realisation in Opt-Out trial site Nepean Blue Mountains Jo-Anna - - PowerPoint PPT Presentation

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realisation in Opt-Out trial site Nepean Blue Mountains Jo-Anna - - PowerPoint PPT Presentation

Aug 06, 2023 457 likes •770 views

HealtheNet & My Health Record benefits realisation in Opt-Out trial site Nepean Blue Mountains Jo-Anna Wood Change & Adoption Manager eHealth NSW Introduction ________________________________________________________________________

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HealtheNet & My Health Record benefits realisation in Opt-Out trial site Nepean Blue Mountains Jo-Anna Wood Change & Adoption Manager eHealth NSW

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Introduction

________________________________________________________________________

  • In October 2015, the Nepean Blue Mountains Local Health District

(NBMLHD) was selected as one of two sites to trial the automatic creation

  • f My Health Records for all residents. The trial commenced in March 2016

and finished on 31 October 2016

  • The trial set NBMLHD on the path to embedding the process of viewing the

NSW HealtheNet Clinical Portal and My Health Record into clinical workflows

  • More work to be done to drive uptake and adoption across all clinical

groups and sustain the use of these systems as part of clinical practice

  • This presentation will cover lessons learned and present clinical case

studies that outline how HealtheNet and My Health Record information is being used successfully in practice, such as by hospital pharmacists and clinicians on the wards for medication reconciliation

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Introduction

________________________________________________________________________

  • In the Nepean Blue Mountains region 98% of patients have an eHealth

record due to less than 2% ‘opting-out’

  • Clinicians view a patient’s My Health Record information through the

HealtheNet Clinical Portal, via their EMR

  • HealtheNet shares a patient’s hospital discharge summary with their My

Health Record, unless the patient requests that their discharge summary is not shared with their My Health Record on admission (or throughout their stay)

  • Adoption increasing as the number of documents in the system grows,

which recently expand to include pathology results

  • We are now seeing patients with over 100 ‘documents’ in their combined

My Health Record and HealtheNet record

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HealtheNet

________________________________________________________________________ Better information results in better patient care HealtheNet helps to improve communication between hospitals, community and private healthcare settings by sharing patient information electronically and securely with:

  • Doctors, nurses and allied health providers across all NSW Health

Local Health Districts and Specialty Health Networks through the HealtheNet Clinical Portal

  • General Practitioners (GPs) by sending discharge summaries directly

to a patient's nominated GP using secure electronic messaging

  • Patients and their care team by sharing clinical documents with a

patient's My Health Record

For further information (including Quick Reference Guides and videos): http://www.ehealth.nsw.gov.au/programs/clinical/healthenet

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HealtheNet

________________________________________________________________________

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Local statistics – info in the record

________________________________________________________________________

  • Approximately 1,500 per month Shared Health Summaries have been

uploaded in NBMLHD since July 2016,

  • There are 88 general practices in our region uploading to the record (out
  • f 108 practices with computers)
  • There are 22 pharmacies in the region uploading to the system, this

number is increasing as more software becomes compliant

  • From July 2016 to Feb 2017 171,000 dispense records have been uploaded
  • 31,852 dispense records from community (retail) pharmacies in the region

were uploaded in January

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HealtheNet

________________________________________________________________________

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Clinical Portal – available documents

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Discharge Summaries

These are the discharge summaries able to be sent electronically in NBMLHD:

  • PowerForm:

― Baseline (Standard) ― Gastroenterology ― Geriatric ― Neurology ― Toxicology ― Renal

  • PowerNote:

― Emergency

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Pharmaceutical Benefits Report

Two year date range

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Pharmaceutical Benefits Report – used by Pharmacist

________________________________________________________________________

How is HealtheNet and My Health Record used in practice (as pharmacists)?

