MINUTES - Network for Improving Complex Care (NICC)Time: 10:00am – 12:00 followed by lunch Date: 10/11/2015

Venue: LCHS Meeting Room 2, 42-44 Fowler Street, Moe Chair: Jess Chambers

Attendees: Jessica Chambers (CWGPCP), Paul Hicks (LRH), Jessica Otter (SCC), Helen Rawlings (LRH), Firhat Firdous (MIF), Sue Smith (WGHG), Kirsten Jeffery (Quantum), Henry Yu (GPHN), Jeanette Douglas (GPHN), Theresa Mullucks (LCC)

Guest Speaker: Suzanne Taylor (LCHS Gamblers Help Service)

Apologies: Liz Meggetto (CWGPCP), Robert Bar (BBSC), Lynne Swayn (BBSC), Debbie Deshayes (Vision Aust), Fiona Jackson (Vision Aust), Pat Giblett (LCC), Kay Jellis (LCC), Annette Wheatland (SCC), Petra Bovery-Spencer (LCHS), Rochelle Virtue (MIND), Kim Krieger (MIND), Kerri Rixon (MIND), Beth Fogerty (MIF), Kathryn Foale (MIF), Brooke Campbell (DHHS), Dolores O’Dowd (LRH), Adrian Terranova (Quantum), Tania Ryan (DHHS), Elizabeth Urquhart (Quantum), Julie Bond (GEO group), Jessica Desira (GEO Group), Dr Umar Ali (RDAC), Gail Willett (LCC), Sarah Davies (MIND), Louise Cristofaro (DHHS)

Topic Owner Discuss or Inform

Outcome Come prepared by

Time

Welcome - - - - 5minsPrevious Minutes & Actions Jess - All actions from previous

meeting have been completed- 5mins

Actions from the August meeting minutes are listed below: Members are encouraged to implement the action plan developed from today’s discussion of ACIC 3c, and in

reflection of their own organisation’s delivery system design. Members are encouraged to forward any information about new programs and services, training

opportunities, conferences, and courses to Jess to disseminate via the CWGPCP newsletter. Members are encouraged to sign up for CWGPCP newsletter if they have not done so already. Click here to sign up.

If anyone is interested in being involved in the eCare Planning project please contact Linda Rowley imago@vic.australis.com.au

Members are encouraged to contact Liz Meggetto with any questions or queries about the GP e-referral project Elizabeth.Meggetto@lchs.com.au

Network members are encouraged to share information about services and training opportunities discussed today with the relevant people or teams at their workplace.

Members to come to the next meeting prepared to discuss and share resources for ACIC Part 3d – Clinical Information Systems.

Clinical Information SystemsHow does your service/practice use information about individual clients and populations of clients with chronic conditions to plan and run effective programs?Refer to ACIC – 3d

All Discuss Network members learn from the discussion and sharing of knowledge. Members are encouraged to review their ACIC scores, identify areas for improvement and create actions from this discussion.

Pre- read ACIC 3d. Be prepared to discuss details about how your service uses data to plan and deliver effective programs. Bring along any resources and information to share.

30mins

A brief overview of the Assessment of Chronic Illness Care (ACIC) was provided to new members. The best practice examples of the delivery system design element of the assessment (3d) were presented and discussed.

Members were provided with the attached action plan template.

The following points of the ACIC were discussed and reflected upon. Attendees are encouraged to take action plans back to their organisation for follow-up discussion and to implement improvement plans.

Registry (list of patients with specific conditions) (best practice example:) … is tied to guidelines which provide prompts and reminders about needed services.

Reminders to providers (best practice example:) … includes specific information for the team about guideline adherence at the time of individual patient encounters.

Feedback (best practice example:) … is timely, specific to the team, routine and personally delivered by a respected opinion leader to improve team performance.

Information about relevant subgroups of patients needing services (best practice example:) … is provided routinely to providers to help them deliver planned care.

Patient treatment plans (best practice example:) … are established collaborative and include self-management as well as clinical management. Follow-up occurs and guides care at every point of service.

Outcome: Network members have a greater understanding and awareness of different clinical information systems, models of feedback, practices for using data to plan services and treatment plans currently practiced by healthcare providers in the local area. Actions: Members are encouraged to implement the action plan developed from today’s discussion of ACIC 3d in reflection of their own organisation’s clinical information systems.

