Information

Strategic Information Management

Information & Communication Technology (ICT) Strategic Plan

2006 – 2011

‘Building a sustainable future’

Updated: September 2008

Version: 2.2

Information & Communication Technology (ICT) Strategy Introduction

2

NSW HEALTH DEPARTMENT

This work is copyright. No part of this publication may be reproduced by any process without the written permission of the copyright owners.

SHPN - (HSPI) 090005

ISBN: 978-1-74187-414-3

© NSW Health Department 2008

Prepared by the Strategic Information Management Branch.

Copies of this strategy can be downloaded from the NSW HealthWeb site www.health.nsw.gov.au


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Table of Contents

1 Introduction............................................................................. 5

1.1 Building a sustainable future for health ...........................................5

1.2 Key programs of work ..................................................................7

1.3 Planned outcomes .......................................................................8

2 The ICT Strategic Management Framework ..............................10

2.1 Strategic Themes ...................................................................... 10

2.2 Describing the ICT Strategic Management Framework ................... 11

2.3 Strategic Planning Process ......................................................... 11

2.4 Criteria for inclusion in ICT Strategy and Investment Plan............... 13

2.5 Upgrade process ....................................................................... 13

3 Where we want to be in 2011...................................................14

3.1 Benefits to the individual patient and clinician................................ 14

3.2 Department level benefits ........................................................... 15

3.3 Hospital level benefits ................................................................ 15

3.4 Area level benefits ..................................................................... 15

3.5 State level benefits .................................................................... 16

4 Key Challenges faced by NSW Health......................................17

5 NSW Health Strategic Response to Key Challenges ..................19

5.1 NSW Health Strategic Framework ............................................... 19

5.2 Results and Services Plan (RSP) ................................................ 20

5.2.1 Strategic Goal 1: To keep people healthy................................. 21

5.2.2 Strategic Goal 2 : To provide the healthcare people need .......... 21

5.2.3 Strategic Goal 3: To deliver high quality health services............. 22

5.2.4 Strategic Goal 4: To manage health services well ..................... 23

5.3 NSW and National ICT Government Drivers ................................. 24

5.3.1 NSW GCIO ICT Strategic Plan ............................................... 25

5.3.2 Council of Australian Governments ......................................... 25

5.3.3 National eHealth program ...................................................... 25

5.3.4 NEHTA ................................................................................ 26

6 The Approach to ICT in NSW Health ........................................27

6.1 Approach to delivery of ICT in NSW ............................................. 27

6.2 Approach to delivery .................................................................. 31

6.3 A Portfolio Management approach ............................................... 31

6.4 Standard processes adopted across the ICT portfolio .................... 32

6.5 A framework for Partnership........................................................ 33

6.5.1 Core, Common and Divergent ................................................ 33

6.6 Integrated governance model...................................................... 34

6.6.1 State based build .................................................................. 36

7 Priority ICT strategies .............................................................39

7.1 Clinical Systems Strategy ........................................................... 39

7.1.1 Objective.............................................................................. 39

7.1.2 Programs supporting this strategy ........................................... 39

7.1.3 Electronic Medical Record...................................................... 39

7.1.4 Primary, Community and Outpatient Care ................................ 41

7.1.5 Clinical Support Systems ....................................................... 42

7.2 Corporate Systems Strategy ....................................................... 42

7.2.1 Objective.............................................................................. 42

7.2.2 Core projects to be delivered .................................................. 43


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7.3 Business Information Strategy..................................................... 43

7.3.1 Objectives ............................................................................ 43



7.4 Sustainable infrastructure program .............................................. 44

7.4.1 Objectives ............................................................................ 44



8 Outcomes of the ICT Strategy..................................................47

9 Measurement of benefits .........................................................48

Appendix A Additional Reference Material/ Resources ...................50


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1 Introduction

1.1 Building a sustainable future for health

Over the next five years, the ICT goal of NSW Health is to ensure the basic systems needed to run an effective and high quality healthcare system are in place.

NSW Health is facing a number of major challenges:

• An increase in demand for services from an ageing population.

• Achieving equity in health to improve health outcomes and life expectancy for Aboriginal people, those in rural and remote communities, homeless people, people with a physical or intellectual disability, refugees and those with a mental illness.

• Staff shortages in critical areas such as nursing, requiring the introduction of more innovative approaches to delivering health care, attracting and retaining staff.

• Improving health status in the population in the face of rising rates of chronic diseases including heart diseases, pulmonary diseases, diabetes and cancer, and risk factors such as obesity and sedentary lifestyles.

• Consumers are becoming more informed, have higher expectations and suffer more complex problems.

• Quality and safety standards are challenged as demands increase.

• Financial sustainability of the health system. Cost pressures are expected to continue to rise, and already represent more than 27% of the state budget.

The Results and Services Plan and Total Asset Management plan establish the framework for NSW Health to meet these challenges.

NSW Health has seven key strategic directions –

• Make prevention everybody’s business

• Create better experiences for people using health services

• Strengthen primary health and continuing care in the community

• Build regional and other partnerships for health

• Make smart choices about costs and benefits of health and health support services

• Build a sustainable health workforce

• Be ready for new risks and opportunities

To meet and prepare for these challenges NSW Health must change the way it delivers services. NSW Health is implementing a major combined clinical and corporate and ICT reform program to address these issues. Implementation of IT solutions to support staff and embed business processes is critical to ensuring change to delivery of services is sustainable. To be successful this requires a change in the way that ICT solutions are procured, designed and implemented.


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Historic investment decisions and decision-making have resulted in Area Health Services developing disparate clinical and corporate applications, supporting mixed infrastructure and integration approaches. This has resulted in:

• Very high integration cost and difficulty gaining a comprehensive clinical or management information;

• Duplication of effort and little reuse of technology assets;

• Existence of information gaps and overlaps;

• Different clinical specialty systems making it difficult to effectively manage the patient journey and give clinicians a single view of their patients;

• Twenty-nine systems support basic HR functions;

• Systems that are more than 20 years old and have limited support.

As a result it is difficult to share patient information and coordinate patient care. From a management perspective, it is difficult to obtain accurate information on system performance. From a financial perspective, the systems are expensive to maintain.

This situation will undermine the long-term sustainability of the Clinical Services Redesign and Corporate Shared Services reform programs. The ICT program has been realigned and refocussed to meet the long terms needs of the reform program. The focus will be on connecting islands of information and technology and rapidly supporting clinical and corporate reform.

The Integrated Clinical Information Program (ICIP) was established in 2000 as a result of recommendations of the NSW Health Council and its objective is to deal with the issues outlined above in a defined forward strategy. The program aims to address these issues by providing core clinical functionality across NSW. Significant progress has been made in the implementation of patient administration, clinical and corporate systems.

The ICT Strategy has been realigned with the core reform strategies of Clinical Services Redesign and Corporate Shared Services. Five major ICT strategies have been defined to support these broader strategic priorities. These are the:

• Clinical Systems Strategy

• Corporate Systems Strategy

• Business Information Strategy

• Sustainable Infrastructure strategy and

• Whole of Government ICT Strategic directions.


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1.2 Key programs of work

Within these strategies, the following core programs will be implemented over the period 2006 - 2011:

• Electronic Health Record pilots implemented and evaluated to support the patient journey across acute, community based and private health services.

• Electronic Medical Records across the state, as a key enabler for clinical reform through Clinical Services Redesign and improved quality and safety. This will provide clinicians with:

� Results reporting: to allow test results and reports from diagnostic services to be viewed at the point of care

� Order management: capacity to order tests, procedures and services online at the bedside. This includes laboratories, imaging, allied health, dietary, catering and other departments. Order management provides decision support to improve patient safety, reduce over servicing and reduce costs.

� Discharge Referral: an electronic summary of the patient’s care which can be sent to another provider, directly or via the Electronic Health Record, such as a General Practitioner to support ongoing care in the community.

� Emergency Department: information specific to Emergency Departments to allow the efficient management of the Unit and patients. It includes triage information, presenting problem, treatment times, interventions etc.

� Operating Theatres: a system to manage the co-ordination of patients, surgeons, anaesthetists, equipment and rooms, and report on utilisation to ensure maximum utilisation to reduce delays and access block.

� Scheduling: the ability to co-ordinate scheduling across an integrated set of information systems to provide a single view of appointments and resource requirements.

• Community Health Systems across NSW that support improved management of patients in the community, particularly aged, chronic disease and mental health patients

• Picture Archival Communication Systems/Radiology Information Systems A standardised statewide approach to procurement and implementation to support the implementation of new service delivery models to address critical workforce issues. This includes the implementation of a centralised image server and storage.

• Patient Administration Systems fully implemented across NSW for more effective and efficient patient management, administration and scheduling and as the foundation for core clinical systems.

• State Unique Patient Identification System fully operational to enable linkage of records across NSW to improve co-ordination of care, underpin the Electronic Health Record and provide the capacity for improved public health information.


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• Corporate Systems, a suite of systems including Finance, e-Procurement, Human Resources, Asset Management and Billing, to underpin the Corporate Shared Services reform and support the management and resourcing of clinical services.

• Business Information Strategy to ensure that accurate, timely, accessible and appropriately presented information is available for to support decision making by frontline clinicians, health service managers and the Executive. This strategy includes an assessment of the replacement of the data warehouse and business Information infrastructure.

• Infrastructure Strategy which will address the immediate needs to support the key programs of work. The strategy will include short-term requirements such as the replacement of obsolete telecommunications network equipment, telephony systems and data centre hardware, acquisition of additional floor space at the Liverpool data centre, the establishment of a Network Operations Centre and the implementation of supporting ICT management processes in Health Support Services. The strategy will be further developed to address longer-term data centre requirements, additional essential equipment replacement and the extension of supporting management processes (ITIL) across the public health system.

• Other systems within the ICT Portfolio, such as ICU, Medication Management, Hospital Pharmacy and Clinical Documentation are scheduled for the second half of the 10 year investment cycle.

• An integrated Enterprise wide architecture for clinical and corporate systems to enable secure, accurate exchange of information to support transition to new service models.

