Pressure in rural regions bears innovation fruit

8 minute read

A central Victorian region has cracked a problem still stumping many large city hospital groups: high-fidelity discharge summary delivery.

“Pressure creates diamonds” is something I once saw on an ad agency white board.

In Australia’s eclectic and divided healthcare set-up, the pressure to deliver effective continuity of care is nowhere greater than in our rural and remote regions. In the regions, the money doesn’t go far: the physical obstacles to delivering continuity across large geographies with many small towns, most now struggling to even have full-time doctors, are large and getting larger.

One could argue that the problem is exacerbated in rural and remote Victoria, because in that state, there exists no mandate for various regional hospitals and services to work together on common problems. Each hospital can, if they want, build and develop their own solutions.

In the cities the hospitals are big and often clustered so they have throughput and funding to afford to go the high ground on expensive EMR-centred solutions, which will often be tied into statewide continuity initiatives, such as electronic GP e-referrals to outpatient clinics and discharge summaries sent to both a patient’s GP via secure messaging and their My Health Record.

But in the country, the hospitals often can’t afford to be operating high-end EMRs with sophisticated network links to state wide portals, the My Health Record, and direct links to local GPs via the secure messaging. An even in bigger urban area setups, the delivery fidelity of things like discharge summaries, even in brand new hospitals, remains relatively poor – there are a lot of ducks that hospital CTOs and clinicians have to get in a row to make it work.

As a result of legacy technology stacks, funding, geography, and unique issues such as a lack of doctors in country towns, rural and remote hospital management has had to become a lot more creative and collaborative in how it approaches these problems.  

In Victoria that creativity has first involved developing collaborating groups with common problems, and then, often, implementing innovative new “edge” technologies to solve the issues of geography, and funding.

A common theme seems to be the use of cloud solutions to reach outwards, to both provide virtual services to less accessible and serviceable populations, and to sort out some long-term continuity and connectivity issues, key among them hospital and healthcare service patient discharge summaries.

In the past few months in Victoria two interesting implementations of cloud-based technologies like Salesforce Healthcloud and the Clinician have been implemented for the delivery of virtual care services in Northern Health and the Barwon district.

Another interesting recent application of cloud in country Victorian health is the implementation of a cloud-based region-wide solution to the patient discharge summary problem across the Loddon Mallee health network by Data Capture Experts (DCE).

Loddon Mallee is a typically eclectic regional health network plagued by all the usual problems of legacy technology stacks, multiple technology implementations, tight funding and the need to service more than 16 small to mid-sized hospitals, eight health centres, spread over 50,000 square kilometres, and a servicing a population of around 320,000.

An unincorporated joint venture between the various CEOs of all the hospitals in the region, Loddon Mallee is a recognition that common health problems in the region are best tackled via collaboration wherever possible.

Part of the work of the group has been to equalise IT architecture over time across the region as much as possible so that it’s easier to tackle common problems, particularly around communications and connectivity. A key strategic priority for the group is listed as “to share services and core functions and to use technology in new ways”.

In the past, the region had handled the problem of patient discharge summaries as best it could, hospital by hospital. Without anything really automated and relying on individual hospital admin to maintain continuity, delivery fidelity to local GPs and locums was very poor.

Kofax TotalAgility is a hyperautomation platform that can manage structured and unstructured document intelligence and process automation. DCE utilises this platform to automate simple and complex processes specific to the health sector.  

The newly implemented DCE solution, called DC2Vue (which is built upon Kofax TotalAgility), integrates with multiple instances of a patient administration system (PAS) implemented across the region. It extracts key admissions and discharge messaging data into the cloud instance, and then delivers that back to regional GPs in whatever way a GP or locum wants or needs to receive a discharge summary. This includes by sending a secure email link to the cloud stored discharge, repurposing the data into a fax which is sent to a practice, via the old secure messaging pathways into the major patient management systems, or even, via an API into a cloud PMS. It also sends every summary automatically to the My Health Record.

One of the interesting things to come out of the project is that the easiest and most common way GPs are wanting to receive their discharges is via a link embedded in a secure email. In the states that aren’t decentralised in technology implementation – NSW and Queensland in particular – the preferred path for communication on both discharge summaries and e-referrals from GPs back to hospital outpatient clinics is secure messaging.

Secure messaging is an old technology and when its use is mandated for communicating between hospitals and primary care, that mandate has the bad effect of locking in very old technology infrastructure in the primary care sector – old server-bound PMS systems, which are set up to use secure messaging.

Secure messaging also suffers from being a mostly one-way communication, reliant on various bodies keeping directories of addresses up to date, GP practice by GP practice. The National Health Services Directory (NHSD) maintained by HealthDirect is a key one, but each secure messaging vendor maintains their own as well, and they invariably fail to keep up. When a message is delivered to a practice or GP that isn’t there any more, it’s not easy to pick up, and there is nothing in the protocol that acknowledges receipt.

While DC2Vue offers secure messaging as a delivery option for a GP practice, it has overcome some of the downsides of secure messaging in many ways by offering a secure email link to the cloud as an alternative. The link is two-factor-authentication-protected and the hospital can confirm receipt when the link is activated.

Also, secure messaging is mostly only available through the GP network. By making delivery far more flexible, the DC2Vue solution is able to reach out and distribute the summaries to a far broader set of health professionals, such as allied health care groups, if needed.

Perhaps the most interesting aspect of Loddon Mallee’s solution is that it is highly flexible and very customer (GP) friendly. It doesn’t hardwire how a GP practice has to interact with a discharge summary, but rather, gives a practice a choice of its most favoured or useful option, including receiving a fax. That’s very different to the one size fits all secure messaging approach of some other states.

In some towns in the region, the GP is the hospital doctor and the DC2Vue system is flexible enough to allow a GP to write the discharge summary for the hospital in their own PMS and have it uploaded via a DCE partnership with Kofax, into DC2Vue, and distributed wherever else it might be needed.

An important consideration of using a cloud solution in Loddon Mallee is that it is not forcing a GP practice to lock in their old desktop PMS technology for many years to come. It operates equally well with old server bound PMS systems as with emerging and increasingly popular cloud-based PMS implementations. And if a practice wants to change their system, the practice isn’t locked in because it needs to retain old secure messaging linkages.

The other side to the flexibility of the solution is that it talks to multiple instances of the patient administration software Loddon Mallee is using in most of its hospitals, meaning that these hospitals have not been forced to redo how they want to run their admission and discharge information. The system integrates individually to each PAS instance to draw the relevant data into the one cloud solution.

“DC2Vue can handle discharge summaries created digitally in the platform, handwritten or even from third party systems due to our partnership with Kofax. The problem solved in the Loddon Mallee was not unique, this solution could be applied to any regional or remote area,” said Leanne Anderson, account director at Data Capture Experts.

Take a test drive of Kofax Total Agility here.

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