How is the eCare Planning project progressing?

Jess Inform Network members are informed of the current progress of the project.

- 10 mins

Linda Rowley provided the following progress update in writing (on 26/10/15) which was presented by Jess in the meeting:

The revised protocol has been signed by 4 of the 7 agencies and if your organisation hasn’t yet signed it, it should be landing on your representatives desk soon. (Update: has been signed by 5 of the 7 agencies)

Linda presented the e-care planning stats at the Central West Gippsland PCP Partnership meeting recently. A couple of things of note are:

a.      156 care plans have been initiated in Latrobeb.      Number of care plans each agency is involved with:         Gippsland Multicultural Service                2         Latrobe City Council                                   57         Latrobe Community Health Service          81         Latrobe Regional Hospital                          13         Quantum Support Services                        3c.       Only 1 care plan is signed – we may need to look at the process around this.

Further information is in the attached PowerPoint – it is very brief and I think you will find it interesting.

Linda will be sending out an invite to a follow up e-care planning working group meeting for early December.

Organisations involved in eCare Planning should continue to promote the online education materials to your staff to increase their skills with the eCare Plan module. www.centralwestgippslandpcp.com/ecare-planning/

Updates to the E-Care Planning Module: There have been no updates to the module since the last meeting

Outcome: Network members are updated about the eCare Planning project Actions: If anyone has any further questions or is interested in being involved in the eCare Planning project please contact Linda Rowley imago@vic.australis.com.au

How is the GP e-referral project progressing?

Liz M Inform Network members will be up to date about the GP e-referral project

- 5 mins

Liz provided the following in writing which was communicated at the meeting:

Argus S2S Project Latrobe and Baw Baw - Update as of 6/11/15

Baw Baw 24 services active from BBSC, LCHS, WGHG, ACSO, Vision Aust 1 GP clinic active 7 GP clinics to be activated in early 2016 by GPHN

Latrobe 27 services active from LCHS, ACSO, Vision Aust 10 GPs clinic active 2 GP clinics considering activation 126 HL7 referrals sent in July 2015 89 HL7 referrals sent in August 2015 154 HL7 referrals sent in September 2015

Resources to support Argus S2S Added Argus/S2S e-referral page website www.centralwestgippslandpcp.com/argus-s2s-ereferral/ Argus S2S online videos on ‘how to process a HL7 referral’ have been developed and are available from

http://www.centralwestgippslandpcp.com/argus-s2s-ereferral/ CWGPCP and GPHN have developed a ‘Toolkit’, which provides ongoing support to GPs and community

health users and ensures the sustainability of the project.

Next Steps Continue to expand number of services available to GPs Continue to expand number of GPs involved Continue to mentor staff on communicating with GPs to increase their use of the system Continue discussions with Argus and Infoxchange around improving efficiency of the system and set up

process

Outcome: Network members are updated about the GP e-referral project Actions: Members are encouraged to contact Liz Meggetto with any questions or queries about the GP e-referral project Elizabeth.Meggetto@lchs.com.au

What’s new with S2S?- S2S traffic report- Updates to S2S- eCare PlanningModule

Jess Inform Network members will be informed on CWG S2S use and updates to S2S

- 5 mins

July – September 2015 S2S Traffic Report shows the S2S use in CWG for the quarter. See summary report attached.

In summary: - Over 13,500 referrals were sent and received by agencies in Central West Gippsland

- This is a 6% increase in the number of referrals being sent and received since the same quarter last year

There have been no updates to S2S

Outcome: Network members know about current CWG S2S usage rates and are familiar with any S2S updates that have occurred. If you are having any problems with S2S, email: support@S2S.org.auActions: None

Guest Speaker Presentation: Suzanne Taylor - LCHS Gamblers Help Service

Sue Inform Network members are provided with information about how gambling impacts our clients and community, and how the Gamblers Help service can assist

- 10 mins

Sue Taylor from Gamblers Help attended the meeting to provide basic education and promote their service. Attached is some of the information that she provided to the group. The Gamblers Help service are available for staff awareness and education sessions in your organisation.

