Fraser Health sees benefits through IT upgrade

SURREY, B.C. – Fraser Health has embarked on a large-scale program to modernize its electronic technology and the way it delivers care. The core technology being used is MEDITECH’s Expanse platform. All of the additional solutions being used will feed into Expanse, giving clinicians and administrators a single view of the patient experience across the giant region.

At the same time, the health authority is introducing new, automated medication dispensing cabinets, front-end speech recognition for clinical note dictation, and tap-and-go roaming desktops that allow employees to securely log into electronic records using their ID badges.

As the province’s largest health authority – and the second largest health system in Canada – Fraser Health delivers hospital and community-based services to 1.9 million geographically dispersed people. It’s supported by more than 30,000 medical staff.

Management and clinicians at Fraser Health realized that with steadily increasing patient loads and medical challenges, new ways of delivering care were called for. As a key strategy, the region is improving its workflows and ensuring that information is available at the point-of-care in real-time.

This will enable more efficient decision-making, limit “document chasing”, reduce the risk of errors and enable care-providers to spend more time with patients.

Victoria Lee, president and CEO of Fraser Health, said earlier this year: “Digital transformation is foundational to providing better health and best-in-health care.”

In April of this year, the health authority began implementing the system – centred around Expanse – at the Eagle Ridge Hospital in Port Moody. The success of the deployment has given the entire region confidence in speeding up the rollout to its 11 other hospital sites.

Benefits of working in a digital environment are already being reported at Eagle Ridge, with some nursing staff stating they’ve gained back two hours per shift at the patient bedside.

One group eagerly awaiting the rollout of Meditech Expanse to all sites is the Fraser Health Advanced Analytics and Data Science team, who’ve been delivering insights based on retrospective data for the last few years.

“They’ve built so many different AI models with just rudimentary data that we’re pulling retrospectively. The ability to have almost near real-time data available to help inform and further optimize those models will take us even further ahead from where we are today,” said Dr. Amyeen Hassanali, chief medical information officer and one of five program sponsors, referring to the ability to do more predictive analytics and early warning interventions.

Analytics and AI-powered forecasting will provide the region with a system of continuous quality control and improvement – an enormous benefit for patients.

Moving forward, the remaining 11 Fraser Health hospital sites are being clustered into five Expanse activations. Fraser Canyon and Mission Memorial hospitals, rural systems similar in size to Eagle Ridge, are scheduled to go live this fall, and the Royal Columbian Hospital, considered a sister site to Eagle Ridge is scheduled for April 2024.

A final grouping is expected to go live in 2025 and will include smaller facilities and long-term care centres.

In the interim, links will connect the new Expanse system and the remaining legacy MEDITECH client/server systems, giving clinicians access to records when patients travel between sites.

Dr. Hassanali stressed that change management and training are essential to a successful implementation. Not only is new hardware and software being deployed, but staff and clinicians need to work in different ways to obtain the benefits of real-time information and quality systems.

For example, for clinicians, new electronic ordering and regional order sets are being implemented, requiring them to work differently than before.

Similarly, nurses are learning how to use a real-time electronic documentation system, closed-loop medication management and medication verification using barcode scanning. Some of them will also be using handheld devices to support bedside documentation.

New, electronic solutions are also being introduced in pharmacy, lab, and diagnostic imaging.

Changes are being made in registration and scheduling, too, with streamlined workflows for scheduling acute and ambulatory settings. The new system simplifies how beds are managed and provides real-time information on patient location.

In short, there are significant gains being made in access to information for clinicians and staff across the enterprise, and in the quality of care for patients.

However, there’s a lot to learn. For this reason, Dr. Hassanali observed that a good deal of time and training is needed. “It’s about allowing providers time to accept the fact that they’re going to be doing things differently,” he said.

Meaningful engagement with medical staff, and ensuring the right clinical representation is in place to help with decision-making related to Advance, is a top priority, said Dr. Hassanali.

Users are supported during the go-live stage in three main ways. First, the health authority attempts to keep patient loads at a manageable level, diverting to other sites or reducing the number of elective surgeries, for example.

“We can never close the doors totally, but we were very successful at getting site occupancy down at Eagle Ridge and it was a huge part of our success,” said Dr. Hassanali.

Second, they try to increase staff levels during the initial go-live period and third, they bring in 24-by-7, “at the elbow dedicated support” for as long as needed – which ended up being six weeks at Eagle Ridge.

One of the early lessons learned from the first implementation, was that the training program must be “truly representative of day-in-the-life scenarios and workflows,” added Fraser Health VP, Digital Provider and Patient Experience, Jennifer MacGregor.

Eagle Ridge employees were given the opportunity to attend a technical ‘genius bar’, to ask technical questions specific to their individual mobile devices and learn more details about how they would be accessing the electronic system remotely prior to implementation.

“You need to be able to train the workflow, walk through what the admission and transfer workflows will be, and train the staff on the steps and the process, not just the functionality of the system,” said MacGregor.

Although new workflows were carefully planned ahead of the go-live, Eagle Ridge staff could ask for help when unexpected challenges were encountered. For example, when they realized the digital workflow for prescribing outpatient antibiotics needed to be modified, a revised workflow was created and extra training was provided.

“We recognize that getting all of our sites up on one system is a very important task for us to do as quickly and efficiently as possible, while ensuring we’re taking time to work through the change management piece,” said Dr. Hassanali.

As the Expanse system and other solutions are rolled out, MacGregor is excited about the conversations they can share – across the region – showing how digital tools can improve the clinician experience and reduce their burden.

“Our CEO, Dr. Lee, is very forward thinking when it comes to how we can transform our clinical operations by leveraging digital technology and that’s why this initiative is foundational,” she said.