Digital transformation of Metro South Health
Caring for Queensland WRIT TEN BY
JOHN O’HANLON PRODUCED BY
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K RIS TOFER PA LMER
OCTOBER 2018
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w w w.busi ne ssc hief. com
A fast-tracked digital transformation at Brisbane’s largest hospital group Metro South Health has just been completed, marking the end of error-prone paper-based recording
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etro South Health is one of
a new patient administration system,
Australia’s biggest and most
rolling out the Cerner integrated elec-
forward-looking healthcare
tronic medical record (ieMR) to more
providers. It runs five major public
hospitals and the replacement of the
hospitals and a network of community
ageing Auslab state-wide pathology
health centres across the south-east-
system.
ern areas of Brisbane. Though it is just
The value being delivered to patients
one of 16 hospital and health services
and the community became evident
in Queensland, one million people
when data was released from the first
– nearly a quarter of the population of
of Metro South’s hospitals to become
the state – depend on Metro South
fully digitised. In 2017, leading tertiary
Health for specialist health, outpatient
facility Princess Alexandra Hospital
and hospital services.
(PAH) rolled out the full Cerner elec-
As the leading hospital group, it has
tronic medical record system, going
been spearheading the transformation
as paperless as possible. Within a
of healthcare across the Queensland
year of going digital, drug administra-
Health, working closely with its eHealth
tion and monitoring errors dropped
Queensland division. Queensland
by 14%, a 33% reduction in drug
Health has developed a strategy for
dispensing and supply incidents, 17%
health ICT and eHealth that calls for an
fewer emergency readmissions with-
investment of more than $1.2bn over
in 28 days of discharge, drug costs
the next 20 years. That figures includes
per weighted activity unit came down
$730mn for clinical software such as
by 14%, stage 3 & 4 hospital-acquired
“ Early in the process we decided it shouldn’t be entirely an IT project but more of a clinical change initiative” — Dr Stephen Ayre, CEO of Metro South Health
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pressure injuries plummeted by 56%
view, and crucially that of the patients,
and healthcare associated infections
into consideration.
reduced by 37%. In the same period
The work he oversaw at PAH had
early identification of deteriorating
been started in 2014 and completed
patients went up by 59%.
over the subsequent 18 months. The experience gained there provided a
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A clinical approach to IT
template for rolling out the programme
Leading the transformation was Dr
at the other facilities, culminating in
Stephen Ayre, executive director of
July 2018 with the completion of
PAH at the time and now Chief Execu-
digitisation at the Queen Elizabeth II
tive Officer of Metro South Health. Dr
Jubilee Hospital (QEII).
Ayre started his career at the sharp
Planning started in 2014 when the
end as a GP before moving into ad-
Department of Health switched to
ministration: he was therefore ideally
a ‘whole hospital approach’ from the
placed to take the clinicians’ point of
module-by-module process it had
CLICK TO WATCH: THE PRINCESS ALEXANDRA HOSPITAL BECAME AUSTRALIA’S FIRST LARGE-SCALE DIGITAL HOSPITAL
$2.3bn Annual budget
2007
Year founded
14,000+ Approximate number of employees
previously utilised. Though the Cerner platform is a comprehensive and well-tested one, it took some work to adapt it to fit the culture and practices of Australia, says Dr Ayre: “Early in the process we decided it shouldn’t be entirely an IT project but more of a clinical change initiative. “We brought a number of internal clinicians and specialists onto the team – an endocrinologist and a cardiac surgeon for example, as well as nurses and technicians. Of course, all the technical and governance aspects of the Cerner implementation were addressed, but the front facing part of it was essentially clinical.” He has taken a lead on the involvement w w w.me t ro so ut h.he a l t h.ql d . g ov. a u
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H E A LT H C A R E
“ We came through a very careful engagement programme with the clinicians within the hospital so that everyone understood the process and its goals” — Dr Stephen Ayre, CEO of Metro South Health 09 of the clinical users of the system
to argue from entrenched positions,
throughout. “As chair of the state-wide
so Dr Ayre has done everything possible
clinical advisory group on the imple-
to encourage a holistic view. “We came
mentation not just at Metro South but
through a very careful engagement
all the other hospitals that are fol-
programme with the clinicians within the
lowing on, we have been keeping the
hospital so that everyone understood
clinicians aligned and focused. We
the process and its goals.”
