EDIS options moving forward

The subtitle of this post might be “What EDIS should we push to adopt as a foundation across Aotearoa, and why should it be Centric?”

Speaking for myself (and perhaps a little bit for the other Waitaha Canterbury ED folks in attendance), we were quite impressed by the work being done up in Waitematā on their Centric EDIS. It is clear there is both great collaboration between the IT teams and the clinical teams at that center, and that there is substantial ongoing support for the product. We have our own homegrown adaptation of the Nelson “ED at a glance” product, which is an extremely functional asset and the product of years of hard work. That said, it is clear the resources behind the Centric product seem to make its progress beyond the EDaaG capabilities inevitable.

It seems there is (rightly) a “pruning” process in place for IT projects across the motu – I’d love to hear if others have great software in place in their departments, have other ideas, or would like to start further conversations between ED clinical groups to help support the process of evolving our digital operations in the next year.

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We’re using centric now in MMH and I have to say I am enjoying it for what that’s worth.

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Considering new emergency department systems in isolation to the broader hospital clinical systems may perpetuate siloed information. In my experience taking an EMR approach brings a lot more benefits where staff across the motu can see what has happened to the patient, (for each episode of care) regardless if they were in ED, maternity, theatre, inpatients, radiology, outpatients etc.

Some patients move from ED to the wards, so a basic need is to automate the bed transfer coordination and pass the clinical notes along with the patient. The obs, meds, labs, forms and outstanding tasks need to be passed along with the patient to the ward systems digitally. Whatever system the wards use, they have to transition all the ED information into their systems.

If it’s a different, disconnected system, or non-existent then there is wasted time in phone calls and waiting for replies. Wasted time searching for information and relaying information to other healthcare professionals. It may include verbal relay of information which is error prone. In general, wherever we have teams collaborating closely its best they share the same collaboration platform.

Also, clinicians are very mobile, so a using mobile app at bedside is a good fit and saves a lot of time.
It might be tempting to try an incremental, modular approach of an app for this function and an app for that function, but clinicians context switch a lot. In the multi-app scenario the clinicians are searching the patient context each time they switch apps. In the scenario of one app that does almost everything, the user experience of context switching can be as simple as selecting from my patient list on the phone.

It might be tempting to try an app for this department and an app for that department, but integration is always going to be patchy and cumbersome resulting in manual, time consuming and error prone workarounds. With different apps how can the whole be managed, how can patients & staff switch between departments easily? Perhaps collaborate for a solution that does everything ED wants and what the rest of the hospital wants too.

Some NHS hospitals have gone to an everything app and report improvement in staff efficiency, releasing time to care by more efficient communications between teams, through digital handover, instant messaging, task management.

For example, The Impact of an Electronic Patient Bedside Observation and Handover System on Clinical Practice: Mixed-Methods Evaluation, University of Nottingham, Nottingham, United Kingdom and similar studies included benefits like:

  • 17 mins per hr observed increase in time spent available at wards at NUH for junior doctors. -
  • 26 mins per hr of nurse activity replaced by more patient focused time & 13 mins per hour increase in presence at nursing station.

They also report benefits such as reduction in incidence of hospital acquired sepsis / Acute Kidney injury, by alerting to healthcare team patient triggering for sepsis, earlier supported discharge by avoiding delays throughout the patient care pathway and a reduction in abnormal lab results going unrecognised.

“Whatever system the wards use, they have to transition all the ED information into their systems. If it’s a different, disconnected system, or non-existant then there is wasted time in phone calls and waiting for replies.”
Agree the information visibility has to be seamless, without discarding any metadata/information. This is where the idea isn’t an EDIS passing information to WardsIS, but specifically the ED information being stored in a structured EHR where the WardsIS can pull the relevant information into a concise, suitable summary of ED (or GP or RH or prehospital) care. I will definitely agree vertically integrated EHRs by the same vendor (see: Epic, Cerner, et al) have massive advantages with integrating different phases of care, anything that is outside their walled garden may yet be stuck there. Different systems can suffer the advantages and disadvantages of the likes of Epic, while others less so.

“Some NHS hospitals have gone to an everything app and report improvement in staff efficiency” almost makes me imagine a sort of Teams-esque workspace, but where each Patient has its own Teams channel for messaging, task management, results acknowledgement, etc.