Nine sites, one EMR and one Order of Filing Standardisation of the cataloguing of forms through clinical engagement

Transcription

1 Nine sites, one EMR and one Order of Filing Standardisation of the cataloguing of forms through clinical engagement Integrated electronic Medical Record (iemr) Program HIC 2013 Digital Health Service Delivery 17 July 2013 Renea Collins, RN Clinical Lead Princess Alexandra Hospital Metro South HHS Erik Barnett, MPT, MBA Clinical Business Application Specialist Health Services Information Agency Department of Health

2 Queensland is a large and diverse state And facilities treat patients from all over Qld 7 times the size of Victoria 2

3 Each patient has a record. Or multiple records all over the state 3

4 At one major facility alone there are. 595,000 patient records on site 44,000 records in circulation + 2,100 requests for records per day sheets of A4 paper to file each day 4

5 But only one person can view the patient record at any one time I have other patients waiting... I just need a signature! I ve been waiting for hours... 5

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7 Introduction The integrated Electronic Medical Record (iemr) journey A collaboration with Cerner Corporation to implement a statewide integrated EMR in Queensland. Key Themes: Access Enable QH clinicians to securely access a SINGLE view of a patient s medical record across multiple sites. One Order of Filing (OOF) To utilise one Order of Filing for all in scope sites. 7

8 Managed Services Background Hosting R2 OERR & Initial Clinical Docs # In-Scope Sites 1 Royal Brisbane & Women s Hospital 2 Princess Alexandra Hospital 3 Royal Children s Hospital R1 Core Build & Scanning Managed Services 4 Cairns Base Hospital 5 Mackay Base Hospital 6 Gold Coast Hospital 7 Robina Hospital Application 8 Carrara Health Centre 9 The Townsville Hospital *1 st Site Scheduled to Go Live

9 Objectives Allowing patient s information to be seen across sites Making clinical information easy to find (consistent at each site) Giving users (Clinicians, HIM, Admin, etc.) the ability to work across sites with greater ease 9

10 Methodology - overview 1 Present to all inscope sites 2 Collaborate with key networks (e.g. Renal) 3 Work with Site (local) Reference Groups 4 Confirm form placement in OOF (> 5,000 forms) Site Clinical Leads 5 Creation of Guiding Principles -Repeatable -Consistent -Standard (OOF Reference Group) Leveraged Cerner and non-cerner sites in Australia and globally: The Alfred, Gold Coast Hospital, NorthBay Healthcare (USA),Children s Hospital of Los Angeles (USA) and Logan Hospital 10

11 Methodology guiding principles General Guiding Principles of the Order of Filing: The OOF follows the patient journey not disease or service specific The iemr is patient centric not facility focused. All clinicians have access to all information for Release One. 11

12 Previous paper Order of Filing (example) Paper 1 Front (Pt. Labels, End of Life) 2 Alerts & Allergies 11 Admin 3 Antenatal 12 Allied Health 4 Preadmission 13 Investigations Pathology 10 Correspondence 18 Admission Admission 5 Emergency Department 14 Investigations Medical Imaging 6 Outpatient Attendance 15 Investigations Clinical Measurements 7 Pain Management 16 Oncology 8 Respiratory & Sleep 17 Hyperbaric 9 Ophthalmology Discharge Referral Preadmission Planning Anaesthetic Procedure Record Pre & Post Operative Orders Emergency Attendance Risk Assessments Progress Notes Medications Fluid Orders Orders / Requests 12

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14 Results to date Data Point Impact 5,097 Forms Created a challenge to ensure consistency in cataloguing a significant # of forms that overlapped. 562 Standardised Names of Forms 149 Duplicate Forms 49 % increase in barcoded forms # of forms where the name of the form was modified to create a consistent use of like forms. =Increase in standardisation improve information flow. # of forms reduced through collaborating with sites. =Increases standardisation improve information flow. Decreases manual intervention workload. Decreases risk of error with less manual intervention. Decreases time for scanning and availability in the system. *Results are tied to the initial five go-live sites and Statewide Forms 14

15 The numbers Sites / # s Cairns Base Hospital Mackay Base Hospital Princess Alexandra Hospital Royal Brisbane & Women s Hospital Royal Children s Hospital Total # of Forms Total Barcoded Forms % of Barcoded Forms % of Barcoded Forms PRIOR % 6% % 0% % 0% % 43% % 50% Total % 20% *Results are tied to the initial five go-live sites and Statewide Forms 15

16 Benefit opportunities to clinical care Topic Area Improved Current Practice Standardisation Knowledge Share Errors Consistency Attention to Priority Areas Conclusion Benefit opportunities Opportunity to re-design & improve current state. Standardisation at sites and across specialties. Cross pollination of knowledge across nine hospitals. Reduction of misfiling with barcoded forms. Consistency in training materials. Adverse Reactions and Alerts consistency in use of a form and process. Clinical Engagement is key into gaining buy in and designing a system that is flexible for future releases. Leveraging Standards (e.g. AS ) and developing Guiding Principles provides direction without dictating local processes. 16

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18 Further Information and contact: Erik Barnett Clinical Business Application Specialist iemr Program Health Information Services Agency Department of Health Renea Collins Clinical Lead, iemr Clinical Informatics & Technology Services Princess Alexandra Hospital Metro South Hospital &Health Service p: e: p: (07)