Technology enabling 'whole of person' not just 'whole of system' care
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Anita Cox & Deanne Rowland, HiNZ 2015 Conference, Christchurch
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Technology enabling 'whole of person' not just 'whole of system' care
- 1. HINZ 2015 Technology enabling ‘Whole of Person’ not just ‘Whole of System’ care H I N Z 2 0 1 5 – H E A L T H O N E & L F T 1 Deanne Rowland, Clinical Lead, Laura Fergusson Trust Anita Cox, Project Manager, HealthOne
- 2. What is HealthOne? H I N Z 2 0 1 5 – H E A L T H O N E & L F T 2 Maternity Theatre Health Connect South (HCS) General Practice Community Pharmacy Care Coordination HealthOne Lab Results Radiology Primary, Community, and Private Health Care Secondary Health Care Other Health provider Other Health provider HealthOne View Oral Health PatientManagement Older Persons Health
- 3. Why HealthOne? The Canterbury Earthquakes H I N Z 2 0 1 5 – H E A L T H O N E & L F T 3
- 4. Purpose of HealthOne • Timely access to patient information across primary, community, private and secondary care • Better, safer clinical decisions • Reduced inefficiencies and duplication • Patient centric H I N Z 2 0 1 5 – H E A L T H O N E & L F T 4
- 5. Primary Care and Community Pharmacy Dispensing is under HealthOne Lab Results Discharge Summary under Discharge Documents Health Connect South H I N Z 2 0 1 5 – H E A L T H O N E & L F T 5
- 6. Primary Care Data Contribution • General Practice patient data including prescribed medications, diagnoses and allergies • Community Pharmacy dispensing • Community Care Co-ordination Canterbury, West Coast, South Canterbury (11 Nov), followed by rest of SI H I N Z 2 0 1 5 – H E A L T H O N E & L F T 6
- 7. HealthOne – Summary Screen H I N Z 2 0 1 5 – H E A L T H O N E & L F T 7 Most recent diagnoses – long term conditions Enrolled GP Alerts/ Warnings Most recent services
- 8. HealthOne Medications Screen H I N Z 2 0 1 5 – H E A L T H O N E & L F T 8
- 9. On-Boarding Partners H I N Z 2 0 1 5 – H E A L T H O N E & L F T 9
- 10. Best for Patient, Best for System • Access & Integration Questionnaire • Technical, Business, Security Requirements Checklist • Community led prioritisation • Impact on patient care, benefits for whole of system H I N Z 2 0 1 5 – H E A L T H O N E & L F T 10
- 11. Pilot – Laura Fergusson Trust • Laura Fergusson Trust Canterbury (LFT) is our pilot organisation for local On- Boarding. Its size, readiness to integrate and the value it will bring to its clients made it an ideal candidate. • Pilot went live on 23rd March 2015. H I N Z 2 0 1 5 – H E A L T H O N E & L F T 11
- 12. LFT Rehabilitation Unit • 7 bed unit providing rehabilitation to Clients who have sustained recent traumatic Brain Injury • ACC contract holder for this service • New client management system, completely cloud based H I N Z 2 0 1 5 – H E A L T H O N E & L F T 12
- 13. The Client is at the Centre DHB GP Other providers- ACC, Community Nursing Client and family/whanau H I N Z 2 0 1 5 – H E A L T H O N E & L F T 13
- 14. Rehab at LFT • Complex presentations • Patient centric care • Support from HealthOne team and LFT CEO H I N Z 2 0 1 5 – H E A L T H O N E & L F T 14
- 15. Before HealthOne Referral received Physical Preadmission assessment Collection of data (including extensive printing & photocopying) Information requested- waiting… Phone calls made…waiting Logon required- not mine (privacy issues) Collation of data Entering of data Delay in REHAB while information obtained Admitted Time taken 1-4 days actual time spent gathering data 5-6 hours H I N Z 2 0 1 5 – H E A L T H O N E & L F T 15
- 16. Issues Collecting Information • Episode based information • Focus on the “problem of the day” • No helicopter view H I N Z 2 0 1 5 – H E A L T H O N E & L F T 16
- 17. Good Rehabilitation Outcomes • Body and Mind • Baseline • Medical/clinical issues • Social issues H I N Z 2 0 1 5 – H E A L T H O N E & L F T 17
- 18. Case Study • “Sam” is a 23 year old man who suffered a TBI as well as extensive facial fractures and orthopaedic injuries in April this year • Admitted to ICU,7 surgeries,27 Radiological procedures, input from 6 teams, 320 Lab results • Teams involved, Neurosurgery, orthopaedics, maxillo- facial, opthalmology, ENT, Infectious Diseases • Referred to RALF on 10 May- assessed 11 May admitted 12 May to RALF with ongoing follow up from the secondary sector H I N Z 2 0 1 5 – H E A L T H O N E & L F T 18
- 19. Summary of Injuries • Diffuse axonal Injury ( Severe Traumatic Brain Injury) Neurological storming Diabetes Insipidus • Removal of frontal skull to allow for swelling • Le Forte III fractures • Extensive eye surgeries involving muscles and nerves • Fractured pelvis • Fractured spine • Prolonged stay in ICU due to neurological deficit • Vocal cord injuries secondary to breathing tube H I N Z 2 0 1 5 – H E A L T H O N E & L F T 19
- 20. Issues for this Admission Client Complex presentation Multiple teams involved Notes held in different systems Access to information can be limited by system knowledge Non coordinated follow up Don’t know what you don’t know Relying on someone else’s knowledge /opinion Know what someone else knows but is it enough H I N Z 2 0 1 5 – H E A L T H O N E & L F T 20
- 21. Admission with HealthOne Referral received Pre admission assessment via HealthOne Data entered onto client file at RALF Information extensive: copied and pasted directly Physical visit Further written information obtained Time spent with family and staff obtaining extensive history rather than paperwork Admitted sooner Rehab begins immediately as staff are fully informed H I N Z 2 0 1 5 H I N Z 2 0 1 5 – H E A L T H O N E & L F T 21 Down to 24 hours or less. Actual time spent gathering physical data 2 hours
- 22. Accessing Information HealthOne Freedom of access to information that is objective, current Freedom to choose what information I want to look at Freedom to review and act in a timely manner e.g. on results and appointments Freedom to access information 24/7 Able to copy and paste Customisable to me Ability to review trends H I N Z 2 0 1 5 – H E A L T H O N E & L F T 22
