jason whakaari - western health melbourne vic

e-Health Interoperability Conference (Sydney, 28/29 October 2014).

ICT

Innovation,

Interoperability

Challenges, AND

BREAK

THROUGHS

Western Health, Melbourne, Victoria, AUSTRALIA

Jason Whakaari, Executive Director – ICT, Capital, & Contracts

(Interoperability)

A system working with at least one other system

to electronically exchange data that can be

interpreted and used by that other system

A Definition

3

ICT Innovation, Interoperability

Challenges & BREAK-throughs

<In the Western Health context>

Hospitals are amongst the most complex service environments in the modern

workplace

Health Care is amongst the most important of human endeavours

Interoperability is enabling an innovation led

transformation of Clinical Workflows & Practice

e-Health <mutual inclusive dependency on interoperability>

Welcome to

Western Health <West Metropolitan Melbourne>

Our Vision Together, caring for the West

Patients – Staff – Community – Environment

5

Our Strategic Priority Areas

Our Sites

FOOTSCRAY HOSPITAL

7

Our Community

• Unprecedented population growth in the West / Increasing

service demand

• High cultural diversity / low socio-economic status

• High & increasing prevalence of chronic and complex disease

• Higher than average rates of diabetes, obesity, some cancers,

mental health, drug & alcohol addiction and infectious diseases

• Outer West - lowest number of GPs, dental services and

pharmacies per capita of any of the regions across Melbourne

On a typical day at Western Health...

840 patients are cared for overnight (acute and sub-acute)

506 patients see a doctor in an outpatient clinic

350 patients attend one of our three emergency departments

62 surgical operations take place

307 patients are discharged

404 patients are seen by our Community and Care Co-ordination Services

130 patients require the services of an interpreter

40 patients are visited at home by our Hospital in the Home program

30 different volunteer roles offer to patients, visitors and staff

14 babies are welcomed into the world at Sunshine Hospital

3031 meals are served

10

People Matter Survey results below sector average on every item

Results inform Executive consideration of People & Culture strategic priorities

Western Health Strategy 2008-2015 OD Plan developed 2010

Western Health Strategy refresh 2011-2015

0%

2%

4%

6%

8%

10%

12%

14%

16%

2007 2008 2009 2011 2013 2014

We

ste

rn H

eal

th im

pro

vem

en

t ag

ain

st s

ect

or

People Matter Survey: The Journey

People and Culture 75% of survey items rated above average for the sector

11

Winner in Victorian Public Healthcare Awards

Victoria, AUSTRALIA

Award Ceremony 13 October 2014

Summary Overview

Innovative Interoperability

Initiatives @ Western Health

13

• 1. Mobile Workforce Infrastructure Layer (BT)

• 2. Digital Medical Record (BT)

• 3a. Intelligent Patient Journey System (BT)

• 3b. Access Glance (bt)

• 4. E-Health Messaging Gateway (c - bt)

• 5a. Patient Context Switching (C)

Where to From Here?

• 5b. CPOE / EMR (C)

ICT Innovation Interoperability Initiatives

@ Western Health

Mobile Workforce Infrastructure Layer

<Link to Video>

Topic 1:



15

• Oracle/Sun J-CAPS Integration Engine (HL7 V2.4)

• Ubiquitous Wi-Fi (Clinical & Non-Clinical Areas)

• Citrix Access Gateway (Multi-user / Remote Access)

• 2 Factor Authentication Access (P-Wd / SMS Code)

• Bring Your Own Device (Access to Clinical Apps)

Where to From Here?

• Azure MS Cloud? (Primary Vs. Archives)

Pre-requisite Mobility Work Flow

Infrastructure @ Western Health

Digital Medical Record (DMR) (BT)

Topic 2:



17

• (Base) Document Scanning Solution

• (Strategic) Clinician culture and transition to e-workflows

Plus:

• Direct system entry for HL7 compliant department systems

• Results viewing (soft landing linked to Pathology change)

• Clinician data entry (e-forms, free text)

• Discharge Summaries / Medication Summary (IP & DC Meds)

Digital Medical Record (DMR)

• Base Document Scanning Solution (PLUS)

18

Digital Medical Record (DMR)

• Interoperability Architecture

Fuji Film

RAD PACS Endoscopy

MIYA DSE

Pathology Emergency

Allied Health

ICU

Pharmacy Dictation

Radiology Fujifilm iCVIS Oncology (iCW)

/ Renal

Birthing Outcomes

3a. Intelligent Patient Journey System (iPJS) (BT)

3b. Access Glance (bt)

Topic 3:



20

MJ delivers seven different

services in the one app.

Clinical

Assessments Notifications

Internal

Referrals

Queue

Monitoring

Medication

Monitoring Clinical

(Medical)

Ready

Discharge

IPJS

Clinical

Information:

Aggregated &

Analysed

1. Clinical Assessments

2. Notifications

3. Internal Referrals

4. Queue Monitoring

5. Medication Monitoring

6. Clinical (Medical) Ready

7. Discharge (Streamlined)

8. Coding Support (ABF)

Intelligent Patient Journey System

• Made up of a range of (e-Smart/Interoperable) Services

Collaborative Project under VIC Govt. MVP Program:

Funding – Dept. Business & Innovation, Host – Western Health, Vendor – Alcidion Corporation (S.A.)

21

Productivity

Best Practice

Safety


• Delivering benefits to clinicians & patients at Western Health

22

Connecting the systems...

