Thank you so much, Melissa. Our final speaker is Christine Kilpatrick. She's been the Chief Executive of Melbourne Health since 2017, and before that she was at the Royal Children's Hospital and in various other roles. She is a neurologist specialising in epilepsy. Christine's a member of several boards, including Orygen, National Centre of Excellence Youth Mental Health, the Walter and Eliza Hall Institute, and the Florey Institute of Neural Science and Mental Health and Victorian Comprehensive Cancer Centre. So she's a very influential person in our state.
Christine's led the introduction of the electronic medical records in two hospitals, starting with the Royal Children's and now Royal Melbourne. And they went live at Royal Melbourne during the pandemic. They were slated to go live at the very beginning of the pandemic and postponed it and ended up going live during the pandemic. So it'll be very interesting to hear from her about how that went. I'm sure there are some unanticipated consequences and local quirks, but we know from hearsay that it's been a success and that it's a crucial element in designing a more patient-centred journey. So to tell us about this journey and what's on the horizon, let's welcome Christine.
Thank you very much, Wendy. Thank you. So what I'm going to talk about briefly is the introduction of EMR in Parkville, in particular across the Parkville or Melbourne Biomedical Precinct.
So the Royal Melbourne Hospital, where I had the privilege of being the Chief Executive over the past three and a half years, we have a strategic purpose, which is about advancing health for everyone every day. And to deliver this, we've identified five strategic goals and in four of these the EMR, electronic medical record, is absolutely fundamental to achieve. Those being that we want our organisation to be a great place to work and a great place to receive care, we want to grow our home first, our home based program, we want to realise the potential of the Melbourne Biomedical Precinct and in particular the connectivity of the four hospitals in the precinct, and of course we want to become fundamentally a digital health service.
And so, it's fair to say that the health sector has been rather slow to use technology to support and to deliver healthcare, and really to implement an enterprise wide electronic medical record. Now, I think there are a number of reasons why that's so in this country. I think our sector is somewhat risk averse. Health has traditionally been risk averse, and probably government, for some good reasons, has been risk averse. We've seen plenty of technology implementations fail, and early attempts, in particular in Victoria to introduce digital health systems, were not particularly successful. Overall weren't successful. So this added to, I guess, the negativity and reluctance to go down this pathway. And then the final point is that obviously it's an expensive endeavour to implement, and costs meant we needed government support to achieve this.
So it became obvious to us that healthcare is really, I think, far too complex these days to be managed on a paper-based system. It's just far too complicated. And the benefits of an EMR are very clear to us all now. They support safe care, reduce variation in care, reduce duplication of care, assist in doing the right thing, in delivering evidence-based medicine. They improve connectivity of care across the precinct, particularly when the four hospitals are on the one system, and they improve the patient experience, as well as of course the fundamental ability for the patients to have access to their own medical record. And of course, very, very importantly to us and to the university and to our medical research usages, is they enhance research across the Melbourne Biomedical Precinct.
So we knew very clearly in our minds that what we needed was an electronic medical record. And in 2018 we were fortunate, we were able to convince the Victorian government and they were committed to funding the implementation of what turned out to be our choice – the Epic system across Royal Melbourne Hospital, Royal Women's Hospital, Peter MacCallum Cancer Centre, using the Royal Children's Hospital EMR, which we had implemented there and went live in 2016.
It was a big program. It started in 2018 and as you heard we went live in August this year. We called it Connecting Care, because that's what it's all about, and these are logos of the four hospitals. So it was a big undertaking and a big cultural change for all four organisations working closely together, but we did successfully do this. Next slide.
And so, I think there are a number of factors which are critical to the success. I mean, I have the experience of doing only two, I must admit, but nonetheless. There are probably not that many CO's who've put in two electronic medical records, or been involved in it I should say. So, critical to success are these factors, I think. You need to get a project director who's done it before, at least once. Preferably a few more times than once. So on the precinct here we recruited Jackie McLeod from the Children's, so putting in at the Children's, and she'd also put in Cerner at Austin. So had a vast experience with both Cerner and Epic, so that was a great success factor for us.
The other is the choice of the product. When we were at the Children's we went out to tender and Epic was our choice, and they had certainly been a good company to work with. You work hand in hand with them and they're as keen to have success as we were keen to have success. So we both needed to succeed to be a successful outcome.
The other is, I think, fundamental is to see the EMR as not an IT project. Although IT is critical of course and IT staff are critical to support it, it must be seen as a clinical change management project. And I learnt that very clearly at the Children's.
