View
524
Download
0
Embed Size (px)
DESCRIPTION
A presentation given by Cheryl McCullough at The Journey, CHA conference for 2012, in the 'Enhancing Outcomes Through Innovations in Technologies' stream.
Citation preview
Paperless Possibilities
October 2012Cheryl McCullagh
Director of Clinical Integration
SCHN-Children First and foremost
current state
• Current frustrations can be overcome when technology makes things easier and repetitious data entry is eliminated.
Is ‘paperless’ a realistic goal?
20
00
-01
20
00
-04
20
00
-07
20
00
-10
20
01
-02
20
01
-05
20
01
-08
20
01
-12
20
02
-03
20
02
-06
20
02
-09
20
03
-01
20
03
-04
20
03
-07
20
03
-11
20
04
-02
20
04
-05
20
04
-08
20
04
-12
20
05
-03
20
05
-06
20
05
-10
20
06
-01
20
06
-04
20
06
-07
20
06
-11
20
07
-02
20
07
-05
20
07
-09
20
07
-12
20
08
-03
20
08
-06
20
08
-10
20
09
-01
20
09
-04
20
09
-08
20
09
-11
20
10
-02
20
10
-05
20
10
-09
20
10
-12
20
11
-03
20
11
-07
20
11
-10
20
12
-01
20
12
-04
-20
Evolving Documentation Strategies
Between the Flags• eform for clinical and rapid
response• Increased vigilance for
complications by coders• Increased coding of arrests and
resuscitation events• Form and call triggered by patient
events
Order Sets (Care Sets)
Medication Reconciliation – Home Meds
Antibiotic Stewardship 4 Kids (ABS 4 Kids)
Search
Phones & Pagers
6 for [ ]
You are not currently logged
in Click here to login
What is ABS 4 kids?
Drug Dose Guidelines Antibiotic Guidelines Contact Us Antibiotic Approval
View Approval RequestsWhat is ABS 4 Kids? ABS 4 Kids stands for "antibiotic stewardship" or otherwise known as "antimicrobial stewardship" for Kids at CHW. Antimicrobial stewardship is defined as processes to assist and support clinicians with decisions regarding the optimal selection, dose and duration of antimicrobial agents. The objectives of ABS 4 Kids are: To optimise antibiotic use to improve patient care To minimise antibiotic toxicity to the patient To reduce the selection pressure for the emergence and transmission of multi-drug resistant bacteria One of the core strategies of ABS 4 Kids consists of online pre-approval of restricted antibiotics (see below). A hierarchical "traffic light" system has been developed based on the resistance potential, complexity of use and cost of each antibiotic. The restricted agent groups, and mechanisms for obtaining approval are specified below: "Red Agents" are antimicrobials of very high resistance potential and/or cost. When commenced during office hours, approval in advance must be obtained from the Stewardship Consultant on page 7092. The approval number must be written on the medication chart. When commenced after hours, approval must be sought on the morning of the next working day. "Orange Agents" are antimicrobials of intermediate resistance potential, cost and/or complexity of use. Initial empiric use of agents in this group is allowed and their use must be registered on the request form below by the clinical team at time of prescribing. The request will be reviewed by the Stewardship Consultant, on the basis of the clinical information provided, on the same or the next working day. If approved, an approval number will be supplied