NSW Program Update

Jonathan Di MichielSenior Program Manager –

Delivery and ImplementationeMR Connect

eMedication Management Conference

15 March 2016

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Australian research shows that errors

can be reduced by more than 55%

with the introduction of electronic

systems to help manage medication

prescribing, dispensing and

administration.

Westbrook JI et al. (2012) Effects of two commercial electronic

prescribing systems on Prescribing error rates in Hospital patients:

A before and after study. PLoS Med 9 (1):e1001164.

doi:10.1371/journal.pmed.1001164

Why eMeds?

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Why eMeds?

Why do it?• Reduce medication errors and associated adverse events

• Reduce variance in prescribing practice

• Improve accuracy, legibility and visibility of medication information communicated between clinicians, patients and healthcare settings

Will eMeds prevent all errors?• eMeds systems can introduce new errors

– Selection errors

– Hybrid records (electronic / paper, electronic / electronic)– Need to monitor for unintended consequences

• Everybody needs to be involved in testing, reviewing, implementing and refining

– Working towards continuous improvement

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eMeds NSW Program Vision

“To deliver smarter, safer, better management of medications for

patients in hospitals across NSW.”

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Program Focus

To put patients at the heart of everything we do

Improve patient safety

Support hospitals to get the best outcomes

Support the integration of all clinical systems

Ensure benefits are realised

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Program Scope

28 Hospitals

in NSW

Deployment Scope• Emergency

Departments• Inpatient areas • Discharge and

prescribing

• Outpatient clinics• Preadmission clinics• 1-way Millennium

to i.Pharmacy interface

People Scope• Prescribers• Nurses• Pharmacists• Allied Health

• System Trainers and administrators

Dependencies• Wi-Fi• Devices

• eMR rollout• Workforce

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High Level Solution Scope

Hospital Pharmacy Processes• Comprehensive patient pharmacy review

• Medication management

• Therapeutic drug monitoring and compliance

Inpatient Medication Management • Configurable decision support for

prescribing

• Structured medication in discharge

summaries

• ED, inpatient and discharge prescribing

• Transmission of medicines information

to other settings

• Medications administration

• Medication orders and supply to wards,

including ward based dispensing

machines

• Medication reconciliation

Outpatient Medication Management • Prescribing in outpatient, pre-assessment clinics and other pre-hospital

admission planning

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Concord*

Business case approved

NSW eMeds Program

commences

Children’s Westmead*

Prince of Wales *

Vendor announced – Cerner

AMS complete

Concord go live –complete

(commenced May)

RPA*

Rollout continues

Program Highlights …

* project commences

2007 2010 2012 2014 2015 Feb Jun Jul Aug Oct Nov 2016 Apr Jul Nov 2018

Prince of Wales go live

commences

Maitland go live commences

Blacktown*

Maitland*

Children’s Westmead go live

commences

RPA go live

commences

Blacktown go live commences

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Wyong and Long Jetty Facility

Coffs Harbour Base

Nepean

Royal Prince Alfred

Blacktown

Sutherland

Children’s Randwick

Canterbury

Bankstown / Lidcombe

…. And much more ahead

* dates indicative

2016 Jul Nov 2017 Jan Mar Jun Aug 2018 Jan Mar Apr May Jun July

Gosford

Woy Woy

Broken Hill Base

Lismore Base

Royal North Shore

Goulburn

Liverpool

Fairfield

Hornsby

Scheduled rollout to commence at each hospital*

Wagga Wagga

Orange Health Service

Ryde

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Promoting Safety and Quality

Detailed consideration must be given to impacts of electronic

medication management on clinical quality and patient safety

• Priorities

– Clinical leadership and engagement

– Design a safe system

– Ensure people are equipped and trained to use it safely

– Use the system to improve quality of care

• Standardisation of the eMeds system design and

implementation

– Promotes medication safety and quality use of medicines

– Reduces unwarranted clinical variation

– Ensures training is transferable for staff moving

between locations

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Role of Reference Model in Standardisation

Benefits of Lead Site-Driven Model

• Reduce clinical risk and improve safety

• Enable medication information exchange

• Improved sustainability of eMeds systems

• Facilitate re-usability of eMeds system artefacts

• Diversity of approach (not design by committee)

• Community of practice collaborating to close the gaps on complex design

• Multiple approaches designed, built and tested:

− Adults / Paediatrics

− IV functionality

Cerner Reference Mel

POW

Concord

CHW

Lead Site-Driven Design

eMeds Reference Model

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Design StandardisationeMeds Reference Model

