Rebecca McBeth

The DHB’s executive director digital enablement Anne Speden said strong clinical engagement has been key to the smooth roll out of the portal.

Southern DHB application specialist Sara Ross said the dashboard closes an information gap between secondary and primary care.

Up to 10 patients a day are using an in-house solution to book their outpatient appointments online with Hutt Valley District Health Board (DHB). uBook is a referral management centre developed by the DHB and supported by its IT team. It allows patients to make or change their own appointments online. On average, five to 10 appointments are booked daily and three to five appointments are changed. Numbers have been steadily increasing since it was introduced in 2011. The DHB says uBook was created to enable patients to have more control over the outpatient booking process. “Having this service has meant more people show up for their appointments on time and we have heard from patients who use the system that they like it and the control it gives them,” a DHB spokesperson said. Patients receive a letter with a unique identifier, inviting them to log on to the uBook portal. The identifier only allows them to book into a correctly specified clinic and within a clinically appropriate timeframe. Most outpatient appointments for services in the general outpatients department are available on uBook, while radiology, orthopaedic and some Ear, Nose and Throat (ENT) appointments are not currently available. Hutt Valley DHB associate director of allied health, science and technical Paul Rigby says the portal is great for patients as “they can identify at their convenience an appointment that suits them. “It’s a real enabler of individual choice and if people can choose their appointment time, they’re less likely not to come,” he explained. Patients are also given the option of calling in to the department if they cannot or do not want to book online. This article first appeared on eHealthNews.nz. 

The benefit of the shared care plan is that a patient’s care plans will be consistent if they move within the region, and new clinicians involved in that patient’s care can view and edit the plans.

Waitematā District Health Board (DHB) in New Zealand has developed a Digital Academy to train its clinical IT leaders of the future. Robyn Whittaker, clinical director innovation at the DHB’s Institute for Innovation and Improvement (i3), said clinicians do not get taught change management as part of their training, but those who can lead IT change are an “invaluable resource.” “These leaders are incredibly important as the translators between the IT people and clinical workflow,” she said. “We need to think about growing that group of clinical IT leaders, and there’s not a lot of really practical hands-on clinical IT change management and leadership training, so we decided to do it ourselves.” The first cohort of 12–15 people to go through the academy will be by invite only and from a range of clinical roles. “It’s for people who work clinically and have a real interest and passion for IT, but feel they need to learn more before they can usefully contribute,” explained Whittaker. In mid-September, they will attend a one-week block course co-developed by the National Institute of Health Innovation (NIHI) at Auckland University and DHB staff. The NIHI and DHB staff will both teach parts of the course, and the DHB is hoping to have external experts contribute as well. Course participants will spend time in different parts of the hospital to learn how other areas work and what IT systems they use. “It’s set up so the group can have really good, robust discussions during the week and continue to learn from each other as they go on,” Whittaker said. There will be a formal assessment at the end, and participants will receive a certificate if they pass. The plan is to run one course annually. Whittaker said feedback from the first group will help to further develop and refine the programme during the week and for the future. “We are trying to learn from the successes of other programmes, like the NHS Digital Academy,” she added. While Waitematā’s academy is aimed at a different level of leader from the NHS, a key message from the UK is that self-directed learning and the network it creates are of great benefit. Whittaker hopes to be able to offer those who complete the course the chance to become one of three digital academy fellows in 2020, who would work part-time on clinical IT projects in i3. She said there is a lot of work to be done in this space, especially with the implementation of the Northern Region Information Services Strategic Plan, which will involve a large amount of change. “It’s so important that these projects are seen to be about clinical change, not about IT,” said Whittaker. This article first appeared on eHealthNews.nz. 

