Approach to Health Innovation Projects:Learnings from eReferralsJim Warren, Yulong Gu, Karen Day,Malcolm Pollock, Sue Whit...
NIHI commission• Conducted from Aug 2010 to Jun 2011• Evaluate electronic referral (eReferral) implementations   –   Hutt ...
The Hutt Valley Solution• Implemented in 2007• 30 general practices referring in electronically  from Medtech32• 28 servic...
Hutt Valley Uptake            GP referral volume by year (iSoft, Concerto)   • 1000 eReferrals per month in 2008; 1200/mo ...
Hutt Valley Triage Latency                                 1                                0.9                           ...
Hutt Valley Upsides and Downsides                       • Upsides                         – Greater transparency          ...
Northland• From 2009• Iterative development of clinically most relevant  forms  – Colorectal, Breast, Diabetes-retinal, Di...
Northland Uptake• Steady  uptake  – Median 26.5    eReferrals    per GP user    in 2010                   eReferral volume...
The Canterbury Initiative (CI)• HealthPathways website initiated in 2009  – Local agreed method for managing a condition (...
CI HealthPathway Development &Dissemination• HealthPathway definition process  – five 90-minute evening meetings  – GP and...
HealthPathways Hits• Used during the  weekdays   – With patient, not     as a casual     browse on     weekend• Stakeholde...
Auckland: IT Project (entering pilot)• Largest scope• Greatest process interoperability• 3 separate phases:  – primary car...
About eReferrals per se• Provide transparency  – Status info and rapid feedback  – Further gains with deeper electronic wo...
What have we learned about the process• It‟s not like upgrading MS Office• Plan for feedback and iteration  – Evaluation w...
Questions?             Thank you!           jim@cs.auckland.ac.nz    (CD with full reports from NIHI stand)
Approach to Health Innovation Projects: Learnings from eReferrals
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Approach to Health Innovation Projects: Learnings from eReferrals

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Jim Warren
National Institute for Health Innovation, University of Auckland
(Friday, 9.30, Innovation in Practice 2)

Learnings from a recent evaluation of four implementations of electronic referrals (eReferrals) regarding the impact of significant changes in New Zealand health sector that have been enabled by information technology (IT) implementations. Qualitative and quantitative data were collected in the evaluation, including project documentations, system transactional data, and stakeholder interviews. Each project demonstrated different approaches to innovation. The Hutt Valley solution was implemented as a standard IT project, notwithstanding the genuinely pioneering nature of the changes to clinical practice. Northland grew their project organically on a relatively low budget. Canterbury have undertaken the most comprehensive approach combining strong clinical leadership with active participation from Funding and Planning to develop clinical pathways that support the appropriateness and quality of referrals. Auckland has the opportunity of building into their programme the lessons from each of these other implementations. The eReferrals experience proves that they should not be viewed as just a ‘project’ that comes to an end at a set date; it must be an ongoing initiative, with ongoing capacity. Extending this to general innovative health IT initiatives, our conclusion is whatever specific approach is taken, the importance of iterative refinement, user engagement and feedback must be emphasised.

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Approach to Health Innovation Projects: Learnings from eReferrals

  1. 1. Approach to Health Innovation Projects:Learnings from eReferralsJim Warren, Yulong Gu, Karen Day,Malcolm Pollock, Sue White The National InstituteInformatics for Health Innovation
  2. 2. NIHI commission• Conducted from Aug 2010 to Jun 2011• Evaluate electronic referral (eReferral) implementations – Hutt Valley – Northland – Canterbury – Auckland Metro region (entering pilot operation at time of study)• Three very different projects (and one still taking shape) – What do they tell us about the best approach to IT-enabled health innovation?
  3. 3. The Hutt Valley Solution• Implemented in 2007• 30 general practices referring in electronically from Medtech32• 28 services at Hutt Hospital receiving eReferrals into Concerto – 16 service-specific forms, 12 services using a generic form• Electronic management of workflow – GP notified of receipt, triage/decline and FSA – Hospital can see list of referrals w/ triage pending – Any authorised user can see content on Concerto (e.g. from ED)
  4. 4. Hutt Valley Uptake GP referral volume by year (iSoft, Concerto) • 1000 eReferrals per month in 2008; 1200/mo in 2010 • 56% of total referrals electronic by 2010 • 71% electronic from practices that sent at least one eReferral
  5. 5. Hutt Valley Triage Latency 1 0.9 0.8 0.7 Cumulative frequency 0.6 p07 0.5 e08 p08 0.4 e09 0.3 p09 0.2 0.1 0 0 5 10 15 20 25 30 Days Time from GP letter date to date priority assigned at Hutt Hospital
  6. 6. Hutt Valley Upsides and Downsides • Upsides – Greater transparency – Faster turnaround • Downsides – IT done once and left – Some persistent usability issues • Slow attachment opening • Difficulty attaching photos – Never revisited form content
  7. 7. Northland• From 2009• Iterative development of clinically most relevant forms – Colorectal, Breast, Diabetes-retinal, Diabetes- pregnancy, Diabetes-general and, most recently, Acute referral• 36 general practices, 29 Whangarei Hospital services• From Medtech32, to the door of hospital (RMS-Lite)
  8. 8. Northland Uptake• Steady uptake – Median 26.5 eReferrals per GP user in 2010 eReferral volume per month
  9. 9. The Canterbury Initiative (CI)• HealthPathways website initiated in 2009 – Local agreed method for managing a condition (including referral criteria and fax-able templates) – Over 300 pathways by May 2011• eReferral Management System (ERMS) introduced in July 2010 – 100+ eReferral forms to support HealthPathways• GP empowerment – GP triaging for community referred radiology (CRR) – GPs trained (and paid!) to do skin excisions (GP-to-GP referral)
  10. 10. CI HealthPathway Development &Dissemination• HealthPathway definition process – five 90-minute evening meetings – GP and specialists have „robust‟ discussion – The CI facilitator: “… create an environment that enables change. Relationships provide the vehicle to progress.”• Regular „Information Evenings‟• Feedback on declined referrals – Highly developed in CRR• Quantum of funding for community based procedures
  11. 11. HealthPathways Hits• Used during the weekdays – With patient, not as a casual browse on weekend• Stakeholders indicate substantial demand reduction and more appropriate Google Analytics report for May 2011 referral HealthPathways viewed – For dermatology, US, colonscopy
  12. 12. Auckland: IT Project (entering pilot)• Largest scope• Greatest process interoperability• 3 separate phases: – primary care referrals – referral workflow (including internal and forwarded referrals) – decision support• hA plan measures a good spectrum of outcomes – Acknowledgment and feedback; better tracking; better information and decisions
  13. 13. About eReferrals per se• Provide transparency – Status info and rapid feedback – Further gains with deeper electronic workflow• Acceptable – Although not clear that forcing 100% compliance would work• Unclear – Whether to go with many or few forms – How much the quality of referral data is improved – Whether clinician effort is increased or decreased
  14. 14. What have we learned about the process• It‟s not like upgrading MS Office• Plan for feedback and iteration – Evaluation will identify opportunities for improvement – No need to do it all in one go• Take a wide view to achieve transformation – Don‟t limit horizon to business as usual – Can achieve more if you change workflow (and let funding follow activity)• Disseminate – Each project should contribute to national learning
  15. 15. Questions? Thank you! jim@cs.auckland.ac.nz (CD with full reports from NIHI stand)

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