First published by Pulse+IT on 27/3/2018
Written by Kate McDonald
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The Sydney Children's Hospital Network (SCHN) has gone live with full EMR integration of its new Connect app, allowing messages sent by patients to be directly accessible by the clinical team within Cerner's PowerChart module and patients to receive instructions and information on their personal device.
In what is thought to be the first direct patient content to be integrated into an EMR in Australia – and perhaps even worldwide – SCHN worked with Irish patient experience vendor Oneview to co-design the app, which is now live in all departments at the Children's Hospital at Westmead.
Oneview Connect was first piloted last year with some patient groups to test functionality such as SMS communication between patients and clinicians, appointments rescheduling and notifications of events. The full version integrated with the EMR has now been launched throughout the hospital, with plans to also roll it out at Sydney Children's Hospital at Randwick in about a year.
The new functionality allows communication between patient and clinicians to be accessed and viewed by the clinical team just by logging into Cerner. The data is also captured as a patient note in the patient's record.
SCHN's director of clinical integration Cheryl McCullagh said the idea of integrating the app into Cerner was to allow the whole care team to see any changes to treatment plans or communication with the patient from within their current workflow.
Patients and clinicians are first verified in Cerner and then on the app, allowing them to begin to receive any information finalised within Cerner such as outpatient events, discharge summaries, appointments and rescheduling.
Patients can also receive educational materials and instructions from their clinicians. “It might contain the telehealth link if it's a telehealth appointment, so they can do it straight from their device,” Ms McCullagh said. “If they request a rescheduled appointment it goes back into a Cerner task list, to administrative clerks, and they can reschedule that appointment.”
Clinicians can initiate a message in the form of a secure, encrypted SMS that is sent to the patient through the app, which then opens a channel of communication between patient and clinical team.
“They can use it at any time,” Ms McCullagh said. “It creates a communication mechanism that the patient sees in the application but the clinician sees in Cerner, like a note. It also wraps up into a note into the record.
“This is the first patient direct content into the electronic medical record that we've had and it means that the whole treatment team can see what communications have occurred and whether treatment plans have changed.
“The whole health team has a record of that consultation and communication, but also the patient has a record in their phone if they need to share that information if there is a change to their treatment plan or instructions.”
Many of the patients using the app have a chronic disease and are receiving ongoing treatment between physical appointments. With much chronic disease managed in the
outpatients setting these days, it means adaptions to treatment plans often occur when the patient is at home.
Ms McCullagh said the app can help reassure patients and families that adaptions can be made in the moment and any changes to things such as medications effects and
preferences can be seen by the whole care team.
An example might be a cystic fibrosis patient who is on a round of steroids, but the medication is not having the same effect as previously. With the app, they can message their care team asking if they can increase the dosage rather than wait for an appointment or present to the ED. The care team can make an assessment and message them back or arrange for a physio visit.
For the care team, this is all done within Cerner. “The care team is notified there is a message when they log into Cerner, with the message appearing in the clinical team's message centre in PowerChart and also in the patient record,” Ms McCullagh said.
“A range of people can review the messaging. It is usually done by a team, not by a person, and you can see if you are looking at the patient's record if they have a message waiting.
“All of our clinicians work in Cerner all day every day – they can't actually do their work unless they do. So it's not a problem and we make sure the families know this is a Monday to Friday, business hours service and if they need emergency help they call emergency.”
While Oneview is best known for its patient infotainment system, which is used at Westmead, Ms McCullagh said the company was actually engaged as a co-developer of the app because of its co-design capability. SCHN also worked with Microsoft on the supporting infrastructure – the app won a global Microsoft Health Innovation Award earlier this month – along with Cerner and Sansoro Health, which develops APIs to help systems integrate with EMRs.
Ms McCullagh said the hospital chose to co-design an app with Oneview because there wasn't anything on the market that allowed integration in the EMR or direct communication from families.
“We are the first site in the world to have Connect and we are co-designing it with patients and families and with Oneview, but it has been picked up by other hospitals in the US,” she said. “This is the first direct patient content in an EMR in Australia but we think it is quite novel worldwide. There might be a couple of other examples but nothing really direct to a record.”
The app is just one element of SCHN's My Electronic Medical Online Record or Memory strategy, which was developed in 2014 in part to address problems identified by patients and families in their hospital journey.
Some of the major issues identified were the necessity to constantly carry information with them at all times, a lack of information on why they had to wait and what to do in that waiting period, and common bugbears such as keeping track of medications and changes to treatment plans.
At the time, SCHN took a look at what other children's hospitals around the world were doing and saw that patient portals and the integration of communication systems for patients, external providers and internal providers was the way forward. An app that could share information between patients and clinicians was one of the strategy's main elements.
“The problem initiation really came from patients and families,” Ms McCullagh said. “They said our issues are that we know about the treatment when we get here, but it is about the ongoing communication we need to have with you, to navigate a system as complex as we have, in a chaotic environment with lots of paper flying around, and how do we keep that messaging consistent.”
To assess whether SCHN is actually solving that problem, it has engaged eHealth researchers Tim Shaw and Melanie Keep from the University of Sydney to do an evaluation of patient and family responses to and adoption of the tool, how they feel about it and whether or not it is creating efficiencies or inefficiencies.
“So far those results are looking really good,” Ms McCullagh said. “In terms of assessing health outcomes, we are just now at the point now of pulling six months of data that has been communicated and see if there are any themes around impact on health outcomes, interventions and reduced presentations and those sorts of things.”
The project received an honorary mention in the Best Digital Transformation Project category at Australian Healthcare Week in Sydney last week.
Reproduced with the permission of Pulse+IT