Case Study: Point of Care Testing and

using Mobile Technology in the Hunter

Area HiTH Service

Presented by: Simone Dagg

Hunter New England Local Health District

Greater Newcastle Cluster

Community Acute Post Acute Care

HiTH Program Manager

May 2013

Todays Presentation

• Brief over view of GNC CAPAC Service

• Outline the journey of a GNC HiTH

Anticoagulation client, Mr CAPAC, and the use

of mobile technology to support his episode of

care:

• Point of Care (POC) testing

• Mobile Computing

• Clinical applications (E-scheduler, spread sheets, Intranet)

• Mobile Phones

HNE Local Health District – 8 Clusters

HNE Local Health District – 8 Clusters

CAPAC Catchment

Area The pink line represents

the geographic boundary

for the CAPAC service.

Within 1 hr driving time

from Newcastle CBD.

1500 km2 catchment area (land

area only).

Covers Local Government Areas

of Newcastle, Lake Macquarie and

Port Stephens

Images of our region

The CAPAC Umbrella

HAH Pre-Hospital

Health / COPs

partnership

6 week

program

TACP Post - Acute

Enablement /

ACF

avoidance

12 week

program

HITH Warfarin Stabilisation

Acute infections

Heart failure

COPD

Rapid response

Orthopaedic Early Discharge

CAPAC model

• One team / multidisciplinary

• Avoids delays in access to other providers

• Improved responsiveness

• Access to a variety of skills

• Acute and aged care

• Catchment / geographical allocation

• Pooled resources

• Greater flexibility with leave

CAPAC Organisational Structure

TACP case

co-ordinators

TACP program manager

Service

Manager

CAPAC

Medical

Director

CAPAC

Service

Development

Co-ordinator

Medical Registrar

CAPAC

Nurses

RN’s

ENs

AINs

OT

Physiotherapy

Dietician

Social worker

Administrati

on

Assistants

HAH program

manager

CAPAC

Technical

Assistant

s

CAN Role

Allied Health

Team Leader

HITH program

manager

HAH case

co-ordinators

Anticoagulation Service

• Diagnosis such as DVT, PE, AF, TIA / stroke

• Warfarin loading in conjunction with “Clexane”

• Clients requiring re-stabilisation of INR and

Warfarin dosing

• Combination of POC and formal testing

• Use age adjusted protocol for Warfarin dosing

Point of Care Testing (POC)

• Home based INR testing is a core component of

the CAPAC HiTH service

• POC testing was introduced in 2006

• POC testing, uses a capillary blood sample

• Validated procedure using comparative results

to those obtained from venous blood samples

and laboratory tested

• POC INR testing is convenient, safe, acceptable

to clients, increases efficiencies in health care

delivery

Mr CAPAC

• 64 year old gentleman, chest pain, palpitations,

atrial fibrillation

• New to warfarin

• Referred from hospital for anticoagulation

induction and dose stabilisation

• Reported to have poor access

• Lives 45 minutes from base

• POC testing commenced from 1st visit

Why POC ?

• Ability to dose at visit - elderly clients with hearing, sight or

cognition issues

• Less painful and less invasive – excellent for for clients

with poor venous access and needle phobias

• Distance- large catchment area

• Enables more visits - nil need to drop bloods, dosing

completed at visit, quicker procedure

• Client acceptability

• Cost effective alternative

• Increasing usage in GP practices ensures

transfer of care seamless

CoaguChek® XS

• Small hand held device

• Easily transported in insulated bag

• Requires drop (8 µl) of capillary blood,

• Easy to use and it provides a precise PT/INR

result usually in less than 1 minute

• Competency developed for clinicians

• Currently upgrading machines

CoaguChek® XS Plus system

• Touch screen technology

• Built-in QC

• External liquid QC

• Internal storage of results (2000)

• Ability to identify clients and staff

• Comments field for each test

• Code keys preloaded (60)

• Ability to inter face with local labs

Mobile Computing-The Need

• Rising demand on community based services

• Expansion and evolution of community based services

– Including the GNC CAPAC/ HiTH service

• Increasing client complexity

• Access to accurate and timely information

• Optimisation of clinical time

• Existing paper based system time consuming, bulky and

error potential due to transcription

• Improve communication between services

• Increased client involvement in their episode of care

Mobile Technology

• Mobile computers

– GNC utilises the Clinical Health Information

Enterprise (CHIME) for documentation

– Ability to access clinical applications

– Anticoagulation spread sheet

– E-scheduler

• Mobile phones

Mobile Computing

• Compact design, light weight, adequate screen

and keyboard size

• Sufficient internal memory and graphic

components to support programs

• Internal modem

• Long battery life

• Docking station

E-scheduler

Anticoagulation – E-scheduler

Anticoagulation Spread Sheet

HNE Health LHD Home Page

Clinical Applications

E-scheduler Links

Mobile Computing Challenges

• Type of computer required to ensure quick

processing and support of information

• SIM – internal vs external modems

• Black spots in coverage

• WHS issues – Transporting devices

– Suitable home environments

• Battery life

• Varying levels of clinician acceptance and

computing knowledge

Mobile Phones

• WHS - clinicians work in isolation and the mobile phone is an

important aspect of keeping safe

• Messaging medication orders as second check

• Messaging results of POC testing

• Ability to communicate with support staff while

still with clients

Mr CAPAC - Discharge

Take Home Messages

• Advances in technology combined with HiTH

development has allowed us to “do things differently”

• POC testing is safe, reliable, efficient, less invasive and

has a high level of client acceptance

• Mobile computing allows “in time” documentation,

access to clinical applications to support clinicians in

providing timely, accurate and safe care for HiTH clients

• Future directions for HiTH services includes telehealth to

support staff esp medical with remote medicine issues

Questions ?