helen jarvis, ballarat health services - the role of e-referral in discharging

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Electronic Tools to Assist with Discharge Planning Helen Jarvis Program Manager Central Intake and Post Acute Care 24 th July 2014

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Helen Jarvis, Program Manager, Central Intake Referral Team, Ballarat Health Services delivered the presentation at the 2014 Discharge Planning Conference. The 2014 Discharge Planning Conference - Assisting health services to adopt an integrated and consumer directed approach to discharge planning. For more information about the event, please visit: http://bit.ly/dischargeplan14

TRANSCRIPT

Page 1: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Electronic Tools to Assist with Discharge Planning

Helen Jarvis

Program Manager Central Intake and Post Acute Care

24th July 2014

Page 2: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

BALLARAT

Ballarat is one of Australia’s fastest growing cities with

more than 2,000 people moving to Ballarat each year.

Page 3: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

BALLARAT

Page 4: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Ballarat Health Services is Victoria’s

second largest regional health

service, providing a comprehensive

range of general and specialist care

across key medical and healthcare

disciplines including acute care, sub-

acute care, residential aged care

services, community care, mental

health, dental and rehabilitation

services. In 2012/13 there were

32,355 inpatient separations and

53,308 attendances at the

Emergency Department.

BALLARAT

Page 5: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Central Intake and Post Acute Care

Central Intake

Central Intake is an access and referral management service providing consumers/carers/patients

with a single point of entry to those programs within the scope of Community Programs as well as

facilitating navigation of the broader community service system

Central Intake Referral Sources Email Fax In Person Internal Mail Phone Total

Community Programs 5098 1881 16 958 133 344 8430

Allied Health 654 3577 8 4291 898 36 9467

GRAND TOTAL 5752 5458 24 5249 1031 380 17897

Post Acute care

The Post Acute Care (PAC) program assists patients to recuperate following an acute hospital

admission, sub acute admission or an emergency presentation and to facilitate their

independence or transition to continuing care.

Page 6: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

E-Referrals

What do we want in a E-Referral System?

Easy access

Improve efficiency of referral procedure

Eliminate duplicate data entry

Minim Data Set should be transferred from one system to another without the clinician keying anything in

You should be able to confirm that the referral has been sent and acknowledged

Rely on minimal training & expertise

Provide statistical information

Simplify transfer of information

Page 7: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Electronic Referral System

Referral Information Management System (RIMS)

The RIMS electronic referral system was initially trialled in the sub acute sector of Ballarat Health

Services and was formally adopted mid 2005

System for collecting, sending & storing referrals electronically

Primarily based on SCTT tools

Supports secure email, Autofax & printing

Pop-up calendar function on all date fields

Auditing at the referral, provider and form level

Facility to flag forms intentionally not completed

“Lock down” facility to restrict forms to read only after sending

Facility to supersede forms to generate a duplicate for editing after sending

Facility to transfer form definitions between RIMS installations

Page 8: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

RIMS

Patient

management

System

PAS

Connecting Care

Service Provider

Pathway

Page 9: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Key Benefits

Streamlined data entry and better data quality

Linked to patient management system to provide demographic and episode data and

integrated with Connecting Care.

The forms required by each agency are automatically generated by the system,

Referrals are stored electronically to enable analysis of referral activity;

The user interface guides users to complete relevant fields based on the information

needs of the receiving service provider;

Forms can be emailed to agencies using Public Key Infrastructure (PKI) encryption

capability through the Connecting Care system, otherwise they are able to be

automatically faxed through a standalone electronic fax management system, or

printed and manually faxed or mailed out.

Page 10: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

RIMS Referrer Statistics Department Referrals

Post Acute Care 1128

Social Work 876

Emergency 838

Central Intake 634

HARP 609

3 North 467

2 North 271

4 South 259

Hospital in the Home 244

ACAS 217

Inpatient Rehabilitation 186

Occupational Therapy 178

Gandarra Palliative Care 158

3 South 157

Transition Care 157

4 North 100

Geriatric Evaluation & Management 67

Rehab in the Home 67

Cognitive Dementia & Memory Service 21

Diabetes 21

Domiciliary OT 20

Jim Gay Unit 20

2 South 17

Wound Care CNC Team 16

PDPU 14

Midwifery 4

Clinical Services 3

Dialysis 3

Outpatient Department BH 3

Information Technology 2

Psychiatric Services 2

Acquired Brain Injury Clinic 1

Total 6760

Page 11: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Provider Referrals

Ballarat District Nursing And Healthcare Inc. - Nursing 912

Ballarat Health Services - Community Programs - Central Intake 902

Ballarat Health Services Post Acute Care 694

City of Ballarat Council - Home Care 654

Ballarat Health Services - Base Hospital - Respite care - Aged Care Assessment Service 561

Ballarat Health Services - Hospital Admissions Risk Program 371

Ballarat Health Services - Continence Resource Centre 365

mecwacare 207

City of Ballarat Council - Home Maintenance 173

Ballarat Hospice Care Inc - Palliative Care 166

Ballarat Health Services Carers Choice Grampians Region 157

Homecare Plus 108

City of Ballarat - Meals on Wheels 92

East Grampians HS Post Acute Care 76

Ballarat Health Services -TCP & RC 74

Maryborough District Nursing Service 69

Moorabool Shire Council - Home Care Assistance 64

Hepburn Shire Council - Home Care (Housekeeping Assistance) 55

Maryborough Post Acute Care 54

Ballan District Health and Care - Support groups - District Nursing Services 53

Djerriwarrh Health Services District Nursing 52

Hepburn Health - Daylesford District Nursing Services 48

Ballarat Health Services - Central Intake for Community Programs - Dietetics 45

Golden Plains Shire Council - Home Care 36

East Grampians - District Nursing Service 35

Beaufort District Nursing Service 28

Ballarat Health Services - Central Highlands Coordinated Community Care Linkages 27

