The Kids Rehab emr project Improving non-clinical support systems for clinicians working in an ambulatory setting

Transcription

1 The Kids Rehab emr project Improving non-clinical support systems for clinicians working in an ambulatory setting Lynn McCartney, Clinical Nurse Consultant Cerebral Palsy & Movement Disorder Service, Kids Rehab, The Children s Hospital at Westmead Change Champions Conference, Brisbane

2 ehealth background The Children s Hospital Westmead (CHW) campus + Sydney Children s Hospital Randwick (SCH) campus = Sydney Children s Hospital Network (SCHN) Oct 2013 access to NSW Health HealtheNet Programme Statewide Clinical Portal provides NSW Health clinicians access to patient information from the patient s National ehealth Record (NeHR) Reliant on patient consent, accessed via a link in Cerner PowerChart

3

4 SCHN MEMORY strategy GP visits Medications Specialist reviews Home health emr Treatment plans The medical record is the memory of our patients care and clinical events, it is the storage, encoding and retrieval model for health information, lasting the life of our patients, and beyond Screening / immunisations Diagnostics Hospital admissions

5 patients on database 50 staff

6 Project aims 1. Paper records Reduce duplication of documentation Reduce costs & storage of paper files Improved accuracy, legibility, and consistency 2. Patient clinical data Timely access to information through real time data entry Centralised data repository 3. Data reporting Consistent reporting of adverse events Ministry of Health data requirements (BIS Directorate & ABF) 4. Operational processes Centralised and streamlined intake process Billing process for compensable patient

7 Timeline Initial brief and project scope Project team convened Workflow & design development Training, SuperUsers & trial in mock environment 1 st July go-live 2015 Review & report development

8 Project team Kids Rehab Department (50) Multidiscplinary Project team (6) Physio OT N/Psych Admin Clinical Lead (CNC) & emr Application Manager (2) Case Manager Service Coordinator Sponsors (Medical Head Kids Rehab & Manager emr Unit) (2)

9 Workflow Registration Clinical Intake Triage Referrals & Actions Statistics Forms (clinical documentation) Referrals & Actions Statistics Billing

10 Build & design specs Template forms Automated letters Patient data Activity collection Billing data

11

12

13

14

15

16

17

18 Documentation Clinical discipline Number of notes in emr Physiotherapy Notes 557 Occupational Therapy Notes 379 Speech Pathology Notes 210 Neuropsychology Notes 276 Clinical Psychology Notes 133 Social Work Notes 656 Case Management Notes 868 Nursing Notes 273 Medical Notes 171 Total 3523 (70 % increase in the 6 months post go-live)

19 Prior clinical activity July August Sept Oct Nov Dec

20 12 month clinical activity

21 Achievements Quality Availability of patient clinical plans to all staff Real time clinical assessment data Safety Standardise adverse event documentation (casting & Botox clinics) Audit Clinical hours & intervention types (inform Models of Care) Reporting Mandatory reports for Clinical Data Set & ABF Improvement Reducing time taken to access key clinical information Centralised Intake Reduction in paper records

22 Staff survey Most positive aspects Areas for continued improvement 1. Support provided by the emr Unit at 1. More opportunity to contribute to the go-live form designs 2. Communication about aims and 2. Review of Intake/Triage process objectives of the project 3. Training given by the Kids Rehab staff 3. Design review of the Referrals and Action form to assist team communication

23 Sustaining change Paper records Discipline specific data reports Sub-acute care / inpatient workflow Ongoing training Research

24 Lessons learned Communication Collaboration - Clinicians & IT staff - Cross services - what worked & what didn t - training Common goal - Learning Patient Care

25 Acknowledgments Dr Mary-Clare Waugh Jodie Schuster Tony Fitzsimons Karen Bau Kirsty Stewart Helene Chew Tracey Ferguson Sara Coombes Kanchan Le Bon