ACHSE

An Area Perspective of the NSW Health Technology

StrategiesNovember 2007

Dr Jean Evans DHSM, MSc (Computing)

Chief Information Officer SESIH

Agenda

1. iPART & Accenture Architecture Reviews, Galt Report

2. SESIH and its Information Systems

3. Progress to Date• State-wide Service Desk (SWSD)

• Electronic Medical Record (eMR)

4. Project Categorisation – SESIH Priorities

5. Challenges

6. Benefits of NSW HealthTech Strategies

iPART, Accenture ICIP Review, Galt Report Feb 2004 “Establish a standard governance model for all ICIP

projects accommodating different deployment and support models, aligning programs and funding with clinical outcomes and recommendations of the iPART and Galt Report” Accenture ICIP Architecture Review

Increased collaboration including:• Consolidated purchasing of hardware, software &

maintenance• Establishment of a centralised architecture, planning &

strategy group, supported by a centralised PMO• Consolidation of applications design & development activities• Introduction of procurement best practices within

participating AHS etc

iPART, Accenture ICIP Review, Galt Report Feb 2004 (continued)

• Benefits as per Galt Report• More efficient and effective deployment of IM&T systems

• Enhances project delivery success and the targeting of funds to strategic initiatives

• Releases captive resource value by resolving duplication of both effort and infrastructure while leveraging economies of scale and best practice

• Savings from detailed technology changes eg maintenance, operating costs, software licensing, telecommunications

• Provides a stable base of resources and capabilities from which AHS with more-developed IM&T capabilities can continue to lead and demonstrate value in IM&T deployment

SESIHS Public Hospitals & Facilities

Sacred Heart Hospice St George St Vincent's Shellharbour Shoalhaven Sutherland Port Kembla Sydney/Sydney Eye Sydney Children's Wollongong

Bulli Calvary Coledale David Berry Garrawarra Gower-Wilson Kiama Milton-Ulladulla Prince of Wales Waverley War

Memorial Royal Hospital

for Women

SESIHS

13 local government areas Population:

1.162M (2006) representing 18% of NSW population. Projected to reach 1.24M by 2011

Area: 6,331 square kilometres highly urbanised areas of eastern Sydney, southern

Sydney, Wollongong and Port Kembla, rural areas of Kiama and Shoalhaven

SESIH Information Services - Statistics

• Approx 16,000 users across 132 sites including Community Health units

• 320 Windows servers, 20 VMS servers, 18 Unix servers• 4,500 printers• 140 applications (approx.)• No. of SESIH internet visits per month: 30,000• No. of Intranet visits per week: 65,000• 1,200 web pages including Hospitals and Services pages• 100,000 files which include web pages & documents on

the Intranet• 1 million messages handled per week• 550 VPN users logged in remotely

Progress to Date

Statewide Service Desk (SWSD)– Sutherland venue– Originally SESIH’s areawide Help Desk– Previous challenges: staffing, responding to all

calls within accepted period of time– Transitioned to HT SWSD 15 months ago– Obvious challenges as a result of change:

change of procedures for users, introduction of ITIL and expectations of Area staff to be available for training etc., different software

– But – improvements in % of calls answered, standardisation in procedures etc., and

– Establishes a model for the State for the future

State Approach to eMR: Management & Governance

The following is the agreed high level Governance structure, as presented to the ICT Management Committee on 19 July 2007.

ProgramCCB

CAG

EMR Steering

Committee

AHS Level (PROJECT)State Level (PROGRAM)

AHS EMRReference

Group

ICT Mgmt Committee

CIO Forum

CE

CIO

DCO

DCS

EMR Leadership

Group

EMR AHS Project

Management Meeting

EMR AHS Project

Management Meeting

EMR AHS Project

Management Meeting

EMR AHS Project

Management Meeting

EMR AHS Project

Management Meeting

EMR AHS Project

Management Meeting

EMR AHS Project

Management Group

Monthly

Monthly

Monthly

Weekly

Weekly

Monthly

Weekly(on per AHS)

PMO ClientLiaison Officer

Project Manager (Cerner)

AHS Business

Lead

AHS Change Manager

DDG

Local Committee

Local Committee

Application Focus Groups

Local Committee

LocalEscalation

Fortnightly

StateEscalation

Escalation point as appropriate for the issue

ProgramRRB

AHS Education

Co-ordinator

AHS CSRPRep

AHS IntegrationArchitect

• Paul Goetzheimer (Chair)