for annotation on the patient's medication chart. "Green agents" are those where there are no restrictions on use. If required, antibiotic advice is always available by paging the Infectious Diseases registrar (during working hours) or the Infectious Diseases Physician or Clinical Microbiologist on call. Other useful resources include the Australian Therapeutic Guidelines - Antibiotic (available via CIAP) and the Drug Dose Guidelines. CHW "Traffic Light" Restricted Antibiotic Formulary
Historical Challenges• ‘pockets’ of information• No consistent model of analysis / reporting • Consistency and completion of tasks
• Different source systems
• Access
• Timing
• Quality
• Duplication
Risks• Limited $• ABF • Private Patient Revenue• Costing• Site systems differences• Infrastructure• Sustainability
• Patient Safety
Service Needs
• Integrated approach to multiple needs– Strategy – Planning – Costing – Reporting – Performance management– Service delivery– ‘real-time’ information
Strategic Directions AlignmentNational Health Direction
Creation of Local Health Districts and Specialty Networks Implementation of Activity Based Funding (ABF)State Health Strategy
Patients at the centre of everything we do
access to timely, quality health care
keeping people healthy to avoid unnecessary hospitalisation
The Creation of NSW Kids and Families
State ICT strategy
Clinical Systems integration- EMR and unified patient record
Corporate systems integration
Information for performance and ABF
Sustainable Infrastructure
SCHN strategy
Strategictechnologyinvestment
Development &implementation
of responsive IT systems
Meeting the needs for the performance
framework
Delivering seamless
clinical care
Providing infrastructure for research and
educationSCHN IMTS
Sustainability and accuracy Single patient view Access to information Innovation
Aim- connecting information for outcomes
Single patient view
Sustainability and accuracy
InnovationStandardised information
PatientService
Staff• Work with MOH/ e-health and
tele-health international leaders• Equipment universally interfaces
with the eMR• User satisfaction• Up to date technology• Smart theatres 2012/13• Lanier voice recognition
• eMR basis for clinical information• Full redundancy of critical systems,
regular scheduled downtime• Reliable interfaces - no duplication
of systems or data entry• Minimal unplanned downtime due
to preventable internal mechanisms
• Seamless integration of automated information
• Combined local HIE by Dec 2013• Unified and accessible eMR by
2015 (including remote access)• Enterprise Imaging Repository• Unified Implementation of eMR for
inpatient/outpatient notes• Implementation of eMM
• CHIMP/ CHARLI/ e-policy/ Pathlore/ e-quality
• Single data input• Implementation of eMM• Use of innovative data collection
Strategy eMR Orders/Results Growth Charts PAS/Scheduling Allergies/Alerts Outpatient Billing Between the Flags Allied Health Mental Health EDW Client & WL
2000-2011
Dept Databases
Paper
Medical Records
Department Records
Document Imaging
eMR + HPUX Migrations Patient Registry for IHI Enterprise Image Repository Scheduling Correspondence PathNet Millennium Outpatient Reporting PowerNote & MPages Review SCH eMR Workflows eMR Phase 2
