Whole-of-life clinical repository through The Viewer

It’s not easy to impress armed services personnel, but when the Wide Bay Health Service District triaged patients for three air-evacuations to Brisbane during Bundaberg’s recent flood, the RAAF loadmaster was heard to say that he wished all airlifts could run so well.

When it became clear that ex-Tropical Cyclone Oswald’s floodwaters would close Bundaberg’s hospitals, staff quickly generated discharge summaries so that the receiving hospitals could assess them in Queensland Health’s The Viewer portal, which accesses the state’s clinical data repository (CDR).

Intensive care and neonatal patients were first sent to the city’s sole hospital with a safe electricity supply, then evacuated by the Royal Flying Doctor Service.

A further 123 patients needed evacuation, and were sent to the airport with a three-day supply of their medications to reduce the strain on receiving hospitals. Using the information from their discharge summaries, health service staff were able to triage them for the three flights on the air force’s C-130 Hercules transport planes.

(GP software vendor Best Practice also jumped into action during the floods, providing free copies of its clinical software and computers for use in local disaster clinics for volunteer doctors treating evacuees and those people displaced by the floods.)

On arrival at their receiving hospital, each patient's information was able to be viewed by Brisbane staff so that the appropriate care could be given.

When Bundaberg’s hospitals were back in action, local patients evacuated to Brisbane were able to be re-admitted with discharge summaries from their time down south.

It was a huge turnaround from the situation in 2011, when Cairns patients escaping Tropical Cyclone Yasi had come to Brisbane with plastic bags filled with their paper records.

In the two years since The Viewer’s release, it has been taken up by 235 facilities state-wide.

“It's the foundation of a shared electronic medical record for patients in Queensland's public hospitals,” Paul Carroll, senior director at the department's Health Services Information Agency, said.

“[The Viewer] was something we never had before and gives our clinicians access to patient details, encounters, procedures and ED information, medication summaries, pathology and radiology reports, adverse reactions and discharge summary information.

“The success of the system is evidenced by its adoption rate and you have something like an average of 64,000 views per month now, just 12 months after it was rolled out.”

Queensland is unusual in that historically, records have been centralised, even though patients often access the system through a combination of community clinics, small and regional hospitals as well as tertiary facilities.

It is understood that other jurisdictions have shown interest in developing a similar functionality, but that proves almost impossible with decentralised systems.

Some of the clinical value is in cases in which a patient is unconscious, unsure about medication, can’t remember previous operations, or is managing a chronic condition such as diabetes.

Administratively, Mr Carroll said The Viewer comes in handy to find patients in the system, or to analyse reports, which can now take place in a matter of hours instead of days.

“Where previously locating a paper chart could take time, The Viewer means doctors have some key patient information at their fingertips on one screen,” Mr Carroll said.

“Wherever the old paper system takes time, we don’t have that any more.”

Users have taken to it with alacrity – there has been a 70 per cent increase in views over the last year – and downtime is minimal, principal project manager (technical) Paul McKee said.

“It's available on every desktop 24/7,” he said. “It's designed around the most recent .Net Framework. It's flexible – the user interface is ours so we can modify it to add more things to it.”

It is a busy time at the moment for The Viewer project team. The data repository is going through an upgrade that will significantly improve response times and use 90 per cent or less of current storage requirements. At the moment there is enough storage space to last until 2033.

“It’s fair to say we came to a realisation that the front end was fine but the back end was really worrying in some respects – in terms of longevity and storage space,” David Evans, The Viewer’s project sponsor and medical superintendent at QEII Hospital in Brisbane, said.

“This is going to be a big repository one day – whole-of-life for many people.”

The eventual reality of having ante-natal to post-mortem data for entire families would also be a boon to researchers, although The Viewer is not yet a research tool and there is no plan on the table to keep a separate repository of de-identified data.

New systems are also coming into The Viewer. In the next six months, radiology department reports from six more hospitals will be added to the ranks of the 98 hospitals already in the portal.

By the end of October, as part of the National E-Health Strategy, Queensland will be uploading discharge summaries to the PCEHR.

“We’re also going to expose the PCEHR to Queensland Health doctors through The Viewer,” Mr Carroll said.

“So if you are navigating a patient in The Viewer, you’ll hit the PCEHR button, and it will then go in and search the PCEHR. If there’s any information on that patient, it will then bring it up to the Queensland Health doctor.”

The plan is to have PCEHR linked to The Viewer by the end of this year.

Mental health reports, in the form of a summary document, will enter The Viewer for the first time in 2014.

“We understood that up to 20 per cent of admissions to emergency departments are related to a patient with a mental health history,” Mr Carroll said. “In Queensland we are trying to demystify people’s perceptions about mental health.

“The mental health project team is leading this agenda to share mental health summary information via The Viewer, and it’s hoped that if we can make this information available, particularly at the point of presentation ... the clinicians will be more equipped to provide the necessary care.”

Queensland Health is conducting a separate project with Cerner to deliver an integrated electronic medical record (ieMR) for its hospitals. It is hoped that the ieMR will be made available statewide via The Viewer. Implementation of the Cerner ieMR will take place between 2014 and 2016.

“We’ll add systems in as we can,” Mr Carroll said. “We’ve got 30 or 40 feeds that people want.

“It’s in-house, so we can do those things as the need arises or the demand from the PCEHR requires it.”

The project team hopes to migrate more enterprise systems – such as cardiology, endoscopy, and anaesthesia – into the CDR in 2014.

Posted in Australian eHealth

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