I’m interested to find out what solutions NZ public hospitals are using to replace the traditional paper “Progress Notes” for inpatients.
In Queensland, Australia (in 2012-2014) I have used a Cerner system which is based on a system of folders. Nurses, doctors, allied health or whoever writes in the paper progress notes currently, enters their notes on the system electronically directly. They then can be viewed by timeline, or by service (so you can just search for the physio notes for example, or just the Dr notes).
In more recent times it seems some services now have their own software solutions that they enter their notes in, which then upload to the medical record. So in theory the inpatient electronic record could include a collection of these in amongst the directly typed in notes.
What hosptials in NZ have full or nearly full electronic progress notes for in patients and how are they achieving it?
Damon Thompson
Anaesthetist
Clinical Information Officer
Southern DHB
Hello Damon - I’m not sure about public hospitals, but aged care facilities are using Healthcare Compliance Solutions Ltd (HCSL) http://agedcarecompliance.com/services/ in-the-cloud software for recording both care planning and progress notes. The progress notes work as per the example you described.
Regards - Gillian Robinson (RN, BN, Director)
Dictated progress note (ICU - daily, some specialties - more sporadically and seemingly for Pts who have longer admissions) - appear as documents on Clinical Portal.
scOPe (previous name Orthoscope) - for Orthopaedics only (not sure if it’s used by all or some teams for progress notes). Bear in mind that at ADHB, scOPe is being used like an EMR within a more rudimentary EMR (the latter being a collection of clinical documents within clinical portal), so if you don’t have access to scOPe you won’t see them, unless they are printed and placed in the paper notes during the admission - not sure if those get scanned into the “final” record (3M)after the Pt is discharged .
We also seem to have a number of templates that can be used as Progress Notes but are ?legacy / perhaps were created and then forgotten about? I am not entirely sure, but they exist as Soprano Medical Templates in the document template list when you access a Pt’s record on Clinical Portal (Concerto).
I suspect all of this will change when Concerto gets upgraded in the near future.
I really enjoyed using Cerner in Oz. With the work Healthshare are doing in our region they have developed a very generic progress note with Orion which is yet to be released.
Fair to say in the NZ public hospital sector our HIMSS EMRAM maturity is pretty low
K but we’re all keen for it to move up
J.
In the Northern Region we have a couple of longstanding relatively standalone EMR solutions used in community, mental health, palliative care settings (HCC
by Intrahealth in Auckland, Counties, Waitemata, and Jade in Northland) - not particularly well integrated outside of these areas.
Outside of these clinical areas, as Era describes, we have pockets of electronic paper replacement (e.g. various admission and progress notes, etc, via Soprano
Medical Templates in Concerto/Clinical Portal, or other solutions such as Scope), but not a true multidisciplinary EMR as you describe Damon.
We (Northern Region) are keen to achieve that. And have a regional plan to get us there. Just the small matter of time & $$$.
Hi, Damon,
In Nelson Marlborough we are using papyrus (well paper). IN our view: Cortex (as per CDHB), an iOS application that does templates clinical notes (incl exam templates / photo capability - I think - as well as being a team task / messaging centre. Also Patientrack that does our nursing obs is also bringing out a clinical notes capability, has assessment templates (X-linked across the suite) and is now being integrated with the Smartpage paging solution. THey are also launching a ‘community’ maodule that excites me as a GP as then the assessment will track the patient, e.g. wound assessment which could certainly follow the patient to District Nursing and potentially to GP-land.
Of note, Health Alliance looking for a DHB community tool which will do all this ‘and be a system that other e.g. GPs could use’. Is anyone else thinking (from a ‘system process’ point of view supported by Tech) of separating Ambulatory from ‘Inpatient’ systems as an approach? (Is this another thread perhaps) @eras , interesting re ScOPe. I know it as a Waitlist → theatre → op note → audit tool.
It isn’t NZ, but here in Birmingham we are just implementing inpatient noting at the present, as an expansion of the simple electronic noting that was being used in the ICU. Its strength is that it is deeply ingrained in the EPR and truly multi-disciplinary. Its weakness is that it is not easily visible to outside agencies or applications.
What we really need in NZ is simple, open standards based noting - which is consistent across applications and systems. This then opens it up to searching (a la Google), AI, and tailored views as well as ensuring notes aren’t lost. It is only text; how hard can this be? The challenge is in the metadata (staff ID, location, tags, etc).
Most of our current digitisation of notes (nicely painted by @eras) is merely replicating the limitations of papyrus in the digital space. We must aim higher, people!
In NSW Australia , eRIC is a statewide eMR for ICU which has successfully been implemented. It was implemented in phases and feedback used to simultaneously improve it to deploy further. Now it’s implemented statewide. If googled there are good videos.
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Cortex has been developed in General Surgery in CDHB and is being rolled out more widely. We also have Patientrack for Obs and Nursing assessments. So we have the unfortunate situation of multiple apps being required for a ward round namely Medchart, Patientrack, Health Connect South, Cortex. Its a real issue to consider if not going for a monolithic EHR.
Waitemata DHB has been using progress notes for its community services for more than 10 years. It is a simple Orion solution adapted from their now sunsetted product Soprano ( I believe WDHB are still using it though). At the time a wonderful IT manager did some local configuration to enable online/offline functions.
It was easy to use, allowed you to code certain information e.g. visit location, type and what I liked the most about it was that it was easy to search for notes of specific disciplines e.g. dietician notes, public health nurses. It is accessible to inpatient staff with the right permissions and this really supports inpatient care for patients with complex and long term conditions.
I was really interested in progress note functionality so for one of my human centered design papers at university wrote about ideal functionality and created some rough mock ups. These were created after a period of follows watching predominately nursing and allied health staff to see how they wrote their notes.
Hawke’s Bay DHB Mental Health Service have had full electronic (combined) inpatient and outpatient notes for 11 years, it’s chronological (latest on top), can filter by department, date / timeline & author (but not discipline). The inpatient notes are typed into the referral that’s open to the inpatient unit. The outpatient notes are typed into the referral that is open to the outpatient / community clinician. e-note writing function is available to all other departments within the DHB - though uptake by other departments has been slow & steady over the last 11 years.
Aged care services I work with throughout NZ are using Healthcare Compliance Solutions Ltd progress notes as part of the EMR which is built into their clinical module as part of a broader quality and risk / bench-marking system . Some of the corporate aged care providers have their own systems but still heavily paper based in this sector.
@lara I am surpirsed you hadn’t see that before. It’s an extract of a report I did from my research at ward 10 doing the nursing follows. I handed it over to Andrew, Robyn and I know Peter Groom has read/referred to it a fair amount. I can send you the whole report if you want as it had some interesting findings.
I would love to see what you came up with though Sounds like a visit sometime soon would be worthwhile.
See you this week
AM
Sounds like a visit sometime soon would be worthwhile.