Australia’s first large-scale digital healthcare facility, Queensland’s Princess Alexandra Hospital, has been awarded HIMSS EMRAM Stage 6 accreditation for its connected care transformation, one of only three of the nation’s healthcare providers to achieve the distinction.

HIMSS Analytics announced that PAH had attained Electronic Medical Record Adoption Model Stage 6, an international benchmark measuring a hospital's use of advanced IT to improve patient care.

Dr Stephen Ayre, executive director of the PAH-QEII Health Network, said the EMRAM worked as an effective benchmarking tool, providing an IT strategy road map to achieving clinical and operational excellence.

“The Princess Alexandra Hospital is proud to be the third Australian hospital to attain HIMSS EMRAM Stage 6 certification. It’s a tribute to the organisation’s culture of collaboration, commitment to innovation, transformational change, quality and the ability to leverage technology to maximise patient care,” Ayre said.

“It signifies a cultural adoption of innovation in the best uses of ICT in support of better connected, more efficient, integrated, safe care, which can deliver improved health outcomes.”

In order to achieve certification, PAH met all criteria for the preceding stages and demonstrated Stage 6 capabilities, including the implementation of full physician documentation and charting for progress notes, consult notes, discharge summaries or problem list and diagnosis list maintenance, as well as closed-loop medication administration and clinical decision support.  

The 1200-bed hospital also introduced eMAR and bar coding or other auto identification technology, such as radio frequency identification (RFID), integrated with the computerised physician order entry and pharmacy for medication administration. The “five rights” of medication administration are verified at the bedside with scanning of the bar code on the unit dose medication and the patient ID. Pharmacy also implemented an inventory management system.

The magnitude of the implementation was compounded by the scale of the hospital, which in the 2015-2016 financial year handled 104,273 patient admissions, 60,593 emergency department admissions and 21,560 operating theatre cases.

The other two EMPRAM 6 accredited Australian facilities are St Stephen’s Hospital Hervey Bay with 100 beds and the Royal Children’s Hospital Melbourne with 300 beds.

PAH aims to be the only Australian facility to have achieved EMRAM Stage 7 – the highest level – in 12 months.

The transition to Stage 6 was a “difficult task”, according to a Medical Journal of Australia article late last year detailing the process by authors at PAH, Queensland’s Metro South Health and the University of Queensland.

By the time the digital conversion began in November 2015, 5384 staff had received about 32,000 hours of training over 18 months, with mock patients used in dress rehearsals testing the new technology.

When it occurred, according to the authors, the switch initially caused some inefficiencies, including a 25 per cent increase in the average length of an emergency department stay, which returned to baseline within six months. But patient outcomes in the six months post roll-out saw no "significant difference in the number of rapid response team calls to deteriorating patients or cardiac arrests."

Other consequences from the transition can include poor clinician morale and the cost of implementation, but the benefits save lives.

“Hospitals that have achieved HIMSS EMRAM Stage 6 and Stage 7 accreditation have reported significant reductions in medical errors, reduction in prescribing errors, improved efficiency and safety of the medication management process, improved readmission rates, reductions in duplicate orders, to name just a few benefits,” Ayre said.

According to Ayre, PAH has defined a range of measurable advantages from reaching the highest levels of accreditation based on research, data from other hospitals, and the hospital’s own operational data, such as a 6 per cent reduction in length of stay, reduction in emergency readmission within 28 days of discharge, and reduction in pathology turnaround time, 15 per cent reduction in reported falls, 5 per cent improvement in reporting of pressure injuries and 18 per cent reduction in actual infection rate.

The PAH test case transition is part of Queensland Health’s $1.26 billion investment over 20 years to implement ICT and ehealth throughout the state’s healthcare infrastructure.