Electronic Health Records (EHR, EMR)

Clinical and non-clinical staff of today spend too much time on things that do not interoperate, according to Royal Australian College of General Practitioners (RACGP) President Dr Harry Nespolon. “Let me give you what a normal day in general practice is like without interoperability. I see a patient, who has been to the hospital the night before, first thing in the morning. The patient tells me that the hospital advised him to get some ‘stuff’ done. I check my inbox, but there isn’t a discharge summary,” he said, at a recent Australian Digital Health Agency (ADHA) event. “If I am lucky enough to have a discharge summary, there may be just some vague instructions to contact a particular department, which may not know of this patient’s needs. This wastes my non-clinical time, which sometimes even results in achieving nothing. “So much time is spent ringing up other departments, scanning, faxing, moving paper from one side of the room to the other, etc. It’s very inefficient and I rather have my clinical and non-clinical staff talking to patients instead of waiting on machines to do things. As a practice owner, I can’t wait for this to be right,” he said. Nespolon addressed the pressing need for interoperability, saying that it enables healthcare to spend more time on patients and producing better outcomes, rather than chasing things up. “If we were able to access the hospital’s pathology or appointments, for example, we can see what was written on the notes. That would save us so much time; one thing that you can’t compress in medicine is time.” eHealth NSW CEO Dr Zoran Bolevich said there has been some skepticism around interoperability in healthcare, but mentioned that interoperability issues exist in the paper world as well. “Even in the paper world, there are issues with communication and how departments work with each other to communicate information,” he said. Bolevich said the current systems in many healthcare organisations are challenged in: Information flowing seamlessly between systems, resulting in new sources of patient safety risk Continuity of care where various departments or organisations share information seamlessly for better patient-centric experiences Enabling a learning system that uses data to improve patient safety, healthcare quality and outcomes. “A lot of systems have data hoarded in fragmented IT systems, so we need a system we can mobilise for analytics and research. But for that to happen, we need to develop our workforce. We need more data scientists, clinicians with digital health skills, technologists that understand health and clinicians that understand technology,” he said. A SYMBIOTIC RELATIONSHIP Queensland Aboriginal and Islander Health Council Independent Director and GP Dr Steve Hambleton, said while it is true that healthcare needs to evolve with changes in technology, the same should be said of technology.  “Technology too, needs to evolve to support healthcare. Computerisation by itself is not the solution; software needs to be able to fit into the clinical workflow. Computers are good at doing routine things but healthcare isn’t routine – every patient is different and that’s why it’s challenging to build software that works for everyone,” he said.  “We’ve got to think about the way our health system is set up, who it’s focused on and the data repositories that we have. A lot of them are still paper-based and data is locked up in paper. It’s very hard to get it out. “The lack of connection and availability of data is reflective of the way we practice. With a patient ending up in hospital because of medication misadventure every two to three minutes, it’s worth reflecting on what we’re trying to solve.” [Read more: We need to get the digital basics right and quickly: Tim Kelsey | What’s needed to drive innovation and improve affordability in healthcare?] As a result, Hambleton called for a future-looking, interoperable system that moves today’s “average care” to one that is universal and personalised. ADHA Chief Executive Tim Kelsey said interoperability is the solution to making the future of health digital. “The momentum [of digital] is growing. My Health Record is just a part of the solution in Australia. The solution is interoperability – broadly, a modern, person-centered health service that has dealt with all the inequities introduced by paper-based health provision and no longer supported by fax machine in care delivery,”  he said. CORE VALUES Kelsey addressed four core values required for a modern connected health service: Participation: Empowering the recipient of healthcare to be able to fully participate in health decisions by providing them with access to health information in a consumable way.  Collaboration: Having a broad consensus behind the delivery of digital tools.   