ACT Health documentary on the digital health record
A documentary following the digital health record during and in the months before and after the system was launched. Footage ACT Health
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NewsTranscript
00:00If we could confirm as you're doing that list, if Pathology and Merlin is up, that would be good.
00:09Yeah, so Merlin, I can definitely tell you at this stage is not.
00:13Pathology, Brian was looking very, Brian Sharpe was looking a whole lot more comfortable than he was about six hours ago,
00:18so I'll get that update through straight away.
00:21Okay, so AVS interim manager's up.
00:24That's got a whole lot of stuff hanging off it.
00:26So has Pox Accelerator.
00:28There we go, Pox Accelerator, I'm guessing Jed Webb's also tied into that.
00:31Jed Webb's up.
00:32Yeah, because it's tied to Pox Accelerator as well.
00:34Yep.
00:35Okay, which case it sounds like you're mostly up now, so we'll get confirmation on the remaining bits.
00:40Great, thank you.
00:42Do we know what's wrong with the machines?
00:45Okay, no worries, I'll find out now, thanks.
00:48Okay, the question is, if we're delaying 15, 20 minutes, it's a different answer than if we're delaying an hour.
00:53Yep.
00:54And if we're delaying three hours.
00:56So the left side is issues, problems, and basically we haven't gotten to the ones in the middle
01:03because we've been kind of working through the ones on the left.
01:06Don't have C-board, and that's either of the C-boards.
01:09Correct.
01:10So both C-boards are not good?
01:12Correct.
01:13Okay.
01:17We've got one, two, three, four, five, our left critical one's done.
01:21We've got three we're stuck with, right?
01:24Is that what you're suggesting, Peter?
01:26Well, what I'm saying is at this point in time, my advice is we may get them all working in the next three minutes.
01:32I think that's highly unlikely.
01:34The team advised me they are confident they'll have them up and running by 5am.
01:39My recommendation at this point in time, I think, to the group, subject to other views,
01:44is that we need to look at potentially not going live at 4am, potentially delaying that to 5am,
01:52I would suggest perhaps touching base again at 4.30.
01:55I don't know.
01:56Is it failing or not failing?
01:58Yeah.
01:59Okay.
02:00Yeah, we moved it over.
02:03Peter, it's Ross.
02:04So just clarify for me, you're 60 minutes behind.
02:06Does an hour give you enough time?
02:09Do you think you know where you are at 4.30 or do you think you need a bit longer?
02:15Look, to some extent, Ross, it's how long is a piece of string.
02:18I would love to take another two or three hours.
02:20Realistically, I don't think the health services have two or three hours.
02:23I think at this stage, if you give us another 35 minutes,
02:26we should have a lot more advice and guidance on where we're travelling.
02:29We have 4.45.
02:304.45?
02:35Yeah, look, I think that's all right with us.
02:37We'll just have to figure out the kind of messaging out to teams.
02:41We've got an issue.
02:42The further this pushes out, of course, then we're pushing into med rounds and other things,
02:46and so we start to think, well, what's the plan B?
02:48If you're not ready to go live, you can't bring it online.
02:50So we're doing some of that work in the ER at the moment.
02:53OK.
02:58Whilst I work in IT, this is not an IT project.
03:01This is purely a clinical transformation activity.
03:04You can look at it from a, I don't know, a Tolkien way, one system to rule them all.
03:09Fundamentally, the idea is it's one single system
03:12that gives clinicians at their fingertips the information they need
03:15to help provide better care for the patients that they have in front of them.
03:18But at the end of it, we will train over 10,000 people across the ACT public health system.
03:22We're doing a Big Bang approach,
03:24and it's really important to recognise what I mean by a Big Bang approach.
03:27We are going to rip and replace on day one over 35 systems,
03:32and these are systems that most people use every single day in their job.
03:36They will all be removed.
03:38Those 35 systems are responsible for nearly 90% of the data processing we do across the health system.
03:46How are we all feeling about 32 days away when we go live?
03:53There is nervousness.
03:56Yeah, it's a very stressful program.
03:58There's a lot of stress around, so it's not just managing your own,
04:01but managing how other people are impacted by you,
04:04and, you know, everybody else is on high tension right now,
04:08and I know that we all want to achieve something amazing.
04:11It's the unknown, I guess.
04:14When we press the big red button at 4am on the 12th,
04:18it's a bit like, why 2K? What's going to happen?
04:21I've been over at Manchester. I watched their go live.
04:24It was absolute utter chaos,
04:26and if I think it's going to be anything different here in the ACT, I'm kidding myself.
04:31In a project of this size, and it's equivalent of doing sort of 40 or 50 big IT projects all at once otherwise,
04:36and those who aren't involved in healthcare IT I think don't quite understand
04:39the enormity of what we're doing and the complexity of it.
04:42When you make a decision, you make the best decision at the time you've got, and you move forward.
04:46If you need to come back and revisit it, you do,
04:48but if you agonise for days over things, you're sunk.
