Calvary and CSC partner to use PCEHR for end of life care

Healthcare provider Little Company of Mary Health Care and software provider CSC are working together to develop new ways of sharing essential information to better manage end of life care for patients in the Calvary network of hospitals and palliative, aged, community and home care services.

The plan is to develop an electronic solution using CSC's i.PM patient management system, which is installed throughout the Calvary public and private hospital network and in over 300 other hospitals in Australia and New Zealand.

The solution is underpinned by CSC’s Health Information Exchange and is designed to enable much of the NEHTA-specified eHealth infrastructure, including the use of the PCEHR from within CSC products, to share information with external healthcare providers.

Mark Doran, CEO of Little Company of Mary Health Care, said patients approaching the end of life use health services at a higher rate than at any other time in their lives.

“To meet the needs of these patients, we must coordinate care across multiple care episodes,” Mr Doran said. “eHealth technologies that allow us to share information internally and externally are vital to achieving this kind of care continuity.”

Little Company of Mary Health Care’s national director of clinical services, Sue Hanson, said it was nationally recognised that clinicians often had difficulty recognising that a person was approaching the end of their life, leading to difficulties providing appropriate care that was in accordance with their wishes.

“Recognising that a person is in the last year or so of their life does not mean that they are dying, but it does signal a time when we should be starting to redesign their care to achieve outcomes that are closer to their goals and preferences,” Ms Hanson said.

“As a healthcare system we are not very good at that, and even if an individual clinician does recognise that a person is approaching the end of their life, we have a limited capacity to communicate that to other clinicians or to other services that might also be involved in that person's care.”

Little Company of Mary Health Care is planning to embed a screening tool within its clinical practice in emergency departments, medical wards and residential aged care facilities that will help clinicians identify when somebody has moved into that last year of their life.

The organisation has developed an End of Life Care toolkit that includes the paper-based screening tool along with appropriate assessment tools and goals of care records. The idea is to digitise this toolkit, and to use both i.PM and the PCEHR to alert other clinicians and service providers that a person is at risk of experiencing problems or receiving inappropriate care in that last year of their life.

“We use screening tools that are based on evidence that has come out of places like the Centre to Advance Palliative Care (CAPC) in the US, where they are widely used, and we have developed a toolkit that is relevant to the Australian context,” Ms Hanson said.

“The missing link and why this project is exciting is that all of these tools can currently be used within a single episode of care. But we know that people move between healthcare services. Currently there are manual processes in place for attaching records to patients and sending records along, but they often don't work.

“So this is an ideal way, using two tools: the i.PM system, which is used widely across public and private health services, and then the PCEHR, which is an opportunity to connect with people who aren't linked to the i.PM system to share this information between care providers.”

CSC's healthcare solutions director, Byron Phillips, said the project would involve two streams of work: the first to enable the Calvary network to use what he calls some of “the NEHTA essentials”, such as Individual Healthcare Identifiers, organisational identifiers, secure messaging, a view into the PCEHR and assisted registration.

“All those things are enablers of doing what Sue ultimately wants to do and it will obviously open the door to many other care coordination opportunities,” Mr Phillips said.

The second stream of work is the specific end of life care project, which will involve CSC making some modifications to i.PM to allow better triaging of patients entering the last stage of their life.

“There are a lot of people who can be identified for more appropriate care far earlier than we realise,” Mr Phillips said. “When they turn up in emergency departments for example, it not only may be the wrong place for them, but further unnecessary pressure is placed on hospital resources.

“Early triaging is some of the work that we are doing in i.PM to be able to record that and put them on the path of better management in the right care setting, which in future may not always be a hospital.”

Mr Phillips said that some of the work Ms Hanson and her team have done on screening will be stored within i.PM for broader clinician access. “These details will be further complemented by the i.PM PCEHR viewer and with notifications in the PCEHR originating from previous patient episodes to identify screened patients to other clinicians, irrespective of the care setting.”

He said the project will provide a significant opportunity for any of CSC's patient management customers to leverage their existing software to provide real healthcare benefits as a result of the new national eHealth enablers.

“The more patient-related information we can place in the PCEHR that directly improves patient and carer experience and workflow, the more we will encourage its use,” he said.

“We have tried to make the introduction of the first phase very simple and low impact, with the introduction of the patient health identifiers into i.PM, for example, being achieved without the need to upgrade the core i.PM product.

“This is pretty significant for some of our customers with extremely large numbers of hospitals using i.PM. It provides an opportunity for a lot of customers to begin to place rich content in the PCEHR, content that we believe absolutely key to drawing more people into using it.”

Ms Hanson said communicating the patient’s goals of care and preferences about end of life care is key to providing high quality person-centred care as patients move around the health, aged and community care systems. However, she believes there is a lot of confusion about the difference between advance care directives and goals of care.

“Advance care directives only kick in when people can't speak for themselves and where we have had no opportunity to discuss with them their values and choices,” she said. “Most people don't die unexpectedly – almost 75 per cent of all deaths could have been expected.

“Most people have an extended period of time when they are able to communicate with us and share their values, goals and preferences for care.

“Directives are things that operate in the last couple of days of a person's life. I think that will only be helpful for that small number of people who have a sudden death where they had no opportunity to share with anyone, but that's not how the majority of people die. We believe this is a much more useful conversation to have with people earlier.

“What this system will communicate or push up to the PCEHR is the fact that there is a retrievable goals of care document on the system and that the new provider or clinician can retrieve that goals of care plan and verify or extend the discussion with the person or their nominated substitute decision-maker at each intervention.”

Ms Hanson said the Little Company of Mary Health Care and CSC project will develop systems that have broad applicability across multiple settings of care to support better communication between clinicians and service providers, and to support the delivery of person-centred, appropriate and high quality care for all people as they approach and reach the end of their life.

Posted in Australian eHealth

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