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Rebecca: Tēnā koutou katoa. Welcome to eHealth Talk NZ. I'm Rebecca Macbeth. I'm the media editor at HINZ. And I'd like to thank Third Age Health for sponsoring this podcast episode, where I'm joined by Chief Technology Officer, Sangira Samarawera and Clinical Change Lead, Talita Noel. Sendjiwa, can you start by telling our listeners what was the problem you were looking to solve when you decided to develop a clinical portal?
Sanjeewa: Kira, Rebecca, We wanted to make life easier for our clinicians to deliver patient care and we looked at it from four different lenses. One from a lens of patient care and patient outcomes. How do we make sure patient continuity of care, et cetera, is delivered consistently all the time. We looked at the overall clinician experience. How do we make life easy for them so they can just do the clinical stuff with less admin work to do? Third lens we looked at was privacy and security which is fundamental to everything we do. And lastly, operational excellence. We wanted to make sure we delivered things in a way that made sense and was efficient and delivered high quality care. We wanted the clinical portal to be a collaborative platform in partnership with our clinicians. So the everybody was working off a single source of truth that was available twenty four by seven.
Rebecca: And so Talita, what were the clinicians, the GPs, the care teams experiencing day to day that made you realize something really needed to change?
Tolita: we found that our clinicians were juggling across many different systems between the PMS, RMS, invoicing systems, and then paper consult registers. They were also working in silos, so important updates weren't always coming across. Teams would spend a lot of time looking for particular information or deciphering handwritten notes, which is not only difficult to interpret, but also opens us up to clinical risk.
Rebecca: So is that clinical risk when things aren't all connected that something might slip through the cracks, would you say?
Tolita: Absolutely. If A is trying to communicate with B and the information isn't flowing, there's always that risk of gaps, particularly when the clinician is working, alone in a facility and they don't have a backup.
Rebecca: So can you just describe briefly what did accessing resident information look like before the portal in that case?
Tolita: clinical information wasn't always available as needed, and again, as it was spread across multiple different sites, it was hard to find the correct information. reliance on handwritten notes made information harder to read, interpret, and to share consistently. And it was also difficult to get a complete, accurate view of the residence history. And understanding of some clinicians share sites. So if a previous clinician had been on site and the notes hadn't actually been shared across, it was difficult to have oversight.
Rebecca: So it's that core thing that everyone's searching for, which is right information, right time, in the
Tolita: Absolutely.
Rebecca: right hands. So, Sanjua, before you decided to build a portal, what other options did you explore and why did you end up deciding to create your own?
Sanjeewa: one of the unique challenges we face is that our clinicians work across a large number of different age residential care facilities. And each of these facilities will have their own different systems. and we might have a single clinician who might work in the mornings at one facility, use one type of IT systems, and in the afternoon they've got to go to a different facility. So the diff the the ecosystem was quite complex for our clinicians to navigate. And so one of the things we aspired to do is, you know, coming back to one of our founding principles was how do we make this simpler for our clinicians? So we looked at what was already there in the market, but in order to work across all our different diverse customer base and facilities, we basically found there are some unique things that we do the way we do, which were there were no products In the market for us to easily adapt. So we basically undertook an exercise, you know, working with our clinicians. So it was pretty much a clinician-led exercise with their input to find out what were the pain points they encountered on a day in, day out. And then we set out to digitize that. That's basically how we embarked on this challenge and ultimately what we were trying to do is to make sure no matter where you worked as a clinician for third age health, which facility you went to, you had a single simple way of doing the same process repeatedly, consistently. And we know in healthcare consistency is very important and in terms of, you know, delivering high quality care. So we wanted to make sure clinicians didn't have to learn two, two, three different systems. in order to deliver care. you know, delivering care is already challenging enough without having to learn multiple systems like that.
Rebecca: So can you just give us a bit of an overview of the portal? How does it interact with other systems and how does it work from a user perspective?
Sanjeewa: everything starts with our planned care model in terms of scheduling medical rounds. So we started everything from how we plan the care, who should be seen, who should be prioritized based on needs and other events that happen in between different rounds. So we started all the way from the workflow from planning, scheduling, delivering the actual care Capturing notes, and then giving full transparency of what care was delivered back to our facilities so that once our clinician has left the facility, the nursing teams and the clinical teams in our customers and our facilities had 24 by 7 access to how that care was delivered. And if for any reason a resident required care in between scheduled rounds, the team that would deliver, say for example, you know, after hours care also had access to the notes and the care that was delivered during a
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scheduled round.
Rebecca: Great, so Talita, who's using it now? How widely has it been rolled out so far?
