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

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.

Paper patients' notes out, digital records in

By: Louise Hall

BY THE end of next year, every public hospital in NSW will move from paper patient notes to electronic medical records that can be accessed by any health worker, the Government has announced.
The Minister for Health, John Della Bosca, said the $100 million project to digitise 250 hospitals will save money by eliminating duplicate diagnostic tests and imaging. It will also improve patient safety by alerting staff to a deteriorating patient and reduce the likelihood of errors.
Mr Della Bosca said doctors, nurses, allied health and social workers will be able to access a centralised repository of a patient's medical chart, laboratory results, prescriptions and referrals, no matter where the patient enters the health system.
Peter Garling, SC, recommended an urgent roll-out of electronic medical records (eMR) in his special commission of inquiry into acute care services, which found NSW's record-keeping system is "a relic of the pre-computer age" that puts patient safety at risk.
He said various hospitals and community health centres have established ad hoc databases but they were "spasmodic and patchy". The inability of distinct IT systems to synchronise with each other and lack of IT support staff meant clinicians had to rely on incomplete data to make important medical decisions and spent time chasing information.
Mr Della Bosca said the Government would make implementing information and communication technology within its capital works program a priority, which will make NSW Health the biggest IT user in Australia.
A basic eMR system that allowed clinicians to order diagnostic tests and view results online was successfully trialled at St George, Calvary, Sutherland and Lismore hospitals last year and by last month 20 hospitals were using it.
"Prior to the introduction of eMR, some requests for medical imaging and pathology could require referral back to the requesting clinician due to incomplete or illegible hand-written records," Mr Della Bosca said.
"This technology will improve the efficiency of hospital care and free up doctors and nurses to focus on patients and not paperwork, which will further improve patient safety."
The next step will link hospital-based records to primary care providers, such as GPs, by way of an electronic discharge summary.
But the Health Action Plan For NSW, released in March, revealed the Government would not meet Mr Garling's 18-month deadline for a digital radiological imaging system. This is to be set up in every public hospital to electronically transmit medical images to remote locations.
And an electronic health record, which would extend patients' information beyond hospital walls to all GPs, specialists and health systems in other states, was not possible without a national e-health strategy, it said.
A report commissioned by the Federal Government last December found state and federal governments have spent $5 billion on electronic health initiatives over the past 10 years but have made little progress towards creating a national system for sharing information.
NSW Health has admitted that two previous attempts to implement electronic medical records in 1991 and 1999 had failed, at a cost of $12 million and $30 million respectively.
The National Health and Hospitals Reform Commission has recommended an individual patient-controlled electronic health record owned by the patient who decides which health care providers can access it.

$96m medical IT system useless: whistleblowers

By: Nick Miller

A NEW $96 million computer system for Victorian hospitals that promised to cut down on dangerous medication errors will be almost useless when it goes "live" this year, insiders say.
Other new computer systems that handle finance and manage patient records are plagued with serious problems that take days, even weeks, to fix.
And in a further embarrassment for the years-overdue $360 million HealthSMART program, a hospital chosen by the Government to be a flagship "lead agency" — Ballarat Health System — has quit the project because it could not justify the expense.
An anonymous letter from "health-sector employees" sent to The Age says the Cerner clinical systems, intended to cut down on mistakes in doses or combinations of medicines, is being rushed into hospitals — with none of the medication functions working — so the Government will not be embarrassed before next year's election.
"The whole reason for this system was to introduce electronic medication," the letter says. "But next year is an election year and we must hit the agreed dates. This means the system will be almost useless when first live."
Documents released to The Age by the Department of Human Services under freedom of information, and the department's own website, confirm that when clinical systems go live at the first two hospitals late this year, they will not include its most significant functions.
These include ordering pathology tests or medical scans, medication management for emergency patients or inpatients, and "decision support" functions that cross-check drugs and doses.
Leaked reports show other new HealthSmart systems are highly unreliable.
In the last quarter of 2008, the reports showed serious problems with the "PCMS" system, which tracks patient records, books operating theatres and warns doctors of a patient's particular allergies or chronic health problems.
As of December, the system was used at five health services, including Northern, Frankston and Royal Women's hospitals.
Hospitals also reported major problems with the FMIS financial software that runs budgets, purchases, accounts and assets at seven hospitals, including Box Hill, Northern, Frankston, Monash and Peter Mac.
Ten hospitals were targeted for the Cerner clinical system, with Eastern Health, the Royal Victorian Eye and Ear Hospital and Ballarat Health Service as "lead agencies". The Age's FoI documents say Ballarat is "unlikely to proceed given costs included in business-case".
One hospital CEO told The Age he "will be very surprised if it stacks up", as the system cost hundreds of thousands of dollars to run each year.
Another senior Victorian health IT expert said most hospitals would never take up the software. "No one likes using it because it's s---," he said. "It's totally inflexible."
A Health Department spokesman denied all the allegations, without giving any detail.
A spokesman for acting Health Minister Lisa Neville denied that hospitals were being pressured over HealthSMART to avoid embarrassment before the election.
Opposition health spokeswoman Helen Shardey said it was vital that Victoria's hospitals got a modern IT system, but the Government was failing to deliver one. "It's a massive cost to health services, and it seems the timing is being driven by the next election rather than the best clinical care," she said.

