Shaping Informatics for Allied Health - Refining our voice

SHAPING INFORMATICS FOR

ALLIED HEALTHREFINING OUR VOICE

Tamzin Brott, Waitemata DHB

Rebecca George, Canterbury DHB

SHAPING INFORMATICS AND REFINING OUR VOICE

1. Introduction

2. History of Allied Health and data

3. Shaping vs. defining

4. Relevancy of Informatics

(Break)

5. Current examples and projects – sharing of experience

6. Future of Informatics in Allied Health

7. Takeaways

A HISTORY OF ALLIED HEALTH

• Broad ‘umbrella’ term• Diverse mix of professional disciplines• Not homogeneous• Frequently defined by exception• Shared aim - culture of Allied Health professions being ‘allied to each other’

TRADITIONAL APPROACH – DATA FOR DATA’S SAKE• Contacts – disappeared into the ether?• Meaningless numbers• Numerous Approaches - PIMS, CaseMix, manual, electronic

• Numerous measurements – minutes, blocks, days wait, priority

• Business vs Clinical• Process/structure outcomes vs clinical and patient experience outcomes

QUALITY IN ALLIED HEALTH

Measures should centre around function

Strategic focus on better outcomes and patient experience

Need to demonstrate who we are, what we do and what we achieve

Lack of Homogeneity

Unlikely suited to a one-size fits all approach

Lack of agreement about quality measures

Variation in measures

Lack of agreed definition around Allied Health

QUALITY IN ALLIED HEALTH – ACHIEVING A BALANCE

SHAPING VS. DEFINING

“The use of technology and data, providing information to generate knowledge, that in application drives change’’

SHAPING VS. DEFINING

• Identify need – create questions• Data visualisation methods• Application – effect change or support status

SHAPING VS. DEFINING• Apples with apples• Health Round Table• National Allied Health Data Collaborative• Standardisation • benchmarking, best practice, service equity

NATIONAL ALLIED HEALTH DATA COLLABORATIVE• Purpose• Coordination, transparency, ownership

• Function• Sharing, standardisation, benchmarking, collaboration

• Vision‘To create a culture of inspired Allied Health staff who regularly inform their practice with knowledge made available via data collection’

NATIONAL AUDIT AND RESULTS• Objective• Method• Results

• Who

• How

• When

• What

RESULTSTop:

Responding clinical service setting

Bottom:

Frequency of data collection

WHOSE RESPONSIBILITY IS IT?

Data entry50% Highest percentage were Admin staff

28% Combination of clinical and admin staff

21% Clinician only

11% No one entering referral information

Top 5 Data fields

NHI 91%

Location 86%

Date received 81%

Date actioned 75%

Reason for referral 75%

AUDIT CONCLUSIONS:Indicators suggested common data content

Significant differences indicated, include:• Service Settings Who• Content consistency What• Use / analysis Why• Data collection methods How

AUDIT CONCLUSIONS:

• Standardisation of data will bring;• A greater breadth of data• Robust analysis• Strength in application

THE RELEVANCY OF DATA AND INFORMATICS NOW

Why the emphasis now?• Explosion of IT development• Patient journey visibility• Powerful analysis • Ownership versus input

AIMS:Visibility of information‘Passive data collection’Relevant reportingRegular application of knowledge acquired

What is your current reality? How does it shape up against your vision?

DATA VISUALISATION

INFORMING OUR STAFF - DATA VISUALISATION

DATA VISUALISATION

JULY 2012 - MARCH 2015

COLLABORATIVE DATA

• A single public house block• $12m 2002-2008• Population type• Focused solution

DATA EXAMPLES….

USING MOBILE TECHNOLOGY TO IMPROVE PATIENT AND CLINICIAN EXPERIENCES OF ALLIED HEALTH IN THE COMMUNITY SETTING (WAITEMATA DHB)

Key Problem: Increasing community waiting lists across all AH disciplines No increase in FTE to match volumes from new inpatient services Clinicians required to return to base in order to complete electronic

records No real time access to health information at the point of care and decision

making in the community Increase in part time workers leading to less access to infrastructure


Improve clinician workflow

Provide real time access to health information at

the point of care and decision making

Improve patient experience

Meet needs more fully during visit with real time access to health

information

Improve clinician experience

Provide clinicians with opportunity to complete administration tasks on

the road


Baseline Data: Average time spent on patient related administration tasks ranged from 182

minutes to 288.7 minutes per clinician per day (mean=182. 8 minutes, median=165 minutes)

50% participants believed being able to access Concerto (electronic documentation) in the community could absolutely improve their workflow

Above average levels of enthusiasm to trial mobile devices in the community


• 12 community allied health clinicians were provided with real time access to clinical documentation and peer reviewed discipline specific apps via an iPad air

• Three data measures were collected over a 19-week period:

Week 1-2Time & motion study

Clinician questionnaire


Clinician questionnairePatient questionnaire


Clinician questionnairePatient questionnaire


• Collected 270 days of time and motion data, including 493 direct face-to-face patient contacts.

