Cheryl McCullough - Technology & innovation: Is a paperless hospital a realistic goal?
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Cheryl McCullough - Technology & innovation: Is a paperless hospital a realistic goal?

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A presentation given by Cheryl McCullough at The Journey, CHA conference for 2012, in the 'Enhancing Outcomes Through Innovations in Technologies' stream.

A presentation given by Cheryl McCullough at The Journey, CHA conference for 2012, in the 'Enhancing Outcomes Through Innovations in Technologies' stream.

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  • Further driving summary workflows is the ability to see both graphical and relational information in one view so that you can quickly see what is going on with the patient. A result in isolation is data – results in context of other pertinent patient information is information.
  • Once the medication is selected they are prompted to answer simple questions relating to the appropriateness of the medication. The right handside of the program provides information about standard accepted indications and their criteria as well as useful resources along the way
  • **Users can click on the links (blue buttons) and open relevant documents to support decision making and overall patient management eg re isolation, communication with public health unit etc
  • Local approach in alignment with the current State and National direction. Involves all levels of the organisationAmbitious, aspirational, necessaryCreates conflicting demands for scarce resourcesIM&T connects with all areas of service, which intersect with all aspects for the broader SCHN strategy model.Rapidly changing technical and health environment
  • should be the ultimate repository for clinical care, activity reporting, treatment and research analysis. To improve patient care with technological advances in line with consumer expectations.Achieve a standard way of working with information for all network users for better outcomesAims:Sustainability and AccuracyStandardised Access to informationSingle Patient Record View InnovationHealth Information is available whenever and wherever it is needed.Support for a complete eMR, accessible in multiple locationsReduce scanned records CHW/implement scanning SCHIncrease direct entry to EMR (automated where possible)Ensure all clinical activity is capturedOutcomesAccessible eMR from all sites, including remote accessImplementation of eMR for inpatient/outpatient notesImplementation of eMMUse of innovative data collection eg, barcoding/trackingProvide accurate and complete activity dataDelivering improved health care via new mechanisms of communication and intervention using the latest in technology. Regularly connect with international leadersRegularly update and refresh programs and technology infrastructure Minimising effort of data entry, maximising outcomesOutcomesDemonstrate international leadership in health information systems Use of innovative data collection eg, barcoding/trackingclinical equipment universally interfaces with the eMRUser satisfaction with efficient data entryProvide up to date technology and advice for users
  • Search algorithms based on the ACCP/SCCM criteria for Severe Sepsis search in real-time, within the Millennium database. As data is entered, as a byproduct of documentation or other means, the Lighthouse solution looks for patients who are eligible based on the evidence.

Cheryl McCullough - Technology & innovation: Is a paperless hospital a realistic goal? Cheryl McCullough - Technology & innovation: Is a paperless hospital a realistic goal? Presentation Transcript

  • Paperless Possibilities October 2012 Cheryl McCullagh Director of Clinical Integration
  • SCHN-Children First and foremost
  • current state
  • Is ‘paperless’ a realistic goal? • Current frustrations can be overcome when technology makes things easier and repetitious data entry is eliminated.
