Blacktown Mt Druitt Hospital (BMDH) in Sydney’s west has achieved the remarkable feat of converting a 500-bed acute facility with 2000 staff from a paper to a digital environment in less than two years, with no extra resources and with a minimum of fuss.

From first discussions in February 2013 to go-live in all 17 inpatient units in September this year, the hospital now completes 85 per cent of its clinical documentation electronically, including orders, results, consults, observation charts and discharge summaries.

It has introduced BYOD and corporate mobility, remote access, clinical and business support tools and is now about to introduce a scanning solution for paper records. It is also preparing for the statewide roll-out of electronic medications management and an electronic ICU system.

All this has been done with existing staff and existing hardware, with only a two-person IT project team that only came on board part of the way through the implementation. According to Peter Rophail, transition manager for the $324 million Blacktown Mt Druitt Hospital expansion project, it has been “cheap, quick and successful”.

Mr Rophail, a hospital physiotherapist, told an Australian Information Industry Association (AIIA) NSW healthcare special interest group meeting in Sydney today that the key to the success of the project was to not think of it as an IT implementation but as an exercise in clinical redesign.

“It is really about redesign and system improvement,” Mr Rophail said. “We are taking a different approach, where it is really about implementation rather than installation.”

BMDH is currently undergoing NSW’s largest hospital capital works program, which will see a new building open at the end of next year at a cost of $322 million. In advance of the move to the new building, which will be completely paperless, BMDH decided to implement an electronic medical record and go as paperless as possible through a project known as Paper-Lite.

“We started to talk about this in February 2013 … about moving to a paperless environment,” Mr Rophail said. “There was really strong executive support for that and they essentially said we want to move paperless for a whole bunch of reasons, we can’t give you any resources, but see what you can do.

“It has to be done before we finish the [redevelopment] because we want to move into our new building in a paperless environment. You’ve got about 30 months to do it.”

So they did. Mr Rophail said the project team looked at other jurisdictions as well as overseas to see how this sort of a transformational IT project could be best achieved, but most of those high-value projects took many years and many millions.

“That model was not going to work for us, so what we decided to do was flip it over from being an IT project to being a clinical redesign project,” he said. “That was really key. For the first six months, all we did was meet with clinicians once a month; we had a select group of clinicians that we had hand-picked to assist us with this. We didn’t really talk about IT – we talked about clinical practice.

“At the end of that period we had a really clear set of priorities that were coming through from the clinicians in terms of what was required from our IT systems to improve the business. We did a proof of concept a few months later – we took all of those things, we trialled them, and we turned one ward digital for 24 hours just to see how that would look and socialise the ideas.

“Six months later we did an initial go-live, so we flipped a whole ward digital … and then a few weeks after that we did the main go-live, where we did our other 16 inpatient units and brought the rest of the hospital on.”

Even though this was an incredibly fast implementation, Mr Rophail said that in retrospect the actual go-live period could have been much faster.

“From the thought bubble from the start to when it was finished was 19 months. The actual part of the implementation from we don’t have a digital record to the whole hospital is digital, was about six weeks. In that six weeks, five of those weeks was us just learning the lessons of the first ward to go live, and then we flipped over the rest of the hospital in four days.

“There’s lots of things we would have done differently, but we thought we would have one 28-bed unit go live and then we would need six or eight weeks to get the rest up to speed. We really should have done it one ward one week and the rest the next week.

“The program stretched out too long and small change is just as disruptive as big change. We needed the same resources and there was just as much disruption to do one unit as 16. We would have compressed the program. If I could go back now to when we did the proof of concept to when we finished the roll-out, it should have been 12 to 16 weeks as opposed to eight months.”

BMDH now has people from 10 local health districts (LHDs) throughout the state coming to see how it was done. eHealth NSW, which helped to develop some of the internal systems, is also keen to play a role in disseminating the lessons learned, as much of the technology used is part of the NSW statewide build.

The electronic medical record BMDH has used is the existing Cerner EMR, which allows mobile and remote viewing and creation of assessments and progress notes, pathology, imaging and dietary electronic orders, and discharge summaries and consultation notes. The project also involves improvements and new functionality to Cerner.

Clinicians can access the system wirelessly on their own devices or through laptops and COWs. All existing paper medical records and forms that cannot be made electronic are being scanned and incorporated into the system.

