Update on Electronic Health Record development

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• Update on Electronic Health Record development-
• The Austin Health Experience
• Vicki Moritz
• Project Manager June 2003

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Electronic Patient Record

• Overview
• Why do it?
• What is it?
• Standards
• Current progress
• Challenges
• Current benefits

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Electronic Patient Record

• Why do it?
• Information accessible
• Clinical decision support requirements eg
  drug-drug interaction checking
• Highlighting of important data
• Improve data availability for research
• Improve data flow to referring doctors/GPs

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Electronic Patient Record

• What is it?
• Orders- including prescribing
• Result viewing
• Generation of discharge summaries
• Clinical pathways
• Electronic recording of observations, charting,
  progress notes

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Electronic Patient Record

• Where are we?
• Pilot system in ED
• Outpatient scheduling
• Medical record tracking
• Balance of administrative requirements system
  tested
• Infrastructure for clinical implementation

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Electronic Patient Record

• Key issues
• Executive support critical
• Project team is representative of the process
• Technical infrastructure
• Training issues
• Business practice re-engineering

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Electronic Patient Record

• Key issues
• Standards- Privacy and data security
• New State and Commonwealth legislation
• Patient consenting requirements to be met
• Data access requirements

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Electronic Patient Record

• Key issues
• Standards- Messaging and Communication
• HL7 v2.3 (?v3)
• Local interfaces
• Discharge summary template defined by GPs- Event
  summaries

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Electronic Patient Record

• Key issues
• Standards- Data standards, Classification and
  Coding systems
• SNOMED-CT combination of SNOMED and READ codes
• NHS/US standard
• Medication coding issues

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Electronic Patient Record

• Product development
• Existing integrated system purchased by ARMC
• Gap analysis to migrate to the web product
• Workflow analysis
• Specification process with end user involvement
• Software prototype delivery

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Electronic Patient Record

• Product development
• Testing and fine tuning
• Reports are a useful window into quality of data
  migration
• The challenges of interfacing
• Installation
• Troubleshooting- Quick fixes
• More fine tuning.

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Electronic Patient Record

• Challenges
• People issues
• Change management
• Integrated product is challenging past
  ownership practices
• Data quality and maintenance
• Availability for end user testing

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Electronic Patient Record

• Emergency dept prototype
• Needed to meet administrative and clinical needs
• Proof of concept with vendor as stand alone
  system
• 24 hour/7 day complex clinical service
• Proof of concept for Pathology system interface
  and electronic data transmission to GPs

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Electronic Patient Record

• Current ED system- floorplan
• Replaces the whiteboard- visible throughout the
  department
• Visual representation of patient information,
  alerts
• Patient acuity and time spent in the department
  clearly visible

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Electronic Patient Record

• Current ED system- triage screen
• Completed by nursing staff
• Captures clinical urgency and whether likely to
  admit
• First capture of clinical information
• Electronic capture of injury surveillance data
• Coded data entry for later retrieval

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Electronic Patient Record

• Current ED system- Order screen
• Order sets driven by presenting diagnosis
• Current orders for
• Pathology, order sets and favourites
• Radiology
• Consults
• Prescribing to follow
• Building in decision support

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Electronic Patient Record

• Current ED system- Other screens
• Registration/patient search
• Patient movement- ward, radiology and back etc
• Bed request for bed managers, wards
• Clinician screen tracks treating clinician
• Discharge- final diagnosis and discharge summary

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Electronic Patient Record

• Current ED system- Prototype EPR
• Patient details, previous episodes, notes
• Patient alerts
• Orders placed- Radiology and Pathology
• Results from Kestral Pathology system
• Diagnosis
• Well received by nursing staff particularly

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Electronic Patient Record

• More challenges
• Better process required for system and user
  testing- project staff now trained
• Change requests need to be handled formally to
  reduce scope creep
• Prototyping is best for end user understanding
  of the specification
• Training requirements significant

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Electronic Patient Record

• Clinical rollout
• Teams developing order sets
• Decision support infrastructure
• Clinical leadership
• Passive in place eg information links
• Active decision support
• Pop up messages on ordering troponin
• Order set restructuring in ED
• Development of questionnaires for structured data
  input

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Electronic Patient Record

• Clinical rollout
• Modular implementation
• Gradual replacement of existing results interface
• Follow by orders/discharge summaries
• Pilot units
• Development of unit specific data input screens
• Structured data entry

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Electronic Patient Record

• Current benefits
• Patient information is accessible throughout the
  department
• ED information visible to others outside ED eg
  bed managers
• Information integrated into the EPR (nurses like
  this!)
• Better patient confidentiality
• Statutory reporting simplified

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Electronic Patient Record

• Current benefits
• Order sets developed by senior clinical staff to
  guide ordering by residents
• Testing request forms now legible
• Barcode labels now generated for patients and
  Pathology testing
• Discharge summary largely auto populated into a
  word template and FAXed or emailed to GP

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Electronic Patient Record

• Current benefits for OP
• OP letters emailed/FAXED directly to GP- Failure
  to attend etc
• Better quality data
• Integrated eg updated GP information
• Pictorial representation of clinic numbers eg red
  for overbooked!

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Electronic Patient Record

More information Vicki Moritz- Project
manager ARMC, Melbourne, Victoria vicki.moritz_at_au
stin.org.au Trak Systems- MedTrak Woolloomooloo,
Sydney, Australia http//www.trak.com.au/