  • Correspondence EIR Link Nursing Transfer Form Clinical Care Summary LDAP QAS Deceased Patient Alert CVAD documentationv500 PowerChart HIE extract upgrade 2007.04 Daily Specials HPUX Migration OPD Note doc Height/Weight inbound Rev 7.8 upgrade Document Imaging Allergies, Problems and Alerts Visit Followup - NAP doc ENT OutpatientDRG v6 upgrade Clinical Documents Ax Haem SMS OPD Multi Provider Billing ProjectOrders & Results CAPAC Disaster Ward HeCare ED Citix Passthrough to SQL 2004.03 upgrade VMS upgrade WLCOS /DoH policy CHAQ doc Ward access-CCIS Upgrade Oracle 9i upgrade Message Centre Ad-hoc security Rapid Response CERS Rehab Unit doc Action Plan doc Asthma Medicare Expiry in PMDocument Loader Patient Risk doc ClinDoc tab Custom PWS Growth Chart VMS 7.2 upgrade PICU doc Transition care Scheduling/PM patch stage2 go-live PBRC PET scanner NM Armbands PBRC stage1 go-live Scheduling Billing&Extract INP SQL upgrade Growth Chart Fenton2000-012000-022000-042000-052000-072000-092000-102000-122001-022001-032001-052001-072001-082001-102001-122002-012002-032002-042002-062002-082002-092002-112003-012003-022003-042003-062003-072003-092003-112003-122004-022004-032004-052004-072004-082004-102004-122005-012005-032005-052005-062005-082005-102005-112006-012006-022006-042006-062006-072006-092006-112006-122007-022007-042007-052007-072007-092007-102007-122008-012008-032008-052008-062008-082008-102008-112009-012009-032009-042009-062009-082009-092009-112009-122010-022010-042010-052010-072010-092010-102010-122011-022011-032011-052011-072011-082011-102011-112012-012012-032012-042012-062012-082012-09Inpatient Discharge Summary VMS 7.3 upgrade Scheduling Phase 2 Wireless in ED/theatres/SU Haem/KFZ doc 2007.16 upgrade ICU Admission flag Office 2010 upgrade Patient Registry go-live VMS & TCPIP upgrade Attending Doctor2 capture Patient Management RIS go-live Order reprint one page DocLoader Authentication 2007.19 code Allied Health go-live Scheduling Phase 3Paediatric Risk form INP-GP/Paed data Between the FlagsED summary Oracle 8.1 upgrade Middleton f/u doc eHR Growth Charts -Burns Unit doc SUPI/ Advanced Dental Unit doc EDW extract Hagar - ES80 Nursing Transfer Summary NSW Bed Board Surgical f/u docpatch VMS Mental Health go-live HIE extract upgrade Growth Charts implemented Enhanced View Phone/Communication Immunisation updateAmbulance extract HeCare ED Scheduling Demographics Banner Kids Care Centre ED PRAT tool Clinical Summary tab Pre-admission clinic assessments Citrix for PChart
  • Evolving Documentation Strategies
  • Between the Flags• eform for clinical and rapid response• Increased vigilance for complications by coders• Increased coding of arrests and resuscitation events• Form and call triggered by patient events
  • Order Sets (Care Sets)
  • Medication Reconciliation – Home Meds
  • AntibioticStewardship4Kids(ABS4Kids)SearchPhones & 6 for [ ]Pagers You are notcurrently logged in Click here to login View Approval Requests What is ABS 4 Kids? ABS 4 Kids stands for "antibiotic stewardship" or otherwise known as "antimicrobial stewardship" for Kids at CHW. Antimicrobial stewardship is defined as processes to assist and support clinicians with decisions regarding the optimal selection, dose and duration of antimicrobial agents. The objectives of ABS 4 Kids are: To optimise antibiotic use to improve patient care To minimise antibiotic toxicity to the patient To reduce the selection