Eight more district health boards (DHBs) in New Zealand will be assessed on their digital maturity using HIMSS Analytics maturity assessments over the next 12 months. The Ministry kicked off its digital health maturity model project early this year, with Southern DHB the first to complete the assessments, followed by MidCentral DHB, which is awaiting its report. All DHBs are now being offered the chance to have an assessment using four HIMSS maturity assessments: EMRAM, O-EMRAM, CCMM and INFRAM. Ministry of Health Group Manager of Digital Strategy and Investment Darren Douglass says the intention is that the remaining DHBs will have assessments in 2020/2021. The Ministry and HIMSS are holding a workshop on Nov. 20 during Digital Health Week NZ 2019 in Hamilton for those wanting to learn more about the assessment process. HIMSS Analytics Global Vice President John Daniels says the workshop will focus on how organisations can leverage the HIMSS maturity model road maps to guide their journey toward digital transformation. He has been impressed with the level of engagement from the Ministry and the DHBs HIMSS has worked with so far. “It seems everyone is on the same boat wanting to drive healthcare forward from a digital transformation perspective, and one of the big challenges organisations face is getting everyone working toward a common goal,” he said. The HIMSS assessments score hospitals and care settings on their adoption and use of electronic medical records on a scale from 0–7. At the workshop, Daniels will provide an overview of the maturity models, looking at how and why they were developed, as well as a deeper dive into EMRAM and O-EMRAM. He says the process not only identifies the gaps in maturity, but provides details around those gaps, such as what factors are preventing the organisation from having a certain capability. Daniels hopes the workshop will attract senior IT leaders, clinical leaders and industry partners as the groups need to work together on the transformation journey. “For the most part, I think the culture is there in New Zealand that will enable this sort of transformation to occur, but you need the right leadership and the people using the systems to be on board and everyone working together, as it takes a team effort,” he added. Douglass hopes that people from across the sector will attend the sessions at HINZ 2019 as their organisation may be invited to participate in an assessment. “Undertaking the HIMSS maturity assessments uses an international tool that can assist DHBs in their roadmaps for digital investment. A New Zealand glossary has been developed to ensure the assessment fits the New Zealand health environment,” he said. There will also be a session at the HINZ Conference 2019 regarding the learnings from the assessments that have been completed. This article first appeared on eHealthNews.nz. 

Counties Manukau Health/District Health Board (DHB) in New Zealand has gone live with electronic medication management in its emergency department, aged care facilities and medical wards. CM Health clinical sponsor and director of allied health Sanjoy Nand said MedChart electronic medication management was rolled out to inpatient services from April this year. The next stage of the project is to implement across surgical, with 80 per cent of these services due to be live with electronic medication management by the end of 2019. The DXC Technology system includes an electronic medication chart, ePrescribing, pharmacy review, decision support and medication administration. Counties Manukau conducted a pilot in some aged care wards last year in order to understand the training and device needs and how much support staff needed to go live with the electronic system. “We used that information, along with a benefits analysis, to get the business case to the board for roll-out to the rest of the organisation,” said Nand. The business case was approved at the end of 2018 and the DHB chose to implement first in ED, then across the rest of inpatient services, after discussions with other DHBs that have already gone live such as Southern, Canterbury and Waitematā. “Implementing MedChart aligns with our Healthy Together Services objective of improving the delivery of safer patient care achieved through a reduction in adverse drug events and prescribing errors,” he added. Starting in ED meant the team had to look closely at patient flows throughout the hospital. “One of the biggest challenges was making sure that whenever a patient comes in, we only move from electronic to paper once, so we’re not creating a mismatch by going from electronic to paper then back to electronic,” Nand explained. “We did a lot of work to make sure staff were aware when to use paper and when to use MedChart.” He said another key challenge is ensuring there are enough devices available for staff on the floor to ensure clinical workflow is not affected. The DHB plans to go live with MedChart in maternity in 2020. This article first appeared on eHealthNews.nz.

Capital and Coast District Health Board (DHB) in New Zealand is piloting the Resident Guide app for onboarding junior doctors. The six-month pilot begins in mid-August and involves all resident medical officers (RMOs) at Wellington Hospital. Junior doctors are rotated around hospitals four times a year and need to quickly upskill on the way things are done at each new location, such as how to book tests and consults with other specialties. The cloud-based Resident Guide app provides access to a combination of local operational and clinical guidelines. 3DHBs (Capital & Coast, Hutt Valley and Wairarapa DHBs) chief clinical information officer Steve Earnshaw said the aim of introducing Resident Guide is to make access to essential information easier for RMOs to find and engage with. Earnshaw added that local information is already being loaded into the app and the August start date will provide time to fine tune and make improvements before the transition period in November when a new group of RMOs arrive. “Change-over is always a difficult time and this will help the new RMOs by providing them with everything they need to know on an app on their phone,” he said. MedApps co-chief executive Tom Collins said the regular movement of junior doctors is like starting a new job every few months. “The information is all site specific, so they have to start from scratch every time,” said Collins. “Resident Guide means that when you rotate you are not making mistakes and it’s a confidence builder for junior doctors who are trying to do the best for themselves and their patients.” The platform is already live at 28 facilities in Queensland, Australia, where it is also being used by nursing staff. This article first appeared on eHealthNews.nz.

