A presentation given by Cheryl McCullough at The Journey, CHA conference for 2012, in the 'Enhancing Outcomes Through Innovations in Technologies' stream.

1. Paperless Possibilities
October 2012
Cheryl McCullagh
Director of Clinical Integration

2. SCHN-Children First and foremost

3. current state

4. Is ‘paperless’ a realistic goal?
• Current frustrations can
be overcome when
technology makes things
easier and repetitious
data entry is eliminated.

5. Correspondence
EIR Link
Nursing Transfer Form
Clinical Care Summary
LDAP QAS
Deceased Patient Alert
CVAD documentation
v500 PowerChart HIE extract upgrade 2007.04 Daily Specials
HPUX Migration
OPD Note doc Height/Weight inbound
Rev 7.8 upgrade Document Imaging Allergies, Problems and Alerts Visit Followup - NAP doc
ENT OutpatientDRG v6 upgrade Clinical Documents
Ax Haem
SMS OPD Multi Provider Billing Project
Orders & Results CAPAC Disaster Ward HeCare ED Citix Passthrough
to SQL
2004.03 upgrade
VMS upgrade WLCOS /DoH policy CHAQ doc Ward access-CCIS
Upgrade Oracle 9i upgrade Message Centre Ad-hoc security Rapid Response
CERS
Rehab Unit doc Action Plan doc
Asthma Medicare Expiry in PM
Document Loader Patient Risk doc ClinDoc tab Custom PWS Growth Chart
VMS 7.2 upgrade PICU doc Transition care Scheduling/PM patch stage2 go-live
PBRC
PET scanner NM
Armbands PBRC stage1 go-live
Scheduling Billing&Extract INP SQL upgrade Growth Chart
Fenton
2000-01
2000-02
2000-04
2000-05
2000-07
2000-09
2000-10
2000-12
2001-02
2001-03
2001-05
2001-07
2001-08
2001-10
2001-12
2002-01
2002-03
2002-04
2002-06
2002-08
2002-09
2002-11
2003-01
2003-02
2003-04
2003-06
2003-07
2003-09
2003-11
2003-12
2004-02
2004-03
2004-05
2004-07
2004-08
2004-10
2004-12
2005-01
2005-03
2005-05
2005-06
2005-08
2005-10
2005-11
2006-01
2006-02
2006-04
2006-06
2006-07
2006-09
2006-11
2006-12
2007-02
2007-04
2007-05
2007-07
2007-09
2007-10
2007-12
2008-01
2008-03
2008-05
2008-06
2008-08
2008-10
2008-11
2009-01
2009-03
2009-04
2009-06
2009-08
2009-09
2009-11
2009-12
2010-02
2010-04
2010-05
2010-07
2010-09
2010-10
2010-12
2011-02
2011-03
2011-05
2011-07
2011-08
2011-10
2011-11
2012-01
2012-03
2012-04
2012-06
2012-08
2012-09
Inpatient Discharge Summary VMS 7.3 upgrade Scheduling Phase 2
Wireless in ED/theatres/SU
Haem/KFZ doc 2007.16 upgrade
ICU Admission flag Office 2010 upgrade
Patient Registry go-live
VMS & TCPIP upgrade Attending Doctor2 capture
Patient Management RIS go-live Order reprint one page
DocLoader Authentication 2007.19 code Allied Health go-live
Scheduling Phase 3Paediatric Risk form
INP-GP/Paed data Between the Flags
ED summary Oracle 8.1 upgrade Middleton f/u doc eHR Growth Charts -Burns Unit doc
SUPI/ Advanced Dental Unit doc EDW extract
Hagar - ES80 Nursing Transfer Summary
NSW Bed Board Surgical f/u docpatch
VMS Mental Health go-live
HIE extract upgrade
Growth Charts implemented Enhanced View Phone/Communication Immunisation updateAmbulance extract
HeCare ED
Scheduling Demographics Banner
Kids Care Centre ED
PRAT tool
Clinical Summary tab
Pre-admission clinic assessments
Citrix for P'Chart

7. Evolving Documentation Strategies

9. Between the Flags
• eform for clinical and rapid
response
• Increased vigilance for
complications by coders
• Increased coding of arrests and
resuscitation events
• Form and call triggered by patient
events