pressure for the emergence and transmission of multi- drug resistant bacteria One of the core strategies of ABS 4 Kids consists of online pre-approval of restricted antibiotics (see below). A hierarchical "traffic light" system has been developed based on the resistance potential, complexity of use and cost of each antibiotic. The restricted agent groups, and mechanisms for obtaining approval are specified below: "Red Agents" are antimicrobials of very high resistance potential and/or cost. When commenced during office hours, approval in advance must be obtained from the StewardshipWhat is ABS 4 Drug Dose Guidelines Antibiotic Guidelines Contact Us Antibiotic Approval Consultant on pagekids? 7092. The approval number must be written on the medication chart. When commenced after hours, approval must be sought on the morning of the next working day. "Orange Agents" are antimicrobials of intermediate resistance potential, cost and/or complexity of use. Initial empiric use of agents in this group is allowed and their use must be registered on the request form below by the clinical team at time of prescribing. The request will be reviewed by the Stewardship Consultant, on the basis of the clinical information provided, on the same or the next working day. If approved, an approval number will be supplied for annotation on the patients medication chart. "Green agents" are those where there are no restrictions on use. If required, antibiotic advice is always available by paging the Infectious Diseases registrar (during working hours) or the Infectious Diseases Physician or Clinical Microbiologist on call. Other useful resources include the Australian Therapeutic Guidelines - Antibiotic (available via CIAP) and the Drug Dose Guidelines. CHW "Traffic Light" Restricted Antibiotic Formulary
  • Historical Challenges• ‘pockets’ of information• No consistent model of analysis / reporting• Consistency and completion of tasks• Different source systems• Access• Timing• Quality• Duplication
  • Risks• Limited $• ABF• Private Patient Revenue• Costing• Site systems differences• Infrastructure• Sustainability• Patient Safety
  • Service Needs• Integrated approach to multiple needs – Strategy – Planning – Costing – Reporting – Performance management – Service delivery – ‘real-time’ information
  • Strategic Directions Alignment National Health DirectionCreation of Local Health Districts and Specialty Networks Implementation of Activity Based Funding (ABF) State Health StrategyPatients at the centre of access to timely, quality keeping people healthy to avoid The Creation of NSW everything we do health care unnecessary hospitalisation Kids and Families State ICT strategyClinical Systems integration- EMR Corporate systems Information for Sustainable and unified patient record integration performance and ABF Infrastructure SCHN strategy Strategic Development & Meeting the needs for Delivering Providing infrastructuretechnology implementation the performance seamless for research andinvestment of responsive IT systems framework clinical care education SCHN IMTS Sustainability and accuracy Single patient view Access to information Innovation
