Look, no paper!

The Children's Hospital at Westmead is expanding the Hospital's electronic patient record to include paperless medical records with a system from NSW software company TOWER Technology.

The Hospital has taken a leap forward by going live with a new system that captures the paper patient record as electronic images and makes this available instantly across the hospital and remotely. This enhances the existing electronic health record that allows for online order entry for pathology tests and x-rays, results viewing as well as integrating electronic systems at the bedside in Intensive Care and the Emergency Department, discharge summaries and letters. The Hospital has also been a leader in providing clinicians with on-line digital x-ray images since 1995. The addition of document imaging capabilities will allow doctors to have a single integrated patient view of all new and historical information by computer.

The Children's Hospital at Westmead (CHW) will be the first hospital in NSW where all patient information will be stored and accessible on-line throughout the hospital and potentially to clinicians anywhere in Australia.

Dr Ralph Hanson, Director of Information Technology at The Children's Hospital at Westmead said, "The intention is to provide clinicians with a single electronic view of all patient information as quickly and easily as possible. This will no doubt lead to better patient care as well as providing more time to treat patients rather than searching for information."

Rob Clarke, TOWER's Manager for Healthcare said, "CHW is the latest of six Australasian hospitals now using our application, and the first to have this integrated with a clinical workstation. Other hospitals are now investing in clinicals and CRIS will be a major and useful component of their EMR (Electronic Medical Record) strategy for the future."

A key aspect of the approach taken by The Children's Hospital at Westmead is change management. It often takes years to change learned clinical practice in large hospitals. New systems provide challenges to work practices and this is often disruptive and can result in rejection by key staff members. Dr Hanson said, "Document imaging helps overcome some of these barriers by acting as a bridge between the familiar paper file and electronic clinical systems. By appearing to be a logical extension to the Cerner clinical workstation, retrieving images instantly for viewing in CRIS is only a few 'clicks' away."

Doctors have been both enthusiastic and wary. "We have worked with TOWER and Cerner to make the clinicians' experience as easy to use and effective as possible," said Dr Hanson. "As more records are captured over the next months, the benefits of fast and easy access will begin to pay dividends for all concerned."

The new TOWER CRIS (Clinical Record Information System) provides all the facilities for Medical Records staff to capture and process paper records from when a patient is treated and discharged. This new process includes image scanning the paper on high-speed colour scanners and then passing the document images through to quality assurance and indexing so that the documents can be searched and found easily. Completed records are then analysed for diagnosis and treatment codes so that costs can be recovered based on the procedures undertaken. The CRIS application streamlines this process and allows the Clinical Information Department to focus on quality, completeness and do this faster.

Health Information Manager, Nadine Ghassibe, who runs the Medical Records operation said, "Our mission in Medical Records is to deliver clinicians with complete and accurate information as quickly as possible while maintaining patient privacy and regulatory compliance. CRIS provides this while giving clinicians instant access 24 hours a day without having to call us to deliver." Nadine believes that rather than spending time running around chasing and delivering paper files, her team will now focus on new ways to serve the Hospital, clinicians and patients better.

Paper in hospitals will be around for some time but, for The Children's Hospital at Westmead, starting today, mountains of paper files become a thing of the past - while their images remain.

Background

The Children's Hospital at Westmead has been a pioneer in the use of information technology in the special area of children's healthcare. It was the first hospital in NSW in 1995 to use a clinical workstation supplied by the Cerner Corporation and run on a reliable HP Unix platform. The implementation of the Cerner modules to date at the Hospital has enabled clinicians to instantly access a broad range of clinical information including patient results and reports, record clinical information and order electronically at the point of care. Despite this approach, Hospital clinical practice has meant that the Hospital has kept a parallel paper-based record for all other information not captured on computer. Patients were treated using information recorded in both the paper chart and electronic systems.

This however is not unusual, as almost all hospitals in Australia, New Zealand and the world over maintain a paper record as the primary repository of patient clinical information.

At the 339-bed Hospital, these paper records require up to 27 full-time specialist staff in Medical Records to service requests for numerous patient clinics and emergency visits, and subsequently code, track, locate and refile these vital records. In addition clerks on wards also handle the records for clinic preparation and other paperwork. The Medical Records library grows by up to 2 million new pages of records per year and typically has over 5 million pages (or 2.5 years of records) stored on-site for fast access in case of emergency. Not only is the process vital, it is required to be both timely and the information needs to be complete and easily found by treating doctors.

Australian law also requires that these records be maintained securely for many years after a patient is treated to support both research and medico-legal process. The Hospital's clinical information systems will help the Hospital also to comply with the Health Records Information & Privacy legislation that comes into effect in April 2004.

For further information, please contact:

Gilly Paxton
Manager
Public Relations
The Children's Hospital at Westmead
(02) 9845 3568
(02) 9845 0000 (page via switchboard)