NSW eMR Program Update for May 2010

NSW eMR Program Update for May 2010

http://www.emr.health.nsw.gov.au/__data/assets/pdf_file/0011/114887/eMR_Bulletin_-_May_10_final.pdf

E-health move will not be held back by privacy worries, NSW Health says

Health officials advice people worried about privacy issues related to the use of electronic health and medical records to not be doubtful as the real health advantages far exceed the little potential drawbacks.

The deputy director-general of NSW Health, Dr Tim Smyth said the state is working actively on the introduction of e-medical records and is going for a business case to provide electronic prescribing service.

Dr Smyth regards privacy worries related to electronic medical records are overemphasized and can trigger unnecessary concerns.

He said, "I've never seen privacy as an obstacle and it's often used as an excused by some players not to do anything."

He said in a speech at an e-health forum in Sydney, people often confused privacy which is data a person wants other people to know, with the security of that information.

Dr Smyth said, "Being able to transfer information is critical (and) e-health has the potential to reduce errors."

With Healthelink, health records are only accessible by authorized health care providers under the signed contract to "respect the privacy of records and to maintain confidentiality of the information".

David Roffe, CIO of St Vincent's & Mater Health Sydney said people in chronic care usually want to share their health information.

He sad e-health systems for the management of medication cut down errors and NEHTA-compliant secure messaging is the way forward.Adam Powick, consultant of Delloitte e-health stated, "People place a great deal of trust in the health system and for good reason."

The use of passwords, with regard to information security remains a concern, said Dr Smyth, as NSW doctors who moved, for example, from Blacktown hospital to another in the city have to change their passwords due to different systems operated, and he is working to get the issue solved.

Doctors blast data system

By: Terry Deefholts

THE electronic medical records (EMR) system meant to streamline hospital data continues to frustrate North Coast doctors more than six months after its installation.

One US study has found software produced by the same company has increased paediatric mortality in one emergency department (ED).

The study, entitled Unexpected Increased Mortality After Implementation of a Commercially Sold Computerised Physician Order Entry (CPOE) System, was completed by eight doctors and related to the implementation of a CPOE system (produced by Cerner) in the Children’s Hospital of Pittsburgh in 2002.

It found the mortality rate at the hospital increased from 2.8 per cent (39 of 1394) before the CPOE implementation to 6.57 per cent (36 of 548) after CPOE implementation.

Local doctors warned of an increase in mortality rates before the current Surginet system, another Cerner product, was introduced in Grafton last year.

Chairman of Grafton Base Hospital’s Medical Staff Council Dr Allan Tyson yesterday blasted the system, saying standard computer skills were no help when using Surginet.

Dr Tyson referred to a time-and-motion study conducted by a fellow North Coast doctor which found it took four times longer to properly record patient records in the Cerner system than writing it down in the old paper method.

It is understood the same doctor video-recorded doctors struggling to use the system.

“No one is objecting to the concept of electronic records; we know it is the way we have to go,” Dr Tyson said. “But this system is very user un-friendly.”

A screenshot of some Cerner software which local doctors say is similar to the GBH system which is dangerous and inefficient.

He gave one example in which the enter key didn’t save data and move on, deleting and going back instead.

“Queensland and Victoria are using different software, both of which are better as far as I’m aware,” he said.

Another doctor, who has worked in the GBH ED, contacted The Daily Examiner but preferred to remain nameless, described the EMR system as a “total disaster”.

“It’s been bought by the State and rolled out across all NSW hospitals at a cost of between $70 million and 100 million,” the doctor said. “Some patients are still not having notes written. It is easy to document notes in the wrong patient’s chart and the rest of the hospital is still using paper, so the notes from the ED aren’t even in the notes for the rest of a patient’s admission. I have found that it hampers my ability to quickly assess what is going on with a patient when a medical emergency team is called to the ward.”