It also includes the well-regarded Between the Flags observation chart for nurses, which is integrated into Cerner, as well as an electronic dashboard for all active emergency theatre booking forms or green sheets.

A new patient summary is also included, called mPage, along with new forms for nursing and social work, allied health discharge summaries and clinical documentation for physiotherapy.

“It is essentially 85 per cent of our documentation,” Mr Rophail said. “[We have introduced] mobility, BYOD, which is really important but also corporate devices; remote access, which we’ve always had but have never really implemented well.

“Records scanning, so that we have a comprehensive digital record, and then introducing things like clinical support tools, using the fact that so much data is in the system to assist clinicians with making decisions, but also things like electronic theatre bookings and so on.

“Essentially, all of that has been implemented at Blacktown this year. In September, Blacktown became the first public hospital, in NSW certainly, arguably in Australia, to implement an electronic medical record for almost all of its inpatient documentation. That’s a really big achievement.

“We did ours in a very short time and virtually within existing resources, so cheap, quick and successful.”

Just-in-time training and clinical risks

One of the most intriguing elements of the implementation was the use of just in time (JIT) training. Rather than the long and laborious task of shoehorning busy clinicians into classroom-based educational sessions on how to use the system, BMDH instead decided to teach each clinician what they needed to know when they needed to know it.

“Just in time training worked really well for us,” Mr Rophail said. “We started training our 2000 staff two weeks before go-live. We stripped down a four-hour training session to 10 minutes of key information, so that whenever Professor Whatever comes on the ward, someone can grab him and teach him everything he needs to know in five or 10 minutes rather than trying to do it through classroom-based training and all of the logistics and so on.”

He emphasised that it was very much a clinician-driven, clinician-owned process. “That sounds simple and easy to do, but to get clinicians to own and drive a project like this requires a lot of investment up front.

“That first six months, where all we did was talk to people, was really the key to the success of the whole project. By getting that bit right, the rest of it seemed to be pretty straightforward. We did bottom-up planning – clinical practice, what the gaps were, what the frustrations were in clinical practice, what the risks were – and then rolling them up to plan out solutions that might address those things.

“We started at a point that is confronting for some of our staff, [that] we are going to do this within existing resources. We are going to take what we have and what we can get through partnerships, and that’s what we are going to use to implement this massive change. That starts the conversation at a completely different level.

“We took a really mature approach to managing risk and I think this is really important. In the clinical setting, resistance is expressed as risk. If a clinician doesn’t want to do anything, they will tell you that it’s unsafe and will affect the quality of care. That is really a cover for, ‘I don’t want to do it’.”

Marketing was used extensively, with a lime-green colour scheme chosen for communication materials, and the choice of the Paper-Lite brand. Mr Rophail said the hospital invested a lot of time in getting the marketing right. “When you are working in an organisation as big as our one – it’s 2000 staff, 24 hours, seven days a week – you need a way to communicate messages and this was the vehicle for that,” he said.

And it was all pretty much achieved within existing resources.

“We did end up having to put someone part-time because no one understood the techie part, so we needed someone from IT … and we also needed someone for a few months to do some building for us, so we did end up with a couple of positions.

“We didn’t invest in any hardware – we reused what we already had – but subsequent to go-live we’ve now been able to get some additional devices procured to support it. Suddenly everyone is very interesting in being involved and having a role.

“The big one for us is that we would achieve our human objectives – we would still continue to deliver safe care efficiently but also that we had compliance. The struggle for us from the start was always about how to get 2000 clinicians to use this record in the way that it was intended. We’ve done that, so we are very happy.”

This article first appeared in the November 2014 issue of Pulse+IT Magazine.

Despite popularising smartphones in the consumer market and developing the iOS ecosystem in which many health and fitness apps exist, Apple cannot claim to be an early entrant into the field of consumer health. In fact, the company lags long-time rivals Google and Microsoft’s efforts to provide health services to consumers by many years.

This is not to say that being a trailblazer in the health informatics space presents the fastest route to success, with the Google Health offering being shut down in 2011, just a few short years after being launched, and Microsoft’s HealthVault platform only being supported in a limited number of overseas locations despite launching seven years ago.

