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New South Wales Health Symposium - Cheryl McCullough

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Transcript: I’m Cheryl from the Sydney Children’s hospitals network, and I was asked to come and share a little bit of our journey with you, and how we are using technology to connect with patients.

We have been working on the digital integration of our health services for more than twenty years and that has focused on what happens internally in our hospitals. We’ve recognised in the last five years or so that we really need to find a way to connect with patients who aren’t in hospitals, because that’s where they are most of the time.

Many of our patients are not local to us; they come from all over Australia and other parts of the world, and we need to talk to them wherever they are during the course of their life. Then we need to hand them over to care of health providers as they move into their outward.

This is a little bit of how we are going to tackle that.

We went to market to see if anybody was helping patients connect pieces of information across many providers, and there wasn’t someone who could do that for us at that time. But there were people willing to work with us to co-design what we wanted. We knew that we couldn’t integrate with every medical system out there, we couldn’t work with every GP, every hospital and every practice across Australia.

We had to find a way to make the patient the conduit of all that information. Oneview was very successful in approaching us, saying that they could commit to working with us and providing a way for patients to share their information with others.

We worked internally first really to set up the hospital system so that they could talk to their teams while they are in our care and during that period. We’ve had that live for about a year now, and we’ve had great results in terms of looking at the patient experience, and that has improved by about 20% since we introduced Oneview to the bedside.

In that time, we’ve been working on the development of the mobile application which is really connecting patients while they’re not with us. So, it is the same sort of tool but the information flows from the inside of hospital to the outside of hospital.

We have introduced the basic things, like how to register yourself, how many proxies you might have. Proxies can be parents, they can also be siblings, they can be carers, they could be another doctor, or perhaps a school teacher depending on what the needs are.

It allows your appointment to come through and come into your native calendar; clinician-patient communication, and an SMS-type communication that comes back into the medical record. We have pushed education through the application, and we also support to connect with Skype and social media. There is a place in for patients to start recording their own information so they’re collecting the narrative of their healthcare journey.

It is simple, it works like every other app. You don’t really have to train people how to use it, they open it up and once they’re in it, they’re off. It is very, very simple.

We have a future plan, where we will include things like wearables and patient reported measures at home. Basically, we can send the appointment, they can bring it into the native calendar, we give them instructions, we make sure they are ready for the appointment and that they are doing the right things to prep. They also get SMS push reminders so they get pinged a couple of days before and just before the appointment to make sure they turn up on time.

We also have Cerner as our EMR. We wanted to make sure clinicians are really only having to work in the one place so Cerner is the basis for the clinicians and my health memory, the app that Oneview helped us develop is really the place for the families. But, they cross over, and where they cross over is the communication place which allows those messages that patients and families are having during the time outside of hospital to come back into the record for us to see.

It means, from a medical legal perspective when we are changing the plan of care, we have a record of that. We can also recognise that as activity in terms of where to change a treatment plan – we are intervening here. We can make sure that patients and families have a record of those communications and care plan changes because it’s in their phone; they’ve got that history as well.

It’s been popular. We have had about a 60% uptake in the pilot group. We have only been running it for three months and we have had around 300 patients registered, and we are bringing on another two hundred this month. If all that goes well, we will go live with the rest of the hospital within the next couple of months.

We are also adding quite a few other pieces, and we are asking the University of Sydney to help us evaluate this, so they are working with us to really check in and make sure that patients and families are happy to use it, the clinicians are finding that it is efficient, and, what’s the theme, the content of the information that we are actually getting out of the patient communication and does it change health outcomes.

This is our first family that signed up. They are really happy. They have got two kids with CF and it really makes managing their care a lot easier. They said, “why did it take you so long?” We are lucky we have a cohort of patients and families who are really technologically savvy. 97% of them come in with a mobile device. They have it with them most of the time, so we know we can get in touch with them when we need to.

A few of the things that we are bringing along soon will hopefully help us both inside the hospital and outside the hospital, to create some efficiency. We are really hoping that the Australian Commission will help us with some Paediatric focused patient reported experience and outcome measures so we have started connecting with them. We want to make sure that we are working from referral right through to all of the other treatment options in their home and other provider situations.

We have created a shared care summary in the Cerner space, which is compartmentalised and can be annotated by patients back in the Oneview application. It is really opening up those sorts of connections that are going to help us share care in a better way. The aim of this is to make sure that our patients are people first, they get to live where they want to live, they get the care that they need, they are in contact with us when they need to be but they carry on as normal for the rest of the time.

We are hoping that we’re going to get some new information from those periods between healthcare events that we have not been able to do before, and maybe that will help us change their health and really see why some patients do better than others. We are hoping that the information that is connected in the application will actually be used as intelligence data to keep winding up what we do next. We will be able to connect with patients wherever they are across Australia and around the world.

But also, this is creating that efficiency for healthcare, reducing duplication, empowering patients to make better provider decisions. Hopefully, making decisions that are really intelligent because they will have improved their health understanding, their health literacy. There will be transparent communication between our providers and hopefully better lifelong skills outcomes, and a record for life which is really what we want to set the next generation up for.

I want to say thank you, I really appreciate being able to come here and share that little piece of the story with you. And it is just a piece, we have a long way to go.

Thank you very much to our partners Oneview, who have taken an enormous amount of patience to work with us, with our families, with our partners and with the University to make sure we get this right.

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