PAMS – On the move to joining up our patient’s journey.

The delight in Kiri Munro’s voice was great to hear as the Registered Nurse at the Puntukurnu Aboriginal Medical Service (PAMS) clinic in Kunawarritji came on-line with Communicare, in real-time.  All four PAMS clinics at Jigalong, Parnngurr, Punmu and Kunawarritji are now working live off the same Communicare server located in Newman.

For those with clinics based in the metro area or in regional and rural towns this might seem like a “So what?”, but 750 km east of Port Hedland, getting an internet connection that is sufficiently robust to support Communicare has been a challenge. In the “cities” internet connections are around $60 per month for 100 gigabytes with 2/ 1megabyte links, over satellite links it is $1,000 per month for 4 gigabytes with 512/256 and 10:1 contention rates!!!!

Nearly there ... en route to Parnngurr

Roadside attention

The only connections available to the internet at the PAMS’ clinics are via satellite links.  Extremes of heat and cold in the desert, violent winds, dust storms and the occasional cyclone have been the downfall of previous attempts to operate economical domestic links.  The need for change to industrial strength tele-communications was an immediate priority for client safety, to support the health workers, ENs, RNs and GPs in their delivery of services and to improve Medicare income.

PAMS returned to community control in July 2009.  In 2009-2010 the Board focused on rebuilding the Board, engaging with the communities, re-establishing consistent service delivery, appointing a full-time CEO, rebuilding the administrative infrastructure of the Service, including moving offices in Newman, and employing a consistent complement of staff.  For 2010-2011 the focus is on strengthening community engagement, health promotion linked to service delivery, and improving the state of clinic buildings, with the objective of leading to RACGP Accreditation through AGPAL.

A component of the service delivery has been to upgrade tele-communications to support the clinicians and provide reliable internet access in staff housing.  While under administration, PAMS’ clinicians faxed patient information to Newman where it was transcribed into Communicare.  In April 2010 the Communicare server was moved from Newman to Jigalong and notebook computers were loaded with Communicare off-line for the very remote clinics.  The notebooks were sent to Jigalong on the mail plane for weekly synchronisation.

In September 2010 the Board decided to install a new satellite communications system including advice from the AMSANT technical team who have been deploying such systems for remote clinics in the Territory and Ngaanyatjarra Lands in WA.

Logistics for even getting the equipment to Newman, let alone out to the communities, was a nightmare.

300 kgs of concrete and other items to unload to replace punctured tyre

Each satellite base required 600kgs of cement for weights, and that was just the beginning.

Ground work at Kunawarritji

Parnngurr dish in place

To get the items in-place required 5,000 kms of driving on dirt roads, much at night to keep to schedules – no kangaroos were harmed, however, driving the Toyota Troopies such distances was crippling – coins had to be tossed to decide who would have the comfort of the Nissan Patrol!

Making the most of travel time before the darkness

Servers were established in Newman to support Terminal Services and real-time access to Communicare through ThinPoint clients.

All computers have been upgraded to be on the same version of operating system, Windows7 Professional.  The system went live in December 2010 with all connections working by 6^th January 2011.

Satellite modems, switch, wireless router and 900 MHz radio in place

Access to PathWest reports is now immediate as is viewing x-rays and other images along with the reports through Global Diagnostics.

Wired up and working hard

A real benefit is also being realised for the Registered Nurses who are now completing CRANA courses on-line to maintain their registration, from home.

As part of a collaboration with UWA, the web-based patient information system Medical Messaging Exchange (MMEx) is being installed in 2011 as the starting point for better support of medical images for eyes, ears and wounds, and medication management, along with enabling Shared Individual Electronic Health Records (SIEHR).  The first SIEHR links will be to the Kimberley ACCHS, if all goes well.

PAMS has used its self-generated income to establish the satellite links and limited funding through the WA WACHS, COAG-CTG for improving the patient journey and for enhanced support for chronic disease management and child and maternal health.

PAMS is on-track to realising the Board’s vision of making the transition from faxed paper records, to real-time client clinical information, to shared electronic health records, in one year.  All these actions would not have been possible without the commitment of the clinical staff, permanent and locums, to embrace the process by putting up with all the logistical and teething problems of so many changes in such a short period of time.  Many thanks!

Contact: Chris Renshaw