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RCH EMR Team
#RCHbigbang #HIC19 Mike.south@rch.org.au
RCH EMR Team #RCHbigbang #HIC19 Mike.south@rch.org.au April 2016 - - PowerPoint PPT Presentation
RCH EMR Team #RCHbigbang #HIC19 Mike.south@rch.org.au April 2016 - - PowerPoint PPT Presentation
RCH EMR Team #RCHbigbang #HIC19 Mike.south@rch.org.au April 2016 EMR implemented Why might this be of interest & why now? 1 st Epic implementation in Australasia Extensive Big - Bang methodology 1 st Hospital patient / family portal
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April 2016 – EMR implemented
Why might this be of interest & why now?
1st Epic implementation in Australasia Extensive “Big-Bang” methodology 1st Hospital patient / family portal Structured benefits monitoring program 3 years
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Big-Bang: Broad
Inpatient wards, OP clinics Emergency Dept ICUs Theatre / Anaesthesia Oncology Mental Health Service Regional Outreach clinics Hospital in the home
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Big-Bang: Deep
Documentation Ordering Medications (eMM) Blood management Barcode scanning Device integration All mobile apps Scheduling Referrals My Health Record Patient/family portal External provider portal Self-service analytics Research
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RCH Services still on paper 1st May 2016 : None!
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Big-Bang: Novel
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Big-Bang: Why?
Avoid financial / momentum issues Achieve benefits sooner Patient safety all electronic vs hybrid workflows
Extensive literature review / site visits / external review
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Benefits – a structured program All Departments Leadership Workshop Benefit Owner Ongoing Monitoring 8 quarters before and 8 quarters after go-live Health Round Table, Uni of Melbourne Statistics
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Benefits
An EMR has potential for real improvements in:
Staff satisfaction Clinical outcomes / patient safety Patient / family engagement Operational efficiency Financial performance Research
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Staff satisfaction
Survey – satisfied/highly satisfied
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Staff satisfaction
Survey – satisfied/highly satisfied
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Inpatient & Outpatient 2017 Outpatient November 2018
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Operational / financial
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Patient portal accounts
Patient / family engagement
Satisfaction survey
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Clinical incidents
EMR related
16 ISR 4. No Harm/Near miss 10 ISR 3. Minor harm Missing referral x2 Wifi drop out in Neuro theatre Research med not in system Doc could not sign med admin Missed dose hydrocortisone Med rec completed incorrectly TPN order wrong Lost letter Patient address wrong Many suggestions for new EMR functionality
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Investigations
- 6.3%
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Medication safety
- 13.4%
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Patient safety - Detecting the deteriorating patient
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Deteriorating patient
+13%
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Mortality
(p= 0.0145)
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Standardised mortality rate (HRT)
- 27%
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Mortality
55 - 84 fewer deaths since go-live
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Causality?
Imaging tests per episode Mortality MET calls Medication errors
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Extending our system
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Conclusions
“Big-Bang” approach validation Health informatics saves lives
Acknowledgements
Clinical Epidemiology & Biostatistics Unit, University of Melbourne Health Round Table
#RCHbigbang #HIC19
Mike.south@rch.org.au