People Driven Innovation PAH - 20 months on Michael Draheim CIO, - - PowerPoint PPT Presentation

People Driven Innovation PAH - 20 months on

Michael Draheim CIO, Metro South Health Adjunct Professor, UQ Business School

Metro South Health

Who are we - Prin incess Ale lexandra Hospit ital

billion

Metro South Health

What have we Im Imple lemented

• Structured clinical notes
• Emergency Department
• Surgery, Theatres & Anaesthetics
• Integrated inpatient clinical information
• Pathology and Radiology orders and results
• Scheduling – Outpatients and Elective Surgery
• Device integration & Closed loop observations
• Managing deteriorating patients workflow
• Positive person identification
• CPOE & Medication Management – Closed loop
• Clinical trials
• Reporting, Analytics and Data Warehouse
• 7/24 (downtime)

Princess Alexandra Hospital - Year 1 Digital Hospital Experience

Activity Go Live Post Go Live

QWAU 10% (April 2017 YTD) Seps 7.2% (April 2017 YTD) ALOS 5% (April 2017 YTD)

Reducing care variation Variation

• 80+ Power Plans introduced
• 40+ Order sets activated

Power Plans ordered 12,220 (May 2017) Unique patients 80,518 (May 2017) Total measured 57.7M (May 2017) transactions

Performance benefits Hospital standardised mortality

Rapid response 45% Cardiac arrests 15 less than predicted

(2016 cf 2015)

Emerg re-admits 4% Falls with injury 12%

(2016 cf 2015)

Failure to rescue

Metro South Health

Make the Case - Why Dig igit ital

• 10% of patients with a drug allergy are prescribed that

drug during a hospital admission

• There are more people in hospital from preventable

medication incidents than from asthma and breast cancer combined

• 30% of all radiology and pathology investigations are

inappropriate or unnecessary 1

• Most Australian doctors can’t order a chest

X-Ray electronically.

1.Harvard Medical School, PRESCOTT, 2013

Metro South Health

Be Cle lear why y

• Text

Have a Cle lear Strategic Focus

Communicate what you are doin ing and why

• Large and extremely complex
• Big Bang approach – Two parts
• Created a digital focus
• People focus staff and patients
• Clinically safe - continued patient care and no

patient harm

• No patient or staff complaints
• Focus on the patient journey

Metro South Health

Our Crit itic ical l Success Factors

• Absolute commitment by Board, Executive & Clinical

Leaders

• Trusting in our people - High levels of culture, morale and

ambition

• Outcome focus
• Clinical engagement & clinical governance
• Critical mass of SMEs and change champions through all

areas

• Medical grade Wi-Fi - “No holes”
• Adequate number of user-centric workstations - “No

queues”

• Contemporary, tailored multimodal training
• Communicate, Communicate, Communicate

Metro South Health

Metro South Health

Workforce Transformation

• Have a clear Vision = end to end digital and new

models of care

• Move the conversation from IT to one of clinical

change

• Clear understanding - not a move from a paper chart

to electronic forms - its real time information at point

• f care
• An integrated team delivers success
• Understand this is a platform for the future
• Workforce Vs work transformation
• Role redesign opportunities

Metro South Health

Lessons Learnt

• Training of staff
• Fund training attendees
• Computer literacy
• Multimodal
• Device integration – is essential
• Changing existing work/care delivery methods
• Requires support
• Adoption services
• Reporting and Analytics
• Start early
• Link to benefits

Metro South Health

Clin linic ical Transformation – Lessons Learnt

• Clinical staff embedded in all design,

configuration and testing & support

• Hospital stakeholders running

implementation not project

• Home grown resources
• Build on cultural strengths
• Decision support is important - eg

managing deteriorating patient

• Patient workflow focus

Clin linic ical Governance and In Independent Oversight

• Clinical Safety Watch Program

(Independent Assurance)

• Embedded patient safety officer role in the

Command Centre

• Patient Safety input before decision to

progress into next phase of implementation

• Now is embedded practice for go lives
• Essential for medication Management
• versight

Metro South Health

Clin linic ician Feedback is is Essential

Metro South Health

• Independent, academic

research (UQ)

• Pre (7-18 March 2017) &

Post (21 Apr-8 May 2017) MARS release

• Research approach:

 Survey (total responses received from 437 individuals)  Interviews with 53 Individuals  Focus group involving 88 individuals Total participants: 578

Metro South Health

Don’t underestimate BAU

Success Story – Clinical Deterioration

• Worked with multi-disciplinary Clinical & IT team to identify core attributes in

visualising current and trended data associated to deterioration of patients within the confine of their hospital stay.

• Integrated multiple datasets from silo systems into MSH Warehouse

– ieMR, HBCIS (PAS), Rapid Response Team Local Database

• Data visualised via Interactive Dashboards – giving ability for clinical staff to

review: – When and where deterioration is occurring within the hospital – Patient’s ‘at Risk’ of deteriorating to point of requiring Rapid Response – Clinical Outcomes attached to patients who have deteriorated

Clinical Deterioration Dashboard

Red & Yellow Alert (ieMR)

Success Story – Medications Clinical Monitoring

• Worked with key senior clinical staff to develop visualisation of key

medication ordering/administration data to allow safety and quality monitoring – especially for ‘risky’ medications/workflows (i.e. Insulin & Heparin)

• Results

– Live clinical safety & quality monitoring of medication orders & administration – Ability to instantly identify ‘risky’ patients (i.e. BGL >16, High/Low APTT etc.) – Ability to intervene before administration of medications where unwarranted care deviation – Identification of consistent data trends to help assist in optimising functional design of electronic prescribing within ieMR

Digital Diabetes Dashboard

Success Story – Pathology & Radiology Endorsement

• Interactive dashboards providing near real time visibility Results being ordered, and

consequently endorsed within the ieMR Results – Ability to filter by location, clinician designation, encounter type, Pathology Catalogue type, date etc. – Views of the data can be changed to display by Unit, Treating Clinician or Ordering User – Clinicians & Executives are able to query the dashboard down to staff/patient level, and if desired, expose result specific data attached to each event

• Results

– Transparency across organisation as to compliance with viewing/endorsing results – Ability for Clinical Leadership to follow-up with services/staff who require more attention/support

Pathology & Radiology Results Dashboard

Metro South Health

Th Thank you!