Delivering on the eHealth Vision for NSW

Jonathan Di Michiel, Program Director for the eMR Connect Program at eHealth NSW  will be speaking to the eMedication Management Conference on Tuesday 14 March 2017 on Delivering on the eHealth Vision for NSW. Here, he talks about leadership and collaboration, the challenges facing an IT-enabled health system, expected business outcomes as well as integration of current and future eMR systems.

How is eHealth NSW delivering on the vision of a ‘digitally enabled & integrated health system delivering patient‑centred health experiences & quality health outcomes’?

The eHealth Strategy for NSW Health (2016-2026) sets out a clear vision for delivering world-class, eHealth-enabled healthcare services across NSW over the next decade.

The eMR Connect Program is an integral part of the eHealth NSW strategy of delivering core clinical systems to enhance the quality of patient care and achieve improved health outcomes.

The Program is rolling out electronic medical records (eMR) for patients in hospitals, electronic medication management (eMeds) in hospitals and extending the eMR to support community health and outpatient care.

What are some of the greatest challenges facing an IT-enabled health system like NSW Health?

The eHealth Strategy for NSW Health (2016-2026) identifies seven focus areas for building an eHealth landscape in NSW:

• Integrated ‘paper-lite’ core clinical information systems
• eHealth solutions that support integrated care
• Enhanced information and tools to foster organisational effectiveness
• Enhanced data management, analytics and health intelligence
• Enhanced patient and provider access to digital health information
• Minimum standard for infrastructure, networks and security, and
• Consistent approach to fostering IT enabled innovation.

Each of these focus areas includes strategic investment priorities and initiatives, as well as specific approaches to delivery of technology platforms, eHealth-enabled services and digital experiences.

How does eMR Connect integrate with current and future eMR systems?

We need to look at the system holistically, not from an individual program perspective, and ensure it is scalable and sustainable.

Interoperability is crucial.  In NSW, eHealth systems from a number of vendors are being deployed in multiple care settings. As the amount and complexity of information captured in these systems continues to grow, so too does the need to ensure that patient safety is supported across the care continuum and from one care setting to another.

At eHealth NSW, we place a great deal of emphasis on the handover of care from one eMR to another; for example, between the eMeds system and the Electronic Record for Intensive Care (eRIC) system being rolled out to Intensive Care Units.

Across how many sites is the eMR Connect Program?

Our digital footprint across NSW is well established, and growing.

The first phase of the eMR finished in 2011 and delivered the eMR to emergency departments and operating theatres as well as some electronic functionality to the wards. This eMR foundation is now at 144 hospitals across NSW, including 73 hospitals in rural Local Health Districts.

‘eMR2’ extends the eMR with clinical documentation, assessment and decision support components to enhance care for patients in hospitals. It’s currently live at 139 hospitals of a total scope of 179.

Community Health and Outpatient Care (CHOC) extends the eMR to provide clinicians with timely access to information, to manage appointment scheduling, wait lists and referrals between local health service providers. Rollout of CHOC was completed in 2016, and is now available across all Local Health Districts at 333 community health facilities.

The scope of the eHealth NSW Electronic Medication Management (eMeds) program has increased and will be rolled out to 58 hospitals across all Local Health Districts.  eMeds is currently live in 10 NSW Health hospitals. During this year, eMeds will roll out to 12 hospitals.

How was collaboration achieved between eHealth NSW’s eMR Connect Program team, LHDs & the vendors?

For eMR Connect, our approach to achieving collaboration has four components:

• State-wide governance, with a focus on safety and quality
• Early engagement with Local Health Districts to allow appropriate timeframes for planning and with clinicians to allow meaningful clinical input into the solutions delivered
• Support for local project implementations
• Partnering with vendors to deliver on the program scope, working together to solve issues.

For Cerner eMeds implementations, we work to a clear consulting framework and this sets out the responsibilities of all parties and the timeframe for key deliverables.

That said, relationships are key.  The strength of the relationships developed is particularly important when issues crop up, as they inevitably do. If there is a strong relationship of trust, issues can be resolved more constructively and quickly.

What are some of eMR Connect’s expected business outcomes ? 

eHealth NSW is committed to developing a digitally enabled and integrated health system that supports patient‑centred health experiences and quality health outcomes. Building useable and safe systems, which can be used safely and utilised to improve safety and quality, is a critical underpinning principle in achieving this vision.

As we roll out eMeds, we are aiming to improve safety and quality, notably the demonstrable reduction in adverse drug events.

The accelerated scope of the eMeds program for NSW Health will also allow the deployment of eMeds to more sites, more quickly and with the best use of resources.

Another key focus for our program is supporting effective change management so that eMeds is not only ‘live’ in a hospital but being used efficiently and safely.

What has been the reaction from front line staff and patients affected by the introduction of new technologies?

Our staff live and work in a digital world.  While there is always some initial inconvenience arising from a change in clinical practice, increasingly clinicians are expecting the solutions available in the workplace to keep pace with the systems they use in their personal lives.

We need to ensure patients and their families are comfortable with how and why their personal clinical information is being collected. The on-site teams tell us that patients understand this and are comfortable with information being recorded electronically and devices being used at the bedside.