Aged-care provider Ryman Healthcare in New Zealand has built its own electronic care planning system that runs on 3,500 tablets deployed in residents’ rooms across its residential aged-care villages. The myRyman application has removed paperwork for both care planning and rostering and improved staff and resident satisfaction. The $20+ million project has seen wi-fi deployed across all Ryman’s villages and the organisation’s IT team grow from three to 60 people since 2015, when work first started. Clinical nurse specialist Victoria Brevoort said myRyman directs the care delivered in a resident’s room. When a staff member logs into the tablet they are presented with a schedule of tasks that need to be completed that day, as well as information about the resident, such as their interests and family. “People know much more clearly what they have to do and when they have to do it and it’s more accountable because they have to complete the task in the system,” she said. “It has freed up our staff to spend more time with the residents, one on one. They can record what they talk about in the system, so we see the resident as a person, rather than a collection of tasks we need to do for them.” Ryman corporate affairs manager David King said the organisation’s audit results have significantly improved since implementing the system, as 81 per cent of its villages now have four-year accreditation. The technology project is also generating a wealth of data that is being mined for insights. “We’ve discovered a whole load of data that we’ve never had before, and it’s a gold mine because it provides a closed loop between tasks and clinical outcomes,” King added. A central dashboard of information allows Ryman’s business intelligence team to identify any anomalies quickly, such as a spike in falls, which can then be investigated. Differences in performance between villages can also be interrogated in order to improve performance across the network, he explained. Chief executive Gordon MacLeod said that “not only has it done what it set out to do – get rid of paperwork – but the data we’re collecting from it means we better understand care outcomes and allow us to lift our standards of care even higher’’. This article first appeared on eHealthNews.nz.

MidCentral District Health Board (DHB) has published one of New Zealand’s first district-wide digital health strategies. Called Te Awa, the five-year strategy is collectively endorsed by the DHB, Central PHO, Manawhenua Hauora, the Clinical Council and the Consumer Council in the region and was developed after extensive district engagement and consultation. An introductory message says that developing and using digital technology “will help us to improve access to services, to address and minimise health inequality, to improve the quality and safety of our services, and to increase the control people in our district have over their own health”. The strategy has four guiding principles, which are: people-powered; one district; information sharing; and being a good digital health steward. The objectives of the strategy are to digitise the consumer, families and whānau experience with improved access to information and to digitise end-to-end processes, allowing the smooth flow of information between services and across organisational boundaries. It aims for better interconnected communications and collaboration, as well as better use of data for planning and decision making. Also, inclusive information management and stable and secure ICT services. Steve Miller, chief digital officer MidCentral DHB, said Te Awa is a people/ whānau – centred strategy with a focus on wellness, which makes interagency collaboration key to its success. “With over 60 percent of a person’s heath being attributed to various social determinates, it’s important we collectively engage in collaborative co-design as a system to enable quality living, healthy lives and well communities,” he explained. The strategy has seven strategic portfolios with multi-year funding pathways, allowing a more agile delivery method for the projects within them. “We are seeking to take a more ‘learn and adapt’ approach to accelerate value delivery and better manage risk by breaking initiatives into smaller three-monthly cycles,” Miller said. The portfolios are; consumers, families and whānau-centred; workforce management; innovation; data and analytics; knowledge management; business management; infrastructure and IT services. Miller said the strategy seeks to rationalise a large number of existing suppliers and applications and to develop a co-investment partnership approach with industry to accelerate the district’s digital transformation. MidCentral DHB has been chosen by the Ministry of Health to pilot four HIMSS digital maturity assessments from August this year. Miller says the results will help determine the organisation’s areas of focus to get the best results. This article first appeared on eHealthNews.nz.