Queensland Health Improves Patient Critical Care with MetaVision

About the health network

Queensland Health (QH) is responsible for the management administration and delivery of public sector health services across Queensland, Australia’s second-largest state by area, with a population of 4.5 million. QH is comprised of 17 health service districts, a range of statewide support services, and supporting corporate functions. QH purchased a statewide enterprise license for iMDsoft’s MetaVision clinical information system (CIS) and has deployed MetaVision in selected ICUs throughout its network of public hospitals. MetaVision has been installed in 16 hospitals and  implemented in a diverse range of ICU settings, including paediatric, neurosurgical trauma and cardiac units.

The challenge

Prior to choosing MetaVision, ICUs across Queensland operated using a range of standards, including a number of different information systems as well as paper records. QH recognised that variations across ICUs create significant barriers to providing the best patient care, compliance with health care initiatives, support of research advancement of professional interests and the encouragement of clinical best practices.

As stated in the Queensland Health Patient Safety and Quality Plan (2008-2012): “With a geographically dispersed workforce delivering a variety of solutions to specific problems, the challenge is to adhere to world’s best practice at all times. To do this we must identify the best practice, educate all of our people, and monitor and reward the implementation of the best practice. In this way we will reduce variation in outcomes and improve the outcomes for our patients”¹. QH reviewed research linking cumbersome paper-based processes, poor information standards, and illegible records to waste, inefficiencies and errors. All of these combine to heighten risks for patient safety. With this in mind, QH sought to implement an enterprise-wide CIS solution to facilitate care standardisation, enforce clinical best practices and provide a modern and flexible platform for its ICU network.

The solution

QH based their selection of a CIS system on the following criteria: a strong track record of performance in ICUs advanced clinical decision support capabilities that can adapt and expand over time, and the ability to standardise the configuration of the system across the network. QH also sought a vendor which had experience in region-wide and multi-site implementations, and that was committed to having a significant local presence through which it could provide support. Following a broad vendor selection process MetaVision was chosen as the single electronic patient record for the network’s ICUs, replacing paper records and competing software systems.

MetaVision was selected by a multi-disciplinary team of QH clinicians and health practitioners. A major factor in the decision was the ability of the system to be tailored to meet the needs of different ICU specialties, while enabling a CIS enterprise standard for the ICUs across the state. Additionally QH took into consideration MetaVision’s track record of successful implementations in region-wide health networks and in major hospitals in countries such as the UK, USA, Germany, The Netherlands, and France, as well as Australia.

As an advanced point-of-care CIS built especially for the critical care environment, MetaVision automatically gathers data from bedside devices and hospital information systems. The system generates a comprehensive electronic medical record and clinical data repository, including medications, observations pathology results, and progress notes covering the entire patient stay. MetaVision’s ability to improve patient safety through the standardisation of medication and clinical protocols, its advanced decision support tools, and its capacity to analyse and report clinical data for quality improvements and research were additional key factors in the selection of the system by QH.

Dr. Brent Richards, Director of Intensive Care at the Gold Coast Hospital and Chair of the State Intensive Care Clinical Network has provided executive leadership to the QH project team in both the planning and roll-out of the project. QH began their implementation of MetaVision with a successful installation at Gold Coast Hospital in August 2011. The standard configuration for the statewide deployment was designed through a collaborative process by a group of ICU users from multiple disciplines across the state, and serves as the basis of all the MetaVision implementations. Strong support was also received from QH executive and IT. Installations to date include The Prince Charles Hospital (December 2011), The Townsville Hospital (April 2012), and Rockhampton Base Hospital (June 2012). Logan Hospital will be next to come online in November 2012. User acceptance has been high, with rapid adoption across the sites among all ICU clinical and administrative staff.

The results

The implementation of MetaVision has delivered significant benefits that are already having a positive impact on patient care and safety, clinical and operational costs and quality throughout QH.

Single configuration with flexibility at site level

Queensland Health spent significant resources building consensus around ICU system design and configuration statewide. However, individual site needs and requirements still needed to be accommodated. The unique flexibility of MetaVision enables the ability for individual departments to modify the system according to their needs, while maintaining commonality of key configuration components across the network. QH recognised that smaller ICUs would struggle to install their own system, given the time and effort required to develop a local configuration, and decided to put the time and effort into creating a state-wide configuration designed for implementation across multiple sites of varying size, acuity and specialisation. This configuration is beneficial for all Queenslanders, ensuring access to a quality system and standard of care across all Queensland public ICUs.

