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In 2012, Queensland Health began its digital health journey, which has seen the digital reinvention of nine Queensland Health hospitals – with many more earmarked for renewal as the scheme is rolled out across the State.
The transformation included the launch of the integrated electronic Medical Record (ieMR) – distinct from a standard electronic medical record, due to its integration with pathology, radiology, emergency department and surgical theatre tracking, outpatient scheduling, biomedical devices (such as patient bedside monitoring), dispensing software, automated dispensing cabinets and the State Patient Administration System.
Ahead of the eMedication Management Conference, we spoke with James Grant, the scheme’s pharmacist lead, to get insights into how the program has been received by staff and patients within the digital hospitals.
How have hospital staff responded to the digital transformation?
The shift from a hospital reliant on paper records to a fully-fledged digital hospital has been a radical transition so far. Once fully transitioned I am sure they will find it difficult to imagine how they coped with the old “paper” system.
Although we are just a few years into the program, much of the day to day clinical work seems streamlined and less chaotic. It’s akin to the arrival of mobile phones or PCs. Even those who showed initial technophobic resistance now own one and couldn’t imagine life without one.
What are some of the inefficiencies of the old system that, as a pharmacist, you no longer have to deal with?
Prior to the digitisation, pharmacists would have to spend considerable time re-entering patient identifiers into many systems (pathology, patient flow systems, dispensing software, prescription tracking); correcting PBS quantities on discharge prescriptions; numbering charts in each review (and flicking between fluid charts, insulin charts, and NIMCs to capture all the medications and fluids); copying admission notes onto medication admission plans from medical charts; finding patient charts in order to process a discharge; and finding and adhering patient ID stickers to progress notes and NIMCs missing them.
Now, thanks to the digitisation, only a couple of these tasks even remain and they can be done faster than before.
How have patients reacted to the ieMR?
One of the fascinating aspects was that many patients thought we already were digital! When they go into their Banks, or even online Shopping, it’s all electronic to a large degree (or can be). It was such a basic presumption that advertising the further digitisation of the hospitals often led to a double-take by the patient as they noticed the paper that was being used before going live.
Are there any weaknesses associated with the new system?
There is of course a risk of data inaccuracy, but this issue is not exclusive to electronic records. If anything, electronic records mitigate much of the risk of data inaccuracy implicit in paper records (which are far more liable to human error).
There are also legitimate concerns about network security, but again, these risks are no greater than that of other sectors, like transport and banking, which have progressed considerably with their digital transformation.
Of course, there are bountiful opportunities to improve the ieMR and Queensland Health is working on several improvement projects across the platform.
What other opportunities do you believe the ieMR can offer that haven’t yet been exploited?
So far the focus has very much been on utilising ieMR within a clinical setting, particularly, point of care at the bedside. However, data analytics and more proactive health delivery – based on better prediction and availability of the whole picture – is yet to be truly tapped and that’s an exciting space to be moving towards.
What considerations do hospitals need to make before going digital?
There needs to be an appropriate level of underlying infrastructure (e.g. hospital-grade Wifi connectivity, devices and support), along with strong senior clinical and executive leadership.
There must also be a sense of openness to re-design the underlying care delivery models, possibly adapting the way care is administered, rather than simply digitising existing practices “like for like”.
James Grant will be speaking at the eMedication Management Conference – 13 – 14 March, Sydney – on what’s next with the MHR opt out and the opportunities with this new source of information.
