New era for records at NSW Health

from IDM Magazine May-June 2009

Clinical and clerical staff at St George Hospital are pioneering the latest Electronic Medical Record (eMR) clinical system for NSW public hospitals, developed as a joint initiative between NSW Health and US healthcare IT supplier Cerner Corporation.

There are many implementations of the Cerner eMR across NSW. The version at St George Hospital is one of the latest, resulting from a state-wide clinical redesign strategy initiated by NSW Health in 2006. St George Hospital’s eMR includes solutions for ordering, results reporting, eMR repository, operating theatres, and emergency departments.

The implementation of an electronic medical records systems for public hospitals is a massive project for NSW Health.

NSW Minister for Health, John Della Bosca has announced that $A100 million will be spent to roll out the eMR platform to 188 hospitals across the State by the end of 2010.

“The new eMR replaces many existing paper records and makes secure patient information available to authorised clinicians from computer workstations across the hospital,” Della Bosca said.

“A major benefit of the eMR program is the completeness of patient data and information on medical orders.“Prior to the introduction of eMR, some requests for medical imaging and pathology could require referral back to the requesting clinician due to incomplete or illegible hand-written records.

“This technology will improve the efficiency of hospital care and free up doctors and nurses to focus on patients and not paperwork which will further improve patient safety,” he said.

At the heart of the Cerner eMR platform is a single database where patient details are entered once and accessible to all clinicians with approved security access anywhere in the hospital. Information gathered about the patient from many service departments can guide clinical decisions through the use of rules and alerts.

Hospitals in NSW are at varying stages of implementing the eMR technology platform.

St George Hospital’s eMR includes solutions for ordering, results reporting, eMR repository, operating theatres, and emergency departments.

Other public hospitals across NSW are operating on different platforms and databases, and there are many still with paper-based records and workflow.

Craig Smith, Acting Chief Information Officer at NSW Health, said, “The aim of the state-wide implementation of the eMR is to provide a foundation layer of functionality to many sites and a common level of service across the state. This will ensure that quality core foundation of ICT capability is in place to then support more sophisticated solutions.

“Additional modules of the eMR are proposed for future works as part of the NSW Health ICT Strategic Plan and are subject to approval of funding,” he said.

“There are departmental systems at individual hospitals that are not part of the eMR system and, based on business need, some can be integrated into the system, some can interface with the eMR and others that do not need to do either. Examples of departmental systems are Renal dialysis systems, Obstetrics systems.”

The migration to the Cerner eMR platform does not also involve scanning of historical patient records, however, some NSW sites are scanning records in preparation for potential use in the future.

“More than 2700 staff at St George Hospital have undertaken training in the use of the eMR, which will soon roll-out to other hospitals in South Eastern Sydney Illawarra Area Health Service,” the Acting Chief Executive of South Eastern Sydney Illawarra Area Health Service, Ms Elizabeth Koff said.

“Clinical staff at St George Hospital have played an integral role in helping to further develop the eMR modules and their efforts in helping to steer this initiative are recognised.”

The eMR implementation at St George represents a move to having a standardised, state-wide, medical record system that will eventually allow patient information to be securely accessible in every public hospital, regardless of where the patient is seen.

The eMR manages clinical information for patient care and treatment. It replaces many of the existing paper records and makes the information available in a secure way to authorised clinicians from any location in the hospital.

Doctors, nurses and allied health professionals can record a patient’s details and clinical information from arrival in hospital, to discharge to compile a complete view of the patient’s care.

  • The eMR core system components are:
  • Emergency Department (FirstNet);
  • Operating Theatre (SurgiNet);
  • Electronic Orders and Results (PowerOrders and PowerChart); and
  • Electronic Discharge Referrals (EDRS).

Patient information will be available to authorised doctors, nurses and allied health professionals at the point of care where they will be able to:

  • Record patient care where and when it is delivered.
  • Review progress and order treatment or diagnostic tests from any workstation within the health facility.Be prompted with alerts and allergies at the time of ordering.
  • Continually review results and outcomes as well as alter care as required.

“Patients can expect that their data will be collected once and continue with them through the hospital visit by anyone that interacts with their care,” stated Rick Heise, Managing Director of Cerner Asia Pacific.”