Canterbury goes digital

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eHealthNews.nz editor Rebecca McBeth

Canterbury DHB is in the midst of upheaval as it works to electronically move data and processes online and prepares to physically move people and hardware into new buildings. eHealthNews editor Rebecca McBeth looks at how far they have come and where to next.

Canterbury DHB has been on its journey towards digitisation for a decade, since the board saw the need to create an “information continuity”, says executive director planning, funding and decision support Carolyn Gullery.

“We can’t have continuity necessarily, as a service provider, so we saw continuity of information as very important and the only effective way of doing it was digitally,” she says.

CDHB chief digital officer Stella Ward agrees, adding that the community the board serves is digital and there is an expectation that “if you are not online you are extinct”.

“Coming from staff, their expectation is they have the right tools to do the job and those tools are digital, and coming from the leadership and the board is that we will be more efficient and cost effective and productive by using technology,” Ward says.

A line in the sand

The board’s 2007–2008 Health Services Plan really kicked off the move to go digital, with Canterbury committing to a best of breed approach to development of its IT systems.

“We have a very clear way of working and it’s this evolutionary agile model as opposed to a big bang, very expensive system. We have come at it from a build, connect, link-up what already exists perspective,” says Gullery.

A clear sense of the direction of travel and strategy in the region is coupled with strong support from the Canterbury board, which helps when getting business cases approved.

Canterbury chose not to migrate information from previous paper notes, but to start with a clean slate.

A lot of information was already online, such as laboratory and radiology results, so it was a matter of digitising things like doctors’ reports and letters, as well as discharge summaries.

“We just drew a line in the sand and said, ‘from now on we will collect information digitally’, and we didn’t go back,” Gullery explains.

Since implementing these systems, the health board has not had to build any more warehouses for paper notes, whereas Gullery says they would be on to the third or fourth warehouse by now without the changes.

Driving from the bottom up

Gullery believes that too often people make the mistake of simply digitising what used to be a paper process. She believes it is key that the workflow process drives the development of the IT, not the other way around.

“We have made that mistake a couple of times where we have allowed the IT to drive the workflow and it doesn’t work, so we’re very clear now that we start with the people who have to deliver the service,” she says.

“We tend to drive things much more from the bottom up than the top down, so it’s very much about the teams here saying what they need to do their job.”

She adds that all the major IT systems in use, such as Orion Health’s Concerto and the Health Connect South clinical portal, have regular upgrades, “so people are used to the fact that it will be upgraded so it means change has become a constant as opposed to a problem”.

“It’s a constantly evolving landscape and the idea that we have gone with is very specifically interoperability, so if you want to play in the Canterbury system you have to be comfortable linking to other IT in the system and we have to be able to pull the data out the back of your system into our data warehouse and interrogate it,” Gullery says.

However, the current 50–60-year-old hospital buildings are not designed with digital services in mind. This has made implementing IT harder where it is difficult to get wi-fi to work and not enough information points are available.

Digital ready

Canterbury is in the midst of a massive redevelopment project. This includes a new hospital at Burwood, which opened in 2016, and a new Outpatients facility and Acute Services building on the Christchurch Hospital campus, both due to open over the next 12 months.

Ward says the new buildings will be digital ready, which means there is an appropriate amount of infrastructure to support the technology, which will change over time.

She says the facilities have been designed to not house so much paper and new digital workflows that can be transferred into the new buildings are already being put in place.

Each hospital department is working its way through removing paper from its processes, such as digitising pre-admission forms and bookings.

Not only does the CDHB team have to determine how to digitise a process, but they must then decide where the various pieces of information should live, such as within the clinical portal or another application.

Starting new

With new systems also comes the need for new hardware and the team has looked at which devices work best with particular systems.

“What we have found is that some of the applications will work on smartphones, but some need to be on iPads or tablets,” Ward says.

Systems that require longer-form information, such as the Patient Track e-observations system and MedChart e-prescribing system, need larger devices.

There will also be computers on wheels and laptops, and there will be times, such as ward rounds, when multiple digital devices will need to be in use, she explains.

Nursing stations will have large electronic whiteboards and the CDHB is innovating with Hewlett Packard on how to make these able to display multiple applications at the same time.

“The thing we have been learning about digital, and something that’s really important in the design, is you just need to increase the capacity, because everything needs to connect to either Bluetooth or wi-fi, including all the kit, like smart pumps,” Ward says.

“Pretty much everything new is coming with software so how do we make sure the data is not stuck inside that device, but ensure there’s a way for that data to be surfaced and support a data-driven healthcare system?”

“That won’t happen on day one but over time the digital hospital will need to be able to accommodate that,” she says.

Driving change

As more clinical applications come into use, Canterbury will need more people who are clinically trained, but with an understanding of informatics and software.

The DHB has been investing in this space and now has a clinical application team sitting inside the information services group.

Ward says the board has a growing number of people who are competent in this area. Super-users get additional training and there are clinical application specialists who have a “deep understanding of the application and the impact it has on the work flow”.

“Training and support needs to be done by credible clinical champions who are ‘at the elbow’, so while we still run online training and sessions, the main change happens with having credible super-users who are able to support the change,” Ward says.

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