Case study: St Vincent's Hospital electronic discharge summaries

This article first appeared in the April 2013 edition of Pulse+IT Magazine.
Sydney's St Vincent's & Mater Health introduced electronic discharge summaries in January last year. Nothing new, you might say, but the difference with St Vincent's is that it is the testing ground for delivering high quality discharge information in a standardised format that all GP software systems can read, and which can be uploaded to the patient's PCEHR at the push of a button.

When St Vincent's Hospital in Sydney began work on introducing electronic discharge summary functionality in 2011, it did so with two clear objectives in mind: to add value to the information sent to a patient's GP, and to ensure safe clinical handover.

As part of its work with the Eastern Sydney Connect Wave 2 project, however, it was also tasked with developing some elements of electronic discharge summaries that have not faced other hospitals or health systems that have instituted the practice, including creating and rendering the summaries as CDA documents, ensuring they can be received in the correct GP's desktop system and viewed through that system, and at the same time developing the ability to upload the summary to the patient's PCEHR.

Those extra elements have been difficult to institute, and the work is far from over, but as of late 2012, the vast majority of patients discharged from St Vincent's are provided with a detailed, clinically useful discharge summary that can be sent to the patient's GP and, at the same time, be uploaded to the PCEHR.

St Vincent's is the first hospital in Australia to achieve this feat, and its clinical information system provider, Emerging Systems, is the first acute care software vendor to integrate the functionality within its installed product.

Now, St Vincent's is able to send and receive four types of CDA documents – discharge summaries, eReferrals, specialist letters and events summaries – to and from GPs, and send them up to the PCEHR through Emerging Systems' EHS.

The module of functionality within EHS that links the GPs to the hospital is called GP Connect, and the module that links the hospital to the PCEHR is called PCEHR Connect.

It has taken a lot of human hours and quite a lot of money, but the team that has developed the new functionality believes that the end result – real information sharing between GP, hospital and patient, as well as improved clinical handover – is a worthwhile objective.

Today, St Vincent's consistently achieves 82 per cent of patients leaving hospital with a discharge summary. That summary contains a great deal of valuable information that is drawn from a number of different systems, including EHS and CSC's MedChart electronic medications management system, to provide a clinically useful document.

According to Adrian Verryt, St Vincent's internal change and adoption manager for the PCEHR, the system has been designed so that the junior doctors tasked with creating the discharge summary need only focus on the clinical content to be included, as the interface with the PCEHR all occurs in the background with minimal input for the clinician.

“There is a clinical synopsis, a summary of the stay, list of discharge medication from our MedChart eMM system, any results outstanding or pending and then follow-up appointments or risks or alerts,” Mr Verryt says. “In terms of filling it out, it's a sequence of tabs that doctors work through and once completed they can finalise the discharge summary.”

The hospital has the patient's GP's details in its database, including the GP's Healthcare Provider Identifier – Individual (HPI-I) and HealthLink electronic data interchange (EDI) address. So from within EHS, the doctor simply has to finalise the discharge summary and press the button. And then?

Then, according to St Vincent's CIO David Roffe, “a miracle happens”.

To read the full story, click here for the April 2013 issue of Pulse+IT Magazine.

Posted in Australian eHealth

Comments   

# Terry Hannan 2013-04-24 22:29
This is exciting work. The concept of e-summaries has been around for decades and measured benefits were shown by Fries and Whiting-O'Keefe in the 1980s. The questions that need to be asked why has it taken so long to get to this point in one institution in Australia and what will be their outcome measures? Also how will they measure the 'quality' of the data and information within the summaries.

Fries. J. Alternatives in medical record formats. Medical care. 1974;12:871-881

Whiting-O’Keefe QW,Simborg DW,Epstein WV,Medical Care 1980;18:842-852

In reference to Coiera's article why is e-health so hard here is another reference on discharge summaries and communication with PCP.
Kripalani, Sunil MD, MSc; LeFevre, Frank MD; Phillips, Christopher O. MD, MPH; Williams, Mark V. MD; Basaviah, Preetha MD; Baker, David W. MD, MPH. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians Implications for Patient Safety and Continuity of CareJAMA. 2007;297:831-84 1

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