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Verdi Internship Intro

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John Iaria

on 27 May 2015

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Transcript of Verdi Internship Intro

» Difficulty tracking referrals

» Only viewable by one person

» Bottlenecks in workflow

» Lost referrals

» Many risks - limited accountability
» Automates referral process

» Enables staff to spend time on more pressing areas

» Identify bottlenecks

» Sydney Children's Hospital had a 30% improvement
using a patient reminder service from Telstra
The Referral Process
How it works
Track Referrals
Faster and more secure workflow
Reduce costs
Make reporting easy
Reduce risk
» Follow a referral through every step
of the process

» No need for maintaining spreadsheets
» Quantify costs and losses associated with referrals

» Increase revenue from State and Federal funding
due to early detection of invalid referrals
» No Paperwork

» Received automatically

» Monitored at every step of the process

» Eliminate lost referrals - no referrals have ever
been lost using V-Referral

» Automatic patient reminders
The only workflow solution that processes referrals
received via fax, paper or electronic submission.
Clinicians are mobile
» Need to access information while doing rounds

» Need to make decisions while away from the hospital

» Have been known to take photos of patient wounds on their own
devices and send these to other clinicians for advice and opinion

» 89% of doctors use smartphones and 51% use tablets -
100% consider a mobile app to be essential

» Securely encrypted information, only available to those with

» Clinicians will have the information they need to make the
right decisions while outside of work

» 100% of young training doctors surveyed
admitted to regularly using their smart phone
devices to take clinical photos, 85%
of whom said they had inexcess of 100
such patient images stored on their personal
Reduce Patient risk
» Clinicians won't need to wait until they are at the hospital
before making informed decisions

» Clinicians can sign off on reports and test results from any

» Staff don't need to wait for a terminal

» Fewer adminstrative staff are required to manage patient
Improve efficiency
» Clinicians won't need to wait until they are at the
hospital to make informed decisions

» Low upfront cost and can be easily budgeted for

» Saving to Hospital which may not be
able to afford the CAPEX of mobile devices
Save costs
» Information from disparate systems is presented in
the one easy to read format

» Can be overlayed onto any existing system
Utilise existing infrastructure
» Easy to use

» Save time and effort

» Intuitive to learn
» Extend the life of older information systems

» Add and delete systems and retain the
same interface
» Limit the need for issuing multiple licenses
to Clinicians

» No large upfront cost - easy to budget for

» Low risk OPEX solution vs rip and replace
high CAPEX offerings of competitors
» The upfront cost of an EMR can go into the hundreds of
millions of dollars but effectiveness and clinician
satisfaction plateaus as more complexity is added

» The rate of failure for implementing
new EMR systems is between 30-50%.
Underutilisation very common

» Practices that adopt EMR solutions
gradually using an incremental
implementation approach are
90% successful
Physicians demand driving more EHRs to go mobile, 17 june 2013 American Medical Association

Australiasian Journal of Dermatology, Kunde et al, 2013
Peter MacCallum
The situation
» Only Public Hospital dedicated to cancer and home to the largest
cancer research centre

» Needed a cost effective eMR and integration of multiple databases

» Cancer treatment is complex, multidisciplinary and involves multiple
admissions and outpatient visits

» Longevety: PMCC has 7 booking programs and couldn't afford to
replace them all at once
» Verdi can evolve as the organistation does
(popcorn databases can be integrated)

» Customisation: Views at PMCC are customised to their preferences

» Used across the entire hospital, (in 2012-13 FY) 2242 users
invoked services through Verdi from 4700 devices

» V-Notes is used more than any other application including Pathology
(2,656,000 ind. patient records accessed over 1 yer Vs. 2,204,000)
Peter MacCallum
"Verdi is the greatest advance in the medical record since the invention of paper."
Professor John Zalcberg
OAM Chief Medical Officer & Director,
Division of Haematology and Medical Oncology
Mater Health Services
The situation
» Spending $2-3M PA on maintaining a paper based record

» Use of clinical systems in private practice is prevalent. This drives
expectations from clinicians in hospitals

» Capital dollars are scarce and there is competition for this
(ie. Clinical equipment)

» Needed faster access to the Patient Health Record
Mater Health Services
The proposed architecture
Mater Health Services
» Established in 2007

» Endorsed by Clinical Directors and Mater Board within 4 months

» 7 weeks to launch Verdi with:

» 1200 beds
» 20 services and 180 databases
» 1 x IPH FTE Technical Staff Member
» 1 x Mater FTE Technical Staff Member
» 1 x IPH Project Manager
» Training program
Mater Health Services
Implementation Challenges
» Mater legacy pahology system:
Vendor chose to write their own web service access

» Same patient with multiple UR# - Verdi can link to either PAS or
Enterprise Master Patient Index

