Clinical

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eHealth NSW in Australia has announced that it will be working with a number of industry partners to enhance the safety and quality of patient care, with clinicians at one of the state’s major rural hospitals harnessing the power of digital tools in two proof-of-concept (PoC) projects. At the 325-bed Wagga Wagga Base Hospital in the state’s south-east, eHealth NSW and Murrumbidgee Local Health District are partnering on two PoC projects which combine the expertise of Alcidion, CSIRO and Evidentli and use Apple products. PoC 1: Mobilising data to improve the safety and quality of care during a patient’s hospital stay The first PoC project is exploring how critical test results can be shared securely and in real time via mobile devices to support enhanced clinical decision-making. For Dr Stephen Wood, Director of Wagga Wagga Base Hospital’s Emergency Department (ED), this PoC has the real potential to assist clinicians with making decisions about the diagnosis and treatment of patients in time-pressured ED environments. “We want to give clinicians fast access to meaningful data insights which can help them to identify patients at risk of deterioration, and provide more timely mobile access to pathology results and X-rays,” Dr Wood said. A team of 10 ED clinicians is trialling mobile notifications of real-time pathology results and risk indicators, via Alcidion’s Miya Precision Clinical Decision Support (CDS) tool. Notifications will be delivered through Apple products, including iPad, iPhone and Apple Watch. The Miya Precision platform uses the Fast Healthcare Interoperability Resources (FHIR) to map data to standard terminology. This can form a basis for integrating other Artificial Intelligence and Predictive Analytics algorithms to monitor and detect safety problems. “The platform is able to deliver additional clinical insights including deteriorating kidney function, coagulation management, antibiotic stewardship, management of gram-negative bacterial infections, low blood glucose and sepsis monitoring,” said Kate Quirke, Chief Executive Officer of Alcidion Group. In order to prove these capabilities, the CSIRO’s ED re-admission risk algorithm will use the data supplied and make the results available via the Miya Precision platform. CSIRO is Australia’s national science agency. David Hansen, Chief Executive Officer of CSIRO’s Australian e-Health Research Centre, added: “It’s exciting to work with NSW Health to bring new technologies into everyday use in healthcare. Data-driven healthcare is very much the future of innovation in healthcare – this project is part of that transformation.” PoC 2: Creating an open platform for digital innovation in NSW Health The second PoC aims to create an open platform that provides access to simulated data, which researchers and developers can use to test functionality and feasibility of their models in a safe environment and without putting patients’ privacy at risk. Multiple yet anonymised datasets are being mined, via the Miya Precision platform, to cover common health challenges such as diabetes, cancer and cardiovascular disease. Cloud software company Evidentli is using its Clinical Research Automation software, Piano, which connects to a variety of data sources and provides security and workflows to automate research. Best-of-breed statistical, analytic, and documentation tools will enable Murrumbidgee LHD to perform clinical research in a fraction of the time it has historically taken. And, because Piano transforms data into open standards and automatically documents methods, research is immediately reproducible and ready for peer review. The platform, said Dr Wood, is “an incredibly powerful research tool which accurately captures activity to give insights into factors such as a patient’s risk of readmission as well as compliance with clinical pathways and the provision of clinically appropriate care”. “The digitisation of healthcare is ramping up and all clinicians need to embrace it with a view to developing a platform that improves access to the information they require to deliver timely and appropriate clinical care,” said Dr Wood. “We are excited to be a part of these six-month projects and I hope that both prove to be successful.” Recent digital health-related developments in Australia Earlier this week, CSIRO and GenesisCare announced a A$5.1M research partnership which focuses on an emerging area of science called theranostics to develop new therapies against some of the most fatal and difficult-to-treat cancers affecting Australians. The federal government of Australia recently announced that it will invest A$5M to facilitate the implementation of PainChek’s pain recognition app in Australian residential aged care centres (RAC’s), according to a Mobihealth News article.

