Despite more widespread use of electronic medical records, paper forms still proliferate in the acute care sector, often because they have been designed over several years to fit in with clinical workflows and can prove easier to use than electronic systems.

Software is now available that can mimic current patient care processes and paperwork, enabling capture of information on existing paper forms in a structured digital form, without changing current work practices and processes.

Irish software company Slainte Healthcare has recently worked with two Australian healthcare organisations – the new Chris O'Brien Lifehouse cancer centre in Sydney and Calvary Healthcare's Bethlehem private hospital in Melbourne – to implement its Vitro intelligent paperless chart.

Vitro is able to replicate any existing paper form and includes pre-defined workflows that clinicians regularly use. The forms guide clinicians through treatment pathways and allow them to do electronic signatures and drawings, and accept typing, dictation or 'hand-written' notes using the cursor. Handwriting is converted to text and entered on the form.

This approach of automating forms can fill information gaps according to users’ needs, embrace pre-existing workarounds, and in so doing eliminate any requirement for scanning of paper records. As a web-based system, it can be used on mobile devices, or what Slainte calls “intelligent paper on glass”.

At the Chris O’Brien Lifehouse, clinicians and pharmacists have changed their chemotherapy manufacturing process and improved medication management by using the software.

The system was given the green light in December last year and went live in February. It is automating the creation of a chemotherapy worksheet, covering workflow processes online, administration, preparation, manufacturing, final check and dispensing by pharmacy staff.

The result was that the time to create a worksheet was reduced to just a few minutes, and on day one of go live, the pharmacy workload was achieved well ahead of the previous schedule. The project has helped the Lifehouse streamline and enhance medication management, improve patient safety and significantly speed up the dispensing to patients.

The Calvary Hospital Group is also implementing the same software to track the patient journey as part of a transition to a comprehensive EMR. The first pilot implementation is in palliative care, at Bethlehem in Melbourne, and will mimic existing procedures and documents to enable an electronic record to support the way that the hospital staff currently work.

The hospital’s existing workflows, processes and practices, and related paper forms, are being captured as digital data. This avoids the major disruption, and much of the cost, of major process change inherent in a typical EMR implementation project.

The new approach being taken by Calvary’s hospitals offers the potential to rapidly move to a paperless environment, in effect what might be called an “EMR lite”, where each patient’s information, and all information systems, can be integrated and accessed online by all appropriate clinicians.

The subsequent transition to a fully comprehensive EMR can then be accelerated at a speed to suit the respective hospital, tailored to clinical care and clinicians’ acceptability. The new fully electronic environment is then able to be further modified and developed on an ongoing basis, as healthcare and eHealth evolves and changes continually into the future.

AGED CARE AND CHRONIC DISEASE MANAGEMENT

This type of software and its methodology is particularly appropriate for the rapidly increasing sectors of aged care and chronic disease management, where healthcare requires eHealth support across multiple providers, both private and public, who require a shared services method of collecting and recording patient information.

The ability to bridge and fill in the gaps of unconnected systems, replacing paper forms and records which seem to have a life of their own, can make the patient journey seamless for patient and carers alike.

At Cork University Hospital (CUH) in Ireland, the Vitro software has been selected to assist a world-leading research project in the use of a new medicine, Calderol, for the treatment of cystic fibrosis (CF) patients who have the G551D gene mutation. CF is Ireland’s most common genetically inherited disease, with the highest proportion of CF patients and their carers of any country in the world.

The new approach with the Vitro software will provide easy access to patient information, a huge reduction in time spent replicating patient data, a streamlined workflow, and collection of data at the point of care. The CF Clinic will introduce full paperless patient care before the same approach is extended throughout CUH, and a diverse range of community caregivers in chronic disease management.

PATH TO A SHARED HEALTH RECORD

The automation of paper forms and records, together with mimicking existing workflow and care processes, is an alternative way to introduce a shared health record. It brings an easy and rapid method for healthcare providers to move to a totally electronic environment, in which eHealth solutions can be introduced at low cost.

By being able to capture all data, transactions and processes in an online environment, this technology offers healthcare providers new opportunities to finally discard paper forms and records in three key ways:

ease of transition and change management in eHealth
continual improvement and introduction of new services unhindered by paper
cost effectiveness and efficiency through ubiquitous online information.
The ground-breaking idea of mimicking the way clinicians currently work enables a faster adoption of change, with a much lower management risk. It enables clinicians to move quickly to a paperless environment, avoiding the high cost of traditional change management challenges with new technology.

Accepting the status quo of existing work practices means changes to patient care processes are minimal and implementation is typically rapid, with little staff training required.

By transitioning paper forms and records into digital form with little or no disruption and at low cost, the journey to an EMR can be expedited. A prolonged, often indefinite period of supporting a hybrid EMR, comprising both paper and electronic records, can be avoided.

www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1820:intelligent-paper-on-glass-mimics-clinical-workflows&catid=16:australian-ehealth&Itemid=327

Bryn Evans is a director of JEMS Consulting and has many years’ experience as a CIO in healthcare and a clinical software supplier. He writes extensively across a range of categories and genres, notably in the areas of management, information technology, sport, travel, history and fiction.