In May, Beerescourt Medical Centre's legacy practice management system crashed due to a significant server issue, with no timeframe given for when it would be back up and running. The crash meant the practice was left hanging without access to any information or backups, and threatened disarray. Within only days, indici was implemented and structure was returned. Beerescourt's legacy system remained down about a week.
Thrown into crisis management mode, the decision was quickly made by Beerescourt and Primary Health Care Limited (PHCL) to move the practice to the indici practice management system (PMS).
The move to indici had been in the pipeline since December when Beerescourt joined PHCL, but work was yet to begin due to multiple system migration barriers. The circumstances surrounding the legacy system's fail forced indici to get around these problems quickly, highlighting the mature experience of indici's onboarding team and demonstrating its flexibility in times of crisis.
"We'd had fairly regular outages before," said practice manager David Gaines "But they were much smaller and could be dealt with by our PMS provider quite quickly. This outage was much larger, and we were told on the morning of the second day that despite people working on it overnight, they still could not identify what the issue was let alone give us a fix timeline."
So starting from a blank slate, the decision was made to perform a rapid transition to indici.
It seemed "the most natural move to make," said Nikki Sargent, Ventures clinical practice systems specialist. "indici stood up a cold environment, basically a shell, and quickly worked to configure it, adding users and patients as they went."
A flexible plan began to take shape to check everything vital would be covered and that in the haste of the project, nothing was missed. There was little choice but to make decisions 'on the go' as the project progressed.
"The decision to move to indici from scratch gave us an immediate ability to plan our day and start basic consulting tasks," said David. "The Beerescourt team had been excited about the idea of making a change for a while and the frustration with the current PMS helped make the case with them for change."
Within the day, staff were confidently using the indici system. By the second day, the practice was already reconciling. The reception team were particularly quick to pick up indici, which significantly helped the success of the implementation.
"The initial effect, since the old system was down anyway, was we were able to keep electronic notes and manage our day, which had been a challenge without our previous appointment books. It was easy to pick up these basic tasks in indici," said David. "As services were linked into the new indici system, the new capabilities were immediately apparent and that made up for the shortfalls seen in not having medical notes readily available."
The GPs have also coped well with the change.
"Everyone has been adaptable and flexible, picking up the basics of indici really quickly," said clinical director Rebekah Doran. "It's been a welcome relief to go from having to write things manually on bits of paper, floating around the desk, to quickly having an electronic platform again for prescriptions and record management. We've also had locums join us during this time and indici has proven to be quick and efficient to train them in too."
Ventures commercialisation manager Will Hughes emphasizes that it's not a matter of being able to transition practices to indici in days for some but weeks for others.
"This was a response to a crisis to keep business continuity, and tasks were preformed much quicker than the ideal," said Will. "We're really proud of how we were able to so quickly step in and get Beerescourt a solution, it was a pretty exceptional circumstance and not the preferred way to onboard a practice."
In a clear time of need, it was also noted that many of the associated partners (such as the National Enrolment Service) recognised the urgency of the situation and were just as responsive as indici. Their collaboration made it all possible.
A significant amount of support was needed for Beerescourt Medical Centre staff - on top of quickly learning a new system they were learning to perform tasks they previously didn't have the ability to perform with the legacy system.
"It was all-hands-on-deck providing wrap around support - the practice support team, the indici team, the PHCL team, business continuity staff...everyone was involved in onboarding, training and supporting the practice thorough this crisis," said Will.
Being a cloud-based solution, indici also allowed for multiple parties in multiple locations to smoothly work together and get the job done.
"It wasn't necessary for a bunch of people to descend on the small practice, which would have added further disruption to an already stressful situation," said Nikki.
The clinical information transfer has recently been migrated and it's a process of change for Beerescourt staff.
"The change process has been intense," notes Will. "There's a significant amount of change management still to come."
But David is optimistic.
"The previous PMS eventually came back online and has been used as a backstop for medical notes," he said. "All consulting is happening in indici though, and I am getting a lot of positive feedback even with the way it all came about. Everything is starting to come together, we are currently providing top-up training with clinical oversight now that medical information is available in the system."
This situation highlights the risk practices face when a practice management system (PMS) vendor hosts their data. If the vendor goes down, so does access to all practice data.
At times, PMS hosting vendors have refused practices and PHOs the ability to add tools or software to access and manage their own practice data. This has occurred recently in Bay of Plenty and in Wellington, causing a wide range of disruption and additional costs.
PMS vendors often view data as belonging to themselves rather than the practice, leading vendors to refuse to support mass (a practice moving) data migration, claiming there is no obligation to support this and that GP2GP provides this function.
Pinnacle and a growing number of other networks dispute this and are working with the Ministry of Health to bring about changes in standards.
Practice data is just that. A practice should be able to choose where their data is, how they access it and which system they wish to use. Patients also have rights to easily access their data and a practice shouldn't face additional costs to provide them with access to that data.
Pinnacle strongly recommends practices with non-cloud based PMS' spread the risk and retain some independence by not using the practice management system vendor to also host their system.