Kids' network looks outward to portals and linking with Lync
The Sydney Children's Hospitals Network (SCHN) is hoping to implement a patient portal, self check-in kiosks and the use of Lync or Skype for patient to clinician communication in the next year or so as part of its five-year strategy for a digital approach to health.
The network, which was established in 2010 and is the largest network of hospitals and services for children in Australia, includes the Children's Hospital at Westmead in Sydney's west and the Sydney Children's Hospital at Randwick in the east.
As SCHN's director of clinical integration Cheryl McCullagh says, the creation of a network with facilities 50km apart “gives you a kick in the pants” when it comes to implementing electronic systems, so a five-year Information Management and Technology Strategy (IMTS) has been developed involving both corporate and clinical systems as well as infrastructure improvements such as WiFi and patient and equipment tracking.
As part of the overall IMTS is the Memory strategy – or My Electronic Medical Online Record – which aims to have a fully integrated health record for children implemented by 2017. As Ms McCullagh told an Australian Information Industry Association (AIIA) NSW healthcare special interest group meeting late last year, part of the Memory branding is to reiterate that the strategy is aimed towards a shared memory of all patients' health history.
The IMTS includes a large amount of work including the development of an electronic medical record, much of which is based on Cerner's EMR, as well as electronic medication management, due to be introduced this year, and some redesign of the pharmacy system. Each hospital is implementing what it needs on its own timescale, but by 2017, the plan is to link the two record databases to become one SCHN patient record with a view to also creating a patient-owned shared record for shared care on a mobile app.
Ms McCullagh said that in addition to ensuring corporate and clinical systems worked together, implementing back-scanning of paper records and introducing new systems such as EMM, the network has taken a more outward-facing view to see how patients, their families and the wider health community can become involved.
“What we had before was very inward looking and focused very much on getting our EMR together,” she said. “It didn't have a lot of automation and it didn't have a lot of integration with the rest of our corporate systems. Our next roadmap really looks more at that outward-looking stuff and says we need to connect with the rest of the world to make this more efficient.”
Part of this is developing a patient portal as well as more widely using the existing Lync video conferencing and document exchange system already used in the network on a corporate level. Both hospitals have a number of family advisory councils, mainly based around the different specialities or conditions, but the network has also recently formed its own council to ensure patients and their families get their say.
“We talked to our patients and our families,” Ms McCullagh said. “If you're not actually serving the people that you are supposed to serve then you are not doing your business right.
“We asked some what they wanted and they said their biggest issue was that they felt unsafe because the communication between their teams and the providers internally and externally wasn't actually consistent enough that they could rely on it.
“They felt they had to carry the information with them all the time. This is something that we want to address in this integration. They also didn't understand why they were waiting, why there were gaps between services, and they didn't have any visibility of those times when they were waiting a lot and what they should be doing in between.
“We also looked around the world to see what was going on in this space and patient portals and the integration of communication systems for patients, external providers and internal providers is really the direction that people need to take to get to this sort of integrated care. That is how we've approached the next step in the strategy.”
In addition to improving wayfinding, the roll-out of Wi-Fi at both hospitals as part of SCHN's infrastructure strategy has been fast-tracked as families wanted access to the internet, she said. “It is for them first, and clinically second. That has been a key part of our decision-making.”
Ms McCullagh said the whole network – which also includes the Newborn and paediatric Emergency Transport Service (NETS), the Pregnancy and newborn Services Network (PSN), the Children's Court Clinic and palliative care service Bear Cottage – uses Lync and other interactive forms of communication to a high level and had made the organisation efficient on the corporate side across each facility, but it had not yet been used much in patient care.
“We've used that a little bit in telehealth but not much more than that,” she said. “We think there's a capacity to use this to make our workforce more efficient, so we are going to focus a lot on trying to create a relationship in a patient portal where we can provide one-to-many kinds of service.
“We can have group services, we can have video services and we can potentially exponentially increase the efficiency of our workforce. There is a lot of repetitive work in clinical work and a lot of education.”
The network's current roadmap is leading it towards achieving HIMSS level 6 – Ms McCullagh said it was recently evaluated at 5.2, which she thinks is a bit of a stretch – and which she places a lot of importance on.
“It gives a lot of credibility to the direction that we are taking,” she said. “The evidence shows you really only get that efficiency and return on investment at level 6 and more so at level 7, so that's why we have headed very strongly to reach level 6 to try and get some of those efficiencies.
“It is such a powerful thing to say that there is a worldwide organisation that measures this and says you can get to this point and have a 97 per cent decrease in errors, or you can have a multimillion dollar or billion-dollar impact on your overall health budget.”
The ultimate aim, however, is to have “a lifetime e-record for all," she said. “It is not just the clinical but the corporate processes, so we put data it once, we use it all the time, it is always safe, it is always available and it will inform our processes and make us more efficient.
“There are a lot of loops particularly in chronic care with patients coming back into the system – about half of our population is our chronic care patients – so we do need to keep that continuum.
“It is an aspirational story but is also a realistic one, because the technology is here. It's not the technology that is holding us back.”
Posted in Australian eHealth