andrew young, endoscopy information system, healthshare nsw - nsw health case study: leading the...
DESCRIPTION
Andrew Young delivered the presentation at the 2013 eHealth Interoperability Conference. The 2013 eHealth Interoperability Conference program is a balance between updates on state-wide interoperability projects, health service eHealth project case studies, and discussions of overarching principles such as information governance, data standardisation, and the future direction of eHealth in Australasia. For more information about the event, please visit: http://www.informa.com.au/eHealth13TRANSCRIPT
NSW Health Case Study –
Endoscopy Information
System
eHealth Interoperability Conference
12th September 2013
Overview
• Project Planning
• Setting Standards
• Sustainable Change
• Interoperability
• Lessons Learned
NSW Health
• 15 Local Health
Districts & 1
Children’s Hospital
Network
• 84 acute public
hospitals
• Approx 1.6 M
hospital admissions
(2010/11)
• 26.3 M non-admitted
visits
• 2.5 M emergency
department
attendances
Endoscopies
• Approx 120,000 endoscopies performed per year
• Facilities perform up to 7,200 endoscopies per year
Project Planning
• Initiated by Agency for Clinical Innovation
Gastroenterology Network (2008)
– National Bowel Cancer Screening
recommended EIS
– Required for patient safety, quality,
productivity benchmarks
• Implement standardised local, district and
state level
Setting Standards
• Minimum data set
– Defined by clinicians (gastroenterology
network)
• Adult
• Paediatric
– National bowel cancer screening data
• Capture billing codes (MBSE)
Prior to EIS
• Largely paper based reporting
– Scanned to medical records
• Siloed hospital unit based systems
– Sharing of data via USB, scanning, email
• Manual counting
– Procedure numbers
– Endoscopist accreditation
Sustainable Change
• Program sponsor: Agency for Clinical
Innovation
– NSW Health clinical pillar for clinical
leadership
– Project and BAU sponsorship
• Implemented by HealthShare NSW
– Corporate arm of NSW Health
Endoscopy Information
System
• Record clinical procedure documentation
• Capture digital images
• Automated reports, letters and follow-up
instructions
• Used by endoscopist consultants, fellows
and registrars
– Gastroenterologists and surgeons
• Structured data for research
Procedures
• Upper and lower GI
– Gastroscopy
– Colonoscopy
– EUS: Endoscopic ultrasound
– ERCP: Endoscopic retrograde
cholangio pancreatography
Interoperability
• HL7 v2.3
• Patient administration feeds to EIS
– Demographic feeds
– Episode details
• Scheduling interface to EIS
– Appointment details
– Procedure information
• Results interface to eMR
– Procedure notes and URL
Data and Message View
ORU
PAS
Appt
eG
ate
/ JC
AP
S
Endoscopy
Information
System
Demographics
Episode Details
Appointment
Procedure
ADT / SIU
eMR Results
Infrastructure
• 9 Instances
• Prod, Test, Train
HUNTER
NEW ENGLAND
NORTHERN SYDNEY
CENTRAL COAST
SOUTH-EASTERN SYDNEY
ILLAWARRA SHOALHAVEN
WESTERN SYDNEY
NEPEAN BLUE MOUNTAINS
NORTHERN NSW
MID NORTH COAST
WESTERN NSW
FAR WEST
SOUTH-WESTERN SYDNEY
SYDNEY
CHILDRENS NETWORK WESTMEAD
SYDNEY HSS IT SITES
SOUTHERN NSW
& MURRUMBIDGEE
TRAINING
Bateman’s Bay
Goulburn
Wagga Wagga
Health Network
LHD
eMR
LHD
PAS
PC: Citrix client
DATA
BASEDATA
BASE
DATA
BASE
Application
Server
DATA
BASE
Application
Server
DATA
BASE
Application
Server
Application
ServerCitrix
Farm
PVMD
Terminal
PVMD
session
Application
Server
Citrix
Client
Citrix
session
PRODUCTIONTEST
ENDO
PC: Thick client
PVMD
Terminal
PVMD
session
PAS/Cerner/EMR
HSS Cumberland data-centre
9 * MS Windows.net
application servers
State-wide EIS Server
Oracle 11g server
with 9 DB instances
MS SQL Server 2008 R2
ProVation image capture
workstation
in the procedure room
Accessing application servers via
ProVation ‘thick client’
application installed on PC
Citrix Server Farm
(5 servers)
Workstations other than
image capture workstations
can access application servers
via Citrix
System Architecture
HL7 Interfaces:
- Demographics (ADT)
- Procedure Note Results (ORU)
Endoscopy Procedure with Image Capture
Doctor’s Procedure Documentation
Immediate Electronic Data Retrieval
IBM
Patient Report
Hospital eMR
� Past Procedure Notes� Previous Procedure Images� Data Reports
Information Architecture
Procedure Report
Patient Instructions
Nation Bowel Cancer Screen
Program
Results View in PowerChart
Results Text View in
PowerChart
Procedure Note via EMR
Program Rollout
• Goal 33 sites
– 80% procedures
• Currently 25 sites
since Nov 2012
– Plus 14 HNE sites
Benefits
• Improved access to information leads to time saving
– Discharge summary
– Patient enquiries
– National bowel cancer screening forms
– Common reporting, data capture,
processes
Lessons Learned
• Interfaces
– ADT manipulation required
– Legacy MRN pools
– Dropped network connection
– Handling error messages
– Scheduling: Single procedure codes
only
– Results: mismatch episode
Lessons Learned (cont)
• Information Technology
– Buy-in
– Citrix
– Limited use of network logins, impacts
LDAP
Lessons Learned (cont)
• Clinical
– Clinical champion
– Endoscopist buy-in, change
management
– Accessing doctors for pre-training
– Ideally reduce list on first use
• 1.5 times longer at the end of first list
– Nursing buy-in
Lessons Learned (cont)
• Lack unique identifier
• Common systems often require different interfaces
• Different processes exist
– Pathology ordering
– Booking, arrival / check-in
