Providing clinicians with real-time data via mobile technology to enhance clinical decision-making, improve patient safety and enable remote patient monitoring

Our client

Murrumbidgee Local Health District (MLHD) provides a range of public health services to the Riverina and Murray regions of New South Wales, Australia. It provides services across a geographic area of approximately 125,561 square kilometres, where around 243,228 residents live.

MLHD is the largest employer in the region, with over 5,000 healthcare staff working across 33 hospitals and 12 primary health care centres.

Patient safety and the reduction of preventable harm to patients is at the heart of MLHD. The organisation has initiated an “Our People, Our Future” excellence strategy to support bottom-up quality improvement that results in safer, harm-free care at all facilities across the region. Every team in MLHD – whether a ward, department, office, service or centre – will identify and agree to demonstrate behaviours that enable a safety culture program.

When it comes to eHealth, MLHD is supported by eHealth NSW, an organisation in the NSW Ministry of Health. eHealth NSW is responsible for setting eHealth strategy, policy and standards and working with Local Health Districts (LHDs) and Health Agencies to implement statewide core systems and ensure compliance with statewide standards.

The challenge

MLHD and eHealth NSW partnered with Alcidion to see how the organisation could mobilise data to improve safety and quality of care during patient’s stay in hospital.

It started with an innovation proof-of-concept (PoC) project in the Emergency Department (ED) of MLHD’s biggest hospital, the 325-bed Wagga Wagga Base Hospital.

MLHD wanted to explore how critical test results could be shared securely and in real-time via mobile devices to enhance clinical decision-making. The clinicians felt this had real potential to assist them in making decisions about the diagnosis and treatment of patients in time-pressured environments like the ED.

“We want to give clinicians fast access to meaningful data insights which can help them to identify patients at risk of deterioration and provide more timely mobile access to pathology results and X-rays.”

– Dr Stephen Wood, Director of Wagga Wagga Base Hospital’s Emergency Department

Core to the PoC project was gaining access to real-time data from the electronic medical record (EMR) and converting it to the Fast Healthcare Interoperability Resource (FHIR) standard.

The solution

Supporting clinicians in the ED

Alcidion worked with a team of ten ED clinicians to configure Miya Memory, a mobile Electronic Medical Record (EMR), that provides access to comprehensive patient records, critical test results and risk indicators in real-time, via mobile devices.

Miya Memory exploits the vast amount of information available in an organisation’s EMR and clinical systems, distils that data and presents it in an intuitive and focused user interface that aligns to local clinical workflows. Clinicians can immediately access information, identify problem areas and trends and be informed to deliver personalised and precise care.

“The clinicians quickly realised the opportunities and capabilities Miya provided, and how it could support their workflows. They became advocates for the system and started to ask for more notifications to automate other workflows. The app was adopted very quickly.”

“Data was configured to individual clinician needs to highlight at-risk patients and to identify any emerging Hospital Acquired Complications (HAC). This will contribute to delivering safer patient care. In conjunction, the Miya Memory App was configured with approved current best practice to embed safety and quality into clinical workflows.”

– Thomas Glanville, Director Murrumbidgee Internal Transformation Team

Helping to manage COVID-19

When the COVID-19 pandemic started, MLHD decided to leverage the other capabilities of Alcidion’s Miya Precision to create a dashboard for the monitoring of COVID-19 positive and at-risk patients, both in-hospital and remotely.

Miya Precision integrates data from various mobile and wearable devices used to monitor patients. It feeds this data into a dashboard that displays risk based on relevant criteria for all test results including COVID-19, as well as time since diagnosis, location, isolation status, active problems, action plans and other triage considerations. Through this dashboard, clinicians have a heightened visibility of patients of interest, regardless of their location.

Visiting Medical Officers can access information from wherever they are using their mobile phones outside the hospital which increases the timeliness of actions and changes to care plans.

The result

The PoC was a resounding success and Miya Memory has now been rolled out to 60+ clinicians across Wagga Wagga Base Hospital.

The ability to monitor and be alerted to patient safety impacts in real-time has provided clinicians with decision support to synthesise actions that will positively impact care and improve patient safety.

“Clinicians found it useful to have data available on their mobile phones and want more mobile devices and functionality to support their clinical decision making. In particular, the clinicians found that it was useful to be able to show patients their data, thereby improving their engagement with managing their health.”

“Also, having clinical data available in a mobile environment has improved clinical engagement with ICT.”

– Thomas Glanville, Director Murrumbidgee Internal Transformation Team

Miya Precision’s automation and mobility capabilities have also helped clinicians by improving their workflow, clinical handovers and general quality of life.

“For instance, in a rural context, a doctor can be in charge of the ED virtually. So with Miya Memory, if they do get a call at two in the morning, they are able to review patient records on their phone, diagnose the patient with the available medical imaging and pathology results, and safely provide support to the team without leaving their home.”

– Thomas Glanville, Director Murrumbidgee Internal Transformation Team

It is also supporting patients who prefer to be treated at home rather than in a hospital. For example, MLHD was treating an 80-year-old woman  who had recently suffered a heart attack. The woman had become unwell but did not want to be admitted to hospital again.

Her daughter said, “When mum was in hospital and with the COVID restrictions, family couldn’t visit.  We were allowed one person, one hour per day only.  It was very hard for all the family.”

Respecting her wishes, the doctor instead admitted her to the Hospital in the Home (HITH) with a monitoring armband. Only a few hours after the patient was fitted with the armband, the virtual care staff detected a decreased respiratory rate on Miya Precision and called the doctor. The doctor had a video call with her and decided to do a home visit where he examined her, adjusted her medication and continued with home monitoring. The patient and her family were much happier with this solution and impressed with the remote monitoring capabilities.

The future

MLHD is looking to expand the use of Miya Precision to other teams within the Wagga Wagga Base Hospital. They are aiming to adapt it for other specific clinical workflows including the surgical team, orthopaedics, medicine and paediatrics. Once they have perfected these workflows, they will evaluate rolling  Miya Precision out to the other facilities, including another base hospital and 29 facilities that have co-located aged care.

“A visualisation of real-time HAC presence and mitigation has also been made available to the Head of Safety and Quality at MLHD as a PoC for future real-time HAC monitoring.”

“Further, by extracting the data from the EMR and converting it to FHIR standards, there is opportunity to use the data for more innovation using Natural Language Processing (NLP) on textual data. In particular, we believe NLP can deliver a positive return on investment from improved episode coding, providing high quality data to inform better clinical care for our consumers.”

“We are also looking at supporting consumers to access to their own care planning in community, and where appropriate, monitoring devices to support our clinical teams to manage them where the patient chooses. So if they want to receive care at home, this sets us up to be able to do that.”

– Thomas Glanville, Director Murrumbidgee Internal Transformation Team