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Special Report: Information technology changes DP
Australian system relies on e-discharge summary
Physicians prefer electronic discharge summary
[Melanie Jane Alderton, Bapp Sci Hons, health information manager of medical records for Balmain Hospital in Balmain, New South Wales, Australia, has researched the use of electronic discharge summaries in Australia. Discharge Planning Advisor asked her in this Q&A story about her research and about how information technology impacted discharge planning in her country.]
DPA: In your research you've concluded that a majority of general practitioners prefer the electronic discharge summary. What are some of the reasons for this preference?1
Alderton: The main reason is legibility. Doctors' handwriting has commonly been illegible. The electronic discharge summary (eDRS) has more complete information. The fields in the form act as a prompt for the clinician to fill in, such as Pdx, Adx, history, summary of treatment, and follow-up information. In addition, the discharge medications and recent diagnostic tests are also automatically populated into the document.
DPA: In the United States, hospitals are slowly moving toward electronic medical records, including discharge summaries. We still have a long ways to go. How far along are Australian hospitals with regard to electronic medical records and integration of the discharge process?
Alderton: First, the discharge summary is really one of the foundation building blocks to the medical record, as this is the key document used for ongoing patient care, continuity of care, and communication between all other health care providers.
General practitioners in Australia are more advanced than tertiary institutions in the transmitting and access of electronic health information. They are more than ready to receive discharge summaries electronically, but we are progressing rather slowly in making it available to them electronically. This mostly has to do with data security and privacy issues. Our Area Health Service has just commenced on a pilot project working with general practitioners who elect to "opt in" to receive discharge summaries electronically.
Nationally, we are slowly progressing towards the goal of an electronic health record. The main problem, as I am sure you would be familiar with, is the many disparate clinical information systems. New South Wales is probably leading the way, and, in fact, our specific area Health Service is leading the way in New South Wales.
The New South Wales government has regulated that organizations may only purchase one of two [IT products] PAS - Cerner (US) or iPMS (UK), and this has helped with amalgamation.
We have a hybrid record part paper and part electronic. Within area health services, the electronic information can readily be shared between different hospitals. A web site that gives information of what is happening nationally is located at http://www.nehta.gov.au/.
DPA: Please tell us a little more about your findings.
Alderton: There's not much more to say other than what was published. I was only evaluating the quality of information between the manual and electronic discharge summary. The eDRS scored higher on completeness, although there were slightly higher medication errors due to transcription. Also, doctors the general practitioners felt that the information in the discharge summary for follow-up could be improved on.
DPA: As hospitals switch to electronic documentation and records, what would be your advice on how best to handle this transformation?
Alderton: There really needs to be a comprehensive change management strategy with pre- and post-evaluation of the various components. Most importantly, all affected staff need to be kept updated with the progress and made to feel they are part of the process, as well as being given adequate training. This is probably the biggest key to a successful implementation.
My other suggestions are:
Ensure staff feel part of the process and there are feedback mechanisms in place.
Champions should be identified in each area to assist with the change management.
The implementation should be piloted and evaluated first in a smaller area. Do not go live until there has been extensive testing and trialing.
Develop a comprehensive back-up strategy paper and manual that can be implemented in times of system failure so that there is no risk of compromised care to patients.
Ensure there are clear links between paper-based and electronic information so that users of the information have a complete record.
Have a comprehensive and systematic training program whereby users are only given access to the system when they have completed training.
1. Alderton M, Callen J. Are general practitioners satisfied with electronic discharge summaries? HIM J. 2007;36(1):7-12.