New South Wales News

November 2014

Dear ASEM Member (NSW)

Please forgive me for not updating my news recently.

2014 has been a year of major changes for me. After some health scares, I have retired from clinical Emergency Medicine after forty – five years on the job. I miss my colleagues and the contact with my patients. I had reached the point where I was treating the grandchildren of some of my earlier patients. In some families, I had treated four generations. I always described my work as similar to General Practice with the excitement of acute medical emergencies thrown into the mix. I truly miss the work. However, I do not miss the stress of ever increasing administrative demands.

I am still involved with the teaching of Emergency Medicine through Notre Dame University. I am keen to continue to work with ASEM.

I am happy to report that the Spring Seminar On Emergency Medicine (SSEM) in Darwin this year was the usual success. As well as an excellent educational program, the social events organised by the Seminar were extremely enjoyable. The weather was beautiful, a sea breeze kept the humidity down. The days felt more like holiday time in Hawaii. There was a park with a safe swimming beach near the conference venue. My grandchildren enjoyed the wave pool and an adventure at a crocodile park. I have some great photographs. The SSEM 2015 will be held in the Barossa Valley, SA. As always, it will be family friendly.

If you have any issues to raise via ASEM ,please contact me at $Q$hbzmfndjofsofz@hnbjm.dpn

Gayle McInerney

August 2013

Dear ASEM Member (NSW),

The last few months have been very hectic for me. The Emergency Department where I am working is undergoing major changes. The future looks excellent but progress means that balance can be upsetting in the short term.

Winter is here with its problems of bed block and difficulty meeting NEAT targets.

Another of my concerns is the number of overseas trained doctors who cannot find a supervised hospital post in order to work towards registration. Most have passed the AMC exams but cannot get work. These doctors are intelligent, hard working, multilingual and desperate to practice medicine. I do not know what advice to give them when they approach me for a job. I cannot employ them. Does anyone have any answers?

On a happier note, Dragon Voice Recognition seems to be a good investment to improve electronic documentation.

I am looking forward to the Spring Seminar on Emergency Medicine 2013 in Rotorua. Some of the family are coming with me including three of the grandchildren. It looks a family friendly conference as always.

If you have any issues to raise via ASEM, please contact me at $Q$

Gayle McInerney

April 2013

Dear ASEM Member (NSW)

Best Wishes for Autumn. Good luck with achieving your NEAT Targets especially when Winter hits.

College of Urgent Care Physicians
ASEM representatives attended the Goodfellow Symposium held in Auckland, New Zealand in March this year. The symposium was held in conjunction with the College of Urgent Care Physicians (CUCP). The following information is from the CUCP website (

The College of Urgent Care Physicians trains doctors in Urgent Care, an independent branch of medicine recognised by the Medical Council of New Zealand (currently under the old name 'Accident and Medical
Practice'). After successfully completing a four year training programme, trainees are awarded Fellowship of the College of Urgent Care Physicians and may practise independently in Urgent Care facilities.

CUCP defines Urgent Care as primary care services that are episodic, with a no-appointments system, covered by CUCP's training programme, and are delivered from a CUCP-approved Urgent Care facility.

Standards New Zealand, in conjunction with CUCP, has developed standards for community based urgent care clinics. Hospital standards are not being discussed. CUCP has stressed that the key features that
distinguish an Urgent Care Clinic from a general practice are the presence of x-ray on-site or within (covered) wheelchair distance and extended hours, e.g. 8am - 8pm seven days.

CUCP generally accepts Clinics that meet the above criteria and hospital Emergency Departments for Urgent Care training purposes.

Facilities that nearly meet these criteria may be considered by CUCP individually with reference to other indicators of Urgent Care functionality, including actual opening hours and how well these meet
the needs of the community served, proximity of x-ray, dedicated plaster and resuscitation rooms, equipment levels, orthopaedic clinics on-site, and an assessment of whether the physicians provide Urgent Care.

The CUCP was formed in 1992 by doctors working in community clinics and hospital emergency departments, and became an incorporated society, the Accident and Medical Practitioners Association, in 1995.

The New Zealand Medical Council recognised Accident and Medical Practice as a branch of medicine in 2000.

In 2011, AMPA changed its name to College of Urgent Care Physicians Incorporated, the Branch name to Urgent Care, and the doctor's designation to Urgent Care Physician.