» External providers: results from Box Hill Pathology and internal Path
Lab displayed as one view

» Majority of systems already had APIs available - Verdi services fetch
data trough IP Health extensions of Microsoft ADO.Net provider model
Mater Health Services
Usage Results
» Unique Patient Records accessed: 19,154

» Total Patient Records accessed: 62,818

» Average number of services accessed per user: 13

» Total number of service requests: 44,579

Mater Health Services
» Significant increase in the percentage of Patient Records accessed
concurrently by multiple users with no additional cost

» Significant increase in the percentage of remote logins

» Easier location of key information due to predictability of format

» Constraint of licence costs for viewing of information in source
information systems

Data Source: Mater Hospital - February 2011
"The electronic patient record
has made life easier, it saves time. Everything is available and traceable. We know who has looked at what record when, which is important both in terms of clinical trials and confidentiality and privacy."
Professor John Zalcberg
OAM, Medical Oncologist and Chief Medical Officer
at Peter MacCallum Cancer Centre
"Verdi is the greatest advance in the medical record since the invention of paper."
Professor John Zalcberg
OAM, Medical Oncologist and Chief Medical Officer
at Peter MacCallum Cancer Centre
"Verdi as a communication tool is absolutely vital to the well-being of patients, it allows forwarding planning, it allows recording of real time events around that patient and it allows subsequent recall of events down the track, whether that's for medical reasons, medicolegal reasons.... it's a very useful tool."
Dr David Skewes (Anaesthetist)
"I looked up Verdi and instantly there was this array of information, correspondence letters, previous pathology, past history... that was completely relevent. It completely improves the quality of patient care."
Dr Sarah Swan (Pathologist)
"It is an extaordinary tool to use. There is nothing like it anywhere I have seen."
Dr David Bernshaw
Reduce risk and cost:
Each product can be implemented one at a time - there's no need to do it all at once
We implemented Verdi in a 1200 bed hospital in less than 8 weeks
New systems can be integrated over a few hours. We can train your IT staff or do it for you
It's all accessible through an intuitive interface - so it's simple to learn
Accessing this information can be tedious and confusing.
Hospitals have lots of information
in a number of repositories from a variety of systems.
All the information,
from any location with one login
Utilise existing systems
Save costs
Save costs
Gain greater accessibility and efficiency. Reduce risk with no changes to hardware or upfront investments in new systems
The Mater Hospital in Brisbane has about 20
systems with 180 unique services -
a doctor would have to access on average 5-6 different
screens without Verdi.
Dr. Sarah Swan, Pathologist

Self-organises within the team to perform work
Assists the product owner
Break down user stories into tasks
Communicates progress consistently
Provides feedback on both work and development processes
Supports team success
Works across many areas
Has the overall vision of the product
Interacts with the stakeholders, etc
Maintains the backlog and prioritises it
Identifies and adds user stories
Defines acceptance criteria for the user story
Verifies that these criteria are met
Agile development coach
Gets road blocks out of development's way
Authority on the agile process being followed
Sets up and handles sprint planning, review, retrospective
Shields development from outside interference
Including the product owner
Push for understanding and change within the organisation
May be actual company customer, or internal team
Participates in sprint review session
Delivers feedback on functionality and design
Provides priority information to Product Owner
Identifies gaps in user story list and product backlog
Scrum Master
Product Owner
Scrum Roles
Often executive level management
Provides high level goals and customer needs
Informs team of long term organisational goals
Periodically reviews product and provides feedback
User Stories
As a <user>, I want <functionality>, so that <goal>.
Written from a specific user's point of view
User Story workshops are used to prepare initial list
Starts as a simple sentence
No implementation details
No UI assumptions
Flexible to change and still meet goal
Typically estimated in story points
As it approaches the top of priority queue it is prepared
Broken into smaller stories if needed
Only complete if it meets the Definition of Done
Daily Scrum Meeting
All team members attend
Limited to 15 minutes
Answer the following questions:
What did I do yesterday?
What will I do today?
What is blocking me from completing work?
Scrum Master should listen for issues they need to assist with
But team is not 'reporting' to scrum master
They are reporting to each other
Sprint Review
Purpose is to inspect the product
Open to stakeholders, customers, etc
New functionality is demonstrated
Feedback is provided, resulting in:
New stories
Updating priority

Sprint Retrospective
Purpose is to inspect the process
Limited to the team
Answers the following questions:
What went well?
What went poorly?
How could we improve?
Real focus is to get team talking in a safe environment
Identify what is holding them back
Follow up on solving those issues
Acceptance Testing
Given...When...Then (mostly)
This is testable
Part of 'Definition of Done'
Set by Product Owner - agreed upon by Verdi team
Pivotal Tracker

Sprint Planning...
Full transcript