• An enterprise wide governance model to ensure an integrated approach to governance, investment, planning and change management across the ICT programs in NSW Health.

1.3 Planned outcomes

This ICT Strategy supports close strategic alignment to major NSW Health and broader whole of Government initiatives. The Strategic Plan has been developed to support the strategic directions outlined in the NSW Health Results and Services Plan, and the core reform programs designed to underpin the plan, such as Clinical Services Redesign and Shared Corporate Services.

The ICT Strategy aims to improve rural coverage to support rural and remote strategies, and improved support for public health, health promotion and preventative strategies to better predict and manage future demand

This strategy will deliver the following key outcomes:

• More patient focused and informed care leading to better patient outcomes ie :

� the right information is available at the right time and in the right place


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� Information available to support the patient journey reducing adverse events

� Improved discharge referral planning improving the transition of care from acute to community settings and reducing risk of adverse events.

• Improved quality and safety by ensuring that clinicians have access to information they need to provide safe care and by providing systems to embed consistent, predictable processes across the state to improve quality and safety

• Information to support the more effective management of health services and improved clinical and corporate processes.

� Improved theatre utilisation and use of resources, reducing waiting times and patient delays

� Reduced access block in Emergency Departments

� Enterprise wide scheduling allowing better matching of resources to demand, planning and more effective resource usage

• A highly skilled workforce with access to the information and tools they need to manage their work

• Improved collaboration within health and other related agencies within NSW, with the private sector and nationally to increase interoperability and better information flow to support improved patient outcomes and increased efficiency.

• Significant savings – new structures, governance arrangements and development and deployment methods

� Rapid deployment of core programs will reduce overall project management costs, which are the major cost component

� Potential to integrate with the change management activities already in train with CSRP and Corporate Shared Services, reducing cost and increasing value of the change management process. This will also help to embed the ICT processes within the clinical and corporate reform programs to ensure that the change is sustainable.

� Minimises duration of impact on clinicians in AHS’ and increases the speed to delivery of benefits for clinical care

� Reduced training costs (can train once for all components, not multiple times for each individual component)

Information & Communication Technology (ICT) Strategy The ICT Strategic Management Framework

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2 The ICT Strategic Management Framework

2.1 Strategic Themes

In summary, the ICT Strategy revolves around three strategic themes:

• Significantly improved support for clinicians and patient care

• Strategic alignment to major NSW Health initiatives; and

• Considerable cost savings.

These themes are expressed in terms of five Strategic Objectives

1. Use of ICT to enable major clinical reform programs;

2. Reduce the duplication and cost in administrative systems

3. Deliver a core set of high quality information to all levels of the organisation

4. Build an ICT Infrastructure that is available and responsive and supports the requirements of the clinical and corporate systems reforms; and

5. Adopt a coordinated, portfolio approach to the management of ICT to ensure that the maximum benefit is gained from NSW Health’s investment in ICT

These central concepts to the strategy are expanded out in the body of the document and are summarised in Figure 1.

Sustainable Infrastructure

Business Information (BIS)

Clinical Systems Corporate Systems

• Statewide integrated

Electronic health record• Electronic Medical Record

• Community & Primary

Care• Clinical Support (PAS,

Diagnostic)

Better systems

• Human Resources

• Finance• Asset Management

• eProcurement

• Billing• EAI

• Identity Management• Telecommunications

• Desktop Consolidation

ICT Portfolio ManagementProcesses for Core, Common & Divergent Applications

ICT GovernanceIntegrated Governance Models across AHS’ and the Department

ICT Asse

t Management

Investment Management

Enable Clinical Services

Redesign Program

Deliver

• Statewide integrated

Electronic Health record• Electronic Medical Record

• Community & Primary Care

• Clinical Support (PAS,

Diagnostic)

Standardised data sets Embedded in operational systems

Available to clinicians & decision makers Provided in a timely & user friendly manner

Support clinical & corporate systems Uniform Information ManagementData quality Standards Business Continuity Build enterprise architecture

High QualityServices

Patient

Figure 1 –Core elements of the NSW Health ICT Strategy


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2.2 Describing the ICT Strategic Management Framework

This document provides the central description of NSW Health’s ICT Strategy for the period 2006-2011.

It is supported by a number of more specific documents covering:

• The ICT Asset Management Strategy;

• NSW Health’s Enterprise Architecture. This document forms the core of NSW Health’s ICT Architecture documents, that are specific to:

� The Clinical Systems Architecture

� The Corporate Systems Architecture and Strategy

� The Business Information Strategy

� The Infrastructure Strategy; and

� The Integration architecture strategy

• The ICT Governance Framework

• The ICT Portfolio Management and Program of work

• The ICT Investment Plan 2006-2017.

This collection of documents describes NSW Health’s ICT Strategic Management approach. Figure 2 provides a graphical illustration of these documents and their hierarchical organisation.

Level 0 Input Documents

Internal External

Health RSP State Health Plan

Corporate Plan

State Plan

TAM PeopleFirst (GCIO)

Level 1 Whole of NSW Health

ICT Strategy

ICT Strategy “at a Glance”

ICT Strategic Plan NSW Government ICT Strategy alignment

Level 2 Enabling plans

Level 3 Action Plans

ICT Asset Management Strategy

NSW Health Enterprise Architecture

ICT Governance Framework

ICT Communication Strategy

ICT Portfolio Investment Plan

SIM Business Plan

Clinical Systems Architecture

Corporate Systems Architecture

AHS ICT Strategic Plans

Program Plans

Figure 2 –The Documents that describe NSW Health ICT Strategic Management Approach

2.3 Strategic Planning Process

The ICT Strategic Plan forms one level of a planning hierarchy that encompasses the following levels:


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State Plan

Results and Services Plan

Total Asset Management Plan

NSW Health Plan

ICT Strategic Plan

Enabling plans

Figure 3: Planning hierarchy

The ICT Strategic Plan is driven by the overarching priorities of NSW Health as defined by the Results and Services Plan and NSW Health Plan. To ensure that the ICT portfolio is closely aligned with the RSP and Corporate Plan, NSW Health has taken the following steps:

From the RSP:

• Selected those results and associated services which will be dependent on the ICT assets working well

• Identified ICT asset-related risks which may prevent achievement of services and results

• Identified those services and service measures which will depend on the ICT assets working well.

From the NSW Health Corporate Plan identified:

• The ultimate goal or vision for the community

• The contribution NSW Health will make towards achieving this goal or vision

• The focus for achieving the goal or vision, including intended outcomes, risks and strategies

• Strategies for measuring where performance targets have been met

• The cost of achieving the goal or vision and meeting performance targets.

The outcome of this has informed the development of the ICT portfolio aimed at effectively supporting services needs.

Key dates in the strategic planning cycle are shown below. For more detail see the SIM Strategic Planning Framework.


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April / July

Review of Agreed

TAM with schedule of

changes and

preliminary business

cases, including

strategy gateway

July

Results and Services Plan sets strategic direction

August

Treasury forecast of

10 year budgets

October

Proposed TAM;

Asset Strategy

aligned with RSP

and including final

business cases;

completed business

case gateway

Figure 4: Planning cycle

2.4 Criteria for inclusion in ICT Strategy and Investment Plan

ICT priorities are set and reviewed annually. Each initiative is evaluated against 5 principles to determine the priority of the project and its position in the investment program. The principles are:

• Level of contribution to major service reform agendas and alignment with planned NSW Health Results and Services, priorities and plans.

• Extent to which the project supports the patient journey across multiple care settings and improves the quality and safety of health care for the largest number of people.

• Capacity to deliver improvements in efficiency and effectiveness in healthcare delivery and workforce utilisation.

• Degree of conformance with state ICT strategic planning requirements.

• Level of potential to generate a positive return on investment.

2.5 Upgrade process

It is intended that only new initiatives should be included in the forward investment program. The ongoing requirement to replace existing systems should be addressed through the procurement and contractual process to ensure NSW Health has access to future product upgrades through the support and maintenance agreements formulated with vendors.

Information & Communication Technology (ICT) Strategy Where we want to be in 2011

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3 Where we want to be in 2011

By 2011 we plan to have implemented the core clinical and corporate systems across NSW to support patient journeys through the health system and to provide the corporate systems and management information needed to manage the health system efficiently.

Implementation of the ICT Strategy will deliver benefits at five levels – individual patients and clinicians, Clinical Departments, Hospital, Area wide and State.

3.1 Benefits to the individual patient and clinician

From a clinical perspective, the end-goal of the strategy is to achieve a ‘single view of the patient’. The single view of the patient means that every clinician involved in the patients care (doctors, nurses, pharmacists, physiotherapists etc…) have a full understanding of the patients complete care needs and medical history. They can understand what other practitioners’ roles and contributions are and can work together effectively as a team across all parts of the system. Corporate systems are in place to effectively support the delivery of clinical care and support s single employee view.

The strategy benefits the patient as it means that all the information clinicians need to deliver the best possible care, with an optimal outcome is easily available whenever and wherever it is needed.

This helps clinicians by reducing the time they spend trying to locate information or unnecessarily repeating tests, increasing the time they have available for direct patient care.

The following figure illustrates this concept.

Connectivity

Supporting SystemsHR-Payroll Rostering Asset Mgt eMarketplace

Billing FMIS BedBoard Provider Directory

PACS/RIS

TheatreSystem

Results

Reporting

DischargeReferral

Electronic

PrescriptionSupport

Order

Management

PAS

ICU

EHR

UPI

CommunityHealth

ED

System

Single View of Patient

(Simplified diagram)

Figure 5: Single view of patient

There are also significant benefits to frontline managers from a fully integrated suite of systems that will allow improved business intelligence.


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For example a Nursing Unit Manager (NUM) on a ward can more effectively plan and care for patients with a full understanding of all demands, such as patients waiting in the ED, coming from surgery and being transferred in, and of ward capacity such as current available beds, pending available beds, quarantined beds and staff availability and skills sets.

At Hospital, Area and Department executive levels, a complete portfolio allows an integrated analysis of health outcome indicators, demand for services, resource availability, clinical and support services performance and financial management.

