PRMs implementation
The following diagram illustrates from a high-level the technical and change implementation approach. These components are further explained below.
Components of the technical and change implementation approach
Feasibility and preparation involves meeting with a centre’s Oncology Information System (OIS) administrators and other key contacts to understand potential integration and how the centre has set up their OIS.
The initial kick off meeting includes all key staff members, both clinical and technical. Institute staff run through how the PRMs system works and provide examples of how other sites have implemented the system from a workflow perspective.
Technical configuration is where the Institute’s PRMs technical team coordinates the interface build to allow for the integration of the OIS and the PRMs system, and configures the PRMs system with the appropriate settings according to the site’s preferences.
Planning and mapping workshops are set up by the Institute’s PRMs team and held with the site’s key clinical staff members to determine the workflow that best suits the centre/department.
The Institute’s PRMs technical team work closely with the site's OIS administrators and the OIS vendors to test the integration and implementation of the system and subsequently to resolve any issues found.
Coaching and training of the site staff is completed at times suitable for the centre’s staff.
User acceptance testing involves site staff working through a number of scenarios in order to test the system is working as expected before the site goes live.
The technical go live is where the system itself goes live by being pushed into the site’s production environment.
The practical go live is where staff begin onboarding patients onto the system and patients begin completing surveys.
The PRMs team work closely with the site in an ongoing nature to review and refine both the system functionality and its use.
Implementation roadmap
The system is currently live in 10 local health districts with a number of others in progress or interested in implementing it.
System support
The PRMs service operates in line with LHD Cancer Service hours. It is supported by Statewide Service Desk (SWSD) and second/third level support teams across eHealth NSW and Cancer Institute NSW. To contact the team, please email us at cinsw-prms@health.nsw.gov.au.
What have we learned so far?
The PRMs team have made a number of observations through their implementation to date. These include:
Surveys
The surveys are being equally used with some sites doing both.
Frequency
Most common frequencies are 14, 21, 30 and 60 days.
Cohort
The cohorts selected vary and cohorts change and increase the longer a site is doing the surveys.
Administer
Radiation therapists, nursing and administrative staff are engaging patients to complete the surveys at point of care.
Review
Nurses, care coordinators and social workers are the staff who are most commonly reviewing the results of the surveys.
The PRMs team have identified a number of recommendations for future implementations based on on their lessons learned, these include:
People
- An influential sponsor is critical
- Codesign is essential from a system and engagement perspective
- Evidence to support your approach is a must
- Be prepared for data security and privacy questions
- Identify the right people to be champions, don’t take a hierarchical approach
Processes
- PRM workflows need to complement existing clinical workflows to be sustainable
- Challenge pre-conceived ideas and generalisations such as older people not being able to use technology
- Check-in often, review and continue to adjust the implementation and solution in order to embed this as ‘usual care’
Tools
- Integration of both the technical project and change management, from the beginning, enables and enhances engagement
- Provide a semi-structured change management approach, as flexibility is needed to meet site-specific needs
- Taking a staged approach with system development provides a more responsive and accurate delivery of functionality
If you would like more information on the Patient Reported Measures Program, please email us at cinsw-prms@health.nsw.gov.au.
