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Electronic personalised care plans live across Canterbury

Tuesday, 14 May 2019  
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Picture: Canterbury DHB shared care plan. editor Rebecca McBeth


More than 1500 electronic personalised care plans have been created with patients in Canterbury.


Allied health staff are leading the charge in implementation of the patient-centric plans, which are predominantly designed for use with complex patients with multi-faceted ongoing needs.


A phased implementation saw the online plans go live for allied health staff in March and April at Christchurch Hospital, Burwood Hospital and adult community service teams across paediatric and adult services.


The software tool being used is Orion Health’s Coordinate and the PCPs are linked into the electronic shared-care record HealthOne and clinical portal Health Connect South, alerting users if a plan exists for a patient and allowing them to view it.


Canterbury District Health Board project manager Rowena Woolgar says the concept came about when a group of services from CDHB were designing new models of care, presenting an opportunity to introduce new ways of working.


Previously, shared documents at points of transfer could only be used one at a time, and the last person to contribute would be listed as the author.


“We wanted to think ahead to how we could better utilise our patient record, not only to make the work more seamless for our staff, but also to make the patient journey better,” she says.


“The collaborative care team from the Canterbury Clinical Network had been working on an electronic PCP which fitted many of the requirements for this kind of tool, and we chose to form a joint project team to refine and roll out the plans.”


The digital PCPs can be edited and viewed by any member of the care team at the same time and show who has entered specific information, giving greater visibility to input from multiple health professionals for one patient.


Woolgar says the PCPs are patient-centric: the first piece of information entered is what matters most to the patient. 


Second are the goals the patient wants to work towards in their healthcare journey, and third are the actions needed to help them achieve their goal.


Allied health staff saw the potential benefits of adopting the PCPs and worked with Woolgar and other members of the team to develop principles for use and guidance documents, undergo training and gain executive support and sign-off for the implementation.


Hospital allied health staff now routinely review the PCP when a patient is admitted and update it when a patient leaves their care, allowing it to be picked up by the next health professional, who could be hospital based or in the community.


“Allied health is predominantly paper based [in CDHB hospitals] so this is a move towards using electronic records consistently,” Woolgar says.


“AH staff are now using these in a consistent constructive way across the patient journey and other health professionals can see that.”


Nursing and medical staff will be engaged next to familiarise them with the concept, provide use-case scenarios and get them using the plans. Nursing staff are already starting to contribute.


PCPs have been moved on to a regional platform via Health Connect South, with a regional steering group for the South Island set up.


Access rights have been switched on for all users, so they are available to anyone in the health system to create, edit and use.


“It doesn’t matter if the patient is admitted into hospital or with a GP or community team, they’ll have the same information in the same place written in the same way,” Woolgar says.


“Everyone has the right to continually amend it with the patient present.”


Read more news:

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National health systems opened up with FHIR

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