Tolita: So we have over sixty facilities using the clinical portal at the moment. We began the journey in October 2024 with our first site. So it's been a slow controlled rollout approach where we actually individually reach out to each facility, discuss with them, set up a training program and make sure they're comfortable before we go live, just to ensure A smooth transition. This stage approach has been working well so far. And There were also a few clinicians who were quite eager and some facilities have requested it once they've heard some other sites had it. So when someone expressed interest, we were able to go and support them as well and then word of mouth started to flow.
Rebecca: You know you've got good technology if clinicians are asking to use it, so good signs there. So what were some of the biggest challenges then throughout the project?
Sanjeewa: We all know that age care is very complex already. So In terms of challenges, often in a transformation project like this, the biggest challenge is not the technology, and it's actually far from it. the key success, of a transformation project is how do you drive adoption? As Talita pointed out, we've had a concentrated, focused effort to drive adoption from day one in a very meaningful way that is safe and without importance. Forcing extra workloads on both the facilities and our clinicians. So we had to create an adoption approach that focused on supporting our clinicians all the way through. And the key challenges have been always balancing change management, training, and you know, rolling out a new technology as part of delivery of care, as a day-to-day normal routine. So I think the change management program that we put together to support this initiative is probably the biggest challenge. But again the success in the adoption is an indication of how successful the change management program has been.
Tolita: One challenge our team found was not fear of change, but maybe some change anxiety from both clinicians and also facilities. Fortunately a lot of them once they'd experienced the training found that the system was really simple and easy to use. However, it's it was about getting them to adopt the new behaviours because some of these facilities had been doing the same process for twenty plus years with some of the nurses. So whenever you introduce a new system, there is a bit of anxiety about trying new things and adopting our way of working and also allowing there the autonomy for them to make their own decisions for the best way they want to use the system And building confidence took time. So with our training, our ongoing support, reaching out after the first month with any additional training and support, we always offered that as well, and requesting feedback and trying to then adopt that feedback into how we work.
Rebecca: Sendhia, how have you approached cyber security, particularly around access to and sharing of patient information?
Sanjeewa: right from day one when we started this initiative, we approached, cybersecurity and protecting personal information as one of the foundation tenants. So we wanted to make sure everything we designed from ground up, took into account the obligations we have to protect patient information and also from a security point of view as well. we are custodians of a lot of sensitive patient information and so the approach was about privacy by design, you know, in terms of how we approached it. There were probably three key principles we followed. one is that, you know, how do we pr you know we make sure that every workflow step was designed so that, you know, patient privacy, patient information, patient privacy was you know always managed. the second one is around managing risk with cyber security. So obviously we took a more risk based approach to reducing risk and making sure, you know, frameworks like Zero Trust Security were foundations of it. And the other thing is obviously when it comes to cybersecurity it's not a do it once and implement once and forget about it. You know, it's a continuous journey. So we've embarked on a since the day one of this project, cybersecurity continues to evolve and refine because the threats in the market change and as we have seen. and when you're doing anything with technology, the key challenge in healthcare is always about balancing the security we must deliver and the privacy which we must deliver with clinical usability. So So it's that triangle that we need to constantly do that. And I think we've been working with our clinicians to fine-tune that and make it easier step by step, but always we've taken a no-compromise kind of an approach around privacy and security. So it's foundation tenants in terms of our entire program for transformation.
Rebecca: Yeah, it's certainly a balance, isn't it? So you mentioned there, you work with clinicians around the cybersecurity steps, but Talita, how important was generally clinician involvement in the project? And can you just talk about how the portal can support better clinical decision making?
Tolita: involving clinicians was very important. They're the ones on the floor using this day-to-day. So they have to be happy with the system. It has to work with them. So from the very beginning, as Sanjeevas said, we involved clinicians with each step, with user feedback, testing, like discussing improvements and we had some people like Sanjeeva and a couple of other staff members actually went out on site and followed their workflow so they could understand how the rounds work 'cause we really wanted to ensure that it makes sense with how we're working. When clinicians have easier access to trusted information, they're able to make decisions with greater confidence. So when they have that access to the patient without having to try to decipher the notes from the handwritten document and the
information is there if especially even if somebody's not yet enrolled with our enrolment process on the portal, they can see full information, the NHI, so they can use systems such as Test Safe to go and look at that history. So it gives them that little extra layer of protection if the GP to GP documents haven't come through yet. And they can spend some time focusing on the residents instead of the administration side of it.
