Hutt Valley DHB eReferrals Project


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Adrian Lumsden, Applications Support Manager, Hut Valley DHB

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Hutt Valley DHB eReferrals Project

  1. 1. <ul><li>Adrian Lumsden </li></ul><ul><li>Just - Applications Support Manager, </li></ul><ul><li>and the only person left at the DHB with any vague idea about the eReferrals project. </li></ul><ul><li>NOT IT Manager! ( But my staff were impressed – for 2 seconds ) </li></ul>
  2. 2. Tom’s request: “… ..what we’d like to hear is the good, the bad and the ugly bits of the project, plus – where to from here.”
  3. 4. What’s so cool about eReferrals? What is the problem that they can fix?
  4. 5. The Referral Problem Too little <ul><li>Frustration with excessive information </li></ul><ul><li>Frustration at receiving insufficient information - legibility </li></ul><ul><li>Duplication – re-requesting & phone calls inefficient </li></ul><ul><li>Re-keying patient data is inefficient </li></ul><ul><li>Significant risk of lost paper </li></ul><ul><li>Poor security </li></ul><ul><li>Slow acknowledgements and updates (if any) </li></ul>Too much
  5. 6. How it works Senders’ sites Recipient sites Practice Mgt Sys Forms engine Submission gateway Referral mgt sys Patient Mgt Sys Forms distribution server XML HL7 Comms/ Infrastructure Message delivery Logging & integrity Referral gateway Message translation Transmission to DHB Monitor/acknowledgement
  6. 7. Key Milestones <ul><li>Design Specifications (March 2003) </li></ul><ul><li>Project begins (Aug 2005) </li></ul><ul><li>Software “delivered” (July 2006) </li></ul><ul><li>First electronic referral (Nov 2006) </li></ul><ul><li>Relaunch of pilot (April 2007) </li></ul><ul><li>Rollout begins (Aug 2007) </li></ul><ul><li>Operational stability (Dec 2007) </li></ul>
  7. 8. The Good Stuff
  8. 9. Benefits to the Patient <ul><li>Smooth transition of responsibility for their care </li></ul><ul><li>Good logistics and communication </li></ul><ul><li>Continuous medication management </li></ul><ul><li>Continuity of their clinical record – ring any bells…? </li></ul><ul><li>Good information to support the delivery of high quality care </li></ul>
  9. 10. Key features for GP’s <ul><li>Created in GP Patient Management system </li></ul><ul><li>Used Medtech forms – until Healthlink waded in! </li></ul><ul><li>HVDHB service specific templates </li></ul><ul><li>Form prepopulated with patient & GP details </li></ul><ul><li>Attachments (lab results, photos) </li></ul><ul><li>Copy in patient and referrer inbox </li></ul><ul><li>Real-time referral status messaging </li></ul>
  10. 11. GP – HVDHB – GP Automatic messages to referrer inbox <ul><li>When e-referral is: </li></ul><ul><li>Received Inbox message </li></ul><ul><li>Registered </li></ul><ul><li>Reviewed </li></ul><ul><li>Prioritised Inbox message </li></ul><ul><li>Processed Inbox message </li></ul><ul><li>Declined Inbox message </li></ul><ul><li>Updated if required </li></ul>
  11. 12. <ul><li>Referral visibility at all times in patient’s EMR </li></ul><ul><li>Referral work lists for consultants and administration staff </li></ul><ul><li>Overdue warnings – no more paper in drawers! </li></ul><ul><li>Notation ability to communicate with other staff </li></ul><ul><li>Date time stamps – complete audit trail </li></ul><ul><li>Real-time messaging from clinician to GP about current status of referral </li></ul><ul><li>Referral outcome automated to GP </li></ul>Why my hospital likes them
  12. 13. Electronic V Paper - April 2008
  13. 14. Electronic V Paper - August 2010 Note new radical 3D Pie Chart!
  14. 15. The Bad Stuff
  15. 16. <ul><li>Variability in General Practices </li></ul><ul><li>Extended period of testing......... </li></ul><ul><li>Preparation and buy-in from all staff </li></ul><ul><li>Structured information sensitive to change </li></ul><ul><li>Maintain both paper and electronic systems </li></ul><ul><li>Senior hospital clinicians need to be on-line </li></ul><ul><li>Transition from paper to electronic </li></ul><ul><li>Referrals used for other purposes! </li></ul>
  16. 17. <ul><li>More bad.... </li></ul><ul><li>‘ Parked’ forms creating problems </li></ul><ul><li>GP practice system set up varied (Broadband vital!) </li></ul><ul><li>Medtech Upgrades </li></ul><ul><li>New Healthlink Forms – where did they come from Tom? </li></ul><ul><li>IT capability of GPs and support arrangements </li></ul>
  17. 18. <ul><li>And yet more bad........ </li></ul><ul><li>( Hey Tom – you asked ) </li></ul><ul><li>Varied referrals handling process </li></ul><ul><li>2+ people can make changes at same time </li></ul><ul><li>Lack of central ownership </li></ul><ul><li>No unique identifier to track end to end </li></ul><ul><li>Inability to lock down Status buttons </li></ul><ul><li>Does not cater for all – paper and electronic </li></ul>
  18. 19. And the downright ugly…… <ul><li>Can be much slower than prioritising paper referrals </li></ul><ul><li>Four vendors working together without one contractual relationship covering all parties. </li></ul><ul><li>No write back to our Patient Management System – seriously. </li></ul><ul><li>Inflexibility of software – we can’t even sort drop-down lists in alphabetical order. </li></ul><ul><li>Prohibitive cost to add another service/form to eReferrals solution. </li></ul><ul><li>And in my (humble) opinion – we shouldn’t have copied the existing manual process – we should have looked at the whole process/flow. </li></ul>
  19. 20. Where to from here? <ul><li>For HVDHB – we’ve been in a holding pattern waiting for the Orion and ADHB eReferrals Project to kick into life. </li></ul><ul><li>Starting to look at ways that we can develop our own internal and external referrals. </li></ul><ul><li>CRISP (Central Region Information Systems Plan) vision includes implementing National standards, and sending eReferrals into the proposed Regional CDR so they will be viewable by the whole region. </li></ul>
  20. 21. Thanks for listening.