The ICT Strategy is focused on the priority areas or activities required to underpin these and will be addressing them in its forward strategy as resources and funding become available. Other initiatives will only be added to the ICT work plan if they do not compromise delivery of these core functions, or to address an urgent issue.

3.2 Department level benefits

By 2011 clinical departments will have access to systems that improve work flow within the Department, provide decision support for clinicians and access to information needed to support the most effective management of resources. This will mean that clinicians will have immediate access to critical information to make sure that the right decisions are made for patients. This, combined with rules built into clinical systems and better communication between staff in the department, will mean better and safer care for patients.

3.3 Hospital level benefits

The implementation of well integrated core systems across a hospital, including for example Results Reporting, Order Management, Patient Administration Systems, Scheduling and Human Resources means that information can be collected once and be accessible to all who need it. This will minimise problems at handover and allow enterprise wide management of human and other resources to increase efficiency and reduce access block as patient’s move between departments. Good information allows the patient journey to be more efficient allowing time to see more patients.

3.4 Area level benefits

Areas will benefit from the implementation of these systems as they will have access to standardised information from all facilities to manage their resources more effectively, support planning and demand management and management of patient transfers between hospitals in their Area with


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minimum duplication of diagnostic procedures and delays for patients. Improved communication between hospitals and clinicians in the community will support patient care better once they leave hospital and reduce the risk of readmission.

3.5 State level benefits

Implementation of core systems across NSW will deliver significant benefits. While benefits are derived at each level, the full value of ICT will be achieved when these systems are implemented across all Areas. Standardised clinical and corporate information, collected as a by product of patient care, provides support for NSW Health to achieve the targets set under the Results and Services Plan by improving patient journeys across the health system, improving timely access to services, strengthening co-ordination and integration across the health system. Accurate information will allow better utilisation of resources and management of future demand.

Information & Communication Technology (ICT) Strategy Key Challenges faced by NSW Health

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4 Key Challenges faced by NSW Health

NSW Health is facing a number of major challenges:

• A steady increase in demand for services from an ageing population. In NSW, the proportion of people over 65 is increasing rapidly. In every year between 2012 and 2028, the aged share of the Australian population is projected to increase by more than 0.35 percentage points – an increase around 4 times the long term average.

• Staff shortages in critical areas such as nursing and medicine

• Hospitals running at maximum capacity

• The rate of chronic diseases including heart diseases, pulmonary diseases, diabetes and cancer is increasing. The rate of obesity in our younger population is on the rise and our increasingly globalised society increases the risk of pandemics.

• An increasing body of medical knowledge that staff cannot manage and use without advanced IT systems

• Health services are increasingly challenged by more expensive medical technologies and pharmaceuticals

• Consumers are becoming more informed, have higher expectations and more complex problems.

• Quality and safety standards are challenged as demands increase and there are fewer staff to manage them. For example, from 2000 to 2005 the average occupancy for NSW hospitals stood at a high 93%. Some metropolitan hospitals’ surgical and medical wards average 95-98%, when 85% is generally considered a much safer working capacity for these beds.

• In the period July to December 2007 57,808 incidents were reported. The key factors that cause these adverse events are:

� Communication

� Policies and procedures

� Knowledge, skills and competence issues

� Work scheduling

• Clinical ICT is becoming an increasingly important enabler of health system reform, yet the core systems to underpin reform are not currently in place.

• Constraints in capital and recurrent funding, skilled project management and implementation resources and capacity of the health systems to accommodate large scale change all restrict the potential speed of implementation of core systems.

• There are many competing demands for the funds that are available for ICT. Determining priority and scheduling projects into the forward program is complex and requires ongoing review to ensure funds continue to be allocated in areas of greatest potential benefit.

Information & Communication Technology (ICT) Strategy Key Challenges faced by NSW Health

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When considered collectively, the convergence of issues creates an environment of significant risk that must be addressed. The only way NSW Health can realistically meet these challenges is to change the way it delivers services. NSW Health has embarked on a major clinical and corporate reform program to address these issues. The implementation of appropriate IT solutions to support staff and embed business processes is critical to ensuring this change is sustainable.

Information & Communication Technology (ICT) Strategy Strategic Response to Key Challenges

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5 Strategic Response to Key Challenges

5.1 NSW Health Strategic Framework

There are a number of key drivers that are influencing NSW Health strategic directions. These relate to both the demand for health services, driven by factors such as the aging population, and supply within health, for example workforce shortages in key areas of the health system. The wider government priorities and directions, such as the Council of Australian Government priorities around Mental Health and Health workforce and whole of government ICT strategies also drive the strategic directions and investment decisions of NSW Health.

At the highest level, the Results and Services Plan sets the strategic directions for all NSW Health Programs. This is supported by a number of strategic programs aimed at delivering the Results and Services Plan.

The ICT Strategic Plan aims to support the Results and Services Plan by ensuring close alignment with the reform programs and strategies underpinning the Results and Services Plan. All levels of NSW Health planning take into consideration the NSW whole of government and National strategies.

Figure 6 provides a schematic overview of the context of the ICT Strategic Plan.


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Figure 6 - Context of the ICT Strategic Plan.

The sections below overview the NSW Health strategic response to the challenges outlined above and identifies the relationship between the ICT programs and the broader Health priority areas.

5.2 Results and Services Plan (RSP)

The RSP represents NSW Health’s primary strategic response to the challenges faced by NSW Health. NSW Health has four primary goals:

1. To keep people healthy

2. To provide the health care that people need

3. To deliver high quality services

4. To manage health services well

These are underpinned by seven key strategic directions:

• Make prevention everybody’s business

• Create better experiences for people using health services

• Strengthen primary health and continuing care in the community

• Build regional and other partnerships for health.

Broader Healthcare

Environment

Health Needs of NSW Population:

• Demographics• Medical Technologies

• Disease Patterns & Trends• Consumer Expectations

NSW Health Strategic Response

HealthFutures

• Demand & Supply • Opportunities

• Risks

• Partnerships• Future Service

Delivery Concepts

Service Delivery Challenges: • Staff Shortages

• Hospitals Running at Max. Capacity

• Quality & Safety Challenges• Geographic Challenges

Clinical Services Plans

Statewide & AHSs

Annual Operational Plan• Burden of Disease

• Challenges (Pop. Health; Primary & Community;

Acute)• Risks & Priorities

• Current Year Programs

Corporate Strategic Plans

Statewide & AHSs

RSP

• Infrastructure Needs

• Information Needs

Enabling Plans Workforce; Safety & Quality; Asset Mgt;

Research & Teaching;

Procurement; Financial Mgt; IM&T

Outlook1 Year

Outlook5 Years

Outlook20 Years

Enabling Programs –

Annual GoalsAnnual Budget; Capital

Asset; Recruitment & Development; Goods &

Services; IM&T

Health IT

Strategic Context

Current State - NSW Health IT

NEHTA

Broader IT

Environment Govt. CIO Strategic Plans

Whole-of-Govt Plans

TreasuryTAM Policy

� Portfolio Approach for: 1. Strong Alignment with the RSP, TAM & Whole -of-Govt

IT 2. Improved Integration, Cost Control & Risk Management 3. Improved Transparency of Planning & Implementation4. Coordinated Approach to Implementation, Change

Management, Architecture, Security & Privacy

� Statewide Approach to: 1. Ensure Consistent IT Capabilities and Support Across

AHSs2. Leverage off Common Knowledge, Skills &

Methodologies (SIM, State Builds & HSS)

3. Eliminate Redundancies, Ensure Integration & Standardise Reporting and Cost Control

� New Funding Model:1. To Meet the Specific Needs of IM&T Investments2. To Meet Strategic Goals within the Proposed Timeframe 3. For Economies of Scale, Network Benefits & State

Buying Power

ICT Portfolio

NSW Health Goals

Common GoalsKeep People Healthy

Provide Needed Health Care Deliver High Quality Services

Manage Services Well

Common Strategic Directions

Goals

Govt. CIO GoalsICT Strategic Executive Plan

Reporting

Treasury GoalsMonthly Reporting and RSP

Other health jurisdictions


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• Make smart choices about costs and benefits of health services

• Build a sustainable the health workforce

• Be ready for new risks and opportunities

The ICT Strategic Plan will provide essential support to all four goals and seven strategic directions. These are being supported by a number of core reform programs and strategic initiatives. ICT is a critical enabler for each of these programs to support long term sustainable change. The section below summarises the relationship between the health strategic goals and enabling IT initiatives.

5.2.1 Strategic Goal 1: To keep people healthy

Reducing risk factors in the population is a major strategic objective for NSW Health. NSW Health is increasing the focus on health promotion and preventing illness and implementing strategies to increase immunisation rates, reduce the impact of chronic disease, reduce diabetes through interventions for people at high risk. ICT can support many of these strategies by providing automatic alerts about risk factors, such as gaps in immunisations, or overdue screening or check ups.

What we will do:

• Implement Electronic Medical Records to flag health risk factors so patients can be given early advice and referred for preventative care.

• Implement Community Health systems to support monitoring of patient in the community including automatic reminders of screening, implementation of care plans to improve management of chronic disease.

• Improve information through the Business Information Strategy to support evidence based research to target health promotion activities more effectively.

• Implement Outpatient scheduling systems and discharge/referral components of the EMR to encourage more proactive outpatient care for the prevention of acute care admissions.

5.2.2 Strategic Goal 2 : To provide the healthcare people need

Health services need to be available when needed, are effective and co-ordinated to meet each individual’s needs. ICT plays a major role in providing the tools that are needed to underpin new models of care and make clinical reform sustainable. Supporting information flow along the patient journey plays a large part in improving the experience of people as they move along the journey, and making sure that the care they receive is appropriate.

NSW Health is striving for a health system that helps people access the healthcare they need through an integrated network of primary and community health services. ICT supports this strategic direction by


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providing the infrastructure and systems needed to support communication across health services

What we will do:

• Implement Patient Administration Systems and the Electronic Medical Record to support efficient admission, elimination of redundancy in entry of demographic information and patient history taking allowing a more informed and efficient experience.

