Hawke’s Bay District Health Board successfully rolled out the central region Clinical Portal in August. Thousands of clinicians are now using it on a daily basis.

The go-live

Clinical Portal went live at Hawke’s Bay DHB on Wednesday 28 August 2019 at 6pm.

The smooth go-live and impressive uptake of the portal since then is credited to the strong sense of partnership and collaboration the Information Services team cultivated with clinicians.

Every decision regarding the portal was clinically led, down to the exact time and day of the roll-out, which was chosen to make it easier on staff.

A pilot user group of clinicians had been testing the portal, from Orion Health, since June 2018, meeting regularly with the Information Services (IS) team to identify areas for enhancement and improvement.

The IS team focused heavily on communications with future users, attending face-to-face meetings with clinical groups wherever possible.

Hospital physician John Gommans says the real shift came this August when access to historical results and clinical notes went live on the portal. It also became the only way to create discharge summaries and sign-off results.

“That’s when Clinical Portal became the number one way to access information,” he says.

In just a few months there have been more than 3500 unique logins and more than 2000 staff are using it to view patient information every day.

A new approach

Anne Speden, the DHB’s Executive Director Digital Enablement, describes how in order to move onto the regional portal, the information services team first had to “win the hearts and minds of clinicians.

“For the past nine months we’ve been working with the regional clinicians to try and understand the problems in their business in order to put these enhancements into the clinical portal,” she says.

She adds that the focus of the IS team is very much on the people and process and how to add value to the ecosystem, rather than on the technology.

“We’re refining workflow and business tools through this so the technology doesn’t drive the workflow,” Speden says.

“It’s about being agile and light-touch as clinicians are busy people, so we can change along the way and make it work.”

Gommans has been involved with the clinical portal project from its inception more than seven years ago when he was chief medical officer for the DHB. Having relinquished this organisation-wide role, he continues to be a clinical lead locally and regionally from a delivery and governance perspective working in partnership with the IS team.

“Early on we had an information services plan, but that lost clinicians because it really didn’t deliver, so they disengaged as it was not seen as worth their time to get involved,” he says.

“This has turned around over the last 24 months with a new approach from Anne (Speden) and her team. They are engaging with us and designing the service to help address the things that matter to us, focusing on what’s making a difference.

“There’s such a difference with this partnership approach and we have a strategy to make it happen.”

Dental Specialist and Chief Medical & Dental Officer Robin Whyman agrees, saying: “the go-live went well because of the relationships built beforehand.

“The IS team were known very well by clinicians on the floor and there were people coming around, making sure everyone was ok.”

A regional portal

Hawke’s Bay worked jointly with shared services provider, TAS, to deliver the portal as part of the ongoing Regional IT Programme which TAS is delivering on behalf of the DHBs.

The Central Region now has three DHBs using the regional portal - Hawkes Bay, MidCentral and Whanganui - with the others contributing live data as part of their onboarding process.

Capital and Coast, Wairarapa and Hutt Valley DHBs will implement in 2020.

TAS says the region is starting to realise the clinical benefits from a common clinical portal, such as reductions in time searching for patient information and more seamless collaboration to deliver safe and effective care.

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“Crucial to the project’s success was input from the other DHBs. They shared their experience and devoted considerable time to this regional work,” a TAS spokesperson says.

Gommans explains that both patients and staff tend to move between the central region DHBs frequently, so sharing information about them is hugely beneficial to clinical care and to reducing duplication of work.

“Previously someone could be discharged from Palmerston North Hospital one day and admitted here the next and we didn’t know anything about them,” he says.

“And it’s not just patients moving around: junior doctors who came here had to learn a completely new computer system. Now, our clinical portal is recognisable to them.”

His vision is for, “one portal, one log-in for every clinician in the central region”.

Real clinical benefits

Intensivist Mat Bailey says the move to the regional portal, as well as a regional Picture Archiving and Communication System, has transformed the ability of clinicians to see all of the relevant information about their patients in the right place at the right time.

Hospital staff have also gained greater visibility of what is occurring in primary care and vice versa.

Using Manage My Health software, hospital clinicians can now see a summary of their patient’s general practice record and GPs can access the clinical portal to see what is happening with their patients in hospital.

The Patients Primary Care Record has been accessed more than 7400 times since go-live and more than 800 messages have also been sent to GPs using the new ‘note to GP’ functionality.

Bailey describes this development as a “game changer”.

“We’re starting to see an increase in the cadence of product enhancement and with that increased focused on what’s clinically required, we are starting to see how we can facilitate workflow by developing this product,” he says.

“We are in the early phases of looking at how do we measure the impacts and what the next steps are.”

Looking to the future

The Central Region has adopted a clinical user story methodology for its portal development.

A Regional Clinical Working Group of Senior Medical Officers (SMOs) from the six DHBs makes decisions about the next enhancements and will become a formal governance group going forward.

The group holds quarterly workshops where clinical teams and project managers present ‘user stories’ for enhancements they want to see next in the portal release.

Gommans says an internal system road tests the user stories before taking them to the regional group for a prioritisation process which decides which enhancements are done first.

Speden explains that this process is not a technical conversation, but a pragmatic one between clinicians to see which enhancements would genuinely help the most patients.

She adds that it is important that some local enhancement can also be done.

“It’s a regional portal, but there are things we can do locally that others might not want. It’s important to have that flexibility,” she explains.

Whyman is pleased to see clinicians taking ownership of the portal and engaging with its development.

One of his registrars has become one of 150 ‘super-users’ and now gives updates on Clinical Portal at every staff meeting and asks for feedback.

“We are still at that early stage of Clinical Portal where we have grown a lot of confidence with it, in anticipation of the other things it will bring,” he explains.

“Now the SMOs are saying, ‘when is this coming?’.”

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Posted on behalf of NZHIT Member Ministry of Health

https://www.health.govt.nz/our-work/digital-health/digital-health-stories/hawkes-bay-dhb-clinical-portal

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