NSW a silent success in e-health

NSW is leading the country in e-health with both doctors and patients benefiting from new technology, but why wont Health Minister John Della Bosca tell us about it, writes Bryn Evans.

When will some really good health news get some coverage? While the media has recently been fixated by the world financial crisis, political backstabbing, or the misdeeds of the latest rogue doctor, real progress has occurred in NSW e-health that will bring far-reaching benefits to everyone in the state.

On 1 October last year, St George Hospital implemented an electronic medical record system (eMR) for some 2300 clinicians across its emergency department, all wards including pathology and radiology, nine operating theatres and more than 300 outpatients clinics, and allows electronic discharge forms to be sent to general practitioners. The project has been hugely successful, and is the start of a state-wide program by NSW Health to introduce the eMR to every hospital in the state.

The eMR system was first deployed at the St George Hospital in the South Eastern Sydney & Illawarra Area Health Service (SESIAHS), followed by Calvary and Sutherland hospitals, and will be rolled-out to each hospital in the Area Health Service for some 1.3 million people.

All hospitals in the Illawarra region will go live in the next two months, followed by the Northern Coast Area Health Service which is in the middle of its eMR roll out.

In time eMR will spread state-wide.

Some Area Health Services with earlier, less comprehensive eMRs, are planning upgrades.

So why does NSW Health Minister John Della Bosca not tell us about it?

The eMR rollouts mean that patients treated in SESIAHS will have their patient details, medical history, test results and treatment notes updated and instantly available to any clinician attending to them.

No more tedious and inefficient questions such as “Which hospital and doctor did you last see?”, “What did your last test results state?”, “What medication are you on?”, or “Do you have your ultrasound scan with you?” that drive every patient to distraction.

There will be an immense improvement to patient safety as the eMR becomes available everywhere in NSW.

Adoption of an eMR on this scale is the most ground breaking IT project undertaken in Australian healthcare, and NSW Health is leading the way. It is the first step in a journey to provide electronic information that better supports clinicians and brings improved care to patients. Work procedures and practices will be fundamentally transformed as knowledge is shared to provide better patient care.

The eMR finally brings the benefits of ubiquitous online access, akin to electronic banking, within the reach of clinicians and health consumers. It also provides the foundation of information for the personal electronic health record, which health consumers could access over the Internet within the foreseeable future.

But why cannot NSW Health tell the public about this success?

Maybe they are scared of success, and the resulting demands by the Garling Inquiry for more funds to speed up deployment.

For once NSW Health have some really good news. It is following best practice, and has got it right, so they should tell us about it!

Vic rethinks e-health

By: Karen Dearne

VICTORIA is ruling a line under its patchy HealthSmart IT rollout, and has returned to the drawing board with plans for a new whole-of-health ICT strategy for the period 2009-2013.

When the now-$427 million program began in 2003, it was hoped that the ICT refresh and rebuild across the state's public hospitals, rural alliances and community health providers would be complete within four years.

But in April this year, Victoria's auditor-general Des Pearson said HealthSmart had been overly ambitious in its targets, and was at least two years behind schedule.

More than half of the original budget had been spent with only 24 per cent of the planned installations complete.

