I though perhaps a opening just giving some background on the strength of webPAS and the history in the market.Explain the problem with Clinical Systems without access at the bedside.The fact is now that consumer based tablet devices such as the iPad solve the issues of access. Doctors are even willing to purchase their own device to use for entertainment and for accessing clinical information.
In the past 2 years we have seen the beginning of a new trend in computing devices. The iPhone and now the iPad are the start of a new breed of consumer entertainment. Thee devices are not seen as computers but as entertainment and communication devices. Books, Magazines, Social Media, Music, Video, Photos, Internet access where ever, when ever. This trend will no doubt continue and competition will keep prices down while performance features and functionality increase.
Fixed mounts for iPad are available and being used at various conferences around the world. The ones shown here are designed by a company in Melbourne who we have had discussions with about full sealed unit with RFID capabilities. The RFID capabilities would allow us to have a simple 2 factor authentication of a user, present a security token and enter a PIN, banking type security. Because the device is in a fixed location it can be aware of the patient that is at the location and immediately show the patients clinical record. This make access quick and easy to use. When the device is not being used it can display the Eletronic Bed Card and track diet, diagnostic result availability, medication alerts, attending specialist, house keeping notifications etc
Clinician’s Challenge 2011
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)
17,000 Patients Referred to a Medical Officer of Health Each Year12 public health units provide services to these patients, their families and communities:1. prevent patients from spreading infections to others2. identify causes of infection such as contaminated water or food3. prevent (or detect early) illness among people already exposed to infection or environmental hazards
Risk Assessment & Prioritisation of Public Health Services1. Risk of infection is high2. Seriousness of disease3. Good chance of preventing illness among contacts4. Others likely to be infected from a common source5. Good chance of identifying a common source
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 worksCan eReferral provide workplace and school data?
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 reportedCan eReferral provide occupation and place of work at the time of referral?
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 HealthCan eReferral be quickly adapted to include travel history and symptom data?
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?
Bringing Public Health into the 21st Century? •1900 •1930 •1980 •1990 •2000Send a notice Call the MOH Fax a notification form/lab report Labs National collation Paradox web based cards to Wellington database & national diskettes system
Can Public Health Services Use NHIT plan Infrastructure? Care plansPhase 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
Vendor Initiatives eNotificationeReferral Challenge Solution Presentation to Judges Thursday 24th November 2011
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
Use of Resources• Existing infrastructure• Build on existing eReferral work• Streamline data collection to enable triaging
Infrastructure Notifiable Disease Process Overview GPs Medical Officers Labserv EPISERVPathology Labs HLK messaging system Patients Guardians Hospitals Schools Key Internet connections Health messages HealthLink eForms AMS users
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
Cardiac Arrest teams are theambulance at the bottom of the cliff.Early Warning Scores are the fence at the top.
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
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
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 CSC Proprietary and Confidential 11/25/2011 6:45 PM People_FMT 32
iSOFT Mobility Suite CSC Proprietary and Confidential 11/25/2011 6:45 PM People_FMT 33
Demonstration• Entering Patient Observations• Calculation of Score• Alerts Triggered• Switch to iPad Projection of Screen CSC Proprietary and Confidential 11/25/2011 6:45 PM People_FMT 34
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 CSC Proprietary and Confidential 11/25/2011 6:45 PM People_FMT 35
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 CSC Proprietary and Confidential 11/25/2011 6:45 PM People_FMT 36
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, USCSC Proprietary and Confidential 11/25/2011 6:45 PM People_FMT 37
CSC Proprietary and Confidential 11/25/2011 6:45 PM People_FMT 39
HINZ Clinicians Challenge2011 proposal:A clinical translation system
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”…
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 ?”
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
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)
What I was thinking of- screens Entry screen User screen Patient positionPlease 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 >
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
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 dont know now wheezy ? Next page > < Last page Next page >