Now
Document Imaging
PCEHR
Dept Databases
Paper
Medical Records
Department Records
eMR +
Transition to aSCHN eMR
eMR Phase 2 ICU Medication Management Discharge Referral FirstNet/SurgiNet Immunisations Problems/Diagnosis Inpatient Consult Clinical Reporting XR Reporting (MRP) Other
2013 - 2015
Document Imaging
PCEHR
Dept Databases
Paper
Department Records
eMR +· all Documentation· Safety interfaces
2016
Document Imaging
Paper
PCEHR
Dept Databases
Clinical Information Strategy to 2016
Inte
gra
tio
n
The connected record
Internet based health Conferencing
Management Information
• Delivery across the network• Departmental performance against target• CMI NWAU targets over time• LOS benchmarks• Revenue per pt load• Performance against strategic goals• Aspirational-clinical outcomes
NURSE PRACTITIONER
NURSE MANAGER
NURSING UNIT MANAGER
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
REGISTERED NURSE
ENROLLED NURSE
ASSISTANT IN NURRSING
CLINICAL NURSE CONSULTANT
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
VMO
CMO
STAFF SPECIALIST
FELLOW
JMO
DIETICIAN
ADMINISTRATIVE ASSISTANT
SECRETARY
WARD CLERK
CLINICAL SUPPORT OFFICER
BOOKING CLERK
FINANCE STAFF
BUSINESS MANAGER
BOOKING CLERK
IT STAFF
DOMESTIC SERVICES/FOOD SERVICES
FT
E R
EV
IEW
MA
ST
ER
PLA
NN
ING
WO
RK
FF
OR
CE
PL
AN
NIN
G
CLI
NIC
AL
SE
RV
ICE
PLA
NN
ING
NURSING
CORPORATE/IT SERVICES
MEDICAL
ALLIED HEALTH
ADMINISTRATIVE REVIEW
NIC
U
PIC
U
ES
W
SU
RG
ICA
L U
NIT
CLU
BB
E
HU
NT
ER
BA
ILLI
E
CLA
NC
Y
VA
RIE
TY
CA
MP
ER
DD
OW
N
OT
C
OP
D
CA
PA
C
TU
RN
ER
HA
LL
WA
DE
ED
MID
DLE
TO
N
OP
ER
AT
ING
T
HE
AT
RE
S
ANNUAL BED ALLOCATION REVIEWC
AR
DIO
LOG
Y/C
AR
DIA
C S
UR
GE
RY
ON
CO
LOG
Y
PS
YC
HO
LOG
ICA
L M
ED
ICIN
E
EM
ER
GE
NC
Y S
ER
VV
ICE
S
NURSE PRACTITIONER
NURSE MANAGER
NURSING UNIT MANAGER
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
REGISTERED NURSE
ENROLLED NURSE
ASSISTANT IN NURRSING
CLINICAL NURSE CONSULTANT
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
VMO
CMO
STAFF SPECIALIST
FELLOW
JMO
DIETICIAN
ADMINISTRATIVE ASSISTANT
SECRETARY
WARD CLERK
CLINICAL SUPPORT OFFICER
BOOKING CLERK
FINANCE STAFF
BUSINESS MANAGER
BOOKING CLERK
IT STAFF
DOMESTIC SERVICES/FOOD SERVICES
FT
E R
EV
IEW
MA
ST
ER
PLA
NN
ING
WO
RK
FF
OR
CE
PL
AN
NIN
G
CLI
NIC
AL
SE
RV
ICE
PLA
NN
ING
NURSING
CORPORATE/IT SERVICES
MEDICAL
ALLIED HEALTH
ADMINISTRATIVE REVIEW
NIC
U
PIC
U
ES
W
SU
RG
ICA
L U
NIT
CLU
BB
E
HU
NT
ER
BA
ILLI
E
CLA
NC
Y
VA
RIE
TY
CA
MP
ER
DD
OW
N
OT
C
OP
D
CA
PA
C
TU
RN
ER
HA
LL
WA
DE
ED
MID
DLE
TO
N
OP
ER
AT
ING
T
HE
AT
RE
S
ANNUAL BED ALLOCATION REVIEW
SU
RG
ER
Y
INT
EN
SIV
E
CC
AR
E
BU
RN
S
CA
RD
IOLO
GY
/CA
RD
IAC
SU
RG
ER
Y
GE
NE
RA
L M
ED
ICIN
E
ON
CO
LOG
Y
OU
TP
AT
IEN
T/D
AY
T
RE
AT
ME
NT
PS
YC
HO
LOG
ICA
L M
ED
ICIN
E
EM
ER
GE
NC
Y S
ER
VV
ICE
S
GE
NE
TIC
S
EN
DD
OC
RIN
E
NURSE PRACTITIONER
NURSE MANAGER
NURSING UNIT MANAGER
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
REGISTERED NURSE
ENROLLED NURSE
ASSISTANT IN NURRSING
CLINICAL NURSE CONSULTANT
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
VMO
CMO
STAFF SPECIALIST
FELLOW
JMO
DIETICIAN
ADMINISTRATIVE ASSISTANT
SECRETARY
WARD CLERK
CLINICAL SUPPORT OFFICER
