Commissioning the Digital Hospital

Overview

1. Challenges

2. The Drivers

• The Digital Clinician

• Community

3. Making the Case for a DH

4. The Digital Roadmap

5. Benefits Realisation

6. Lessons Learned

7. Discussion points

Metro South Health

Metro South Health

1. Challenges

• Managing growing demand for health services within economic and financial environment

• Growing, ageing, and culturally diverse population

• Increasing prevalence of chronic conditions

• Access to services for people in rural and remote areas

• Siloed health sector focused on sickness

• Disconnected systems and processes impacting information sharing and workflow

• A key to more sustainable healthcare is enabling people to take more control of their own health through use of mobile and telehealth technologies

Metro South Health

2. Drivers - The Digital Clinician

• Digitally transformed healthcare system

• more proactive and preventative care delivered at home

• wearable devices that monitor our health and coach us to improve it

• delivery of just the information a clinician needs, when they need to know it

• Technology may actually free clinicians to concentrate on humanistic aspects of health care

Drivers - Community

• Patient activation

• Population health analytics

• Electronic Health Records – linking patients and providers

• Medical Homes and Smart Homes for the elderly

• Virtual Clinics

• Establish a platform to prepare organisations for the future

Metro South Health

Metro South Health

3. Making the Case for an iEMR

• 35% of hospital referrals may be avoided with iEMR

• 10% of patients with a drug allergy are prescribed that drug during a hospital admission

• More people in hospital from

• preventable medication incidents than from asthma and breast cancer combined

• 30% of all radiology and pathology investigations may not be unnecessary

• Medication management is high risk activity and should be the last system introduced

Metro South Health

Metro South Health

4. Digital Roadmap

• 2015 PAH Digital (1133 beds)

• 2017 PAH Medication/Anaesethetics/Research

• 2018 Logan and Beaudesert (459, 40 beds)

• 2018 QEII (218 beds)

• 2018 Redland (222 beds)

• Be aware that there will be an impact on performance and in particular emergency, elective, and outpatient care. This relates to infrastructure upgrades as well as system introduction.

All clinical services fully digital

Metro South Health

Digital Hospital

• Structured clinical notes

• ED, Surgery, Theatres and Anaesthetics

• Integrated inpatient clinical information

• Pathology and Radiology orders and results

• Scheduling – Outpatients and Elective Surgery

• Device integration and closed loop observations

• Managing deteriorating patients workflow

• Positive person identification

• Medication Management – closed loop

• Clinical trials

• Reporting

• Analytics and Data Warehouse

Characteristics of Success

• Patient-centric focus, not system (strong clinical governance and independent safety plan)

• Believing in the IT – commercial off the shelf, why wouldn’t it work

• Strong Board, Executive and Clinical Leadership

• Clinical staff embedded in all design, configuration and testing

• Hospital stakeholders running implementation not project

• Home grown change management resources

• Integration into clinical workflow

• Decision support (managing deteriorating patient)

Metro South Health

5. Clinical Benefits

• 82% improvement in identification of deteriorating patients

• 14% improvement in standardised mortality

• 22% reduction in pathology turnaround time

• 95t% improvement in radiology endorsement

• 5% increase in reported pressure injuries

• 6% improvement in length of stay

• 28% reduction in actual infection rate

• Improved VTE management

Metro South Health

Clinical Data Analytics – operational metrics

• Patient charts opened: 54,735 daily on average.

• EMR opened: 54,000 times daily .

• 4,000 orders placed per day

• 12,200 administrations occurring per day – administrations uncharted (in

error) = 0.006% (N=70)

• 1500 IV infusions

• 90,000 alerts fired (7% overridden)

Success Story – Medications Clinical Monitoring

• Worked with key senior clinical staff to develop visualisation of key medication ordering/administration data to allow safety and quality monitoring – especially for ‘risky’ medications/workflows (i.e. Insulin & Heparin)

• Results

• live clinical safety and quality monitoring of medication orders and administration

• ability to instantly identify ‘risky’ patients (ie BGL >16, High/Low APTT etc.)

• ability to intervene before administration of medications where unwarranted care deviation

• identification of consistent data trends to help assist in optimising functional design of electronic prescribing within ieMR

Success Story – optimisation of heparin prescribing / monitoring

• State wide Digital heparin Working Group formed - multi-site review of heparin issues

• Dosing = IU/kg/hr (evidence based)

• Reduction in calculation errors

- on paper = Dr calculates IU/hg/hr to IU/hr, then RN to ml/hr (error prone)

- ieMR has built in calculator for weight-based boluses and infusions with additional safeguards to prevent exceeding initial recommended dosing

• PowerPlans to match indication

• Alerts for use of multiple anticoagulants

• Real time dashboard

Medication incident analysis

• Go Live – Patient Safety Watch:

– Formally assessed as reported via CI reporting system

– Reviewed and triaged for appropriate action or escalation

• Transition Period:

– Inter-disciplinary team review/analysis of medication incidents

– Immediate investigation and remedial action (clinician level)

• Current – three pronged approach:

– CI reporting system (Riskman) - managed by Patient Safety team and actioned by Medication safety committee (MSC)

– Adoption coaches escalate issues

– Pharmacy interventions - themes are reviewed and presented to MSC

Digital Visualisation project

Systems Services Safety Performance

Care Transfer

(Electronic Discharge Summary)

Digital Hospital

Radiology Endorsement

Pathology Endorsement

Business Management

Bed Management

Outpatients

Emergency Care

Perioperative

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Clinicians

6. Lessons Learned

• Characteristics of Success • Patient focus

• Project ownership not sponsorship

• Work practice changes 1 year out

• Front load the system

• Deep clinical engagement

• Governance • Parallel Hospital Executive

• Command Centre for “Go-Live”

• Independent “Safety Watch”

• “Rapid Resolver” group

Metro South Health

Communication and Marketing

Digital Hospital: Interactive, Informed, Optimized

Lessons Learned

• Training • looks simple but … significant impact

• New intakes challenging

• Validate capability

• Alerts • What level is appropriate

• We run at 7% lead to practice change

• Change • Moving from project to program

Metro South Health

Staff Training 5,572 staff trained with 94% proficiency: 100% for Go-Live

7. Discussion points

• Data Analytics • Good record but analytics captures clinicians

• Building a research infrastructure

• Driven by limited reporting

• View of personalisation • Research module linked to gene technology and

tissue banking

• Infrastructure • Key to success electrical, email and end to end

support

• “Tap-On Tap-Off” and “Single-User” prerequisite

• Device integration delivers benefits

Metro South Health

7. Discussion points

• Downtime • Scheduled, un-scheduled,

• Big impact

• Don’t forget the “pens and paper”

• The Future • Mobile technology – I have it

• Patient portal – it is coming

• Brings together • Implementation science

• High reliability systems

• Digital Transparency

Metro South Health

• Pioneering digital disruption: Australia’s first integrated digital tertiary hospital – MJA

• Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice – AHR

• Digital disruption ‘syndromes’ in a hospital: important considerations for the quality and safety of patient care during rapid digital transformation – AHR

• The impact of eHealth upon hospital practice synthesis of the current literature – Deeble Institute

• Unpacking the Complexity of Consistency: Insights from a Grounded Theory Study of the Effective Use of Electronic Medical Records - ICSS

Metro South Health

The Team