Launched as a flagship component of iOS 8, Apple’s Health app is the consumer-facing component of its HealthKit developer environment, which the company describes as allowing “apps that provide health and fitness services to share their data with the new Health app and with each other. A user’s health information is stored in a centralised and secure location and the user decides which data should be shared with your app.”

While data sharing between the plethora of health and fitness-related services has existed for some time, the number of services that have sprung up over the past few years has led to an exponentially large number of possible interactions between these various offerings, with many app developers only able to support interfaces with a handful of the most popular third-party offerings.

To read the full story, click here for the November 2014 issue of Pulse+IT Magazine.

The NSW Justice Health & Forensic Mental Health Network (JH&FMHN) has gone live with a new electronic medical record suite from Orion Health, which promises to deliver a complete EMR to patients moving between correctional centres, courts and the community.

The network provides healthcare to adults and young people in contact with the forensic mental health and criminal justice systems, across community, inpatient and custodial settings.

The solution involves the use of Orion Health’s Rhapsody integration engine to streamline and speed message handling between applications and the organisation’s patient administration system.

It also uses Orion Health’s clinical portal to provide a single entry point for all clinical users to access and contribute to the patient’s medical record. The aim is to provide clinicians and healthcare providers with a seamless view of all patient information, including a patient summary screen, problem and allergy information, and notifications of events integrated with electronic results reporting and clinical forms.

Orion’s solution will provide a platform for Justice Health’s migration to a computerised record and will contain a subset of information previously held in paper medical records, including patient details, medical conditions, appointments, pathology results, electronic forms and medicines prescribed.

The data is now held in one consolidated place and therefore available state-wide as opposed to being held in multiple paper files and standalone electronic registers. JH&FMHN is currently digitising paper-based health records and manual processes such as faxing and posting of pathology results.

The Orion Health deployment will support a centralised approach to receiving, disseminating, endorsing and actioning clinical results, and facilitate the continuum of care regardless of the patient’s location or the number of times the patient is transferred.

The network’s CIO, Susan Harman, declined to be interviewed about the roll-out.

Hills has officially signed a partnership agreement with Irish firm Lincor to distribute its point of care technology in hospitals and aged care facilities in Australia and New Zealand.

Hills and Lincor first shook hands on the agreement earlier this year, and last week signed an official agreement that will see Hills market the technology to its existing clients in the acute care sector and tap into the trend of hospitals providing access to electronic medical records, picture archiving systems, patient infotainment and entertainment and integrated nurse call systems at the bedside.

Hills is also eyeing off the residential aged care market with Lincor’s range, which has mobile functionality as well as fixed hardware that can be attached to a wall or as a nurse’s workstation in individual rooms.

The range consists of PatientLINC, which includes a hand-held telephone and integrated camera for video calls, as well as internet access and entertainment options. Patients also have access to educational materials and satisfaction surveys, and medical staff can “prescribe” videos, audio files and documents to educate patients on a condition, course of treatment, and post-discharge care instructions.

Clinicians can use PatientLINC to access the medical record, order and verify medications and share scans and test results with the patient, and through wireless devices it can also monitor vital signs that can be automatically linked to the patient notes.

There is also a ClinicalLINC solution, an addition to PatientLINC that provides secure access to clinical information systems through a wall-mounted terminal adjacent to the bedside. This solution also provides hospitals with an optional bed status management system, a room cleaning checklist and fault reporting.

Last month, Lincor launched an Android-based patient engagement solution called MediaLINC that delivers a range of education, entertainment and clinical content direct to standard HD TV sets. MediaLINC allows patients to review educational videos, documents and post-discharge instructions on the TV, and can also be used by hospitals to display information such as facility news or events.

Lincor was set up in 2003 by three former Apple executives – Dan Byrne, Pat O’Donnell and Enda Murphy – to develop a healthcare-specific solution that would bring information to the bedside. While the company outsources the manufacture of the units and devices, the Lincor team is intimately involved in its design.

However, the company is very much a software rather than a hardware firm, Mr Byrne said. The software is fully integrated into the hardware, with its prime point of difference being that it can interface with the major EMR, PACS and medications software solutions as well as provide internet access, pay TV and video conferencing capability to the patient.

