Sydney Children’s Hospitals Network (SCHN) is now live with a new solution integrated into its Cerner electronic medical record (EMR) that provides a direct communications link between multiple clinicians and their patients or carers through an app on the patient’s mobile device.

The Cartula Health solution went live in November and allows clinicians to send information such as care plans and discharge summaries to the patient’s app from an MPage within the EMR, and to receive communication back from the patient or carer directly in the EMR through HL7 messaging.

It also syncs with the phone’s calendar so notifications of appointments can be sent, along with information about what patients should be doing to prepare for the appointment or procedure and what do bring with them. Admissions information can also be sent by administrative staff.

Data is stored only on the app and in the EMR with no intermediary storage, and the patient or carer can also share their information with their GP or specialist through a web app.

SCHN, which includes NSW’s two tertiary paediatric hospitals, The Children’s Hospital Westmead and the Sydney Children’s Hospital at Randwick, previously used an app from its patient entertainment system vendor Oneview which allowed messages sent by patients to be directly accessible by the clinical team within Cerner’s PowerChart module and patients to receive instructions and information on their personal device.

However, according to SCHN’s director of clinical integration and sustainability Michael Dickinson, that app was in-built and only available at SCHN, and a decision was made with the company not to continue and a replacement found.

Cartula Health’s solution was chosen early last year and has since been tailored for SCHN’s requirements. Cartula Health executive director Bill Vargas told a sponsored Pulse+IT webinar this week that Cartula Health was set up in 2017 and its technology first used in Indonesia, where it provides an integrated care service predominantly for maternity care. It is also used in India for maternity needs, with 150,000 downloads of the app. Cartula is also providing its telemedicine module for the Indian market.

SCHN is its first Australian site and has a number of extra features, including the full EMR integration, Cartula CIO Alex McIntyre said.

“In Australia, we’ve done full EMR integration into the Cerner application at Sydney Children’s using HL7 messaging protocols,” Mr McIntyre said. “At the centre of the application is the patient app and that allows the patient to send and receive information to and from the health service in order to streamline the workflows. All the information is then stored on the patient’s phone or in the EMR.”

The information that can be transferred between the EMR and the phone includes health plans such as asthma care plans and maternity care plans, as well as forms and documents such as admission forms and discharge summaries, along with instructions on what the patient should be doing pre-admission and as they’re recovering from surgeries or procedures.

“We have appointment management, and this is pretty key,” Mr McIntyre said. “It also integrates to the calendar on the phone so the patient will receive reminders on the appointments coming up as well as the location etcetera. It is a far more integrated solution than just getting a text message or an email.

The messaging component embedded within the EMR was designed so that doctors don’t have to use their mobile phones to send text messages or WhatsApp messages where their personal contact details are then available to the patient or the patient’s carer.

“The messaging system that we’ve developed is a clinician-initiated system so they can start a communication channel with the patient and have a conversation by text, and then turn off that communication channel once they believe that the solution has been achieved,” Mr McIntyre said.

“There can be multiple channels happening simultaneously so the surgeon could could send a message and administrators could send messages, for example. The goal is, in order to improve the patient experience, is to make it easier for clinicians and administrators to communicate with the patient.”

The information on the patient’s app can also be shared with other healthcare providers such as their GP or specialist through a web application. Patients can push selected data to the web app and GPs can access it on their desktop by scanning a QR code on the app.

Cartula also has a telehealth offering, although SCHN is not using this. The Cartula app can be used by patients as their personal health record and can share their information as part of a telehealth consult.

Benefits and future expansion

SCHN IT trainer Stefanie Hardingham said one of the main benefits of the app, according to feedback from clinicians and administrative staff, is the ease of registration. Patients are registered through their phone number and date of birth, and the system can be used with both the Cerner patient administration system and DXC’s iPM.

Mr Dickinson said one of the reasons behind choosing the system was to make sure that it was patient and carer centric, which is essential for paediatrics and to make sure the patient and carer were the holders of the information.

“But we wanted to ensure that the app could be used by the parents and the carers outside of just SCHN,” he said. “Yes, we believe we’re important, but we’re not the only people that care for the children or the families. So obviously Cartula achieved that with the capability of being able to link in potentially with other LHDs … or with GPs. Obviously, the usual ones about easy to use, minimal management overhead, easy to register, all those components are important. But the key parts were about integration, patient centric, and not just SCHN focused.”

Mr Dickinson said the most obvious use case was with children with chronic illnesses who see multiple clinicians regularly. About 3500 children/families have so far registered for the app, which represents about 15 per cent of the offers to register SCHN has sent out.

“We’d like to grow that as we continue to identify departments where we believe this will be useful,” he said. “We’re keen to look at how we can use it within virtual care, we keen to look at how we can optimise processes, and obviously, the loading of the docs into the EMR would be the next step. Yes, you can load them up into the app, but actually moving those documents into the EMR would be fantastic.”

Mr Dickinson would like to see the rest of NSW Health adopt the app, particularly for patients in rural or remote areas to share with local clinicians. It could be used to follow a woman’s full maternity journey, including if the child ever needs hospital care.

Of the benefits, he cited the ability to communicate and the ease of registration. The appointment reminders have also proven beneficial, he said. “Our improvement in no-shows is fantastic. And the improvement in patients actually now bring ing what they need to bring or come prepared for what they need to be prepared for, has also improved alarmingly. That’s been really, really useful.”

Ms Hardingham said the SCHN team was currently working on sending more management plans to the app, and there were interested departments that would like their documents sent to the app as well.

“Then the other component is the opportunity to share documents that are in the app with your clinician,” she said. “We are working on picking those documents up, if they’re relevant to our clinicians at the network, and uploading them directly into the EMR so they become part of our record as well.

“This could be blood results from an outside GP or it could be a specialist report that they have received outside of our network. That will allow the clinicians to view those and if they feel they’re relevant, upload them as well.”

Integration with the My Health Record is also on the cards in the future to allow patients easier access on their phones, as well as to add their own information to the MyHR. The app can be downloaded now from the app stores and used as a personal health record.

Source: pulseitmagazine.com.au