Implementing an integrated medications solution is no mean feat, as was made clear by Dr Teresa Anderson, Chief Executive of the Sydney Local Health District, at her presentation at CeBIT 2016. Anderson was heavily involved in the successful roll-out of the Electronic Medical Record (eMR) and, more recently, the Electronic Medication Management (eMeds) systems in clinics and hospitals across NSW. There are multiple complex challenges involved with implementing such systems, said Dr Anderson, and in this line of work errors can potentially be life-threatening, so it is important to proceed with care and due diligence, and establish the following foundations:
- Governance: ensuring there’s governance at state, district and facility level with multiple clinical disciplines represented
- Change management: engaging the clinicians who will be using the system so they drive organisational change
- Collaboration: sharing resources with other state health departments and hospitals
- Training and support: making sure there are adequate resources and training models, as well as 24/7 support for clinicians
- Infrastructure: making sure there’s the right hardware, software, network resources and services required.
In the end, the results speak for themselves: since implementation there has been a 66.1% reduction in prescribing errors per admission, and a 44% reduction in serious prescribing errors per admission. It has also reduced administration errors by 4.24 per 100 admissions, and serious administration errors have gone from 4.2% to just 1.83%.
Dr Anderson shared the lessons she learned through this experience, and while many were project-specific, there were several that could be generalised to implementation of systems outside the area of eHealth:
- User engagement: clinicians, who were the end-users of the systems, were regularly consulted throughout the process, which meant they felt a sense of ownership over the systems and were therefore more willing to integrate them into their day-to-day work. It is also important to have super users, or champions, on the ground in each location to help drive successful adoption.
- User training and support: Sydney Local Health District provides ongoing education and training sessions with the staff, as well as 24/7 clinical and technical support
- Robust downtime procedures: when a system goes offline, it can cause havoc, particularly with a system like this. So it is important to establish procedures for when the system goes down, and to practise these at regular intervals, so users are confident of what to do in such an event.
However, it is important to remember that the system is a tool, and not a replacement for skilled clinicians, and it’s crucial that clinicians know and understand the limitations of the tool. After all, as John F. Kennedy once said, ‘Man is still the most extraordinary computer of all.’