Significant reduction in medication errors as a result of standardisation of medication and clinical protocols

MetaVision has facilitated the implementation of standardised medication and clinical protocols across all QH sites. This effort is already producing very positive results through the reduction of errors, standardisation of care and reduction of costs. At Gold Coast Hospital, the system improved patient documentation and safe medication prescribing by completely eliminating the incidence of missing mandatory patient information for medication charts and significantly reducing the amount of unclear and missing information for medication orders.

Prior to implementing MetaVision, Gold Coast Hospital conducted an audit using The National Inpatient Medication Chart (NIMC) audit tool to review the documentation of key patient details such as patient identification, patient weight and allergy documentation. Gold Coast Hospital also used the tool to review the documentation of medication details such as medication name, route of administration, dose and frequency. The audit comprised 77 patient charts and 1676 medication orders. MetaVision was configured with mandatory fields to improve patient documentation and medication safety through legibility, standardised infusions, medication doses, maximum alerts and administration advice for over 500 medications.

Implementation of MetaVision resulted in a dramatic improvement in the completeness of patient information documentation and safe medication prescribing:

• 100% compliance with patient weight, allergies and identification
• Elimination of errors due to unclear Rx, prescription of drugs that the patient is allergic to, error prone abbreviations or exceeding maximum daily dosage of PRN drugs
• 100% identification of prescribers with a full audit trail of prescriber activity
• Almost 100% elimination of errors of route, frequency & dose

(Post-implementation medication incidents can be attributed to medications that were not configured in MetaVision and to a new rotation of junior medical staff.)

After implementing MetaVision, Gold Coast Hospital conducted a second audit, comprising 70 patient charts and 1104 medication orders, using the NIMC audit tool, with the following results:

Compliance with medication protocols and guidelines for complicated intensive care procedures as a result of advanced decision support

The following system tools were part of the roll-out of MetaVision and support the safety and quality of the clinical workflow:

• Decision support at the point of care for complex, critically ill patients with a high risk for adverse drug events
• Pre-programmed drug warnings with administration guidelines and hyperlinks to drug reference databases
• Decision support for maximum daily doses for renal and liver function impaired patients (using laboratory results and the Event Manager)

Access to research data

The capability for research in the field of critical care has been significantly enhanced with the ability to access data from all of the ICU beds in Queensland (200+) as they go live. This is the first time that this level of data access has been available for critical care research in Australia and New Zealand.

Fast and efficient implementation methodology

iMDsoft’s project implementation methodology was customised for the needs of the QH project. Using a fiexible ten week roll-out schedule for each site based on a centrally managed project methodology and system management process, MetaVision roll-outs and go-lives have been successfully achieved on schedule. The centralised implementation methodology provides the necessary and ongoing support which is especially important for those hospitals which lie outside the major metropolitan areas.

Reduced hardware and project costs

QH has achieved significant hardware and project cost savings by centrally managing hardware and software acquisition costs and the necessary resources for the development and roll-out of the project.

Wide geographical deployment

MetaVision has been successfully deployed across sites that are, in some cases, over a thousand kilometres away from each other, as demonstrated by the implementations at Townsville (1350 km north of Brisbane) and Rockhampton (600 km north of Brisbane). These implementations confirm the ability of being able to manage the system centrally while providing individual sites with the flexibility to modify the system according to their needs and use locally.

“Our collaboration with iMDsoft has been a success. The time frame for the implementation process was relatively short, and user adoption was fast. We have already delivered on our goal of increased patient safety, and are now starting to see the benefits of streamlined workflow and expanded research capabilities. We are looking forward to completing the roll-out into all selected hospitals and the encouragement of best clinical practices, using a leading-edge CIS, across the Queensland Health ICU network.”
Dr. Brent Richards, Director of Intensive Care, Gold Coast Hospital, Chair of the State Intensive Care Clinical Network

References

¹ Queensland Government, May 2009, Queensland Health Patient Safety and Quality Plan 2008-2012 http://www.health.qld.gov.au/cpic/documents/s&q_patient_plan_v4.pdf