It can also integrate with a hospital’s food service software package and allow patients to order from menus electronically, as well as integrate with nurse call systems. For Hills, the plan is to look at how to integrate the technology it has recently acquired through its purchase of the Merlon and Questek IP and wireless nurse call systems as well as Hospital Television Rentals (HTV).

Mr Byrne said the company decided to concentrate on healthcare when an existing customer signed an agreement with the UK government to supply patient entertainment into hospitals as part of a patient empowerment project.

“At that time in the UK it was specifically aimed towards patient entertainment and nothing else, but we very quickly saw that this was an opportunity to put our product into healthcare and into hospitals, and to do more than just patient entertainment,” Mr Byrne said.

“That’s what we have continued to develop, and today we have a multi-functional device at the bedside and a multiplicity of solutions, but it does things significantly more than patient entertainment. It does that very well but it also does patient education and allows clinician access at the bedside.”

From the UK, Lincor then expanded into Europe and now has installations in hospitals in France, Belgium, Holland, Italy and Spain. It then moved into the Canadian market and then the Middle East, and ultimately picked up some contracts on the east coast of the US. Last year, a US venture capital firm called Edison invested in the company, and it now has an office in Nashville, Tennessee.

“And of course Australia then was our next challenge, but logistically it’s not the easiest place to get to from Ireland,” Mr Byrne said.

“Initially we didn’t see it as the biggest opportunity in the world versus the US, but when one considers the footprint that Hills has in 350 hospitals throughout Australia … [it] has indicated to me that we’ve been grossly under-estimating the potential. I think it’s going to be huge.”

Still unfamiliar with the New Zealand market, Mr Byrne and Mr O’Donnell said they would be guided by Hills’ on the ground knowledge.

Lincor went looking for partners in Australia at the same time that Hills was also on the look-out to expand its product offering. Hills, famous for the Hills Hoist and for many years a significant player in heavy industry, was in the process of divesting some of its heavy manufacturing arms and investing in new technology. It had existing clients in the health and aged care industries with its communications and security alarms business, so healthcare became a prime target.

Last year, it set up a health division and set out to develop a portfolio of products specifically for the healthcare market. Hills’ head of health solutions, Peta Jurd, recently told Pulse+IT that the plan was not to get into the delivery of clinical software or infrastructure, but to concentrate on technologies that enable the delivery of care to hospitals, residential aged care and into the community and home.

In addition to buying Merlon, HTV and Questek, Hills has also picked up the distribution rights to the Lively range of home monitoring sensors, and has now added Lincor’s technology to the portfolio.

What Lincor says differentiates it from some of the other players on the market is that it has a fully integrated solution that does not involve meshing different software and hardware solutions together.

“The most critical thing to say about Lincor is that we’re a software company first,” Mr Byrne said. “Our intellectual property is all our own software. What we want to get to is that we become totally hardware agnostic.

“Right now we can put our software onto a multiplicity of devices, and those devices consist of a bedside terminal, a flat screen TV, on the wall, a nurse station or a clinical station in the room, and ultimately to a tablet and iPad for bring your own device.”

Mr O’Donnell said the key issue in any technology in hospitals is reliability and security. “If you put in a bit of software and somebody else puts in a bit of hardware and both of them don’t work together, who is to blame? We stand over a complete solution, from the back end to the network to the device. Everything is all designed as an entity.”

While the technology has a huge range of functions, Mr Byrne said there were few hospitals that were using to its full potential. For example, the bedside device has a fully functional camera so patients can Skype their families, but ultimately that could be used to monitor older patients who might get out of bed and wander, or to monitor patients in secure wards.

It can also be used to link offsite specialists to the bedside and has obvious application in aged care. “We made the decision early on to put high resolution cameras into our devices, where a lot of people didn’t do that,” Mr Byrne said. “We realised that video is going to be key in the future of technology.”

While Lincor is just beginning to test the potential of the Australian market, both companies are in discussions about replacing some of the existing patient infotainment systems that have been rolled out but aren’t functioning as they should.

In the future, the company is looking at how to transform clinical data into something that can be read and understood by the patient both in and out of the hospital. Currently, clinical data can be displayed to the patient in an easy to read format – for example, colour-coded test results or vital signs – but the company also has a patient portal product that can be used both pre-admission and following discharge as an educational tool for both the patient and their families.

