“When clinical staff unfamiliar with OneNote® join our meetings, they say, ‘wow, I can’t believe how well-organised all this information is and how fast and easy it is to find.’”
Clinical Nurse Specialist Tony Galea
Neurologists at The Children’s Hospital at Westmead were confounded by the time and effort required to track records of 800 severe epilepsy patients that go through their department every year. Disparate data from videos, EEG and MRI results were collated manually for weekly departmental patient reviews, but this took hours, and sometimes resulted in omissions. There was clearly a need to create a single structured list of patients, each with a fully connected audit trail of notes and records from various specialists. With help from the Microsoft Australia Health team, The Children’s Hospital at Westmead now has a system that stores patient information in one location with any time access and real-time updates. Microsoft hosted a test site based on Microsoft® SharePoint® Server and Microsoft® Office 2010. Using Microsoft® OneNote®, The Children’s Hospital at Westmead staff can now retrieve and review an entire audit trail of patient data simply by clicking on their tab. Information is impressively well organised and staff find the familiar interface easy to use. Compiling data for weekly presentations once took three hours per patient, but now staff are freed from laborious administration and can focus on giving care. They’ve been able to see more patients and collaboration between doctors, even specialists operating remotely, is much improved.
||"Some patients could be discussed twice in a meeting, while others who should be reviewed, were potentially omitted,"
||Dr Deepak Gill, Paediatric
The Neurology Department at the Children’s Hospital at Westmead investigates and treats children with severe epilepsy. They have an average caseload of about 800 patients per year and individual clinicians may be asked to advise on as many as 50 patients during a typical week.
The Neurology team meet once per week to review patients being considered for neurosurgery. During these meetings, team members need to be brought up to speed on each patient’s situation, which was done using Microsoft Office PowerPoint® presentations containing relevant patient data. Because this data could be anything from video recordings to Electroencephalograms (EEG), Medical Resonance Imaging (MRI), paper and electronic records, it usually took three hours to source, convert and collate the data for each patient’s presentation. Clinical Nurse Specialist Tony Galea comments: “With around five patients being presented a month, collecting data for our presentations would take fifteen hours work or more.”
The fragmented nature of the data also meant that the team had no single structured list of patients. “Some patients could be discussed twice in a meeting, while others who should be reviewed, were potentially omitted,” said Dr Deepak Gill, Paediatric Neurologist at The Children’s Hospital at Westmead
The team also had trouble recording action items that arose as a result of the weekly meetings. With no audit trail or defined processes to document the results of discussions, everything had to be taken down in note form and manually communicated to the appropriate staff members at a later date. There was also no formal catch-up procedure for team members who were called away or absent from a meeting. “Worse still,” says Dr Gill, “the team couldn’t access the patient presentations between meetings.”
As well as managing their own data, The Children’s Hospital at Westmead Neurology team also needed a better way to share case data with epilepsy specialists at the Royal Prince Alfred Hospital, Prince of Wales Hospital and the Sydney Children’s Hospital. “Very few people specialise in severe epilepsy in children,” says Dr Gill, “so it’s important that we share any clinical observations and seek professional second opinions where possible.
The IT Team at The Children’s Hospital at Westmead Neurology Department approached Microsoft in April 2010 looking for a solution. Dr Gill explains: “What we were looking for was a solution that stored patient information in one location and would enable us to access it from any location, and update it in real time.”
The team were put in contact with Dr Simon Kos, Clinical Advocate, and Stephen Edwards, Microsoft Australia Health Team, who observed their weekly meetings to better understand their current challenges. “We took a consultative approach and looked deeper into their clinical requirements,” said Edwards. “Initially the Neurology team just wanted a new videoconferencing solution, but we felt Microsoft OneNote would provide a more comprehensive patient management tool.”
“We wanted to develop a collaborative solution,” Dr Kos adds. “We decided to build a test site at Microsoft, which was based on Microsoft SharePoint Server and Microsoft Office 2010. The real innovation was adding OneNote, which connects all patient data, including Microsoft® Office Word documents, records, images and video into one workbook. OneNote also enables the clinical team to add reference notes, medication directions, medical studies and web articles.
“Once it was built, the Neurology team could immediately see the benefits of accessing data from one location.”
It took three weeks to implement the solution at the Neurology department and approximately three months for the team to adapt to their new tools. “We knew our existing solution wasn’t working, so we were determined to give it a go – and we had a lot of support from Microsoft,” said Dr Gill.
OneNote has made significant improvements in data efficiency and has eliminated the need for specially built patient presentations. “Now, when a child is first seen for an epilepsy evaluation, we can begin entering their history directly into OneNote,” said Dr Gill. “It helps us provide an instant snapshot of the patient, with reference pathways to the original data when full detail is required.”
Dr Kos explains, “The SharePoint site hosts the patient workbook, which can be updated by any team member. The OneNote workbook is designed with tabs down the side, with one tab per patient. To discuss or review patient details and multimedia, the team need only click on the patient’s tab. And there’s a visible audit trail within the workbook, so all members can review notes, action items and proposed therapies at any time.”
Galea adds, “When clinical staff unfamiliar with OneNote join our meetings, they say” ‘wow, I can’t believe how well-organised all this information is and how fast and easy it is to find.
Significant time saving
OneNote has helped make the Neurology Department’s weekly meetings more organised and efficient. The team have also been able to increase the number of patients they review each week.
Clinical Nurse Specialist Tony Galea comments, “I used to create a Microsoft PowerPoint presentation on the patients that would be featured in the weekly meeting, a process that took at least three hours per patient. OneNote means there’s no need to do this, so I am freed up to spend more time caring for patients and less time on administration.”
A simpler, more intuitive system
Microsoft OneNote, as part of Microsoft Office 2010, incorporates a range of new features that are helping staff members operate faster and smarter. Galea appreciates the easy-to-use interface, citing the Ribbon and the streamlined navigation bar as particular time savers. “We’ve also been taking advantage of the simplified notebook customisation, flexible tagging, faster searches within and across notebooks, Wiki linking and better integration with SharePoint technologies,” he said.
Consistent, up-to-date information
With patient data available from one location, information is consistent across the team. Plus authorised staff can access the OneNote workbook from their PCs, notebooks and smartphones, regardless of their location, and see updates to information in real-time. Galea comments: “When we meet at our weekly conference calls, everyone on the team is on the same page where it concerns the patient, diagnosis and treatment. Everyone accesses the same workbook at the same time, whether using their PC or watching the projector screen. This ensures everyone is across the patient’s diagnosis and we can work towards a more efficient treatment.” Doctors and clinical staff who were unable to attend the weekly meeting can access the OneNote workbook and see what was discussed and decided upon.
Easily shared information
If new data is made available about a particular patient, it can be immediately uploaded to OneNote and shared between the team, which means they don’t have to wait till the weekly meeting to get an update. “It’s still in its beginning,” says Dr Gill, “but we can see it becoming an essential tool that has helped our workflow and will replace departmental manila folders which we carry around with us per patient.” OneNote is also a great solution for providing remote specialist surgeons with access to patient data to provide further assessment and treatment. “Microsoft OneNote is helping to ensure that no patient falls between cracks,” said Dr Kos
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