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eHealth NSW has been established as a distinct organisation within the New South Wales (NSW) Ministry of Health in Australia to provide statewide leadership on the shape, delivery and management of ICT-led healthcare. One of the most recent appointments at the agency is its new Chief Clinical Information Officer, Dr Mark Simpson, who joined in January this year. Healthcare IT News learnt from Dr Simpson in an email interview about his new role at eHealth NSW, major projects that he will be working on, as well as his thoughts on the evolving role of the CCIO. Could you tell us more about your role as CCIO at eHealth NSW? I’m hugely excited to have started work as the Chief Clinical Information Officer for eHealth NSW, a role in which I am working collaboratively with NSW Health clinicians from across the state on transformative digital health strategies, programs and services. It’s an exciting time to join eHealth NSW. The 10-year eHealth Strategy for NSW Health: 2016-2026 has led to a great core level of coordinated delivery of digital services across the state, and the next six years will secure the consolidation of that fantastic start – as well as encouraging a much broader engagement of the clinical nursing and allied health professionals who are at the heart of this digital strategy.   You mentioned in an online article by digitalhealth.net that that if there was one top line to describe your CCIO role at NHS, it would be to foster clinical engagement in a broad sense with the clinical team. Does this statement still apply to your new role at eHealth NSW? Based on your experience, how do you think the CCIO role has expanded or evolved? The CCIO role I hold here has very much the same aspirations and expectations as my previous one did at the NHS. In NSW, the state lead role for CCIO does cover all of the local health districts in Australia’s largest state with a population of near eight million. The role is very much a bridge between eHealth NSW, the frontline clinical teams and the implementation teams and my CCIO role is focused on ensuring clinical engagement is at the heart of all projects. There’s a particular focus on how the design of the end products can incorporate Human Centred Design and the kind of user experience that truly enhances the interactions of all clinical staff in a wider sense, including medical, nursing and allied health professionals. Having been one of the first CCIOs in England in 2012, the original CCIO role back then was overall very much as an enthusiastic clinician who was the first of my type in a large tertiary teaching centre which was very much focused on delivering digital systems such as the EMR into a large complex hospital, and in the ensuing seven years the CCIO role has of course matured.  The role has evolved to encompass much more strategic thinking, with many of the complexities of safely implementing large-scale projects into many and varied clinical environments such as secondary hospitals, specialist units, mental health and also bridging into community and primary care. A smaller number of CCIOs have taken on a more formal role of sitting on executive boards and representing the clinical informatics aspect of care at the executive level. This really starts to change the model and engagement for future CCIOs to one in which they can encompass the next level of engagement with the concept, the innovation, the design phase, the safe implementation and the post implementation optimisation lessons learned, which can then feed back into next-level projects. It's also afforded us a larger population of CCIOs, and that’s now evidenced by the great opportunity to deliver teaching, training, education and a level of standardisation of career expectations through such advances as the Digital Academy in the UK. eHealth NSW Chief Executive and Chief Information Officer Dr Zoran Bolevich mentioned at the HealthShare NSW and eHealth NSW Expo 2018 in Sydney that “the next phase of eHealth NSW’s journey will see the organisation embark on bringing a digitally fragmented patient records system together.” Is that something that you will be working on directly? Absolutely; this is one of the central aspects of the process, to engage at a state level with the widest possible clinical engagement process. In NSW the digital landscape is maturing and still somewhat fragmented and this means that information related to patient care is not always available as seamlessly as possible, so the next phase is to look at how to optimise the concept of a potential single digital patient record.  At this stage, the processes involve how engagement with both CIOs, CCIOs and the program governance will manifest itself going forward. The opportunities to ensure clear and seamless transfer of patient information – so that it is always available at the right place and at the right time, and optimises the right care – is something that is absolutely central to my role as CCIO. Could you share with us some of the major projects that you would be embarking on at eHealth NSW?                                                                                                                                                                   The major projects I’m focusing on as eHealth NSW’s CCIO are many and varied. Significant work is underway as part of the eHealth Strategy for NSW Health, which commenced in 2016 with large-scale programs of work including the optimisation of the electronic medical record, the continued success and roll-out of the electronic medication management, along with many other EMR-related projects including managing deteriorating patients, diabetes and end of life care for example.  Looking ahead, large topics for my agenda include the single digital patient record, the safety and quality aspects of all delivery of digital care across the state, and the utilisation of mobility including how that truly impacts and supports frontline clinicians, nurses and allied health professionals. I’m also focusing on the ability to harness new and novel ideas through innovation, research and academia into production and delivery to coalface clinical staff so that they have the most optimal impact on patient care and the safe delivery of services.  The drive to optimise the electronic medical record will be well understood by our frontline staff but I want to ensure everyone has the opportunity to offer feedback and improve the service they cherish while at the same time being part of a broader team of clinicians, nurses and allied health professionals who together are realising the next major milestones of the eHealth Strategy for NSW Health. Patient records and clinical information is inextricably intertwined with big data. How do you see yourself working with colleagues who handle data and analytics at eHealth NSW?           Above photo: eHealth NSW's Clinical Engagement and Patient Safety team. Credit: eHealth NSW The role of eHealth NSW CCIO encompasses the areas of clinical engagement and patient safety and quality assurance and these are the key areas on which my team and I will work closely in the coming four years.  The use of focused data and analytics, including big data and population data, is central to a much closer understanding between the impact of digital care and its safe and optimal delivery of service. I also see some golden opportunities to increase the level of support and open the feedback loop from the analytical aspects of the data to better understanding areas where excellent practice exists and what we can do to share that in practice. This will help us to clearly highlight areas where there are other pressures or challenging situations which require either further resources or more specific and targeted clinical engagement. What are some of the milestones or goals that you would like to achieve as the new CCIO of eHealth NSW?         This is a fantastic opportunity which has brought me halfway around the world to be a part of this digital health strategy as the CCIO of eHealth NSW. My goals are to ensure, to the very best of my abilities, full engagement across the widest possible clinical network. This includes engaging all of the CXIOs, as well as those who are involved in clinical informatics in all guises within the local health districts, so that a wide and active clinical network becomes one of the central pieces to delivering truly impactful digitally enabled healthcare to the people of NSW.   Some other major goals I've set myself is to increase patient and consumer engagement, as this has the opportunity to impact on both the outcome of our digital programs through partnering with those who have the most to gain from the digital strategy itself. Mobility-harnessing innovation through future design is high on the agenda over the coming four years, given the great opportunities to address the significant user challenges in converting design into optimal delivery befitting the clinical environments and having a true patient safety impact. I’m also very interested in engaging with the educational training and undergraduate postgraduate trainers to start delivering a structured career path for future generations of CCIOs or equivalents both across NSW and indeed Australia. Many of the lessons learned globally could be utilised in delivering a career framework that will help guide all staff with an interest in patient safety through digital health to ensure a smooth and focused career path which hopefully will lead to succession planning for Australia’s next generation of CCIOs.                                                     

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