Administering medicine to a patient at the incorrect dose or frequency or worse, giving medication to the wrong person, can potentially create life-threatening situations.
Reducing the risk of medication administration error rates from 1 in 20 to 1 in 3,000 was just one of several benefits SA Health has achieved by deploying centralised enterprise systems that provide shared electronic health records.
Other work practices have improved during delivery of clinical services as well as outcomes for patients presenting at hospital sites across South Australia. Clinicians can immediately access the medical history of patients presenting at a hospital emergency department, including their interactions at other hospitals connected to the system. Turnaround times from x-ray to completion of a radiology report has decreased from an average of more than three days to the same day.
When this project is complete in the next 12 to 18 months as part of the SA government’s ‘Transforming Health’ initiative, shared electronic health records would have been rolled out at seven hospitals and two rehabilitation services across the state.
Leading the charge is SA Health’s CIO, Bill Le Blanc. Having a single record that is accessible for anywhere allows the department to make transformational changes to the way the health system works in the state, he says.
“We spend an awful lot of money training clinicians but the decisions they make are only as good as the information they base those decisions on,” he says. “So it’s vitally important to get improved information into the hands of those clinical decision makers.”
There’s a real timeliness factor in getting information into people’s hands, says Le Blanc. The time to retrieve a paper-based medical record ranges from 15 minutes to several hours.
“Paper records can get lost or misplaced. If you turn up for treatment at a hospital which isn’t the hospital you’ve previously had treatment at – your paper records at another hospital just aren’t accessible by the doctor who is treating you. So we are vastly improving the quality and accessibility of a patient’s medical history to the treating doctor.
The second part of this transformation, says Le Blanc, is about reorganising services that hospitals are receiving and creating specialist centres of expertise. This is necessary as patient journeys span multiple facilities and access to medical records need to be centralised.
“For example, a patient might have major trauma surgery at the Royal Adelaide Hospital (RAH) but because that hospital is reserved for our biggest, most complex cases, once you recover to a state where you no longer need that level of care, you’ll be transferred to a different hospital for your rehabilitation.
“If you have another episode involving high blood pressure, the ambulance will take you to a different facility. This is where it becomes critical to have one single electronic record to have anywhere – because each doctor that treats you still needs a complete picture of your medical history. You can’t get there with paper medical records,” says Le Blanc.
Biggest change in clinicians’ careers
Le Blanc quotes SA Health’s chief medical officer who said that this change in business practices represents the largest single change that doctors and nurses will see in their entire careers.
“The early adopters had the hardest time with change, and naturally blamed the technology for turning their world upside down. As we approach critical mass with our deployment, the senior medical staff from our earlier sites (who were among the detractors at the time) are now our most vocal supporters.
“They took time away from their own hospitals to come and assist their colleagues through the change at the newest site and this has made a major difference in change acceptance. Plus, the health network executive leadership is now driving the change and adoption so that users see our initiative as technology that is supporting business transformation – not transformation being forced upon them by the IT department,” says Le Blanc.
Big data, better medicine
The medical community prides itself on the phrase ‘evidence-based medicine’ but in reality there are huge sections of medicine that are still based on opinion, says Le Blanc.
Opinions vary about what is the best way to treat a particular condition, he says, and clinical analytics based on big data reporting provides doctors with evidence and outcomes on which to base decisions around standardised treatment protocols.
Treatment for a break or fracture on the femur bone in an elderly patient – a common problem – will vary based on the hospital and the opinion of the treating clinician, says Le Blanc.
“We are not trying to take decision-making away from a doctor but we are trying to inform them to say, ‘the evidence says [this is] best practice when a patient reports with symptoms – you can conduct these tests and look at these things,’” he says.
SA Health currently stores 25 years’ worth of historical demographic information about people who visited hospitals, how long they stayed, when they left, and what Medicare was billed for the services provided.
In addition to this, the electronic medical records system is collecting information relating to the medical issue a patient presented with, tests that were conducted and results of those tests, treatments prescribed and outcomes for patients.
“This gives us a big data repository that we can use to ask all sorts of questions – we can start doing things like ‘virtual clinical trials’ particularly in areas where there is not established best practices,” says Le Blanc.
Capturing data about more than one million people in metropolitan Adelaide has also increased clinicians’ appetites for consumption.
‘The appetite for consumption of this data is much higher than my capacity to deliver it,” says Le Blanc. “Their hunger to consume, analyse and use the analysis to inform better treatment is going to result in improved outcomes for the patient and at a lower cost. Research globally shows that if you give someone efficient treatment the first time, they get a better outcome and it is cheaper on the public pursue as well.”
The Internet-of-Things (IoT) is now moving into the realm of biomedical equipment with patient monitoring devices in the new Adelaide Royal Hospital (ARH) collecting enormous amounts of telemetry data. This information is analysed and included in the clinical record.
“We are implementing automated guided vehicles within the new Adelaide Royal Hospital for the delivery of linen, food, medication and sterile instruments within the hospital,” Le Blanc says. “And the first pharmacy dispensing robot in SA is also being implemented in the new RAH.”
The new hospital also has a wireless location service which provides tracking of staff and assets (such as wheelchairs, beds and infusion pumps), and their status.
“So an orderly, for instance, can be dispatched to collect the nearest available wheelchair based on the location of the nearest chair and the nearest available orderly,” he says.
Challenges in healthcare
Like in many sectors, healthcare organisations’ systems are commercial, off-the-shelf packages, which can be tailored to the way an individual hospital operates. What many people don’t realise is that basic business processes from one hospital to the next are quite different, Le Blanc says.
“And each hospital buys into the argument that we should all use best practice but they don’t agree on what best practice is. So when you put in central systems, you lose the ability to tailor it to the way each hospital works.
That’s largely what is happening around the country when they put in hospital-based IT; they are able to tailor it for the nuances around the business processes in that facility. We are having to standardise a significant number of business processes across our entire hospital system,” says Le Blanc.
This amount of change is causing some friction and anxiety for those in the healthcare sector. This is a major challenge of being a health CIO, he says.
“Another challenge is that my customers are not just demanding, they are incredibly intelligent and extremely well educated. They understand IT and their demands are quite sophisticated. They’re also not backward about challenging you.”
Working in this environment means that Le Blanc is having to implement government policies, and deal with the politics of different government agencies, he says.
“The Treasury controls the purse strings, departments like Premier and Cabinet who want to control whole-of-government policy, can influence decisions around technology and the way you implement it.
“Then there’s the politics within the organisation itself because a lot of the doctors also work in the private sector doing consulting. So it’s a politically, intellectually and technically complex environment.”