The other is of course engagement of clinicians. Not only in the implementation and building it and working with it, but also in the choice of the product. And at the Children's we had them on the procurement team and choosing which product they wanted to implement. I think it's key to focus on change management, because that's what it's all about. And so, significant resources for change management are critical. The governance of the project is really, really important. We had all sorts of layers of governance. Something I think maybe we overdid it, but it worked well at the Children's so we used the same model for the precinct and I think it has served us very well.
And the other point is we had a team of 120 and at one stage 150 people working to build EMR, and 64% of those people came from the health services, including the Royal Children's Hospital. So there's a lot of people who understood what they wanted to achieve, understood the health services. And now when many of those go back to their roles, original roles, then they take with them extraordinary amount of knowledge. And similarly for super users, which are critical to a successful go live. These are the people that are trained up and know everything imaginable about the EMR system. We used in house people. So we looked for our own clinicians to become super users, we didn't bring super users from outside. So that certainly worked very well. We also used medical students who worked out to be wonderful super users as well, and I think they very much enjoyed it.
So the project, just at a high level, went across 25 sites of Royal Melbourne Hospital. So it's huge. Five sites for the Women's Royal Hospital and five sites Peter MacCallum Cancer Centre. And 11,900 odd staff needed to be trained across our organizations. And as you heard, we were planning to go live and we're on track to go live, the date was chosen some time ago for the 2nd of May this year, and we are on time, on budget and in scope. But COVID wave one arrived and the end of March we were hearing stories that there'll be a big and serious wave, wave one, and no doubt it that was similar to what we'd seen overseas then 40% of staff would either have COVID and not be at work, they'd be too afraid to be at work, or they'd be furloughed. So we made a terrible, and when I say terrible, a very tough decision, but there was enormous pressure on us to defer and say, "No, we will not go live because of COVID wave one."
Well, by the end of April, COVID wave one was disappearing and we thought we'd dodged a bullet and we would be fine, and so we made a further decision. Yes, we would go live, and we chose the date of the 8th of August 2020. And the reason why it had to be quite a few months ahead is because of all the social distancing we had to change our model of training. We couldn't have lots of people in a room, which we normally would do. We had to have very few people socially distance in a room, and we needed to do online training as well.
So that was our date we chose, the 8th of August. in the next slide you'll see that that was absolutely spot on our peak of COVID patients, in patients, at Royal Melbourne hospital. In fact, it was four days earlier, 99 we had. But it was about 94 patients we had on our go live date. So it was a very difficult July and early August coming up, wondering whether we should keep going. Of course there were a number of staff who thought we should definitely stop, but there's an enormous amount to lose if we stopped and an enormous amount to gain by going live. And so, very nervously, very anxiously, we decided that we'd keep going and we would go live.
In the next slide I think it talks about... I'm highlighting here the benefits of going live. Not going live in a pandemic, but having an electronic medical record in a COVID pandemic and then beyond. The first point to make is that the go live was remarkably, surprisingly successful. And I think staff saw it as a distraction, sounds odd, but a real distraction from what they were going through with looking after COVID patients and managing the situation. So that was a positive.
But the other positives once we had the EMR, we could manage the screening clinics, which we had here at the hospital for patients who came to be screened and swabbed, and screening of visitors who came into the hospital. And the questions, as you may all recall, kept changing all the time. And so, this could be quickly and automatically updated into the EMR, and that happened very frequently and was so much easier. And guidance for PPE could be quickly and frequently uploaded into the EMR and we could keep up to date.
We could understand the COVID status of our patients. We had automatic reports on the number of patients in hospital who were COVID positive, who were suspected COVID, and who had become cleared of COVID and their location. And that was just automatic whereas before that we had bits of paper trying to work out where everybody was.
The other very important issue that I never thought about as being a positive of an electronic medical record was that staff were able to access the medical record either from their home, if they were at home, or from another site or away from the patient, and this was of course an enormous benefit with social distancing during these times.
The other is that we could use telehealth and staff could be at home and use the EMR to do telehealth and enter into the medical record. They could be at home and look at their patient's record when they're an in patient in the hospital and see what was happening.
We also realised now, we never thought of this as a potential benefit of EMR, is that we can support our home based care. And so, we're now starting to use EMR for supporting patients at home, and this is a great asset for our staff. And then finally, of course, virtual care. There are a number of ways of supporting patients out in the community, and EMR is a huge benefit for that.
So I guess we've always seen the benefits of the safety of care and understanding the patients and understanding the flow of patients and having everything at your fingertips and the benefits for research, and they are of course profound. But we had never thought through or thought about these benefits such as telehealth and home based care and virtual care, which has clearly come from the EMR.
So that's been our journey. I make it sound like it was absolute roses. There, of course, was the challenges with the go live. But overall it's been remarkably and surprisingly successful, and I think in a funny, strange way the COVID pandemic probably helped us along the way. So thank you, Wendy.