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Shaping Informatics for Allied Health - Refining our voice
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Transcript of Shaping Informatics for Allied Health - Refining our voice
SHAPING INFORMATICS FOR
ALLIED HEALTHREFINING OUR VOICE
Tamzin Brott, Waitemata DHB
Rebecca George, Canterbury DHB
SHAPING INFORMATICS AND REFINING OUR VOICE
1. Introduction
2. History of Allied Health and data
3. Shaping vs. defining
4. Relevancy of Informatics
(Break)
5. Current examples and projects – sharing of experience
6. Future of Informatics in Allied Health
7. Takeaways
A HISTORY OF ALLIED HEALTH
• Broad ‘umbrella’ term• Diverse mix of professional disciplines• Not homogeneous• Frequently defined by exception• Shared aim - culture of Allied Health professions being ‘allied to each other’
TRADITIONAL APPROACH – DATA FOR DATA’S SAKE• Contacts – disappeared into the ether?• Meaningless numbers• Numerous Approaches - PIMS, CaseMix, manual, electronic
• Numerous measurements – minutes, blocks, days wait, priority
• Business vs Clinical• Process/structure outcomes vs clinical and patient experience outcomes
QUALITY IN ALLIED HEALTH
Measures should centre around function
Strategic focus on better outcomes and patient experience
Need to demonstrate who we are, what we do and what we achieve
Lack of Homogeneity
Unlikely suited to a one-size fits all approach
Lack of agreement about quality measures
Variation in measures
Lack of agreed definition around Allied Health
SHAPING VS. DEFINING
“The use of technology and data, providing information to generate knowledge, that in application drives change’’
SHAPING VS. DEFINING
• Identify need – create questions• Data visualisation methods• Application – effect change or support status
SHAPING VS. DEFINING• Apples with apples• Health Round Table• National Allied Health Data Collaborative• Standardisation • benchmarking, best practice, service equity
NATIONAL ALLIED HEALTH DATA COLLABORATIVE• Purpose• Coordination, transparency, ownership
• Function• Sharing, standardisation, benchmarking, collaboration
• Vision‘To create a culture of inspired Allied Health staff who regularly inform their practice with knowledge made available via data collection’
WHOSE RESPONSIBILITY IS IT?
Data entry50% Highest percentage were Admin staff
28% Combination of clinical and admin staff
21% Clinician only
11% No one entering referral information
Top 5 Data fields
NHI 91%
Location 86%
Date received 81%
Date actioned 75%
Reason for referral 75%
AUDIT CONCLUSIONS:Indicators suggested common data content
Significant differences indicated, include:• Service Settings Who• Content consistency What• Use / analysis Why• Data collection methods How
AUDIT CONCLUSIONS:
• Standardisation of data will bring;• A greater breadth of data• Robust analysis• Strength in application
THE RELEVANCY OF DATA AND INFORMATICS NOW
Why the emphasis now?• Explosion of IT development• Patient journey visibility• Powerful analysis • Ownership versus input
AIMS:Visibility of information‘Passive data collection’Relevant reportingRegular application of knowledge acquired
What is your current reality? How does it shape up against your vision?
USING MOBILE TECHNOLOGY TO IMPROVE PATIENT AND CLINICIAN EXPERIENCES OF ALLIED HEALTH IN THE COMMUNITY SETTING (WAITEMATA DHB)
Key Problem: Increasing community waiting lists across all AH disciplines No increase in FTE to match volumes from new inpatient services Clinicians required to return to base in order to complete electronic
records No real time access to health information at the point of care and decision
making in the community Increase in part time workers leading to less access to infrastructure
USING MOBILE TECHNOLOGY TO IMPROVE PATIENT AND CLINICIAN EXPERIENCES OF ALLIED HEALTH IN THE COMMUNITY SETTING (WAITEMATA DHB)
Improve clinician workflow
Provide real time access to health information at
the point of care and decision making
Improve patient experience
Meet needs more fully during visit with real time access to health
information
Improve clinician experience
Provide clinicians with opportunity to complete administration tasks on
the road
USING MOBILE TECHNOLOGY TO IMPROVE PATIENT AND CLINICIAN EXPERIENCES OF ALLIED HEALTH IN THE COMMUNITY SETTING (WAITEMATA DHB)
Baseline Data: Average time spent on patient related administration tasks ranged from 182
minutes to 288.7 minutes per clinician per day (mean=182. 8 minutes, median=165 minutes)
50% participants believed being able to access Concerto (electronic documentation) in the community could absolutely improve their workflow
Above average levels of enthusiasm to trial mobile devices in the community
USING MOBILE TECHNOLOGY TO IMPROVE PATIENT AND CLINICIAN EXPERIENCES OF ALLIED HEALTH IN THE COMMUNITY SETTING (WAITEMATA DHB)
• 12 community allied health clinicians were provided with real time access to clinical documentation and peer reviewed discipline specific apps via an iPad air
• Three data measures were collected over a 19-week period:
Week 1-2Time & motion study
Clinician questionnaire
Week 10-11Time & motion study
Clinician questionnairePatient questionnaire
Week 18-19Time & motion study
Clinician questionnairePatient questionnaire
USING MOBILE TECHNOLOGY TO IMPROVE PATIENT AND CLINICIAN EXPERIENCES OF ALLIED HEALTH IN THE COMMUNITY SETTING (WAITEMATA DHB)
• Collected 270 days of time and motion data, including 493 direct face-to-face patient contacts.
