ACT and Queensland hospitals go paperless in ICU
Calvary Hospital in the ACT went live with the MetaVision electronic clinical information system from iMDsoft in its intensive care and coronary care units in late July, joining Canberra Hospital, two private hospitals in NSW and six public hospitals in Queensland in installing the system.
Canberra Hospital has been using MetaVision for over two and a half years, along with the Sydney Adventist Hospital and Macquarie University Hospital. Three large hospitals in Brisbane are currently rolling it out.
The Royal Brisbane and Women's, Princess Alexandra and Royal Children's hospitals will join Gold Coast, Prince Charles, Townsville, Rockhampton, Cairns and Logan hospitals in using the system as part of a statewide enterprise roll out that will hopefully take in the rest of the smaller regional hospitals as well.
Brent Richards, director of intensive care at the Gold Coast Hospital and chairman of Queensland's Statewide Intensive Care Clinical Network, said he hoped the system would be rolled out to as many as possible.
“Politics and dollars are always a challenge but when we do the next three, it will be about two-thirds of the major hospitals done,” Dr Richards said. “There are still some mid-sized ones that we'd like to do but that will be very dependent upon executive buy-in in those sites.”
Dr Richards has been a champion for the new system, which he said is delivering improvements in workflow.
“The first thing is that with automated systems, it is all legible and identifiable,” he said. “You don't quite realise how important that is until you've got it. The more you've got it the more you realise that it is so much easier and safer.
“ICU is incredibly complex and can be quite hard to computerise, because we have a lot of data flow. You want to capture all of that data including the data from the equipment interfaces, which is transferred minutely in MetaVision.
“Giving drugs is a lot more complex because ICU patients frequently have numerous infusions, and there is frequent real-time management of infusions – titrating medication infusions is normal in ICU – and the system has got to be able to capture it.”
MetaVision is able to capture information from the vast range of medical devices used in ICU and present and analyse data for better clinical decision making. At the moment, nurses must manually change the dosage levels for infusion pumps in the system but Dr Richards said it was hoped that at the new Gold Coast University Hospital the pumps would be able to interface with the system so it captures that information automatically.
Dr Richards said simple legibility in clinical notes was one of the main benefits, along with safety improvements.
“One of the best things about iMDSoft is it has a very strong allergies to medications functionality,” he said. “Not many systems do that. If I put in that they are allergic to penicillin and I try to put in any [in that family of antibiotics] it comes up with an alert. You have to double sign it before you can go ahead.
“That is a basic safety mechanism. They are the simple and obvious things, but it also makes it easier to follow pathways. The nurses are probably using that a lot more than the doctors to date – there are numerous evidence based pathways that nurses follow in ICU so they are doing really well with that.
“Medically, we are starting to develop a lot more pathways, particularly admission order sets. What happens there is that your workflow starts to change. One of the reasons why we chose this system is that it has inherent capacity to use pathways. When you use it first you say 'why can't I do what I would normally do', but about six months later you think it's brilliant.”
Toni Laracuente, business development manager for iMDsoft, said the system was specifically designed for the complex environments found in critical care.
“It covers intensive care for adults, paediatrics and neo-nates, and it is also an anaesthetic system as well, so it works in the OR,” Ms Laracuente said. “We also have many specialist departments using it for critical care such as burns, neuro, trauma and cardiology, all areas of high acuity.
“MetaVision allows them to create a fully automated environment and there is no paperwork. It does a full electronic medical record, medications management and decision support, and also all of the very complex IV infusions. There are not many critical care systems on the market because it is an extremely complex area to work in.”
Dr Richards said the Gold Coast ICU is a completely paperless system, with the only paper coming from outside of the department. “All of the observation charts are on the system, all of the notes are in the system, all of our prescribing is in the system, and all of our monitoring of fluids is in the system.”
He said the first six installations were relatively easier than what is confronting PAH, Royal Brisbane and the Royal Children's, as all of those were previously using paper. The three hospitals in Brisbane are changing over from the Philips CareVue system.
Ms Laracuente said that bringing the three Brisbane hospitals over to an enterprise system “is a whole new project on its own”.
“It's not just going from paper to electronic,” she said. “They have particular things that they are comfortable with and have used for many years, so we have to accommodate those organisational issues.”
However, Dr Richards said he believes in getting people to change early and hard. “If you leave it for too long it gets harder and harder,” he said. “It is all about what is best for the patient, so we are going to have to change.Health information systems are about continuous improvement, and therefore there will be constant change.”
While the MetaVision system does have the ability to interface with third-party EMRs, in Queensland it is currently being used as a standalone product. It can draw information from the Hibiscus patient administration system and the AusLab laboratory system, but Dr Richards said he wanted to keep the ICU database as the source of truth for ICU data.
There are no plans as yet to interface the system with the Cerner EMR that is being rolled out in some hospitals in Queensland, as the Cerner system is only a basic version and is not on an enterprise level, Dr Richards said.
“We said early on that unless they ran an enterprise system we were not going to interface, in part because you end up waiting. The question becomes, how long do we wait for everyone else's system before we put ours in, and how does that compromise what we are doing?
“Eventually you have to draw a line in the sand and say, today there are all of these systems out there that we can interface to and there are some that we won't. When they are ready to interface to us, then we can sit down and decide how to do it.”
Dr Richards said one of the most important reasons for choosing an enterprise model and a statewide roll out was to ensure that smaller hospitals could use the system and that pharmacopoeias were standardised across the state, which is particularly important for paediatric intensive care.
“You can still put some subtle variations in locally but we can have a standardised pharmacopoeia,” he said. “We've got the adult model and that's pretty well locked in, and now we are working on paediatrics.
“The big units like the Gold Coast and PA, they are big enough and capable enough to look after themselves, but there is no way a smaller hospital like Rockhampton has got the time to build their own configuration nor the technical ability to maintain a CIS internally. There are on-site coordinators at the smaller sites managing local governance and education, with the technical management of servers and gateways all centred in Brisbane.”
iMDsoft has introduced some new add-ons this year, such as MVpanorama, which provides cross-patient management for critical care, and MVdashboard, a browser-based application for accessing unit and patient data at a glance.
Queensland ICUs have not yet taken these new additions on board, as they are first looking at a newer medications orders and pathways module, Dr Richards said.
An interface to pharmacy systems has not been set up as they differ between hospitals, and infusions can cause a lot of problems for standard pharmacy systems. However, Dr Richards said the pharmacists at his hospital still love the system.
“When they come down to review the charts, instead of having to go bed to bed and review the charts and try to correlate that, which can take 10 minutes per patient, they can now see it all on one system, which saves them an enormous amount of time,” he said.
“And it takes them away from the mundane things pharmacists have to do. Now they have more time to be a clinical pharmacist, which they really like.”
It is hoped that once the three major Brisbane hospitals come on board, the government will find some funds for the remaining hospitals, including Ipswich, Redcliffe, Nambour and Toowoomba.
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