Australia's first digital public health service

Queensland’s Metro South Health recently completed an ambitious project to replace paper-based medical records with integrated electronic medical records across five facilities. Clinician input helped guarantee the project’s success.

Health care is changing and so are our hospitals. Innovation and the introduction of digital platforms are shaping the way we build and plan our hospitals.

In 2015, Brisbane’s Princess Alexandra Hospital (PAH) became the first large-scale public hospital in Australia to replace paper-based medical records with integrated electronic medical records (ieMR). An ieMR means a patient’s medical information is documented and accessed via a secure electronic medical record, across all services including emergency, acute medical, surgical, mental health, cancer, rehabilitation and allied health services. The ieMR automatically uploads observations and vital signs from patient monitoring devices; allows efficient electronic ordering of radiology and pathology tests; and provides decision support for clinicians in prescribing, verifying and administering medicines to our patients.

Following the implementation at PAH, Metro South Health — Queensland’s largest public health service by population — embarked on an ambitious project to roll out the ieMR across all other hospitals and facilities within 13 months. Since last year, Logan, Beaudesert and Redland hospitals, as well as the Wynnum-Manly Community Health Centre, have joined PAH in becoming digital facilities. At the time of writing this article, the organisation is preparing to complete the rollout with a final ‘go live’ at QEII Jubilee Hospital (4 June 2018).

The uplift to a digital platform has required an enormous effort, from redesigning brownfield sites to remapping and redesigning wards and medication rooms, all while keeping up with the regular demands of a health service.

Princess Alexandra Hospital, Qld, has undergone a digital transformation.

A clinical change project

The success of this project has depended largely on it being treated as a clinical change project — not just an IT system implementation. To engage clinicians in the project, the complex and technical nature of the IT components had to be transformed into a language and context which resonated with clinicians and staff who were not IT specialists. In addition, when delivering such a large-scale change, the safety of patients needed to remain the highest priority. The implementation was achieved with zero patient harm, demonstrating the success of clinically driven processes for tailoring the rollout.

As with any large-scale change in a healthcare organisation, the digital implementation necessitated changes to models of care. For clinicians, it changed the way they thought about healthcare systems; it changed the way care was provided, in particular the engagement between patient and clinician; and it changed multidisciplinary team interactions. For these reasons, there was no single ‘one size fits all’ model that could be applied throughout the transformation — changes had to be designed and delivered in close consultation with each unique clinical area.

Metro South Health also needed to ensure that patients understood the benefits of the digital platform, such as better monitoring to alert clinicians faster to deterioration, while being reassured that the security of their personal data was safe.

Consultation with stakeholders ensured the program was successful.

Infrastructure and workplace redesign

As health care continues to change, so do the requirements of the infrastructure in which it is delivered. To support the digital hospital implementation, since 2014 all Metro South Health facilities have participated in extensive consultation with key infrastructure experts, clinicians and relevant stakeholders to redesign work environments.

Infrastructure works at Princess Alexandra, Logan, Beaudesert, Redland, Wynnum-Manly and QEII facilities are now complete. All wards and departments now have access to various medical devices and IT equipment, all connected to the ieMR.

Metro South Health’s key principle when planning and delivering these infrastructure upgrades was to ensure quality patient care with minimal impacts and costs to the organisation and its staff. A key focus was to ensure the infrastructure works implemented today would be sustainable for future workflows. Each department was individually assessed to meet safety standards, to ensure ease of movement for clinicians and to determine whether future digital workflows would work with their current configuration.

All facilities received extensive electrical system upgrades to meet the demand for connectivity with the digital hospital devices. The infrastructure works were completed with immense speed, while maintaining patient safety and comfort, infection control and the highest building standards. A team of device experts was deployed to integrate the new technology following the electrical works. This was not without some challenges in maintaining services while upgrades were undertaken.

Now leading to the final infrastructure uplift and digital implementation, QEII Hospital will benefit from lessons learnt from all other Metro South Health facility go live experiences.

Logan Digital Hospital Emergency Department.

Lessons learnt

The implementation has provided Metro South Health and its staff with opportunities for growth, innovation and continuous enhancements to the way the organisation provides patient care.

Crucial to the success of the project was the leadership role of clinicians. Having clinicians deeply embedded in the project ensured staff not only understood the role they played in the go live process, but also in realising the benefits to patient care through the ongoing use of the digital hospital system. While there was limited capability to change the functionality of the system, there was a significant opportunity to understand clinical workflows in each hospital and how they might be redesigned to be best supported by the ieMR.

This included a stringent, hospital-driven clinical governance framework that was essential to ensuring the safety of patients during the transition period and beyond. During each hospital’s go live phase, daily clinician meetings were held to compile feedback from all levels of the hospital, to conduct a ‘triage’ on any issues which arose and to plan and deliver solutions to address those issues.

Critical also was the unswerving support of the board and senior executive in providing a successful outcome.

Metro South Health is looking forward to seeing the ongoing successes that the ieMR will bring to patients across the health service as we provide a connected information service between our facilities.

*Dr Stephen Ayre is the Chief Executive of Metro South Health in Brisbane. Dr Ayre has worked in senior management across health, including community health, medical services and executive leadership roles. Prior to his current appointment, Dr Ayre was the Executive Director of Princess Alexandra Hospital during its implementation of the Digital Hospital Program.

Top image: Workstation on Wheels, used by clinical staff to access the digital systems. All images ©Metro South Health