There is a growing desire among society for personal autonomy to be respected in the healthcare industry, and for individuals to have the opportunity to say what’s important to them.
Advance Care Planning (ACP) is a concept that was introduced internationally in the late 1980s, only gaining traction in New Zealand much later. The New Zealand Ministry of Health now acknowledges the importance of this concept, and has created guidelines for the healthcare workforce on the creation and execution of well-designed ACPs.
Canterbury DHB has acknowledged these societal trends and are helping people plan for the end of their life by implementing the first electronic Advance Care Plan.
Advance Care Planning is a process of discussion and collective planning for a patient’s future healthcare, so that they can have the opportunity to indicate their preferences for their own care while they are still competent. ACP involves an individual, whānau and healthcare professionals, and takes into consideration the following things:
- The person’s values, beliefs and goals
- Their current and future health
- Treatment and care options
These plans are nurturing difficult conversations by breaking down communication barriers and reducing stress at a time where the patient requires care and can no longer make decisions for themselves.
Canterbury DHB’s vision is of an integrated health system that keeps people healthy and well in their own homes, providing the right care and support, to the right person, at the right time and in the right place. In order to support the ACP, they recognised that they needed strong infrastructure systems and support, which is where Orion Health comes in.
In 2014, Canterbury DHB implemented their first electronic ACPs, then stored in the Connected Care Management Solution (CCMS). However, sharing this information across providers was difficult, especially in acute care. In July 2016, a new system, Orion Health’s Care Pathways was implemented so that ACPs could be accessed through a shared portal. This established an interface that enabled electronic ACPs to be created, viewed, shared and updated by healthcare professionals across the health sector.
The ability to integrate with the already established HealthOne and Health Connect South(HCS) solutions ensured the ACPs were able to be shared in a single system, and that healthcare professionals could access important patient information easily.
The beauty of incorporating ACPs with these systems is that plans can be viewed, information can be updated, and plans can be reported on in terms of quality and quantity. The reporting functionality provides healthcare professionals with the ability to review plans and check for inconsistencies or issues that may not have been identified yet.
The new electronic ACP system has achieved outstanding results, with over 1600 electronic ACPs published to date, and a consistent publication of 70-100 new ACPs per month. Jane Goodwin, Advance Care Planning Facilitator, Canterbury Health attributes this to the responsive and user-friendly IT system implemented in collaboration with Orion Health.
The overall visibility of ACPs has increased due to the ‘Care Plan’ alert feature in the new system, making it easy for hospital staff to identify whether a patient has an ACP. Canterbury is now in a position where 81% of electronic ACPs are being recognised without any prompting from the ACP facilitators, compared to 68% three months before the new system was implemented.
The solution is contributing to Canterbury DHB and Orion Health’s shared vision of keeping people healthy in their own homes and staying out of hospital. Patients now have the opportunity to pass in their preferred place, reducing acute bed days and hospital resources used. It is an example of how user-friendly electronic platforms are fundamental in gaining support from clinicians and improving patient-centric care. The electronic ACP system is helping patients to have a voice when they no longer have one.
Listen to Jane Goodwin, Canterbury DHB discuss the success of the solution in her talk at the recent HiNZ 2017 conference here.