  • Aim- connecting information for outcomes • Combined local HIE by Dec 2013 • eMR basis for clinical information • Unified and accessible eMR by • Full redundancy of critical 2015 (including remote access) systems, regular scheduled • Enterprise Imaging Repository downtime • Unified Implementation of eMR • Reliable interfaces - no duplication for inpatient/outpatient notes of systems or data entry • Implementation of eMM • Minimal unplanned downtime due to preventable internal mechanisms Single Sustainability • Seamless integration of automated information patient view and accuracy Patient Service • Work with MOH/ e-health and • CHIMP/ CHARLI/ e-policy/ Pathlore/ e-quality Staff • tele-health international leaders Equipment universally interfaces • Single data input • Implementation of eMM Standardised with the eMR • Innovation • User satisfaction Use of innovative data collection information • Up to date technology • Smart theatres 2012/13 • Lanier voice recognition
  • Clinical Information Strategy to 2016 2000-2011 Now 2013 - 2015 2016 eMR eMR + eMR + eMR +Strategy Orders/Results HPUX Migrations all Documentation Growth Charts Patient Registry for IHI Transition to aSCHN eMR Safety interfaces PAS/Scheduling Enterprise Image Repository eMR Phase 2 Allergies/Alerts Scheduling Correspondence ICU Outpatient Billing PathNet Millennium Between the Flags Outpatient Reporting Medication Management Allied Health PowerNote & MPages Discharge Referral Mental Health Review SCH eMR Workflows FirstNet/SurgiNet EDW Client & WL eMR Phase 2 Immunisations Problems/Diagnosis Inpatient Consult Clinical Reporting XR Reporting (MRP) Other Document Imaging Document Imaging Document Paper Imaging Document Paper Imaging Medical Records Medical Records Integration Paper Department Records Department Records Paper Department Records Dept Dept Dept Databases Databases Databases Dept Databases PCEHR PCEHR PCEHR
  • The connected record
  • Internet based health Conferencing
  • Management Information• Delivery across the network• Departmental performance against target• CMI NWAU targets over time• LOS benchmarks• Revenue per pt load• Performance against strategic goals• Aspirational-clinical outcomes
  • VMO CMO STAFF SPECIALIST MEDICAL FELLOW JMO NURSE PRACTITIONER ONCOLOGY CAMPERDDOWN HUNTER BAILLIE NURSE MANAGER SURGICAL UNIT CLINICAL SERVICE PLANNING MIDDLETON OPERATING NURSING UNIT MANAGER THEATRES VARIETY TURNER CLANCY CLUBBE CAPAC NURSE EDUCATOR/CLINICAL NURSE EDUCATOR WADE CARDIOLOGY/CARDIAC SURGERY HALL NICU PICU ESW OPD OTC EMERGENCY SERVVICES ED REGISTERED NURSE PSYCHOLOGICAL MEDICINE WORKFFORCE PLANNING ENROLLED NURSE ASSISTANT IN NURRSING MASTER PLANNING NURSING ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANTFTE REVIEW CLINICAL NURSE SPECIALIST 2 OCCUPATIONAL THERAPIST SOCIAL WORKER PSYCHOLOGIST PHYSIOTHERAPIST CHILD LIFE THERAPIST ALLIED HEALTH DIETICIAN ADMINISTRATIVE ASSISTANT CLINICAL SUPPORT OFFICER WARD CLERK ADMINISTRATIVE REVIEW BOOKING CLERK SECRETARY FINANCE STAFF IT STAFF CORPORATE/IT SERVICES BUSINESS MANAGER DOMESTIC BOOKING CLERK SERVICES SERVICES/FOOD
  • VMO CMO STAFF SPECIALIST MEDICAL FELLOW JMO SURGERY NURSE PRACTITIONER ONCOLOGY CAMPERDDOWN GENERAL BAILLIE NURSE MANAGER SURGICAL UNIT CLINICAL SERVICE PLANNING INTENSIVE MIDDLETON OPERATING NURSING UNIT MANAGER THEATRES CCARE VARIETY TURNER CLANCY BURNS CLUBBE TREATMENT CAPAC NURSE EDUCATOR/CLINICAL NURSE EDUCATOR WADE CARDIOLOGY/CARDIAC SURGERY HALL NICU PICU ESW OUTPATIENT OPD OTC EMERGENCY SERVVICES ED REGISTERED NURSE HUNTER PSYCHOLOGICAL MEDICINE MEDICINE WORKFFORCE PLANNING ENROLLED NURSE ASSISTANT IN NURRSING MASTER PLANNING NURSING ENDDOCRINE ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANT GENETICSFTE REVIEW /DAY CLINICAL NURSE SPECIALIST 2 OCCUPATIONAL THERAPIST SOCIAL WORKER PSYCHOLOGIST PHYSIOTHERAPIST CHILD LIFE THERAPIST ALLIED HEALTH DIETICIAN ADMINISTRATIVE ASSISTANT CLINICAL SUPPORT OFFICER WARD CLERK ADMINISTRATIVE REVIEW SECRETARY BOOKING CLERK FINANCE STAFF IT STAFF CORPORATE/IT SERVICES BUSINESS MANAGER DOMESTIC BOOKING CLERK SERVICES SERVICES/FOOD
