firstBASE Limited

Information Worker Solutions

Awards

firstBASE is the only New Zealand organisation to be a finalist in the 2004 Microsoft Worldwide Partner Program Awards. The selection recognises excellence in the design, development and delivery of Project ECLIPS - a ground breaking initiative for Northland District Health Board.

The project also won the Health Informatics of New Zealand (HINZ) and Ministry of Health  Sharing Excellence in Health & Disability information Management Award.

Project ECLIPS focused on the issues within New Zealand’s primary and tertiary community based healthcare sectors, where historically the availability of information for patient care and the provision and collection of statistical information on care administered to patients is cumbersome, inaccurate and poor.

As a consequence of manual data recording procedures, workers in the community environment spent a great deal of their time shuffling paper as opposed to caring for their patients. This is a disincentive to fill in vital information needed for funding and service continuum contracts. With the transposition of data, error rates of recorded information were high.

Prior to this project District Nurses captured patients visit information using pen and paper, initially in hardcover diaries and later transposed to paper forms. This information was sent using a variety of mechanisms (fax, internal mail, hand delivery) to data input operators to be keyed into a reporting system. The process could take many days with remote area staff often missing submission deadlines.

The project provided community-based staff with an InfoPath application for referencing patient records, ASP.NET and .NET Compact framework applications for scheduling visits and capturing statistics while working in the office (Server & PC) and the field (Mobile device - Pocket PC).

Solution
The ECLIPS application is used in three contexts: (i) Data entry, planning and scheduling (in the office); (ii) mobile data viewing, entering statistics and scheduling (in the field); (iii) entering or synchronising statistics (in the office).

Desktop usage
Desktop uses two technologies to interact with the user:

· Web browser (Internet Explorer) is used to navigate the portal, enter and edit the data

· InfoPath 2003 is used to fill in the patient form and submit it to the system

There are several server technologies hosted on the desktop:

· Web server (IIS) is used to host ASP.NET application for schedule, data editing and statistics viewing/editing

· SharePoint Services is used to store pending and submitted patient files in XML form

· BizTalk Server is used to receive submitted XML data and store it to database

· SQL Server is used to store the systems database

Mobile device usage
There is a custom application on Pocket PC running on .NET compact framework, enabling the user to view and edit data as well as schedule new visits.

Customer Situation & Results
Northland District Health Board (NDHB) provides Primary, Secondary and Tertiary Healthcare Services to the entire Northland Region of New Zealand.  Secondary services are provided at four hospitals.  Information Technology support is administered from the Base hospital in Whangarei and spans NDHB funded primary and tertiary care sectors. NDHB has 2100 + staff and 400 + desktops.

Many Northland patients live in remote locations and have limited access to healthcare service centres.  Average incomes are lower than in many other regions, unemployment higher, and housing standards lower.  A high proportion of the population are of Maori ethnicity who are in particular need of health services.

These factors result in significant challenges for NDHB information workers, particularly where services are provided at patient’s homes or in remote clinics.

Accordingly, the key elements of the solution design were:

· The use of form based data entry and display in a manner that reflected the previous paper based entry

· Translation of what was unstructured information into a structured and more available form

· In the office and off site (field) access to the required functions and information

· Field data entry simplification through the use of pick lists only on the mobile device

· Rules based synchronisation of data between the office system and mobile devices

Measured against the project objectives was a resounding success:

· The time taken to collect Community Healthcare operational statistics was reduced by 95%

· Users found the application significantly reduced their workload

· Data accuracy was improved, validation rules being applied on entry

· Data legibility was improved through the provision of an electronic record

· Access to referral / patient data was improved, a single file copy being replaced by a PC based office copy and a Pocket PC subset for field review

· The accuracy of operational statistics was improved through the use of pick lists for entry of data values, and by avoiding data transposition and keying errors

The completeness and accuracy of clinical audit information was improved, the system providing user, date and time stamp information for each transaction.