The doctor said he was about to start a letter-writing campaign on the issue because “to sit back and do nothing is to tacitly approve of the use of an inefficient and potentially dangerous system”.

Professor Peter Croll, head of Information Technology at Southern Cross University, said the Queensland Health payroll system that underpaid, overpaid and missed paying staff was an example of IT systems failing to meet expectations.

Professor Croll quoted Professor Jon Patrick’s critical essay on the failings with the Cerner system which concluded “any clinical information system has to be changeable promptly and at the will of each independent clinical community”.

“The ability to cope with change is often one of the biggest omissions in IT deployment,” Professor Croll said. .

Professor Peter Croll will deliver a free lecture on the risks and benefits of eHealth at the Coffs Harbour campus of Southern Cross University tonight from 5.30pm. RSVP to Donna McIntyre on 6620 3503.

Electronic records step forward for hospital

Electronic records step forward for hospital

The local hospital has taken an advance towards the paperless management of patients with its new electronic medical records (eMR) system. The hospital is the first facility in Greater Western Area Health Service to launch eMR, which is a system designed to help clinicians and other staff manage patient care more efficiently.

The computerised system includes electronic ordering and results from pathology and radiology, documenting care in the emergency department and operating suite and an electronic discharge summary. Other hospitals in NSW have demonstrated a range of benefits using eMR, including having legible records, less paperwork and improved communication of patient information.

Published Friday, 16th April, 2010

* Brock Roberts, a registered nurse, operating the new eMR program.

“This is a very exciting and fundamental change in how we manage patients and their records during their treatment,” said Broken Hill Health Service General Manager Rod Wyber-Hughes.“Local staff have been involved in testing the system and being trained in its use in preparation for the launch and transition phase to an electronic system,” he said.

“It is a new system and we are asking (for) the public’s patience as there may be some delays during the initial implementation phase while staff get use to the system,” said Mr Wyber-Hughes. Sue Beahl, the Nurse Unit Manager for the Operating Theatre, said there were numerous benefits to the eMR. “We can schedule

patients in quicker, track available resources and utilise staff in the operating theatre,” said Ms Beahl.

The eMR’s also work even when the power is out. Ms Beahl said they change over into a “down time” form which allows them to continue functioning. The city will be followed by Greater Western hospitals at Orange, Bathurst, Dubbo and Mudgee.

An initial focus for eMR will be on emergency departments and operating theatres.

Is Brown Qld Health's white knight?

By: Suzanne Tindal

CIO profile Ray Brown stepped in two weeks ago as the latest chief information officer for Queensland Health, hoping to bring some stability to a division that has seen a number of faces move through the head technology spot in quick succession.

Ray Brown
(Credit: Queensland Health)

The health department's technology leadership game of musical chairs started in July last year when Paul Summergreene, who had moved over to health in the closing months of 2007 from his CIO position at the state's Department of Transport, left after less than a year in the chief information officer job.

His contract had been terminated, Queensland's Health informed the press at the time. There had been reports that his expenses were being examined, but the department wouldn't comment on the issue.

His position was filled briefly in an acting capacity by the clinically adept Dr Richard Ashby. Ashby had served in several hospitals in emergency medicine and medical administration roles. The Australian Medical Association was pleased of the appointment because of Ashby's clinical experience.

"We have seen millions of dollars in health IT funding wasted over the years in Queensland, so the appointment of a highly regarded senior hospital clinician who is acutely aware of exactly what is required to provide optimal patient outcomes is very welcome," it said at the time.

Yet Ashby didn't remain long, leaving in January to become the executive director and director of medical services at Princess Alexandra Hospital.

A bit of stability in the leadership of the division for the next little while would be a good outcome for the division, so that's what I hope occurs.

Ray Brown

Queensland Health again had to fill the void with an interim appointment, reaching into the ranks of its information division. Brown had been acting as the executive director ICT service delivery since June 2008, before which he had been pursuing an IT career in the Queensland public service, holding senior roles in the Police, Corrective Services and the former Department of Families.

