As they brought their teenage daughter into the emergency department, the girl’s family was placing its faith in the expertise of the hospital’s clinicians, but behind the scenes was another life-saving contributor to her care. Without it, she would have died.
Just as MRIs, CAT scanners and other devices are seen as essential medical equipment, the ground-breaking EMR system implemented at the Royal Children’s Hospital Melbourne has shown itself to be a lifesaver.
“I'm quite sure in the old paper world she would have died,” RCH’s Chief Medical Information Officer, Professor Mike South, told Healthcare IT News Australia.
“She would have died before anyone even checked her ECG. So the speed and efficiency of having that information all connected up with the rest of her clinical information saved her life.”
The teenage girl was feeling generally unwell when she presented at RCH’s emergency department and displayed no clear cause. Doctors there examined her thoroughly and conducted tests, including an ECG, but found no explanation.
“The emergency department couldn't find anything wrong. She didn't seem too unwell so they sent her home with a plan to come back if anything changed. She lived way out in the country so her family set off to drive home,” South said.
Meanwhile, in RCH’s EPIC system, the ECG was immediately provided to cardiology for a specialist to double-check.
“Pre the electronic world that ECG would have been a piece of paper and it would have been put in the internal mail and it would arrive in cardiology a couple of days later, and maybe by the end of the week if you're lucky a cardiologist has had to look at it and decided if there is anything abnormal. So not in real time in any way.”
This time a cardiologist quickly assessed the ECG and detected some very minor concerns to be investigated.
“So he rang the emergency department and said, ‘I think she should come back and we should have another look at her.’ So they rang the family, they turned around and headed back into the hospital,” South said.
“And as they came into the waiting room she had a cardiac arrest, her heart stopped beating, and she collapsed on the floor.”
RCH adopted a full, enterprise-wide electronic medical record in a big bang implementation in April last year, simultaneously switching over wards, theatres, the emergency department, clinics, outreach services and bedside equipment, and activating a mobile-friendly patient and family portal.
The implementation was such a success RCH was the first public hospital in Australia to gain HIMSS Analytics’ Electronic Medical Record Adoption Model (EMRAM) Stage 6, and the first Australian hospital to reach Outpatient Electronic Medical Record Adoption Model (O-EMRAM) Stage 6.
Recognising the use of advanced IT to improve patient care, HIMSS Analytics developed the EMRAM as a method of evaluating hospital electronic medical record systems, while the O-EMRAM evaluates electronic medical record systems for outpatient facilities, including physician practices, clinics, outpatient centres and specialist clinics. No Australian healthcare provider has achieved Stage 7 – the highest level.
South says the key to the success of the RCH digital transition was including clinical staff in the process.
“You see implementation models where the clinicians are not really part of the decision-making. In a way it's imposed on them. Somebody’s saying: ‘This is what you will do’. Whereas we had our clinicians involved and actually wanting to have an electronic medical record and then picking which vendor we would have and then designing every element of the system.”
The benefits to clinical care demonstrated early on, according to South, including in the case of the teenage girl.
Unable to restart her heart, the emergency team placed her on an ECMO cardiac pulmonary bypass machine, taking over the function of her heart and lungs.
“Her heart was not working well for two or three days and then it recovered. And now she's out of hospital and back to being a healthy teenager,” South said.
“It’s one of thousands of examples of improvements to care that can be achieved when information can be dealt with quickly and effectively.”