Queensland paramedics still have to print digital ambulance reports when transferring patients to hospital, despite the advent of the state’s unique digital health record.
An audit of emergency department (ED) wait times [pdf], published this week, reveals that hospitals lack the integration of the system with the supposedly integrated electronic medical record (ieMR).
“Although the Queensland Ambulance Service (QAS) has become part of Queensland Health since October 2013, there is a lack of system integration with ieMR modules in hospitals,” the report says.
“This prevents Queensland Health from being more successful in improving performance and identifying short-term root cause problems.”
Paramedics currently use iPads to “record detailed treatment and transportation information for each patient they serve” on an electronic ambulance report form (eARF).
The eARF was introduced to replace the paper ambulance report form when the ieMR was implemented.
But the electronic form “is not linked to the digital hospital system through the iEMR,” which means that paramedics have to “print digital ambulance report forms and provide hard copies to emergency services.”
“This is not an efficient use, but it is a critical process for sharing information,” said the Queensland Audit Office.
Worse, in cases where ambulances are rushed to new jobs, paramedics can only turn in their paper forms at the “next available opportunity,” which could be the next shift.
Queensland Health said verbal communication between paramedics and emergency department personnel during delivery “partially mitigated” the risk that key information about the patient’s condition and treatment would not be conveyed.
Integration suspended under six-month IT project freeze
The audit reveals that work was underway to “improve patient delivery in emergency departments” through a system interface project that began in February 2019.
But the project was suspended in March 2020 “to focus on the Covud-19 planning and response effort” and the freeze continued under the government’s “six-month suspension” on all new non-essential IT jobs.
The six-month freeze was one of several savings measures introduced in response to the pandemic in July 2020 with the goal of redirecting $ 3 billion to state coffers over three years.
Earlier this year, it was revealed that projects worth a combined $ 92 million were suspended in various departments, although it was unclear at the time whether Queensland Health had stopped any.
“When the project was discontinued, Queensland Health had been testing a pilot digital solution called the Digital Ambulance Report Application at Princess Alexandra Hospital,” the audit said.
“This solution aims to enable the exchange of QAS patient data with emergency services, specifically the electronic ambulance report form.
“The project was suspended as part of the Queensland government debt and savings plans. Due to this hiatus, Queensland Health has not compiled any findings from the trial. “
The audit recommended that the system integration project be resumed to “improve the real-time (instant) exchange of QAS data with emergency services”, which Queensland Health agreed to.
Queensland Health said this would allow “electronic transfer of ‘Electronic Ambulance Report Form (eARF)’ data to Queensland Health emergency departments” in the short term.
But “more scoping work” is expected to “integrate systems and provide real-time data exchange.”
The audit also found that QAS was not always removing access to systems from former staff, and that the corporate network accounts of 28 of the 71 employees who left in April 2019 were not deactivated six months later.
Seven of these accounts were “accessed after the staff separation date,” although a subsequent QAS review found that none had accessed patient records.
Since then, QAS has initiated quarterly user access reviews and, following approval by the ICT management committee in October 2020, has deactivated 300 inactive user accounts.