Information technology in South Africa is at an exciting crossroad where critical decisions need to be made on how to leverage the benefit of technology so that clinical outcomes and systems management improve. However, it is essential to do it right the first time to prevent wastage, unnecessary duplication and incurring excessive cost. Learning from other successful projects provides an opportunity to take on the good and manage the challenges effectively.
Successful implementation of patient cantered, electronic health records (EMR) in the region of South West Australia provides an important framework for consideration. Understanding the process (since 2002) as well as having a comprehensive project management plan with an emphasis on the value of building the system from foundation (PAS) to finishing touches (Specialist unit modules) is only part of the challenge. The human factor of change management to adoption remains the greatest obstacle. This article emphasises the executive support at grass root level as well as lessons about sustained training for staff. Resistance is inevitable with change; it is how it is managed that makes the implementation successful.
The benefits for the patients and the hospital alliance derive from the single instance of the EMR coupled with a master patient index and high levels of adoption from clinical staff. This enterprise platform has translated into improved patient safety and better medication management. This has been good for patients as well as the staff who provide care with everybody a winner.
– Physician Executive at InterSystems, Gene Elliot
Clinical adoption of EMR systems is one of the biggest challenges faced by the heads of hospitals and hospital groups embarking on the journey from paper to electronic records and interoperability.
“Hardly a day went by that I didn’t have to do battle with a doctor or medical professional over the requirement to use the system,” recalled Chief Executive of Portland District Hospital in Victoria, Australia, Christine Giles.
Speaking to a group of eight healthcare executives from four hospital groups considering furthering transformation programs, her advice was clear: “Make sure you have a toolkit to use in your challenging conversations with them, and don’t give them any other option. It’s a journey, not a sprint – don’t allow a fall-back position, as it will become the position.”
I recently had the pleasure of accompanying these eight guests who had come to visit Giles’ highly successful EMR implementation at Portland District Hospital (PDH), in the South West Alliance for Rural Health (SWARH) region in Victoria.
PDH’s EMR journey started in 2002 when SWARH implemented a single instance of the EMR’s emergency module across its hospital network in South West Victoria. Since then and over a 10-year period, PDH has successfully added pathology, radiology, clinical notes, PAS, records management, theatre, outpatient notes, and administration and community modules, and they were the first hospital in the district to deploy electronic medication management. In addition, SWARH has built a single master patient index across the region to eliminate duplication of patient records across all hospitals.
Medication management has proven to have a big impact on patient safety and clinicians’ time. According to the PDH head pharmacist, medication errors due to incomplete or illegible prescriptions disappeared overnight, and the time required for most medication management processes was halved – a massive win for safety and productivity.
The high level of clinical adoption that PDH has achieved impressed the visitors. Giles stood firm about the requirement for clinicians to adopt, because in the end, it comes down to patient care and safety, and she knows that going electronic is the right thing to do for the patients and the future of the hospital. She also chose to bypass digital records and go straight to electronic records, as she felt going digital would simply be disruptive and a duplication of change management.
Giles and Chief Health Information Manager, Claire Holt, were diligent to ensure staff had extensive input into the system’s design and were thoroughly trained in its use before each module was released. They allowed users to come back to training as many times as they needed, holding open sessions that they could drop into. And when users brought issues to them, the leaders knew it was important to show quick results to keep everyone on side. They worked closely with the nurses union as well, to ensure that all external bodies were supportive.
The journey has not been without challenges. Many departments had a long list of excuses why they did not have time to use the system. Visiting surgeons and locums will resist, but will need to work in and be quickly educated and supported. Processes need to be in place when there are staff changes. And when there are issues, executive support is often required, Giles advised.
COO of SWARH, Katherina Redford, said: “The paper record has been given time to evolve over a number of years. Hence it is now easy and quick to use. An EMR needs to be given the same opportunity. It takes a long time to gain consensus, and strong governance (project and clinical) is key to decision making.”
PDH was asked, if they were to do it again, what path would they take? They were very clear: “We would definitely follow the HIMSS adoption model. It really makes sense to implement the PAS first.”
– InterSystems Marketing Director for Asia Pacific, Fiona McDonald-Crowley
To learn more about the EMR that PDH implemented, InterSystems TrakCare, please click here.
Fiona McDonald-Crowley’s original article can be found here.