The complexity of e-health programs lies as much in engaging stakeholders as it does with developing the technology itself, according to a senior manager in eHealth NSW’s electronic record for intensive care (eRIC) program.
The eRIC project aims to implement a statewide clinical information system designed to drive better patient outcomes in the intensive care units (ICUs) of NSW hospitals.
The system will eventually be hosted out of the NSW government’s GovDC data centre, and provide services to around 800 beds in 40 ICUs across the state.
Building the system has been a Herculean task that has involved implementing around 500 business and technical requirements, including things like medication management and decision support modules.
“We’ll be integrating with most of the hospital systems, in particular the patient administration system, radiology laboratory, electronic medical records, and so on,” eRIC program clinical and strategic advisor Angela Ryan told the CeBIT conference earlier this week.
“There’s also a large number of medical devices that support a patient when they’re inside intensive care. All of those will also be interlinked.
“And in addition to that, we’re developing a state-based solution around reporting, so there’s tools for benchmarking and operational reports. That suite of reports has already been built.”
While eHealth NSW is keen to create a system that has been “developed by clinicians for clinicians”, engaging with busy health professionals can pose challenges.
“Clinicians are obviously very, very keen to be involved, but they’re also very busy people… They have limited time to provide to us, so we have to be creative in the way we engage with them and in the way we use their time,” Ryan said.
To compensate for this, eHealth NSW used things like working groups throughout the project to get clinicians on board.
“The working group and the subject matter expert groups are really driving the decisions, discussion and making recommendations to the operational [management] group and steering committee, who represent our local health districts and other partners," Ryan said.
“[There are subject matter expert groups covering] pharmacy, paediatric, neonatal, research and reporting. So there’s something for every particular problem we’ve come up against."
It also brought clinicians in on the vendor evaluation process, with the medical professionals making up around 75 percent of its evaluation panel.
“Most of the clinicians involved in that had also been involved in the development of the business case, so there was a lot of passion and ownership around what was being evaluated and procured,” Ryan said.
Once the build phase got underway, regular workshops were held with clinicians both face-to-face and over video conferencing.
“We herded a large number of clinicians to a large number of workshops, and that’s continued throughout the course of the build. We had around 200 clinicians attending over a two-week period,” Ryan said.
“The build team – who are also half clinicians – would demonstrate what they had built over the course of the week, and then people would have to opportunity to interact with what was presented.”
A sandbox environment was also deployed to allow clinicians to test the usability of the new platform.
“That gives them the opportunity to influence the look and feel of the application, and then they can apply their real-life scenarios and test them in that context," Ryan said.
Bringing in other stakeholders
While the project has always had a heavy emphasis on clinical engagement, during the later phases that engagement was extended to a larger number stakeholders outside the ICU.
“In our early phases, we were single-minded and the view was focused inside the ICU, but as we are heading closer to deployment, we’ve broadened that thinking and started to engage a lot more with our non-ICU partners,” Ryan said.
“Particularly given the number of interfaces the system will be communicating with, and not just from a system point of view but also a clinical point of view.”
An example of where this was necessary was with clinical handovers, where a patient is moved into or out of an ICU ward.
“Clinical handover is well-known an area of concern, there’s a lot of research into the risks associated with patients as they’re moving in and out of different environments within a hospital. And it can present particular risk coming in or out of ICU,” Ryan said.
“We’re trying to mature our approach, and by setting up [a] committee looking at those clinical risks, we’re not just focusing on ICU.”