Electronic Health Records (EHR, EMR)

In the third episode of the HIMSS Australia Digital Dialogue Series, hosted by Tim Kelsey, Senior Vice President, HIMSS Analytics International, guest speakers Neville Board, Chief Digital Health Officer at Victoria’s Department of Health and Human Services, Dr Nathan Pinskier, Member of The Royal Australian College of General Practitioners (RACGP) Expert Committee ehealth, Advisor ADHA Secure Messaging, Renza Scibilia, Manager - Type 1 Diabetes and Consumer Voice, Diabetes Australia and Peter J.K. Weston, APAC Leader, Healthcare Solutions, Hyland Healthcare, Australia discussed COVID-19’s impact on digital health developments in Victoria, and what needs to be done to maintain the momentum from the ‘gains’ made from the pandemic. COVID-19'S IMPACT ON DIGITAL HEALTH DEVELOPMENTS IN VICTORIA Board laid out the context with regards to digital health priorities in Victoria – over 50% of beds in public hospitals are already supported by EMRs and there are multiple EMRs since health services do their own procurement within the given assurance framework.  Some of risks associated with work processes often have to do with paper and digital applications have brought in to reduce this along the continuum of care. “For primary care, we have been given a strong boost by My Health Record with a high uptake of 90% by GPs and community pharmacies. For patients in the public health setting, knowing what medicines they are on is useful, time saving and reduces risk,” said Board. In terms of the digital context, Victoria is in the process of rolling out unique patient identification across health services. Looking forward, digital health support will also be created for touch points in mental health and aged care. “We’ve spent a decade developing national strategy, and in January and February, along comes COVID, and within a matter of a few weeks, we’ve seen healthcare organizations around the country having to fundamentally change the way they do business,” said Dr Pinskier. He added that in General Practice, specialist practice and paramedic practice, there are waiting rooms that are empty as people as afraid of visiting clinics and sitting in carparks. Telehealth, which has seen a struggle in uptake in over a decade, suddenly became mainstream in a matter of weeks.  “We’ve got telehealth and we still have to provide people with a whole lot of information and documentation, and we have not developed a model by which to do that. For instance, how do you hand over a prescription across a digital screen? It’s really hard to do. We are able to work with the federal department at state levels to implement image-based prescriptions as an interim, until we move to the new world of digital prescribing.”  Other challenges include handing a sick note digitally, and My Health Record was not designed to deal with PDFs. He said that a rethink is required to think about what needs to be achieved in a digital world and how to best support telehealth, which is likely to be stay as a dominant model of care.  Scibilia observed that what has been happening with the diabetes community is applicable to other chronic health conditions and other health service users – a lot of processes were paper-based, forms need to be double signed, and all of these processes have to be streamlined due to the pandemic.  “There was a real surprise in the community that these things happened so quickly, especially considering it’s what advocates have been asking for for so long – things such as easily accessible telehealth consultation,” she said. Commenting on what Dr Pinksier said earlier, Weston said that the technologies already exist to enable organizations to be able to have content delivered to them, whether it is on a mobile phone, tablet or computer. He hopes that medical image and content can be enabled on My Health Record. “In the medium and long term, I am really excited in terms of delivering smarter solutions that enable access by anyone, anywhere securely and leveraging that on My Health Record”. MAINTAINING MOMENTUM FROM THE 'GAINS' MADE FROM THE PANDEMIC While telehealth adoption has increased rapidly in the Victorian public health setting in response to the pandemic, Board said that two broad areas of concern: which care models are amendable to video conferencing and which patient/client cohort are comfortable with video conferencing?  “We have to look very carefully at each use case such as chronic disease and mental health, to see what other tools need to be in place for that care cohort to be looked after. I think we have to look at mixed models and not make everything digital,” Board said. “Nothing beats a face-to-face consultation and we still recognize it as the gold standard,” Dr Pinkier said. What he observed with the rapid roll-out of telehealth is that 90% of the consultation funded under the MDS are telephone consultations and only about 10% are video. The reason for that is that is easy to pick up a phone compared to setting up a video call.  If opportunistic providers go into telehealth unfettered for all kinds of basic things and start undermining the fabric of tradition practice, it can lead to the decline of general practice and fragmentation of care.  “The telehealth model we have implemented is a rushed one and it needs a comprehensive review. We also need to have conversation once and for all about mandated (software) standards, and what we would like to see is a standardized approach to how software is funded and implemented, concluded Dr Pinkier.   

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At the HIMSS APAC Malaysia Digital Health Summit session titled “Digital Health - From Innovation to Adoption” by guest speakers Wilson Choo (Chief Executive Officer of Sunway Medical Centre Velocity) and Dr Ng Xin Jun (Manager of Sunway Group Healthcare), both shed light on the various technological healthcare advancements made at Sunway Medical Centre Velocity (SMCV) as a case study. At SMCV, an integration project between its patients’ monitoring devices and electronic medical record was developed in order to achieve a seamless and wireless transfer of patients’ vital signs with “Early Warning Scores”.  A key feature of the new implemented EMR at SMCV is its Computerized Physician Order Entry (CPOE) which allows doctors to order medicine or laboratory/ radiology services via the system whilst being able to check the status of these orders. Similarly, nurses would also be able to key in their orders for medication as well as the respective procedures which they have carried out on each patient.   Clinical Decision Support is another feature embedded within the EMR which allows healthcare providers to gain access to the drug allergies as well as medications administered to patients. This results in better healthcare decisions and effectively prevents any medication errors. A system aptly named “Early Warning Score” was developed for scoring the physiological measurements of patients and routinely recorded at the patient’s bedside. Its purpose was to allow for early identification of acutely ill patients and recorded information such as a patient’s temperature, systolic blood pressure and urine output. A key success factor underlying the success of this integration project was due to the efforts of a governance committee. Frequent meetings were held every month to discuss any ambiguities or to resolve any issues within the system. Priority was given to resolve issues pertaining to patient safety and system enhancements. Relevant key stakeholders such as management personnel or members of the clinical team and vendors were brought into these meetings whenever necessary. Digitalization and innovation was also amalgamated within the hospital’s daily operations as well. Sunway Medical Centre was one of the earliest companies who adopted tele-consultation during Malaysia’s Movement Control Order (MCO) period (a form of countrywide lockdown due to COVID-19), which allowed patients to continue to consult doctors even when they were at home. A patient portal was also developed which facilitated the booking of appointments and retrieval of radiology results online.  Patients were also encouraged to download the hospital app on their mobile devices which allowed them to check the queues at the hospital to reduce their waiting times at the medical facility. Insurance integration is also in the works, which will enable patients to make electronic payment, billing and payment integration with major insurers. This will also provide greater transparency to patients as they will also be able to track the status of their insurance applications. A long term direction for the hospital was also put in place with plans to include progressive initiatives to make crucial patient information more accessible and timely, even allowing doctors to have real time visibility of vital signs on their mobile devices.

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