Improved clinician workflow
•Reduced time spent on administration tasks by average of 29 minutes per clinician per day•Utilisation of time between visits to complete administration tasks
Improved patient experience
•101 patients completed survey•93% reported improved experience when mobile device used•93% rated comfort with mobile device in home as 7/7
Improved clinician job satisfaction
•Reported reduction in stress levels•Able to take breaks as a result of time saved•Improved clinical practice associated with education and therapy apps
USING MOBILE TECHNOLOGY TO IMPROVE PATIENT AND CLINICIAN EXPERIENCES OF ALLIED HEALTH IN THE COMMUNITY SETTING (WAITEMATA DHB)
Patients have told us;
Patients said: Clinicians said:Time & motion data
Baseline Midway Final130
140
150
160
170
180
190
182.8
171.6
153.6
Mean time spent on patient re-lated administration tasks
(minutes per day)
“seeing the muscles on
the iPad really
helped me understand
the importance
of the exercises”
“knowing my notes were being written then and there I felt
my issues were acknowledged”“instead
of checking
and getting back to me you
get answers
right now”
“Now I can complete my notes and have time for a
lunch break and don’t
leave work feeling
burnt out and
resentful”
“I can do my documentation or
equipment ordering or phone calls between
patient visits and I have time for urgent issues or
colleagues in need of peer advice when I return to
base”“I feel I am providing a
better service as a
health professional
”
USING MOBILE TECHNOLOGY TO IMPROVE PATIENT AND CLINICIAN EXPERIENCES OF ALLIED HEALTH IN THE COMMUNITY SETTING (WAITEMATA DHB)
Key outcomes for clinicians• 81.8% increased their direct face-to-face patient contact time• 13 minute average increase in direct face-to-face patient contact per clinician per day,
equating to 65 minutes, per week for a full time clinician. • 90.9% reduced time spent on patient related administration • 26.7 minute average reduction of patient related administration of per clinician per
day, equating to 133.7 minutes, per week for a full time clinician.• 45.4% reduced their travel time by a combined daily average of 55.8 minutes per day
• Next Steps…
AMAU REFERRAL AUDIT
• Purpose of AMAU• rapid medical assessment unit, focussing on managing medical patients
often with an undifferentiated diagnosis who need prompt investigation and treatment, and timely medical, nursing and Allied Health assessment
• First year report = exploration of ‘front loading’ with Allied Health to:• Support implementation of Frail Older Persons Pathway• Assess and determine the needs of acutely unwell patients – right time, right
place
AMAU REFERRAL AUDIT
• We wanted to know:• What was the volume of referrals for Allied Health services over a 2 week
period?• Is there sufficient Service provision to meet AMAU referral demand?
• A referral audit completed over a 2 week period (inclusive of weekends) during July 2014 by each Allied Health discipline receiving AMAU referrals and providing service.
AMAU REFERRAL AUDIT
• Allied Health Service Provision – When does it occur and what’s the unmet need?
AMAU REFERRAL AUDIT - SUMMARY• Three key issues identified:
1. More referrals made than accepted2. Majority of referrals made are initiated outside of usual work hours3. A significant number of patients transferred/discharged prior to their referral
being processed by Allied Health
• Inferences made;• A large amount of time may be being spent processing referrals for non
existing patients• Referrals may be being made too early / out of context to the patient’s status • Patients are being transferred / discharged off AMAU before AH provision
WEEKEND SERVICE DEMAND AUDIT
• To support the ‘Allied Health Weekend Service Rostering and extended hours service provision’ business case.
• To provide an understanding of AH service provision;• during ‘weekend’ hours• how staffing can be streamlined to provide this service effectively.
WEEKEND AUDIT RESULTS: Total Per
weekend% of total
Total patients referred for service (exc. SLT) over 2 weekends across all disciplines 275 137.5
Total number of contacts 324 162 Ave. No. patients per Saturday for all disciplines (exc. SLT) 76.5 Saturday 56%
Ave. No. patients per Sunday for all disciplines (exc. SLT) 61 Sunday 44%
LOCATION OF SERVICE DEMAND• ICU, Orthopaedics (18/19) and ED highest
volume• Different locations focus for different
professions• Significant lack of demand from high turnover
wards i.e. 23/24• Good MDT input in AMAU• Potential for greater MDT input into Acute
Stroke Unit
FOCUS OF SERVICE
• Physiotherapy and Dietetics - majority of follow up contacts
• OT and SW – new patients and assessments
• Physiotherapy discharged a greater number of patients
• OT and SW had larger proportion of discharges overall.
WEEKEND AUDIT OUTCOMES
• Requirement for operational standardisation of staffing resource
• Discussion of service deliver y models• Full service all areas
• Criteria limited service to all areas
• Full service to limited areas
• Identification that AH are not inhibiting patient flow
KEY QUESTIONS…
• Who or what are you curious about?
• What are the questions you want answers to?
• What are the data elements needed to answer that question?
• What information do you want to communicate?
• Who do you want to communicate with once you have that information?
• How are you going to communicate that information?
DISCUSSION TIME…..
• A vision statement?• A project?• An intention with direction?• A need for Collaboration/Key
contacts?
• Group discussion time• 25 minutes• Draft• Present idea at the end
If you tell people where to go, but not how to get there you’ll be amazed at the results.
George s Patton
CONCLUSION
• Get our business hats on• ‘Data provides Information, that gives us knowledge, upon which
to act’• Making the patient’s journey visible• Engagement and Integration• Involving ourselves in system development locally/regionally
CONTACT DETAILS
• Rebecca GeorgeClinical Lead - Informatics in Allied Health Allied Health ServicesCanterbury District Health Board [email protected], (03) 364 4581 / 027 839 3196
• Tamzin BrottHead of Division Allied HealthMedicine, Health of Older People & Surgical and Ambulatory ServicesWaitemata District Health Board
[email protected], (09) 442 7252 / 021 983 129