14. Order Sets (Care Sets)

15. Medication Reconciliation – Home Meds

18. Antibiotic
Stewardship
4Kids(ABS4
Kids)
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View Approval
Requests
What is ABS 4 Kids?
ABS 4 Kids stands for
"antibiotic
stewardship" or
otherwise known as
"antimicrobial
stewardship" for Kids
at CHW. Antimicrobial
stewardship is defined
as processes to assist
and support clinicians
with decisions
regarding the optimal
selection, dose and
duration of
antimicrobial agents.
The objectives of ABS 4
Kids are: To optimise
antibiotic use to
improve patient care
To minimise antibiotic
toxicity to the patient
To reduce the
selection pressure for
the emergence and
transmission of multi-
drug resistant bacteria
One of the core
strategies of ABS 4
Kids consists of online
pre-approval of
restricted antibiotics
(see below). A
hierarchical "traffic
light" system has been
developed based on
the resistance
potential, complexity
of use and cost of each
antibiotic. The
restricted agent
groups, and
mechanisms for
obtaining approval are
specified below: "Red
Agents" are
antimicrobials of very
high resistance
potential and/or cost.
When commenced
during office hours,
approval in advance
must be obtained from
the Stewardship
What is ABS 4
Drug Dose Guidelines Antibiotic Guidelines Contact Us Antibiotic Approval Consultant on page
kids?
7092. The approval
number must be
written on the
medication chart.
When commenced
after hours, approval
must be sought on the
morning of the next
working day. "Orange
Agents" are
antimicrobials of
intermediate
resistance potential,
cost and/or complexity
of use. Initial empiric
use of agents in this
group is allowed and
their use must be
registered on the
request form below by
the clinical team at
time of prescribing.
The request will be
reviewed by the
Stewardship
Consultant, on the
basis of the clinical
information provided,
on the same or the
next working day. If
approved, an approval
number will be
supplied for annotation
on the patient's
medication chart.
"Green agents" are
those where there are
no restrictions on use.
If required, antibiotic
advice is always
available by paging the
Infectious Diseases
registrar (during
working hours) or the
Infectious Diseases
Physician or Clinical
Microbiologist on call.
Other useful resources
include the Australian
Therapeutic Guidelines
- Antibiotic (available
via CIAP) and the Drug
Dose Guidelines. CHW
"Traffic Light"
Restricted Antibiotic
Formulary

23. Historical Challenges
• ‘pockets’ of information
• No consistent model of analysis / reporting
• Consistency and completion of tasks
• Different source systems
• Access
• Timing
• Quality
• Duplication

24. Risks
• Limited $
• ABF
• Private Patient Revenue
• Costing
• Site systems differences
• Infrastructure
• Sustainability
• Patient Safety

25. Service Needs
• Integrated approach to multiple needs
– Strategy
– Planning
– Costing
– Reporting
– Performance management
– Service delivery
– ‘real-time’ information

26. Strategic Directions Alignment
National Health Direction
Creation of Local Health Districts and Specialty Networks Implementation of Activity Based Funding (ABF)
State Health Strategy
Patients at the centre of access to timely, quality keeping people healthy to avoid The Creation of NSW
everything we do health care unnecessary hospitalisation Kids and Families
State ICT strategy
Clinical Systems integration- EMR Corporate systems Information for Sustainable
and unified patient record integration performance and ABF Infrastructure
SCHN strategy
Strategic Development & Meeting the needs for Delivering Providing infrastructure
technology implementation the performance seamless for research and
investment of responsive IT systems framework clinical care education
SCHN IMTS
Sustainability and accuracy Single patient view Access to information Innovation

27. Aim- connecting information for outcomes
• Combined local HIE by Dec 2013 • eMR basis for clinical information
• Unified and accessible eMR by • Full redundancy of critical
2015 (including remote access) systems, regular scheduled
• Enterprise Imaging Repository downtime
• Unified Implementation of eMR • Reliable interfaces - no duplication
for inpatient/outpatient notes of systems or data entry
• Implementation of eMM • Minimal unplanned downtime due
to preventable internal
mechanisms
Single Sustainability • Seamless integration of automated
information
patient view and accuracy
Patient
Service • Work with MOH/ e-health and
• CHIMP/ CHARLI/ e-policy/
Pathlore/ e-quality Staff •
tele-health international leaders
Equipment universally interfaces
• Single data input
• Implementation of eMM Standardised with the eMR
• Innovation • User satisfaction
Use of innovative data collection
information • Up to date technology
• Smart theatres 2012/13
• Lanier voice recognition