04:51You simply won't make the timeline,
04:53and at a burn rate of over $200,000 per day for the team,
04:56it's too costly to sit there for a week and just contemplate your navel.
04:59You just need to make a decision and move on, and we need to be realistic.
05:03This is over a $300 million project.
05:05That is the biggest project of an ICT type that the ACT government has ever undertaken since establishment,
05:10and so we undertook both a national and international recruiting process to bring people onto the team,
05:15and we sat down, we designed it very carefully to ensure that each team had that right blend of clinical skills
05:20as well as the technical skills to ensure that we had success from day one.
05:24We had credential trainers come on board who we trained up to deliver all the training to nearly 12,500 people.
05:31We were running training from 8 o'clock in the morning to 9 o'clock at night, six days a week.
05:37The credential trainers that came on board were really keen, really enthusiastic, and they just ran with it.
05:44They just were so excited, particularly the people who'd come from the clinical areas.
05:49They could see the benefits of this system, and because of that, they just wanted to make it work.
05:55It was a very clear requirement at the time that security of the records for any patient who enters the public health system
06:04would be a highest priority for us to keep those records secure.
06:08We've had to build about 1,700 servers we have now in production.
06:12These servers are split between two data centres and have been established in a way that we can provide high availability.
06:20If we lose one data centre, we can fail over to another data centre,
06:23and that has also meant that we've had teams putting out thousands of new devices,
06:28so we've got more printers out there, label printers, scanners, more computers on wheels.
06:33Because you need to have that balance of people who fully understand all of the zeros and ones that go behind an IT system,
06:40but also people who fully understand what it's like to be on the front line in front of patients.
06:47I think Rebecca Healand did the majority of the recruitment,
06:50and I think she probably interviewed about 600 people over that time frame, to be honest.
06:55So yeah, I was the chair on the analyst panel.
06:58Lots of applications, and had to do days upon days upon days of interviews,
07:05which was both exhausting but inspiring at the same time,
07:09because it was just so exciting to meet so many people who were so excited, really wanted to be a part of the program.
07:15It gave me this massive advantage because I'd met so many people,
07:18and then when the whole team started on the 27th of January in 2021,
07:22I was like, hi, hi, hi, I know all these people, it was really great.
07:25COVID, like everything, had a massive impact on the DHR as well.
07:29We went from having to negotiate an entire contract with an American software vendor,
07:35completely by videoconference at the time, where we weren't allowed to travel, really.
07:38But then, of course, August 2021 came around, and we had like an explosion of cases.
07:46A lot of our team went out and did testing.
07:49So we did huge long shifts in testing centres because we had, you know, the ACT public were waiting 8 to 10 hours to get a COVID test.
07:59Every clinician in Australia was really required to be on the front line during COVID.
08:02Finding the ability for people to actually be released from those roles and to come here was a real challenge as well.
08:07I had nurses that went to nursing homes to do shifts because there weren't enough nurses in nursing homes.
08:13I had, you know, trainers that went off to do vaccinations.
08:18And then, of course, we worked from home.
08:20And that was really difficult from a team's perspective because everything we do is so collaborative.
08:25We do not work at all in any silos.
08:28But I think COVID also gave us a silver lining, which was the health system pulled together like never before.
08:34People were focused on an outcome, what mattered for patients, what mattered to the community.
08:37And I think that helped us enormously with the digital health record.
08:40And the other part is we did a very simple and quick and dirty cut down implementation of the DHR for COVID vaccinations.
08:47We turned it around in just over two weeks.
08:50And that actually gave us a chance to actually get the system out there and being used by our staff every single day who were providing vaccinations.
08:57And that was a massive change for us.
08:59And I think the benefit really was ordinary users were telling their colleagues what they thought of the system, both the good and the bad.
09:04And that helped enormously with our change management after that for the rest of the project.
09:08Ten days out or 240 odd hours as somebody else helpfully reminded me this morning.
09:12I'm feeling confident. We'll go live. It will be a great success.
09:16If the system doesn't work, the system doesn't work.
09:19I think if you don't give it a go, then you're just going to be sitting there forever trying to make something perfect.
09:25And it's never going to be perfect.
09:28So what team are we working on?
09:30So these ones have got issues. These ones are done. These ones we're doing later. It's OK.
09:41So these ones are...
09:44He's running! He's running!
09:46Epiphany connecting!
09:49Epiphany!
09:52No, it's picking up. It's working.
09:58It's working?
09:59Yes, it's working.
10:07Yeah, it's positive now.
10:10Ah!
10:15Great.
10:16Wonderful. So then can I suggest my formal recommendation as the commander for the digital health record,
10:22command centre to Rebecca, Dave and Ross,
10:28is that we go live with the digital health record at 5.30 this morning.
10:33Agreed.
10:35Yeah, agreed.
10:37I think agreed.
10:39Great.
10:48In which case we'll do that.
10:50Now there's still 30 seconds of time for everyone to say,
10:54this has been a long journey for probably the last five, six years,
10:58and I would suggest it's probably going to set the future for healthcare in the Territory for the next 10 plus years.
