Tasmania’s unique eMM journey –progress, achievements and lessons

from a whole-of-state approach

Peter FowlerClinical Lead, State-wide Medication Management Projects, DHHS

Unique Tasmania

Tasmania’s approach to eMM

A system overview

Some major / key achievements

Lessons learned

Tasmania’s unique eMM journey

Tasmanian public hospitals

Launceston General

Hospital

300 beds

23,400 wt seps/year

Royal Hobart Hospital

490 bed tertiary referral

hospital

39,900 wt seps/year

North West Regional

Hospital

140 beds

8,300 wt seps/year

Mersey Community

Hospital

100 beds

6,900 wt seps/year

H

HH

H

Start in 2007 – now have substantial eMMfunctionality across the state

Modular expansion – discrete elements of functionality

State-wide implementations

Relatively low cost – no budget for large programs

Project-based funding approach

Tasmania's approach to eMM

Projects teams include both IT and clinical staff – recent projects have used pharmacists as clinical lead and trainers

Run old systems with the new for a time

Expanding to primary health sites

Local vendor (HealthCare Software – Clinical Suite)

Tasmania's approach to eMM

State-wide eMM functionality

Prior to admission

medication historyOutpatient

consultation summaries

Outpatient prescriptions

Discharge summaries &

procedure reports

Medication reconciliation at discharge

Medication counselling

sheets

Discharge prescriptions

Medication reconciliation

& meds management

plan

eCharts -Inpatient

prescribing & admin.

• Patient lists andworkflow and task management

• Importation of dispense details• Notes and messages to other care

providers (Drs, RNs, Allied Health) • Drug allergy recording and checking

• Drug interaction checking• Duplicate therapy checking• Clinic workflow management

• Dispensary workflow management andprescription tracking

• Links to knowledge sources (e.g. PBS, Formulary, DORA, AMH)• Standard terminologies (AMT V3, SNOMED-CT)• Discharge and OP consultation summaries to GPs

and other nominated recipients• Discharge summaries to DMR & MyHR• Labs on discharge summaries to MyHR

• Visibility and management of MyHR consent• Prescribe and dispense messaging

to NPDR• NPDR viewing

Rx

Modular implementations – Project funded

2007 Electronic Discharge Summary, secure messaging

to GPs, iPharmacy integration

Cwlth –

HealthConnect

2009 Medication reconciliation and clinical pharmacist

activities

Tas – Pharmacy

Systems Project

2011 Electronic discharge prescription generation Cwlth/Tas –

Pharmaceutical

Reform

2012 Enhanced formulary Tas – Formulary

cost savings

2014 Electronic outpatient prescription generation,

NPDR,

AMT

Cwlth - THAP

2015 Enhanced prescription management & consent

model, further NPDR, SNOMED-CT alert/allergy

coding

Cwlth - THAP

2016 WIP – Labs to MyHR, eCharting pilot,

(Primary health clinical pharmacy support)

Cwlth

Medication History

& Reconciliation

Inpatient medication chart Discharge

prescription

Discharge

summary

Outpatient

prescription

12 3 45

100 users 5,000 users 500 users 500 users 500 users

Pharmacists All doctors, all nurses

Junior doctors

(allied health &

nurses)Junior doctors Senior doctors

50/day 1,000/day 100/day 100/day 500/day

Key steps – paper to electronic

Alignment with investment priorities of CEOs (& DHHS and Cwlth)

Creating the value proposition for key users, esp. doctor (Med Rec benefits discharge prescribing then discharge summaries)

The vendor and product development

Determining priorities

Pros and cons of modular approach

Affordable

Work to clearly defined endpoints

Increasing user familiarity makes subsequent implementations easier

Always looking for $$ for the next stage

Projects targeted to funding objectives – not always local priority

Support requirements expand continuously

Duplicate systems for some time

Pros Cons

System overview

Demographic info

Clinical info

Detail of a selected visit

Links to recent visit details

Current tasks and previous actions

Detail of a current visit

Hover-over

SNOMED drug reaction term(RASH returning Hives)

Link to info sources including ERRCD and Tasmanian Medicines Formulary

Select from profile meds

NPDR viewer

MyHR consent

PBS support

MyHR double consent trigger for dispensings

MyHR integration:

Discharge summaries

Prescriptions and matched dispensings to NPDR

Robust consent model

Standard terminology

SNOMED-CT – Drug reaction terms

AMT v2 – AMT v3

Outcomes and key achievements

HCS-CS derives product file from MIMS

Pack size, PBS and TGA information

AMT coding to TPP level

Medicines linked: iPharmacy HCS-CS MIMS AMT

Simplified NPDR integration: one system (HCS-CS) for prescribe and dispense details and consent status

AMT V3

Outcomes

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre reform 6/11 11/11 5/13 5/14 5/15

All sites - Transfer of patient information to GP – High risk patients

All inpatient admission meds histories and med reconciliations are recorded electronically

Approx. 40% of outpatient and almost all discharge prescriptions are generated electronically

Electronically generated prescriptions are dispensed 33% faster than hand-written prescriptions

NPDR integration – prescriptions and dispensings

Incorporation of standard terminologies (AMT V3 & SNOMED-CT)

Outcomes

Pathology results in discharge summaries to MyHR(different pathology systems in south, north and northwest – state-wide implementation), first go-live March 2016

Pilot of eCharting and administration

Next Steps – work in progress

Challenges and risks:

Gradual implementation leads to increasing support requirements – not provided by project-funded model

Finding funding for the next stage

Who owns the system? (a shared vision)

Inpatient charting (key component) not clinically tested / validated.

Lessons learned

Modular approach has enabled Tasmania to incrementally invest in eMM capability – with advantage and disadvantage

Vendor has developed eMM capability aligned with PBS, NEHTA and local requirements

MyHR / NPDR integration achieved including AMT v3 through MIMS

SNOMED-CT for drug reaction terms

Tasmania has made significant progress towards paperless, closed-loop medication management

Conclusion