28. Clinical Information Strategy to 2016
2000-2011 Now 2013 - 2015 2016
eMR eMR + eMR + eMR +
Strategy Orders/Results HPUX Migrations all Documentation
Growth Charts Patient Registry for IHI Transition to aSCHN eMR Safety interfaces
PAS/Scheduling Enterprise Image Repository eMR Phase 2
Allergies/Alerts Scheduling Correspondence
ICU
Outpatient Billing PathNet Millennium
Between the Flags Outpatient Reporting
Medication Management
Allied Health PowerNote & MPages Discharge Referral
Mental Health Review SCH eMR Workflows FirstNet/SurgiNet
EDW Client & WL eMR Phase 2 Immunisations
Problems/Diagnosis
Inpatient Consult
Clinical Reporting
XR Reporting (MRP)
Other
Document Imaging
Document Imaging
Document
Paper
Imaging
Document
Paper
Imaging
Medical Records Medical Records
Integration
Paper
Department Records
Department Records Paper
Department
Records
Dept Dept
Dept Databases Databases
Databases
Dept
Databases
PCEHR PCEHR PCEHR

29. The connected record

31. Internet based health Conferencing

33. Management Information
• Delivery across the network
• Departmental performance against target
• CMI NWAU targets over time
• LOS benchmarks
• Revenue per pt load
• Performance against strategic goals
• Aspirational-clinical outcomes

34. VMO
CMO
STAFF SPECIALIST
MEDICAL FELLOW
JMO
NURSE PRACTITIONER
ONCOLOGY CAMPERDDOWN
HUNTER BAILLIE
NURSE MANAGER
SURGICAL UNIT
CLINICAL SERVICE PLANNING
MIDDLETON
OPERATING
NURSING UNIT MANAGER
THEATRES
VARIETY
TURNER
CLANCY
CLUBBE
CAPAC
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
WADE
CARDIOLOGY/CARDIAC SURGERY
HALL
NICU
PICU
ESW
OPD
OTC
EMERGENCY SERVVICES ED
REGISTERED NURSE
PSYCHOLOGICAL MEDICINE
WORKFFORCE PLANNING
ENROLLED NURSE
ASSISTANT IN NURRSING
MASTER PLANNING
NURSING
ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANT
FTE REVIEW
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
ALLIED HEALTH DIETICIAN
ADMINISTRATIVE ASSISTANT
CLINICAL SUPPORT OFFICER
WARD CLERK
ADMINISTRATIVE REVIEW BOOKING CLERK
SECRETARY
FINANCE STAFF
IT STAFF
CORPORATE/IT SERVICES BUSINESS MANAGER
DOMESTIC BOOKING CLERK SERVICES
SERVICES/FOOD

35. VMO
CMO
STAFF SPECIALIST
MEDICAL FELLOW
JMO
SURGERY
NURSE PRACTITIONER
ONCOLOGY CAMPERDDOWN
GENERAL BAILLIE
NURSE MANAGER
SURGICAL UNIT
CLINICAL SERVICE PLANNING
INTENSIVE
MIDDLETON
OPERATING
NURSING UNIT MANAGER
THEATRES
CCARE
VARIETY
TURNER
CLANCY
BURNS CLUBBE
TREATMENT CAPAC
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
WADE
CARDIOLOGY/CARDIAC SURGERY
HALL
NICU
PICU
ESW
OUTPATIENT OPD
OTC
EMERGENCY SERVVICES ED
REGISTERED NURSE
HUNTER
PSYCHOLOGICAL MEDICINE
MEDICINE
WORKFFORCE PLANNING
ENROLLED NURSE
ASSISTANT IN NURRSING
MASTER PLANNING
NURSING
ENDDOCRINE
ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANT
GENETICS
FTE REVIEW
/DAY
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
ALLIED HEALTH DIETICIAN
ADMINISTRATIVE ASSISTANT
CLINICAL SUPPORT OFFICER
WARD CLERK
ADMINISTRATIVE REVIEW SECRETARY
BOOKING CLERK
FINANCE STAFF
IT STAFF
CORPORATE/IT SERVICES BUSINESS MANAGER
DOMESTIC BOOKING CLERK SERVICES
SERVICES/FOOD