• Extend implementation of community health systems, with a major focus on aged care, chronic disease and mental health.

• Extend the implementation of the discharge referral component of the EMR to ensure GPs have access to information from hospital stays to make sure patients get the care they require when they are discharged.

• Support quality and safety with medication management tools, prescription support tools, clinical pathway capabilities, prompts and individualized patient safety alerts and full patient information and activity archiving.

• Implement scheduling, waiting list management and theatre systems to manage surgical demand and capacity.

• Implement integrated PAS and patient flow tools to increase visibility of areas of delay and constraint.

• Implement PACS/RIS technology to support remote diagnostic reporting minimise delays and travel for patients in rural and remote areas.

• Enhance the Incident Information Management System to identify and manage incidents effectively.

• Implement the Business Information Strategy to give clinicians and frontline managers the tools and information they need to provide care more effectively.

5.2.3 Strategic Goal 3: To deliver high quality health services

There are currently three levels of government and multiple agencies involved in funding and delivering health services, resulting in complexity


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and duplication. Improved collaboration within and beyond the health system is vital to improve the links and improve co-ordination and the quality of services provided across the health system. ICT provides the infrastructure and tools needed to improve this level of collaboration. Quality and safety will also be enhanced through decision support tools for clinicians through the Electronic Medical Record, and by more appropriate use of resources through rostering and other HR tools.

What we will do

• Implement the Electronic Medical Record and Medication Management to provide decision support to reduce the risk of adverse events and improve the quality and safety of care.

• Implement Electronic Discharge Referral Systems to improve the communication between hospitals and General Practice to ensure appropriate ongoing care in the community.

• Collaborate with other Human Service agencies in the implementation of HSNet to improve co-ordination of different types of services that may be accessed by one person.

• Implementation of state wide PACS/RIS, and particularly the establishment of a state image archive, will allow reporting on images from specialists anywhere in the state, regardless of the patient’s location. This will reduce unnecessary travel and help to address some of the significant workforce shortages NSW Health is facing. It will also provide the technical support for new models of service provision.

• Improve Community Health systems to support mental health, aged care and chronic disease services in the community.

• The establishment of Area wide clinical repositories to underpin results reporting, order management and clinical documentation will support much more streamlined care across all services within an Area Health Service. Shared access to information will improve collaboration between hospitals and providers across an Area.

• Implementation of standardised corporate systems to ensure that resources with appropriate skills are available when and where needed.

5.2.4 Strategic Goal 4: To manage health services well

The health system needs to be able to make the most effective use of finite resources and manage costs effectively to ensure long-term sustainability.

What we will do:

• A renewed focus on the information needed to manage the health system well, at all levels from state to individual managers and clinicians, has seen the development of the Business Information Strategy. The projects recommended in this strategy will be implemented over the next 3 years providing a robust basis for decision making, performance monitoring and patient care.


24

• A focus on consolidating IT services and infrastructure across NSW Health to reduce expenditure on infrastructure and back end systems and services. This will enable a greater focus on implementation of information technology to directly support patient care.

• Implementation of Finance, Asset management and procurement systems to ensure our resources can be managed effectively enterprise wide.

• Implementation of a state wide Human Resources Information System to replace the current 29 systems will provide the basis for informed decisions about the health workforce. It will support more effective management of rostering, learning and development and qualifications, improving the quality and safety of care provided to patients and the working environment of staff.

• State wide implementation of systems like PACS/RIS will provide opportunities to implement new service delivery models to address workforce shortages.

5.3 NSW and National ICT Government Drivers

The NSW Government IT environment feeds into, and, to some extent, constrains the NSW Health ICT strategic plan. This program aims to ensure that NSW strategic initiatives align with, and where possible have the opportunity to inform, national and broader state initiatives.

The government ICT principles and strategies with which NSW Health needs to demonstrate alignment are:

• NSW GCIO ICT Strategic Plan

• Council of Australian Governments

• National eHealth program

• NEHTA

These are discussed in the following sections.


25

5.3.1 NSW GCIO ICT Strategic Plan

The NSW Government has set new directions for IT through the NSW Government CIO Executive Council. Primary goals include:

• Using IT to reduce back-end service costs while maintaining frontline services

• Increasing investment in frontline service technologies

• Delivering savings through IT strategies in both capital costs and recurrent costs

• Reducing the total cost of IT

The Government has proposed a number of new measures to achieve its primary goals including:

• A single capital fund for IT

• A statewide IT plan

A focus on fewer software applications, shared infrastructure, common processes and aggregated purchasing

5.3.2 Council of Australian Governments

The Council of Australian Governments (COAG) has identified significant areas of national interest including mental health, health workforce, action plans for influenza pandemics and progress towards electronic health records. ICT is an enabler for many of the COAG priorities. COAG has an ambitious health and ageing reform agenda proposed for implementation from 2009. This includes a program of hospital reform, improvements to Indigenous health, chronic disease management and preventative health care. The ICT program outlined in this strategy directly supports the COAG reform agenda, through its focus on the implementation of systems that will enable clinical reform in both acute and community settings.

5.3.3 National eHealth program

The eHealth initiative is a State, Territory and Australian Government initiative, originally established in 2000 to promote and provide the foundation for e-health across Australia.

Since its inception, the Australian Government has contributed $128m to e-health projects in various locations across Australia. A further $10m was committed in December 2005 for managed health network grants. The program has overseen a number of Electronic Health Record trials, but in 2006 expanded the scope to encompass a wider eHealth focus. The aim of the eHealth program is to increase collaboration across jurisdictions and to support consistency in approaches to eHealth to underpin a national health information network. The eHealth Program is also responsible for establishing the appropriate regulatory frameworks to enable ehealth intiatives.


26

5.3.4 NEHTA

NEHTA’s primary goal is the development of national health information management and communications technology standards and specifications.

NEHTA is progressing a number of work programs that will have a direct impact on NSW Health’s ICT strategic plan.

These include:

eHealth interoperability: developing a Framework for Interoperability to enable efficient and secure electronic exchange of information between health organisations.

Clinical communications: NEHTA is undertaking a program of standardisation of key clinical information. It is intended that the format of, and data contained in, clinical communications such as patient referrals and hospital discharge summaries will be standardised across all health IT systems, according to the specifications set by NEHTA. These specifications will be built upon existing standards, extending these as necessary. This work includes the establishment of a common, coded clinical language (clinical terminology).

Unique Healthcare Identifiers – This program is developing a single National identifier for individuals accessing healthcare services, providers within the public and private healthcare systems and health organisations. At least initially, the individual identifier is not expected to be used as the primary identifier by most jurisdictions.

Individual Electronic Health Record: NEHTA are preparing the data and interoperability standards and business case for the development and implementation of a national electronic health record.

Identity management: Standards to ensure the accurate identification and secure access of individuals to clinical information.

Secure messaging: NEHTA is working to define national standards and shared infrastructure to ensure that the electronic exchange of clinical information between healthcare providers is reliable and secure.

Supply chain: NEHTA has established a National Product Catalogue (NPC) to provide a central source of data for the purchase of healthcare products within health departments in each State and Territory.

Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health

27

6 The Approach to ICT in NSW Health

6.1 Approach to delivery of ICT in NSW

To meet and prepare for the challenges it faces NSW Health is implementing changes to the way it delivers services. NSW Health has embarked on a major combined clinical and corporate and ICT reform program to address these issues. Implementation of IT solutions to support staff and embed business processes is critical to ensuring change to delivery of services is sustainable.

This section provides an overview of the approach that Strategic Information Management uses to deliver the ICT portfolio and the core strategies, programs and projects that will be delivered over the 5 years of this ICT strategy.

There are three primary bodies responsible for delivery of ICT:

Strategic Information Management (SIM)

SIM is responsible for the development of ICT strategy, working with stakeholders to determine investment priorities, budget negotiation and ensuring overall program delivery. SIM’s role includes:

• Development and maintenance of the NSW ICT Strategic Plan and investment program

• Interface with Area Health Services and other key stakeholder groups

• Business case development and review of Area IM&T proposals • overseeing the delivery of the IM&T strategy, • Ensuring compliance with government, Departmental and Branch

standards, architecture and policies • Identify, assess and address the enterprise architecture needs of

NSW Health by developing and maintaining appropriate policies, standards and procedures for information management.

• Managing, planning and developing integration strategies, architecture, standards and policies to enable effective and consistent integration of a wide range of systems throughout NSW Health.

Health Support Services

Health Support Services is responsible for the implementation and ongoing support and maintenance of core clinical and corporate systems. Health Support Services are responsible for providing specific clinical and corporate IT services to the Area Health Services as defined under s126G of the Health Services Act 1997. This includes the provision of hardware and hardware asset management, software, application support systems and system implementation management.


28

Area Health Services

Area Health Services are responsible for the management of local implementations, change management and training of staff and benefits realisation.

Accountability shifts from SIM to Health Support Services as the projects move across the project lifecycle as shown below.

Figure 7: Project lifecycle

The NSW Health ICT Strategy is illustrated in summary form in figure 8.


29

Figure 8 –ICT Strategy “At a glance”

Drivers(Why)

• Make prevention

everybody’s business.

• Create better experiences for

people using health services.

• Strengthen primary health & continuing care in the community.

• Build regional & other partnerships for health.

• Make smart choices about the costs and benefits of health services.

• Build a sustainable health workforce.

• Be ready for new risks and opportunities.

RSP

• Clinical Services Redesign Program

• Corporate Shared Services reform

program

• Develop a performance culture around information

Internal


• Council of Australian

Governments

• National eHealthprogram

• NEHTA

External

Themes

Strategic alignment to major NSW Health

initiatives

Considerable ICT cost savings

Significantly improve

support for clinicians and patient

care

Strategy(How)

Supporting Programs (Initiatives)(which will be delivered through)

Implement systems that

• Improve

communication,

• Minimise delays,

• Improve handover management

• Provide a more cohesive patient journey; and

• Support flexible

allocation of resources to ensure services meet

patient needs

Implement the core systems needed to underpin the

Corporate Shared Services

reform program.

