The Tasmanian approach to eMM T om Simpson, Executive Director, - PowerPoint PPT Presentation

The Tasmanian approach to eMM T om Simpson, Executive Director, Statewide Hospital Pharmacy Peter Fowler, Clinical Lead, Statewide Medication Management Projects T asmanian Health Service

Agenda  Context – Tasmania, eHealth strategy  Our journey – Goal state, progress thus far  Modular approach taken (pros/cons)  Overview of system  AMT  Project and training approach  Outcomes

North West Regional Hospital Launceston General Hospital 140 beds 300 beds 8,300 wt seps/year 23,400 wt seps/year Budget $81m Budget $195m Mersey Community Hospital 100 beds 6,900 wt seps/year Budget $65m Royal Hobart Hospital 490 bed tertiary referral hospital 39,900 wt seps/year Budget $366m

Context  Limited capital funding for eHealth   Opportunistic focus on Commonwealth/State priorities  Multiple eHealth strategies over last 15 years   Forces multiple, smaller-scale investments  Small Australian market for EMM, immature vendor capability   Modular approach is aligned with developing maturity

Our EMM journey

Our EMM journey  Tasmania has, over the past 8 years, implemented major EMM functionality  Modular expansion  Project-based funding approach  Relatively low cost – (no budget for large programs)

Progress 2007 Electronic Discharge Summary, secure messaging to GPs, Cwlth – HealthConnect iPharmacy integration 2009 Medication reconciliation and clinical pharmacist Tas – Pharmacy Systems Project activities 2011 Electronic discharge prescription generation Cwlth/Tas – Pharmaceutical Reform Tas – Formulary cost 2012 Enhanced formulary savings 2014 Electronic outpatient prescription generation, PCEHR, Cwlth - THAP AMT, NPDR 2015 Enhanced prescription management & consent model, Cwlth - THAP further NPDR, Snomed alert/allergy coding Next Paperless PBS scripts stages eCharting

Tasmanian implementation 2 5 3 1 4 Medication History Inpatient medication chart Discharge Discharge Outpatient & Reconciliation prescription summary prescription 100 users 5,000 users 500 users 500 users 500 users Pharmacists All doctors, all nurses Junior doctors Junior doctors Senior doctors 50/day 1,000/day 100/day 100/day 500/day C’wlth investment CEO investment priority priority

Our ‘accidental priorities’  Small user base better than large multi-D user base  Tech-savvy users easier to train than tech-resistant  Align stages with investment priorities for CEOs (+ DHHS and C’wlth )  Invest in steps that ease doctor workload (eg. Med rec  easier discharge summaries)

Modular, incremental approach Pros Cons  Affordable  Always chasing $ for next stage  Clearly-defined endpoints  Projects ‘targeted’ to funding objectives, not necessarily local  Clinician engagement for the priorities ‘hard bits’ is easier as they already use the system  Support requirement expands invisibly  Implementation out-of-order

System overview

Patient banner Current episode Previous episode Clinical tasks

Creating list of medications on admission

Generating discharge prescription

Snomed and AMT coding of drug allergies (note search term ‘nose’ – Snomed offers various contextual results)

AMT v3  HCS Clinical Suite uses MIMS as basis of product file  Automatic population of pack size, PBS, TGA information  AMT coding of all ‘trade product packs’  Each stocked item is linked as follows:  iPharmacy  HCS  MIMS  AMT*  NPDR integration is easier – only one system – HCS for both prescribe and dispense events.

Outcomes  All inpatient MH&Rs now electronic  ~40% of outpatient scripts generated electronically  Majority of discharge scripts generated electronically  Electronically-generated scripts are dispensed 33% faster than handwritten scripts  NPDR integration

Training and project approach  Combination of IT and clinical project staffing  current projects have used pharmacists  Choice of pharmacist/nurse is important  Peer respects is more important than technical skill  Recognise training needs differ  eg. Registrars needed less training than consultants  Keep the ‘old’ alongside the ‘new’ where possible  eg. Handwritten prescriptions – eg. still need them when in private rooms

Challenges and risks  Gradual implementation means incremental approach to ongoing support – this remains a significant issue for us  Identification of funding for next stage  Who is system ‘owner’ across the state? (Not pharmacy)  Inpatient charting module of HCS Clinical Suite has not been clinically tested/validated yet

Conclusion

Conclusion  A modular approach to EMM has enabled us to incrementally invest.  This approach has some advantages and some disadvantages.  An Australian vendor, HealthCare Software, has developed EMM capabilities that align with PBS, NEHTA, and local requirements.  NPDR and PCEHR integration has been achieved, including rapid implementation of AMTv2 and v3 through MIMS. MIMS is a partial solution for AMT encoding.  Tasmania is a significant way into its journey towards paperless, closed-loop medication management.

Thankyou Tom.simpson@dhhs.tas.gov.au 03 6222 8451