NSW Health IT – Has Much Changed over the Years?

The following press release appeared over the weekend (always a suspicious time!).

02 May 2009

Patient care and safety enters the digital age

NSW Minister for Health, John Della Bosca, announced today that the State Government had started rolling out new electronic medical records (eMR)s technology into public hospitals across the State to help improve patient care and safety.

The Minister said the new technology would also make it easier for doctors and nurses to track the condition of patients through the health system as hospital information would be linked between facilities via eMRs.

“The $100 million project will be rolled out to 188 hospitals across the State by the end of 2010,” Mr Della Bosca said.

“The new eMR replaces many existing paper records and makes secure patient information available to authorised clinicians from computer workstations across the hospital.

“A major benefit of the eMR program is the completeness of patient data and information on medical orders.

“Prior to the introduction of eMR, some requests for medical imaging and pathology could require referral back to the requesting clinician due to incomplete or illegible hand-written records.

“This technology will improve the efficiency of hospital care and free up doctors and nurses to focus on patients and not paperwork which will further improve patient safety,” he said.

The benefits for patients include:

• Decreased delays in retrieving clinical information;
• Timely availability of integrated patient information, including results of tests and patient scheduling;
• Reduced duplication of orders for diagnostic tests; and
• A reduction in the potential for errors.

The benefits for doctors, nurses and allied health professionals is that eMR will allow them to:

• Record patient care where and when it is delivered
• Review progress and order treatment or diagnostic tests from any workstation within the health facility
• Be prompted with alerts and allergies at the time of ordering
• Continually review results and outcomes as well as alter care as required.

“In his Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals, Peter Garling SC recommended the implementation of the eMR into NSW hospitals as a way of improving the sharing of information and communication among medical teams,” Mr Della Bosca said.

“Results from the initial trials and roll-out reveal a positive take up of the new technology by clinicians, demonstrated by the use of electronic medical orders to request blood tests and x-rays.

“The eMR is one of the cornerstone projects of NSW Health’s Information and Communication Technology Strategy, which is modernising the way health services are supported in NSW.

“Delivering a statewide eMR will help provide consistent delivery of quality healthcare for patients in both rural and metropolitan hospitals across the State,” he added.

For a range of health information, go online to www.health.nsw.gov.au

The release is found here:

http://www.health.nsw.gov.au/news/2009/20090502_01.html

The SMH followed up thus

Paper patients' notes out, digital records in

• Louise Hall Health Reporter
• May 2, 2009

BY THE end of next year, every public hospital in NSW will move from paper patient notes to electronic medical records that can be accessed by any health worker, the Government has announced.

The Minister for Health, John Della Bosca, said the $100 million project to digitise 250 hospitals will save money by eliminating duplicate diagnostic tests and imaging. It will also improve patient safety by alerting staff to a deteriorating patient and reduce the likelihood of errors.

Mr Della Bosca said doctors, nurses, allied health and social workers will be able to access a centralised repository of a patient's medical chart, laboratory results, prescriptions and referrals, no matter where the patient enters the health system.

Peter Garling, SC, recommended an urgent roll-out of electronic medical records (eMR) in his special commission of inquiry into acute care services, which found NSW's record-keeping system is "a relic of the pre-computer age" that puts patient safety at risk.

.....

The next step will link hospital-based records to primary care providers, such as GPs, by way of an electronic discharge summary.

.....

NSW Health has admitted that two previous attempts to implement electronic medical records in 1991 and 1999 had failed, at a cost of $12 million and $30 million respectively.

The National Health and Hospitals Reform Commission has recommended an individual patient-controlled electronic health record owned by the patient who decides which health care providers can access it.

Full article here:

http://www.smh.com.au/national/paper-patients-notes-out-digital-records-in-20090501-aq6k.html

The NSW AMA reaction is here:

AMA casts doubt on hospital paper scrap plan

Posted 1 hour 14 minutes ago

The Australian Medical Association (AMA) has cast doubt on plans for all of New South Wales' public hospitals to scrap paper records by the end of the year.

The association's state president, Dr Brian Morton, has welcomed the State Government's $100 million project to move to electronic medical records.

.....

"I think there must be extreme cynicism as to the ability of NSW Health and the State Government to actually respond in implementing change and to actually allow independent audit of the process, so that we can see as a community that change has occurred and that quality of care really is improving," he said.

Full report here:

http://www.abc.net.au/news/stories/2009/05/03/2559261.htm

Quite telling is this report from Computerworld.

http://www.computerworld.com.au/article/301824/nsw_health_spend_100m_electronic_medical_records?eid=-6787

NSW Health to spend $100m on electronic medical records

Patient information to be shared between health facilities

Rodney Gedda 04 May, 2009 14:32

After many promises and trials, NSW Health has committed $100 million over the next two years to replace existing paper-based health records in public hospitals with a state-wide electronic system aimed at improving patient care.

NSW Health anticipates the new electronic medical record (eMR) technology will make it easier for doctors and nurses to track the condition of patients through the health system as hospital information will be linked between facilities electronically.

Minister for Health, John Della Bosca, said the $100 million project will be rolled out to 188 hospitals across the state by the end of 2010.

“The new eMR replaces many existing paper records and makes secure patient information available to authorised clinicians from computer workstations across the hospital,” Della Bosca said.

“A major benefit of the eMR program is the completeness of patient data and information on medical orders.”

A similar system is the NSW Healthelink project, which began about five years ago and was well received by clinicians.

Healthelink now claims 70,000 subscribers.

Della Bosca said prior to the introduction of eMR, some requests for medical imaging and pathology could require referral back to the requesting clinician due to incomplete or illegible hand-written records.