BOOKING CLERK
FINANCE STAFF
BUSINESS MANAGER
BOOKING CLERK
IT STAFF
DOMESTIC SERVICES/FOOD SERVICES
FT
E R
EV
IEW
MA
ST
ER
PLA
NN
ING
WO
RK
FF
OR
CE
PL
AN
NIN
G
CLI
NIC
AL
SE
RV
ICE
PLA
NN
ING
NURSING
CORPORATE/IT SERVICES
MEDICAL
ALLIED HEALTH
ADMINISTRATIVE REVIEW
NIC
U
PIC
U
ES
W
SU
RG
ICA
L U
NIT
CLU
BB
E
HU
NT
ER
BA
ILLI
E
CLA
NC
Y
VA
RIE
TY
CA
MP
ER
DD
OW
N
OT
C
OP
D
CA
PA
C
TU
RN
ER
HA
LL
WA
DE
ED
MID
DLE
TO
N
OP
ER
AT
ING
T
HE
AT
RE
S
ANNUAL BED ALLOCATION REVIEW
SU
RG
ER
Y
INT
EN
SIV
E
CC
AR
E
BU
RN
S
CA
RD
IOLO
GY
/CA
RD
IAC
SU
RG
ER
Y
GE
NE
RA
L M
ED
ICIN
E
ON
CO
LOG
Y
OU
TP
AT
IEN
T/D
AY
T
RE
AT
ME
NT
PS
YC
HO
LOG
ICA
L M
ED
ICIN
E
EM
ER
GE
NC
Y S
ER
VV
ICE
S
PE
RI-
OP
ER
AT
IVE
A
ND
CR
ITIC
AL
CA
RE
ME
DIC
AL
PR
OG
RA
M
AM
BU
LAA
TO
RY
AN
D
EM
ER
GE
NC
Y
ALLIED HEALTH PROGRAM
DIAGNOSTIC PROGRAM
NURSE PRACTITIONER
NURSE MANAGER
NURSING UNIT MANAGER
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
REGISTERED NURSE
ENROLLED NURSE
ASSISTANT IN NURRSING
CLINICAL NURSE CONSULTANT
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
VMO
CMO
STAFF SPECIALIST
FELLOW
JMO
DIETICIAN
ADMINISTRATIVE ASSISTANT
SECRETARY
WARD CLERK
CLINICAL SUPPORT OFFICER
BOOKING CLERK
FINANCE STAFF
BUSINESS MANAGER
BOOKING CLERK
IT STAFF
DOMESTIC SERVICES/FOOD SERVICES
FT
E R
EV
IEW
MA
ST
ER
PLA
NN
ING
WO
RK
FF
OR
CE
PL
AN
NIN
G
CLI
NIC
AL
SE
RV
ICE
PLA
NN
ING
NURSING
CORPORATE/IT SERVICES
MEDICAL
ALLIED HEALTH
ADMINISTRATIVE REVIEW
NIC
U
PIC
U
ES
W
SU
RG
ICA
L U
NIT
CLU
BB
E
HU
NT
ER
BA
ILLI
E
CLA
NC
Y
VA
RIE
TY
CA
MP
ER
DD
OW
N
OT
C
OP
D
CA
PA
C
TU
RN
ER
HA
LL
WA
DE
ED
MID
DLE
TO
N
OP
ER
AT
ING
T
HE
AT
RE
S
ANNUAL BED ALLOCATION REVIEW
CA
RD
IOLO
GY
/CA
RD
IAC
SU
RG
ER
Y SU
RG
ER
Y
INT
EN
SIV
E
CC
AR
E
BU
RN
S
CA
RD
IOLO
GY
/CA
RD
IAC
SU
RG
ER
Y
GE
NE
RA
L M
ED
ICIN
E
ON
CO
LOG
Y
OU
TP
AT
IEN
T/D
AY
T
RE
AT
ME
NT
PS
YC
HO
LOG
ICA
L M
ED
ICIN
E
EM
ER
GE
NC
Y S
ER
VV
ICE
S
PE
RI-
OP
ER
AT
IVE
A
ND
CR
ITIC
AL
CA
RE
ME
DIC
AL
PR
OG
RA
M
AM
BU
LAA
TO
RY
AN
D
EM
ER
GE
NC
Y
ALLIED HEALTH PROGRAM
DIAGNOSTIC PROGRAM
RE
SE
AR
CH
NURSE PRACTITIONER
NURSE MANAGER
NURSING UNIT MANAGER
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
REGISTERED NURSE
ENROLLED NURSE
ASSISTANT IN NURRSING
CLINICAL NURSE CONSULTANT
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
VMO
CMO
STAFF SPECIALIST
FELLOW
JMO
DIETICIAN
ADMINISTRATIVE ASSISTANT
SECRETARY
WARD CLERK
CLINICAL SUPPORT OFFICER
BOOKING CLERK
FINANCE STAFF
BUSINESS MANAGER
BOOKING CLERK
IT STAFF
DOMESTIC SERVICES/FOOD SERVICES
FT
E R
EV
IEW
MA
ST
ER
PLA
NN
ING
WO
RK
FF
OR
CE
PL
AN
NIN
G
CLI
NIC
AL
SE
RV
ICE
PLA
NN
ING
NURSING
CORPORATE/IT SERVICES
MEDICAL
ALLIED HEALTH
ADMINISTRATIVE REVIEW
NIC
U
PIC
U
ES
W
SU
RG
ICA
L U
NIT
CLU
BB
E
HU
NT
ER
BA
ILLI
E
CLA
NC
Y
VA
RIE
TY
CA
MP
ER
DD
OW
N
OT
C
OP
D
CA
PA
C
TU
RN
ER
HA
LL
WA
DE
ED
MID
DLE
TO
N
OP
ER
AT
ING
T
HE
AT
RE
S
ANNUAL BED ALLOCATION REVIEW
CA
RD
IOLO
GY
/CA
RD
IAC
SU
RG
ER
Y SU
RG
ER
Y
INT
EN
SIV
E
CC
AR
E
BU
RN
S
CA
RD
IOLO
GY
/CA
RD
IAC
SU
RG
ER
Y
GE
NE
RA
L M
ED
ICIN
E
ON
CO
LOG
Y
OU
TP
AT
IEN
T/D
AY
T
RE
AT
ME
NT
PS
YC
HO
LOG
ICA
L M
ED
ICIN
E
EM
ER
GE
NC
Y S
ER
VV
ICE
S
PE
RI-
OP
ER
AT
IVE
A
ND
CR
ITIC
AL
CA
RE
ME
DIC
AL
PR
OG
RA
M
AM
BU
LAA
TO
RY