Transform operational data

into management insight

Integrate NSW health’s

strategic objectives with front

line service delivery

Drive management

accountability

Develop and maintain

standards and architecture

needed to support state wide

ICT initiatives

Identify and manage business

impact of technology

Rationalise the technical

infrastructure

Electronic Medical Record program

• systems needed to manage patients effectively in an acute environment.

Primary, Community and Outpatient Care program

• systems to support patient care in the community, outpatient & primary care

environment,

• includes referrals and interaction with other human services.• Statewide integrated Electronic health record accessible by clinicians and

consumers across the public & private health sectors

Clinical Support program

• core support systems such as Patient Administration systems and diagnostic

systems

Corporate Systems program. New systems in the areas of

• Human Resources - Payroll, rostering, L&D, OH&S, Recruitment,

Performance Management

• Finance – General Ledger, Accounts Receivable, Accounts Payable, Fixed

Assets, Inventory Management, Purchasing and Sales Order

• Asset Management - Capital Works Management, Facility Management, Property Management, Maintenance, Cleaning & Security

• e-Procurement - Warehousing, Distribution, Inventory Management,

Catalogue Management, Supplier Management, Product Management &

Tendering

• Billing - Standardised billing management

Establish Business Information Governance and performance management

• Integration of NSW Health’s strategic and planning frameworks and

developing overall value and cost effectiveness performance measures.

Deliver Enabling infrastructure and support

• Ensure the source systems are capable of providing the major indicators

• Standardise the data sets and implement them to provide consistent

information

• Ensure the technical infrastructure is in place to support effective

information management

Define and implement the telecommunications and technical infrastructure to

support the clinical and corporate strategies.

Specify the enterprise architecture, enterprise integration layer and core technical

standards required to manage NSW information assets.

Develop and apply uniform Information management standards across state based

builds and other systems as appropriate

Ensure data quality strategies are in place to ensure maximum value from the information collected across NSW

ICT infrastructure/ EAI - Identity management, EAI strategy and management, telecommunications strategy and desktop consolidation.

Business Continuity Planning

Use ICT to enable major clinical reform

programs

• Clinical Services Redesign

Program,

• Quality and

Safety initiatives;

and

• clinical program areas

Reduce the duplication

and cost in administrative systems

to increase funds

available for frontline

care

Provide a core set of

high quality information all levels of the

organisation in a

timely, user friendly

way to support decisions that drive real

results for the

Department and its

stakeholders

An ICT infrastructure

that is:

• Reliable

• Responsive

• Available; and

• Cost effective

Clinical Systems

Corporate Systems

Business Inform

ation

Sustainable

Infrastructure

Strategic Objectives(what)

Standardise portfolio

management processes

through collaboration across

the Department of Health, Area Health Services, Health

Technology and third party

providers

Continuously evaluate,

prioritise, select, monitor and adjust programs and projects to achieve business priorities

Implement Processes to determine, develop and manage core, common and

divergent applications;

Application of integrated governance models at AHSs and the Department;

State based build approach to core applications to support a faster, more cost

effective implementation and to underpin predictable processes across the whole

of NSW.

Ensure the maximum

benefit is gained from the investment in ICT

ICT Management by

Health

ICT Strategy Measurement

KPIs Measures

Progress against plan

Earned Value

Coverage

Use of target

technology by

location

Uptake

Adoption of

technology by business users

Availability of

modelsModels published

Information Management

Coverage

% of information

requirements modeled

Uptake

Implementation of

standards in core systems

UseInformation published in

required form

Infrastructure Management

Outcomes

• Better and safer care for patients

Clinical departments will have access to

systems that

• Improve work flow within the Department

• Provide decision support for clinicians;

• Have rules built in

• Provide information needed to support

the most effective resource management

Clinicians will have access to critical

information to make the right decisions for patients.

Communication between staff in the

department will be better

• Information collected once and accessible

to all who need it

• More efficient patient journey

Well integrated core systems across a hospital,

including

• Results Reporting

• Order Management

• Patient Administration Systems

• Scheduling; and

• Human Resources

will minimise problems at handover and allow

enterprise wide management of human and

other resources to

• increase efficiency and

• reduce access block as patient’s move between departments.

• Standardised information from all facilities

• Better patient care once they leave

hospital

• Reduced risk of readmission

Standardised information will support

• more effective resource planning and

demand management

• Minimum duplication of diagnostic procedures and delays for patients.

• Efficient management of patient

transfers between hospitals in the Area

Improved communication between hospitals

and clinicians in the community will support

better patient care once they leave hospital; and reduce the risk of readmission

• better utilisation of resources and

management of future demand

The full value of ICT will be achieved when systems are implemented across all Areas.

Standardised clinical and corporate

information, collected as a by-product of patient care, helps NSW Health achieve

targets set under the RSP by

• Improving patient journeys across the health system,

• More timely access to services; and

• Better co-ordination and integration

across the health system.

• Improving utilisation of resources and management of demand.

Department

Hospital

Area

State

DescriptionGro

up Key Result Area

Performance

Against Budget% Over/Under

Quality of

Service

Agreed SLA levels

met

# severity 1 issues

Quality of

deliverables

Customer

Satisfaction

Process

Maturity

Current Maturity

Level

Effective

Governance

Speed of

resolution on

proposals

Effective

Portfolio Management

Expected v/ actual

Portfolio Risk

Standardisation

achieved

% non-compliant

infrastructure

Cost savings% reduction in annual op. cost

Drivers(Why)

• Make prevention









RSP

• Make prevention









RSP



program


Internal



program


Internal



Governments


• NEHTA

External



Governments


• NEHTA

External

Themes

Strategic alignment to major NSW Health

initiatives

Considerable ICT cost savings

Significantly improve

support for clinicians and patient

care

Strategy(How)

Supporting Programs (Initiatives)(which will be delivered through)

Implement systems that

• Improve

communication,

• Minimise delays,

• Improve handover management

• Provide a more cohesive patient journey; and

• Support flexible

allocation of resources to ensure services meet

patient needs

Implement the core systems needed to underpin the

Corporate Shared Services

reform program.

Transform operational data

into management insight

Integrate NSW health’s

strategic objectives with front

line service delivery

Drive management

accountability

Develop and maintain

standards and architecture

needed to support state wide

ICT initiatives

Identify and manage business

impact of technology

Rationalise the technical

infrastructure

Electronic Medical Record program

• systems needed to manage patients effectively in an acute environment.

Primary, Community and Outpatient Care program

• systems to support patient care in the community, outpatient & primary care

environment,

• includes referrals and interaction with other human services.• Statewide integrated Electronic health record accessible by clinicians and

consumers across the public & private health sectors

Clinical Support program

• core support systems such as Patient Administration systems and diagnostic

systems

Corporate Systems program. New systems in the areas of

• Human Resources - Payroll, rostering, L&D, OH&S, Recruitment,

Performance Management

• Finance – General Ledger, Accounts Receivable, Accounts Payable, Fixed

Assets, Inventory Management, Purchasing and Sales Order

• Asset Management - Capital Works Management, Facility Management, Property Management, Maintenance, Cleaning & Security

• e-Procurement - Warehousing, Distribution, Inventory Management,

Catalogue Management, Supplier Management, Product Management &

Tendering

• Billing - Standardised billing management

Establish Business Information Governance and performance management

• Integration of NSW Health’s strategic and planning frameworks and

developing overall value and cost effectiveness performance measures.

Deliver Enabling infrastructure and support

• Ensure the source systems are capable of providing the major indicators

• Standardise the data sets and implement them to provide consistent

information

• Ensure the technical infrastructure is in place to support effective

information management

Define and implement the telecommunications and technical infrastructure to

support the clinical and corporate strategies.

Specify the enterprise architecture, enterprise integration layer and core technical

standards required to manage NSW information assets.

Develop and apply uniform Information management standards across state based

builds and other systems as appropriate

Ensure data quality strategies are in place to ensure maximum value from the information collected across NSW

ICT infrastructure/ EAI - Identity management, EAI strategy and management, telecommunications strategy and desktop consolidation.

Business Continuity Planning

Use ICT to enable major clinical reform

programs

• Clinical Services Redesign

Program,

• Quality and

Safety initiatives;

and

• clinical program areas

Reduce the duplication

and cost in administrative systems

to increase funds

available for frontline

care

Provide a core set of

high quality information all levels of the

organisation in a

timely, user friendly

way to support decisions that drive real

results for the

Department and its

stakeholders

An ICT infrastructure

that is:

• Reliable

• Responsive

• Available; and

• Cost effective

Clinical Systems

Corporate Systems

Business Inform

ation

Sustainable

Infrastructure

Strategic Objectives(what)

Standardise portfolio

management processes

through collaboration across

the Department of Health, Area Health Services, Health

Technology and third party

providers

Continuously evaluate,

prioritise, select, monitor and adjust programs and projects to achieve business priorities

Implement Processes to determine, develop and manage core, common and

divergent applications;

Application of integrated governance models at AHSs and the Department;

State based build approach to core applications to support a faster, more cost

effective implementation and to underpin predictable processes across the whole

of NSW.