The audit office found that HealthSmart had failed to get the cornerstone Cerner clinical system working at any of its sites, and had replaced only one of 10 HOMER hospital systems which were obsolete when the program began.

Mr Pearson said the project judged most at risk, but with the greatest potential benefit, was Cerner's Millennium suite of e-health records, appointments scheduling, diagnostic services, results reporting and e-prescribing applications.

A $79 million deal with Cerner was signed in March 2006, but costs had risen by $17 million to $96 million in 2006 - the biggest price blowout so far, the audit office found.

"According to the original timelines, the acute hospitals in 10 health agencies should be using the clinical sysytems by now, but even if funding negotiations are concluded shortly, the first four agencies are unlikely to meet the June 2009 completion date," Mr Pearson said.

The department and the Office of Health Information Systems _ which has led the project _ have weathered repeated criticisms over technical and vendor aspects, including contract probity concerns raised in the state parliament.

It's also understood many of the state's health boards have raised concerns over the selection of systems and the likely cost to agencies of adopting the strategy.

Human Services secretary Fran Thorn defended the program at the recent Health-e-Nation conference in Melbourne(September 3), saying the first implementation of the Cerner suite would "formally commence" in October.

"Engagement with the next round of health services is underway in anticipation of rolling out to agencies over the next two years," she said.

HealthSmart was also rocked by early concerns over vendor iSoft's financial status and ability to deliver its next-generation software architecture, Lorenzo, as promised.

IBA Health Group bought out iSoft, and has taken over its contracts to supply the existing integrated patient and client management system, iPatient Manager.

To date, four agencies have implemented iPM, Ms Thorn said, and nine standalone health services are now using the client management system, TrakCare.

"Eight health services and 22 community health services will have these systems by this time next year," she said. "The integrated products support the management of patients across acute and community services, rather that just sharing data."

Last month, the Victorian Government allocated a further $104 million for HealthSmart in its 2008-09 budget.

Ms Thorn said HealthSmart would give the state ``one of the most up-to-date and capable health ICT infrastructures in Australia, ready for the future and able to adapt'' to a changing environment.

``Indeed, HealthConnect Victoria is leveraging off the investment in infrastructure and applications,'' she said.

``In partnership with our federal colleagues, a Shared Electronic Health Record project has been established to prototype a limited SEHR system across a number of public hospitals, primary and community care providers in the Bendigo Loddon/Mallee region.''

This project has received more than $1.5 million in federal funding, from October 2007 until June 2009.

HealthSmart two years behind schedule

By: Karen Dearne

VICTORIA's troubled $320 million HealthSmart project has failed to get the cornerstone Cerner clinical system working at any of its sites, and has replaced only one of 10 Homer hospital systems, which were obsolete when the program began four years ago.

Auditor General Des Pearson said HealthSmart was at least two years behind schedule and more than half of the budget had been spent with only 24 per cent of the planned installations complete.

In a long-awaited review, Mr Pearson said the original budget, which involved health agency co-funding, was not realistic, and the targets were too ambitious.

Victoria's Human Services Department and the Office of Health Information Systems have consistently deflected concerns raised in the state parliament by vendors, industry observers and even an anonymous group of healthcare workers.

The project judged most at risk, but with the greatest potential benefit, is Cerner's Millennium clinical suite, which includes health records, electronic scheduling, diagnostic services, results reporting, and e-prescribing capabilities.

"The first release of the clinical system has been tested by various user groups and is ready for use, but none of the four lead agencies have committed to using the new system," the report says. "According to the original timelines, the acute hospitals in 10 health agencies should be using clinical systems by now, but even if funding negotiations are concluded shortly, the first four agencies are unlikely to meet the June 2009 completion date."

The $79 million deal with Cerner was signed in March 2006, but costs rose by $17 million to $96 million in 2006 -- the biggest price blowout in the program.

A Cerner spokesman yesterday declined to comment, citing contractual obligations.

Reation suite.

ISoft ran into difficulties supplying systems to the British National Health Service Connecting for Health program, and was subsequently acquired by another Australian firm, IBA Health Group.

Communications director Greg King said IBA Health was "comfortable tracking to the time frames set by HealthSmart" for completion in 2009.

