Clinicians present their winning cases, followed by short-listed vendor solutions

1. eNotification:
eReferral to Public Health
The Challenge
Nicholas Jones (HBDHB)
Lester Calder (HBDHB)
Jill McKenzie (MidCentral DHB)
Jonathan Jarman (Northland DHB)
Phil Shoemack (BOPDHB)
Chris Wong (Ministry of Health)
Colin Kumpula (Ministry of Health)

2. 17,000 Patients Referred to a Medical
Officer of Health Each Year
12 public health units provide services to these patients, their
families and communities:
1. prevent patients from spreading infections to others
2. identify causes of infection such as contaminated water or food
3. prevent (or detect early) illness among people already exposed to
infection or environmental hazards

3. Risk Assessment & Prioritisation of
Public Health Services
1. Risk of infection is high
2. Seriousness of disease
3. Good chance of preventing illness among contacts
4. Others likely to be infected from a common source
5. Good chance of identifying a common source

4. Giardia at the Daycare
• 23 year old patient M has a positive lab test for Giardia.
Public Health receives a lab report via EpiSurv. The patient
is sent a letter requesting further risk information.
• 3 weeks later a GP phones the Medical Officer of Health
(MOH) to refer 2 preschoolers with giardia. The children
attend the daycare where M works
Can eReferral provide workplace and school data?

5. Salmonella at the Delicatessen
• culture result for patient E is positive for Salmonella.
MOH sent lab report automatically with no further
information. Patient sent letter requesting risk
information as most cases are low risk.
• Two weeks later 10 new cases are reported
Can eReferral provide occupation and place of work at the
time of referral?

6. Novel Strain Influenza
• A new strain of influenza has been isolated in Mexico. A
week later WHO reports local transmission of the new strain
in 5 countries. Isolation and early treatment of cases with
antivirals are effective and preventative treatment of
exposed contacts is recommended.
• GPs asked to refer cases meeting clinical and travel criteria
to Medical Officers of Health
Can eReferral be quickly adapted to include travel history and
symptom data?

7. Sunday Night – ED
• It’s 1:00 am and Dr C has just finished her Sunday on duty.
She wants to refer the 3 year old suspect meningococcal
disease case to public health for family follow up first thing
Monday. She’s not sure what information public health will
need and doesn’t want to leave the job to the busy night
shift doctor.
Can eReferral:
• make referral easy for the tired registrar
• ensure essential information accurately passed to MOH
• make sure the MOH and team know a high priority
referral is in his or her inbox?

8. Bringing Public Health into the 21st Century?
•1900 •1930 •1980 •1990 •2000
Send a notice
Call the MOH
Fax a notification
form/lab report
Labs
National collation Paradox web based
cards to Wellington database & national
diskettes system

9. Can Public Health Services Use NHIT plan Infrastructure?
Care plans
Phase two
Decision support
Shared care 4 regions
Lab reports
Radiology
Medications Potentially support
public health
service delivery
Clinical
Data
repository
Primary Secondary &
Phase one
GP2GP •E-referral
& community •E-discharge
tertiary
E-prescribing Medicine reconciliation

10. Vendor Initiatives
eNotification
eReferral Challenge Solution
Presentation to Judges
Thursday 24th November 2011

11. Our Challenge
• Build on existing infrastructure
• Develop an interface for populating missing required data
fields
• Integrate data streams and records
• Provide for two way communication
• Potentially include a notifiable disease specific version of an
eDischarge

12. Use of Resources
• Existing infrastructure
• Build on existing eReferral work
• Streamline data collection to enable triaging

13. Infrastructure
Notifiable Disease Process Overview
GPs Medical Officers
Labserv
EPISERV
Pathology Labs
HLK messaging
system Patients
Guardians
Hospitals
Schools
Key
Internet connections
Health messages
HealthLink eForms
AMS users

14. Clinical – symptoms, Laboratory Results
basis of diagnosis
Medications Travel
Occupation/School Source
Immunisations

15. Change Framework

17. Smart Use of Technology

18. Finally
Innovative
Inclusive
Standards based
Feasible and
value for money
Modular

19. HINZ Clinician Challenge 2011
Early Warning Scoring
Anne Pederson
Jenny Murray
Brian Ackland
24 Nov 2011
CSC Proprietary and Confidential 11/25/2011 6:45 PM People_FMT 19

20. The Challenge

22. Early Warning Scores
• Scoring system based on deviation of
patient’s observations from normal
• More abnormal the observation, the higher
the score and the sicker the patient
• Escalation pathway based on higher
scores matches nursing & medical
expertise with sicker patients
• Early treatment is initiated & the patient
improves