A range of systems collecting data from

different service areas within the Health

Service environment

IPJS has capacity to talk to

other systems, collecting

and analysing patient

information.

IPJS then shares the right

information, with the right

person at the right time.

IPJS

PAS / PMI

DMR / Msg

Gateway

LABS /

PACS

EDIS, +


• (Smart) Electronic Patient Journey Board

Alcidion MIYA Platform DSE: Underpinning iPJS; and, Access Glance

23


• (e-Smart) Patient Journey Portal <drill down capability>

24

Access Glance (Smart) Mobility Bed Access Mgt Tool

• Admissions, Transfers, & Discharges

25

Access Glance

• (Smart) Mobility Bed Access Management Tool

• Increased transparency about capacity and

demand

• Reduces the ‘noise’ associated with bed

management

• Provides management with real time data

• Process of discharge planning

• Why discharge is delayed

E-Health Messaging Gateway (c – bt)

Topic 4:



27

• Development of a messaging platform that includes a GP directory and

increased reporting capacity

• Uses messaging vendor <Healthlink> to securely deliver notifications

from WH Systems, via WH e-Messaging Gateway, directly into GP

desktop Practice Management Systems

• Can reduce clinical risks related to communication breakdown at the

acute/primary care interface and improves continuity of care by ensuring

adequate and timely follow up of patients in the community

< Workflow Efficiencies – Reduction in Errors – Speed of GP Access to Info>

E-Health Messaging Gateway

• (SMD Compliant) Acute -to- Primary e-Messaging Gateway

28

GPs involved in pilot <in collaboration with Medicare Locals>

• 22 practices overall

• 162 GPs = 19.6% of GPs in the area1

1 Based on ML Stats from June 2013.



Phase 1 – Scope of Work <Std Notifications: from Dec 2013>

• Admission, Discharge, Transfer

• Deceased notification

• OP Appointment, Receipt of Referral

• Same day Admission / Discharge

• Women’s & Children’s

29

Pilot practice demographics SWMML

MRNWMML

Practice

No. of

GPs

Medical software No of GPs Medical software

1 5 MD 17 Best Practice

2 4 MD 1 MD

3 8 Zedmed 6 MD

4 7 MD 28 Best Practice

5 9 Zedmed 6 Zedmed

6 6 MD 6 MD

7 7 MD 1 MD

8 3 MedTech 10 MD

9 6 MD 12 MD

10 7 MD 7 MD

11 3 MD - -

12 3 MD --

30

Typical day

Notification type Fax Electronic % sent electronically

Admission 87 13 13%

Discharge 67 11 14%

Deceased 2 0.2 9%

Outpatient

appointment 367 42 10%

Receipt of referral

(outpatients) 44 6 12%

Same day

admission/discharge 35 6 15%

Women's Clinic 3 0.2 6%

Total 605 78 Average: 11%

31



Phase 2 – Scope of Work <Add more complex message content: from Nov 2014 (target)>

• Discharge Summary

• Outpatient Letters

• Medication Summary (IP & DC Meds)

Next Steps • Phase II Roll Out to Pilot GP Cohort

• Roll out of full Phase I & II Functionality to full WH GP Cohort

• Add any additional high value content to GP Cohort

<Explore viable options for in-bound e-referrals from GP to Acute>

5a. Patient Context Switching (C)

<In Development>

5b. What Next / Where to From Here (C)

<Under Consideration>

• CPOE

• EMR Visioning

Topic 5:



33

Vendor Pitch:

Vergence unifies single sign-on, role-based application access, context management, multi-factor authentication and centralized auditing capabilities into a fully integrated, out-of-the box clinical workstation solution.

Patient Context Switching

• Vergence (Caradigm) <formerly Sentillion & then MS>

Australian Deployments:

The Macquarie University Hospital, Sydney (AUS)

34

• Enables automatic alignment of Patient details across multiple

systems when changed in other bridged systems that are open

• Vendor Bridge Integration (Development in WH environ)

• P&CMS / PAS (CSC iPM), Digital Medical Record (BossNet CMS),

Radiology PACs (Fuji Film), Allied Health (HMS), EDIS (CSC)

• Includes Single Sign-On solution in WH deployment


• Vergence (Caradigm) <formerly Sentillion & then MS>

35

• Enables automatic alignment of Patient details across multiple

systems when changed in other bridged systems that are open

• Vendor Bridge Integration (Development in WH environ)

• P&CMS / PAS (CSC iPM), Digital Medical Record (BossNet CMS),

Radiology PACs (Fuji Film), Allied Health (HMS), EDIS (CSC)

• Includes Single Sign-On solution in WH deployment

Where to From Here

36

• Engaged PWC to support an organisation wide e-Heath

Visioning & EMR Options Assessment

• Working through CPOE / EMR Options Discussion with WH

Executive & Board

• Watch this space?


• CPOE / EMR

Recap of Key Topic Areas



38

• 1. Mobile Workforce Infrastructure Layer (BT)

• 2. Digital Medical Record (BT)

• 3a. Intelligent Patient Journey System (BT)

• 3b. Access Glance (bt)

• 4. E-Health Messaging Gateway (c - bt)

• 5a. Patient Context Switching (C)

Where to From Here?

• 5b. CPOE / EMR (C)

ICT Innovation Interoperability Initiatives

@ Western Health

Q & A

(Time Permitting)

<www.wh.org.au>