Taking down the Sky Tower, one file at a time

At over 300m in height, Christchurch Ophthalmology Service’s paper files could reach the top of Auckland’s Sky Tower. But what if they went digital? Could they take down their paper tower one file at a time?

The project
Since April the Orion Health Christchurch team has been working with the Canterbury District Health Board (CDHB) on the delivery of electronic forms in Health Connect South (HCS) for clinicians and administrative staff in the Ophthalmology Service.

The project aimed to facilitate the capture and access of structured data, therefore enabling staff to make consistently informed decisions. The project aligned with the wider CDHB strategy to move to a ‘paperlite’ clinical environment. The Christchurch team rolled out a controlled go-live in October this year.

The paper problem
The Ophthalmology Outpatients was a paper-based service located at the Christchurch Outpatients facility. It was rapidly becoming unsuitable for the clinical environment to continue with paper-based data capture because the Service sees 51,000 patients per annum. This number of patients generated a large volume of paper records, which required off-site storage and retrieval:

  • Clinical records for eye outpatients are a lifelong requirement because of the chronic and acute nature of the diseases. As a result, there was an increasing demand for space to store these files.
  • Two staff members (one full-time and one part-time) are required to support and maintain clinical paper file management, including off-site storage and retrieval.
  • The annual cost of supporting an off-site service for these records is estimated at NZ$70,000.
  • In 2018 there were over 300 linear metres of clinical records in storage, and the number is growing.

The data problem

In addition to this ever-growing tower of paper, the Christchurch Ophthalmology Service had no standardised clinical coding of diagnosis and procedures from their consultations. Health Connect South wasn’t capturing any structured data for eye outpatients, which meant limited visibility of the work that goes on within the Service – to both internal stakeholders, as well as outside providers.

The solution
The aim was to provide generic ‘eye’ digital forms in HCS and transfer all paper-based documentation to a digital format. Phase 1 delivery of a digital solution included:

  • Clinical Tests Form
  • Visual Fields Form
  • Pre-Admission Form (as a checklist in Phase 1; a full version of the form to be delivered in a future phase)
  • Problem List diagnoses
  • Consultation documentation
  • Eye Admin list (populated with clinic outcomes to assist administrators with manual entry into SIPICS in the interim)
  • Clinic outcomes and rebooking instructions

The successes
The project resulted in significant wins for the Christchurch Ophthalmology Service. All documents are visible in HCS and can be accessed by those who have HCS accounts, which saves staff time and removes the need to maintain paper records. This, in turn, has reduced clutter in the physical work environment, as well as slashing storage, stationery and courier costs.  

The feedback
The feedback from the Ophthalmology Service was hugely positive. There was a lot of excitement about the solution, and an overwhelming feeling that they would like to roll it out to all clinicians and administrators as soon as possible. 

The future
The Orion Health Christchurch team continue to work with the Christchurch Ophthalmology Service and CDHB on future enhancements to the digital solution. Now that the solution has been up and running for a few weeks, the Service has identified some enhancements to the forms that will improve workflows even further. These changes have been scheduled for the end of January.

The following further enhancements are planned for 2020:

  • Mechanisms to electronically report findings to referrers/GPs
  • Tracking components of essential test results
  • Further subspecialty electronic documentation

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