  • As an additional resource for medication history/reconciliation
  • Useful screening tool for unusual/omitted medications to prompt further

investigation

  • Useful for identifying regular pharmacy/GP/Medical Specialist
  • Can indicate level of compliance through dispensing history

Wade McKeown Pharmacist Nepean Hospital Pharmacy Department

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Medicare Benefits Schedule Information

Medicare Information View contains a selected date range of Medicare data:

  • Pharmaceutical Benefits

Report Information (PBS)

  • Medicare Benefits

Schedule Information (MBS)

  • Australian Immunisation

Register

  • Australian Organ Donor

Register

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Shared Health Summary

A Shared Health Summary is uploaded to the patient’s My Health Record directly from their GP’s practice software. It may contain:

  • Adverse Reactions
  • Medications
  • Medical History
  • Immunisations
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Prescription records

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Dispense records

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Imaging Repository

Indicates no images/reports available If images/reports available this icon appears

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Imaging Viewer

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Benefits Realisation Pilot

  • The benefits realisation pilot partnered with clinicians and together we have

identified key benefits of the (combined) systems

  • We are now starting to track and measure these benefits
  • The benefits are measured through either quantifiable data
  • E.g. how many discharged patients had a discharge summary sent to

HealtheNet, their GP and My Health Record?

  • Via case studies and stories such as asking clinicians "how much time was

saved by having access to other LHDs discharge summaries?" or "how do you use HealtheNet to support your medication reconciliation processes?

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Benefits Realisation Pilot Approach

  • Workshop 1: 5 key stakeholders
  • Workshop 2: 30 key stakeholders including executive, health information

managers and medical records, administration managers, clinicians (Head of Renal Medicine and Head of ENT Surgery, ED Nurse Unit Manager etc)

  • Presentations and in-services conducted to over 500 clinicians between

December 2016 and April 2017

  • Developed relationships with key clinical groups such as pharmacists,

NUMs and junior doctors who were keen to embrace the technology

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Benefits

HealtheNet Benefits – validated and prioritised by NBMLHD stakeholders on 30/3/17

  • 1. Enhance integrated care by improved information sharing with primary care
  • All GPs to receive an electronic discharge summary directly as well as it being sent

to My Health Record

  • 2. Access to patient information contained in record on presentation to ED
  • Increased viewing of HealtheNet and My Health Record for medical history, allergies

and current medications on presentation to ED

  • 3a. Provide an aggregated source of relevant patient information
  • Increase the number of times HealtheNet is viewed for every patient, on first

contact/encounter, across all specialties

  • b. Viewing of diagnostic images
  • Increased use of the imaging portal, particularly in Outpatient Services
  • c. Viewing of pathology information
  • Increased viewing of pathology results in HealtheNet
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Benefits

HealtheNet Benefits – validated and prioritised by NBMLHD stakeholders on 30/3/17

  • 4. Access to and visibility of patient medication information
  • Increased viewing of record for medication reconciliation purposes on admission

and throughout patient stay.

  • 5. 24/7 real-time access to past results (medications, radiology, pathology, discharge

summaries from other LHDs)

  • Reduced time spent searching for information from other LHDs/labs, and reducing

time spent waiting for information to arrive (a fax, paper record, GP clinic to open)

  • 6. Improved patient engagement and involvement in their healthcare
  • Improve patient awareness and use of their My Health Record through viewing

information and entering OTC medicines, allergies and ACD.

  • 7. Improved handover and continuity of care between acute and primary care settings
  • Increased GP contribution to and viewing of the record – SHS & Prescribe uploads,

viewing DS & pathology info.

  • Increased viewing by community pharmacy and other providers (dentistry,

specialists etc)

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Confirm benefit sources, measures and baseline targets

Baseline Target Target Outcome Descriptio n Outcome Owner Measure Name Measure Owner Data source and ID Data source and ID Perio d 1 Perio d 2 Period 3 Final Current [The name

  • f the

relevant

  • utcome]

[The name

  • f the

person nominated with making sure this

  • utcome

happens] [Metric #1 The name

  • f the

measure] [The best authority

  • n this

measure] [Where will this data come from? E.g. Name of system] Wherever possible use measures that already exist in the business! [The starting figure at comme ncemen t of the project] [Where did this data come from? E.g. Name of system] Wherever possible use measures that already exist in the business! [Goal amount for the current period]

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Pharmacist use – Nepean & Blue Mountains Hospitals

________________________________________________________________________

How is HealtheNet and My Health Record used in practice (as pharmacists)?

