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The Mission-Critical Foundations for a

Digital Landscape in NSW Health. Where

to Next?

Dr Zoran BolevichChief Executive, Chief Information Officer, eHealth NSW

NSW Medical Leadership Forum

2 March 2018

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Overview

• eHealth Strategy for NSW Health

• Progress Update

• Where to Next?

• Key Challenges and Considerations

• Q&A

Patient Story – Mrs P.

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• A 10-year program of innovation, investment and

implementation identifying key eHealth goals

• Vision of a digitally enabled and integrated health

system delivering patient-centred health

experiences and quality health outcomes

• Providing the direction for eHealth initiatives to

ensure NSW Health organisations harness

innovations and digital solutions in clinical care,

patient engagement, business services and smart

infrastructure to meet future demands

eHealth Strategy for

NSW Health 2016-2026

1. Patient Safety First

2. Leading Better Value Care

3. Systems Integration

4. Digital Health and Data Analytics

5. Strengthening Governance and Accountability

NSW Health’s top 5 Strategic Priorities

NSW Health reform

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Three Horizons of the eHealth Strategy

Consistent

Foundations

“Patients have

consistent interactions

with healthcare

systems that address

their health

and wellbeing.”

Integration

“Patients benefit

from strong partnerships

that provide coordinated

and integrated

health services.”

Personalisation

“Patients experience

customised healthcare

and education available

when and

where needed.”

Horizon 1

Years 1– 3

Horizon 2

Years 1– 7

Horizon 3

Years 1– 10

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eHealth Strategy Progress – January 2018

Focus Area Current Initiatives Current Progress NSW Health Coverage Basis

Electronic Medical Record

Intensive Care Systems

Pathology Lab Results

HealtheNet

Health Wide Area Network

State-wide Infrastructure Services(Identity & Access Management)

Wireless

Finance Systems*

Asset & Facilities Management*

Rostering

87%of facilities

17%of ICU beds

55%of pathology laboratories

100%of facilities

76%of facilities

99%of staff

60% of facilities

100%of organisations*

100%of organisations*

75%of staff

* The technical system is fully deployed for use by all LHDs. Further work required to implement the system consistently across the state required for usability and adoption uptake.

35%

0%

0%

73%

29%

66%

30%

100%

100%

25%

%

%

Progress by January 2018

Progress in 2016

Electronic Medication Management Systems (eMeds)

14%of facilities

0%

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Clinical Programs

• Electronic Medical record (EMR2) live in 156 hospitals

• Electronic Medication Management (eMeds) live in 30 hospitals

• Electronic record for Intensive Care (ERIC) live in 8 hospitals

• New PACS/RIS system (10 LHDs and NSW Pathology) – moving towards implementation phase

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NSW Health: Our Digital Presence

(Daily Usage Statistics)

40,000Appointments booked

259,000Tests Ordered

48,000Clinicians use eMR

725,000Charts opened

120eLearning modules available across NSW

130eMR Quick Reference Guides in Learning Live

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Corporate Programs

• HealthRoster:

– 18 NSW Health entities and over 100K (75%) of in scope staff are now using the system

– HealthRoster (9.0) deployed in December 2017, incorporating multiple enhancements and improved functionality

• Recruitment and Onboarding (ROB):

– 28 Health entities now using the system

– 2,700 recruitment campaigns managed using ROB, attracting 240,000 online views

– More than 700 candidates hired and onboarded using ROB

– Next stage will be design and development of additional functionality

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Infrastructure Programs

Clinical Applications Reliability Improvement (CARI) Program

– increasing the reliability and availability of essential clinical applications for NSW Health

– Migrating all eMR domains to the Government Data Centre

– Providing eMR disaster recovery service

Conference, Collaboration & Wireless (CC&W) Program:

– Deploying Patient Wi-Fi, Skype for Business and core wireless capability across NSW Health

State Wide Infrastructure Services (SWIS) Program

– Over 120,000 users are now on the State-Wide email platform with over 160,000 identities matched and deployed

Health Wide Area Network (HWAN) Program

– At end 2017, 50 per cent of all NSW Health sites were connected to the HWAN network including most hospitals

– Rural HWAN program connects 184 sites across the state

– Rollout to metropolitan LHDs is continuing throughout 2018

• Complete Horizon 1 implementations

• Improve use and usability of systems

• Progress clinical decision support

• Advance data analytics

• Progress Systems Integration and Integrated Care

• Engage patients and consumers

Where to next?

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Ongoing Investment in Digital Health Solutions

• NSW State Budget 2017-2018 saw a record $536 million additional investment (over eight years) in eHealth which will see the “phasing out of paper patient files”. The investment includes:

– $286 million for the Whole of System Digital Platform, enhancing the digital infrastructure supporting the clinical and other health-related systems across NSW

– $236 million for Digital Patient Records extending the Electronic Medications Management (eMeds) roll out and ensuring patient records are easy to read, accurate and instantly accessible whenever needed

– $14 million for the HealtheNet Pathology Results Repository, giving clinicians easier access to public hospital pathology results no matter where tests originally happened

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Total Achieving Integrated Digital Patient Records* $236.2m

Full implementation of EMR2 including Cancer integration (Aria/Mosaic) $32.6m

eMeds to a total of 178 sites and Master Drug Catalogue $87.6m

Community Health Reporting and optimised functionality $5.0m

Security and Auditing $7.1m

Rural Wireless $10.0m

End point Clinical Document Scanning $3.0m

Analytics $6.0m

Innovation $2.0m

Ambulance EMR improvements, Emergency Department integration and resilient CAD platform $20.5

