Hospital staff pushing a patient down the corridor on a gurney

Data in Darlinghurst: Reviewing a hospital's data practices to inform a future electronic medical records system

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St Vincent's Hospital is a leading tertiary referral hospital and research facility located in Sydney's Darlinghurst. As part of the hospital’s Inclusive Health Strategic Plan, we were engaged to review how it collected and used the data of vulnerable patients and to explore system improvements that might inform a future electronic medical records (EMR) system.

How should a hospital collect and use the data of vulnerable patients?

Due to St Vincent’s inner-city location and the reputation of its community health services, one in three inpatient and emergency department (ED) patients present with psychosocial risks. But the hospital was constrained by legacy data systems, which had limited capacity to share data and did not support the capture of social characteristics relevant to patient care. Rich psychosocial histories on the patients existed, but were siloed within various systems.

This project responded to the difficulty to efficiently gather and analyse this data and sought to ensure that the hospital’s implementation of an EMR would support the care of its most vulnerable patients.

“St Vincent’s Hospital Sydney is ingrained in the fabric of inner-city Sydney,” says Senior Consultant Will Mallett. “By virtue of its location and reputation of its community health services, St Vincent’s treats a significant number of patients experiencing vulnerability. It was important to do this for those people.”

“Hospital presentations for these patients can be distressing and have the potential to perpetuate social stigma. Ensuring that staff can access the right data at the right time is critical to not only creating a patient-centric experience, but also identifying care needs before they have to be communicated.”

“Figuring out the data points and analytics required to support this decision-making was difficult, considering the vast range of options. But hearing real-world examples from staff lead to very practical recommendations.”

How do you map a data ecosystem?

The journey and health outcomes of vulnerable patients are a product of how their data is collected, shared, and analysed. To assess the state of St Vincent’s data use and to inform our recommendations, we mapped its data ecosystem. We started by dividing this ecosystem into four key components:

  • Datasets – The data St Vincent’s gathered on vulnerable patients and the frameworks in place to standardise its collection.
  • Information systems – The tools the hospital used to store its vulnerability data and the degree of integration and information-sharing between systems.
  • Analytics – The methods it used to extract insights from vulnerability data and how that informed clinical decision-making.
  • Patient experience – The health outcomes and patient experiences that eventuate from the interaction of data collection, storage, and usage.

To map the hospital’s data use and propose future solutions, we conducted a number of activities:

  • Document review – We reviewed St Vincent’s documentation, including process maps, system architecture, vulnerability frameworks, and data dictionaries.
  • Initial consultations – We consulted with six stakeholders in ED, nursing, inclusive health (drug and alcohol, homeless health), innovation and improvement, patient flow, and social work. We also toured the hospital’s campus and emergency room.
  • Survey – We surveyed staff to determine how data on vulnerable people was then collected, the benefits/limitations of its vulnerability frameworks, the functions of its systems, the data points it captured as a priority, and future system recommendations.
  • Focus group and presentations – We used group participation to test insights and socialise proposed solution.

The way forward for St Vincent’s and its vulnerable patients

Our final report mapped the data points that St Vincent’s collected on its vulnerable patients, and what frameworks and information systems it used to collect and store that data. The report assessed its information systems on criteria including data richness, accessibility and functionality, the better to understand how these could support the hospital’s clinical decision-making.

“The most exciting aspect of the project was translating the knowledge of front-line staff into their data systems,” says Mallett.

The second half of the report made recommendations as to how St Vincent’s could evolve its data use as it transitions to an EMR. The recommendations explored how the hospital could be more inclusive in its language surrounding vulnerable patients and proposed opportunities to move to a more predictive and preventative model of care through data analytics and interoperable systems.

Both the current- and future-state assessments of data use included patient journeys for vulnerable patients at St Vincent’s. It did this to demonstrate how the data ecosystem could create a stigmatising experience for a patient, while the ideal future state, with a single view of the patient, might empower staff to make more data-informed decisions to enhance the experience and outcomes of a vulnerable patient.

“After years of treating and developing relationships with patients experiencing vulnerability, the St Vincent’s staff are now able to quickly assess both medical and social needs,” Mallett says.

What you can learn from our work with St Vincent’s Hospital

Emergency departments may represent a safe and familiar environment for people experiencing vulnerability and are typically the first point of call within the healthcare system.

The know-how of staff can help overcome data gaps and siloed systems but codifying their knowledge is the key to a scalable solution.

A holistic healthcare journey for people experiencing vulnerability does not end at hospital discharge. Connecting with community and social services establishes a necessary support network.