Rebecca: So does it integrate with some of the shared care records, Senji, in terms of pulling information
Sanjeewa: our first two sort of phases of our program as focused on really f building the foundations. we have just completed the development of a fire API framework, which you know is to open up the platform for interoperability with any wider healthcare sector participants. So what we are planning to do as we ramp up the adoption, we wanna focus on removing the need to duplicate data entry wherever that happens to be. So our first two phases have really focused on removing paper and duplicate data entry and wastage within the workflows. And now that we have a full end-to-end workflow that's fully digitized, the next phase of it is to really open up for interoperability. so we've adopted a fire-based industry standard its API framework to make that possible and at the moment we are in discussions with multiple parties to make that happen.
Rebecca: So, Talita, what has the impact been for staff, for clinicians, and importantly for residents
Tolita: Glad you asked about the residents at the end. I think one of the most important things for the residents is the improved privacy. on the healthcare system there is a lot of email information being sent around and the portal allows EPOA documents and enrollment forms or personal information to be put directly on a secure platform so it's not being emailed across. There's better visibility of clinical activity, real time transparency for the facilities to see what is being actioned by the clinician and how long it's taking them. And centralized digital resident records so it's accessible to our internal team, the clinicians, and the facility themselves. Also with improved enrollment tracking, so we actually are using the clinical portal internally to track all enrolments and to be able to have almost a dashboard to be able to chase up what's needed and make sure that we're getting the GP the GPD documents, follow it up and getting that information so that we have the past medical history and that our clinicians can start actioning as soon as possible and caring for the resident to the best of their ability. Also we're finding that as the facility can plan the round ahead of time and the clinician doesn't have to get to site to then see the clinical checklist. They can do a little bit of inboxing or have a little read of what is needed prior to the round and start planning what they want. and we're finding that very helpful.
Rebecca: It's giving some time back essentially isn't it? So looking back, what have been the biggest lessons that you can pass on to others
Sanjeewa: at the end of the day, technology is is purely an enabler. And so when you're actually doing a transformation project, you want to really focus on how to create value for the stakeholders involved. And in what we found is that the best ideas have come from, the cold phase where the clinicians who doing the day-to-day work and also nursing teams at our facilities that have made suggestions on how to do things better. So I think it's really important to make sure the end user involvement, to make sure it's clinically led as well, to drive some of those, key improvements. End of the day we're trying to make patient care better. And it'll only become better if it's easy for clinicians to do their job. And bottom line is the technology ultimately is just there to facilitate and enable that. So the clinician workflows, the processes, the change management. those things are the ones that actually make or break a s a transformation project. Technology obviously is very key and important but it's only the enabler at the end of the day.
Tolita: completely agree. it's engaging the clinicians early on and often and engaging the facility and the actual users. also just some lessons learned were for me personally that it doesn't need to be a rush and it's actually better to make sure we're doing things correctly the first time rather than rushing things out and then trying to come back and fix our mistakes. So we really took our time and ensured that we had engagement and that everyone was happy to move on before we moved on. so it's definitely the slow and steady approach has been really helpful.
Rebecca: Great, and so just finally, what's next for the clinical portal? How do you see it continuing to evolve?
Sanjeewa: I think that's a very interesting question because we have many requests of what people would like to see, both from our clinicians, from our customers. that's a good place to be in. so we have got a program where we're doing incremental improvements as part of a continuous improvement program, but we're also looking at what new things to tackle on. So at the moment a lot of the focus is on things like how do we support our after hours care teams, making some of those submission of requests being more self-service, making sure that data sets are 24 by 7 available, driving the interoperability with the API frameworks. We've also introduced the use of rosters in our platform so that we can generate a lot of the scheduled rounds automatically without manually having to create them. So we'll see more and more Innovations that will actually lift that productivity because we've laid a solid foundation on it. and I think at the end of the day, we will be driven by our clinicians and our end users. And I think also want to highlight, I think, some of the adoption we've had and the success we've had so far in this initiative has been a testament to the clinicians in our teams and also to all the customers that have actively volunteered and participated. And given fantastic feedback and supported by a really great team here at Third Age Health as well, as the wider project team. So it's been a real collaborative team effort to make this where it is today. And I see that as continuing to be a very collaborative team effort with our customers and our clinicians to make patient care in aged care so much, better.
Tolita: for me personally, my favorite part of this has been able to go out and get to know a lot of the facility staff and see how they work in their space and also meeting our clinicians and spending some time with them. So it's been a really amazing opportunity and I've really enjoyed it. and thank you, Sanjeeva, for all of your hard work and your mentoring as well.
Sanjeewa: It's been a team effort. we are representing a outcome or result that's been contributed by many, many people in our teams, and with our customers and clinicians.
Rebecca: Excellent. Well, it's been lovely having you on the show able to share some of those lessons Thanks for joining me today. And thanks to Third Age Health for sponsoring this podcast episode. You can learn more about Third Age Health by visiting their website, is thirdagehealth.co.nz.