Healthcare IT projects have a poor track record – so why did the digital transformation of Princess Alexandra Hospital succeed when so many others have gone disastrously wrong?
For decades, technology has been transforming working practices in almost every sector – except for the one area where it could potentially make the biggest contribution to society.
Healthcare providers, and hospitals in particular, are still largely reliant on old-fashioned paper-based systems. Outside of the US, very few have advanced electronic medical record (EMR) systems.
Digital systems can reduce the risk of human error and cut costs. Monitoring devices which track patients’ vital signs can alert doctors, allowing them to respond more rapidly and make more informed decisions. So why have hospitals been so slow on the uptake?
According to Professor Andrew Burton-Jones, a business information systems specialist with UQ Business School and an expert on healthcare IT, the whole history of digital healthcare has been fraught with problems, including major failures with EMR systems in the UK and US, and issues in Australian hospitals.
“Digital technology is without doubt the future of healthcare,” he says. “However, healthcare is the most complex industry on the planet and all the factors that derail IT projects in other industries are magnified – from politics and funding to the diverse range of professions and complex work processes. Given these risks, and the Hippocratic Oath to ‘do no harm’, the reluctance to go digital is understandable. But with the growing challenges facing the health system, hospitals are starting to realise that the risk of not going digital is even greater.
“Experience has shown that EMR systems can cause a host of problems if not implemented well – reducing clinicians’ morale, quality of care and efficiency. The digital transformation of hospitals therefore requires very careful management.”
The previous failures of IT projects make the transformation of Brisbane’s Princess Alexandra Hospital all the more remarkable. In November 2015 it became Australia’s first large-scale digital hospital. Patients are now given printed wristbands with unique bar codes, while vital signs are recorded and uploaded to their medical record via Wi-Fi.
With over 6,500 staff and more than 830 overnight beds, Princess Alexandra Hospital is one of Queensland’s largest teaching hospitals. Yet the project went live over just four weeks.
Now a team of researchers have identified some of the main factors behind its success and the lessons it holds for others. One of the leaders involved, Michael Draheim, Adjunct Professor at UQ Business School and Chief Information Officer at Metro South Health, said that staff had many valid concerns.
“Clinicians were worried about how they would fit in the training; whether the new system would result in errors; slow down their work and result in technology, rather than the patients, being the focus of attention,” he explained.
“It was clear that a traditional approach to IT implementation would not work and that clinicians would have to drive the project, rather than act as consultants. Therefore the leadership team included practising clinicians, not only IT staff and team members with clinical experience.”
The preparation for ‘Digital go-live’ involved 32,000 hours of training for nearly 6,000 staff. Extensive simulations were conducted so that clinicians knew how to use the system in real-life situations. They also trialled it across a range of settings, from a fracture clinic appointment to a geriatric assessment, to ensure it could support their way of working. The disruption had to be balanced against the long term clinical benefits, and senior staff accepted that care would be temporarily slower and less efficient.
With patient safety being the biggest concern, an independent team was set up to look out for any adverse impact. Clinical staff sat beside the go-live help desk team to listen for problems, while others did the rounds of the hospital each day, and a patient safety dashboard was set up to monitor key indicators such as cardiac arrests and patient mortality.
During the four-week period, the patient safety team reported twice daily to ensure that patient safety was paramount. “This clear focus on patient safety helped to engage clinical staff, reduce anxiety and allowed the roll-out to progress to the next step,” said Michael Draheim.
One of the major technical challenges was integrating the new system with legacy systems, some of which had been in service for more than 30 years.
The project created widespread redesign of clinical and business workflows, including at outpatient clinics, and some procedures such as operating theatres were slower. In the emergency department there was an initial increase in average length of stay although this began to improve after six weeks and had soon returned to normal.
Despite the challenges of the change, no patient harm was detected and there was no significant difference in terms of clinical calls to deteriorating patients or cardiac arrests, or mortalities in the six months afterwards.
Patient records are now readily available at the bedside in real-time, ECGs and vital signs are collected electronically at the point of care, and the data helps support decision making. Professor Burton-Jones says the real benefits will be seen when the data can be used to improve the quality and efficiency of health care.
Retrieving large-scale data has proved more challenging than expected so achieving that goal is ongoing, but the team has started by developing a digital dashboard to report on calls to deteriorating patients as well as other key clinical indicators.
The Hospital is on track with the second phase of the Digital Hospital roll-out, covering electronic medications management, anaesthetics and research support. The project, known as MARS, incorporated lessons learnt from the November go-live and clinical use over the last 15 months.
The Princess Alexandra Hospital is now a leader in Digital Health transformation in Australia, and is working with other hospitals to support the move to Digital Health.
Michael Draheim added, “While changes to workflows and the way we report data are being refined, the majority of clinicians can’t believe that we stayed on paper for so long!
“A key lesson is that digital transformation of a hospital is a clinical change event and the focus must be on clinically safe patient outcomes, rather than IT project goals. Clinical leadership is central to success.”