New technology improving access to patients’ electronic health records

New technology has optimised healthcare delivery and outcomes at several Victorian health services by improving access to patients’ electronic medical records (EMR).

Led by AHRA Research Translation Centres, key stakeholders worked together to implement an open-source data infrastructure platform called CogStack supported by the Monash Partners Learning Health System (LHS). Modified for Australian use by a team at Monash University, CogStack allows information to be extracted from an EMR, regardless of whether it is structured information such as
drop-down menus, unstructured free text or information contained within scanned documents or images.

Past Monash Partners Executive Director and lead investigator, Professor Helena Teede AM, said the technology is enabling information not previously accessible to be harnessed. “In the past we have only been able to examine the smallest amount of information entered into a patient’s health record,” she said. “It was limited to structured data such as age, what unit someone was admitted into, and how long their stay was. So, this technology is a game changer,” said Professor Teede.

The National Learning Health System Data Management Platform project received a $1.9 million Coronavirus Rapid Response grant from the Medical Research Future Fund in 2020. Monash Partners led the project, supported by Health Translation South Australia, which worked with local government on LHS and natural language processing needs, and Sydney Health Partners, which led nationwide research on health service use of artificial intelligence.
The Western Australian Health Translation Network and Health Translation Queensland were non-funded collaborators on the project.

The aim of the project was to enable Australia’s health system to learn and be responsive to community needs during a crisis and beyond. Professor Teede said one example of the platform’s impact is the new ability to link Australians more rapidly to cutting-edge clinical trials.

“The use of CogStack can replace current manual processes and is expected to reduce the number of people who are missing opportunities to access innovative advanced treatments,” she said. “Health Services will be able to identify people that might benefit from a particular clinical trial, based on their diagnosis and test results, using much more efficient and accurate systems.

“Potentially, our hospitals will be able to rapidly identify symptoms and patterns for conditions, such as COVID-19, and set up prompts and processes to check test results, identifying those at highest risk and reducing disease spread.”

“Access to the information within an EMR matters. Insights into
patients can be gained in ways not always possible from an individual
clinician perspective.”

One of the first Victorian health services to implement CogStack for clinical trials was Alfred Health, which used it to improve trial recruitment. The technology enabled Alfred Health to screen many more patients for trial suitability, in less time than the existing process of manual identification.

“We’ve identified far more patients through CogStack than the clinical team has using their existing processes,” said a user. “It’s maybe not a perfect comparison, but I think that shows that it’s been of value and successful.”

Professor Teede said the application of CogStack has been transformative, and that by improving access to information it delivers an unprecedented ability to improve healthcare and patient experience.

“Access to the information within an EMR matters. Insights and trends become clearer when information from many people is combined, and different insights into patients can be gained in ways not always possible from an individual clinician perspective.”

Professor Teede pointed to the National Centre of Health Ageing (NCHA), which is a partnership between Peninsula Health and Monash University. NCHA used CogStack to estimate how many people in the region have dementia and identify the suburbs they live in. By applying this knowledge, Peninsula Health hope to identify people with dementia earlier and refer them to diagnostic and ongoing services and supports sooner, and closer to home.

Professor Teede said the project demonstrated that large-scale use of EMR information can also improve the quality and safety of healthcare by supporting clinicians to make evidence-based decisions.

“A platform for managing this data, which supports a learning health system, can improve patient experience and outcomes, improve service efficiency through better coordinated care and communication, deliver better value and reduce costs, whilst optimising health system performance,” she said.

Towards a national data management platform and Learning Health System
AHRA Members and Project Partners:
Monash Partners Academic Health Science Centre (lead)
Health Translation SA
Sydney Health Partners (funded)
Western Australian Health Translation Network
Health Translation Queensland (non-funded)
Health Translation SA worked with local government around LHS and Natural Language Processing (NLP) needs and Sydney Health Partners led research on health service use of AI nationally.

Other partners:
Alfred Health, Monash University, the National Centre of Health Ageing (Peninsula Health), Outcome Health, Kings College London, Australian Digital Health Agency, Digital Health CRC, Safer Care Victoria

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