As at November 2011, there are about 200 CUCP Urgent Care Physicians, with around 70% working in community Clinics and 30% in hospital Emergency Departments (with a collegial relationship with a Fellow of

- To develop and advance the delivery of Urgent Care.
- To represent its members to statutory bodies, government, the media and other entities.
- To foster research in Urgent Care.

Further information regarding the CUCP is available on their website:

FirstNet Remediation
The following information was received from Dr. Michael Barrett in March,2013.

FirstNet Remediation status highlights are as follows:

*FirstNet enhancements
Good progress on the top 35 highest priority changes: 14 already delivered or superseded, 15 submitted to Cerner, 6 still to be documented.

The Reinstate Dr Exam enhancement (where the patient goes back onto the To-Be-Seen list if not seen by the doctor) is targeted for delivery in code version 2012.01.14.

*Voice recognition
Preparation is going ahead apace. User training will begin on 25 March and last a month. Users may start using voice recognition immediately after training.

Several LHDs have requested extra licences and these users are being accommodated in the training schedule.

*Performance and reliability
System performance and reliability have been much better following infrastructure and Cerner 2012 upgrades. Reduced to a monitoring activity.

The new printing solution (Charting XR) is delayed because it does not provide “like for like” functionality to replace the old solution. Options are being evaluated.

The DA2 reporting solution has been used successfully by LHD staff at Sydney West. The plan is to move to Production after completion of the upgrade in progress at Sydney West .

*Remediation Plans
These have been delayed due to the level of effort required for voice recognition."

Spring Seminar on Emergency Medicine
The Spring Seminar on Emergency Medicine, 2013 will be held in Rotorua, New Zealand. For further information please click on the link below: ASEM Courses September

If you have any issues to raise via ASEM, please contact me at $Q$

Gayle McInerney

December 2012

Dear ASEM Member (NSW),

May I take this opportunity to wish you a Merry Christmas and a Happy New Year!

Recent Highlights for FirstNet Remediation
Dr Michael Barrett has kindly provide the following information for Emergency Departments regarding the
progress of the FirstNet Remediation program.

Emergency Department visits:

- 60 completed, 3 further requested.

Voice recognition:

- Microphones delivered and being distributed to LHDs

- Area CIOs briefed re installations

- Planning for training commenced. User training scheduled for February 2013

FirstNet enhancements:

- 6 detailed requirements with Cerner. These include Reinstate Dr Exam, Alerts, Sort/Filter Results (Message Centre), Results to Follow Patient (Message Centre), Tracking Control history and Triage Form lock

- Specifications being iterated with clinician and specialist review

- The aim is to include at least one enhancement in the Cerner general release code by March 2013


- Next release of Discern Analytics 2 tool implemented in SBB to overcome a security gap

- Data definitions and reports being migrated and tested


- Repeatable evidence found for memory problems involving mPages, Internet Explorer 7 and iView. These cause application crashes. Fixes are being pursued.

TSS led team is implementing measurements to identify the source/s of slow response times across North Coast. Very slow responses (>60 sec) have been observed."

Personally, I have yet to notice any improvement in the practical functionality of FirstNet.

I repeat my complaints:

1) poor facility for medical documentation
2) too many choices as to where to document
3) need to duplicate or paste data to produce a discharge summary
4)too many steps to order tests
5)test orders automatically cancelled when a patient is discharged or admitted to a ward
6) diagnoses codes that cannot cover every possible diagnosis
These are my main gripes. However, there are plenty more on the list.

As you would be aware, ASEM publishes a quarterly Newsletter. ASEM is keen to disseminate the views of members and to encourage discussion on matters of interest. Please feel free to express your views. Send me material that you would like to see published and I will send it on to the editor of the Newsletter.

The Spring Seminar on Emergency Medicine 2013 will be held in New Zealand, Rotorua.

If you have any issues to raise via ASEM, please contact me at $Q$

Gayle McInerney

October 2012

Dear ASEM Member (NSW),

The Spring Seminar on Emergency Medicine held at Port Douglas last month was a great success. As usual, the venue was wonderful and very family friendly. The educational presentations were interesting and held the attention of conference delegates. There was a full house at each session despite the beautiful weather and the attractions of the holiday center.