AN
D
EM
ER
GE
NC
Y
ALLIED HEALTH PROGRAM
DIAGNOSTIC PROGRAM
RE
SE
AR
CH
ED
UC
AT
ION
NURSE PRACTITIONER
NURSE MANAGER
NURSING UNIT MANAGER
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
REGISTERED NURSE
ENROLLED NURSE
ASSISTANT IN NURRSING
CLINICAL NURSE CONSULTANT
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
VMO
CMO
STAFF SPECIALIST
FELLOW
JMO
DIETICIAN
ADMINISTRATIVE ASSISTANT
SECRETARY
WARD CLERK
CLINICAL SUPPORT OFFICER
BOOKING CLERK
FINANCE STAFF
BUSINESS MANAGER
BOOKING CLERK
IT STAFF
DOMESTIC SERVICES/FOOD SERVICES
FT
E R
EV
IEW
MA
ST
ER
PLA
NN
ING
WO
RK
FF
OR
CE
PL
AN
NIN
G
CLI
NIC
AL
SE
RV
ICE
PLA
NN
ING
NURSING
CORPORATE/IT SERVICES
MEDICAL
ALLIED HEALTH
ADMINISTRATIVE REVIEW
NIC
U
PIC
U
ES
W
SU
RG
ICA
L U
NIT
CLU
BB
E
HU
NT
ER
BA
ILLI
E
CLA
NC
Y
VA
RIE
TY
CA
MP
ER
DD
OW
N
OT
C
OP
D
CA
PA
C
TU
RN
ER
HA
LL
WA
DE
ED
MID
DLE
TO
N
OP
ER
AT
ING
T
HE
AT
RE
S
ANNUAL BED ALLOCATION REVIEW
CA
RD
IOLO
GY
/CA
RD
IAC
SU
RG
ER
Y SU
RG
ER
Y
INT
EN
SIV
E
CC
AR
E
BU
RN
S
CA
RD
IOLO
GY
/CA
RD
IAC
SU
RG
ER
Y
GE
NE
RA
L M
ED
ICIN
E
ON
CO
LOG
Y
OU
TP
AT
IEN
T/D
AY
T
RE
AT
ME
NT
PS
YC
HO
LOG
ICA
L M
ED
ICIN
E
EM
ER
GE
NC
Y S
ER
VV
ICE
S
PE
RI-
OP
ER
AT
IVE
A
ND
CR
ITIC
AL
CA
RE
ME
DIC
AL
PR
OG
RA
M
AM
BU
LAA
TO
RY
AN
D
EM
ER
GE
NC
Y
ALLIED HEALTH PROGRAM
DIAGNOSTIC PROGRAM
Patients and Families
Why paperless• We must improve patient care and access• We must address financial sustainability
• Requires– Governance and Infrastructure– standardisation – Sharing– Advocacy– clinician experts
Service Value• Credibility of information• Feeling safe using the information• Better reflection of complexity• Safer documentation and patient care• Improved accuracy reporting up• Ability to refute inaccurate data and contribute
to understanding of paediatric differences
Future
• Connecting IT with strategy• Solving network gaps• Single patient view• Innovating• Automation • Reliability• Clinician driven
The searchable and shared recordSepsis Early Detection Logic
Streamlining multicentre clinical research
• The solution: Online data collection and multicentre project management for clinical research, in real time
• The benefits: - Minimise paper and streamline database creation– Data entry workload spread across research team– Delay in collation of results faster research outcomes– Potential to integrate with eMRs and other data sources
• PTNA = Paediatric Trials Network Australia– A new network of paediatric researchers committed to improving child
health through clinical research. (Institutional membership model)– Currently purchasing the above solution, which will be trialled by Dec 2012
and made more broadly available to the PTNA membership in Q2, 2013.– For more information, visit www.ptna.com.au
Advocacy
• Working with the
• Development of a set of Paediatric CCs and CCLs for Clinical Review– Step 1- Identifying diagnoses with a demonstrated impact on cost and
length of stay.– Step 2 – Assessment of paediatric vs adult impact of CC diagnoses by ADRG– Step 3 – Refine CC list to exclude CCs with high adult impact– Step 4 - Addition of closely related diagnosis codes to resulting CC list
• Need to recognise paed cost drivers, home and social context