  • VMO CMO STAFF SPECIALIST MEDICAL FELLOW MEDICAL PROGRAM JMO AMBULAATORY AND SURGERY PERI-OPERATIVE NURSE PRACTITIONER CRITICAL CARE ONCOLOGY CAMPERDDOWN GENERAL BAILLIE NURSE MANAGER SURGICAL UNIT EMERGENCY CLINICAL SERVICE PLANNING INTENSIVE MIDDLETON OPERATING NURSING UNIT MANAGER THEATRES AND CCARE VARIETY TURNER CLANCY BURNS CLUBBE TREATMENT CAPAC NURSE EDUCATOR/CLINICAL NURSE EDUCATOR WADE CARDIOLOGY/CARDIAC SURGERY HALL NICU PICU ESW OUTPATIENT OPD OTC EMERGENCY SERVVICES ED REGISTERED NURSE HUNTER PSYCHOLOGICAL MEDICINE MEDICINE WORKFFORCE PLANNING ENROLLED NURSE ASSISTANT IN NURRSING MASTER PLANNING NURSING ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANTFTE REVIEW /DAY CLINICAL NURSE SPECIALIST 2 OCCUPATIONAL THERAPIST SOCIAL WORKER ALLIED HEALTH PROGRAM PSYCHOLOGIST PHYSIOTHERAPIST CHILD LIFE THERAPIST ALLIED HEALTH DIETICIAN ADMINISTRATIVE ASSISTANT CLINICAL SUPPORT OFFICER WARD CLERK ADMINISTRATIVE REVIEW SECRETARY DIAGNOSTIC PROGRAM BOOKING CLERK FINANCE STAFF IT STAFF CORPORATE/IT SERVICES BUSINESS MANAGER DOMESTIC BOOKING CLERK SERVICES SERVICES/FOOD
  • VMO CMO RESEARCH STAFF SPECIALIST MEDICAL FELLOW MEDICAL PROGRAM JMO AMBULAATORY AND SURGERY PERI-OPERATIVE NURSE PRACTITIONER CRITICAL CARE ONCOLOGY CAMPERDDOWN GENERAL BAILLIE NURSE MANAGER SURGICAL UNIT EMERGENCY CLINICAL SERVICE PLANNING INTENSIVE MIDDLETON OPERATING NURSING UNIT MANAGER THEATRES AND CCARE VARIETY TURNER CLANCY BURNS CLUBBE TREATMENT CAPAC NURSE EDUCATOR/CLINICAL NURSE EDUCATOR WADE CARDIOLOGY/CARDIAC SURGERY CARDIOLOGY/CARDIAC SURGERY HALL NICU PICU ESW OUTPATIENT OPD OTC EMERGENCY SERVVICES ED REGISTERED NURSE HUNTER PSYCHOLOGICAL MEDICINE MEDICINE WORKFFORCE PLANNING ENROLLED NURSE ASSISTANT IN NURRSING MASTER PLANNING NURSING ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANTFTE REVIEW /DAY CLINICAL NURSE SPECIALIST 2 OCCUPATIONAL THERAPIST SOCIAL WORKER ALLIED HEALTH PROGRAM PSYCHOLOGIST PHYSIOTHERAPIST CHILD LIFE THERAPIST ALLIED HEALTH DIETICIAN ADMINISTRATIVE ASSISTANT CLINICAL SUPPORT OFFICER WARD CLERK ADMINISTRATIVE REVIEW SECRETARY DIAGNOSTIC PROGRAM BOOKING CLERK FINANCE STAFF IT STAFF CORPORATE/IT SERVICES BUSINESS MANAGER DOMESTIC BOOKING CLERK SERVICES SERVICES/FOOD
  • VMO EDUCATION CMO RESEARCH STAFF SPECIALIST MEDICAL FELLOW MEDICAL PROGRAM JMO AMBULAATORY AND SURGERY PERI-OPERATIVE NURSE PRACTITIONER CRITICAL CARE ONCOLOGY CAMPERDDOWN GENERAL BAILLIE NURSE MANAGER SURGICAL UNIT EMERGENCY CLINICAL SERVICE PLANNING INTENSIVE MIDDLETON OPERATING NURSING UNIT MANAGER THEATRES AND CCARE VARIETY TURNER CLANCY BURNS CLUBBE TREATMENT CAPAC NURSE EDUCATOR/CLINICAL NURSE EDUCATOR WADE CARDIOLOGY/CARDIAC SURGERY CARDIOLOGY/CARDIAC SURGERY HALL NICU PICU ESW OUTPATIENT OPD OTC EMERGENCY SERVVICES ED REGISTERED NURSE HUNTER PSYCHOLOGICAL MEDICINE MEDICINE WORKFFORCE PLANNING ENROLLED NURSE ASSISTANT IN NURRSING MASTER PLANNING NURSING ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANTFTE REVIEW /DAY CLINICAL NURSE SPECIALIST 2 OCCUPATIONAL THERAPIST SOCIAL WORKER ALLIED HEALTH PROGRAM PSYCHOLOGIST PHYSIOTHERAPIST CHILD LIFE THERAPIST ALLIED HEALTH DIETICIAN ADMINISTRATIVE ASSISTANT CLINICAL SUPPORT OFFICER WARD CLERK ADMINISTRATIVE REVIEW SECRETARY DIAGNOSTIC PROGRAM BOOKING CLERK FINANCE STAFF IT STAFF CORPORATE/IT SERVICES BUSINESS MANAGER DOMESTIC BOOKING CLERK SERVICES SERVICES/FOOD
