Tuesday, November 08, 2016

It Is Good To See Some Hospital Implementations Sharing Their Experiences! Helps Us All But Self Promotion Not As Helpful.

This appeared last week:

Digital revolution rolling out in hospitals

Authored by  Charlotte Mitchell
TWO Australian hospitals have successfully gone completely digital, and one of the project leaders says there’s no reason others can’t start the process.
Ms Jackie McLeod, project director of the electronic medical record implementation at the Royal Children’s Hospital (RCH) in Melbourne, told MJA InSight that with careful preparation, a digital transformation can have incredible results.
“You have to involve clinicians and executives, and make it the total focus of the organisation. It isn’t easy, but the benefits are there,” she said. “Would a hospital really choose to run on paper forever? To me that’s not acceptable.”
Ms McLeod was commenting on an article published today in the MJA which discussed the digital transformation of the Princess Alexandra Hospital (PAH) in Brisbane over a 2-week period. PAH was chosen as the exemplar site for a Queensland-wide electronic medical records (EMR) program and to become Australia’s first tertiary digital hospital.
The authors said it was a difficult task to transform such a large, diverse organisation and clinicians had valid concerns about the adequacy of training, maintaining hospital workflows and patient safety. Additional training was provided to staff, and software was customised to enable practice across different hospital settings. A patient safety team was also deployed to monitor adverse events.
“Although adverse events continued to occur, we did not detect any significant harm directly attributable to the transformation,” the authors wrote.
They said that with patient records available throughout the hospital, “data from the EMR will be collated to provide rich clinical information to facilitate system improvements”.
Lead author of the article and co-director of clinical service improvement at PAH, Dr Clair Sullivan, told MJA InSight that initially there was widespread disruption of normal hospital workflows. This disruption continued to lessen, yet remains a challenge.
“Digital transformation is the future of health care but it is hard.”
Dr Sullivan said that some of the challenges that remain at PAH included data extraction and pathology workflows, and ongoing work was being done to deal with those issues. There also still needed to be a completion of the clinical workflows with electronic prescribing.
Ms McLeod said that when the RCH decided to go digital, they went to the market for a vendor and selected Epic, a popular system used throughout the United States.
“Unlike [PAH] which has implemented one part of the roll-out, we took the step of implementing everything together,” she said.
What we wanted was a system that went right across the patient journey, not just being digital in one area and not in another. After we signed with Epic, we then went through a 19-month implementation with the whole suite of Epic modules.”
Lots more here:
This article is based on a paper in the Medical Journal Of Australia.

Pioneering digital disruption: Australia’s first integrated digital tertiary hospital

Clair Sullivan, Andrew Staib, Stephen Ayre, Michael Daly, Renea Collins, Michael Draheim and Richard Ashby
doi: 10.5694/mja16.00476
Digital technology now underpins most industries; however, the health care sector (particularly in hospitals) has been slow to transform from traditional paper-based systems of care. In the United States, for example, federal legislation and financial incentives have facilitated the implementation of electronic medical records (EMRs);1 but there are only a handful of advanced EMRs in hospitals outside the US.2 The roll-out of a digital hospital includes an EMR system and other technical components, such as integrated digital vital sign monitoring and digital electrocardiogram (ECG) records. This transformation prompts revolutionary change in the way health care is delivered and monitored.
The enthusiasm for digital transformation in health has been tempered by previous failures, such as some of the unsuccessful EMR installations in the National Health Service in the United Kingdom.3 Digital health care in Australia is well established in primary care and private specialist settings, but so far it has been chequered and controversial in hospital settings, with several independent reviews previously commissioned by government and other bodies.4
There are known adverse consequences and costs accompanying digital transformation of a hospital. These can include poor physician morale, increased frustration and reduced efficiency of care — particularly in the emergency department (ED) and outpatient setting.5,6 Previous EMRs have also struggled to support traditional clinical workflows, with the American College of Physicians calling for EMRs to support the cognitive flow of physicians.7
However, there are many benefits to the installation of an EMR system, which include more efficient and effective care, clinical decision support and a reduction in adverse events.8,9 There is no doubt that digital health care is the future. We describe here the challenging digital transformation of the Princess Alexandra Hospital (PAH) into the first integrated digital tertiary hospital in Australia.

Digital transformation

PAH was chosen as the exemplar site for a statewide EMR program and to become Australia’s first tertiary digital hospital. It is an adult teaching hospital that delivers quaternary level care to a diverse, high acuity patient cohort. PAH has 6529 staff members, 833 overnight beds and cares for over half a million outpatients a year. The aim was to build an integrated digital hospital which provided care across the emergency, inpatient and outpatient settings. Vital sign monitoring and ECGs are digitised and delivered to the EMR via Wi-Fi for immediate viewing. Medications are the only significant component not included in this implementation and are planned for early 2017.
After an 18-month pre-implementation stage, the digital transformation of PAH was achieved using a big bang approach, with digital conversion occurring rapidly over 2 weeks.
Lots more here:
Both these articles make interesting reads and are well worth the time spent.
I am interested regarding the claims in the title that this is a novel innovation in Australia. Having seen all of this at RNSH 2-3 months ago it must be that there has been a major delay in publication. I note also there are a few hurdles in Brisbane to be overcome!
Read all about what I found in August 2016 here:
David.

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