Ensure the maximum

benefit is gained from the investment in ICT

ICT Management by

Health

ICT Strategy Measurement

KPIs Measures

Progress against plan

Earned Value

Coverage

Use of target

technology by

location

Uptake

Adoption of

technology by business users

Availability of

modelsModels published


Coverage

% of information

requirements modeled

Uptake

Implementation of

standards in core systems

UseInformation published in

required form

Infrastructure Management

Outcomes



systems that












systems that











to all who need it



including




• Scheduling; and

• Human Resources



other resources to




to all who need it



including




• Scheduling; and

• Human Resources



other resources to





hospital




demand management









hospital




demand management





























Department

Hospital

Area

State

DescriptionGro

up Key Result Area

Performance

Against Budget% Over/Under

Quality of

Service

Agreed SLA levels

met

Quality of

Service

Agreed SLA levels

met

# severity 1 issues

Quality of

deliverables

Customer

Satisfaction

Quality of

deliverables

Customer

Satisfaction

Process

Maturity

Current Maturity

Level

Process

Maturity

Current Maturity

Level

Effective

Governance

Speed of

resolution on

proposals

Effective

Governance

Speed of

resolution on

proposals

Effective


Expected v/ actual

Portfolio Risk

Effective


Expected v/ actual

Portfolio Risk

Standardisation

achieved

% non-compliant

infrastructure

Standardisation

achieved

% non-compliant

infrastructure




31

6.2 Approach to delivery

A portfolio management approach is used as the basis for prioritising, selecting and monitoring programs and projects and making sound investment decisions that provide the greatest benefit to the health system. It is underpinned by common processes across ICT at a Departmental and Area level. The ICT portfolio is managed within a collaborative framework that defines:

• Processes to determine, develop and manage core, common and divergent applications

• Application of integrated governance models at Area Health Services and the Department

• State based build approach to core applications to support a faster, more cost effective implementation and to underpin predictable processes across the whole of NSW.

This section provides an overview of how the strategy will be delivered, with a focus on these elements.

6.3 A Portfolio Management approach

NSW Health uses a coordinated portfolio approach to the management of ICT. A portfolio management approach provides the basis for evaluating, prioritising, selecting and monitoring programs and projects and adjusting this where necessary to achieve the business priorities. Portfolio Management can be explained in terms of four inter-related frameworks as described in the following diagram.

PORTFOLIO MANAGEMENT FRAMEWORK

The strategic framework used to

determine where investment should be

focused to meet strategic priorities, what

resources are to be made available and the

anticipated return on investment

Are we doing the right projects?

Are we doing the projects right?

Are we getting the benefits we anticipated?

Are we getting projects done well?

Strategy/Investment Planning

Ensuring projects are aligned with

architecture and standards, consistent with

other initiatives, consistent with core,

common and divergent principles

Alignment with architecture

Consistent operational processes, planning,

quality assurance, best practice project

management disciplines and

methodologies, skilled resources and

appropriate tools

Project delivery

Clear definition of benefits and metrics,

processes to measure and report on

benefits

Benefits realisation

GOVER

NANCE

Figure 9 - Portfolio Management Framework


32

A portfolio management approach enables NSW Health to:

• Establish an ICT structure closely linked to corporate strategy and program areas to ensure that the right programs and projects are undertaken to meet NSW Health’s strategic objectives.

• Determine whether business requirements can be met within existing solutions and within existing organisational capability and resources.

• Allocate the right resources to the right programs.

• Ensure the ongoing alignment of the portfolio and individual projects with the health system’s strategic objectives.

• Manage the appropriate distribution of limited resources.

• Manage the interdependencies between projects across the portfolio.

• Assess and manage risk.

• Monitor progress of projects against the intended strategic outcomes.

The outcome of this approach is:

• A closer alignment between health strategies and ICT projects allowing a greater level of responsiveness to emerging priorities and strategic objectives.

• Improved management of ICT risk through an understanding of the business implications of the program, interdependencies and broader ICT context.

• Improved understanding of how new business processes and systems will deliver improved performance by defining benefits and linking these to new business processes.

• Improved control through a portfolio management framework, addressing compliance with standards and architecture, quality assurance, financial and project management processes.

• Development of a framework for the Executive and senior management to use to promote and direct change management.

6.4 Standard processes adopted across the ICT portfolio

Core processes and standard guidelines for operation underpin the delivery of the ICT Strategic Plan. The processes relate to the stages of the project lifecycle, while the guidelines identified in the diagram below apply to the portfolio as a whole and to individual projects within the portfolio. Details for each of these processes, guidelines and templates can be found on the SIM website at http://internal.health.nsw.gov.au/sim


33

Quality management

Risk management

End a project - acceptance into service

Business case management Program

planning

Funding allocation

Risk management

Issue resolution

Stakeholder management

Communication framework

Benefits realisation

Project Inception

Identify an opportunity

Construction: development, integration & testing

Manage a program – provide capability, deploy to users

Operational service delivery

KEY PROCESSES

State based build

Supporting innovation

Asset management

Solution design and State Based Build

STANDARD GUIDELINES

Figure 10 - Core processes and guidelines underpinning the ICT portfolio

6.5 A framework for Partnership

For NSW Health to effectively implement this strategy it must be done as a collaboration between the Department of Health, Area Health Services, Health Technology and third party providers.

There are three key components of the collaboration framework. These are:

• Processes to determine, develop and manage core, common and divergent applications;

• Application of integrated governance models at AHSs and the Department;

• State based build approach to core applications to support a faster, more cost effective implementation and to underpin predictable processes across the whole of NSW.

6.5.1 Core, Common and Divergent

All applications and associated projects are classified as core, common or divergent. This classification will influence how each project will be prioritised, governed, funded, procured, implemented and managed.

Core: Applications and projects that are expected to provide all state wide core functions. These will be directed, controlled and funded by the Department.

Common: These applications provide common solutions across a collaborative group. They will be controlled collaboratively to achieve the desired outcomes for the group.

Divergent: Applications aimed at innovative solutions to localised


34

groups to enable design flexibility to explore new solutions to specific requirements.

The table below outlines the key characteristics of each category.

Rule Core

(Directed) Common

(Collaborative) Divergent

(Localised)

Extent of Solution Scope State Wide Solution AHS Wide or Collaborative

Group Wide Solution Local Solution

Funding Centrally Funded Capital/AHS

recurrent Central or AHS capital/

AHS recurrent Local or AHS Funding

Sponsorship DOH lead (AHS supported) AHS lead (DOH supported) AHS or Local Department

(advised to DOH)

Repeatability Must be State Based Build Will form the Basis for a

State Based Build Meets local need and can be

scaleable

Technical Infrastructure Must utilise the Core TSS

Infrastructure Must utilise core TSS

Infrastructure Will utilise local or AHS

infrastructure

Deployment Team State Led Deployment with

Mixed Resourcing

State or locally Led Deployment with Mixed

Resourcing

Locally Led Deployment with Local Resources

IT Architecture Compliance Full Compliance Complies to Common

Architectural Components Limited Compliance

Product Selection State Wide Product Selection Collaborative Product

Selection Local Product Selection

Business Case Approval DOH/Treasury DOH-AHS/Treasury AHS/Local if under $250k

Priority/Constraints (i.e. funds, resources etc)

Managed as part of State ISSP

Managed as part of AHS ISSP

Must not be done at expense of core/common

Governance State led governance with

mixed representation

State or locally led governance with mixed

representation

Local Governance with formal reporting

Examples PAS, UPI, EMR, OT, ED, Corporate systems, EHR,

Community…

ICU, PACS/RIS, Pharmacy, LITI

Surgical Audit, JONAH, Checklist

Detail on the processes in place to determine, develop and manage core, common and divergent applications can be found on the SIM website at http://internal.health.nsw.gov.au/sim .

6.6 Integrated governance model

The governance framework for the ICT portfolio has been structured to:

• Standardise governance for corporate and clinical initiatives at all levels

• Integrate the ICT program with clinical governance at a local level.

• Provide an opportunity to reinforce standard Area governance models

• Provide a single Governance framework for Area Health Services and the Department – tightly aligning timeframes, business cases, resourcing and outcomes.

The purpose of the Project Governance framework is to ensure that projects remain relevant and deliver the stated business benefits. Effective governance should ensure both that the NSW Health focuses on “doing the right projects”, and that the right people focus on “doing the projects


35

right”. The governance structure is intended to reduce the risk to the portfolio that would occur if there were to be a complete disconnect between strategy and delivery.

The governance approach has been defined to ensure that the ICT portfolio is:

• Focussed on supporting the health strategic directions

• Based on business outcomes ie improved clinical corporate outcomes

• Enterprise wide – encompassing both the Department of Health and Area Health Services

• Balanced between strategic and tactical initiatives

• Dynamic

• Flexible, to accommodate changes in the environment.

There are close linkages between the ICT Strategy, the Enterprise Architecture and the governance model. This is articulated in the ICIP Architecture Governance report (http://internal.health.nsw.gov.au/sim).

In summary:

• The strategy must encompass how the current state constrains or enables strategy options

• The architecture must be developed and implemented to support the business strategy

• Governance must ensure that the strategy and architecture remain aligned as implementation proceeds.


36

The diagram below shows the major elements of the governance model.

programs

Executive ICT Stakeholder Groups

SEAB

(Senior Executive Advisory Board)

Monthly Reports from SIM, HSPI,

DPE, Q&S

Support Services

ICT Management Committee

Monthly Representation from all

AHS Directors of Corporate Services

AreaDepartment

CEs

Business Information Clinical Systems Corporate

SystemsInfrastructure

Clinical Advisory Group

ICT Focused Committees Business/operational Focus Executive Positions

Corporate IT Program St Committee

Director-General

DD-G Health System

CIO & CE Health

CIO AdvisoryGroup

Figure 11 - Governance framework

Details of the Governance model can be found at http://internal.health.nsw.gov.au/sim .

6.6.1 State based build

All core applications will be developed using a State Based Build. This will support both interoperability across the state and a faster implementation of core applications. The “Fast Track” methodology is comprised of 2 phases:

1. Content Development

This phase is characterised by an intense design and build of a prototype, followed by a series of clinical review sessions. A methodology for the design and build of SBB content has previously been developed and utilised. The Fast Track methodology leverages this approach and adds in the more efficient prototype model. The prototype assists clinicians in gaining a better understanding of the application and offers the opportunity to view the process as part of an integrated workflow. This approach facilitates informed decision-making.

2. Implementation

The implementation phase is designed around the State defined content. Although this introduces a large amount of content in a single project, it achieves greater benefit and is more cost effective. The Fast Track Method


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reduces the time, cost and complexity of implementation by using a standard design with State Build content. Resource constraints and the extended learning curve to get AHS staff up to speed that were an inherent part of the old methodology, are minimised by the new approach. The implementation team assigned to the project have the application knowledge to build the database. A rapid implementation also eliminates the inevitable scope creep that occurs during any long IT project.

