How to really get what you want, not necessarily what you asked for

How to really get what you want, not necessarily what you asked for Cheryl McCullagh, Director of Clinical Integration The Sydney Children s Hospitals Network Cheryl.mccullagh@health.nsw.gov.au

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SCHN Information Management and Technology Strategy (IMTS)

IMTS Strategy 2012 The IMTS aims Single patient view Sustainability and accuracy Access to information Innovation Principles Solving network gaps Automating and integrating processes Clinician driven

EMR Strategic Roadmap 5 years Voice Rec in ED NAP forms END PAS feed To CHW EIR SCH scanning Healthenet NEHR Mental Health CHOC FirstNet VR Lanier Clin-docs EMR2 POW EMM CCIS TBA Move off ipm to SCHN stack EMR SCHN Randwick Westmead Reports Lync MRD Scanning Coding Email wifi IT support PCs Printing BYOD 2013 2014 2015 2016 2017 Backscanning Lanier PathNet c/compass NAP forms CCIS Endoscopy Mental EMR SCHN Health FirstNet CHOC VR Lanier Voice Rec. Doc. Referrals EMM EMRP SurgiNet Rehab Clin-docs Oncology EMR2 Billing App. PAS: add Facility ID 16

Branding The shared memory of our patients health history.

Good Brands Identify the message Contain the essence of the message Simplicity, but with a back story Flexibility to tell a short and long story Longevity Currency Memorable Personal Credible Honest

A fully integrated health record for all children: safer care better access current complete records reduced risk reduced errors accessible education improved reporting

Incentive to change

Clinicians 21

Researchers 22

Coding/counting 23

Efficiency

Space 25

Vendor relationships Long term Takes work Get as close to the business as you can Manage the polygamy or the affairs Good vendors Clear ROI Maximise the workforce Make things easier Honest Share the blame Get dirty Play well with others Knowledge of the landscape

Vision Current road map leads to HIMSS 6 Still disconnected pieces of the EMR with little automation Roadmap 2 takes us all the way to an integrated care digitally enabled health service in the same timeline

Problem? SCHN has about half the technical infrastructure and functional software to create a digital health environment. We want to maximise the current momentum to go all the way Pieces approach is not reaping efficiencies SCHN wants to create a true digital hospital A proactive strategy, can unify Prefer to do it once and do it right

MEMORY 2 Strategic Roadmap- 3 years Backscanning NAP forms VR Lanier c/compass E-training Clin-docs EMR2 Referrals EMM Cardiology documentation EMRP Patient Portal Self check in Security and tracking Patient and family apps Randwick Infrastructure, register at birth, Tap on log on, Mobile capability, Full redundancy, BYOD, monitor and device connection 2015 2016 2017 SINGLE EMR Westmead E-billing Cardiology documentation E-Education VR Dragon EMR apps Outpatient documentation FirstNet SurgiNet Spot registration Patient and family Self apps check in Patient Portal Automated coding Smart pumps Pharmacy Bar coding and e-imprest. Security and tracking 29

Complete emr function and redesign User experience improvements Integration the smart theatres Improved patient identification Electronic consents process Virtual clinics Pharmacy automation and integration Single dose medication dispensing Redesign the workforce for the future Review And Update Checkout Document

Patients and Families Needs Communication and safety real time understanding of waiting times Way finding Possibilities Family portal My problem list On line education Self check in Self assessment Referral and appointment tracking E-clinic Results Q and A on line Contribution to the record patient and family apps transition

Lync/skype for families and staff In hospital Phone services Nurse call Peer group meetings Parent groups Out in the world Clinical consultation Patient to clinic lync Education across sites Home care Lync OPD

Quality, safety, audit and reporting Requirements should be a bi-product of workflow Automate audit and evidence Clinical outcome reporting Predictive care Survey and audit Patient and procedure matching Improved supervision of high risk patients Real time coding, counting Real time research

Patient Centred Reporting

Change Management Training and Support model

37

38 Shared Clinical Documents created by NSW hospitals across the State (HealtheNet sites only) Linked to NSW Electronic Blue Book Child Record Linked to Enterprise Patient Registry to collate NSW identifiers across LHDs including the IHIs Linked Enterprise Medical Imaging Repository to ALL NSW Medical Images and Reports Cross-LHD Alerts, Allergies, Encounters Shared Patient Information from the National ehealth Record (PCEHR) Cross-LHD Visit History

39 Chandler Lou Linked Enterprise Medical Imaging Repository to ALL NSW Medical Images and Reports

Docum. Billing Private Patients parents Admin. Corporate Building Education Security

Implementation Conflicts Process CHW Go Live Aug 2015 Client Executive Session Project Kick-off System Review Design Review System Validation Sessions Trainer & Conversion Prep Maintenanc e Training Integration Testing 1 Integration Testing 2 Post Conversion Assessment 10/3/14 10/03/14 12/03/14 14/7/14 29/09/14 8/12/14 16/02/15 6/04/15 18/05/15 29/06/15 16/11/15 ICCIS EMM/EMR Oncology Project Milestones EMR2 End-User Training EIR/PCEHR/CHOC/Lync/.

