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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
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