Total HealtheNet Pathology Results Repository* $13.8m

Integrating 4 hubs $8.5m

Clinical Access to state-wide Pathology Results (mobile App) $0.2m

Pathology Results reporting and Analytics $0.7m

Strategy Development for additional Hubs (e.g. Forensic, Kids) $0.3m

Strategy Pathology orders $0.8m

Total Whole of system digital platform* $286m

State wide Infrastructure Services (SWIS) $52.7m

Health Wide Area Network (HWAN) $26.5m

Data Centre Reform (DCR) - LHD and NSW Health Data Centre Migration $31.6m

Clinical Systems Reliability Improvements $7.7m

Hardware Refresh $109.5m

*Note Total figures include change management, overheads, contingency and funding allocated in 2016/17

Total capital allocation $536M

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• eMR2 – Completion of the electronic medical record solution implementation and increasing consistency across NSW to support further reduction of the hybrid medical record

• eMeds – Expansion and acceleration of the electronic medication management implementation across NSW and investigation of the feasibility of additional functionality, including high risk and complex medications and the next phase of the Master Drug Catalogue

• Community and outpatient documentation – Delivery of enhanced reporting functionality

• Security – Enhancement of the digital patient record security to monitor compliance to theHealth Privacy and State Records Act

• Scanning – Delivery of software and devices to enable single page document scanning of prioritised documents at point of interaction between clinicians and patients

• Integration – Increased integration between core EMR and ‘best of breed’ systems, e.g. Oncology Information Systems (Mosaiq and Aria)

CORE EMR FUNCTIONALITY BY 2020

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Improving Use and Usability of Systems

• Clinical engagement and training

• Use of ‘Lights On’ data

Time spent per doctor per month per patient in the eMR

Individual doctors

Monthly summary for a doctor

Summary view of a clinician’s activity on 12th Jan

Analysis of decision support alerts

Drill down is available to the doctor level

Examples of trends over time

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Improving Use and Usability of Systems

• Clinical engagement and training

• Use of ‘Lights On’ data

• Single sign-on

• ‘Tap on – Tap off’

• Mobile forms

• Performance enhancements

• Medical device integration (strategic procurement)

• User-centric design (human factors)

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Clinical Decision Support

• Order sets

• Pathways

• Active clinical decision support (e.g.

recommended diagnostic tests; dosing of

complex meds)

• Artificial intelligence (future)

• How should we approach introduction of these

tools?

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Data Analytics

• New governance model

• ‘Data Lake’ approach

• Real time analytics for safety

and quality (electronic version

of ‘Global Trigger Tool’)

• Defining opportunity areas for

clinical analytics

http://www.ehealth.nsw.gov.au/publications/nsw_health_analytics_framework

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Systems Integration and Integrated Care – Focus Areas

• Statewide integration of electronic patient records

– HealtheNet (discharge summaries, pathology, imaging, dispensed meds)

– Cerner Health Information Exchange (new!)

– EMR ‘Superdomain(s)’ (early discussions and conceptual work only)

– Integration between Ambulance EMR and Hospital EMR (funded)

• Working with the Australian Digital Health Agency to enable successful implementation of My Health Record

• Working with the Agency for Clinical Innovation (ACI) to accelerate progress in Patient Reported Measures

• Designing statewide approaches for active Shared Care Planning

• Designing statewide approaches for active eReferrals

• Building on previous proof-of-concept investments and lessons from evaluation

HealtheNet and My Health Record

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National Children’s Digital Health

Collaborative

• A new national initiative we’re leading on behalf of

the Australian Digital Health Agency

• Has moved into an implementation phase with five

initiatives

• The Child Digital Health Record initiative (led by

NSW and VIC) has commenced and is in an early

design phase

• Child Digital Health Record pilot sites are currently

being confirmed (Western NSW LHD, Western

Sydney LHD and the Children’s Hospital

Westmead)

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• Big promise of ‘digital transformation’

• Explosion of health apps

• Proactively and intelligently identifying needs and responding with tailored solutions for patients and providers

• Home monitoring

• Smart devices and implantables

• Genomics and proteomics

• Artificial intelligence

• Importance of Innovation Framework to actively manage innovation

Engaging Patients and Consumers

(incl. Personalisation)

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Key Challenges and Considerations

• Clinical engagement – role of the CCIO

• Workforce (clinical informatics, data analytics etc.)

• Sustainable funding models and support models

• Benefits realisation

• Cybersecurity

• Interoperability of systems

• Safety of health information technology

• Clinical solutions design governance

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The Clinical Solutions Design Governance Framework

• governing the design of all digital clinical solutions built by eHealth NSW

• ensuring that design decisions are made by the best possible team of clinicians and other staff

• ensuring all clinical solutions are developed using appropriate human-centred design (HCD) methods

The CSDG Framework will help eHealth NSW build better, safer clinical

tools by:

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The Framework at a glance

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• Provides a balance between clinician involvement and the technical

expertise that is required to ensure that eHealth NSW builds safe, secure,

scalable, robust and usable digital clinical solutions

• Continue to be adjusted based on lessons learnt along the way, especially

where resource implications are significant

• Testing using prototype elements has commenced in

• End of Life Management DWG

• Mental Health DWG

• Secure Image System

Important Aspects of the Framework

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Thank you

Dr Zoran Bolevich

Chief Executive, Chief Information Officer

eHealth NSW

zoran.bolevich@health.nsw.gov.au