In order to achieve the anticipated benefits from a rapid implementation of a SBB, it is necessary to establish the critical success factors as follows:

• In order to ensure that the developed SBB content is applicable and practical in a NSW Health setting, it is important that the development has clinical input and endorsement. Nomination of appropriate clinical representatives and ensuring their attendance at SBB content development workshops is critical to this process.

• The implementation of the SBB components must be per the agreed functional stack. Implementing only part of the stack or modifying the implementation to a sequential approach limits the benefits, increases the cost and risk associated with the project. The design of the Fast Track method is based on “more in less time”.

• Critical to the success of the Fast Track method is a commitment to adequate, funded, executive-endorsed organisational change. This organisational change should include comprehensive marketing, a positive, public, executive involvement, and a comprehensive training program. With a Fast Track approach, sites will encounter more change in a shorter period of time and therefore managing the change is critical.

• The SBB is designed with both mandatory and flexible components. The planned flexibility is to accommodate site specific variations. Modifying the SBB beyond what is accommodated by the design, will introduce additional risks and effort to the project. In addition, it will increase the effort required when adding on future applications.

• The implementation of the SBB components will drive change and in many respects tighten many existing manual processes. However, the SBB has not been designed to police errant behaviour, it is designed to support clinicians in their workflow. Adequate training on appropriate use of passwords, privacy policies and procedures etc must be included in the implementation.

3. SBB Maturity Model

The SBB uses a maturity model to progressively enhance the functionality of the application as the experience and expectations of users increase. The maturity model is based on the following principles:

• All Area Health Services contribute to the development of each version of the SBB.

• Version 1.0 of any application is implemented as the SBB. Enhancements can be proposed by any Area Health Service, but must


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be endorsed by the majority of members of the Application Advisory Group (AAG).

• Every Area Health Service has equal weight in the AAG.

• Every proposed change must go through a formal change control process and be reviewed by the AAG, even those that are specific to one Area (eg establishing the facility codes for hospitals in that Area).

• The primary function of the AAG is to consider and endorse changes for each version of the SBB. New versions will be released on an annual basis.

SBB functionality can be classified as:

• Required core: required content and functionality to support common business and application functions, including standardised KPIs and reporting and a consistent user interface for mobile staff. Required content must be consistent across all implementations.

• Modifiable within guidelines to support area specific clinical processes, assessments and third party applications

• Localised content where site specific information is required in the build (eg code table for local facilities).

The diagram below demonstrates the SBB maturity model concept:

Figure 12: SBB maturity model

5

SB

B M

atu

rity

SBB V1

AHS 1 AHS 4AHS 2 AHS 3

SBB V2

SBB V3upgrade

upgrade

upgrade

f ix/ enhance

6 mth pre deploy AAG

Build lock down

AHS 1

f ix/ enhance f ix/ enhance

Triage (Note: triage is a process)SMEs as required

Clin ical Advisory Group (CAG)

ICT Management Committee

Information & Communication Technology (ICT) Strategy Priority ICT strategies

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7 Priority ICT strategies

The ICT Strategy has been realigned with the core reform strategies of Clinical Services Redesign and Corporate Shared Services. Five major ICT strategies have been defined to support the broader strategic priorities. These are the Clinical Systems Strategy, the Corporate Systems Strategy, Business Information Strategy, Sustainable Infrastructure strategy and Whole of Government ICT Strategic directions.

This section outlines:

• the initiatives that are being delivered in this stage of the ICT Strategic Plan (2006-2011)

• initiatives scheduled for the second phase of the 10 year plan, between 2012 and 2016.

7.1 Clinical Systems Strategy

7.1.1 Objective

The Clinical Systems Strategy will implement the core clinical systems needed to underpin the Clinical Services Redesign Program, Quality and Safety initiatives and clinical program areas.

The focus will be on systems to improve communication, minimise delays, reduce handover problems and support the patient journey. Systems will support the flexible allocation of resources to ensure services meet patient needs.

7.1.2 Programs supporting this strategy

Three programs support the Clinical Systems Strategy. These are:

• Electronic Medical Record program to implement the core departmental systems needed to manage patients effectively in an acute environment.

• Primary, Community and Outpatient Care program to implement the infrastructure and systems to support patient care in the community, outpatient and primary care environment. It includes referrals and interaction with other human services, and the pilot for the Electronic Health Record program.

• Clinical Support program to implement core support systems such as Patient Administration systems and diagnostic systems.

7.1.3 Electronic Medical Record


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Strategy Phase 1 2006-11

Initiative Functional scope

Results reporting Will allow test results and reports from diagnostic services to be viewed at the clinical workstation

Order management Enables clinicians to order tests, procedures and services online. This includes laboratories, imaging, allied health, dietary, catering and other departments. Order management provides decision support to improve patient safety, reduce over servicing and reduce costs.

Emergency departments

Information specific to Emergency departments to allow the efficient management of the Unit and patients. It includes triage information, presenting problem, treatment times, interventions etc.

Operating theatres System to manage the co-ordination of patients, surgeons, anaesthetists, equipment and rooms, and report on utilisation.

Discharge referral Provides a summary of the patient’s care which can be transmitted electronically to another provider such as a General Practitioner to support ongoing care in the community

Enterprise scheduling

The ability to co-ordinate scheduling across an integrated set of information systems to provide a single view of appointments and resource requirements. Initiative involves strategy and planning activity as well as development and implementation of the scheduling solution.

Assessment of EMR requirement for Justice Health, small facilities and ASNSW

This will assess the functional requirements specification for small facilities, conduct an options analysis and recommendations on solution and a transition and implementation plan

Electronic Medication management

Pilot of the Medication management/ePrescribing component of EMR with decision support/alert capabilities. This will be followed by the state implementation.

Transition strategy for LITI applications

Assessment of fit between strategic products and specialist requirements, including an options analysis, recommended strategy and migration plan

Intensive Care Units clinical information system

Functional specifications, Procurement options and strategy for ICU feeding into an updated business case

Strategy Phase 2 : 2012 - 2016


Clinical documentation

Clinical alerts and pathways for specialist clinical areas. The project involves a planning phase, including development of requirements and a business case.

Intensive Care Units clinical information system

Procurement and implementation of an ICU solution.

Medication Management

State wide implementation of the Medication Management solution. Alignment with, and dependencies between, the NSW Hospital Pharmacy initiative will be addressed in the planning for this project.


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7.1.4 Primary, Community and Outpatient Care

Strategy Phase 1 : 2006 - 2011


PCOC Strategy

Development of an information strategy for Primary, community and outpatient care

PCOC business case

Development of a business case for the IT infrastructure to support this sector

Community health & Outpatient Care Information Project

Development of a state wide data set that contains a record for each service provided to patients in primary, community health and outpatient care settings. This includes projects to standardise data across collections.

CHIME Strategic and tactical management of the CHIME system, including end of life strategic planning

Cerner community Alignment of Cerner developments with community health requirements

Outpatient Units EMR for Outpatient Clinics (extension of PAS)

Electronic Health Record – pilot

Provider and consumer access to integrated health record containing summary level information from public hospitals, ED, community health, outpatients, diagnostic services, dental clinics and GPs

Electronic Health Record evaluation

Policy, technical, functional and business outcome evaluation of pilot implementation

Electronic Health Record post implementation review

Assessment of effectiveness of project management, budget, resourcing, process and scope management for implementation of the pilot

Ambulance Electronic Patient Record

Development and implementation of an Ambulance Electronic Patient Record (AEPR). This will give ambulance officers access to a sophisticated system for Emergency Clinical Information using mobile technology.

Strategy Phase 2: 2011-2016


Electronic Health Record – Phase 2 state implementation

Provider and consumer access to integrated health record containing summary level information from public hospitals, ED, community health, outpatients, diagnostic services, dental clinics, GPs, private hospitals, aged care facilities and pharmacies. This phase will extend the rollout to all Area Health Services.

Outpatient Clinics stage 2

Implementation of advanced clinical decision support for Outpatient services

Community Health solution – CHIME replacement

Implementation of an Integrated Community Solution for Community Health Services

Mental Health migration

Transition of mental health requirements from SCI-MHOAT, MHOAT, MAJIC and FISCH to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support.

Drug and Alcohol migration

Transition of D&A requirements from FISCH, MERIT, ICIS and FISCH to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support

Allied Health Transition of Allied health requirements from AHMIS to the Integrated Community Solution and Outpatient EMR solution,


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including Clinical Decision Support

Aged and Chronic Care

Transition of aged care requirements from ACE (and other MH applications) to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support

Sexual Health Transition of sexual health requirements from SHIP to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support

Oral Health Development of migration strategy for oral health requirements from ISOH

7.1.5 Clinical Support Systems

Strategy Stage 1: 2006 - 2011

Initiative Functional scope/deliverables

Complete implementation of PAS

Replacement of legacy HOSPAS and WINPAS products with Cerner/iSoft Patient Administration systems

PACS/RIS Procurement strategy, establishment of hubs, statewide picture archive

Review of pathology systems

Development of strategy for pathology system replacement.

Pharmacy migration Migration planning and timeframe established for migration from AMFAC to iPharmacy. Migration from single site to multi site implementations hosted in clinical hubs.

Incident Information Management System

Planning for IIMS upgrade including strategy, business case and EOI and implementation.

Bed management strategy

Assessment of strategies to provide IT support for improved capacity management. This includes options for enhanced Bedboard functionality


Initiative Functional scope/deliverables

Hospital pharmacy rollout

State wide implementation of a replacement hospital pharmacy system.

7.2 Corporate Systems Strategy

7.2.1 Objective

The Corporate Systems Strategy will implement the core systems needed to underpin the Corporate Shared Services reform program. This program aims to reduce the duplication and cost in administrative functions to increase funds available for frontline care. This strategy is underpinned by the Corporate Systems program.