Queensland Health may have hit the jackpot this time. Brown hasn't followed the pattern of leaving after only a brief stint on the job. Instead, he was appointed formally to the chief information officer position last week.

And despite much attention being directed at the leadership turmoil, the CIO doesn't believe that it has damaged the long-term technology strategy of Queensland Health.

Since 2006, the IT gurus of Queensland Health have had a mission: to bring the state's hospitals into the modern world of state of the art clinical information systems. Summergreene's predecessor Sabrina Walsh had primed the way by obtaining funding of upwards of $650 million over four years for e-health initiatives.

Whichever leader was in the hot spot, the e-health holy grail was never out of sight, according to Brown. "The e-Health strategy has stood the test of time and remained sound. Each incumbent of the Queensland Health CIO role has built on the direction and progress of the e-Health Strategy without the need to re-visit significant elements of the strategy or the project artefacts delivered," he tells ZDNet.com.au in an interview last week.

When the CIO started in the role in the acting capacity, it had been his focus and it would continue to be so for the next few years, he says.

Around 20 per cent ($243 million) of the funding first made available in the 2007/2008 financial year had been spent, Brown says. The remaining 80 per cent would be spent by 2011/2012.

So far one of the standout successes has been getting an enterprise discharge summary system up and running, a national first, Brown says. The system sees hospital reports go out to GPs who can use them to service outpatients. Brown says, 55,000 summaries have already gone out from 56 hospitals, with June next year seeing 120 facilities being capable of issuing the summaries.

The e-Health strategy has stood the test of time and remained sound.

Ray Brown

Another win has been getting a new imaging system coming online so that diagnostic images taken in rural locations could be examined and used to diagnose remotely.

Brown is also proud of a statewide mental health system which can now be accessed by all mental health workers. Queensland is the first state to set up such a system, according to Brown.

Looking ahead, of course, the "big ticket item" will be setting up an electronic medical record for Queenslanders. Brown says that Queensland was on track to meet the timeline recommendations made by the National Health and Hospitals Reform Commission, which suggested every Australian should have an electronic medical record by 2012.

"Generally speaking we're pretty comfortable that where we're at today will allow us to actually achieve most of those time frames that are in that report," Brown says.

Yet Queensland Health's outlook doesn't look as rosy as some, having had a later start than some states on creating the records. "At some level I think we're behind some of the other states," Brown admits. He points out that NSW and Victoria had done more work in that area. He stresses, however, that Queensland Health was ahead in other areas, and could catch up on the systems in which it was lagging.

"The forward work program and the way this organisation is structured is probably going to allow us to certainly catch up if not pass some of those other jurisdictions in terms of their e-health agenda," he says.

However, he can't forget that e-health is only good as long as the systems are reliable. Earlier this year one of Queensland Health's datacentres had a train of small problems which lead to some applications going off line.

Brown acknowledges that datacentres are on the agenda at the moment. "We will be migrating all of our production environments over the next four to five years to the new government datacentres that are being established," he said. Those new datacentres, like the Polaris datacentre in Springfield, have at least a tier three rating.

At some level I think we're behind some of the other states.

Ray Brown

There isn't really a planned time for migration, according to Brown. As the department refreshes equipment, the new equipment will be set up in new datacentres instead of in the current ones. The electronic medical record will be established straightaway in a new datacentre.

Along with updating datacentre facilities, Brown will also be looking to make hospitals wireless as the electronic health agenda comes online. The department has recently been doing trials with Cisco to gauge how mobile devices can benefit the health environment.

The results have been positive. Yet in order for mobile devices to have the required affect, older hospitals need to be networked. With only $60 million budgeted this year for all IT infrastructure, this could require an additional line of funding. "That won't cover wireless for the state, that's for sure," Brown says.

