A vision for change leadership: Trust, transparency and accountability at University of Wollongong Library

At the University of Wollongong (UOW) Library, we created a vision for digital transformation through the Future-Ready Library Strategy (University of Wollongong Library, 2018). This was a conscious commitment to becoming a ‘digital-first' library and with a strategic and disruption-ready mindset already in place at the onset of the COVID-19 pandemic, we were able to apply and accelerate many of our planned initiatives. At the start of the crisis, the library leadership team adopted a business continuity approach to decision making, inclusive of representatives of critical service areas for regular and frequent discussion and action. This approach enabled the sustained delivery of core and critical resources and services while remaining aligned to the vision (University of Wollongong, n.d.). This case study examines the strategies and approaches taken at UOW Library over the past five years and outlines our successes and challenges through change leadership that we believe goes beyond change management and to the heart of our people centred approach to leading in the library. © 2023 Elsevier Inc.

Service evaluation of home spirometry following lung transplantation

Introduction and ObjectivesFollowing Lung Transplantation recipients perform regular spirometry to assess allograft function. Due to infection risks during the COVID pandemic, this was difficult to perform when vulnerable immunosuppressed patients were shielding. Therefore, we provided our patients with home spirometry allowing them to be perform spirometry remotely.MethodsBluetooth spirobank spirometers and an app created by patientMpower to transmit the data were given to 164 lung transplant patients. The service was then evaluated by comparing results from the device against recent (>3 months) spirometry performed at the hospital. The views of clinicians and patients were also obtained about the service through questionnaires.Results164 patients were provided with home spirometers, 112 questionnaires were collected from clinicians following patient consultations and 94 patients were interviewed for their experience. Nearly a quarter of patients (23%) reported difficulties with the spirometer’s initial setting up or using the smartphone app.The FEV1 and FVC readings from home spirometry correlated well with measurements taken in clinic with an R2 of 0.69 and 0.59 respectively (p<0.01 n=78). Clinicians found home spirometry useful in 79.6% (n=112) of consultations and felt the need for hospital spirometry was removed in 63% of cases.Patients were asked to perform spirometry daily or once a week after lung transplantation depending on when they had their transplant. 50% of patients met this goal submitting readings at least three times per week. The median patient rating of the program was 9 out of 10 (10= excellent, n=91). Patient evaluations indicated that the spirometer was easy to use (91.4%), compact (86.0%), and the app was helpful (71.0%) (n=94). In comparison to the previous analogue spirometer, 88.4% of respondents preferred the new Bluetooth spirometer (n=73).ConclusionWe found Bluetooth home spirometer provided accurate results, which was useful in the clinical setting and is acceptable to patients. In addition, it provided real time remote monitoring aiding in assessment of allograft function, which was a benefit over the analogue counterpart particularly during COVID.

