Networking key to understanding issues of people at the coalface

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Picture: Nelson Marlborough DHB clinical director information systems Dr Bev Nicolls

eHealthNews.nz editor Rebecca McBeth

Nelson Marlborough DHB clinical director information systems Dr Bev Nicolls says spending time networking combined with his clinical experience informs his approach to clinical IT issues, including how to do things smarter across the system.

For the clinical director of information systems at Nelson Marlborough DHB, the key to performing well in his role is simple: “network, network, network”.

Bev Nicolls tells eHealthNews.nz that a capacity to network allows clinicians in digital health roles to “understand the active issues of the people on the ground”.

IT that makes life easier

Nicolls moved to New Zealand from the UK as a GP in 2006 and has “always been interested in IT as a way of helping myself by making my life easier”.

He took up the newly created clinical informatics role in 2013, starting on 1.5 days a week. It has, since February this year, increased by an extra day, leading Nicolls to reluctantly retire from his general practice in June, but staying qualified and doing locum shifts to maintain his connection with the coalface.

He now sits with the DHB’s application support staff where he is heavily involved in clinician-based implementations like electronic sign-off of laboratory results.

“From a GP standing, we have been signing off results electronically for 15–20 years, so I have developed clear disciplines and standards which allow me to be very consistent about my expectations of how the system needs to work well and safely,” he says.

Being a respected colleague makes it easier to talk to fellow clinicians and gently suggest how things need to be done, he says.

“Part of the challenge is that using IT systems is not necessarily easier for clinicians, but if used effectively, care will be safer as visibility and availability of information will be enhanced.”

One idea for the e-laboratories project was setting-up a buddy system within a clinical team, which gives visibility of what other clinicians are doing and ensures they take responsibility for tasks that are part of their everyday work load.

“It’s about being consistent and appropriate about where clinical responsibility lies and not being quick to ask IT to take ownership for stuff that can and should be done locally on the ground,” says Nicolls.

The DHB has also implemented an electronic document management system, which means that as of December 2017, all Clinical Services paper clinical records are being scanned and stored electronically.

The notes are accessed through the Health Connect South portal and the DHB is in the process of changing the document viewing platform to be more clinically friendly, making it quicker and easier to navigate around.

The big questions

Nicolls says that when large volumes of clinical data become digital, the question becomes what to do with it all?

“It’s a chance to tidy up the inconsistencies in where documents are filed and how they are accessed,” he explains.

“But the big question is what is the electronic health record? Nelson Marlborough clinicians can access the electronic records of everything that used to be on paper, but in the future will we want everything cluttering up the system?” he asks.

Questions such as these are core to Nicolls’ thinking as the region embarks on a project to examine current models of care within the primary care sector and how to do things smarter across the wider system.

As part of this, the Nelson Marlborough Top of the South Alliance has prioritised implementation of Health Care Home for this financial year.

Five practices will adopt the model between October 2018 and April 2019 and the plan is to offer the programme to future tranches as funding allows.

The new model improves access to care by offering alternative options for patients via email and telephone as well as doing proactive care planning for all patients by fundamentally changing the way the practice team functions.

A vision for digital health

Nicolls’ vision is to separate inpatient care from everything else, accepting ambulatory care as the key construct and then looking at how best to support that with IT across the wider health system.

“One perspective is that primary care systems already have the capabilities, including clinical communication, patient portal, medication prescribing and problem lists, as well as clinical notes,” he says.

“As primary care is typically seen as the healthcare home, there is an argument for expanding this capability outwards to support all of ambulatory care.”

He describes hospital systems as “maturing at a certain rate” and says while the South Island is doing relatively well, “now is the time to take a step back to ensure that we are, as a whole health system, maximising the health dollar as we develop information systems to support the HCH model and the move towards genuinely patient-centred care.”

Sharing ideas

Sharing ideas for the future, such as this, comes back around to networking.

Nicolls attends a monthly clinical informatics governance group attended by clinicians across both NMDHB hospitals as well as the two-monthly heads of department meetings and invites himself or is summoned to departmental and senior doctors’ meetings.

He also sits on the South Island Alliance clinical informatics leadership group and the HiNZ clinical and technology advisory group.

“Spending the time networking and going to departmental meetings, stopping people in corridors and putting yourself out there, there’s no substitute for that,” he says.

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