This is unlikely to be the only roadblock to Brown's goals in what will be a challenging period of e-health implementation. Yet, most importantly for Queensland Health, Brown at least looks set to remain for a time yet. This will likely bring a little more stability to the department which has seen CIOs pass through too quickly.

"A bit of stability in the leadership of the division for the next little while would be a good outcome for the division, so that's what I hope occurs," he says. And, as mentioned before, he believes in the e-health chalice he has been handed, which could be half the battle.

Make e-health funding priority: AMA

By Karen Dearne

THE Australian Medical Association has called for priority funding for e-health adoption, saying the roll-out should start with e-prescribing and electronic sharing of essential patient information.

E-health is one of seven key areas identified for urgent action, with AMA president Andrew Pesce handing the doctors' Priority Investment Plan to Prime Minister Kevin Rudd and Health Minister Nicola Roxon at a meeting in Canberra.

The AMA wants the Federal Government to assume full responsibility for funding the nation's public hospitals, with the states retaining control over operations and local governance arrangements.

Dr Pesce said the time for talk was over.

"We are offering real solutions to real problems," he said.

"The AMA fully supports the roll-out of e-health initiatives in order to integrate systems, reduce fragmentation and duplication, streamline service delivery and improve quality and safety.

"Priority needs now to go to funding the infrastructure for e-health - especially electronic health records - given that the investment to date has focused on development of standards and technical specifications."

But the AMA rejects the recent National Health and Hospitals Reform Commission recommendation that patients should control their own e-health records, saying medical practitioners should control the electronic sharing of patient information between healthcare providers.

Dr Pesce flagged doctors' concerns over person-controlled health records at an e-health forum last month.

The AMA's action plan for investment includes closing the health gap for Indigenous Australians; boosting patient access to GPs and allied health services; medical training and a restoration of facilities for people with mental illness and sub-acute care.

The AMA also wants to see remote communities wired-up for e-health services such as telehealth and web-based consultations.

And it suggests a new monitoring system, Bed Watch, should be implemented to allow continuous reporting on the number of beds available in public hospitals, and to identify occupancy issues such as access block in emergency departments.

NEHTA releases strategic plan

By: Karen Dearne

THE National E-Health Transition Authority has released a strategic plan repositioning itself as an implementation agency with a role well beyond its present funding to 2012.

"Since its establishment, there has been a misalignment between NEHTA's current direction and the expectations of the various stakeholder groups," the plan says. "As the organisation evolves it is important to ensure a foundation exists for 'what' it has been put in place to deliver."

NEHTA will "co-ordinate and manage the uptake of e-health systems which are of a high priority, interoperable and scalable" nationwide.

Chief executive Peter Fleming said the 2009-2012 plan outlined how NEHTA would fulfil its mission in relation to delivering the National E-Health Strategy adopted by the Council of Australian Governments last December.

"We have considered our future work program based on the (Deloitte) strategy and other important work completed this year, including the National Health and Hospital Reform Commission recommendations," he said.

"As a result we have produced our plan to clearly show our stakeholders the directions we are taking to drive the adoption of e-health."

The four priorities echo program outlines produced by the organisation since its creation as a not-for-profit company owned jointly by all state and federal governments. These are to urgently develop the essential foundations required to enable e-health; coordinate the progression of the priority e-health solutions and processes; accelerate the adoption of e-health, and lead the progression of e-health in Australia.

However, the 46-page document contains little new information, and lacks clear action plans or timelines, with most of the real work scheduled post-2012.

While the Deloitte strategy recommended establishing a fresh, independent, national e-health body to handle investment, implementation and regulatory functions - potentially leveraging NEHTA's assets - NEHTA says it is "in a unique position to drive the e-health agenda" within Australia.

"NEHTA has an overarching sense of the landscape of e-health, both nationally and internationally," it says. "This places us in a strong position to orchestrate key activities and inform key decisions."

In January, Mr Fleming told The Australian a number of large-scale production pilots would start this year but so far there has been no major announcements.