The Tasmanian approach to eMM T om Simpson, Executive Director, - - PowerPoint PPT Presentation

The Tasmanian approach to eMM

T

• m Simpson, Executive Director, Statewide Hospital Pharmacy

Peter Fowler, Clinical Lead, Statewide Medication Management Projects T asmanian Health Service

Context – Tasmania, eHealth strategy Our journey – Goal state, progress thus far Modular approach taken (pros/cons) Overview of system AMT Project and training approach Outcomes

Agenda

Royal Hobart Hospital 490 bed tertiary referral hospital 39,900 wt seps/year Budget $366m Launceston General Hospital 300 beds 23,400 wt seps/year Budget $195m North West Regional Hospital 140 beds 8,300 wt seps/year Budget $81m Mersey Community Hospital 100 beds 6,900 wt seps/year Budget $65m

Limited capital funding for eHealth

 Opportunistic focus on Commonwealth/State priorities

Multiple eHealth strategies over last 15 years

 Forces multiple, smaller-scale investments

Small Australian market for EMM, immature vendor capability

 Modular approach is aligned with developing maturity

Context

Our EMM journey

Tasmania has, over the past 8 years, implemented major EMM functionality Modular expansion Project-based funding approach Relatively low cost – (no budget for large programs)

Our EMM journey

Progress

2007 Electronic Discharge Summary, secure messaging to GPs, iPharmacy integration

Cwlth – HealthConnect

2009 Medication reconciliation and clinical pharmacist activities

Tas – Pharmacy Systems Project

2011 Electronic discharge prescription generation

Cwlth/Tas – Pharmaceutical Reform

2012 Enhanced formulary

Tas – Formulary cost savings

2014 Electronic outpatient prescription generation, PCEHR, AMT, NPDR

Cwlth - THAP

2015 Enhanced prescription management & consent model, further NPDR, Snomed alert/allergy coding

Cwlth - THAP

Next stages Paperless PBS scripts eCharting

Medication History & Reconciliation Inpatient medication chart Discharge prescription Discharge summary Outpatient prescription

1 2 3 4 5

Tasmanian implementation

100 users 5,000 users 500 users 500 users 500 users Pharmacists All doctors, all nurses Junior doctors Junior doctors Senior doctors 50/day 1,000/day 100/day 100/day 500/day CEO investment priority C’wlth investment priority

Our ‘accidental priorities’

 Small user base better than large multi-D user base  Tech-savvy users easier to train than tech-resistant  Align stages with investment priorities for CEOs (+ DHHS and C’wlth)  Invest in steps that ease doctor workload (eg. Med rec  easier discharge summaries)

Modular, incremental approach

Pros

 Affordable  Clearly-defined endpoints  Clinician engagement for the ‘hard bits’ is easier as they already use the system

Cons

 Always chasing $ for next stage  Projects ‘targeted’ to funding

• bjectives, not necessarily local

priorities  Support requirement expands invisibly  Implementation out-of-order

System overview

Current episode Previous episode Clinical tasks Patient banner

Creating list of medications on admission

Generating discharge prescription

Snomed and AMT coding of drug allergies (note search term ‘nose’ – Snomed offers various contextual results)

AMT v3

HCS Clinical Suite uses MIMS as basis of product file

Automatic population of pack size, PBS, TGA information AMT coding of all ‘trade product packs’

Each stocked item is linked as follows:

iPharmacy  HCS  MIMS  AMT*

NPDR integration is easier – only one system – HCS for both prescribe and dispense events.

 All inpatient MH&Rs now electronic  ~40% of outpatient scripts generated electronically  Majority of discharge scripts generated electronically  Electronically-generated scripts are dispensed 33% faster than handwritten scripts  NPDR integration

Outcomes

 Combination of IT and clinical project staffing  current projects have used pharmacists  Choice of pharmacist/nurse is important  Peer respects is more important than technical skill  Recognise training needs differ  eg. Registrars needed less training than consultants  Keep the ‘old’ alongside the ‘new’ where possible  eg. Handwritten prescriptions – eg. still need them when in private rooms

Training and project approach

Gradual implementation means incremental approach to

• ngoing support – this remains a significant issue for us

Identification of funding for next stage Who is system ‘owner’ across the state? (Not pharmacy) Inpatient charting module of HCS Clinical Suite has not been clinically tested/validated yet

Challenges and risks

Conclusion

 A modular approach to EMM has enabled us to incrementally invest.  This approach has some advantages and some disadvantages.  An Australian vendor, HealthCare Software, has developed EMM capabilities that align with PBS, NEHTA, and local requirements.  NPDR and PCEHR integration has been achieved, including rapid implementation of AMTv2 and v3 through MIMS. MIMS is a partial solution for AMT encoding.  Tasmania is a significant way into its journey towards paperless, closed-loop medication management.

Conclusion

Tom.simpson@dhhs.tas.gov.au 03 6222 8451

Thankyou