  • As an additional resource for medication history/reconciliation
  • Useful screening tool for unusual/omitted medications to prompt further

investigation

  • Useful for identifying regular pharmacy/GP/Medical Specialist
  • Can indicate level of compliance through dispensing history

Wade McKeown Pharmacist Nepean Hospital Pharmacy Department

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Examples in Practice– Blue Mountains Hospital

________________________________________________________________________

77yo female admitted to Blue Mountains ED for worsening heart failure eGFR 70mL/min. BSL 20.6. PMHx of diabetes - only Linagliptin charted on admission. Medication History (in relation to diabetes) Investigated using HealtheNet & My Health Record:

  • GP Shared Health Summary contained Lantus and Linagliptin - both

medications dispensed

  • GP prescription for Gliclazide MR 30mg BD (no record of dispensing)

Issues: documentation, issues with management of diabetes, patient compliance Benefits of eHealth: ability to track multiple behaviours over time (i.e. multiple doctors and patient)

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Examples in Practice – Nepean

________________________________________________________________________

  • Pt 1: Norspan (Buprenorphine) Patch removed on admission

(not documented)

  • Pt describes increasing pain over following days, requiring ↑ pain relief.
  • HealtheNet & My Health Record used to discover/confirm patient usually on

Norspan 10microg/hr Patch.

  • Pt 2: Charted for Stelazine (Trifluoperazine) 25mg daily on

admission

  • Unusual dose, no clear indication, pt presented with fall.
  • HealtheNet & My Health Record used to confirm pt dispensed 5mg tablets
  • Further investigated, usually dose 5mg BD
  • Pt 3: Presents from Nursing Home with Hx of AF, no relevant

medications, but INR 1.8 on admission

  • HealtheNet & My Health Record used to confirm pt on Warfarin.
  • Confirmed with NH, warfarin on separate chart which was not faxed/lost on

admission.

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Pharmacist perspective – Nepean/ Blue Mountains Hospital

________________________________________________________________________

Benefits of HealtheNet & My Health Record data:

  • Additional source of accurate patient medical information
  • Available 24 hours

Current Limitations of the data:

  • Incomplete records – some of the data e.g. dispense records may be missing if a

retail Pharmacy doesn’t contribute

  • There is some latency in Medicare data which means it may not be up to date
  • Some medication changes occur verbally
  • GP Shared Health Summary may not be up to date e.g. changes since record was

created

  • Discharge summaries can be incomplete or inaccurate
  • The system doesn’t track patient compliance accurately but is suggestive
  • Not all medications included or traceable i.e. over the counter/complimentary

medications

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Use on the wards - Nepean Hospital

Utilised HealtheNet and My Health Record as a way of double checking what scripts a patient had filled and what medications they are on. Example 65 year old gentleman on multiple medications, admitted to respiratory ward for infective exacerbation of COPD.

  • He was unsure of the exact doses of medications and his wife was unable to

bring in his medications that day

  • Used the system to ascertain exactly what scripts he had filled to help chart his

correct medications Kate Sandy Resident Nepean Hospital

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More information

___________________________________________________________ The power of HealtheNet & My Health Record for patients video (99 seconds)

www.programdelivery.info HealtheNet Info Website http://www.ehealth.nsw.gov.au/programs/clinical/healthenet

HealtheNet

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Thank you!

Questions?

___________________________________________________________

Jo Jo-Anna Woo

  • od

Change and Adoption Manager | He HealtheNet | eHealth NSW Tower B, Level 13, Zenith Centre, 821 Pacific Highway Chatswood NSW 2060 Mobile: 0421998185 | joanna.wood@health.nsw.gov.au