Almost one in ten Australians received mental health services in 2016-17, up from 5.7 per cent in 2008-9; spending in this area has now risen above $9 billion a year.
It’s a critically important area of Australian healthcare demanding equal doses of efficiency and effectiveness.
In Victoria’s Southern Campaspe Loddon Mallee region, Bendigo Health Psychiatric Services (BHPS) triages on average 30 patient referrals each day. It currently has 1,160 active patients and manages records associated with around 20,000 patients in total.
To enhance patient services by streamlining operations and boosting the efficiency of its teams, BHPS has co-developed and deployed a cloud based digital clinical system to support staff in caring for consumers and patients accessing the service. As well as connecting to Bendigo Health systems, a number of innovations were delivered in the release, including the use of Microsoft Cognitive Services, to enable speech to text conversion of clinician notes. Connection to CSIROs Ontoserver reference sets also enables the latest in Australian clinical terminologies to be used within the clinicians workflow, to ensure the right medication and allergy terms are used.
Bianca Matthews (Development and Systems Coordinator, Psychiatric Services), explains how the solution is transforming the delivery of services to patients: “If our triage referral pathway is streamlined and as efficient as possible, we have access to the information that we need in real time to make critical clinical decisions around what a patient’s care needs are enabling a timely and appropriate response.”
“We spend less time chasing the information we need…or waiting for that information to reach us with a report that comes through 24 hours later. We (now) have that information…in real time…to work with the patient – to work out and tailor our response to their immediate needs across the region.”
Reach and response
The Southern Campaspe Loddon Mallee region spans just over 37,000 square kilometres, covering about a quarter of Victoria. One of the critical requirements for any information system is that it is able to support users right across that area – for BHPS currently that amounts to 440 users across 30 clinical programs spread throughout the region.
BHPS provides inpatient, residential and community services. It’s the latter two that the Microsoft Azure based psychiatric service solution is focussed on, which together represents around 70 percent of the services business.
Danny Lindrea, Director ICT Architecture & Applications for Bendigo Health explains that developing the BHPS solution on Azure means that the integration with Bendigo Health’s other systems, also on-Azure, has been straightforward. As a result information silos are avoided ensuring a patient’s health information is readily accessible in its entirety at the point of care.
He explains that for BHPS; “’Phase One’ was a rewrite of our old triage system. That went live over 12 months ago. It’s been very well received. For the first time, if we triage someone via phone or in person and their follow-up treatment is to be in one of the community teams, they can see that in real time and are not reliant on a report the next morning.”
As a cloud-based solution the information is also accessible by any authorised user from any device regardless of time or location. That flexibility is an enormous boon for staff and further mitigates the risk of treatment delays or incomplete clinical information being available at the time of critical clinical decision making.
Authorised BHPS staff now have access to real time information regardless of location. This includes ready access to patient information while conducting home visits across the region.
BHPS’ 24-hour regional triage service handles referrals from an array of sources across the region including emergency departments, small rural hospitals, Drug and Alcohol services, GPs, schools, friends and family as well as self-referrals. BHPS also offers a number of specialist services supporting expectant or new mothers across the region who are displaying mental health symptoms and may need extra support.
According to Matthews, live access to information for staff working across the region is particularly important when supporting patients in crisis, increasing response times and enhancing patient safety.
To further streamline staff access to data, BHPS has deployed a series of dashboards. Instead of next-day reports the dashboards provide real time access to information that reflect what is happening across the service at the point of care.
Trish Arnold (Project Manager, Community Psychiatry DMR Project), explains that by tailoring dashboards to individual staff and the team/s in which they work, real time information and workload requirements are filtered and managed according to their role. “Rather than staff now having to work out which are relevant to them, they use an automated filter specific to them team/s they work with. This way the system will only display the triage referrals relevant to them and their workload. So, in regards to time efficiency, I think that has been a huge benefit.“
The second phase of the digital transformation, currently being implemented, streamlines the documentation requirements and clinical and medico-legal pathways for the organisation, and utilises Azure’s Cognitive services for speech-to-text input so clinicians can dictate letters and notes directly into the system. Initially driven by medical staff, speech-to-text functionality has been very well received and as a result consideration is being given to extending the use of the functionality across the system.
Streamlining paperwork is essential for BHPS’ efficiency and statutory compliance. Under the Victorian Mental Health Act 2014, BHPS have an array of reporting requirements. To assist in ensure these are met in relation to compulsory patients, BHPS have employed a Mental Health Tribunal Coordinator. The Administration and Mental Health Act dashboards within the system ensure that, parallel to the clinical management of patients, all legal requirements are managed and reported appropriately and in accordance with these statutory requirements, further supporting the service in protecting the rights of these patients.
Matthews explains; “Beforehand this was heavily reliant on clinicians knowing what they had to communicate and to whom within the required timeframes. Now that’s all automated. The Mental Health Tribunal coordinator gets live notification regarding the legal status of our compulsory patients across the region allowing her to manage and schedule the required Mental Health Tribunal hearings accordingly.”
“At the same time, a separate live notification goes…to our administration staff allowing them to record the completion of that paperwork in the statewide CMI database, streamlining our reporting requirements with the Department of Health.”
With Azure as the foundations for both Bendigo Health and BHPS’ information systems Lindrea believes the organisation is well placed to continually evolve, enhancing outcomes for both staff and patients. Lindrea explains future scenarios could include:
“You’ve got the likes of virtual healthcare where you’ve got voice, video, consultations – they can start to be in real time. You’ve got the patients’ information in that same platform of technology. So, we know about telehealth, about Skype for Business that we can use for virtual healthcare. This is the first time I’ve seen it all in the one platform, one window. Then you’ve got your workflow tools, cognitive services like Cortana. I think is very powerful once you get to this platform and how you apply that to the model of care – the options you’ve got to suit health care workers and to keep treating the patient safer, better, more efficient and in real time.”