Sean Duncan

Dr Sean Duncan trained and practiced in Newcastle (UK) prior to moving out to Christchurch in 2018.

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The Challenges Of Introducing An Electronic Inpatient Notes Programme To A Large General Medicine Department

Aims
Christchurch Hospital General Medicine department is one of the first medical departments in New Zealand to transfer from inpatient paper notes to an electronic health record server. Electronic notes have been shown to have financial, efficiency and patient safety benefits on the global stage. This presentation aims to describe the challenges associated with rolling out an electronic inpatient notes programme ‘Cortex’ in a large General Medical department in Christchurch Public Hospital.

Methods  
The transition of General Medicine to Cortex was modelled on the surgical services transition in July 2017. Weekly meetings and feedback sessions were conducted for 6 months prior to the roll-out date 13th November 2019. Interviews of the clinical leaders involved in this process as well as the RMO users were undertaken to gain qualitative information. The challenges experienced were documented both personally and recorded live on an online task management programme ‘Trello’.  SMO and RMO feedback was collected after the role out through an email survey.

Results
General Medicine at Christchurch Hospital have successfully transitioned entirely to electronic inpatient medical notes. The biggest challenges were (1) Recognising the differing notes requirements of a medical department to a surgical department, (2)The creation of business rules surrounding electronic documentation and handover, (3) Assessing and acquiring device requirements and establishing a new infrastructure for these devices, (4) Ensuring that patient information was not missed whilst teams were actively transitioning.  The majority of RMO and SMO feedback is positive with perceived improvements in ward round efficiency, allied health communication and better quality of documentation. Free-text feedback raised concerns of: poor integration with existing programmes, difficulty in information assimilation compared to paper notes and reduced quality of consultation due to ‘screen-gazing’.

Conclusion
The roll out of ‘Cortex’ as an electronic in-patient notes programme in General Medicine at Christchurch Hospital has been overall well received. There are however a number of valid concerns that will need to be addressed as the department moves forward with ‘Cortex’.  Having a greater understanding of the challenges that they may face when contemplating their own transition to Electronic in-patient notes will allow Clinical Leaders, and ultimately, DHBs to make more informed decisions