Customer Solution Case Study
/ / Leading Healthcare Provider Replaces Paper Forms with E-Prescribing Solution
Overview
Country or Region: New Zealand
Industry: Healthcare
Customer Profile
The Auckland District Health Board (ADHB) is New Zealand’s largest public healthcare provider. It treats almost 2 million patients annually and provides services for 30 percent of the country’s population.
Business Situation
ADHB wanted to streamline the process of ordering prescriptions. This would free doctors to spend more time with patients and reduce clinical risk.
Solution
A new prescriptions system with pre-populated electronic forms and an automated dosage calculator, developed jointly by Microsoft and Simpl Group, is currently under trial.
Benefits
n Significant time savings
n Reduced clinical risk
n Integration with the pharmacy
n Future-proof development roadmap
n Extensible solution / “As clinicians, we need to standardize documents and it is currently a huge issue within the health sector. InfoPath 2003 and XML provide a very good mechanism for standardizing templates…”
Dr. David Mauger, Paediatric Oncologist, Starship Children’s Hospital
Auckland District Health Board (ADHB), the country’s largest public healthcare services provider, has piloted a new e-prescribing solution. The technology was developed with support from the Microsoft New Zealand Innovation Centre and The Simpl Group, and is based on Microsoft® Office Professional Edition 2003. The solution replaces paper prescription forms, making prescription ordering 100 times faster and freeing doctors to focus on delivering the best possible service to their patients. It also reduces clinical risk by pre-populating electronic forms built into Microsoft Office InfoPath® 2003 with patient information and by automating dosage calculations. The technology supports ADHB’s mission to provide healthcare services that lead the sector globally, and positions the organisation as an innovator in terms of service delivery.
Situation
Drug prescription errors are well-documented in the health sector, both locally and internationally, and can lead to devastating if not fatal consequences if left undetected. As a result, healthcare providers must ensure the utmost in patient care standards, and enforce multiple checks to detect any prescription errors before drugs are dispensed. The administration work involved in prescribing drugs and checking the accuracy of the prescription is extremely time-consuming.
Taking a global lead in this area is the Auckland District Health Board (ADHB), which is trialing a prototype e-prescribing solution based on the Microsoft® Office InfoPath® 2003 information gathering program, a next-generation form-creation application. The solution was developed in partnership with the Microsoft New Zealand Innovation Centre and systems integrator The Simpl Group.
As part of the pilot, clinicians working in the Paediatric Oncology department at Starship Children’s Hospital will be able to automate the drug prescription process using mobile Tablet PCs. The validity of prescriptions will be automatically checked, creating clinical efficiencies and increasing patient safety and standards of care. The solution has the potential to be adopted by other departments within the ADHB and by other organizations across the health sector.
Dr. David Mauger, Pediatric Oncologist at Starship Children’s Hospital, says new prescription solutions are particularly vital in the area of cancer treatment, where the potential of patient harm in the event of error is much greater. “The margin between benefit and harm is much narrower for cancer treatments than any other treatment,“ he says. “Cancer treatments typically involve multiple drugs, which have to be compatible and need to be taken concurrently. Typically, existing e-prescribing solutions are not well suited to cancer treatments because they only work out individual, rather than combination, dosages.”
Currently, pediatric oncologists at Starship Children’s Hospital manually fill out a drug order form to prescribe drugs and record key patient details, including name, date of birth, gender, NHI Number, height, weight, and surface area. The surface area calculation is of particular importance because this determines the required dosages of drugs. The form also captures the treatment start and end dates and drug administering instructions. Once completed, it is given to the pharmacy department where drugs are ordered and prepared. A second Drug Recording form is then manually filled out to record drug treatment administration.
“There is a misconception that technology is widespread in the health sector,” says Dr. Mauger. “While it is commonly used to streamline business processes, it is not widely used to manage clinical processes. Most people would think electronic prescribing is common, but in reality, very few health providers across the globe are doing this.”
Solution
Several years ago, Dr. Mauger recognized the potential of technology to help eliminate drug prescription errors and further ensure patient safety. He began searching for an e-prescribing solution, but no suitable products were available at that time. He explains: “We wanted a solution that would enable specialists to prescribe drug treatments electronically, calculate the dosage, check the validity of the calculations, and transmit the prescription directly to the pharmacy. In my 30 years’ experience within oncology, I have never come across a solution that can do this.”