23. Cardiac Arrest teams are the
ambulance at the bottom of
the cliff.
Early Warning Scores are the
fence at the top.

24. Current System
• The nurse takes some observations on a patient
• These are then manually recorded on a
patient’s chart
• The nurse must then recognise the signs of
early deterioration and be ‘empowered’ to call
for help
• Lack of experience & medical politics may
prevent a call for help

25. The Paper Problem

27. 1

29. Early Warning Score Matrix

30. Why The System Fails
• The observations aren’t performed
• The score either isn’t calculated correctly or
even at all
• The correct action isn’t followed
• If treatment fails, a futile cycle may be
perpetuated
• The patient continues to deteriorate making
Cardiac Arrest or Intensive Care admission
more likely

31. The Electronic Solution

32. A Little History
• webPAS 20 Years of Evolution in New Zealand
• webPAS Clinicals began in Taranaki in 2001
– Wireless Laptops on Trolleys
– Strategic direction to Internet Technology
• Recording Clinical Observations on a Computer
– Barrier to Clinical Systems Implementation
• Access to Computers
• Access at the Bedside
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33. iSOFT Mobility Suite
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34. Demonstration
• Entering Patient Observations
• Calculation of Score
• Alerts Triggered
• Switch to iPad Projection of Screen
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35. Deployment Options
• Mobile Devices as we have just demonstration
• Fixed Bedside iPad provide a Cost Effective Touch Screen Alternative to
more traditional bed side computers ( < $1200 )
• Token Based Authentication
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36. Summary
• Innovation
• Touch Screen Data Entry
• Notification via Multiple Method (SMS/Email/Facetime Video Conferencing)
• Feasability
• Existing Application Environment used Widely in NZ webPAS
• Proven technology platform implemented at Cabrini
• Integrated with exist infrastructure and IT Management
» No additional Integration
» No Additional Database/Application Servers/Backups/Management
• Effective Use of Health Workforce
• Clinician provided with effective access to information
• Reduce phone call to ward on patient progress
• Free up time for patient care
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37. Prize Money
• Explore international practices concerning hand-held devices
and vital signs/EWS within tertiary level hospitals:
• Macquarie University Hospital, and Rapid Response
Conference (Sydney, May 2012)
• Cabrini Hospital Melbourne
• King’s College London Hospital, UK
• HIMSS Conference 2012, US
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38. THANK YOU
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39. CSC Proprietary and Confidential 11/25/2011 6:45 PM People_FMT 39

40. HINZ Clinicians Challenge
2011 proposal:
A clinical translation system

41. What I do as an intensivist
 I see many patients who are seriously ill
 They need a diagnosis quickly
 I see many patients from different ethnic
groups
 They or their relatives don’t speak English
 Often my patients are too weak to care for
themselves so they need help for everything
 “We’re going to give you a bed bath”…

42. Which is why…
 I would like a clinical translation system !!!
 Not intended to replace medical interpreters
 Is intended for :
 Where the patient is so sick, there is no time to
call an interpreter
 Questions with only ‘Yes’, ‘No’, ‘Don’t know’ answers
 Where what is to be translated seems to be too
trivial to call an interpreter
 “Would you like some water to drink ?”

43. A clinical translation system
 The hardware platform used needs to be very
portable and have a long battery life
 It would be good to have pictures/ diagrams/ short
videos to go with audio of the translated words
 Text and translated text should be in big letters for
visibility

44. What I was thinking of – ‘trivial phrases’
 Nurse selects common phrases she/he wants to help
explain to patient
 Family member who can speak both languages
invited to go through this selection of phrases &
record translations
 Now whenever needed, patient or nurse can select
the needed phrase (without family member needing
to stay at bedside)

45. What I was thinking of- screens
Entry screen User screen
Patient position
Please translate these phrases :
Please sit up
Please lie down
We will roll you over
We will give you a bath Please sit up
(English)
We will dress your wound (Samoan)
Next page > < Last page Next page >

46. What I was thinking of – critical
questions
 Doctor determines the most important questions
asked of patients in emergency situations
 These questions adapted so they have only ‘Yes’,
‘No’, ‘Don’t know’ for answers
 Trained interpreter goes through this selection of
phrases & records translations

47. What I was thinking of - screens
Entry screen User screen
 Please translate these phrases :
Respiratory
Are you short of
breath usually ?
Do you get more
short of breath when
you lie down ?
Do you have a cough
usually ?
Do you have a cough
Have you or are you now usually ?
coughing up blood ? (Samoan)
Have you been or are you Yes No I don't know
now wheezy ?
Next page > < Last page Next page >

48. So, how about it ?