Improved clinician workflow

•Reduced time spent on administration tasks by average of 29 minutes per clinician per day•Utilisation of time between visits to complete administration tasks

Improved patient experience

•101 patients completed survey•93% reported improved experience when mobile device used•93% rated comfort with mobile device in home as 7/7

Improved clinician job satisfaction

•Reported reduction in stress levels•Able to take breaks as a result of time saved•Improved clinical practice associated with education and therapy apps


Patients have told us;

Patients said: Clinicians said:Time & motion data

Baseline Midway Final130

140

150

160

170

180

190

182.8

171.6

153.6

Mean time spent on patient re-lated administration tasks

(minutes per day)

“seeing the muscles on

the iPad really

helped me understand

the importance

of the exercises”

“knowing my notes were being written then and there I felt

my issues were acknowledged”“instead

of checking

and getting back to me you

get answers

right now”

“Now I can complete my notes and have time for a

lunch break and don’t

leave work feeling

burnt out and

resentful”

“I can do my documentation or

equipment ordering or phone calls between

patient visits and I have time for urgent issues or

colleagues in need of peer advice when I return to

base”“I feel I am providing a

better service as a

health professional

”


Key outcomes for clinicians• 81.8% increased their direct face-to-face patient contact time• 13 minute average increase in direct face-to-face patient contact per clinician per day,

equating to 65 minutes, per week for a full time clinician. • 90.9% reduced time spent on patient related administration • 26.7 minute average reduction of patient related administration of per clinician per

day, equating to 133.7 minutes, per week for a full time clinician.• 45.4% reduced their travel time by a combined daily average of 55.8 minutes per day

• Next Steps…

REDUCING HOSPITAL ACQUIRED PNEUMONIA FOR STROKE (WAITEMATA DHB)

AMAU REFERRAL AUDIT

• Purpose of AMAU• rapid medical assessment unit, focussing on managing medical patients

often with an undifferentiated diagnosis who need prompt investigation and treatment, and timely medical, nursing and Allied Health assessment

• First year report = exploration of ‘front loading’ with Allied Health to:• Support implementation of Frail Older Persons Pathway• Assess and determine the needs of acutely unwell patients – right time, right

place

AMAU REFERRAL AUDIT

• We wanted to know:• What was the volume of referrals for Allied Health services over a 2 week

period?• Is there sufficient Service provision to meet AMAU referral demand?

• A referral audit completed over a 2 week period (inclusive of weekends) during July 2014 by each Allied Health discipline receiving AMAU referrals and providing service.

AMAU REFERRAL AUDIT

• Allied Health referrals in AMAU

AMAU REFERRAL AUDIT

• Accepted Allied Health referrals in AMAU

AMAU REFERRAL AUDIT

AMAU REFERRAL AUDIT

• Allied Health Service Provision – When does it occur and what’s the unmet need?

AMAU REFERRAL AUDIT

• When are referrals made – day of week and hours?

AMAU REFERRAL AUDIT

• Unmet need outside of usual work hours?

AMAU REFERRAL AUDIT - SUMMARY• Three key issues identified:

1. More referrals made than accepted2. Majority of referrals made are initiated outside of usual work hours3. A significant number of patients transferred/discharged prior to their referral

being processed by Allied Health

• Inferences made;• A large amount of time may be being spent processing referrals for non

existing patients• Referrals may be being made too early / out of context to the patient’s status • Patients are being transferred / discharged off AMAU before AH provision

WEEKEND SERVICE DEMAND AUDIT

• To support the ‘Allied Health Weekend Service Rostering and extended hours service provision’ business case.

• To provide an understanding of AH service provision;• during ‘weekend’ hours• how staffing can be streamlined to provide this service effectively.

WEEKEND AUDIT RESULTS: Total Per

weekend% of total

Total patients referred for service (exc. SLT) over 2 weekends across all disciplines 275 137.5

Total number of contacts 324 162 Ave. No. patients per Saturday for all disciplines (exc. SLT) 76.5 Saturday 56%

Ave. No. patients per Sunday for all disciplines (exc. SLT) 61 Sunday 44%

LOCATION OF SERVICE DEMAND• ICU, Orthopaedics (18/19) and ED highest

volume• Different locations focus for different

professions• Significant lack of demand from high turnover

wards i.e. 23/24• Good MDT input in AMAU• Potential for greater MDT input into Acute

Stroke Unit

FOCUS OF SERVICE

• Physiotherapy and Dietetics - majority of follow up contacts

• OT and SW – new patients and assessments

• Physiotherapy discharged a greater number of patients

• OT and SW had larger proportion of discharges overall.

WEEKEND AUDIT OUTCOMES

• Requirement for operational standardisation of staffing resource

• Discussion of service deliver y models• Full service all areas

• Criteria limited service to all areas

• Full service to limited areas

• Identification that AH are not inhibiting patient flow

KEY QUESTIONS…

• Who or what are you curious about?

• What are the questions you want answers to?

• What are the data elements needed to answer that question?

• What information do you want to communicate?

• Who do you want to communicate with once you have that information?

• How are you going to communicate that information?

DISCUSSION TIME…..

• A vision statement?• A project?• An intention with direction?• A need for Collaboration/Key

contacts?

• Group discussion time• 25 minutes• Draft• Present idea at the end

If you tell people where to go, but not how to get there you’ll be amazed at the results.

George s Patton

PRESENTATIONS…..

• Select one/two from each group

CONCLUSION

• Get our business hats on• ‘Data provides Information, that gives us knowledge, upon which

to act’• Making the patient’s journey visible• Engagement and Integration• Involving ourselves in system development locally/regionally

CONTACT DETAILS

• Rebecca GeorgeClinical Lead - Informatics in Allied Health Allied Health ServicesCanterbury District Health Board [email protected], (03) 364 4581 / 027 839 3196

• Tamzin BrottHead of Division Allied HealthMedicine, Health of Older People & Surgical and Ambulatory ServicesWaitemata District Health Board

[email protected], (09) 442 7252 / 021 983 129

mailto:[email protected]

mailto:[email protected]

Shaping Informatics for Allied Health - Refining our voice

Healthcare

Transcript of Shaping Informatics for Allied Health - Refining our voice