Transcript IT working group

IT and JMOs in NSW
Deniz Durmush (Network 2 – Bankstown),
Samuel Hall (Network 4 - Liverpool),
Alana Lessi (Network 9 – Prince Of Wales),
Vanessa Lusink (Network 12 – John Hunter),
Jessica Reagh (Network 6 - Hornsby),
Samuel Roberts (Network 12 – John Hunter),
Jaime Santibanez (Network 13 - Coffs Harbour),
Michael Smith (Network 14 - Nepean)
Summary
• Part A – State of IT in NSW health
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Importance of IT to JMOs
Survey responses and what different networks are using)
5 most common grievances and successes
Electronic handover practices
» Medical Officers Notice Board
» Electronic Whiteboard
» Powerchart multipatient task list/medical handover
• Part B - Governance
– Hierarchy tier
• Part C - Ways forward
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Blackbox
Medcom2012 (Nepean)
Patient Controlled Electronic record
Ways for JMOs to get involved
Part A - State of IT
Importance of IT
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Ordering/reviewing pathology
Ordering/reviewing imaging
Electronic discharge summaries
Operation reports
Accessing medical resources
Patient contact information – LMO/specialists
Rosters
Discharge medications direct to pharmacy
(limited)
Interns spend 22% of their time on
documentation and administrative tasks
Double the time spent on direct patient care
[Westbrook et al. 2008]
Methods of investigating IT across
different networks
• IT working group of the JMO forum was each
assigned two area health services to obtain
information from in the form of a semistructured survey.
• This information was then pooled and
evaluated in a qualitative nature through a
round table discussion.
State of IT
• Various programs being utilised
– Powerchart
– Electronic whiteboard
– Separate Pathology and Radiology programs (eg.
Auslab, Centricity and Intelliviewer)
• Migratory workforce
– Registrars rotate through different networks
– Poor orientation leads to lack of education and
interest in learning new programs and setting up
electronic handover.
5 best attributes of IT
• Structuring medical handover and formalising
communication between teams and after
hours staff
• Ordering imaging and pathology
• Access to imaging and pathology results
• Access to patient medical records and details
• Electronic medication charts (where utilised)
5 Common barriers
• Insufficient number of computers
• No wireless capability or lack of access for JMOs
• Different programs utilised for patient records,
pathology/radiology results and handover
• Poor orientation and use of programs used across
medical staff
• Lack of maintenance and capability of computers
• JMOs reported frequent difficulty in accessing computers in ward and
office settings.
• That a majority of computers were needed for both urgent and non-urgent
activities created problems in accessing them for the latter purpose.
• JMOs noted that computers frequently had to be shared with other health
providers, and competing for access to them was not uncommon.
• A lack of office space, and functioning computer hardware therein, was
also identified as significant issue.
• Being unable to locate and access computers is a source of immense
frustration for JMOs.
Source: Australian Medical Association Council of Doctors-in-Training (AMACDT). October 2010.
JMO Clinical Handover Project
Compared different handover formats aiming to
improve consistency, quality and patient care.
• Metropolitan and rural hospitals
• Tested handover formats:
– Face/face, written, electronic
– Meetings, rounds
– Types of staff, levels of staff
Elements that improve handover
from a JMO perspective:
• documentation (not duplication)
• ISBAR: a clear framework (rather than rigid
structure)
• locally appropriate
• time efficient (improves attendance)
• educational opportunity (improves quality
and quality of care)
• integrated with registrar and consultant
handover (improve patient care)
In Short . . .
eHandover tools:
– allow documentation
– force structured thinking (ISBAR entry boxes)
– have potential to improve efficiency by allowing
overtime staff to view and prioritise all current
jobs.
In Practice . .
• Not all hospitals have electronic handover systems
• Mode of use varies:
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A whiteboard that runs day and night
Documentation for the handover meeting
Documentation for overtime staff from day staff
Current jobs list for overtime staff from nurses on the ward
• Users:
– Mainly teams to RMOs (but often not back to teams)
– Nurses to nurses (shift summary)
Powerchart multipatient task list / Ad
Hoc list
Case Study: JMO experience in a Network 1 hospital
• Official handover requirement: add to Ad Hoc list of
Powerchart; discuss at handover meeting
– New admissions
– Clinical emergencies
– sick patients, patients requiring review after hours
• Ad Hoc list discussed at handover meeting with all
overtime staff present
WAND / MEDCOM
Case Study: JMO experience in a Network 14
hospital
• Official handover requirement: WAND (for
nurse/nurse) and MedCom (for Dr/Dr)
• MedCom is currently being trialled
• Job management assistance as organises
entries ward by ward, can ‘flag’ a sick review
or timed ward task
Medical Officers Noticeboard (MON)
• Effective Communication of Non-Urgent Jobs
• Increased efficiency of JMOs on overtime
shifts
• Replaces traditional paging or whiteboard
system
• Rolled out across 4 hospitals across HNEAHS
• Also has an avenue for electronic
handover/flagging “sick” patients
Implementation
• After initial mistrust now very well accepted
by both medical and nursing staff
• Felt to be more efficient by medical and
nursing staff
• Push for greater implementation into other
hospitals now comes from JMOs
• Anecdotally…much better!
