From the time it first deployed a biplane to reach patients in remote outback Australia more than 90 years ago, the Royal Flying Doctor Service (RFDS) has routinely been an innovator in finding new ways to deliver patient care.
Today, the organisation is just months away from shifting from a fully paper-based medical records system to a digital one.
Dr William Ibbotson, a medical officer for the South Eastern section of RFDS, told Healthcare IT News Australia the move towards digital was a result of RFDS being a federated organisation, meaning there are multiple sections within the organisation that all run on their own systems.  
“We have the South Eastern section (comprising New South Wales, ACT, Tasmania and Victoria), the Queensland section, Central operations (covering South Australia and Northern Territory) and the Western operations,” Dr Ibbotson said. 
“Within the South Eastern section itself, we have 11 bases and 17 aircrafts and provide a range of services. We currently are fully paper-based when it comes to patient records. The problem with that is that it’s very cumbersome and there is a lot of duplication of information across the paperwork. 
“We also do certain amounts of reporting to our state bodies, which is done electronically, so we’re then having to duplicate information to electronic forms.” 
As such, RFDS has been making its push into the EMR space, with a larger aim of improving its digital record keeping and footprint. 


“We have been working towards going digital for a number of years. We initially looked at a number of off-the-shelf solutions, but one of the key issues we faced with this was finding pieces of software that fit what we do,” Dr Ibbotson said. 

“There is software designed for emergency medical response, ambulance services and medical services, but these solutions don’t fit the spectrum of work that we do.” 
This resulted in RFDS’ Queensland section designing and implementing a piece of software named Halo, which the organisation is modifying to include the critical care work that it does in the South Eastern section. 
“When the Queensland sector introduced the software, it found a found a 30 per cent inaccuracy rate when transcripting the paperwork into the electronic systems. This impairs our ability to audit work, research or even attach strong governance systems because we don’t have the high-quality, reliable, comprehensive data sets to improve our processes, understand our patients well, or the outcomes they experience after experiencing our services.” 
Moving towards the EMR system meant that RFDS is enabled with a reproducible, standardised set of documentation that it can use in four areas:
  1. Sending the right resources to the right patients at the right time – data collected will enable the organisation to predict likely disease causes and progressions using the data from the system, so that it can better and more effectively treat patients.  
  2. Providing the most appropriate response – EMRs will help assess if a plane needs to be sent over to a patient, and the crew or skill mix that they require. 
  3. Meeting governance standards – EMRs will prove that the care provided by RFDS is appropriate and in line with best practice guidelines and evidence, and has a positive impact on patient outcomes.
  4. Improving education – with good data sets, RFDS can work on its capabilities to improve medical and surgical procedures, tailor the education that its teams need to ensure it’s reducing complications and errors based on the data, and educating medical students accordingly (it has a partnership in place with the University of Sydney School of Rural Health in Dubbo).

“Rural and remote Australians have poorer health outcomes, so we want to be able to do the best for our patients. These data sets will be of great use to us as we build the clinicians of the future in our setting,” Dr Ibbotson said.

[Read more: From the ground up: Incorporating technology into the fabric of a new digital hospital | RCH’s big bang success story proves EMRs save lives]

The organisation also went through a rigorous EMR engagement process with its staff, starting with the quality and safety assurance team, which provided a view of what needed to be collected and how to do it. RFDS got input from staff from the operational bases when building on new concepts and direction in software. And it also had meetings with developers who advised on the systems in place, information collected, and processes required to collect patient data.

Moving forward, RFDS intends on working on an approach to better integrate its diverse systems.

“We want to better integrate our database for the whole of RFDS as currently, they all use different softwares. They all work very well for the purpose that they were built for, but it would be better if we could find a way of integrating them and have one big database of information,” he added.

“As we go through equipment renewal, we can network all of our equipment together so that we have all the necessary tools to pull all kinds of information together to produce a comprehensive record for our patients. That involves keeping our data in one place rather than having it as multiple silos around our organisation.”

According to Dr Ibbotson, getting access to primary healthcare data would also help build its systems into a “very powerful tool” for improving patient care journeys and healthcare systems in future. 

Dr Ibbotson will be speaking at the Retrieval Medicine: What Has Big Data Ever Done For Us? session at HIMSS AsiaPac18 in Brisbane in November. Learn more here



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