Transparency: Creating meaningful, understandable information about the availability and quality of local care services and understanding the balance between the responsibilities of the recipient of care and opportunities in an information rich, modern service. Trust: Having the social license in place for digital services healthcare will provide in future. Kelsey said secure messaging would play a large role in the uptake of interoperability. “We can’t possibly imagine a world full of precision medicine when we’re communicating ubiquitously using fax machines. It will never happen and it calls out for the development of secure messaging. We need to start… building the necessary foundations in the standards we propose around interoperability for the future.” But there is also a broader challenge of health literacy in Australia, according to Kelsey. “How do we ensure that people are not disadvantaged by the arrival of some digital services? We need to think about how we can support this agenda. The tipping point for that conversation is going to be the arrival of meaningful care facilitation through My Health Record and other infrastructures in Australia, which will hopefully take place in the next year,” he added. GETTING THE FOUNDATIONS RIGHT Software Industry Association Medical CEO Emma Hossack said technology isn’t the only aspect to come under review when it comes to interoperability. She mentioned that the industry needs to ensure that “foundational considerations” are set right.  “We need to make sure that we don’t rush into it driven by a timeframe that’s unreasonable,” Hossack said. “For this, we need to have an environmental scan of all the projects that are currently working, or not; a test bed of areas where there is interoperability, where there’s patient benefits, where efficiencies or sustainabilities lie, etc. That’s absolutely key.” Hossack also addressed the issue of culture and cynicism, saying that those two areas need to be looked into. “We can work it out, but we can’t expect people to take on interoperability and be enthusiastic about it unless it’s going to be sustainable for their business. And let’s get our priorities right because we need to make sure that we’re getting what patients want right,” she said.   “It’s also worth remembering that while we’re an industry, it’s not always all about the money. It’s about making a health system better, more accessible and enabling better outcomes for Australia. And none of that is possible without managing data.” [Read more: “Lifeblood” of modern healthcare: New report looks at urgent need to overcome barriers to data use | After interoperability: FHIR is the gateway for AI] According to Health Intersections Principal Grahame Grieve, interoperability is about information management and people. “It’s not a technology problem; it’s a people problem and an information management problem. Technology comes and goes but information management is where the hard stuff is,” he said. “I talk about interoperability a lot, and about FHIR [Fast Healthcare Interoperability Resource]. But a lot of people misunderstand what FIHR is. It’s not so much about technology. It is two important things – a community of people and a set of technical agreements about information management and exchange. “The FHIR standard and the FHIR community don’t deliver solutions to real-world problems; they exist to enable other people to do it. The challenge then, and the biggest challenge by far, is developing the right story, the right solutions and deploying it.” Grieve addressed three stages to deploying interoperability:  Getting basic capabilities into international standards: These consist of platform standards to build solutions on. Taking those standards and applying them to the Australian context: This involves industry collaborating to figure out what these local guidelines or rules should be, testing them and integrating that process into a sustainable standards cycle. Turning those local agreements into operating software.  “FHIR is scoring goals in the first and second stages around the world, but it’s the third stage that’s the hardest stage, by a long shot. The challenge is that each of these stages means different people, different cultures, different processes and the handover between stages cause potential disconnect,” he said. “Getting continuity to run the process to the ground is the hard part, and it’s increasingly our focus. But in Australia, we’re starting at the back of the pack.  “What we need is the belief that we can collectively get it properly moving and solved. Interoperability can be done, but we have to be realistic about the issues and roadblocks faced in Australia and start navigating our way around them.” To lead a productive conversation around interoperability, the ADHA has released a National Health Interoperability Roadmap Co-design paper, which is currently open for consultation.

