Background State wide Model of care, commenced in 2015 Funded 2 - PowerPoint PPT Presentation

Background  State wide Model of care, commenced in 2015  Funded 2 years initially through NSW Planning and Integrated Care  Currently under Leading Better Value Care Program Musculoskeletal disorders’, conditions that affect muscles and bones: sport injuries, osteoarthritis, osteoporosis, back pain etc.  Osteoarthritis Chronic Care Program (OACCP)  Osteoporosis Re-Fracture Prevention Program (ORPP)  Back Pain Program

NSLHD OACC Program Early 2015, Osteoarthritis Chronic Care Prog Team at RNSH, requested an Integrated OACC Program solution within eMR:  To capture OACCP program specific clinical data about their patients  To be able access to their program data as well as the other available eMR data domains, such as:  Patient Demographics  History of all visits  Pathology & Radiology Results  Diagnosis and comorbidities  Surgeries and procedures  Discharge details

NSLHD - OACC Program  OACCP Coordinator - Physiotherapist  Medical staff  Allied Health team  Rheumatology Researcher  Royal North Shore Hospital  Ryde Hospital  Hornsby Hospital  Manly  Mona Vale

OACC Program Goal  To improve quality of patients life by  Reducing pain  Improving mobility  Encouraging losing weight  To receive feedback from patient via Patient Reported Outcomes Measures  To assess necessity of surgery either remove from waitlist or escalate surgery earlier  To decrease unnecessary hospital visits:  establishing shared care plan with their GP’s  encouraging patient’s to receive care from community services

NSLHD MSIC Informatics and Analytics Program Stakeholders

NSCCLHD OACC Program Clinical Workflow using eMR Phase 1: GP Surgeon Rheumatologist/ Orthopaedist Allied Health Emergency Referred to OACCP OACCP OACCP OACCP Clinic OACCP Interventions Discharge Coordinator Coordinator Coordinator Visit End Exit Assessment Referral Presentation Process complete complete complete Patient Visit details OACCP Initial Assessment OACCP Initial Assessment OACCP Initial Assessment With captured Osteoarthritis HOSPITAL DETAILS OACCP Assessment Automated GP Referral to: such as Hospital name Document Discharge Letter Rheumatologist Medical Speciality Client profile - Summary of the Multidisciplinary team Admission date/time Physical Assessment certain test finding based on clinical needs, PATIENT DETAILS MSIC Assessment -Medication such as. Unique ID -interventions Demographic DASS21 – Patient -Care information Reported Outcome Management Plan Personal details Measure PRESENTATION DETAILS KOOS and/or HOOS This workflow repeats for Reason for Admission Source of Referral Setting up Personal WK12, WK26, Final Visits Care /Goal

To achieve these goals… Next requirement is a robust integrated solution that allows :  To access their patients historical and near real time clinical data  To visualise individual or specific population treatment trend on a daily basis  To ask questions of their own data, benchmark and use data  To assess effects of changes in their practice  To assist with continuing evaluation of the program

Existing NSLHD EMR system doesn’t have a capacity to meet these requirements  An Operational system  Integrate multiple data sources, view only  Reporting capacity is limited to predefined, not adhoc  Database architecture is not designed to allow online analysis  Any plan to extract certain datasets may have significant impacts on system performance NSLCCHD - Enterprise EMR System

Phase 2: MSIC Informatics and Analytics Application using QlikSense MKM Health

Filter : Year Jan 2016 – 20 July 2018 Example Dashboard 1: OACCP Program Profile MSIC Prog : OACCP

Filter : Year Jan 2016 – 20 July 2018 Example Dashboard 2: OACCP Clinical Progress MSIC Prog : OACCP

Conclusion  It has been proven that the program provides data driven decision making capacity to clinicians to support clinical program quality and safe patient care.  It can be introduced into the eMR, that requires cross disciplinary collaboration with strong leadership.  It allows accessing and analysing near real time Patient Reported Outcome Measures periodically to provide more personalised care to patients  To response to clinician’s ongoing questions about their data, and to explore the data with full potentials, following skills are vital  SQL Programmer with Data Visualisation and BI expertise  Data Scientists/Engineers for advance analytics

Special Thank you Ms Jillian Eyles, Physiotherapist , Researcher at RNSH Rheumatology Mr Matthew Williams , Lead OACCP Coordinator, Physiotherapist at RNSH Ms Anna Butcher , Service Development Manager, NSLHD Musculoskeletal and Neuroscience Ms Robyn Speerin, ACI Musculoskeletal Network Manager Prof Jonathan Morris, Obstetrics and Gynaecology Director, Biostatistics and Health Informatics, The Sydney University Ms Ann Mirapuri, Manager eMR and Clinical Programs, NSLHD ICT Mr Simon Hill , Director NSLHD ICT

Acknowledgements Osteoarthritis Chronic Care Program NSLHD Musculoskeletal and Neurosurgery Network Anna Butcher, Service Development Manager Prof David Hunter, Program Director Matthew Williams, Senior Physiotherapist, RNSH NSCCLHD ICT eMR Support Unit Carin Pratt, Physiotherapist, RNSH Jillian Eyles, Researcher , RNSH Rheumatology Chris Oxby, eMR Architect Jenny Gilbert, eMR App Specialist Osteoporosis Refracture Prevention Program Samrit Pamnani, eMR App Specialist Prof Lyn March, Program Director A/Prof Roderick Clifton-Bligh, RNSH Endocrinology Lillias Nairn, Physiotherapist, RNSH MKM Health- Best Patient Outcomes Christian Girgis, Registrar, RNSH Endocrinology Kaye Hocking, Business Development Manager Vivek Krishnan , Technical Lead Back Pain Program Prof Rodger Laurent, Program Director Patricia Schlotfeldt, Physiotherapist Agency for Clinical Innovation Robyn Speerin, Musculoskeletal Network Manager