Here is more news on FirstNet.
1) Andrew Hugman from Prince of Wales Hospital is currently attending the Cerner Health Conference in Kansas City, USA. He is representing the NSW Advisory Group for FirstNet He reports-
"It is blatantly clear that Cerner has finally realised they need to pull their collective socks up .....There appears to have been a back to the drawing board approach to all their design methods and a greater focus on what the customer wants."

2) The Chief Executive of Health Support Services, NSW Government has approached Western Sydney Local Health District regarding participation in a State-wide pilot for the use of voice recognition to enter clinical documentation into the Cerner FirstNet system.

As you would be aware, ASEM publishes a quarterly Newsletter. ASEM is keen to disseminate the views of members and to encourage discussion on matters of interest. Please feel free to express your views. Send me material that you would like to see published and I will send it on to the editor of the Newsletter.

The Spring Seminar on Emergency Medicine 2013 will be held in New Zealand.

If you have any issues to raise via ASEM, please contact me at $Q$

Gayle McInerney

August 2012

Dear ASEM Member (NSW),

Here is a brief update on First Net 2011 Independent Review of Cerner FirstNet, Deloitte

Executive Summary 2.7.1
nsw Health should continue with the operation and enhancement of the FirstNet system and initiate a remediation program to address the issues in this report. The full report can be accessed at

2012 New program to improve FirstNet
The FirstNet Remediation Program has been established to improve the operation and effectiveness of FirstNet in hospital emergency departments.

The FirstNet Remediation Program with ED clinicians input will develop and implement hospital specific plans to improve:
● Immediate usability
● Access, performance and work processes
● Functionality
● Training and support.

Specifically, the FirstNet Remediation Program will:
● Expand and consolidate the State Baseline Build to achieve greater standardisation and efficiencies
● Assess and improve governance and organisational structures
● Assess and upgrade infrastructure, improve training and support
● Work with stakeholders to enhance the system.

The outcomes
Improved usability of FirstNet will enable clinicians to spend more time with patients and reduce time at the computer. Increased electronic clinical documentation will contribute to improved communication among
clinicians leading to better patient care and patient safety.

The FirstNet Remediation Program Team
Kate Gardner, Clinical Liaison Manager has extensive experience as an ED clinician, while Mike Barrett, the FirstNet Remediation Program Manager, has a strong background in project management, systems
architecture and strategy.

Next Steps
The FirstNet Remediation Program team will visit EDs across NSW to talk to ED Directors, clinicians and ED support staff to confirm known issues and identify additional issues. Suggestions about further improvements
will be sought from staff.

The team will work in co-operation with clinicians and Local Health District management to develop a remediation plan for each hospital.

For more information Please contact:
Kate Gardner, Clinical Liaison Manager
$Q$ or 02 8644 2621

The Program Manager for FirstNet Remediation is Dr Mike Barrett. At a recent presentation he stated that the common theme of concerns was-
1) Access (Sites did not have enough computer access for staff. He
showed a picture of a typical "dead COW park" displaying non functioning
2) FirstNet Usability (Problems involved work flow,documentation and
the ability to view notes.)
3) Support
4) Reporting

Possible partial solutions were-
1) Voice Recognition ( Each user needs a high speed computer that is dedicated to his or her use. The initial cost is > $4,OOO per user.)
2) Reporting tool DA2 ( This is not an end user friendly tool. It may need computer programing level skills.)
3)Daily computer restarts.

Can Dr Barrett's team succeed where all others have failed? This remains to be seen.

2012 Manly Emergency Department Voice Recognition Evaluation
100% of doctors rated the use of Dragon ( Voice Recognition) as having made documentation easier.
( The full report can be accessed at Click on resourses, publications,reports,Electronic Medical Record.) You can see a Noance Dragon Medical Demo if you go to U Tube.

As you would be aware, ASEM publishes a quarterly News Letter. ASEM is keen to disseminate the views of members and to encourage discussion on matters of interest. Please feel free to express your views. Send me
material that you would like to see published and I will send it on to the editor of the News Letter.

Don't forget to register for the Spring Seminar on Emergency Medicine to be held 25-28 September at the Sheraton Mirage, Port Douglas just before the October Labour Day long weekend.

If you have any issues to raise via ASEM, please contact me at $Q$

Gayle McInerney

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Tel/Fax: (07) 3134 2272
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