An interview with Associate Professor Michael Franco and Associate Professor Naomi Dobroff.
In August 2019, the first Go-Live of the Electronic Medical Record (EMR) was completed. Over three years later, the EMR is now a well-established digital platform across Monash Health with over 12,000 active users, delivering safe, high-quality, and timely care.
In the lead-up to the Victorian Heart Hospital opening, the Digital Health team used the opportunity to drive change and introduce further innovations to our digital toolbox.
Chief Medical Information Officer Associate Professor Michael Franco and Chief Nursing and Midwifery Information Officer Associate Professor Naomi Dobroff discuss their leadership through change, reflecting on their achievements in the digital health space and looking to future innovation.
As the Program Director EMR and Informatics Program, Michael reflects on his career path, “I have always had an interest in leadership, but it is curious where I have landed. In certain forums, I must remind myself I am a practising doctor. My interest in digital health came from being passionate about looking after patients. Working in oncology and palliative care, I saw opportunities for improvements and how to use digital systems to improve patient care. So being a practising doctor certainly helps.”
Being General Manager of the EMR and Informatics Program, Naomi has had an impressive career path, previously working at Monash Health for ten years in nursing manager and associate director roles; she then moved to Eastern Health and Austin Health. Finally, returning to Monash Health with a passion for improving patient care and nursing professionalism using digital systems. “It’s been great working with Michael to transform the organisation from a clinical perspective using digital platforms.”
With their expertise across different areas of clinical informatics, they can strongly support each other and work together by workshopping ideas and zooming out to look at the bigger picture, as Michael puts it, “From down on the dancefloor to up on the balcony.” Naomi attributes their success to their circle of influence and looking at “who are the people that can assist you in getting change to happen.” As a team, they have been able to design and implement large-scale programs that have produced substantial positive changes in behaviour and transformed how Monash Health operates from the ground up. Michael says it all comes down to “connecting digital health with patient outcomes. The reason we do what we do is to make patients better more of the time. We can do this through the 12,000 clinicians who now use the EMR and are happy to do it because they see the benefit for their patients and them as practitioners.”
Both agree that their most significant achievement and highlight from the last few years was Phase 1 of the EMR, “From the business cases to design, through to the implementation, the way we worked across Monash Health was amazing,” Naomi says. Michael remembers the excitement of working with many people across the organisation, “I got to have direct engagement with ward teams and nurse managers, unit heads and DCOs. We ensured everything was covered and everyone was comfortable making such a major change with thousands of patients still in the hospital.”
The team continually pursues further improvements and gaps to bridge with technology. Naomi points out, “It is not just a paper replacement; the EMR changes workflows, and people start thinking differently. Our clinicians are getting very savvy with the technology and can ask for certain changes or improvements to positively impact patient care. An example of continuous improvement in workflows is the TOTO (tap on, tap off) system to log into and out of the EMR rather than inputting a long password repeatedly throughout the day. We make it as streamlined and user-friendly as possible, so our clinicians are providing care and not using technology for technology’s sake.”
An essential benefit of digital systems is collecting, studying, and interpreting large volumes of data for insights that inform better care. Michael adds, “It supercharges research and quality improvement activities; we’ve had the EMR for three years and are just scratching the surface of what is possible.”
One aspect of Digital Health and continuous improvements is changing how people work. Naomi and Michael discuss how they deal with the resistance they sometimes face when implementing innovative technology and changing workflows.
Naomi talks to the importance of collaboration: “We have subject matter experts and medical advisors on board from the start. They are involved with designing, building, and implementing the systems. They are very aware of the areas they have come from and can assist with some of those conversations to understand the concerns.” Michael adds, “From the beginning, you must put yourself in that person’s shoes and see it from their point of view. Rather than immediately butting heads and going into solution mode, we must understand the group and why they are struggling and be willing to sit back and listen.” This is a core reason both wanted to get into the informatics space. Michael recalls that traditionally digital change in health care has had the approach of ‘here’s a new system, you guys deal with it,’ which was not helpful for anyone. Naomi agrees that she has seen projects during her career that failed because they have not had buy-in from the core users from the start. Both also sit on advisory groups with the Department of Health involved with new systems’ evaluation and tendering processes. The knowledge they gain while working ‘upstream’ with the Department means they get timely access and understanding of the latest platforms and emerging trends for enhancing digital health deliverables.
Sometimes the simple aspects of a system can create the most significant impact on patient care, such as digital prescribing, which reduces errors in interpretation, and digital patient files allowing for real-time viewing of patient records. These advancements give treating teams across Monash Health more time to direct toward patient care. The Delegate meal ordering system enables patients or carers to order meals directly through an app, which works with the EMR for patient allergies and has significantly enhanced the patient experience. The patient portal and kiosks introduced at the Victorian Heart Hospital allow patients to log in and see their subsequent appointments, streamlining their experience.
The goal for the future of the Digital Health team is continuous improvement in patient care, leveraging existing systems, simplifying, and innovating. It uses the available data for insights that inform future care and integration strategies for systems that provide patient-centred health records and workflows, leading to better healthcare outcomes.
In this regard, Naomi sees the connection between digital platforms and people as key for implementing change: “Connecting people like us and our teams, who have worked in clinical settings, with the technology and end users. That resonates with our executive and leadership teams and the teams on the floor because any change we propose is always connected back to clinical practice.”
For Michael, it has been about connecting digital health with patient outcomes and safety: “We do what we do in health care to make patients feel better. My mantra is, ‘nothing is technology for technology’s sake.’ It is technology to improve a gap we see in health care. Technology that allows us to go one better for our patients.”
Approved by:
- Associate Professor Emilio Pozo, Executive Director Digital Health
- Associate Professor Naomi Dobroff, Chief Nursing & Midwifery Information Officer / General Manager, EMR & Informatics Program
- Associate Professor Michael Franco, Chief Medical Information Officer / Program Director EMR and Informatics Program