• Olivia De Sousa

• John Baulderstone

• Robyn Wright

• Linda Watson

• Sheetal Ram

• AHS Business Lead (as required for AHS Changes)

• Paul Goetzheimer (Chair)

• Olivia De Sousa

• John Baulderstone

• Robyn Wright

• Linda Watson

• Sheetal Ram

• AHS Business Lead (as required for AHS Changes)

• Paul Goetzheimer (Report)

• Matt Gollings

• Robyn Cook

• 1 x CIO (tba)

• 1 x Senior Clinician (tba)

• Paul Goetzheimer (Report)

• Matt Gollings

• Robyn Cook

• 1 x CIO (tba)

• 1 x Senior Clinician (tba)

• Katherine McGrath (as reqd)

• Mike Rillstone (Chair)

• Frank Cordingley

• Matt Gollings

• Rick Heise

• Paul Goetzheimer

• Katherine McGrath (as reqd)

• Mike Rillstone (Chair)

• Frank Cordingley

• Matt Gollings

• Rick Heise

• Paul Goetzheimer

State Approach to eMR

Electronic Medical Record (eMR)– Relationship between Cerner, HT, SIM and

SESIH

– Project commenced February 2007

– SESIH is first area to implement “full-stack” – Emergency Department, Operating Theatres, Order Management & Results Reporting, Enterprise-wide Scheduling, E-Discharge Referral

– Hardware hosted from HT

– First site to “go-live” expected to be Jul 08– All Area sites to be live within 12 months

State Approach to eMR

• Supporting the patient journey• Equity of access to information systems• State based build approach to:

• Reduce the cost of building the eMR• Reduce the costs and effort of upgrades• Build once and deploy state wide • Rapid deployment methodology• Limited funds available

• Phase one to realise benefits before additional Treasury funding provided

The Electronic Medical RecordThe Electronic Medical Record

Assessment• Past History• Current Illness• Examination• Diagnosis

Orders•Diagnostic tests•Diet•Medications•Treatment•Consultations•Referrals

ResultsReview• Diagnostic tests• Text reports• Trends• Graphs

Charting•Vital signs•Fluid balance•Urinalysis•Other physiological measures

Care Pathways• Prescribe Treatment• Clinical guidelines• Variance reports• Outcome analysis• Discharge Summary

Progress NotesRecord •Interventions•Change in status •Outcomes

Clinical Workstation - PowerChart

Clinical Repository

Discharge Referrals• Summary of Rx• Medications• Follow-up Care

Pathology RadiologyClinical Measures Pharmacy

Food Services

Clinical Specialty

Clinical Support Systems

Allied Health

Patient Administration & Enterprise SchedulingPatient Administration & Enterprise Scheduling

Emergency

Decis

ion

su

pp

ort

, sta

te b

ased

bu

ild

wit

h s

tan

dard

ised

cod

esets

Operating Theatres

Key Benefits of the eMRKey Benefits of the eMR

• Integration of clinical information at the desktop

• A reduction in information silos • A reduction in errors and duplication• Ability to track orders and results online• Improved ordering practices• Better planning and resource utilisation in

outpatient clinics• Improved theatre utilisation• Improved processes in ED as information is

integrated with orders, results and scheduling

Project Categorisation Prioritisation - Core Common Divergent: SESIH Priorities

Principles Core(Centralised)

CommonCollaborative/

Federated

Divergent

1. Extent of Solution Scope

State Wide Solution AHS Wide or Collaborative Group-wide Solution

Local Solution

2. Funding Centrally Funded Capital/AHS Recurrent

Centrally or AHS Capital/AHS Recurrent

Local or AHS Funding

3. Technical Infrastructure

Must utilise the Core HT infrastructure

Must utilise the core HT infrastructure

Will utilise local or AHS infrastructure

iPM Upgrade Patient Billing Jonah

eMR Patient Costing PowerFTE

PACS/RIS including Justice Health

RIS, Hermes Nuclear Medicine

Challenges

Establishing boundaries Agreeing who has overall responsibility for delivering Understanding each other’s priorities, and working

with these – Areas often impacted with priorities outside of those in HT Plans

80/20 rule in SESIH– Operational activities always take priority

Funding requirements Resourcing availability Flexibility in model to support changing NSWH

priorities, eg: recent Integrated Primary and Community Health Policy: Implementation Plan

Benefits of NSW HealthTech Strategies

Funding availability Shared knowledge and experience (Benefits

Realisation, Change Management etc) Standardisation Methodologies: Method-M, Project

implementation, Sharing of documentation Equity across Areas for project

implementations Service Partnership Agreements Rationalisation