ACHSE
An Area Perspective of the NSW
Health Technology Strategies
November 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:
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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
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Enhances project delivery success and the targeting of funds
to strategic initiatives
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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
Bulli
Calvary
Coledale
David Berry
Garrawarra
Gower-Wilson
Kiama
Milton-Ulladulla
Prince of Wales
Waverley War
Memorial
 Royal Hospital for
Women
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 Sacred Heart
Hospice
 St George
 St Vincent's
 Shellharbour
 Shoalhaven
 Sutherland
 Port Kembla
 Sydney/Sydney Eye
 Sydney Children's
 Wollongong
SESIHS
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13 local government areas
Population:
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1.162M (2006) representing 18% of NSW population.
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Projected to reach 1.24M by 2011
Area:
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6,331 square kilometres
highly urbanised areas of eastern Sydney, southern Sydney,
Wollongong and Port Kembla,
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rural areas of Kiama and Shoalhaven
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SESIH Information Services - Statistics
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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
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Statewide Service Desk (SWSD)
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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.
DDG
CE
Monthly
ICT Mgmt
Committee
DCS
Monthly
CIO Forum
CIO
Monthly
CAG
• Katherine McGrath (as reqd)
• Mike Rillstone (Chair)
• Frank Cordingley
• Matt Gollings
• Rick Heise
• Paul Goetzheimer
• Paul Goetzheimer (Chair)
• Olivia De Sousa
• John Baulderstone
• Robyn Wright
• Linda Watson
• Sheetal Ram
• AHS Business Lead (as
State
Escalation
Fortnightly
Weekly
• Paul Goetzheimer (Report)
• Matt Gollings
• Robyn Cook
• 1 x CIO (tba)
• 1 x Senior Clinician (tba)
Local
Committee
EMR
Leadership
Group
Program
CCB
required for AHS Changes)
DCO
EMR
Steering
Committee
Weekly
Local
Escalation
AHS EMR
Reference
Group
EMR
EMR
AHS Project
EMR
AHS Project
Management
EMR
AHS Project
Management
Meeting
EMR
AHS Project
Management
Meeting
EMR
AHS Project
Management
Meeting
EMR
AHS Project
Management
Meeting
Weekly
AHS Project
Management
Meeting
(on per AHS) Management
Meeting
Group
State Level (PROGRAM)
Program
RRB
PMO Client
Liaison
Officer
AHS
Business
Lead
AHS
Change
Manager
Local
Committee
Local
Committee
Application
Focus
Groups
Project Manager (Cerner)
Monthly
Escalation
point as
appropriate for
the issue
AHS
CSRP
Rep
AHS
Education
Co-ordinator
AHS
Integration
Architect
AHS Level (PROJECT)
State Approach to eMR
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Electronic Medical Record (eMR)
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Relationship between Cerner, HT, SIM and SESIH
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Project commenced February 2007
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SESIH is first area to implement “full-stack” –
Emergency Department, Operating Theatres,
Order Management & Results Reporting,
Enterprise-wide Scheduling, E-Discharge Referral
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Hardware hosted from HT
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First site to “go-live” expected to be Jul 08
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All Area sites to be live within 12 months
State Approach to eMR
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Supporting the patient journey
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Equity of access to information systems
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State based build approach to:
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Reduce the cost of building the eMR
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Reduce the costs and effort of upgrades
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Build once and deploy state wide
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Rapid deployment methodology
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Limited funds available
Phase one to realise benefits before
additional Treasury funding provided
Decision support, state based build with standardised codesets
The Electronic Medical Record
Clinical Workstation - PowerChart
Assessment
Orders
Results
Progress Notes
Charting
Care Pathways
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•Diagnostic tests
•Diet
•Medications
•Treatment
•Consultations
•Referrals
Review
• Diagnostic tests
• Text reports
• Trends
• Graphs
Record
•Interventions
•Change in status
•Outcomes
•Vital signs
•Fluid balance
•Urinalysis
•Other
physiological
measures
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Past History
Current Illness
Examination
Diagnosis
Discharge
Prescribe Treatment Referrals
Clinical guidelines • Summary of Rx
Variance reports
• Medications
Outcome analysis
• Follow-up Care
Discharge Summary
Clinical Repository
Emergency
Operating
Theatres
Pathology
Radiology
Clinical
Measures
Pharmacy
Food
Services
Clinical
Specialty
Clinical Support Systems
Patient Administration & Enterprise Scheduling
Allied
Health
Key Benefits of the eMR
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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
Common
(Centralised)
Collaborative/Federated
Divergent
1. Extent of Solution
Scope
State Wide Solution
AHS Wide or
Collaborative Groupwide 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
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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
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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
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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