Outcome: Network members valued Sue’s presentation, the discussion that followed, and the resources provided.Actions: Members are encouraged to contact Suzanne Taylor Suzanne.Taylor@lchs.com.au or Stephanie Cohen Stephanie.Cohen@lchs.com.au if they would like more information on Gamblers Help or would like an educational presentation at a staff meeting at their organisation.

Is there any upcoming training, workshops or forums of interest?

All Discuss Network members will know about upcoming training and forum opportunities

Bring along any info you have about upcoming training.

10 mins

The following training sessions, workshops and forums were discussed:

End of life care framework consultation session - Tuesday 17th November, Traralgon

The 2015 Advance Care Planning & End of Life National Conference – 24th & 25th November, Melbourne

Connecting Women Across Gippsland Conference and dinner - Wednesday 25th November, Warragul

Changes to Aged Care: what does it mean for you? – Thursday 26th November, Morwell

Rural Matters: Gippsland Acute Care Symposium – Friday 27th November, Churchill – (link to LV Express article)

Network members are encouraged to sign up for the CWGPCP Newsletter where we advertise local, state-wide and national training opportunities. Click here to sign up.

Network members are encouraged to forward any training that they come across and would like to share with others to Elizabeth Meggetto, elizabeth.meggetto@lchs.com.au for dissemination.

Outcome: Network members know about upcoming training and forum opportunities in the area

Actions: Network members to disseminate information within their workplace about the upcoming training.What is happening within your agency?

All Discuss Network members provide updates on projects happening within their workplaces.

Bring along any info to share about your service or projects within your agency.

30 mins

LRH Currently trial running a new trauma education session for health professionals – to understand trauma, the impact it has on the workplace and the impact it has on the people you work with. Currently just for LRH staff, but plans are to roll out to the region.

LCCAlzheimers Australia have invited Theresa to participate on an advisory panel to develop a ‘community kit’ for people with dementia and their families within the local communities.

WGHGTwo programs will be merging in the near future with possibly a new name - Integrated Community Outreach Services (ICOS) & Continuing Care.

MIFMI Fellowship are engaged in the ‘Let’s Talk about Children’ parenting program.

QuantumHave received growth funding for projects with Drouin Caravan Park and Miners Rest in Wonthaggi.

CWGPCPWe are currently completing individual Service Coordination Survey reports for each of the organisations that participated in the survey this year. Attached is a copy of the CWGPCP aggregate report that was discussed in today’s meeting. Individual reports should go out before the end of the week.

Outcome: Network members are updated about projects happening in the local area Actions: None

Plan for 2016 NICC meetings

All Discuss Network members will discuss format and content of 2016 NICC meetings

- 10 mins

The members who attended today’s meeting agreed that in 2016 the NICC meeting would include a focus on underperforming elements from the Service Coordination Survey. They also agreed that they would benefit from more presentations from local services, similar to Sue’s about the Gamblers Help service.

The meeting in February will include: In-depth discussion about ‘initial needs identification’ Presentation from Elizabeth Urquhart about the new women’s groups that Quantum Community

Connections Program is supporting Presentation from Henry Yu with a brief overview of GPHN projects Review of the NICC terms of reference What are the actions from this meeting?

Jess Inform The meeting actions will be allocated for completion before the next meeting

- 5 mins

The following actions came from the meeting:

Members are encouraged to implement the action plan developed from today’s discussion of ACIC 3d, and in reflection of their own organisation’s clinical information systems.

If anyone has any further questions or is interested in being involved in the eCare Planning project please contact Linda Rowley imago@vic.australis.com.au

Members are encouraged to contact Liz Meggetto with any questions or queries about the GP e-referral project Elizabeth.Meggetto@lchs.com.au

Members are encouraged to contact Sue Taylor or Stephanie Cohen if they would like more information on Gamblers Help or would like an educational presentation at a staff meeting at their organisation. Suzanne.Taylor@lchs.com.au, Stephanie.Cohen@lchs.com.au

Network members to disseminate information within their workplace about the upcoming training.

Next Meeting:Tuesday 9th February, 2016, 10am - 12noon followed by lunch, in the Moe LCHS Activity Room.

Future Meeting Dates for 2016: Tuesday 10th May Tuesday 9th August Tuesday 8th November

All meetings will be held from 10am – 12noon followed by lunch, in the Moe LCHS Activity Room.