  • VMO CMO STAFF SPECIALIST MEDICAL FELLOW MEDICAL PROGRAM JMO AMBULAATORY AND SURGERY PERI-OPERATIVE NURSE PRACTITIONER CRITICAL CARE ONCOLOGY CAMPERDDOWN GENERAL BAILLIE NURSE MANAGER SURGICAL UNIT EMERGENCY CLINICAL SERVICE PLANNING INTENSIVE MIDDLETON OPERATING NURSING UNIT MANAGER THEATRES AND CCARE VARIETY TURNER CLANCY BURNS CLUBBE TREATMENT CAPAC NURSE EDUCATOR/CLINICAL NURSE EDUCATOR WADE CARDIOLOGY/CARDIAC SURGERY CARDIOLOGY/CARDIAC SURGERY HALL NICU PICU ESW OUTPATIENT OPD OTC EMERGENCY SERVVICES ED REGISTERED NURSE HUNTER PSYCHOLOGICAL MEDICINE MEDICINE WORKFFORCE PLANNING ENROLLED NURSE ASSISTANT IN NURRSING MASTER PLANNING NURSING ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANTFTE REVIEW /DAY CLINICAL NURSE SPECIALIST 2 PatientsPROGRAM ALLIED HEALTH and OCCUPATIONAL THERAPIST SOCIAL WORKER PSYCHOLOGIST PHYSIOTHERAPIST Families ALLIED HEALTH CHILD LIFE THERAPIST DIETICIAN ADMINISTRATIVE ASSISTANT CLINICAL SUPPORT OFFICER WARD CLERK ADMINISTRATIVE REVIEW SECRETARY DIAGNOSTIC PROGRAM BOOKING CLERK FINANCE STAFF IT STAFF CORPORATE/IT SERVICES BUSINESS MANAGER DOMESTIC BOOKING CLERK SERVICES SERVICES/FOOD
  • Why paperless• We must improve patient care and access• We must address financial sustainability• Requires – Governance and Infrastructure – standardisation – Sharing – Advocacy – clinician experts
  • Service Value• Credibility of information• Feeling safe using the information• Better reflection of complexity• Safer documentation and patient care• Improved accuracy reporting up• Ability to refute inaccurate data and contribute to understanding of paediatric differences
  • Future• Connecting IT with strategy• Solving network gaps• Single patient view• Innovating• Automation• Reliability• Clinician driven
  • The searchable and shared record Sepsis Early Detection Logic
  • Streamlining multicentre clinical research• The solution: Online data collection and multicentre project management for clinical research, in real time• The benefits: - Minimise paper and streamline database creation – Data entry workload spread across research team – Delay in collation of results  faster research outcomes – Potential to integrate with eMRs and other data sources• PTNA = Paediatric Trials Network Australia – A new network of paediatric researchers committed to improving child health through clinical research. (Institutional membership model) – Currently purchasing the above solution, which will be trialled by Dec 2012 and made more broadly available to the PTNA membership in Q2, 2013. – For more information, visit www.ptna.com.au
  • Advocacy• Working with the• Development of a set of Paediatric CCs and CCLs for Clinical Review – Step 1- Identifying diagnoses with a demonstrated impact on cost and length of stay. – Step 2 – Assessment of paediatric vs adult impact of CC diagnoses by ADRG – Step 3 – Refine CC list to exclude CCs with high adult impact – Step 4 - Addition of closely related diagnosis codes to resulting CC list• Need to recognise paed cost drivers, home and social context