11:04It's been an amazing collaboration across the public health system
11:07and with EPIC as our partner.
11:09So can I say to each and everyone who's been involved, thank you.
11:14Yeah, Peter, can I, from Canberra Health Services' perspective,
11:18thank you and your team.
11:20I think there's been some terrific leadership from across the board,
11:23particularly as we've approached the sort of shorter end of the runway,
11:26the way that people have been able to pull together.
11:28And I think the legacy this will leave for the health system will be marked,
11:32not just today, but for many years to come.
11:34So thank you to all involved as well.
11:38Yeah, I'm just going to second that.
11:40Peter, we really appreciate everything that everyone over there has done
11:43and just seeing this great collaboration right across the health system.
11:46So well done both over those years, but well done for the last few hours.
11:50We know how tense it's been and we know the anxiety levels are often high at these times.
11:55So fantastic work.
11:57No, look, and I think we couldn't have done it without everyone across government,
12:00across the public health system working together.
12:02So this is an amazing outcome.
12:04And of course, I forgot to say thank you to DDTS and our other partners as well,
12:08but we are there.
12:10So in which case, we will go live in three minutes.
12:13In three minutes.
12:34I want to thank the team for the Digital Health Record.
12:37It's a massive team and it's been a massive amount of work
12:40over more than two years to get to this point of rolling out
12:44and going live with the Digital Health Record.
12:47And we've now had more than 8,000 people log on to the EPIC system
12:52through the DHR rollout.
12:54And at any one time, we've got up to 3,000 users on the system
12:58using a single electronic health record,
13:01replacing more than 40 systems across our ACT public health services.
13:11Our doctors have adapted to the change really, really well.
13:15Particularly the junior medical staff and the ward doctors,
13:19they've been champions of the system from literally from the first week.
13:24I think it's made it so much easier for us to look at patients
13:28that might be being referred from Canberra Hospital.
13:30We can see their chart, last documented review and those sorts of things.
13:35There's a little bit of a delay in getting started,
13:37but once we were up and running,
13:38those first few days were really quite daunting for everyone,
13:41despite, I guess, the preparation that we've put in over the last 18 months.
13:44And so those first few days, there were times when having our reliance on paper
13:49and going into a patient with a bit of paper that I knew that was the patient,
13:53not needing that bit of paper and going in to find that patient
13:56was quite a different experience.
13:58My hope is that the interface is a little bit more user-friendly
14:01for us to work with, so it's not quite as clunky
14:04or that, you know, there's one way to do something
14:07rather than 25 different spots that we're meant to be entering stuff in.
14:11People that were probably nearing retirement
14:14or those who were really anxious about the technology aspect
14:17when they've been paper-based for a 20, 30, 40 year nursing career
14:22who just got it and got into it and understood it
14:26and were able to ask questions.
14:29I think having all the information in one place is really important.
14:33Like, since COVID, I've had a few hospital visits
14:36and visits to emergency via ambulance.
14:39And, yeah, it is hard to remember everything
14:42from when you're in hospital and what you've been told.
14:45I think the staff in the emergency department
14:47have been incredibly well supported through DHR rollout,
14:51both by the DHR team but also our leadership team,
14:54both nursing and medical.
14:56I don't think anybody is particularly fond of change
14:59and there were certainly some who were more adaptable than others.
15:02But overall, I think staff have appreciated that it's the way forward.
15:07This is the end of the beginning.
15:09The next phase, I think, is the most exciting
15:11when we can start to optimise the system.
15:15It's something that we try not to lose sight of,
15:17the fact that we've wanted and needed this
15:19for the better part of a decade, really.
15:21And the fact that we're here now is a really massive step.
15:24We're already seeing real-life benefits with the system.
15:27Over 20,000 patients have avoided an additional blood test
15:31because we've been able to add those tests
15:33onto existing blood that's already been taken.
15:36We've prevented 6,000 people from being prescribed a medication
15:40that they were allergic to.
15:42The biggest thing for me in that first week
15:45was the patients were interacting with their own healthcare
15:48because we snapped them onto the snapboard
15:50and put their appointments in,
15:52not realising that they had the app ready
15:55from when they'd had their vaccination
15:57and they were saying,
15:58Oh, yes, it's right.
15:59I am coming in to have my appointment and my review.
16:03I'm still constantly in shock, I think,
16:05at the amount of work people are putting in
16:06and the fact they're putting their lives on hold
16:08with their families to do this.
16:09This is more than a job for me.
16:12It is actually about what legacy we're leaving
16:15for the public services here in Canberra
16:18and for making sure that health services
16:21are going to be sustainable into the future.
16:23When I look at it and go 5, 10 years from now
16:25when I'm hopefully family or friends or myself or kids
16:28or someone's in hospital,
16:29we'll be able to sit there and actually go,
16:31the care they're getting is better
16:33because of the work we did today
16:34and that's kind of,
16:36that is the real motivating factor, I think.
16:38We all live here, we're all part of the community,
16:40we all want it to succeed so we can all actually enjoy it.