We recently caught up with Kate Renzenbrink, Chief Clinical Informatics Officer (CCIO) at The Royal Victorian Eye and Ear Hospital (Eye and Ear) in Melbourne. Kate shared insight around recent digital projects, priorities, and the wider digital health landscape in Australia.
Kate recently started working for the Eye and Ear having previously held similar roles in other public hospitals in Victoria, and shared how she “leapt from clinical into digital health because I saw the opportunity to really uplift clinician capability to support the quality of care. I also liked that it is an advocacy role; I’m that bridge between clinical and ICT. Digital healthcare means a lot of different things, but for me the core is information sharing and using technology to do it.”
With a qualification in health informatics as well as a Bachelor of Nursing, Kate explained that a lot of her role is “being that liaison, being that advocate, so that people’s work and importantly the way in which they work is reflected in the design of implementation and the tools that we end up using”.
Whilst there is “a lot of innovation” out there that Kate has been able to tap into, she emphasised that “it’s not just about innovations related to the expensive shiny new things or major projects – for me the interest is in the small stuff that can make a difference, and the iterative change that sustains change and improvement. The people who I work with all absolutely understand the problems that they face in their roles and know what they need to fix them; but they may not have a voice at the table.”
Culture is “a big decider of what gets done”, Kate added, “and my role is often helping to navigate that; seeing those opportunities, helping people with their projects.”
In line with this, one of Kate’s main focuses is on Electronic Medical Record (EMR) implementation. “That’s been so interesting, because I immediately saw that the EMR is never going to solve all of the problems we have. It’s everything around it that we need to tackle and take into account, like interoperability, connected care, and right at the centre of everything, the patient voice. A lot of concerns in this area tend to revolve around access to information and simplifying processes. So I have done a lot of thinking around that, when it comes to service redesign and using that feedback so staff and patients have a better experience.”
Focus on data at the Eye and Ear
What is happening with regards to data at the Eye and Ear and what are the key priorities?
Kate reflected that the hospital differs from most major hospitals, “as most of our surgeries are day surgeries, and the length of stay overall is really short. But we still need to use our resources to provide expert specialist care to the community. We still need to look at our data in detail; we need to understand who’s coming in, what the trends look like around required surgeries or conditions, how we plan for that, workforce needs, and so on.”
She shared that the hospital is “currently undergoing a big infrastructure uplift – we are awash with data, and everyone wants dashboards, everyone has data queries. We needed to put the tools in place to help people self-serve and get access to the data they need, making it more efficient for them and for our digital team.”
Kate highlighted a particular project she is working on which involves reaching out to patients before their presentation in clinic and after cataract surgery, using a mobile phone questionnaire and triaging their scores to “pick up those patients who need earlier clinical assessment”. Looking at that data and organising it in the right way “helps us use our resources really efficiently and safely”, she said.
In the surgical service, another project also underway looks at waiting lists for surgery. “We are working on increasing visibility of who is waiting and how long they are waiting, and strengthening communication between patients waiting for surgery and their care teamin the community, whether that be GPs or communitycare,” she shared.
Kate acknowledged the importance of data with regards to research at the hospital. As an example, she referred to a project focusing on development of a cochlear implant that administers steroid medication via the electrode that is placed in the inner ear. “The research evidence is showing that the implant offers more longevity, and addresses an important problem with previous cochlear implant surgeries because the surgery itself can cause inflammation and scarring which impacts underlying natural hearing. Pushing ahead with bringing research data into clinical practice can help us work out what we can do better to keep improving people’s hearing.”
Kate also pointed to the importance of joint projects between different teams or different organisations, noting that they “really strengthen and uplift that shared capability. It is particularly important since we are only going to see patient populations growing along with demand for healthcare; so we have to be smart about how we use data to help us work out areas of need.”
Part of Kate’s role as CCIO over the next five to 10 years will be helping to deal with this increased demand. “I’m thinking about what kind of skills we’re going to need in our workforce and how we bridge what we’re doing with more virtual care when it is safe. It needs to be more seamless, more connected, and we need to be taking on board patient needs and feedback too.”
The digital health landscape in Australia
We asked Kate for her thoughts on the wider digital health landscape in Australia: is there a particular challenge she would like to see solved, to make a difference to staff and patients?
“Patients need to have visibility of their health information, as often they are the only continuity in their own care,” she said. “On a related note, I would like to tackle secure messaging and the ability to share information so that practitioners can have that information they need to care for the people in front of them.”
Transitions of care is another space which offers room for improvement, she considered. “Our GPs have different software and capabilities, and we haven’t really addressed those transitions very effectively, which is often down to an information visibility issue.”
In Victoria, Kate shared, there are plans to implement a health information exchange. “This will recognise how networked information is, and we will also need to look at making sure the consumer has complete access, so they can challenge things if needed,” she said. “I see a lot of information summarised, reduced for efficiency, that ends up being incorrect. This incorrect information can get stuck in systems, and once it is in there digitally, it’s hard to remove – there’s a long process to get rid of inaccurate data.”
Digital leadership
On what it means to be a digital leader, Kate commented that she truly enjoys her role. Previously, she said, she has “not always been able to give people the care I know they need because of limitations and constraints. So this role feels like a great opportunity to share knowledge and help problem solve.”
When it comes to the CCIO role, Kate reflected that whilst the focus tends to be on the digital health tools themselves, she has always been more interested in people and helping them to do “more of what they want to do”, as well as releasing time to care.
“Money comes into it, and we’ve got to be responsible; but we also have a responsibility to look after people, keep them safe, and respect their humanity, their choices, and their beliefs,” she said. “It’s always about the people, and as I see it, digital means we can reach more people.
Kate pointed out that many healthcare organisations are “living with the decisions that were made 10 years ago, when it came to buying the systems we have; and things have changed since then. We are trying to re-imagine our future. It can be frustrating, not having what we want in place right now. You know what you haven’t got and what you would like to see, and you get to have interesting and useful conversations with people about the opportunities for doing things differently and improving.”
Looking to the future
Kate said that improving usability of systems across the hospital is a “big priority” moving forward, and added: “We’re talking about the data t a lot too, because we’re seeing emerging technologies and applications of these like machine learning, and there’s some momentum now for where and how we apply them, ethically and safely.”
For data, Kate stressed the importance of looking at “how clinical work shows up in systems, and particularly nursing. Here in Melbourne, like the rest of the world, we are facing a clinical workforce shortage; Nursing makes up half of our overall healthcare workforce and so if the clinical work completed by nurses doesn’t show up in our systems, then we are at risk of not realising the value of nursing.”
The key to moving forward and supporting new models of care, Kate concluded, is to “codify nursing knowledge, embed nursing and clinical terminologies so that we can share data effectively. This is critical for shared understanding and becomes building blocks for interoperability. We need to move toa networked way of thinking, and take advantage of the many pockets of incredible expertise that are out there to provide healthcare that adds health and wellbeing. Sharing experiences is so valuable, and I think we have an obligation to do that.”
We’d like to thank Kate for taking the time out to share her insights with us.