For Staff, Patients and Families and Health E ref Self check in kiosk Specialty clinic face to face Self check in Pt portal update for DC/ meals Registered with pt portal E-clinic with GP billing admit IP notes My team Allied/nursing check in Specialty care billing IP education Triage/Pre assessment Sms reminders Team update education DC communication Education commences referrer informed of plan and dates erfa Pre planning Follow up

ROI Drivers Family led access, input and sharing Diagnosis-specific education -better informed patients Enhanced call work-flow to utilise appropriate resources Real-time messaging between patient and clinician Meal ordering/ housekeeping efficiencies at the point of care Able to administer drugs, collect assessment at the point of care eliminates the need for expensive COWS Readiness for discharge surveys Interactive donor opportunities Enhanced Patient Satisfaction Improved Staff Satisfaction Better workflow Better Communication Better Clinical Outcomes Lower Readmissions Better revenue 43

Should we go forward HIMSS 5.2 Low risk option to create a demonstrator Others can adopt based on evidence from the implementations. Integrate all state systems and more linking pieces Overcomes the slow pace of central programs at an affordable but accelerated pace Strategy of build once and replicate with improvements has been shown to work well overseas.

What is everyone else doing? Workforce efficiencies are required Staff and families expect modernisation UK model expects 1:2.4 ROI, USA 1:3 NSW and SCHN have been leaders in clinical systems development and deployment, but now are being bypassed in some areas QLD; Hervey Bay opened, DOH to fund two HIMSS Level 6 sites VIC; Austin and Peninsula well ahead of NSW in EMM, Epworth hospital going live in Nov with oneview, RCH in Melbourne $48m EPIC solution including mychart have kiosks and wayfinding WA; PMH $200 mill + tender closed to accommodate all NSW; SVH is reviewing options, Chris O Brien- EMR+ Pt education and check-in ACT; Canberra hospital deployed pt portal SA; state model, epas deployed in 4 facilities, simple function

Contract vs outcome 1. See it live/ref check 2. Project management office 3. Change management, adoption, and clinical leads. 4. Workforce redesign 5. Work in development locally to further integrate existing functions 6. Upgrade infrastructure regularly 7. Local workforce development

Careful what you wish for

University California Medical Centre UCSF Benioff Children s Hospital

How do you know you got what you wanted Is it better than you had before Does it meet user expectations Was it on time and on budget Does it integrate and automate or duplicate Does it bring new risks or costs Does it standardise care New knowledge needs to be shared

Research Either you prove (through a RCT) that the new way is better or I am free to do whatever I please (even though there is no scientific reason for my own practice) Can 1 Quantify we validate the safety that what and effectiveness we implement of has an emms value. to reduce medication errors (including adverse drug events), and average length of stay among paediatric patients using a stepped-wedge cluster randomised controlled trial 2 Assess the extent to which feedback (from Aim 1) and subsequent modifications of emms design can improve emms effectiveness in reducing medication errors 3 Assess the effects of an emr in paediatric oncology on workflow, efficiency and patient outcomes 4 Conduct a cost-effectiveness study of emms use in two paediatric hospitals

Future Automation Billing Counting Coding Benchmarking Predictive alerts Remote care Standardise Measuring variation Decrease variation Improving safety and quality Managing risk Reducing waste, duplication, waiting, error Planning services Managing costs

Strength in Numbers

CERS Rapid Response 1) Clinical Review ad hoc form records the response to a call for a clinical review. A hard copy also prints to the patient ward

CERS Rapid Response

Successful implementation for patient outcomes Make the preferred path the standard code variance -why did you chose not to follow the pathway? Imbed in EMR, with soft and hard stops Monitor and measure variation and outcomes, regularly Demonstrate value added in patient and other outcomes Make it easy to do the right thing

Virginia Mason 336 beds HIMSS 6 Cerner since 2001

Virginia Mason Contacts Todd Inslee, P: 206.223.6600 Todd.Inslee@virginiamason.org Ellen Dowling, Administrative Director, Information Systems, P: 206-583-6510 Ellen.Dowling@virginiamason.org TPS TQI Lean Since 2000 VMPS VMI 2009

Can health be more efficient 1. Minimise diagnosis errors 2. Discontinue low value interventions 3. Defer unproven intervention 4. Select care options in terms of cost effectiveness 5. Target clinical intervention to those with greatest benefit 6. Conservative approach to end of life 7. Actively involve patients in decisions and self management 8. Minimise day to day operational waste 9. Rapidly learn and evolve 10. Integrated systems of care that maximise value Scott, 2014,38 Australian Health Review

EMR -necessary and essential Have a clear visions with manageable steps 50% loss of productivity for two weeks Faster is better Plan for the BAU model Dragon and Chart search is life changing Training models have to be faster/better Start simple particularly with decision support signal to noise ratio Add function not complexity Future -patient managed records Get to the front line