Association says the update is more global in scope and fit specifically for the healthcare ecosystem. 

The industry must put patients at the center, use standards like HL7 FHIR and get the entire ecosystem working together, say Kari Hedges, SVP at Blue Cross Blue Shield Association, and Laurent Rotival, SVP at Cambia Health Solutions.

SA Health, the public health agency of South Australia, has made improvements to its troubled electronic medical record (EMR) system, in an attempt to lay the foundation for progressive implementation of new features and functionality. The move is an upgrade from the version the healthcare organisation was using since 2014, and follows an independent review of the program that found its Enterprise Patient Administration System (EPAS) failed, as it “contrasts with other successful EMR implementations in Australia”. The review identified that SA Health’s billing module was “not fit-for-purpose”; and the EPAS has a “flawed governance model” that didn’t empower clinicians to be key decision-makers or allow the system to be tracked, measured or managed, amongst other findings. Following the review, SA Health was expected to scrap and reconstruct its beleaguered electronic patient records.  The upgraded EMR version installed at SA Health’s facilities now consists of Allscripts Sunrise EMR and paperless administration system (PAS), which was a key recommendation in the EPAS Review. Recommendation 13 of the review identified that “the existing Sunrise EMR/Allscripts PAS 14.3 software version be upgraded to 17.3, with the progressive implementation of its new features (not ‘like with like’), and that subsequently there be a regular upgrade path”. Allscripts ANZ General Manager Todd Haebich said the upgrade provides SA Health with a more contemporary, versatile and risk-resilient EMR platform. “The latest version of the Sunrise EMR 17.3 offers many functional benefits, but from an interoperability perspective, it enables SA Health and third-party vendors to extend the EMR with new apps and initiatives, including products from the global Allscripts Application Store,” Haebich said. “The upgrade also brings increased security and resilience, as it provides administrators with greater and more effective capabilities to keep the platform functioning when servers and networks fail.” The upgrade also allows SA Health to introduce the following: Timeline: A patient-centered graphical view of the continuum of care, where the clinician receives a visual view of the patient’s visit history across all settings of care. For a more detailed view of a specific encounter, the clinician can open the desired block to launch the new visit record web portal.   Sunrise Compass: A solution that enables it to build upon and combine the workflow management tool and tasking infrastructure into a single new UI. A new Smart Engine analyses patient conditions such as results, vital signs, problems and observations to dynamically suggest tasks, workflows and actions. Compass aims to increase the quality of care and decrease time to treatment and diagnosis by decreasing manual interventions in the EMR.   Sunrise Mobile: A solution that lets clinicians manage their daily activities. “The upgrade is the first step in ultimately providing SA Health with a system to rival what we have achieved in other geographies like the US, UK and Singapore,” Haebich said. “We welcome the EPAS Review’s recommendation that we play a much greater role in delivering SA Health’s EMR, and we look forward to working more closely with SA Health to fulfil what it has set out to achieve.” This article first appeared on Healthcare IT News Australia.

SA Health has made improvements to its troubled electronic medical record (EMR) system, in an attempt to lay the foundation for progressive implementation of new features and functionality. The move is an upgrade from the version the healthcare organisation was using since 2014, and follows an independent review of the program that found its Enterprise Patient Administration System (EPAS) failed, as it “contrasts with other successful EMR implementations in Australia”. The review identified that SA Health’s billing module was “not fit-for-purpose”; and the EPAS has a “flawed governance model” that didn’t empower clinicians to be key decision-makers or allow the system to be tracked, measured or managed, amongst other findings. Following the review, SA Health was expected to scrap and reconstruct its beleaguered electronic patient records. The upgraded EMR version installed at SA Health’s facilities now consists of Allscripts Sunrise EMR and paperless administration system (PAS), which was a key recommendation in the EPAS Review. Recommendation 13 of the review identified that “the existing Sunrise EMR/Allscripts PAS 14.3 software version be upgraded to 17.3, with the progressive implementation of its new features (not ‘like with like’), and that subsequently there be a regular upgrade path”. Allscripts ANZ General Manager Todd Haebich said the upgrade provides SA Health with a more contemporary, versatile and risk-resilient EMR platform. “The latest version of the Sunrise EMR 17.3 offers many functional benefits, but from an interoperability perspective, it enables SA Health and third-party vendors to extend the EMR with new apps and initiatives, including products from the global Allscripts Application Store,” Haebich said. “The upgrade also brings increased security and resilience, as it provides administrators with greater and more effective capabilities to keep the platform functioning when servers and networks fail.” The upgrade also allows SA Health to introduce the following: • Timeline: A patient-centered graphical view of the continuum of care, where the clinician receives a visual view of the patient’s visit history across all settings of care. For a more detailed view of a specific encounter, the clinician can open the desired block to launch the new visit record web portal. • Sunrise Compass: A solution that enables it to build upon and combine the workflow management tool and tasking infrastructure into a single new UI. A new Smart Engine analyses patient conditions such as results, vital signs, problems and observations to dynamically suggest tasks, workflows and actions. Compass aims to increase the quality of care and decrease time to treatment and diagnosis by decreasing manual interventions in the EMR. • Sunrise Mobile: A solution that lets clinicians manage their daily activities. [Read more: Fremantle Hospital deploys EMR system for better support of care in WA | University Hospital Geelong improves ED clinical workflows] “The upgrade is the first step in ultimately providing SA Health with a system to rival what we have achieved in other geographies like the US, UK and Singapore,” Haebich said. “We welcome the EPAS Review’s recommendation that we play a much greater role in delivering SA Health’s EMR, and we look forward to working more closely with SA Health to fulfil what it has set out to achieve.”

The CEO of the Alliance for Better Health and former deputy national coordinator talks EHR and interoperability challenges, the need for ROI, physicians' changing roles and why "social determinants" might not be the right term.