36. VMO
CMO
STAFF SPECIALIST
MEDICAL FELLOW
MEDICAL PROGRAM
JMO
AMBULAATORY AND
SURGERY
PERI-OPERATIVE
NURSE PRACTITIONER
CRITICAL CARE
ONCOLOGY CAMPERDDOWN
GENERAL BAILLIE
NURSE MANAGER
SURGICAL UNIT
EMERGENCY
CLINICAL SERVICE PLANNING
INTENSIVE
MIDDLETON
OPERATING
NURSING UNIT MANAGER
THEATRES
AND CCARE
VARIETY
TURNER
CLANCY
BURNS CLUBBE
TREATMENT CAPAC
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
WADE
CARDIOLOGY/CARDIAC SURGERY
HALL
NICU
PICU
ESW
OUTPATIENT OPD
OTC
EMERGENCY SERVVICES ED
REGISTERED NURSE
HUNTER
PSYCHOLOGICAL MEDICINE
MEDICINE
WORKFFORCE PLANNING
ENROLLED NURSE
ASSISTANT IN NURRSING
MASTER PLANNING
NURSING
ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANT
FTE REVIEW
/DAY
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
ALLIED HEALTH PROGRAM PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
ALLIED HEALTH DIETICIAN
ADMINISTRATIVE ASSISTANT
CLINICAL SUPPORT OFFICER
WARD CLERK
ADMINISTRATIVE REVIEW SECRETARY
DIAGNOSTIC PROGRAM BOOKING CLERK
FINANCE STAFF
IT STAFF
CORPORATE/IT SERVICES BUSINESS MANAGER
DOMESTIC BOOKING CLERK SERVICES
SERVICES/FOOD

37. VMO
CMO
RESEARCH
STAFF SPECIALIST
MEDICAL FELLOW
MEDICAL PROGRAM
JMO
AMBULAATORY AND
SURGERY
PERI-OPERATIVE
NURSE PRACTITIONER
CRITICAL CARE
ONCOLOGY CAMPERDDOWN
GENERAL BAILLIE
NURSE MANAGER
SURGICAL UNIT
EMERGENCY
CLINICAL SERVICE PLANNING
INTENSIVE
MIDDLETON
OPERATING
NURSING UNIT MANAGER
THEATRES
AND CCARE
VARIETY
TURNER
CLANCY
BURNS CLUBBE
TREATMENT CAPAC
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
WADE
CARDIOLOGY/CARDIAC SURGERY
CARDIOLOGY/CARDIAC SURGERY
HALL
NICU
PICU
ESW
OUTPATIENT OPD
OTC
EMERGENCY SERVVICES ED
REGISTERED NURSE
HUNTER
PSYCHOLOGICAL MEDICINE
MEDICINE
WORKFFORCE PLANNING
ENROLLED NURSE
ASSISTANT IN NURRSING
MASTER PLANNING
NURSING
ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANT
FTE REVIEW
/DAY
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
ALLIED HEALTH PROGRAM PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
ALLIED HEALTH DIETICIAN
ADMINISTRATIVE ASSISTANT
CLINICAL SUPPORT OFFICER
WARD CLERK
ADMINISTRATIVE REVIEW SECRETARY
DIAGNOSTIC PROGRAM BOOKING CLERK
FINANCE STAFF
IT STAFF
CORPORATE/IT SERVICES BUSINESS MANAGER
DOMESTIC BOOKING CLERK SERVICES
SERVICES/FOOD

38. VMO
EDUCATION
CMO
RESEARCH
STAFF SPECIALIST
MEDICAL FELLOW
MEDICAL PROGRAM
JMO
AMBULAATORY AND
SURGERY
PERI-OPERATIVE
NURSE PRACTITIONER
CRITICAL CARE
ONCOLOGY CAMPERDDOWN
GENERAL BAILLIE
NURSE MANAGER
SURGICAL UNIT
EMERGENCY
CLINICAL SERVICE PLANNING
INTENSIVE
MIDDLETON
OPERATING
NURSING UNIT MANAGER
THEATRES
AND CCARE
VARIETY
TURNER
CLANCY
BURNS CLUBBE
TREATMENT CAPAC
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
WADE
CARDIOLOGY/CARDIAC SURGERY
CARDIOLOGY/CARDIAC SURGERY
HALL
NICU
PICU
ESW
OUTPATIENT OPD
OTC
EMERGENCY SERVVICES ED
REGISTERED NURSE
HUNTER
PSYCHOLOGICAL MEDICINE
MEDICINE
WORKFFORCE PLANNING
ENROLLED NURSE
ASSISTANT IN NURRSING
MASTER PLANNING
NURSING
ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANT
FTE REVIEW
/DAY
CLINICAL NURSE SPECIALIST 2
OCCUPATIONAL THERAPIST
SOCIAL WORKER
ALLIED HEALTH PROGRAM PSYCHOLOGIST
PHYSIOTHERAPIST
CHILD LIFE THERAPIST
ALLIED HEALTH DIETICIAN
ADMINISTRATIVE ASSISTANT
CLINICAL SUPPORT OFFICER
WARD CLERK
ADMINISTRATIVE REVIEW SECRETARY
DIAGNOSTIC PROGRAM BOOKING CLERK
FINANCE STAFF
IT STAFF
CORPORATE/IT SERVICES BUSINESS MANAGER
DOMESTIC BOOKING CLERK SERVICES
SERVICES/FOOD