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7.2.2 Core projects to be delivered


Corporate Systems Functional scope

Business case – corporate systems phase 2

Development of a business case for new rostering software, Recruitment, Education and training, Workforce Management, OH&S

Human Resources Payroll, rostering, learning and development, OH&S, Recruitment, Performance Management

Finance General Ledger, Accounts Receivable, Accounts payable, Fixed Assets, Inventory Management, Purchasing and Sales Order

Asset Management Capital Works Management, Facility Management, Property Management, Maintenance, Cleaning and Security

e-Procurement Warehousing, Distribution, Inventory Management, Catalogue Management, Supplier Management, Product Management and Tendering

Billing Standardised billing management

ICT infrastructure/ EAI

Identity management, EAI strategy and management, telecommunications strategy and desktop consolidation.

7.3 Business Information Strategy

7.3.1 Objectives

The Business Information Strategy aims to make a core set of high quality information available at all levels of the organisation in a timely manner and to develop a performance culture around it. This has the potential to transform operational data into management insight, and support decisions that drive real results for the Department and its stakeholders. Business information must integrate NSW health’s strategic objectives with front line service delivery, drive management accountability and be driven by the overall program and change management approach.


There are three major programs under the Business Information Strategy. These are:

Create value for decision makers at the front line

The primary aim of this program is to provide timely, relevant information in a user friendly way to clinicians and decision makers in front line services.

Governance and

performance management

Aimed at integrating NSW Health’s strategic and planning frameworks and developing overall value and cost effectiveness performance measures.

Enabling infrastructure and support

Making sure that the source systems are capable of providing the major indicators, that the data sets are standardised and implemented to provide consistent information and the technical infrastructure is in place


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Business Information

Strategy

Functional scope

Decision making at the front line

Decision support toolkit and portal developed;

Decision support tools rolled out and consolidated through the portal. Integrated transactional, analytic and decision support tools, with staff skilled in using information and the tools available.

Governance and performance management

Evolve indicators and build business information governance.

Map strategy through balanced scorecard and report annually.

Create a single performance framework

Enabling infrastructure and support

Build information standards

Streamline common reports

Create inventory of information assets

Develop knowledge networks

Track compliance to mandatory training

Create single source of truth for clinical and corporate data

Streamline mandatory collections

7.4 Sustainable infrastructure program

7.4.1 Objectives

This program aims to rationalise the technical infrastructure and develop and maintain standards and architecture needed to support state wide ICT initiatives and to ensure the maximum benefit is gained from the investment in ICT.


The infrastructure strategy incorporates the following programs:

Infrastructure Defining and implementing the telecommunications and technical infrastructure to support the clinical and corporate strategies.

Architecture and Standards

Providing the enterprise architecture enterprise integration layer and core technical standards required to manage NSW information assets.

Information management

Ensuring that uniform data standards are developed and applied across state based builds and other systems as appropriate and that data quality strategies are in place to ensure maximum value from the information collected across NSW.


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Strategy stage 1: 2006 - 2011

Project

Functional scope / deliverables

Data quality review from core source systems Principles and responsibilities, maturity model

Analysis of data quality issues affecting BIS, clinical care and performance management

Development of a Data Quality Strategy for NSW Health

Development of data quality improvement strategies

Data Governance Strategy Development of a data governance strategy for data Collections

Data Standards Development and documentation (Leveraging from work done in BI, Corporate Systems, Clinical Systems Programs)

Maintenance and enhancement of NSW Health Data Dictionary PCOC: Ambulatory Care Data Standards Development KPI development HIRD Repository

Knowledge Sharing DPE Web pages Data Analyst’s Workgroup – WIKI / Forum

SNOMED CT Clinical terminology and its fit to e-health Education and training Analysis of SNOMED CT data

HERO Implementation and maintenance of state wide facility for registration of Health facilities

Architecture and standards

Strategy stage 1: 2006 - 2011

Project Functional scope / deliverables

Review of NSW Health Technical Standards

Register of current technical standards

Process established for maintenance of technical standards

Identity Management Strategy

Agreed framework for consistent, consolidated authentication and access control.

Maintenance of Enterprise Architecture

Ongoing maintenance of clinical and corporate architecture, Architectural reviews of compliance of systems; Management of Application Systems Knowledgebase and Health Information Resources Directory

Establish and implement Enterprise Integration layer

Development of message and data exchange standards; Development of integration layer services; Integration governance; Alignment with NEHTA standards

Establish regular audit of state wide IT environment

Improved knowledge of current state of IT across NSW to improve accuracy of forward planning

Establish and maintain State Baseline Build methodology

Document and publish approach to State baseline build


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Infrastructure

Strategy Stage 1: 2006-11

Project Functional scope

Development of Telecommunications Strategy

Definition of, and implementation of Telecommunications infrastructure to underpin ICIP and Corporate Systems Strategy

Infrastructure Strategy Stage 1

Phase 1 addresses the most critical sites in relation to:

• Consolidated data centres and system hardware equipment

• Data centre floor space expansion

• Telecommunications hardware

• Supporting management systems and processes

Infrastructure business case - phase 2

Development of a forward strategy and business case for phase 2

Establish IT Asset Registe

Identification of IT data centre assets


Project Functional scope

Infrastructure phase 2 - 5

Incremental upgrade to state data centres, telecommunications hardware

Information & Communication Technology (ICT) Strategy Outcomes of the ICT Strategy

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8 Outcomes of the ICT Strategy

Implementation of this strategy will deliver the following outcomes by 2011:

• Significantly improved support for clinicians and patient care by improving access to diagnostic test results reducing time to diagnosis and treatment. This, combined with systems to support improved theatre utilisation and use of resources, will reduce waiting times, patient delays and access block. Enterprise wide scheduling will allow resources to be better matched to demand and more effectively used. Improved discharge referral planning, integrated departmental systems and the Electronic Health Record will support the patient journey improving the transition of care within acute settings and from acute to community settings. Quality and safety will be improved through the use of systems to embed consistent, predictable processes across the state.

• The realignment of ICT programs will deliver significantly closer strategic alignment to major NSW Health initiatives allowing greater speed to delivery of benefits. The strategies outlined above will support sustainable clinical and corporate reform as well as Quality and Safety, Chronic Disease Programs, Mental Health, Aged care and other key program areas. There is also close strategic alignment with the national and NSW whole of government ICT strategic priorities.

• The new approach to delivery of the strategy will result in considerable cost savings. The rapid deployment of core programs will reduce overall project management costs, which are the major cost component. This approach will provide the opportunity to align with the change management activities already in train with the Clinical Services Redesign Program and Corporate Shared Services, reducing cost and increasing the value of the change management process. The outlined approach will minimise the duration of the impact on clinicians in Area Health Services and will increase the speed to delivery of benefits for clinical care.

• The strategy has been developed to support NSW Health to deliver against the Results and Services Plan and the State Plan.

Information & Communication Technology (ICT) Strategy Measurement of benefits

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9 Measurement of benefits

Benefits will be driven by the quality of the patient flow between different entities in the health system. Benefits will be delivered at four levels – at the clinical department level, hospital level, Area level and state level. The table below highlights the level at which benefits will become noticeable.

Level Benefit type Benefit

Department Access Reduced time to diagnosis

Quality and safety Reduced adverse events

Cost Fewer tests

Hospital Access Reduced waiting times

Improved patient flow

Quality and safety Reduced length of stay

Reduced readmissions

Improved monitoring of credentials

Cost Reduced clinician administration time

Improved asset utilisation

Improved management of staff resources

Area Access Improved equity of service

Quality and safety More accurate data capture

Cost Improved control of Area finances

State Cost Reduced reporting overhead

IT consolidation savings

Reduced training costs

The framework used to derive the benefits realisation strategy is shown below.

Governance

Process

Data

Requirements

Strategic

Aims

Current

Performance

Applications Functionality Benefits Benefit KPIsBenefit

Realisation

Figure 13 –The Benefits Realisation Framework

The software applications to be implemented in this strategy will provide functionality that enables benefits. When put in the context of NSW Health’s current performance and strategic aims, this functionality will result in benefits to the organisation. Many of these benefits can be measured using specific Benefits Key Performance Indicators (KPIs). In order to measure these KPIs data will be required and potential data


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sources will be identified. Owners for these benefits will be identified and made visible through the governance process.

Three groups will have a responsibility for tracking benefits. These are:

1. Deputy Director General for Health System Performance and the CIO : responsible for managing delivery of benefits across the whole state.

2. ICT Management Committee (Director of Corporate Services) : responsible for ensuring benefits are being managed and recorded at the Area level.

3. Program Management Office : responsible for reporting performance and performing first level diagnosis of under/over performance as input to these groups.


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Appendix A Additional Reference Material/ Resources

Reference Overview

Portfolio Investment Strategy Capital investment strategy for ICT for NSW Health, covering the period 2006/07 to 2016/17

Integrated Clinical Information Program architecture stage 1

Clinical systems architecture for stage 1 of ICIP (EMR, EHR, PAS, Provider Directories, patient flow tools)

Integrated Clinical Information Program Architecture, stage 2

Clinical systems architecture, stage 2, with focus on PACS/RIS, ICU, Operating Theatres, ED, UPI and Discharge referral

ICT Governance model Overview of the governance model for ICT across NSW Health

Corporate Systems Architecture Corporate Systems Architecture, covering Human Resources, Finance, Asset Management, eProcurement, Billing, enterprise integration

NSW Health Data Dictionary Data standards, definitions and classifications that underpin core NSW data collections and systems

Business Information Strategy The Business Information Strategy incorporates strategies to integrate NSW Health’s strategic objectives with front line service delivery, drive management accountability and be driven by the overall program and change management approach.

Core ICT business processes Documented processes to be adopted by SIM and HealthTechnology to support the effective delivery of the ICT Strategy

Health Information Resources Directory

An online tool to identify existing information resources across NSW Health

Application Systems Knowledgebase

An online repository providing information about applications operating across NSW

Corporate Systems Strategy Sets direction for corporate systems across NSW, addressing scope, implementation plan, budgets and infrastructure

ICT Governance Establishes the framework, principles, processes and structures for ICT governance in NSW

ICT Asset Management Strategy Outlines the principles and key elements of the management of the ICT assets in NSW Health