Cross-Tasman collaboration for clinical communities
This article first appeared in the October 2012 edition of Pulse+IT Magazine.
EpiSoft is a secure web-based electronic health record and clinical research software platform designed specifically for use by clinical communities of interest.
One of its first and certainly its most international clinical communities is a group of gastroenterologists and clinical nurse specialists that is working together to not only provide chronic disease management of patients with inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, but also to enable a low-cost, high-value way of conducting clinical trials.
While it was initially targeted at research collaborators, IBD.Net now involves a number of specialists providing clinical care. The technology for IBD.Net is being used at 31 sites across Australia and New Zealand, with a new site recently launching in Singapore, bringing the total to 32.
For Jenny O’Neill, EpiSoft’s executive director and business development director, who wrote the specifications for the system and designed its interface, IBD.Net is exactly what the core product was designed for.
“We have developed a generic health record system that supports clinical research as well as clinical care, mainly targeting particular diseases of interest rather than a broad health record,” Ms O’Neill says.
“It does have a broad health record capability but it’s really designed for the purpose of specialised care. It also supports prospective research and is a low-cost way for investigators to publish their clinical trial protocols and get other sites engaged in participating in their clinical trials.”
In New Zealand, IBD.Net involves clinicians from a number of organisations, including Christchurch District Health Board (DHB), Taranaki DHB, the Shakespeare Specialist Group in Milford, and the Hutt, Wellington, Auckland, Dunedin, Waikato and Middlemore hospitals. It is used by clinicians in six states in Australia as well as the new one in Singapore.
“Basically, EpiSoft supports chronic disease management of the patient in a secure partition of the system and it also supports clinical trials,” Ms O’Neill says.
“It also has a registry capability of de-identified data and benchmarking. So the clinicians have secure partitions where they can manage their own patients and they can benchmark data with each other in a range of different ways – they could do it across the whole group, within set groups that are defined by them, and within a clinical trial group.
“This lets them manage their own patients while at the same time contributing to a de-identified data pool to benchmark outcomes against a much larger group of patients.”
How it works
For the patients, the system’s visit cycle and treatment cycle planner automatically generates a cycle of future appointment dates and test requests. It reminds patients of appointments and requests for online completion of data by SMS.
The treatment cycle planner also incorporates the recording of drug doses in accordance with the standard treatment regimen and a visible audit trail of messages sent to patients is available.
“It establishes protocols of treatment and sets up reminder schedules against a standardised treatment protocol,” Ms O’Neill says. “It can also incorporate requests for secure data capture from the patient as part of the clinician’s clinical workflow, so at a certain point in time, based on the protocol of the patient management, it can say this patient is due to send us a symptom diary, can you please get online and enter it.
“So we have patient secure data capture capabilities as well, which are really effective. They come into a temporary area that is then imported to the record after verification by the clinician.”
Online decision support algorithms have been developed to take complex clinical criteria and create a simple checklist to determine a recommended treatment pathway for a patient or to assess whether a patient is eligible for a particular treatment.
Ms O’Neill says this function is of particular benefit for clinicians with patients taking medication through Australia’s PBS or NZ’s PHARMAC system, as it automates the onerous task of filling out eligibility forms. “The system pre-populates a PDF version of the forms with all necessary data,” she says.
The main benefit of using the system for the gastroenterologists is to provide a low-cost platform for clinical trial data management, Ms O’Neill says. “It combines the interest in research with their clinical care processes. That’s a key benefit and why we are targeting the specialist sector and the academic specialists, but not exclusively.”
For nurses, there are significant time-saving benefits, as the software has been designed to ensure that clinical workflows assist in saving time in clinical care of the patients.
For the patients, the main benefit is in an improved understanding of new treatments, but also the ability to move to a different specialist and take their records with them if they relocate.
“There have been a number of complete record transfers across states in Australia,” she says. “For example, there has been a patient looked after in WA under a professor of gastroenterology over there who transferred the care of their patient when they moved to Melbourne to somebody else.
“They were in a very significantly beneficial clinical trial for that patient, and that patient would have been lost to follow up but we were able to transfer all of their historical records plus their clinical trial information, so they just picked up where the other clinician had left off.”
EpiSoft is also being used by a Division of General Practice in Australia for data capture and reporting for its mental health services provision, along with indigenous chronic disease and a multidisciplinary network of gynaecologists, colorectal surgeons and urologists to undertake quality assurance on patients undergoing surgery for vaginal prolapse and stress incontinence.
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