Innovations conference 2014 anthony arnold oncology information system

ONCOLOGY INFORMATION SYSTEM WEB BASED ACCESS PORTAL DEVELOPMENTEnabling Clinician Access to Improve Care

Anthony Arnold

Director of Cancer Services, Illawarra Shoalhaven Local Health [email protected]

AIM

• To develop a reliable and secure access portal to patient care applications;

• to improve clinician accessibility

• facilitating improved patient management

• more efficient support for clinical decisions

-- Illawarra Shoalhaven Cancer & Haematology Network --

NATURE OF THE PROBLEM

• The current healthcare environment demands real time access for clinicians;

• clinical decision support systems

• enable routine management of patient care

• Historically, accessed via a Virtual Private Network (VPN)

• VPN unintuitive, time consuming, frustration and reluctance to persist with use

• Prevented other simultaneous network connections


EXTENT OF THE PROBLEM

• Increasing feedback regarding problems;

• time to access

• instability, disconnection

• restriction of devices

• An undesirable consequence of VPN access was an inability for staff once connected, to access additional networks

• This prevented clinicians accessing the oncology information system (OIS) whilst connected to their private practice network


EXTENT OF THE PROBLEM

• Multiple site visits and troubleshooting determined issues were not able to be overcome within the current VPN

• An alternate solution was necessary in order to improve clinician access to the OIS

“Old way required use of VPN tag. The reliability was

poor, the environment was buggy, hard to use, had

frequent outages and introduced unpredictable errors.”


PLANNING & IMPLEMENTING SOLUTIONS

• An opportunity existed to purchase an add-on Citrix Gateway Server for the cancer system

• Provide ability to connect remote users adhering to the key foundations of access, security and usability

• CINSW Quality Improvement Grant submission



• A small team was assembled consisting of staff from medical oncology, radiation oncology, medical imaging, ICT and Citrix

• The gateway was installed within the ICT demilitarized access zone and initial pilot testing began within Cancer Services



• Early indications positive

• Prompt expansion

• Further expansion included

• eMR

• iPM

• Centricity PACS

• Inteleviewer

• ISLHD Exec

• ISLHD Finance

• ISLHD Intranet

• Remote Desktop

• Microsoft Outlook


OUTCOMES AND EVALUATION

Cancer Services

Radiology

Neurology

Theatres/Anaesthetics

Renal

ComHealth/PalCare

Surgery

IMACS

OtherTOTAL NO. USERS / SERVICE (N=119)



ISLHD

86%

SESLHD

14%TOTAL NO. USERS/DISTRICT



Dr

Nurse

Physics

RT

Admin/Manager

Other TOTAL NO. USERS/PROFESSION



“The easiest thing for someone with the usual dodgy

ADSL or 3G to get to the Centricity web. It was all I used

this morning at 3.00am to look at a bleeding rectum at

SGH that I was being told needed embolisation

I was able to conclude that the patient was

haemodynamically stable, and had bleeding low in

rectum

= Colposcope + stitch. Result!”


0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

The citrix gateway has improved my ability to access medicalinformation relevant to patient care

The citrix gateway has allowed me to save time spentchasing patient results

The citrix gateway has allowed me to work more efficiently

The citrix gateway has allowed me to communicate moreeffectively with other clinicians

The citrix gateway has had a positive effect on patient safety

The citrix gateway has enabled patients to receive theirtreatment in a more timely manner

Patient Safety(where 1 = Strongly disagree and 5 = Strongly Agree)


“Answer to prayers

The VPN was buggy, hard to use, had frequent outages

and introduced unpredictable errors

Citrix receiver allows me to access thin slice CT data on

any platform. Also fixes most of the remote access for

outside practice issues, something previously not

addressed”

“Timely access = timely treatment”


0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

The reliability of remote access (access from location otherthan hospital) clinical services has improved since the

introduction of the citrix gateway

The speed at which I can remotely access clinical serviceshas improved since the intorduction of the citrix gateway

Reliability of Gateway (where 1 = Strongly disagree and 5 = Strongly Agree)


“It streamlines viewing external images which is very

important when you have 20 people at an MDT”

“Citrix provides easier and more flexible access to

patients' data”

“Allows external viewing of radiology images”

“Delivers what clinicians need to deliver patient care,

transparent non-restrictive information technology”


0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

The citrix gateway has streamlined the running ofmultidisciplinary meetings

The citrix gateway has improved the quality of thedeliberations that take place in multidisciplinary meetings

MDTs (where 1 = Strongly disagree and 5 = Strongly Agree)


• One of the most relevant indicators of success was the expansion of the initial project pilot far beyond initial scope to include the testing of other systems

• Recently extending to

• Pharmacy

• IP Wards

• Wollongong Hospital Bed Managers

• LHD Executive

• LHD Finance


SUSTAINING CHANGE

• A sustainable enterprise level solution

• Citrix is a well-established information technology service provider already heavily integrated with NSW Health

• The success of this pilot project will transform the entire ISLHD remote access portal to this same system, thus further providing sustainability into the future



SUSTAINING CHANGE

• This demonstrates a steady growth in data transfers

• The vertical drop at Jan-14 reflects a system reboot

• A single reboot over 12 months demonstrates sustainable reliability

TRANSFERABILITY & FUTURE SCOPE

• Provides every service in NSW a method of increasing mobility and remotely accessing their critical applications anytime, anywhere

• Benefits to the way care was delivered became immediately apparent to other departments

• ICT have now adopted this solution for the enterprise and are providing this service to their cluster of LHDs

• Any system deployed by Citrix infrastructure can be added to this access gateway


INTEGRATED HEALTH CARE

• Aligns with both the strategic direction of the NSW State Health Plan and eHealth Blueprint;

• Integrate care with the goal of ensuring the patient timely access to safe care and an efficient service

• Ensure that technology remains a crucial partner in transforming seamless patient care and service delivery by the integration of care


CORE VALUES

• The pilot has promoted CORE values in clinical operation, by empowering staff, respecting clinician requirements, collaborating together on solutions, altogether improving our patient care

Ken Masters

Gabriel Beedles

Dr Elias Nasser

Flora Karanfilovski

Graeme Bell

Rod Cummins

Special Thanks and Acknowledgements:


“Cancer Services is a light in the darkness

when it comes to innovation in patient care

As a result of this work the barren plain of

ICT development has sprung back to life

Thankyou”

Healthcare

Innovations conference 2014 anthony arnold oncology information system