39. VMO
CMO
STAFF SPECIALIST
MEDICAL FELLOW
MEDICAL PROGRAM
JMO
AMBULAATORY AND
SURGERY
PERI-OPERATIVE
NURSE PRACTITIONER
CRITICAL CARE
ONCOLOGY CAMPERDDOWN
GENERAL BAILLIE
NURSE MANAGER
SURGICAL UNIT
EMERGENCY
CLINICAL SERVICE PLANNING
INTENSIVE
MIDDLETON
OPERATING
NURSING UNIT MANAGER
THEATRES
AND CCARE
VARIETY
TURNER
CLANCY
BURNS CLUBBE
TREATMENT CAPAC
NURSE EDUCATOR/CLINICAL NURSE EDUCATOR
WADE
CARDIOLOGY/CARDIAC SURGERY
CARDIOLOGY/CARDIAC SURGERY
HALL
NICU
PICU
ESW
OUTPATIENT OPD
OTC
EMERGENCY SERVVICES ED
REGISTERED NURSE
HUNTER
PSYCHOLOGICAL MEDICINE
MEDICINE
WORKFFORCE PLANNING
ENROLLED NURSE
ASSISTANT IN NURRSING
MASTER PLANNING
NURSING
ANNUAL BED ALLOCATION REVIEW CLINICAL NURSE CONSULTANT
FTE REVIEW
/DAY
CLINICAL NURSE SPECIALIST 2
PatientsPROGRAM
ALLIED HEALTH
and OCCUPATIONAL THERAPIST
SOCIAL WORKER
PSYCHOLOGIST
PHYSIOTHERAPIST
Families
ALLIED HEALTH CHILD LIFE THERAPIST
DIETICIAN
ADMINISTRATIVE ASSISTANT
CLINICAL SUPPORT OFFICER
WARD CLERK
ADMINISTRATIVE REVIEW SECRETARY
DIAGNOSTIC PROGRAM BOOKING CLERK
FINANCE STAFF
IT STAFF
CORPORATE/IT SERVICES BUSINESS MANAGER
DOMESTIC BOOKING CLERK SERVICES
SERVICES/FOOD

40. Why paperless
• We must improve patient care and access
• We must address financial sustainability
• Requires
– Governance and Infrastructure
– standardisation
– Sharing
– Advocacy
– clinician experts

41. Service Value
• Credibility of information
• Feeling safe using the information
• Better reflection of complexity
• Safer documentation and patient care
• Improved accuracy reporting up
• Ability to refute inaccurate data and contribute
to understanding of paediatric differences

42. Future
• Connecting IT with strategy
• Solving network gaps
• Single patient view
• Innovating
• Automation
• Reliability
• Clinician driven

43. The searchable and shared record
Sepsis Early Detection Logic

44. Streamlining multicentre clinical research
• The solution: Online data collection and multicentre project
management for clinical research, in real time
• The benefits: - Minimise paper and streamline database creation
– Data entry workload spread across research team
– Delay in collation of results  faster research outcomes
– Potential to integrate with eMRs and other data sources
• PTNA = Paediatric Trials Network Australia
– A new network of paediatric researchers committed to improving child
health through clinical research. (Institutional membership model)
– Currently purchasing the above solution, which will be trialled by Dec 2012
and made more broadly available to the PTNA membership in Q2, 2013.
– For more information, visit www.ptna.com.au

45. Advocacy
• Working with the
• Development of a set of Paediatric CCs and CCLs for Clinical Review
– Step 1- Identifying diagnoses with a demonstrated impact on cost and
length of stay.
– Step 2 – Assessment of paediatric vs adult impact of CC diagnoses by ADRG
– Step 3 – Refine CC list to exclude CCs with high adult impact
– Step 4 - Addition of closely related diagnosis codes to resulting CC list
• Need to recognise paed cost drivers, home and social context