“We are working on making sure that the patient portal provides more and more information to the patient to understand why they’re there, and more importantly to their care giver or even their family who are going to take care of them when they leave the hospital,” Mr O’Donnell said. “It sounds simple, it sounds easy, but it’s just amazing how it’s taken forever to get to this point.

“And the other area that we’re looking at is the whole area of checklists. Before a pilot takes a plane up into the sky the first thing he goes through is a checklist, but if you ask a surgeon to do it before an operation, he won’t, and that’s where errors are made. Simple things are forgotten.

“So what we’re trying to do is develop checklists at the point of care. We have the device there and … and a screen in front of them so they don’t make those errors. That’s the kind of stuff that we want technology to do.”

A panel session hosted by Q&A’s Tony Jones on investing in eHealth and a workshop on the PCEHR are two drawcards at the Health Informatics Conference (HIC 2014), being held in Melbourne in August, along with a US teenager who has developed a new method of cancer detection and patient advocates e-Patient Dave and Regina Holliday.

A program for the conference has been released by the Health Informatics Society of Australia (HISA) for the three-day conference, which will be preceded by four one-day satellite conferences, including the regular Digital Healthcare Design, Nursing Informatics and Indigenous Informatics conferences, as well as a new Participatory Health conference.

This new conference will feature patient advocate Dave deBronkart, better known as e-Patient Dave, who will discuss how engaged patients are changing healthcare. A session on active and independent ageing will also be held to discuss how to use ubiquitously connected technology to engage patients in healthy behaviours and will feature former Tasmanian premier David Bartlett, who had a career in IT and was CIO of the Tasmanian Department of Health and Human Services before entering politics.

e-Patient Dave will also address the main HIC conference in tandem with Danny Sands, co-founder of the US Society of Participatory Medicine. They will discuss the power of ‘e’ in the patient-physician relationship.

Another patient advocate for improved health technology speaking at the conference is Regina Holliday, who made a big impression in her keynote speech at the 2012 HIC conference. She will address HIC 2014 on the second day, along with Stephen Damiani, a Melbourne-based risk management specialist who has set up a foundation to raise funds to investigate rare genetic disorders called the Mission Massimo Foundation, named after a young son who has a form of genetic leukoencephalopathy.

Mr Damiani was the driving force behind gathering a team of geneticists, including Ryan Taft from the University of Queensland, and helped by genome sequencing manufacturer Illumina, that discovered that a mutation in the DARS gene caused Massimo’s condition. The foundation now raises funds for genomic diagnostics, gene therapies and stem cell research.

Budding US scientist Jack Andraka will also speak on the second day. Still in high school in the US, Jack won a $75,000 award at the Intel International Science and Engineering Fair in 2012 for inventing a prototype dipstick-like rapid diagnostic test for pancreatic cancer. He has since given several TED talks, gone viral on YouTube in a video showing his ecstatic reaction to the Intel win, and will discuss innovation and open data at HIC.

He will be accompanied by Hungarian medical futurist Bertalan Mesko, who will present on the digital future of medicine. The duo will then conduct a Q&A session.

A PCEHR consultation workshop will be held on the final day, along with academic streams on eHealth informatics, aged care, realising the benefits of eHealth, and eSafety, featuring the Canadian Health Informatics Association’s Don Newsham and the University of Texas School of Biomedical Informatics’ Dean Sittig, who will also provide a keynote address on eSafety.

The always-popular Q&A panel hosted by Tony Jones will include Department of Health CIO Paul Madden and HISA board member Michael Gill.

The conference will also be addressed by Victorian Health Minister David Davis and federal Minister for Human Services, Marise Payne.

HISA CEO Louise Schaper said the selected international and Australian keynote speakers would set a high benchmark for leadership in innovation.

“Innovation and invention is a theme at every level; it shows the level of energy among HISA members and meets the appetite the health community has for change,” Dr Schaper said.

“To make information sharing easier, for the first time exhibitors will have a newly branded Innovation Expo space where delegates can study, browse and see the future of eHealth for themselves.”

The annual Aged Care Informatics conference will be held on the second day and will be addressed by Alzheimer’s Australia’s Tanya Petrovich on the topic of gaming technology. Paul Fish from continence management company Simavita, which markets a range of “electronic underpants”, will also feature.

