September 2007 HRT0713

1. ElectronicHealthRecordinto the futureDigital Medical Record Project aka Scanned Medical Recordaka Clinical Patient Folder September 2007 HRT0713

2. Introduction • Medical Record • Information Storage & Retrieval • Aid in diagnosis and treatment • Communication & Teaching • Investigation • Compact & easy to use!!!

3. Background • Where is the RHH on this line? ??????????????????????????? Full paper Full electronic We’re probably about here right now – with very few medical record components created electronically We need an incremental transition step. There is a general expectation that we’ll be here in the future (2010? 2015?)

4. Background • The RHH now has four wards located off-site. • Record availability is a Safety and Quality issue. • On average each year, 40 ‘record unavailability’ incidents were reported, relating to record tracking etc. • 5.5km of storage on-site; consumption growing at around 100-300 metres per year. • It was predicted that within 2 years, all available space for records on-site would be consumed.

5. Project

6. Project • Clinician-directed • InfoMedix’s “Clinical Patient Folder” product • Australian vendor who has worked hard with us to fully implement a system in less than 10 months! • Barcoded forms

7. Project • Acquired hardware. • 4 scanning workstations • 1 server for Hobart, 1 backup server in Launceston, each with ≈ 5 years of storage. • Upgrade network including wireless • Additional personal computers

8. How it works

9. 2. New, empty current record folder created, with only alerts sheet and patient labels. 3. As care is provided, all documentation goes into the current record. 4. Upon discharge, the completed record is sent to PIMS, Medical Records. 1. Patient arrives at RHH Using the “current record” 6. The record is available electronically 7. Once all QA processes have been performed, the paper is shredded 5. The contents of the folder are scanned

10. Sample • There is demand for a “one stop shop” for access to information held electronically • The InfoMedix software we are using will take information feeds from multiple sources • Electronic forms capability • One website, one username and password. • Pathology integrated at go-live.

11. Quality Control • Security & Backup. • More secure than paper – automatic audit trail generated, identifying all access to the record. • Apply ‘privileges’ to pages (eg. Where legislation mandates) • Previously, thermal-printed images like this would last ~ 5 years. Archives Act specifies at least 5 years (can be over 50). With DMR, image is now permanent. • Better backup – three different copies kept • Hobart • Launceston • Off-site tape backup • Previously no backup

12. Enhancements • Access • Session timeout • Password expiry alert • Size of record • Feedback • Utility • Admission detail • Data Entry • Outpatients • Operation record • Business Efficiency • Pathology result sign off Close up of timeout screen. Enter your Username and password and you will be able to continue where you left off. Click on the Report Problem or Feedback links to send an email to the DMR team. Perhaps a document is upside down or miss-filed – let them know. You can also leave good news or ideas via this process. When you ‘hover’ your mouse over an admission more information is provided about that admission. This will show Treating Doctor, Unit, Ward and other useful information about the admission. Outpatient progress notes can now be entered directly into the patient’s record.

13. Conclusion • The Medical Record must transition from a paper based medium • DMR provides a cornerstone for future development • The platform installed at the Royal Hobart Hospital provides the basis for a fully integrated, complete statewide medical record. And arguably, an idea for other sites to consider.

14. Conclusion