Has the worm turned for hospital EMRs?
Coming hot on the heels of our poll from last week that asked whether the very large sums being spent on digitising our hospitals were justified – close to 60 per cent of you said yes – came the news late last week that InterSystems had snaffled the huge contract to roll out its technology for the Northern Territory's public health system.
We always had our money on InterSystems, a relative quiet achiever that has seen real progress with its TrakCare suite, which it markets outside of the US. Trak has had a few other high-profile wins in our part of the world, including for the new hospital at Bendigo and the replacement of a number of best-of-breed systems at Macquarie University Hospital in Sydney a couple of years ago, but this implementation will be watched more keenly than most.
We've been closely watching the progress of other digital hospitals in Queensland and Victoria, which seem to be doing surprisingly well. Surprising because it wasn't that long ago that electronic medical records had reputations not worth spitting on and there were serious questions as to why they were being forced upon unwilling clinicians. Australian Digital Health Agency CEO Tim Kelsey tells an amusing anecdote about a hospital in the US that entices doctors with the promise that they don't have to use an EMR at all.
However, besides the financial and administrative benefits, evidence is starting to come through that EMRs and the whole digitisation process can have a beneficial effect on patient safety and care quality as well. That's not to say that the evidence wasn't there before – electronic medications management systems, for example, have been shown to reduce medication errors – but much of it is anecdotal. These days, quantitative and qualitative data is being collected, and things are looking up for EMRs.
Royal Children's Hospital CMIO Mike South told us this week that surveys of his users showed they thought the hospital's new Epic EMR had improved care quality and the efficiency of their work. Another hospital that has gone through the HIMSS EMRAM process, Princess Alexandra in Brisbane, has been collecting data too.
According to PAH, it has seen a six per cent reduction in length of stay at the same time it has experienced increased activity, including a seven per cent increase in hospital separations and a seven per cent increase in outpatients.
It has also seen a reduction in emergency readmissions within 28 days of discharge, a reduction in pathology turnaround time – between five and 21 per cent in ED and 22 per cent across the hospital – and reductions in ordering certain tests.
In addition to a five per cent improvement in reporting of pressure injuries it has seen some pretty amazing reductions: a 15 per cent reduction in reported falls, a 25 per cent reduction in VTE per separation and a huge 18 per cent reduction in infection rate.
Those are numbers to make any hospital administrator wet themselves and are one of the main reasons why they are so eager to get their hands on big funds for a big roll-out. They might have some more ammunition next week, which we hear is when the long-awaited Digital Hospitals Handbook will finally be published. This will provide a blueprint for how hospitals can step on the road towards digitisation, should the funds become available, and with the way our governments are throwing the money around, that is increasingly likely.
This brings us to our poll question for the week: do you think the worm has turned for EMRs and they are now being viewed positively by clinicians? Sign up for our weekend edition and vote in our poll, or comment below.
Last week's poll asked: Do you think the big sums being spent on eHealth are justified? 59 per cent said yes, 41 per cent said no.