February 20, 2024

Key to sustainable clinical adoption of digital solutions

SA Health and the Commission on Excellence and Innovation in Health (CEIH) recently announced the first go-live of the South Australia Statewide Patient Reported Measures (PRMs) Program.

Introduced in 2021, the The PRM program encourages patients to report on their health outcomes and experiences, which physicians can use to make better decisions about their patients’ health. It uses New Zealand-based The Clinician’s ZEDOC solution for near real-time collection and reporting of PRMs. ZEDOC is currently being integrated into the Sunrise EMR, which is also being rolled out in South Africa.

In December, the program went live at the South Australian Medical Imaging (SAMI) Nuclear Medicine Theranostics Service at the Queen Elizabeth Hospital (TQEH) in Adelaide. CEIH PRM Program Director Megan Scott gave Healthcare IT news an overview of their experiences with this first implementation, highlighting a key success factor in increasing the adoption of new digital solutions by physicians. She also explained how they maintain cybersecurity for both patients and physicians amid increasing threats.

Q: Can you walk us through the implementation of the PRMs at TQEH’s SAMI

Shot: Doctors at Theranostics Service have been using a digital electronic medical record for almost a decade, in addition to several other digital solutions. They were would particularly like to be early adopters of the ZEDOC solution and had a high level of feel comfortable with the implementation process given their previous experience implementing digital solutions. As a result, the the execution went very well the service completing a full outpatient clinic on implementation day and both patients and doctors using the ZEDOC solution.

The PRM program team worked with the Theranostics service team to suit them survey project built into the specific solution to their requirements. The process of providing services Discovery, requirements gathering, configuration, testing, training, and workflow planning were conducted over approximately 12 weeks in late 2023, with an implementation date of mid-December. The key priorities for the team were to understand their requirements and make them happen the visualization of longitudinal PRM data via dashboards and support of new clinical data workflows using real-time information as reported by patients.

The services previous digital survey solution patients to complete the survey in the clinic waiting room using a hospital-provided device. With the new one ZEDOC solution, on some days survey invitations are sent to patients forward of their clinical encounters, allowing the patient to complete the survey in his/her own environment own time. There is some evidence that this method reduces the burden on patients and results in better symptom recall by the patient. The ZEDOC solution also enables near real-time assessment of the recent survey results and historical responses presented in a longitudinal format, the presence of which improves partnership and shared decision-making between patients and doctors during clinical consultations.

Early reports from both physicians and patients at TQEH SAMI note that the ZEDOC solution is a significant improvement of their previous solution and approach as it provides an excellent solution user experience for both patients and doctors and a more streamlined process for collecting and assessing patient data.

Such as the collection of PROMs (patient-reported outcome measures).) is part of the patient care continuum, they are considered part of the medical record, subject to the relevant South Australian law and policy requirements for the processing of medical records in the ZEDOC solution. The usage of PREMs (patient-reported experience measures).) is considered a quality improvement activity, where the research results are presentedidentified and used at an aggregate level to improve healthcare. Patients may opt out of receiving or responding to survey invitations or the program entirely if they wish. This process is managed locally by each implementing service and by patients within the patient-facing elements of the solution.

Q: After TQEH, what services are also planned under the Phase 1 implementation? What do you expect the implementation to look like for those services?

Scott: While some components for ZEDOC are similar across the board, each clinical service has the ability to tailor the solution to their requirements. In our experience it is offering a degree of customization improves clinical acceptance and acceptance of the solution in the long term. Customizing survey messages and enabling service-designed patient resources within the solution also improves patient response rates.

Once the PRM tool has been chosen by the service, the PRM team starts configuring the research project in ZEDOC based on the requirements. This work includes adding hospital/service logos and branding to the survey, developing patient resources for the ZEDOC FAQ, designing the survey invitation messages, applying survey milestone configuration (such as when surveys are collected and when invitations are sent) and configuring alerts and response dashboards, as well as broader reporting requirements.

The The remainder of our Phase 1 implementations will take place in February and March 2024, with our next service (Radiation Oncology at the Royal Adelaide Hospital) has already gone live on January 31, 2024. The remaining phase 1 implementation also includes:

  • Selecting Central Adelaide Local Health Network Rheumatology Services;

  • Local Health Network in South Adelaide Plastic and reconstructive surgery services, including hand surgery service, breast reconstruction service and facial skin cancer surgery service;

  • Selecting Southern Adelaide Local Health Network Rehabilitation Services; And

  • Health network for women and children.

Two additional phases of implementation are planned for 2024, with scope negotiations currently underway with SA Health Local Health Networks. More phases are expected in 2025.

Q: Not long ago, local SA Health networks reported a cyber incident that affects their digital environment patient pathways. With digital collection of PRMs underway in South Africa, how do you plan to protect PPIs and other sensitive patient information amid increasing cyber threats? How is the PRM program designed to address cyber threats and intrusions?

Shot: The PRM program has conducted a significant review of the operational, policy and legal requirements related to the handling of personal information. The ZEDOC solution underwent rigorous security assessments during both the procurement and configuration phases and meets SA Health requirements in this regard. Controls have been put in place to minimize the risk of unauthorized access to the system. Core technical resources are allocated exclusively to SA Health and the solution, providing greater visibility and control over what happens inside. Meanwhile, the supplier has an internationally recognized security certification to guarantee operational security competence.


The restpunches have been edited for brevity and clarity.

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