ADHB decided to develop a customized solution in partnership with strategic technology partner The Simpl Group and the Microsoft New Zealand Innovation Centre. The centre is working with national and local government agencies to help identify innovative uses of IT to address key business challenges. Microsoft services and commercial partner expertise were provided at no cost to the agency.
In September 2003, Simpl and Microsoft Services began working closely together to develop a prototype solution using Tablet PCs, Microsoft Internet Information Services version 6.0, XML-based Web services, and Microsoft Office InfoPath 2003, a new application for creating XML-based forms that is part of the Microsoft Office System. Using InfoPath 2003, Simpl developed an electronic drug ordering form identical in image to the existing hard-copy version. In addition, the drug ordering form was customized to include drug recording functionality and to pre-populate information in certain fields, including the patient’s name, NHI Number, gender, and date of birth. Currently, this information is retrieved from a temporary database using XML-based Web services, but this will be integrated with the hospital’s patient management system in the longer term.
Benefits
Significant Time Savings
Dr. Mauger explains the time savings enabled by the new solution. He says: “I’ll be able to enter a patient’s NHI number, and their name, date of birth, and gender will come up automatically. I can pick the course of treatment—of which there will be approximately 30 to choose from—the patient’s height and weight, treatment start and end dates, and the InfoPath 2003 form will then automatically calculate the required dosage.”
Reduced Clinical Risk
In addition to making the prescription process “100 times faster and reducing administration time,” Dr. Mauger says the InfoPath 2003 form will validate the entries and visually flag them if any fall outside what is acceptable.
“The InfoPath solution will add another security layer to ensure the accuracy of drug prescriptions,” says Dr. Mauger. “This will further reduce the risk of harming the patient, while providing them with the best possible care.”
Integration with the Pharmacy
Once the drug order form has been completed, clinicians will be able to sign the form using the digital ink capabilities offered within the Tablet PC. The form can then be submitted electronically to the pharmacy. Because the prototype solution does not currently integrate with the hospital’s existing pharmacy system, the form will be placed in a shared directory on a file server and printed automatically in the pharmacy department. Simpl is also extending the administration functionality within the drug order form to enable clinicians to easily add new drug treatment entries themselves.
Says Dr. Mauger: “The prototype is still in its early days, but will undoubtedly enable clinicians to be more efficient and increase their focus on the patient, rather than the administration side of things. It’s a taste of what is possible with technology in this area.”
Future-Proof Development Roadmap
InfoPath 2003 is a robust technology that enables a number of new development opportunities for the health sector. This is largely because it is XML-enabled.
“As clinicians, we need to standardize documents, and it is currently a huge issue within the health sector,” explains Dr. Mauger. “InfoPath 2003 and XML provide a very good mechanism for standardizing templates. Personally, I think this is the start of something much bigger.”
Mike Hodgson, a Technical Consultant for The Simpl Group, says: “InfoPath 2003 has the potential to become a widespread development tool for lightweight user-interface applications. In many ways, it is perfect for the New Zealand market, because of the high number of lightweight development projects. It is a lot simpler to develop front-end applications with InfoPath 2003 than with Microsoft Excel® or Microsoft Word because of its native support for XML Web services.”
Support from Leading Technology Partners
ADHB received support at every stage of the development process. As a result, it has a working prototype that was created quickly and effectively.
Dr. Mauger says, “The opportunity to work with The Simpl Group and the Microsoft Innovation Centre was extremely valuable. Essentially, we’ve been able to fast-track the whole concept and get a working model going straight away. Without the centre’s support and funding and Simpl’s expertise, the project may have been neglected or would have taken a long time.”
Extensible Solution
This adherence to standards means that the solution can be applied to other functions in the health sector. While the solution is being trialed, Dr. Mauger expects the project to attract significant interest from other departments within the ADHB as well as from external clinics and hospitals.
Dr. Mauger says: “The prototype solution can be easily extended to other departments that prescribe drugs, throughout the ADHB as well as external health providers. It can also set a positive example for the rest of the health sector across the globe.”
Microsoft Office System
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