Mobile Health Technology & Pain Management

Learning Objectives (1) Understand how M-Health technology can improve physician -patient communication. (2) Understand how treatment plan adherence can be improved with M-Health technology. (3) Understand how M-Health technology can provide safeguards against legal liability. Purpose Chronic pain imposes a significant burden on individuals and society. Patient adherence is important for safety and treatment effectiveness. Like many chronic illnesses, more frequent Health Care Professional (HCP) interaction with chronic pain patients would benefit the provider's ability to monitor treatment response to enhance patient safety as well as the efficacy of the treatment. Unfortunately, practical and payor limitations limit this approach, with much care reliant on delayed visits or suboptimal communication through telephone messages. This operational issue/work-flow problem leads to delayed care and unreported changes in clinical status especially including adverse events. In addition, documentation is lacking to justify the need for intervention or prescription changes with opioids as well as other medications. Current health record practices reduce the ability to track clinical data outside of direct face-to-face care, resulting in insufficient documented evidence to support practice treatment decisions and potentially provide litigation protection. A mobile health (mHealth) technology platform has been developed (PainScript) that enhances communication between clinic staff and patients to improve outcomes. The PainScript platform is innovative in its focus on physician practice management, providing a patient-monitoring capability to support adherence with treatments (pharmacologic and nonpharmacologic) and provide early detection of adverse/ serious adverse events. An mHealth intervention is particularly timely now that the Covid-19 pandemic has increased telehealth utilization, changing the delivery of healthcare. Telehealth is a new and proven communication approach, focused on clinical information for improving care;different modalities, recognized by the AMA CPT, include remote Patient Monitoring (RPM), Digital Evaluation & Management (D E&M), Chronic Care Management (CCM), and Remote Therapeutic Monitoring (RTM). Specific examples identified for medication management include clinical questioning, dynamic text messages, smart pill containers/dispensers,1 interactive mobile apps,2 and support over the phone. The majority of pain apps introduced in recent years have focused on the physical characteristics of pain, and few have supported clinician or staff access to real-time pain data and patient adherence.3 Furthermore, few available mHealth products for patients with chronic pain have the clinical evidence of improved patient outcomes needed for mHealth adoption and engagement. Here we review the PainScript platform as evaluated by clinicians and patients with chronic pain. Methods The PainScript patient app provides a HIPAA-compliant and accessible connection between patients and providers. It is integrated into the practice electronic health record (EHR). Patients are enrolled using a smartphone and a digital telehealth app. Once enrolled, patients will provide clinical information, guided by their physician through text messaging, with 3 daily clinically validated questions. The platform is also able to send patients medication reminders and assesses side effects and changes in clinically important measures of outcome. The responses to the questions are then reviewed by the practice via a secure HIPAA-compliant private clinical dashboard. A designated qualified healthcare provider evaluates the triaged responses which lie outside the normative range set by the provider. If required, the results will be elevated to the appropriate level of provider for decision-making. Medication adherence is self-assessed by patients reporting metrics such as when they (1) take all meds as prescribed and (2) are not taking meds that are not prescribed. Assessment questions, direct and indirect, occur on a 14-day cycle to limi repetition of questions yet recur frequently enough to allow for sufficient sampling of clinical measurements. By the end of each 14-day cycle, the proposed National Chronic Pain Surveillance questions may also be covered. Data collection began in November 2021 and has continued to the present. In this , all patients were reviewed for clinical responses over their first 12 weeks on the system. Note that regardless of when an individual response was collected, the data normalizes to when the patient answered the question relative to when they enrolled (for example, all Pain Scale answers from the first 2 weeks, week 3, week 4, etc.). We report here on experiences and data analysis from the platform. Results Through 30 June 2022, patients provided more than 55,000 individual daily clinical responses to their physicians in diverse locations across the United States. Based on initial observational data across all those patients from baseline through 12 weeks on the PainScript platform, there was a 5.5% improvement in average reported levels of pain, 13% improvement in reported levels of fatigue, 17% improvement in reported levels of depression, 28% improvement in reported levels of anxiety, and 28% improvement reported levels of cravings. No patient data was excluded from the observation. Through 12 weeks, patients achieved a 99.8% adherence to their prescribed medication regime - including taking/not taking prescription and non-prescription medications as directed. In nine previous peer-reviewed and published trials, almost all co-funded by the NIH or NIMH, of the PainScript MedieXpert system (2003-2016), Care Plan Adherence results are as follows: 98% satisfaction among caregivers, 95% care plan adherence rate in patients with heart disease (p = 0.002), 90% care plan adherence rate in senior citizens with diabetes, heart failure and fifth- and sixth-grade education levels, and 92% care plan adherence rates in patients with diabetes HbA1c, which was reduced by 8.5% in three months (p < 0.002). In addition, medication adherence results are as follows: 94% medication adherence rate in patients with heart disease, 89% medication adherence rate in patients with HIV, substance- use disorder (SUD), mental illnesses, and homelessness, and 95% medication adherence rate in patients with schizophrenia. Conclusion The modernization of healthcare will be equally important to all clinicians, especially those who treat patients with chronic pain. Preliminary data suggests that PainScript telehealth technology can improve patient care, treatment plan adherence, and medication adherence. The platform bridges a treatment gap that occurs between visits and has been shown to improve clinically important outcomes. Improving physician-patient communication and patient monitoring may reduce the risk of opioid misuse and addiction and provide clinicians with information that can help differentiate addiction from tolerance and physical dependence.4 It may also provide the practice a means to be compensated by the Centers for Medicare & Medicaid Services and many other payors for the time and expertise of providing daily contact with patients, as well as safeguard against legal liability due to enhanced communication and affirmative documentation.

Surf's Up, Radical Approaches to Riding the COVID Waves

Purpose Forewarned by the early COVID-19 experience elsewhere, and the need to create a COVID-safe environment for lung transplant (LTx) patients and their attendant health care workers (HCW), we radically re-structured our ambulatory out-patient model. We replaced our hospital-centric approach, with an entirely home-based telehealth service, that involved the majority of the LTx staff also working remotely from home. Methods Our hospital's LTx service manages over 800 post-LTx patients. From March 2020, LTx staff were instructed to work from home. Exceptions included the in-patient care team, the LTx pharmacist and one LTx physician;both of whom provided liaison between the home-based team and the hospital. The hospital's telehealth portal was used for patient consults, and daily clinics were established. Administrative, nursing, allied health, and physician staff were provided with computers, as well as remote access to the hospital's electronic medical record. Microsoft Teams facilitated communication between team members during clinic. LTx drugs were remotely e-ordered and then posted from the hospital. Pathology slips were emailed to patients and requested bloods were collected locally. Patients received weekly service updates via the Mailchimp email platform. The in-patient LTx team were available for critical in-person assessments, specifically for patients early post-LTx. Results Our LTx service remained operational despite two COVID-19 waves in 2020. To date, 66 LTx have been performed;an 11% drop in activity compared to 2019. The LTx team have remotely provided >175 medical and allied health reviews/wk. In-person reviews were limited to <10/wk. Over 20,000 separate LTx drugs were posted out providing uninterrupted access to LTx-critical medications. Access to spirometry and bronchoscopy remains suboptimal. Despite widespread community transmission, there was no COVID-19 infection in our LTx team, and only a single episode of self-limiting community-acquired COVID-19 infection in our wider LTx patient population. Conclusion Reflecting the need to also provide a COVID-safe environment for HCW, we established a completely remote ambulatory service that maintained both LTx patients and LTx HCW at home. Whilst COVID-19 infections have been avoided, future studies will need to assess whether remote access to LTx has impacted on non-COVID morbidity and mortality in our LTx population.