This network included Dr Paxton, head of immigrant health at RCH; Professor Biggs, head of the International and Immigrant Health Research Group (IIH) in the Department of Medicine at the University of Melbourne and a consultant infectious diseases physician at RMH; and Dr Hibbert, then head of the BioGrid research platform and now clinical integration manager at Precedence Health Care.
Configurable at point of care What these clinicians all agreed was needed was a system to connect patients, practitioners, hospitals and researchers. Working with Arcitecta, what they have come up with is a system that is completely configurable at the point of care and can be used for any patient group or condition. “Refugee health is about population health, but at an escalated pace,” Dr Paxton says. “What I knew some years ago for kids from Sudan, is not always relevant for the groups from Burma, or Iraq … and there are different elements in clinical care for people arriving via boats or those have been in a detention centre. “It is an area of healthcare where you need to have excellent surveillance and responsive systems. There are particular challenges in working with groups who have multiple and complex health issues, especially when all of that care is occurring with the assistance of an interpreter.” In addition to improving surveillance and clinical audits, the network wanted to improve information flow between practitioner and to patients as well. A bespoke system designed by the clinicians themselves was the obvious answer. “They had next to no money, but I could see that it was a really good opportunity to solve some complex problems,” Arcitecta’s CTO Jason Lohrey says. “It was also something we could get our teeth into that had long legs.”
“There are particular challenges in working with groups who have multiple and complex health issues, especially when all of that care is occurring with the assistance of an interpreter.” Dr Georgia Paxton
Dr Paxton took on the job of scoping out how the different clinics worked, their particular workflows and the systems already used, and conducting focus groups of clinicians to understand what they needed from an electronic system and how to maximise dual clinical and research functionality. “I surveyed the clinicians about the 10 most frequent clinical problems they had identified in the focus groups, and asked them how we assess risk and what we look for in the history and examination,” she says. “We put all of that together and came up with specs for these problems. “We put together a set of initial screening tests as we wanted to have decent epidemiological data. At that time I started working more closely with Arcitecta and it became apparent very early on that there was scope to develop a completely configurable system, and that is the real strength of CAReHR.”
Clinical control Dr Paxton says the clinicians using the system have been able to define every point in the system without constantly referring back to the developer. “I can define all of the parameters, which might be a risk factor or a symptom or an exam finding, or it might be a screening
questionnaire. If I want to put a screen for an emerging issue or a patient satisfaction questionnaire, I can enter all of those questions and have complete control over the defining parameters. Then I can combine the parameters into a problem and I have complete control over the problem definitions, so I have a system that I can set up to collect information on common things, like asthma, or rarer diseases like malaria or leprosy. “This is flexibility that you don’t get in a large-scale product. And because I set it up, I can do whatever I need it to do. I can set it up to define all of the parameters, the pathology, and referrals – I can set up CAReHR for my service.” She also says one of the biggest strengths of the system is that clinicians don’t have to double-enter any data. “The parameter appears across different problems,” she says. “You can use it as a checkbox system because you can just tick the boxes or you can use it as a free text system for your notes. There are different user styles.” The system is based on Arcitecta’s Mediaflux technology, a data management platform that is able to manage any type of structured or unstructured data through the capture and storage of metadata fragments, stored as encoded XML. In the case of the CAReHR, it has a web-based front end but the back end is what Mr
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