"The procurement process took longer than expected and the project started nine months later than anticipated, so the department, lead agencies and we as vendor are doing quite well catching up," he said.

"We've got nine lead agencies in our portfolio. We already have three live, we have one in implementation and two others are in the planning stage, so we've only got three sites pending."

Mr King said it was "always good to have a third pair of eyes looking at large projects" such as HealthSmart.

"We don't see anything in his report that we have any major disagreement with," he said.

Oracle achieved the best result among technology suppliers, with its E-Business financial management system implemented in eight of 11 participating agencies. The remaining three were due for completion this month.

Mr Pearson found the Oracle project came in $500,000 over the original budget, at $26.8 million.

TrakHealth has set up its standalone Client Management System in two community health centres, and a further 10 sites wish to install the product.

Mr Pearson found there was "room for improvement" in the shared services arena, where underperformance had a knock-on effect on systems availability.

Meanwhile, a lack of interest by agencies in taking up the payroll system might "trigger" payment of a revenue guarantee to the vendor.

Victorian shadow minister for health Helen Shardey said the auditor's findings were not unexpected, but the extent of the project's failure was a surprise.

"We have supported this kind of technology to bring our health system into the 21st century, so the massive failure is a tragedy," she said. "The project has been completely botched, and it points to a government that is just not capable of delivering on these important projects."

UnitingCare Health Extends Relationship with Cerner

UnitingCare Health (UCH) announced today it has chosen Cerner (NASDAQ: CERN) to remain as its healthcare information technology (HIT) provider for clinical and patient administration system solutions. Commencing their relationship in 1999, the two organisations recently signed a five-year deal, which will provide solutions to all of the health system's hospitals, including The Wesley Hospital and St Andrew's War Memorial Hospital.

"The business of providing private healthcare has become more challenging and highly cost competitive,' said Richard Royle, UCH Chief Executive Officer. 'I'm pleased to affirm that Cerner remains the best fit to our business needs."

UCH conducted an extensive market evaluation of the HIT software suppliers in the Australian healthcare market. The hospital conducted the evaluation, which spanned two years, to ensure it would remain competitive in the changing business environment in Australia. UCH decided to renew its contract with Cerner because it provides the best fit for its business needs and best value for investment.

'UCH has a strong reputation in providing high-quality care in Queensland,' said Rick Heise, Cerner Asia Pacific Managing Director. 'We are proud to extend our relationship with one of the top not-for-profit healthcare systems in Australia, and will continue to work together with UCH leadership to help them continue to deliver safe, efficient care to their patients.'

The five-year agreement will facilitate further enhancements of the Cerner Millennium^® solutions currently in use at UCH.

About Cerner

Cerner is taking the paper chart out of healthcare, eliminating error, variance and waste in the care process. With more than 6,000 clients worldwide, Cerner is the leading supplier of healthcare information technology. The following are trademarks of Cerner: Cerner, Cerner Millennium and Cerner's logo. NASDAQ: CERN. www.cerner.com.

About UnitingCare Health

Launched on the 13th of June 2000, UnitingCare Health now operates one of the largest not-for-profit private hospital groups in Australia. Our group of hospitals contain over 1,000 licensed hospital beds spread amongst our five facilities:

The Wesley Hospital

St Andrew's War Memorial Hospital

The Sunshine Coast Private Hospital

St Stephen's Hospital, Maryborough

St Stephen's Hospital, Hervey Bay

Today the group employs over 3,500 staff, being a mix of full-time, part-time and casual. UnitingCare Health will admit around 90,000 Queenslanders in this 12 months and undertake around 63,000 surgical procedures. In the last financial year, the group had a total annual revenue in excess of $350 million which will be used to improve our services and facilities.

NSW eMR Program

I was recently reading this old article announcing NSW's answer to an e-health solution. Since this project was supposed to be completed by the end of 2009 I thought I would do some further research into it's progress. So far of the 8 area health services that were supposed to be part of this program there is a total of ... wait for it ... zero that are live. Not surprising for a project of this magnitude and considering NSW and Sydney spent 129 million on bringing the Pope to town this year and only 40 million on this vital project. That being said, South Eastern Illawarra Health Service is set to "go live" at St. George sometime at the end of the month and North Coast Area Health Service is set for its first site to turn on in October. We will be watching.