- 23. Sam’s Outcomes Sam Never missed an appointment Had medications changed as a response to bloods on the day Robust relationship with Secondary care Seamless transition from hospital to rehab to community All Staff were fully informed Family was fully informed Attended appointments when it was suitable for him Information was current, didn’t need to be repeated Big impact on Sam’s ongoing care H I N Z 2 0 1 5 – H E A L T H O N E & L F T 23
- 24. HealthOne.... • ... improves communication • ... facilitates rapid transfer of information • ... makes time for care • ... puts health providers on a level playing field • ... has improved the security of our client information H I N Z 2 0 1 5 – H E A L T H O N E & L F T 24
- 25. Moving Forward • Better understanding of the context of long term effects • Presenting the whole of person H I N Z 2 0 1 5 – H E A L T H O N E & L F T 25
Editor's Notes
- HealthOne acts a gateway through which primary and community care can access secondary care patient information. At the same time, HealthOne pulls through data from community and primary care to make it available to authorised secondary care users.
- Although discussed conceptually prior to the Canterbury Earthquakes, HealthOne, or eSCRV as it was initially called, came into being in direct response to the disruption the quakes caused to providing patient care in Canterbury. – Many General Practices were forced to close as a result of damage. Patients were forced to see other GPs at other practices. With no medical record available, GPs were left in the dark as were hospital when requesting GP information. HealthOne was built so this scenario could never happen again but it went one step further because HealthOne has facilitated the electronic sharing of patient information between secondary and primary care; eliminating the wait times and the process involved in requesting results, assessments, discharge summaries etc and providing authorised users with vital information about the patient helping to inform betterr, safe clinical decisions.
- A patient’s hospital record on HCS Role appropriate access Primary care get access to.... Clinical documents Discharge summaries Lab results Role appropriate access
- Making HealthOne available to the wider health care community led to a lot of interest from a variety of healthcare providers e.g. private hospitals in Canterbury and St John that you can see there on the screen but also dentists, physios, podiatrists. It quickly became clear that we needed a really robust way of being able to assess the value of onboarding each organisation both in terms of access and also the patient data they could potentilaly contribute, how that might impact on patient care and on improving services across the whole of system
- In addition to the standardised assessment of the various technical, business and security requirements to on-board, a key part of the process to prioritise the order in which organisations should go first was a community led prioritisation session. All of the organisations you saw on the previous slide and more were asked to present at this group session about the value that access to HealthOne would bring to their organisations and the patients or clients they work with. They were also asked to demonstrate how contributing their data with the wider health community might impact on both those patients and the system as a whole. The organisations were scored according to the those criteria by those present and then these scores were added into a comprehensive evaluation of technical, clinical and business readiness.
- As part of that prioritisation exercise we identified LFT as our pilot organisation for local on-boarding. Its small size and flexibility to meet the technical and security requirements made it the ideal candidate to test out the local on-boarding implementation process. However, it was also the impact that access to HealthOne was going to have for the service and its clients which played a major factor in selecting them for the pilot. LFT is an acute brain injury rehabilitation unit that works with clients that present with multiple and complex needs. So without any further ado, let me hand over to Deanne who will introduce you to the work of the Laura Fergusson Trust and the impact on patient care that access to HealthOne has enabled.
- Clients present with a plethora of complex medical conditions coupled with the impact of a Traumatic brain injury As a provider we are committed to utilising systems that facilitate and enable patient centric care especially in relation to information As an NGO this was a challenge, but was overcome by the whole of system approach of the HealthOne team and the support of the CEO at LFT
- Information in file is episode based- only deals with the current issue when it’s a complex admission. Focus on the “problem of the day” rather than the impact of the problem on the whole person. No helicopter view of the client- no single point of truth
- Rehab is dependent on understanding the impact of the injuries both on the body and the mind, the persons baseline ( pre injury), their other medical/clinical issues, social issues and the clients prognosis ie: the whole of person
- Access to HO meant Sams appointments could be planned for and coordinated if possible eg: appt with Orthopaedics, needed other Xrays- done at the same time as Ortho xrays Blood results were received on the day and changes made to medication to reduce the impact of disease on Sam Sam went from hospital to rehab to community- all providers fully informed and coordinated- seamless transition Sams family were able to see what had been said, results etc Information was availabel and not needing to be repeated constantly
- has been instrumental in improving our clients outcomes by allowing us to communicate with other providers utilising information that we each have access to that is in an objective format. It has allowed us to refer clients quickly and to gain information on the result of the referral in a much reduced timeframe It has also made time for care as staff are not so caught up on the phone waiting for information By allowing NGO’s and Community providers access this improves the credibility of organisations with larger organisations and enhances the whole system
- The contribution of the data from RALF to HealthOne will mean that clients who have been through our service will be better understood in the context of the long term effects of their brain injury when exposed to other providers in the health system- presenting the whole of person.