| Project Objectives / Summary:
This project focused on the compilation and transfer of identified patient information between Illawarra hospitals and GPs via email (& fax). The main emphasis was to assist GPs to access patient information in order to assist with ongoing patient care following hospital discharge. The second phase of the project was transfer of the patient information from the GP to the admitting hospital to notify the patient's health status prior to admission.
The project resulted in the development of Docmail, a computer program designed to retrieve specific patient information from the Hospital Patient Admission System, place that information into an appropriate format and transfer the information to the patient's nominated GP (via fax or email). Data transferred to GPs include the patient's date of proposed booking, admission date, admission ward, change of ward, and discharge date.
The Docmail program (a joint initiative between the IAHS and the IDGP) was implemented into all nine IAHS hospitals and 96 Illawarra GPs purchased an IAHS e-mail account in order to receive Docmail messages via e-mail. In addition, 46 Illawarra GPs receive Docmail via fax, with 40 Shoalhaven GPs also receiving Docmail via fax.
Numerous key areas were identified and actions implemented to ensure the project remained sustainable post project whilst meeting the needs of the target groups and stakeholders. Needs were identified and quality assurance processes were implemented.
In addition to achieving successful implementation, Docmail influenced a number of further initiatives such as the e-mailing of discharge summaries from The Wollongong Hospital and access to patient history on the IAHS Intranet.
Project Collaboration:
- Illawarra Area Health Service (IAHS)
- IAHS Information Service Department
- The nine IAHS hospitals who participated in the Docmail project
- The many GPs who participated in the Docmail project
Project Outcomes:
The e-mailing of discharge summaries from the Wollongong Hospital (TWH)
Prior to the implementation of Docmail discharge summaries from TWH were posted to GPs. The Docmail project was successful in identifying the potential of e-mailing discharge summaries to GPs via the GP IAHS e-mail account. IDGP GPs were given the option of receiving discharge summaries from TWH via fax or e-mail. Discussions were held within the IAHS to extend this service to other IAHS hospitals.
Consultants communicating via e-mail with IOGP GPs
The IDGP made available to Illawarra Consultants a list of GP e-mail addresses in order to communicate freely and timely via e-mail. In addition one Consultant has purchased an IAHS e-mail account in order to communicate more freely to GPs and to have access to available information on the IAHS network.
The Docmail program was implemented within all nine IAHS hospitals
Initially Docmail was only to be implemented in the six Northern Illawarra Hospitals. As it was implemented within the Southern Illawarra, GPs from the Shoalhaven area (which the Shoalhaven Division of General Practice covers) were able to receive Docmail (via fax), which expanded the user base of Docmail.
An investigation into the accuracy of medication information on discharge summaries was conducted.
Highlighted through the Docmail project was the importance of data integrity. Following the investigation of the accuracy of medication lists on discharge summaries; the IDGP and IAHS are reviewing the processes involved in recording medication lists, to improve the integrity of this information.
Rollout of Docmail Statewide
Following the successful implementation of Docmail within the Illawarra, progressions are being made to implement Docmail Statewide. NSW Health held Docmail meetings to form a Docmail Consortium to assist the rollout of Docmail. Docmail was being tested in the South Western Sydney Area Health Service (SWSAHS), and 11 other Area Health Services committed to the initiative (approx. half of NSW Area Health services).
A formalised process for GP accreditation to the IAHS was developed
In order for GPs to purchase an IAHS e-mail account, a process was to be developed to ensure those GPS were accredited to the IAHS (the reason being that e-mail provides an access point into the IAHS network, therefore only GPs accredited to the IAHS can access AHS data.)
An IAHS/ IOGP Information Management Committee was established
As a result of this initiative, a continuing committee was established to further other joint projects in the Illawarra.
Recommendations:
- A necessity for the future of Docmail is an ongoing audit process to ensure integrity of data.
- The successful implementation of the Docmail project is reliant upon a collaborative partnership between GPs, the Division of General Practice and the Area Health Service.
- To be successful Docmail has to be marketed so that GPs become aware of the benefits email communication can provide.
- The challenge is to choose the most appropriate system. A uniform system will improve communisations and potentially improve GP/Hospital relationships. Uniformity between Area Health Services would also be of great significance.
Disseminating Project Information:
- The National Divisions of General Practice Forum 2000, Brisbane, Queensland 24-26 August 2000
- Information was provided to 11 other Divisions of General Practice upon request.
Lessons / Assessment:
The implementation of Docmail highlighted a number of key issues requiring further consideration. The following issues indicate the essential components to developing a successful project partnership such as the Docmail project.
Essential for the successful implementation of Docmail is a collaborative partnership between the local Division and AHS. Without the support of either of these groups the program cannot be successfully implemented. This partnership and successful implementation is reliant upon excellent communication being maintained between all groups, throughout the implementation of Docmail.
Docmail administration
Responsibility for ongoing Docmail administration must be accepted for Docmail to remain sustainable.
Stakeholders to be informed of Docmail
Imperative to the successful implementation of Docmail is effective communication between all stakeholders such as admissions staff, medical records staff, IAHS executive staff, IAHS ISD staff, IDGP staff and IDGP GPs.
Benefits of Docmail
There are a number of benefits provided by Docmail for a GP:
The link to additional information, which displays all previous admissions for the patients as far back as three years;
- Assists in the delineation of patterns that may be occurring with patients admitting to hospital.
- Receiving Docmail messages keeps the GP in the hospital link. Through Docmail the GP can be kept up to date with what is happening with a patient whilst admitted. Potentially this can also improve relationships between the GP and the patient as the GP is better informed of their patient's current health status.
- Docmail messages are transferred directly to the GP. Thus the GP no longer relies on intermediatory processes such as the patient presenting to the clinic (post admission) or a family member informing the GP.
- Therefore the GP is receiving the information first hand, which decreases the likelihood of misinformation being relayed to the GP.
Faxing vs e-mail
E-mailing Docmail messages as opposed to faxing Docmail messages requires further examination. Whilst the IDGP has recommended both the faxing and e-mailing of Docmail messages there are a number of benefits for e-mailing over faxing.
In relation to ongoing Docmail administration faxing is more resource intensive than e-mail. In addition, receiving Docmail messages via e-mail allows GPs to utilise the links to additional information. Receiving Docmail via fax does not allow this function. However, e-mail requires the GP to have a PC, modem, phone line, e-mail account with the IAHS. Most GPs would have a fax machine.
Barriers to Docmail implementation
A failure to inform all stakeholders of Docmail implementation raised instant barriers that initially delayed further progression of the project.
Limited functionality and replacement of data systems used within the IAHS prevented the inclusion of clinical information throughout the life of the project.
GPs unfamiliar with e-mail were initially reluctant to purchase an IAHS e-mail account, hence effective marketing strategies were essential.
Prior to the dissemination of correspondence outlining the medico-legal obligation on GPs receiving patient information via e-mail, some GPs were concerned of the legal implications of receiving Docmail messages via e-mail.
Overall, this was a highly successful project and met both local and wider requirements of "innovation" as a term. The interest shown by other Area Health Services demonstrates the value of the project outcomes. |
