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IMPROVED ELECTRONIC COMMUNICATION: BUILDING SYSTEMS THROUGH COLLABORATION

Ms Nicole Lewis – Bed, BN, GradDip E-Health (HI), Dip IT (Sys Admin)

Hobart, Tasmania, Australia

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LEARNING OBJECTIVES

Learning Objective 1 Explain the benefits of the integration of health records for consumers

Learning Objective 2 Describe the process that lead to the development of the messaging system used at GP Assist

Learning Objective 3 Compare the development methodologies of the messaging system to other messaging systems available in the market

Learning Objective 4 Interpret the benefits of improved workflow to participating practices

Learning Objective 5 Apply the principles used in the development of the messaging system and interaction with General Practitioners in Tasmania to their own work environments

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HISTORICAL RECORDING OF PATIENT INFORMATION

• Historically the process of recording patient information has been manual

• Medical staff would document in one section, nursing in another, results in another etc

• There is an increasing need to merge this void between historical verbal and written methods of collecting clinical information

• Historically “about 10% of clinical communication is via the health record with most (around 50%) being verbal. This causes challenges in improving communication to improve clinical practice as failures in communication are the largest cases of error” (Simpson, L and Robinson, R, 2002, p.6)

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COMPUTERS TO ASSIST WITH DOCUMENTATION

•  Consultations taking place in General Practice, specialists’ rooms, allied health providers and in home care environments are changing in the way that these visits are documented by the health professional

•  There is a need to use technology to better manage health care delivery

•  “We often use computers in information management, but they are our tools, just as stethoscopes or catheters might be yours. The true focus of informatics is on handling information” (Abbott, 2002, p.14)

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GP ASSIST (TASMANIA) •  State – wide After Hours Nurse Telephone

Triage and Doctor Medical Advice Service

•  Provides after hours workforce relief to General Practitioners throughout Tasmania

•  90% of the state’s GP’s use GP Assist

•  Each patient call generates an event summary that is faxed back to the patient’s GP by 9:00am the next day, with the patients consent

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“THE ELECTRONIC DELIVERY OF AFTER HOURS TRIAGE RECORDS TO GENERAL PRACTICE”

•  The GP Assist (Tasmania) Health Connect Project, “the Electronic Delivery of After Hours Triage Records to General Practice and Rural Health Services” aimed to implement the electronic delivery of afterhours triage records to GP and rural health services in a three phased approach as outlined below:

•  Phase 1: To provide electronic event summaries to at least 30 General Practitioners (GPs) running the Medical Director desktop application

•  Phase 2: To support the electronic delivery of event summaries to community hospitals and residential aged care facilities from the triage service

•  Phase 3: To facilitate two way communication between GP Assist (Tasmania) and the same parties in Phase 2.

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FAXING TO TRANSMIT CONFIDENTIAL INFORMATION

The conventional use of fax has severe limitations when information needs to be shared or forwarded to other health professionals

• There is no acknowledgement that the recipient receives the faxes

•  It is difficult to ensure that health information reaches its intended destination

• A fax lacks security, privacy and confidentiality

• There is an inability to transfer health information seamlessly into an electronic format for system integration and interoperability

• The fax can be illegible and difficult to read if copied several times.

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USE OF POINT TO POINT MESSAGING

• The point to point messaging service is a true peer to peer communication link between a sender and recipient

• Does not rely on the use of email or any third party data repositories

• Messages originate at the sender and are only communicated if the recipient is registered and verified by the system.

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HIGHLIGHTS AND INNOVATIONS

• Successful transmission and receipt notification of messages

• Flexible and interoperable design of messaging system

•  Integration of messages automatically into the GP practice software nominated for the project.

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DESIGN OF MESSAGING SYSTEM

• Captures and extracts electronic patient information – call summary from CDSS

• Assessment of call summary against pre-defined criteria

•  Information stored as HL7 file

• Directory server manages storage of registration information from participating general practices and Residential Aged Care Facilities

• Adheres to National E-Health Transition Authority (NeTHA) guidelines.

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Event Manager

Security Service

Message Service

Directory Service

GP Desktop Message Server (SOAP, XML)

GP Practice Server

GP Desktop

GP Desktop

GP MESSAGE SYSTEM

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CONCLUSION • The electronic messaging system demonstrates the successful use of

technology to meet a real need

• The project reached the following achievements: •  The implementation of a secure electronic messaging service in a range of GPs and RACFs

•  The sending of event summaries electronically to participants involved with this project

•  The passage of health information contained in an event summary has been improved

•  GP Assist is now in a position to determine if event summaries have been successfully delivered to the intended recipients

•  The messaging service provided by GP Assist can be deployed to other clients that are interested

•  The sending and receiving of event summaries can now be fully integrated into GP Assist systems for practises using GP Assist that have Medical Director and Best Practice installed

•  The receipting of information is fully supported and a comprehensive client/provided directory is supported

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REFERENCES

• Abbott, P 2002 ‘Introducing nursing informatics’, Nursing January, vol32, no1,p.14

• Engelbardt,S and Nelson,R. 2002 ‘Health Care Informatics: An Interdisciplinary Approach’. Mosby Inc. St Louis, Missouri, pp.49-51

• Simpson, L and Robinson, R, Chapter 2: ‘Concepts in Health Informatics, e-Clinical Governance’, Radcliffe Medical Press, Oxford, ISBN, accessed from http://prodigy.nhs.uk/Training/ClinicalGovernance/EClinicalGovernance/chapter2.asp

• Whetton. S Health ‘Informatics a socio-technical perspective’, 2005, Oxford University Press

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