• Design elements are ratified through the design assurance

process to ensure consistency where required for safety and

facilitate local customisation where flexibility is required

• Starter content and design provided. Localisation permitted to meet local work practice

e.g. Local formulary

• Common design necessary. Change requests go through Design Assurance Process

e.g. Core Code Sets

• Core design is standard but local flexibility permitted for content

e.g. Order Catalogue

State Required

Flexible

Starter

POW

Concord

CHW

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eMeds Program Governance

LHD eMeds

Program TeamCerner

Reference Group

eMeds

Operational

Management

Group

Standardisation

and Reuse

Working Group

LHD eMeds

Program

Steering

Committees

Clinical

Leadership

Forum

Safety and

Quality Advisory

Group

State eMeds

Program

Steering

Committee

eMeds Program

Team

LHD eMeds

Program Teams

Design

development

Design

assurance

Design

consumption

Clinical

Leads

Chair Chair

Medication Safety

Expert Advisory

Committee

Governance Principles

• Clinical input

• Design oversight / change control

• Hospital implementation oversight

• BAU governance

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eMeds Safety and Quality

Governance

• Safety and Quality Advisory Group

– Clinician-led

– Develops and maintains eMeds standards

– Manages risk of variance

• Cerner Reference Group

– Represents lead sites

– Collaborates to develop the eMeds Reference Model

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Supporting Change

Partnering with hospitals • eHealth NSW eMeds Program Change and Adoption team supports

local teams to successfully implement eMeds

Critical success factors for change – six factors that need to be planned for and managed to ensure sites and healthcare professionals are supported through changes to adopt eMeds.

Effective governance and leadership

Effective communication

Effective stakeholder engagement

Targeted learning and development

Integration of new systems into day-to-day work practices –

workflow change

Monitoring, evaluation and ongoing improvement to

realise the benefits

Stages of change – LHDs and users move at different speeds through 5 stages of change.

Aware Understand Commit ActStabilisation

and Optimisation

Processes and activities Tools and methods Templates

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Key Challenges

• Clinical integration across electronic medical records

• Resource capacity to support delivery

• Usability and ‘human factors’

• eMeds readiness – people and systems, e.g. hospital

workforce, infrastructure

• Transition from project governance to ‘business as

usual’ / local ownership

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Find out more about eMeds in NSW

eMeds Hub

• SharePoint site – a source of

information about eMeds in NSW

• Accessible to anyone with a

NSW Health email address

http://ehnsw.sharepoint.nswhealth.net/ap

ps/ClinP-eMedsHub

Contact us

• For feedback, suggestions and

subscriptions to our newsletter

HSNSW-

EMMEnquiries@health.nsw.gov.au

Daniel McCluskie

SLHD eMeds Project ManagerMarch 2016

SLHD eMeds Implemtation

Sydney Local Health District

Inner Sydney LHD

Population 600,000

1 Quaternary Facility

1 Tertiary Facility

2 District Facilities

Tertiary Dental and Mental

Health Facilities

11,000 staff & 1,780 Beds

152,000 ED Presentations

29,000 Operations

161,000 Seperations

Concord Hospital Implementation

Phase 1, 2003- 2011

Proof of concept site

Implemented in 5 Aged

Care wards

105 beds (15% beds)

– Inpatient only

– Limited IV functionality

– Minimal decision support

Phase 2, 2011- 2015

Phase 1 build plus

– Unidirectional interface to

iPharmacy

– Continuous and

intermittent IV therapy

(enhancement)

– Medication reconciliation

– Rebuild of formulary

Concord Hospital: Lessons

RDDS

– Unique experience

– 2.5 Million lines

Go-live

– Reconversion of existing patients

– Resourcing

– Conversion team

Some of the team on go-live morning…

Concord Hospital: Lessons

Training

– Just in time

Support

– 24/7 for Go-Live

Project Closure & Handover

– Acceptance criteria

– Ongoing clinician adoption

– Management of BAU

Royal Prince Alfred Hospital Implementation

Phase 3, 2015- 2016

Phase 2 build plus

– Complex IV

– PCA/Epidurals

– IV Heparin

– TPN

– IV Insulin

– Insulin management

– Multi phase PowerPlans

– New specialities

Royal Prince Alfred: So Far

Transitioned eMeds Project Team to RPA

Clinician engagement

Current state review

Future state synthesis & strategy

Future state review

Finalising build

Hardware

Transition- Challenges and Lessons

Start planning early

BAU optimisation

Resourcing

– Clinical Leads

– Team

Allow time for the transition

– Setting the team up

– Simple things

Second Facility: Challenges and Lessons

Second (and subsequent sites) vs first

– Existing build vs net new areas

– Clinical variation & standardisation

– Hardware

– Culture

– Ongoing relationship with first site

Second Facility: Challenges and Lessons

Change Management

– Critical

– Limited ability to change

Project Timelines

– Governance

– Workforce changes

– Engagement & ownership