Stawell Regional Health - Post Acute Care 27

Stawell Regional Health - District Nursing Service 23

St John of God Hospital Ballarat - Home Nursing Service 22

UnitingCare Ballarat - Do Care 22

RIMS Provider Statistics

Page 12: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Issues

Varied computer skills

Computer access

Currency of PAS information

Confirmation of e-referrals

Policies & Procedures in place for receiving

e-referrals

Cost of Discharging Problems

Readmissions

For the person to be referred to the right

program:

- Hospital admission risk program

- Hospital in the home

- GITH

- TCP

- Restorative Care

- HACC services

- District nursing

Page 13: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Easy access

Improve efficiency of referral procedure

Eliminate duplicate data entry

Minim Data Set should be transferred from one system to another without the clinician keying anything in

You should be able to confirm that the referral has been sent and acknowledged

Rely on minimal training & expertise

Provide statistical information

Simplify transfer of information

What do we want in a E-Referral System?

E-Referrals

Page 14: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Has been in use across Victoria for over 14 years as an online Service Directory and secure

referral and messaging solution.

Is now using the National Health Services Directory (NHSD) as its source of agency, site and

services information.

The NHSD is national asset content managed by a range of organisations and is used by a

wide range of applications for definitive information.

Now sends to and receives secure messages from Argus using sites. Argus is a major

secure messaging system used by thousands of GP, Specialist and Private Allied Health

practices.

Will soon be launched nationwide, allowing a much wider range of medical, primary care and

community services organisations to use secure messaging to better coordinate care across

the spectrum of Spectrum of Services.

Has adopted the national eHealth standard called SMD (secure message delivery) to allow

this messaging to and from GPs.

Connecting Care

Page 15: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

RIMS

Patient

management

System

PAS

Connecting

Care

Service Provider

National Health

Services Directory

(NHSD)

Pathway

Page 16: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Referral Information

Management System

Page 17: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Referral Information

Management System

Page 18: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Referral Information

Management System

Page 19: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

1. Drivers for change

Identified need to reduce the burden on the ward staff making referrals

A review of RIMS found that over the last 3 months ward staff completed 489 referrals to

PAC and Central Intake alone. This is conservatively estimated at 80 hours of data entry.

Our Health Independence Programs, which include HARP, PAC, Centre and Home Based

Rehabilitation programs and Specialist Clinics, need to streamline intake in preparation for

Activity Based Funding and to meet the requirements of the Department of Health.

Central Intake

Screening Tool

Page 20: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

2. Aims

Introduce a system that:

- Requires ward staff to identify patient needs rather than specific

funding and program requirements

- Allows the Referral Team to screen patients and complete referrals

- Supports expansion to remaining Health Independence Programs.

Simplify the referral process and provide additional resources to complete referrals

into PAC and HARP.

Reduce the number of queries about referrals made to PAC and HARP.

Central Intake

Screening Tool

Page 21: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Assess

Coordinate

Communicate

Clarity over role

All Referrals apart from District Nursing and Palliative Care

Central Intake

Referral Team

Page 22: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Screening Tool

Page 23: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Guidelines Documentation on the Screening Tool and Referrals will be ISBAR which is the endorsed

communication tool across Ballarat Health Services

I- Identify Yourself and Patient (using 3 patient identifiers).

S- Situation State the immediate issue/Current situation.

B- Background Relevant past history.

A- Assessment Provide your assessment of the Patient’s current status.

R- Request Be clear about what you are requesting.

Responsibility for actions and clear timeframes.

Central Intake

Referral Team

Page 24: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

6.2.1 The workforce has access to documented structured processes for clinical

handover that include:

Preparing for handover, including setting the location and time while maintaining continuity of patient care

Organising relevant workforce members to participate

Being aware of the clinical context and patient needs

Participating in effective clinical handover resulting in transfer of responsibility and accountability

National Safety and

Quality Health

Service Standards

Page 25: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Consumer Information

Service Coordination Tool Templates 2012

The Service Coordination Tool Templates (SCTT) is a

suite of templates developed to facilitate and support

service coordination.

Page 26: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Consumer Consent

Service Coordination Tool Templates 2012

The SCTT support the collection and recording of initial

contact, initial needs identification, referral and

coordinated care planning information in a standardised

way.

Page 27: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

Summary and Referral

Service Coordination Tool

Templates 2012

Using the SCTT can improve

communication between

service providers, the recording

of information generated by

screening and assessment

processes, information sharing,

and the quality of referrals and

feedback between service

providers. This can assist

service providers to share

relevant information to support

better outcomes for consumers.

Page 28: Helen Jarvis, Ballarat Health Services - The Role of e-Referral in Discharging

National Health Services Directory (NHSD) http://www.nhsd.com.au/

Connecting Care A comprehensive web-based directory providing secure messaging and e-referral

https://www.connectingcare.com/

Department of Health State Government of Victoria, Primary Care Partnership, Service Coordination Tools

http://www.health.vic.gov.au/pcps/sctt.htm

Useful Links