More here:

http://www.computerworld.com.au/article/301824/nsw_health_spend_100m_electronic_medical_records?eid=-6787

The scepticism that anything has changed is pretty obvious.

The recent release should maybe compared to this one:

30 May 2005

Patients to benefit from online access to medical records

Public hospital patients across NSW will have access to state of the art Electronic Medical Record (EMR) technology after the NSW Government today announced a call for tenders to expand the roll out of the EMR system, Health Minister Morris Iemma said today.

"The Electronic Medical Record is a foundation stone of our vision for how we will harness technology to improve patient care," Mr Iemma said.

"The Electronic Medical Record system will give clinicians online access to diagnostic tests for their patient carried out in hospital, regardless of whether as inpatient, outpatient or in emergency.

"From this base we aim to build a network that will ultimately allow consolidated test results to be accessed online from any authorised PC location across the state.

"So if a patient is admitted to Prince of Wales Hospital Emergency Department, their clinician will be able to access diagnostic test results done previously at Nepean Hospital or even Wagga Base Hospital.

"Improved access to clinical information can help reduce delays and give medical professionals the information they need to deliver the best possible care to patients," Mr Iemma said.

"This will be a significant boost for frontline health services delivering better access to a patient's clinical information wherever they are in the health system," Mr Iemma said.

"The system will also allow electronic charting making it easier for treating clinicians to detect trends in diagnostic results."

"NSW Health is looking to secure state-wide EMR coverage, and to do this it is seeking a second provider for point-of-care clinical system to those Areas that currently have not had a provider appointed," Mr Iemma said.

Mr Iemma said that online results reporting is already being used by Sydney West, Sydney South West, the Children's Hospital at Westmead and Central Coast and would be extended to Northern Sydney and Greater Western Area Health Services by early 2006.

This second call for tenders will see this technology rolled out to the remaining Area Health Services.

The Minister said that privacy and security will be assured as each clinician is given a unique identification and password to access the system.

Preserving system integrity and patient privacy are critically important aspects of the project and NSW Health will take all necessary steps to ensure patient confidentiality is maintained.

Roll out of the software will be managed through HealthTechnology, the new shared IT services agency established as part of the restructure of the state health information management and technology function.

For a range of health information, go online to www.health.nsw.gov.au

The release is found here:

http://www.health.nsw.gov.au/news/2005/20050530_04.html

Of course that didn’t quite go as planned!

09 February 2006

Electronic Medical Record Tender Closes with no vendor meeting all requirements

NSW Health today announced that it would review its options for its second Electronic Medical Record (EMR) solution after concluding that no single product presented in the tender could meet the defined requirements to a satisfactory level.

NSW Health's Chief Information Officer, Michael Rillstone, said that while he was sympathetic to vendors, who had put in a significant effort, it was important that NSW Health move forward with its EMR program with confidence that the needs of Area Health Services would be met with minimal disruption to front line health services.

"A number of the clinical information systems presented were currently under development and while these may yet meet NSW Health's requirements in the future, at present they represented too high a risk on a number of fronts.

"We only have one chance to get this right. Health is a complex environment, and that does not mix well with high-risk software implementations, as we have seen in the past.

"Nine responses were received. A comprehensive evaluation found that no single product could meet to tender requirements to a satisfactory level," said Mr Rillstone.

The EMR is aimed at providing an information system that will enhance the health care of people attending NSW public hospitals. It will allow statewide coverage of clinical information systems with the goal of making comprehensive information available to treating clinicians, no matter where a patient enters our health system.

Mr Rillstone said that key modules of the EMR strategy have already been rolled out over the past three years into two Area Health Services and the Children's Hospital at Westmead.

The selection of a second vendor was preferred because it provided a more competitive environment with alternate product options. However, this approach represents no advantage if it comes with significantly higher implementation risks.

"Sound health care and clinical decision-making is enhanced by timely access to quality information.

"For example, having the test results of a patient in hospital quickly integrated into their treatment notes so that treating clinicians can consider the results in the context of the patient's overall condition and current therapies to make timely decisions," Mr Rillstone said.

The Chief Information Officer said it was important to understand that NSW Health remained committed to delivering an EMR and that improving the quality and timeliness of patient care and providing support to busy clinicians as they care for their patients was a priority.

While the current second EMR tender outcome is a setback, work has begun immediately on reviewing the options for moving forward aimed at minimising any delay.

The release is here:

http://www.health.nsw.gov.au/news/2006/20060209_02.html

The bottom line is that unless something has changed dramatically, this is just a joke. I wonder will we get a new announcement of essentially the same thing a further four years (an one or two ministers) hence.

The AMA and Computerworld are perfectly justified in being sceptical! A review of the news releases from NSW Health since 1999 shows at least 2 other seeming starts down the e-Health path that don’t seem to have gone far.

This one, from February, 2001, is my favourite:

Electronic Health Records - Better Care, Your Choice

A SYSTEM of linked electronic health records (EHRs) will significantly improve patient care in NSW hospital patients within two years, the Minister for Health, Craig Knowles, said today.

The full release is here:

http://www.health.nsw.gov.au/archive/news/2001/February/02-02-01.html

Just how focussed efforts are on this newly announced initiative becomes a little clearer when one goes here:

http://www.emr.health.nsw.gov.au/

The information on the eMR page says it was last updated 26th Sep 2008! Only eight months ago!

Funny how EHR has become EMR and then become eMR – I wonder what all that means?

Time will tell I guess if this is serious or not. I, for one, will not be holding my breath.

David.