are building an integrated solution
Resource fairs, he explains, gave
that reconciles the niche demands of
clinicians the opportunity to try out
specialists with the intricacies of the
the system and see how it integrated
IT system,” he says.
with the devices within the hospital such as ECG machines and the
Collaborative vision
anaesthetic equipment and various
It’s been hard work, one senses,
monitors. This helped identify pain
to overcome the tendency for each
points. A common problem when mov-
department, often each individual,
ing from standalone products to a w w w.me t ro so ut h.he a l t h.ql d . g ov. a u
platform such as Cerner can be a perception that functionality is reduced, for example from the anaesthetist point of view. “In fact it allows people outside the theatre and the anaesthetic area to see what was happening with the patient. That continuity of care and management in the pre- and post-operative phase needs to be understood and worked through for the greater good of the patient,” he comments. The ieMR – which automatically uploads observations and vital signs from patient monitoring devices, allows efficient electronic 10
ordering of radiology and pathology tests, and provides decision support for clinicians in prescribing medicines – is the foundation technology, he explains. “Now that the patient records are integrated, all clinicians can view them – wherever they are in our organisation. There is no need for medical staff to travel to a ward to look at paper records: they can see very clearly what happened in the emergency department or in the theatre or in any other areas that a patient may be moved to during their inpatient journey. Even from one hospital to another since there are a number of hospitals throughout the state who now have ieMR.” Soon they all will. Meanwhile work has already started on rolling the system out into the community. General practitioners can get
access to certain components of the record such as pathology, radiology, medications, operative notes and discharge summaries using The Viewer. It is a function already accessible by every GP in Queensland. Software providers such as Medical Director and the pan-Australian My Health Record patient/doctor portal will increasingly be able to interface with the ieMR system to give the community better and faster access to their medical records. “We are very keen to provide access to information,” says Dr Ayre. “There is a whole range of patient-facing services you can update online like appointment checking and registration
“ We’re doing a lot of research around the implementation as well… I am keen to take every opportunity to share the learnings from our digital transformation” — Dr Stephen Ayre, CEO of Metro South Health
data. We are also interested in getting some of the community-based services onto the system.” In the coming year, with the inhouse implementation out of the way,
example of the type of service he’d like to see extended and enabled by the provision of ieMR.
he wants to focus on connecting care, across the five hospitals in the
Proving the project
system and out into the community.
Digitisation has improved efficiency,
Metro South Health’s Hospital in the
increased capacity without extra
Home service, which provides short-
resourcing, and enhanced patient
term home-based acute care in the
care. “I want to make sure that I can
homes of patients that formerly would
maximise these benefits while
have had to be hospitalised, is a good
decreasing the hospital complication, w w w.me t ro so ut h.he a l t h.ql d . g ov. a u
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readmission and infection rates and
the University of Queensland Business
length of stay,” says Dr Ayre.
School with whom we have been work-
“At the same time, we’re doing a lot of
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ing closely since the inception of this
research around the implementation
programme. I am keen to take every
as well. There really hasn’t been much
opportunity to share the learnings
validation of this type of implementa-
from our digital transformation.”
tion and I am pleased to say that we
The last four years have been a very
have just been awarded a collabora-
disruptive time for Metro South Health
tive research grant to work with the
but the outcome has been magnifi-
University of Queensland, Cerner and
cent. A complex IT and clinical change
Vancouver Health. And on the purely
project has been delivered in a very
business benefits we are working with
short space of time and thanks to the
“I’m lucky in that I have had a focused and balanced team, with health professionals working alongside IT specialists” — Dr Stephen Ayre, CEO of Metro South Health
scrutiny it is getting from researchers it
anced team, with health professionals
is sure to be a benchmark for future im-
working alongside IT specialists, some
plementations in Australia and beyond.
of them also with nursing or medical
“Speaking personally,” Dr Ayre reflects, “the biggest challenge for me
backgrounds. “I am very satisfied by what we have
as CEO has been to maintain business
achieved together and excited by the
as usual while so much of the energy of
prospect of maximising the benefits
the organisation has been focused on
from the implementation. My vision has
a single piece of work. Some change
always been that it’s producing really
management components have also
significant benefits to patient care –
been very taxing for our staff. I’m lucky
and that is what we are all about!”
in that I have had a focused and bal-
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www.metrosouth.health.qld.gov.au