Part B - Governance
IT systems structure
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There is a central administration. Each hospital network has a
CIO (chief information officer). Each hospital has in house
desktop support.
The IT program of NSW doesn't write or develop software. It
uses health support services.
Information management (project management)
IT operations
Knowledge development (designs and improves interface)
Client services - this would be the department that would be
consulted regarding creating an new project. Projects need to
be registered as part of a strategy plan
Business
IT working group
Part C: Where to from here?
iHandover
• Many disparate systems generated from
interested parties across different area health
services
– All agree on ISBAR
• Will discussions between nursing and doctors
become a part of the patient’s health record?
MedCom at Network 14: format
MedCom at Network 14: handover
MedCom at Network 14: jobs
MedCom at Network 14: clinical
r/v
Patient results & smart devices
• ‘Black Box’ application at Westmead and
Nepean hospitals
– Access Cerner Powerchart Pathology results
– Patient search/ Location/Provider list functions
– For iPad, iPhone and Android users
Black Box Trial
Individual Health Identifier (IHI) &
Personally-Controlled eHealth Record
(PCEHR)
PCEHR
• Benefits for JMOs
– Reasonably accurate record of their health in one
location
– Potentially reduce chasing of previous medical
history
PCEHR
• Cons
– May not be a complete record of health info
– Patients may supress certain important aspects
of medical hx (eg drug and mental health
issues)
Participation in PCEHR
• May be difficult to encourage participants to
create PCEHR
• eHealth in USA
– Meaningful Use program aims to get electronic
health programs adopted into the health care
system faster.
• Pays providers to create HER (electronic health records)
The paperless hospital
• Macquarie University Hospital: collaboration
with School of Advanced medicine
– 187 beds, 16 OTs, no paper records
Electronic Medication Charts
• MedChart has been used at St. Vincent’s Hospital
since 2004 and Macquarie University Hospital in
2010
• New Zealand plans to fund an electronic medication
management system starting at Dunedin Hospital.
• NHS in UK has initiated plans to roll up ePMA (an
electronic medication chart).
Research for electronic MedCharts
• Westbrook et al looked at the effects of
electronic med charts
– “…significant decreases in medication error when
ePrescribing systems were used”
– Serious errors decreased by 44%
Future state - Clinical systems
strategy 2012-2016
Source - Information Management & Technology Strategic Plan 2012-2016
Other Projects NSW IT has planned
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eMR 2
CHOC (Community Health and Outpatient Care)
Electronic Medication Management (EMM) (tender)
Intensive Care Information System (tender)
Endoscopy Information System
• A new Laboratory Information System.
• Policy on using mobile devices
How JMOs can be involved in IT
development?
Met with CIO for Northern Sydney Health Area
who suggested:
– JMOs attend the local IMC (information
management committee) meetings which occur at
each major hospital network.
• Monthly reports are created and discussed and it would
be a good avenue for JMOs to get involved
References
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NSW Health media release:12 October 2009 “Caring Together: standard principles for
handover to improve patient care”.
http://www.health.nsw.gov.au/news/2009/20091012_00.html
WHO The Research Priority Setting Working Group, December 2008. “Global Priorities for
Research in Patient Safety
“http://www.who.int/patientsafety/research/priorities/global_priorities_patient_safety_r
esearch.pdf
NSW Health “Clinical Handover - Standard Key Principles “, Doc No.: PD2009_060.
http://www.health.nsw.gov.au/policies/pd/2009/PD2009_060.html
NSW Health Acute Care Taskforce “Improving JMO Clinical Handover at all shift changes,
Final Report”. November 2010
National e-Health Transition Authority (NeHTA) prepared by the Australian Medical
Association Council of Doctors-in-Training (AMACDT) “Implementing electronic discharge
summaries: the JMO perspective”. October 2010]
NSW Health Northern Sydney Health District. “Information Management and Technology
Strategic Plan 2012-2016. May 2012.
Westbrook JI, Reckmann M, Li L, Runciman WB, Burke R, et al. (2012) Effects of Two
Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital InPatients: A Before and After Study. PLoS Med 9(1): e1001164.
doi:10.1371/journal.pmed.1001164