Ballarat Health Services has recently deployed the Rhapsody Integration Engine from Orion Health as its new platform to provide connectivity between critical clinical, patient and administrative applications, including pathology, admission, discharge and transfer systems.  

Healthcare is well behind most other industries from banking and finance to retail when it comes to digital transactions and information sharing.
For the large proportion of private and public hospitals across Australia, the paperless future is a long way distant.

Currently, in most hospitals, a patient’s physical chart is still the focal point for care delivery. If that chart is not at the foot of a patient’s bed, records can’t be checked or updated and the risk of error exists.

Many hospitals are keen to turn to technology as a cost-cutting measure, but face the difficulty of replacing established processes and legacy systems.
Paper is still the glue that ties these systems together and provides the means of recording clinical notes on patients, ordering prescriptions, laboratory tests, pathology and radiology, as well as providing specialist referrals and patient discharge summaries.

Orion Health is a global software developer for the healthcare sector founded in New Zealand.

Rhapsody will streamline and speed message handling between applications at Ballarat Health Services, which provides hospital, emergency, diagnostic, aged and mental health services to patients within the Grampians region in Victoria. The organisation relies on its integration engine to ensure that data such as patient contact details, clinical documentation, and clinical test results, is shared among information systems and remains readily accessible to all health professionals involved in a patient's care.
Rhapsody was chosen to replace Ballarat Health Services' previous integration engine because it offered a robust, well-supported solution with the additional capacity required to meet the organisation's message exchange load well into the future. In an environment where any interruption to data flow or message exchanges can impact patient outcomes, it was considered the most reliable solution available. Rhapsody will also enable Ballarat to easily connect to the PCEHR in the future.
Kelsey Grant, Solution Director – Asia Pacific, Orion Health commented, “The information systems at Ballarat Health Services range from legacy to leading-edge applications.  All contain data that needs to be shared with other systems.  Rhapsody is a future-proof investment for Ballarat that ensures no application stands alone and that every solution contributes to the delivery of quality of patient care.”

Ballarat Health Services Director of Information Management Kate Nolan said, "We introduced a scanned medical record using the BOSSnet Digital Medical Record platform from Australia's Core Medical Solutions three years ago. This enabled Ballarat Health Services to provide a platform for an integrated electronic medical record..
"So messaging is really important to maintain a single view of each patient's medical records."

The new messaging platform will allow a change in patient information in one location to spread out to five other clinical systems. So, for instance, results from a pathology test will be distributed to other clinical systems as well as being included with the scanned medical record, removing the need for paper lab results.

"There is lots of detail collected in the various clinical systems and you have to ensure that the output summary that is collected in the BOSSnet single medical record is relevant.

"We are also working with vendors of some of our clinical systems, so that the BOSSNET single medical record can be accessed from within these systems.
Patient data that is created digitally within any of the hospital's clinical systems is able to be messaged to BOSSnet to be included in the digital medical record.
However there are still a large number of clinical documents created from paper that must be scanned upon the patient’s discharge, for example   multi-disciplinary patient progress notes, admission and discharge forms.

"We are in a hybrid mode," said Nolan.

"Our experience has found that ambulatory episodes of care in allied health and mental health services are the highest users of direct data entry, typing their notes directly into BOSSnet via an e-form.

"We have developed over 118 e-forms; data shows that we have also exceeded 2011/12 actuals as at 23rd April 2013 reporting 124,391 e-forms directly from BOSSnet Digital Medical Record; we estimate approximate full year at 153,669. This is an increase of 35,940 or 30.53% e-forms generated electronically.
In addition to this e-discharge summaries continue to be expanded across all clinical specialities and sent via Argus Secure Messaging to GP’s. Data shows that we have exceeded 2011/12 actuals as at 23rd April 2013 reporting 12,933 e-discharge summaries; we estimate approximate full year at 15,710.  This is an increase of an additional 5,868 or 59.62% e-discharge summaries sent electronically to GP’s in 2012/13.

"This has a direct impact for clinical users enabling timely access to clinical information; previously these types of clinical documentation would have been handwritten and scanned and we are only scratching the surface."

Scanning is performed in-house and has grown to over 1.2 million documents annually although with the increase in e-forms Nolan hopes this will reduce over time.

"You always go through resistance when you implement any new system especially with clinicians but now they've seen what it can do they've got an appetite for more. To jump from what we had to fully electronic that's a massive leap whereas now we are on a strategic roadmap for further electronic medical record development”.

"Presently we have a digital medical record which is a hybrid of scanned documents and direct data entry as well as information that arrives via HL7 messaging from other clinical systems."

"Messaging is really important to maintain a single view of each patient's medical records." - Kate Nolan, Ballarat Health Services Director of Information Management.

HL7 is the messaging standard used in healthcare for interoperability between electronic Patient Administration Systems (PAS) and other clinical systems.
Any new system implemented at Ballarat Hospital is able to communicate via HL7 messaging but some legacy systems cannot.

"Our big gap at the moment is electronic ordering for pathology, radiology and medication," said Nolan. We are working with CMS and other BOSSnet sites to introduce this functionality in the next 12 months. In addition to clinical alert management and internal referral management.

Results can be viewed from pathology and radiology in BOSSnet but a doctor still has to fill out a paper form and stamp and sign it before it is delivered with the sample to the pathology department.

Referrals to specialists are still provided on paper although Ballarat has begun using secure messaging to electronic discharge summaries from BOSSnet to GPs.
Ballarat Health Services employs the IBA WebPAS Patient Administration System with manual data entry required for patient information.
While BOSSnet has been deployed for scanned medical records for patents, Ballarat Hospital’s financial and HR records are still stored on paper; however the platform from CMS could be used if we chose to go down this path.

The recently implemented clinical coding query process uses a digital work flow to record and track coding queries for patient admissions.  Coders review the admission documents electronically and use an E Form to record any coding queries.  Coding queries generated by junior coders then appear on a work list and are reviewed by a senior coder before approval.  These approved queries then appear on a report accessible from BOSSnet.  They are reviewed and answered by a medical staff member using an e form.  This completed query is then available for review electronically by the coding manager.  This totally electronic process with access to the DMR at all points has increased the efficiency of the coding query process and allows for queries to be responded to remotely as well.

Andrew Howard, Global ehealth Director - Orion Health, is a former CIO of the State of Victoria and acted as interim CEO of Australia’s National Electronic Health Authority (NEHTA) delivering the Personally Controlled Electronic Health record (PCEHR).

He says that while most hospitals in Australia have an integration engine that links different clinical systems to their patient management application to identify the patient, only a small percentage have taken the next step in providing a single view of all that data across different systems and using the integration engine to drive that into a central store.

"A surprising number of the larger metropolitan hospitals don't have a centralised electronic medical record. There is a lot of paper out there," said Howard.

"A single clinical repository for a healthcare organisation is a fantastic solution when it’s in place and operational, but most hospitals can't rip out and replace every single system they have.

"What Ballarat has done with Rhapsody is connect their systems within the hospital while also providing the capability to connect outside into the PCEHR and provide a coordinated view.

"Orion is also able to provide a clinical and consumer portal to bring together all of that information from clinical applications, radiology, pathology and pharmacy, and imaging into a single view. Ballarat may look at this at a later date.

"What you don't have at the moment is a full alignment of government policies to drive that across Australia."