Connecting with GPs – Implementation of an Electronic Discharge Summary

1. Connecting with GPs – Implementation of an Electronic Discharge Summary Dr Susan Sdrinis Manager, Medical Operations Peninsula Health Brendon Gardner Director, Information Management Peninsula Health Dr John Siemienowicz Executive Director Mornington Peninsula Division of General Practice

2. History with GP Division Notification Process – late 1990s Proof of concept – GP funded, Monash University Semi-automated Notification of admission, discharge and ED attendance Problems with process including identification of local doctor and patient consent Limited to GP Division members Discharge Summaries – Ongoing Issues

3. Discharge Summary GP Survey • Conducted in Sept 2000 for existing hand-written “Acute” discharge summaries • Issues raised • Legibility • Timeliness • Accuracy • Content • Mode of delivery

4. MOU - GP Division & PH Memorandum of Understanding 2nd –signed June 2003 Outcome focused , business plan Joint funding – personnel, behaviour change Outcomes Quality GP identification Referral template Information sheet

5. How do we fix it? • Major change required • Needed to move to an electronic approach • Options • Develop in house? • Work with existing Patient Administration Provider? • Purchase off the shelf software? • Following review of market and options reached agreement to proceed with Orion in Nov 2001

6. What did we implement? • Phase 1 (July 2002 – current) • Electronic Discharge Summary • E-prescribing for discharge medications • Results reporting (with graphing and cumulative views) • Phase 2 (July 2003 - current) • E-prescribing for Inpatients • E-orders for Pathology, Radiology and Allied Health • Event Notification

7. How does the summary get to the GP? • Referring or Local doctor must be picked from existing internal doctor table within system • Preferred delivery mechanism for doctor stored in table • Secure electronic transfer (via Healthlink) • Autofax • Hard copy (posted) • Occurs when summary is triggered as “Final”

8. Barriers • Doctor identification at registration of patient • QIT • Issues with Healthlink regarding transmission of electronic information to GP practices • Training of GP practices in how to retrieve information

9. Number of Electronic Discharge Summaries by Month

10. Timeliness • How soon after the patient’s discharge do you receive the written Discharge Summaries? (2002) • N = 128 respondents • 0-3 days 21 • 4-6 days 38 • 7-10 days 44 • Other – 25 (Weeks to months)

11. Timeliness (cont) • Discharge Summary Review - January 2004 • Total of 969 discharge summaries (EDI & FAX) • < 24hrs 728 (75.13%) • 1 day (same day) 109 (11.25%) > 24 hrs 132 (13.62%) • Minimum = - 2 days • Maximum = 29 days • SD = 3.026 days • Average completion time = 22 hrs 45mins following discharge

12. Factors Contributing to our Success • Working relationship with GP Division • Multidisciplinary approach to Change Management • Senior Clinician Champion • Resource shared by PH and GP Division • Executive & Board Support • Leading (& bleeding!) edge

13. Future • Continued review of the Discharge Summary with the GP Division • Further development of the integrated relationship with the GP Division • Re-commence the improved electronic event notification via Orion • Investigate ways of improving information flow both to and from the GPs.

14. Thank You