Early bird registrations for HIC 2014 close on Monday, June 16. The event will be held at the Melbourne Convention and Exhibition Centre from August 11 to 14.

This story first appeared in the May 2014 issue of Pulse+IT Magazine.

It is no secret that governments are spending more on health and aged care and costs are expected to continue to grow faster than the rest of the economy.

The 2010 Intergenerational Report was a wake-up call because it projected that by 2050, unless there are significant policy changes, we will be spending increasing and unsustainable amounts of our GDP on healthcare, putting pressure on the rest of the budget.

The demand for health and aged care is increasing as more of us will be older as a proportion of the population, but it is also a result of improved treatments, technology and services that people want to access to let them live longer and healthier lives.

The most expensive and complex services are those delivered in hospitals and institutions, such as nursing homes, and whilst it is reassuring that this professional care is accessible when needed, we avoid going there if we can, and older people are no exception.

To read the full story, click here for the May 2014 issue of Pulse+IT Magazine.

NSW Health has released a draft of its rural health plan for the next five years, highlighting improvements in rural eHealth as one of its three main strategies.

The plan has been informed by a number of other NSW Health plans, including the Blueprint for eHealth in NSW and the eHealth strategy for rural and remote NSW.

The draft plan is built around three “directions” – healthy rural communities, improved rural patient experience and rural health services – and has three prime strategies, focusing on the rural health workforce, rural health infrastructure and driving improvements in rural eHealth.

NSW Health has taken on board recommendations from last year’s eHealth strategy for rural and remote NSW in encouraging the six rural Local Health Districts (LHDs) to work with eHealth NSW to collaborate on implementing eHealth solutions.

This includes building greater connectivity across the service network, and grouped investment where appropriate.

A Rural eHealth Governance Group, comprising of the chief executives of the six LHDs and senior executives from eHealth NSW, has been established to develop a governance structure for rural eHealth.

There are six key initiatives, including strengthening eHealth operational and strategic governance by establishing an ICT support framework and change and adoption framework.

The recommendation to implement a Health Wide Area Network (HWAN) has been agreed to, which will set up a direct connection for all rural LHD sites into the core statewide network.

The 25 existing NSW Health internet gateways will be consolidated into three and overall capacity boosted from 1.2Gbps to 30Gbps.

A Statewide Infrastructure Program (SWIS) will include a consistent identity for all rural NSW Health employees, single sign-on to support mobility, and a consistent desktop management and application delivery tool called the System Centre Configuration Manager (SCCM).

Other core infrastructure improvements include allowing rural LHDs to connect to existing telehealth systems across the state, and providing access to booking and scheduling systems and support for high definition mobile video clients. Desktop and mobile conferencing solutions will be integrated into telehealth services.

The plan also commits to the roll-out of HealtheNet, which is NSW Health’s PCEHR project, pioneered in western Sydney. HealtheNet aims to deliver a patient’s clinical information, including access to their PCEHR, in a consolidated view through hospital and community care software systems Cerner and CHIME.

The further implementation of Cerner throughout NSW hospitals will continue under the electronic medical record phase 2 (EMR 2) project.

It also commits to Community Health and Outpatient Care (CHOC), which will deliver a clinical information system to support community and outpatient care for Aboriginal health, aged and chronic care, allied health, child and family, community home nursing, drugs and alcohol, mental health and sexual health.

Electronic medications management will be implemented throughout the rural LHDs, in line with the NSW government’s $170 million, 10-year investment in EMM systems.

A Hospital Pharmacy Product List (HPPL) will also deliver a single list of pharmaceutical products with standardised descriptions, and there will be a statewide approval system for antimicrobial stewardship.

The plan commits to supporting patient access and self-management by raising awareness of the PCEHR and moves to register patients for it through assisted registration tools, this strategy being led by the HealtheNet program in collaboration with Medicare Locals.

The plan also includes some non-clinical IT improvements, including streamlined HR and payroll, and implementing the upgrade from the existing financial management system to Oracle.

NSW Health’s Health Education and Training Institute’s (HETI) online services will also be boosted to deliver standardised education and assessment of staff knowledge across NSW Health.

NSW Health is inviting comments on the plan, which will close on June 9. Feedback can be sent to ruralhealth@doh.health.nsw.gov.au.