups
Out in the world
•
Clinical consultation
•
Patient to clinic lync
•
Education across sites
•
Home care
•
Lync OPD
• Automate audit and evidence • Clinical outcome reporting • Predictive care
• Survey and audit
• Patient and procedure matching
• Improved supervision of high risk patients • Real time coding, counting
• Real time research
Quality, safety, audit and reporting
38
Shared Clinical Documents created by NSW hospitals across the State
(HealtheNet sites only)
Shared Patient Information from the National eHealth Record
(PCEHR) Linked to Enterprise Patient Registry to collate NSW identifiers across LHDs including the IHIs
Linked Enterprise Medical Imaging Repository to ALL NSW Medical Images and
Reports
Cross-LHD Alerts, Allergies, Encounters
Linked to NSW Electronic Blue Book
Child Record
39
Linked Enterprise Medical Imaging Repository to ALL NSW Medical Images and
Reports
Lou
Billing Docum. parents Admin. Patients Private Education Security Building Corporate
Implementation Process
Conflicts
End-User Training CHW Go Live Aug 2015 Project Kick-off 10/03/14 System Review 12/03/14 Design Review 14/7/14 System Validation Sessions 29/09/14 8/12/14 Trainer & Conversion Prep 16/02/15 Maintenanc e Training 6/04/15 Integration Testing 1 18/05/15 Post Conversion Assessment 16/11/15 Client Executive Session 10/3/14 Integration Testing 2 29/06/15ICCIS
EMR2
EIR/PCEHR/CHOC/Lync/….
EMM/EMR Oncology Project
Milestones
For Staff, Patients and Families and Health
E ref Registered with pt portal My team Triage/Pre assessment Education commences referrer informed of plan and dates Sms remindersAllied/nursing check in E-clinic with GP
Self check in kiosk Specialty clinic face to face
billing
Specialty care
Team update
eRFA Pre planning education
billing admit
Self check in Pt portal update for DC/ meals IP notes IP education DC communication Follow up
ROI Drivers
43
Family led access, input and sharing
Diagnosis-specific education -better informed patients Enhanced call work-flow to utilise appropriate resources Real-time messaging between patient and clinician
Meal ordering/ housekeeping efficiencies at the point of care Able to administer drugs, collect assessment at the point of care eliminates the need for expensive COWS
Readiness for discharge surveys Interactive donor opportunities
Enhanced Patient Satisfaction Improved Staff Satisfaction Better workflow Better Communication Better Clinical Outcomes Lower Readmissions Better revenue
Should we go forward
HIMSS 5.2
Low risk option to create a demonstrator Others can adopt based on evidence from the implementations.
Integrate all state systems and more linking pieces Overcomes the slow pace of central programs at an affordable but accelerated pace
Strategy of “build once and replicate with improvements” has been shown to work well overseas.
What is everyone else doing?
• Workforce efficiencies are required
• Staff and families expect modernisation
• UK model expects 1:2.4 ROI, USA 1:3
NSW and SCHN have been leaders in clinical systems development and
deployment, but now are being bypassed in some areas
• QLD; Hervey Bay opened, DOH to fund two HIMSS Level 6 sites
• VIC; Austin and Peninsula well ahead of NSW in EMM, Epworth hospital going live in Nov with oneview, RCH in Melbourne $48m EPIC solution including ‘mychart’ have kiosks and wayfinding
• WA; PMH $200 mill + tender closed – to accommodate all
• NSW; SVH is reviewing options, Chris O’Brien- EMR+ Pt education and check-in • ACT; Canberra hospital deployed pt portal
Contract vs outcome
1. See it live/ref check
2. Project management office
3. Change management, adoption, and clinical leads. 4. Workforce redesign
5. Work in development locally to further integrate existing functions 6. Upgrade infrastructure regularly
University California Medical Centre
How do you know you got what you wanted
Is it better than you had before Does it meet user expectations Was it on time and on budget
Does it integrate and automate or duplicate Does it bring new risks or costs
Does it standardise care
Research
Can we validate that what we implement has value…. 1 Quantify the safety and effectiveness of an eMMS to reduce medication
errors (including adverse drug events), and average length of stay among paediatric patients using a stepped-wedge cluster randomised controlled trial
2 Assess the extent to which feedback (from Aim 1) and subsequent modifications of eMMS design can improve eMMS effectiveness in reducing medication
errors
3 Assess the effects of an eMR in paediatric oncology on workflow, efficiency
and patient outcomes
4 Conduct a cost-effectiveness study of eMMS use in two paediatric hospitals
‘Either you prove (through a RCT) that the new way is better or I am free to do whatever I please (even though there is no scientific reason for my own practice)’
Future Automation
Billing Counting Coding Benchmarking Predictive alerts Remote care Standardise Measuring variation Decrease variationImproving safety and quality Managing risk
Reducing waste, duplication, waiting, error
Planning services Managing costs
Strength in
Numbers
CERS Rapid Response
1) Clinical Review ad hoc form records the response to a call for a clinical review. A hard copy also prints to the patient ward
Successful implementation for patient outcomes
• Make the preferred path the standard
• code variance -why did you chose not to follow the pathway?
• Imbed in EMR, with soft and hard stops
• Monitor and measure variation and outcomes, regularly
• Demonstrate value added in patient and other outcomes
Virginia Mason
336 beds HIMSS 6
Virginia Mason
ContactsTodd Inslee, P: 206.223.6600 Todd.Inslee@virginiamason.org
Ellen Dowling, Administrative Director, Information Systems, P: 206-583-6510
Ellen.Dowling@virginiamason.org
TPS
TQI
Lean
Since 2000
VMPS
VMI 2009
Can health be more efficient
1. Minimise diagnosis errors
2. Discontinue low value interventions 3. Defer unproven intervention
4. Select care options in terms of cost effectiveness
5. Target clinical intervention to those with greatest benefit 6. Conservative approach to end of life
7. Actively involve patients in decisions and self management 8. Minimise day to day operational waste
9. Rapidly learn and evolve
10. Integrated systems of care that maximise value
EMR -necessary and essential
Have a clear visions with manageable steps 50% loss of productivity for two weeks Faster is better
Plan for the BAU model
Dragon and Chart search is life changing Training models have to be faster/better
Start simple – particularly with decision support signal to noise ratio Add function not complexity
Future -patient managed records Get to the front line
