Evolution not Revolution.Evolution not Revolution.Evolution not Revolution.Evolution not Revolution.

Development of a Shared Electronic Health Record

for Queensland.

Dr David EvansDirector Medical Services

Queen Elizabeth II Jubilee Hospital

The Viewer

• Discuss the evolution of a first generation shared electronic record called "The Viewer" within Queensland Health.

• An innovation success – an evolutionary concept built around new and legacy concepts utilising the revolution of internet web services.

Predicting Innovation Success

The successful diffusion of new innovations in the electronic health care and electronic health record space is clearly desirable but can be challenging to

predict. Rogers (1983) defined and determined a set of characteristics including high relative advantage,

consistency with existing values, low perceived complexity, high trial ability and high observability that

determine the likelihood of an innovations success.

Predicting Innovation Success• High relative advantage – interoperability, savings

• Consistency with existing values – legacy systems

• Low perceived complexity – time, simple interface

• High trialability – web skills only

• High observability – ubiquitous access

ConvergenceRight Time – Right Place

“The two most important requirements

for major success are: first, being in

the right place at the right time, and

second, doing something about it. ”Ray Kroc

(American pioneer of the fast-food industry, Founder of McDonald's. 1902-1984)

If Only We Knew What We Know

If Only We Knew What We Know

Now We Know What We Know

PCEHR

Benefits

The Viewer Login Page

Home Page with Patient List

Patient Demographics

Basic information andcontact details (HBCIS)

External consultants (EDS)

URNs forencounters at otherfacilities(Client Directory)

Patient encounters - inpatients and emergency presentations (HBCIS and

EDIS)

Note: Admissions from Outpatients, but no details on encounters within Outpatients

Patient Medication Profiles from eLMS

Patient pathology results from AUSLAB

Out of range results indicated with , and expanded result line bolded. Other results indicated with , and not bolded.

Patient medical imaging reports from:HBCIS RIS, QRiS, CERNER RIS (Only the report is available, no images at this stage)

Patient procedures - from ORMIS

Patient adverse reactions - from eLMS

Dynamic Interoperability

• Early design enhancements and utilisation of current web services have enabled dynamic interoperability with emerging national initiatives (e.g. PCEHR)

Success in Implementation

Utilisation successes demonstrated in

• Disaster management

• Lost paper records

• Financial savings

• PCEHR support

• Ease of use.

Value in Implementation

Hospital Transfers

Queensland Chief Health Officer said 125 patients were evacuated last Monday night and Tuesday to seven

hospitals throughout Brisbane. "The patients are still being cared for and we won't arrange for their return to

Bundaberg until we are sure that it is best for them,"

WHOLE-OF-LIFE CLINICAL REPOSITORY THROUGH THE VIEWER

PULSE Magazine - MICHAEL WONG 17 MAY 2013.

When it became clear that ex-Tropical Cyclone Oswald’s floodwaters would close Bundaberg’s hospitals, staff quickly generated discharge summaries so that the receiving hospitals could assess them in Queensland Health’s The Viewer portal, which accesses the state’s clinical data repository (CDR).

On arrival at their receiving hospital, each patient's information was able to be viewed by Brisbane staff so that the appropriate care could be given.

When Bundaberg’s hospitals were back in action, local patients evacuated to Brisbane were able to be re-admitted with discharge summaries from their time down south.

It was a huge turnaround from the situation in 2011, when Cairns patients escaping Tropical Cyclone Yasi had come to Brisbane with plastic bags filled with their paper records.

Cashable Savings*

�15 mins to access Viewer = $25

or

�Repeat history taking 30+ minutes = $50

�Delay in hospital discharge 2 days = $600

�Time to access and fax or post records = $100

�Repeat testing path or imaging = $3000

�Adverse outcomes?

* All figures rough approximations only.

Cashable Savings• July 2011 – 1237 views per month

• Dec 2011 – 16634 views

• June 2012 – 48803 views

• Jan 2013 – 62539 views

• May 2013 – 74030 views

• Even at $20 saving per view = $1.5M per month

In-House Flexibility

• Rapid front end redesign provides in-house flexibility.

Discharge Summaries on PCEHR

PCEHR on The Viewer.

National standards.

Integration and Functionality

Increasing functionality as more information sources become integrated.

Evolution and Revolution

I have a great respect for incremental improvement, and I've done that sort of thing in my life, but I've always been attracted to

the more revolutionary changes. I don't know why. Because they're harder. They're much more stressful emotionally. And you

usually go through a period where everybody tells you that you've completely

failed. Steve Jobs

Evolution and Revolution

Since when has the world of computer software design been about what people want? This is a simple question of evolution. The day is quickly coming when every knee will bow down to a silicon fist, and you will all beg your binary gods for mercy.

Bill Gates

Evolution and Revolution• Big eHealth is hard

• Despite great visions many things have to be in place to progress achievement.

• Work with opportunities when and as they appear.

• Maintain awareness, stay current and surround yourself with informed people.

• Many opportunities collide and may come from many sources at once – International, Private sector, Commonwealth, State, Clinicians and talented individuals.

Evolution and Revolution• Communications infrastructure – secure,

ubiquitous, email, public understanding and expectations – internet, browser technology, encryption and keys

• Data Storage – existing repositories, data standards, reducing expense of storage and compression algorithms

• Web services - HTML, .Net, C++

Evolution and Revolution

• Legacy systems accessible and ubiquitous

• Messaging standards – HL7

• Codification – SNOMED, ICD10, LOINC, AMT but don’t need to wait

• Conformance Compliance and Accreditation processes in place

• Formatting standards - CDA

• National Identifiers (providers, organisations and individuals)

As long as you don't make ripples, life seems easy. But that's

condemning yourself to impotence and death before you are dead.

Jeanne Moreau

Over the Horizon• Telehealth

• Mobility, smart phones,Google Glass

• Dispersed Wi-Fi and NBN

• Tighter classification and coding to concepts –Big Data in Health

• Standards, standards, standards

• Bring Your Own Device

• Cloud Storage

• Speed of cultural change and new business processes

Progress ….Its all uphill but keep an

eye out for the escalators

Where we started…..

Where we want to be …..

Thank you for listening.

Questions?