eHealth NSW building small site EMR solution for rural healthcare services

eHealth NSW is planning to develop a business case to adapt its electronic medical record roll-out strategy for small sites such as multi-purpose services in rural and remote areas as part of its $48 million rural eHealth program.

eHealth NSW is just over a year into the program, which will see a number of clinical, corporate and infrastructure solutions rolled out to the six rural local health districts, including phases one and two of the Cerner EMR, electronic medications management, HealtheNet, the new ICU solution known as eRIC, the community health and outpatients system known as CHOC, universal wireless and the Health Wide Area Network (HWAN).

Last week, the EMR and CHOC were rolled out at the Wilcannia Multi-Purpose Service and White Cliffs Health Service along with Broken Hill Hospital in the far west of the state. Broken Hill Hospital has also recently been hooked up to the HWAN, which provides remote access, multimedia applications and services, data exchange, voice and video services and wireless access across the state.

Director of the rural eHealth program Kerri Ryan told the Australian Healthcare Week conference in Sydney this week that in addition to the statewide solutions for the six rural LHDs – Far West, Western, Murrumbidgee, Southern, Northern and Mid-North Coast – many sites in these areas had additional needs that required more infrastructure to enable them to implement the first phase of the EMR, known as eMR1.

This is the first iteration of the Cerner EMR that was implemented in 2010, which included foundational functionality such as discharge referrals, results reporting, emergency department management (FirstNet) and surgery management (SurgiNet).

The second phase, eMR2, has concentrated on reducing the amount of paperwork used in the inpatient setting and documenting progress notes, completing mandatory assessments, entering observations and a patient summary page.

However, many small sites such as multi-purpose services – which often include a small hospital or emergency clinic along with residential aged care services and co-located GPs – are still predominantly paper based and require extra infrastructure to get them up to speed.

“For example, in the EMR expansion program we have over 70 sites in rural NSW that are still paper based, so we have had to investigate more infrastructure to support them in implementing eMR1 so they could then take up eMR2,” Ms Ryan said.

“This includes investments in computers on wheels, desktops, mobile devices, network facility upgrades etc. Just recently some good news for us is that sites at Wilcannia and White Cliffs have gone live last week. They are the first sites in NSW to go up with eMR1, eMR2 and community health and outpatient care functionality. It is a big change for them and we are very proud of them.”

eHealth NSW is also introducing a scanning solution to assist smaller sites to scan in letters, referrals and records that can’t be recorded in the EMR. This project has just commenced and will be used to support community nursing staff in the first instance.

“Other work that hasn’t yet reached the project phase is a multi-purpose services or small site solution,” she said. “In recognition of the needs of some of the LHDs, especially in some sites like Wilcannia and White Cliffs, we’ve defined some business requirements for these sites so as to inform future priorities for residential aged care and co-located GPs. They will move into the project phase once we have funding.”

Timeline for implementation

The rural eHealth program is part of the larger eHealth strategy known as the Blueprint for eHealth in NSW, and is aligned with the statewide health plan. It covers 150 facilities spread across 650,000km, over 1.3 million people and 17,000 NSW Health staff.

The plan is to manage and deliver appropriate tools and resources to clinicians and staff to accelerate the use of eHealth solutions in rural and remote NSW. Ms Ryan said this is conducted through rural LHDs agreeing to act together, integrated and supported delivery, and consolidation of funding to support the program of work.

“Under the principles of the model, everyone comes together and no one is left behind,” she said. “We are delivering clinical and corporate applications, high speed networks, devices and technologies to link to the primary sector and in-home care and improving the integration of information.

“Our governance model is unique in regards to major projects across NSW Health as it brings the chief executives of the six LHDs as well as eHealth NSW in partnership to approve the program of works.”

The program began in late 2014 and all streams are due to be finished by 2018, including the incident management system (IMS), the eRIC roll-out (MetaVision from iMDSoft) and EMM, which will be provided by Cerner.

“We commenced our roll-outs in late 2014 and the priority is to build the foundation systems for the EMR and community health,” she said. “We needed the network infrastructure to be in place as part of that process. The wide area network is expected to be completed in July 2016.

“HealtheNet implementation commenced in 2014 and was completed in June last year. That has resulted in GPs having access to discharge referrals across the LHDs.”

Some of the sites are still paper based so the strategy has been to go live with both EMR 1 and 2 rather than a staggered implementation. Ms Ryan said the EMR roll-out began in October 2014 and is due to be completed this November.

“For community health and outpatient care, Northern NSW has completed their roll-out a few months ago now and have over 25 facilities and health centres live. The remaining LHDs are in progress and we expect to have that done by December this year.

“We have go lives occurring every fortnight on average. It is a huge change to our clinical and business practices but also a huge amount of work going on behind the scenes. The HWAN is increasing bandwidth to rural areas and is the largest investment in infrastructure in more than 10 years in these rural sites. The other big commitment is wireless, and that has been rolled out across hospitals and in community health facilities as well.”

Ms Ryan said the remaining in-scope projects in the rural eHealth strategy, including IMS, eMM and eRIC, are in the early planning phases and the implementation will be completed by 2018.