Using the Massachusetts Prescription Awareness Tool will create better access to prescription data for clinicians at Partners.  

Mental health records at the Black Dog Institute’s clinical services arm will soon go digital. The Australian institute for research and services in mental health will deploy Global Health’s MasterCare EMR solution across clinical services, using the clinical and practice management software to transition processes. Black Dog Institute joins a number of other healthcare providers that have recently transitioned over to MasterCare EMR, such as Justice Health Victoria and Bass Coast Health. MasterCare EMR General Manager Kye Cherian said the solution was chosen for being a team-based, client-centric record that supports multiple programs and services. As Black Dog Institute has a number of clinical services – such as a child and adolescent health unit, psychology clinic, and depression and bipolar unit – he said the solution can be configured to suit different workflows within these individual organisations, enhancing workflow functionality across the multi-program community. Specifically, according to Cherian, MasterCare EMR’s mental health modules, such as risk assessments and assessment wizards, would benefit the organisation. “[The] platform can be implemented either as is, or adapted easily for specific client needs and requests,” he said. “The area of mental health is one that requires continuous research, innovation and investment to meet growing demand. the Black Dog Institute clinical services arm’s use of MasterCare EMR will support their research-based approach to delivering and improving mental health services. “Often people with a mental health condition have lifelong needs, and it is essential these services are coordinated and tracked for optimum outcomes and continuous improvement,” he said. [Read more: Fremantle Hospital deploys EMR system for better support of care in WA | University Hospital Geelong improves ED clinical workflows] MasterCare EMR also allows for customised program support across minimum data sets, streamlined data collection, support for more than 25 common federal and state-funded programs, and has an inbuilt practice management system for clinic appointments, billing, online claiming, staff rostering, client management and secure messaging.

Analysts see a best-of-breed strategy finding favor, with companies such as Xenex, Ecolab and VigiLanz preferred over Epic and Cerner for their innovative approaches to patient safety surveillance.

Eastern Health has rolled out a new trial across its Box Hill Hospital to help patients better manage their medication after they leave hospital. DC MedsRec, the community pharmacy-based service for patients discharged from Box Hill Hospital with four or more medicines, aims to reduce the risk of harm from dangerous drug interactions. The trial, conducted in collaboration with the Australian Digital Health Agency (ADHA) and Monash University, will enable eligible patients to meet with trained community pharmacists, who will look at their hospital discharge summary via My Health Record (MHR), along with a range of other medication information on their Electronic Medical Records (EMRs). The pharmacist will then check the patient’s understanding of the drugs they are taking, resolve any potential medicine safety problems and ensure any medication-related recommendations from the hospital are followed up. The pharmacist will also offer to dispose of any discontinued medications and prescriptions for the patient, with their consent. The move follows Eastern Health’s successful EMR implementation at Box Hill Hospital In October 2017, in partnership with Cerner, as part of its Great Digital Information Strategy 2015-2020. ADHA CEO Tim Kelsey said the service was part of a $8.5 million program that trials innovative and new approaches to post-hospital support, palliative care and the management of chronic health conditions using digital technology. “Pharmacists involved in the Box Hill project will be able to access their patients’ hospital discharge summaries quickly and easily using My Health Record,” he said. “The ultimate aim is to ensure patients with complicated medication regimens don’t end up back in hospital after taking a bad combination of medicines.” Monash University Project Lead Greg Duncan said the trial was initiated as a result of poor medication management during or immediately after a hospital stay, which becomes a risk factor in 28 per cent of potentially avoidable hospital readmissions within 30 days. “We know medication errors often occur when patients leave hospital and can mean patients end up being readmitted – so we will assess the impact of this new service on 30-day unplanned readmission rates to hospital,” he said. [Read more: Inability to meet patient engagement demand is “hobbling” Australian healthcare providers: study | NSW’s hospitals enroute to state-wide Electronic Record for Intensive Care (eRIC) implementation] Eastern Health Chief Executive Adjunct Professor David Plunkett said the trial positions the organisation to “provide both excellent clinical care and research”, with real-world benefits. “Community pharmacies from the Eastern Health area will take part in the pilot, with up to 5000 patients potentially involved,” he said. The success of the service will be evaluated after 12 months, with Kelsey adding that the results could potentially shape future projects, helping patients throughout Australia better manage their medicines.