The HealthSMART program was a Victorian Government initiative to modernise and replace existing information and communication technology (ICT) systems throughout the Victorian public healthcare sector. It was launched in 2003 and was designed to run as a single electronic foundation incorporating a finance system as well as patient management and clinical application services.

HealthSMART was scrapped by the Victorian Government in May 2012 due to cost blowouts and a failure to complete within the scheduled deadline of 2007. The project was budgeted to cost $323million, but ended up costing $566million with the system only operational in four health services. HealthSMART was rolled out at Eastern Health, The Royal Victorian Eye and Ear Hospital, Austin Health, and Peninsula Health. At the conclusion of the HealthSMART program these hospitals were given the choice to keep the HealthSMART system or not. The Victorian Government stated they would work with the other state hospitals to examine what systems would be appropriate to their particular services. New ICT projects are being funded through the $100million Victorian Innovation, e-Health, and Communications Technology Fund allocated in the 2012/2013 budget.

With the push for electronic paperless systems, a move to replace current paper charts with electronic medication charts will be inevitable. By examining the lessons learnt by pharmacists working with the HealthSMART system, I hope we can learn many things that may help with future roll-outs of electronic medication chart systems. For this purpose we will only be looking at the advantages and disadvantages of the electronic medication charts used in the HealthSMART program, not the entire program itself.

The electronic medication charts used in the HealthSMART program replaced existing paper charts. Doctors were able to select medications from a pre-populated dose catalogue. The system was programmed with loading doses and medication specific dose regimes.

Advantages of the system included the ability of multiple staff to access medication charts and laboratory data simultaneously. This reduced time wasted searching for charts or waiting for them to be available. However efficiency was dependant on staff having access to a computer. I am unsure if the HealthSMART program allowed for charts to be accessed remotely. Remote access by off-site doctors could eliminate phone orders and allow doctors to amend charts immediately when necessary. For pharmacies that service from an off-site location, this would mean medication charts would be accessible at the time of dispensing and would reduce reliance on hand written or faxed orders, which are sometimes hard to read.

Another advantage was that doctors could not use unapproved abbreviations and had to complete all fields in the chart before the order could be digitally signed. This eliminated ambiguous orders caused by abbreviations. It also reduced pharmacist time spent chasing doctors to complete orders such as orders where the doctor forgot to sign or indicate the route of administration on the old paper charts. Unlike paper charts, which run out of space for medication administration to be recorded, the electronic records did not have space restrictions and so did not need to be transcribed to new charts. This eliminated errors caused by chart transcription. Standard additional directions such as ‘with food’ and ‘swallow whole’ were added to the pre-populated medication orders in the system which reduced pharmacist time spent making annotations to orders.

Disadvantages included the ease of selecting the wrong medication, particularly those with similar names or multiple strengths and dose forms. Pharmacists needed to be extra vigilant for errors on charts caused by medication selection. Many other parts of the patient’s records still remained paper-based so that work-flow was split between the two media. There was still a need to access paper-based histories and to review other records such as medication and health summaries from GPs and nursing homes.

Another disadvantage of electronic charts was their reliance on functional IT networks; system outages caused disruption to patient care. It took time to get extra directions and dosing regimens pre-populated to meet the prescribing requirements of all doctors and to reflect individual hospital formularies. The nature of the pre-populated orders meant doctors had to change pre-set doses and directions when they needed different regimens or wanted to use a medication for a different purpose such as tobramycin ampoules administered via a nebuliser.

Like all systems, there are advantages and disadvantages to electronic medication charts. Hopefully we can learn from the experiences of others, and improve the transition to electronic medication charts.

References:

  1. Meaklim A. The impact of technology within our practice. Proceedings of the 38th National Conference of The Society of Hospital Pharmacists of Australia; 2012 Nov 1-4; Canberra, Australian Capital Territory.
  2. Guan L. Victoria to stop HealthSMART funds. Government News 2012; 32 (3):49.
  3. APP, Hopewell L. Victoria scraps HeathSMART system. ZDNet; 2012. Accessed 28 Mar 2013.
  4. Crozier R. Victoria kills HealthSMART IT project. IT News 2012; May 18. Accessed 28 Mar 2013.

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