Integrated Health System Planning

1. Integrated Health System Planning An exclusive Executive Circle Briefing

2. Agenda • Overview of BC Healthcare Regionalization • Vancouver Coastal Health Transformation • Where we have come from • Where we are going • Success Factors • Challenges • Health Authority Collaboration Projects • Lessons Learned

3. Regionalization Overview • December 2001 NDP government consolidated 52 regional and community health councils into 6 Health Authorities • Created five geographic health authorities to govern, plan and coordinate services regionally, plus the Provincial Health Services Authority to govern specialized province-wide services • Each Health Authority consolidated their IT departments into integrated regional service units. i.e. VCHA merged 8 IT departments into 1 corporate IMIS service unit

4. Health Authority Map • NHA: (patient population: 300,000) • IHA: (patient population: 700,000) • VIHA: (patient population: 700,000) • VCHA: (patient population: 1,100,000) • FHA: (patient population: 1,500,000) • PHSA: (provincial population: 4.3 Million)

5. Vancouver Coastal Health

6. VCH IMIS Context • VCH 2006/07 Operating Budget: 2.3 Billion • IMIS 2006/07 Operating Budget: $63.7 Million • % of total VCHA Operations: 2.77 • Number of IMIS FTEs: 415 • 2006/07 IMIS Capital Budget: $66 Million • Number of Network accounts: 25,000 • Number of PCs: 15,000 • 98 facilities spread across 58,000 km2

7. VCH Regionalization Review • VCH merged multiple regions with multiple clinical, corporate and technical infrastructure systems. • When VCH formed its IT infrastructure: • Lacked cross-site, cross-program, cross-network access to patient data • Lacked a “patient-centric” view of information • Inconsistent data standards and business rules • Silos of clinical information • Resulting in clinical/business issues: • patient safety compromised • inability to implement key strategies • customer dissatisfaction

8. Clinical Systems Journey

9. Clinical Systems - 2002 Richmond Providence Vancouver Coastal Acute Eclipsys SCM IDX LastWord Health Vision McKesson Star Meditech CCD CCD Hospital IS HealthVision ADT Pharmacy BDM BDM Radiology GE ProgRIS IDXrad Laboratory CCD/3G LabVision Misys Lab/CoPath LabVision PACS Intelerad Agfa Agfa DI integration Perioperative GE ORMIS GE ORMIS Pyxis ESI Orbit Per Se ORSOS Cardiology Transcription MS Word SoftMed MS Word MS Word DictaphPHSA Digital(unsupported) Tape Dictaph PHSA & Tape Digital Express DictaphPHSA Digital Express Dictation Coding and Abs. 3M MS Access 3M Softmed 3M Community In4tek PARIS Procura Procura Comm. health Momentum Procura Mental health Synapse Public health RISE Healthware iPHIS Env. health Hedgehog [Various] HealthSpace Primary care PCAC/CHC EMRs [Not supported] Practice EMRs

10. Clinical Systems - 2006 Richmond Providence Vancouver Coastal CareConnect Integrated Electronic Health Record Acute Eclipsys SCM GE CareCast McKesson STAR Hospital IS Pharmacy HealthVision ADT BDM Radiology GE ProgRIS IDXrad Laboratory Misys Lab/CoPath Stentor Agfa Intelerad Agfa Agfa PACS DI integration Stentor Web Viewer, Agfa/Sun Deep Archive Perioperative GE ORMIS GE ORMIS ESI Orbit Per Se ORSOS Cardiology GE MUSE GE MUSE Transcription SoftMed MS Word SoftMed SoftMed Meditech Dictation DictaPhone DictaPhone Dictaphone Coding and Abs. 3M Community In4tek PARIS Momentum Comm. health Procura Mental health Synapse RISE Healthware Public health iPHIS RISE Healthware Env. health HealthSpace Hedgehog Primary care PCAC/CHC EMRs Vendor tbd Wolf, Clinicare, OSCAR, etc. Practice EMRs

11. Clinical Systems - 2010 Richmond Providence Vancouver Coastal CareConnect Integrated Electronic Health Record Acute TBD – Review Underway Hospital IS Pharmacy Radiology GE Laboratory Misys PACS Agfa DI integration Stentor Perioperative GE ORMIS Cardiology GE MUSE Provincial iEHR, PLIS, eDrug, DI, etc. Transcription SoftMed Dictation Dictaphone Coding and Abs. 3 M Community Comm. health In4tek PARIS Procura (home support) Mental health Public health Env. health Hedgehog Primary care PCAC/CHC EMRs IntraHealth Practice EMRs Vendors complying to provincial EMR standards

12. Infrastructure Journey

13. VCH Infrastructure Challenges • Heterogeneous Infrastructure • Inherited every flavour of hardware and OS • Inherited a lot of legacy technologies • Inconsistent Policies and Processes • Everyone did things differently • Different degrees of IMIS Process Maturity • Insufficient Infrastructure Budgets • Want it all integrated yesterday!

14. Email MS Exchange Novell GroupWise Microsoft (MS) Exchange Lotus Notes Healthnet MS Exch Voicemail Nortel Octel Octel Mitel Nortel Workstations Compaq Compaq Hewlett-Packard Hewlett-Packard HP Various Servers & Storage Various Hewlett-Packard Compaq Hewlett-Packard various Hewlett-Packard Lexmark Various HP Printers Hewlett-Packard Hewlett-Packard Desktop operatingsoftware Windows NT 4.0 Windows NT 4.0 Windows 2000 various Network operating system Novell NetWare Windows 2000 Novell NetWare Novell MS various Ethernet Ethernet Ethernet Token ring Ethernet Local area network Wide area network Telus Telus Telus ITSD / Telus Infrastructure - 2002 Providence Vancouver Richmond Coastal

15. Email Microsoft (MS) Exchange Voicemail Nortel Octel Nortel Octel Mitel Workstations Hewlett-Packard Servers & Storage Various various Hewlett-Packard Hewlett-Packard & Lexmark Printers Desktop operatingsoftware Microsoft Windows Network operating system Microsoft Active Directory Microsoft Active Directory Novell NetWare Microsoft Active Directory Novell NetWare Ethernet Local area network Wide area network Telus Infrastructure - 2006 Providence Vancouver Richmond Coastal

16. Email Microsoft (MS) Exchange Voicemail Nortel Mitel Nortel Octel Octel Workstations Cirtix, Thin Client, PC Blades, etc. Servers & Storage Hewlett-Packard Hewlett-Packard Printers Desktop operatingsoftware Microsoft Windows Network operating system Microsoft Active Directory Ethernet Local area network Wide area network Telus Infrastructure - 2010 Providence Vancouver Richmond Coastal

17. Corporate Systems

18. Finance Eclypsis VH Custom Eclipsys McKesson CCD CV NewViews CCD CV Billing/AR (clinical) Billing/AR (other) SAP FICO ACCPAC General Ledger Infinium GL VH Peoplesoft GL Ormed CCD Ormed Com-vida(CV) Accounts Payable Inf. GL Or-med VH Peoplesoft AP ESI Purchasing SAP MM Mc-Kesson VH Peoplesoft Inventory Asset Management PHC Custom Systems Union Budgeting SAP FICO Human Resources Eclypsis Telus PeopleSoft SAP HR Blae-berry Or-med CV Ormed CV Human Resources VH Custom Payroll SAP PAY Staff Scheduling PHC TCT VH TCT Loki RH TCT Procura/SAP Procura Facilities Space Management Archibus FM Plant Maintenance AMMS MR CD MM AMMS SAP PM Pro-Maint Facilities Security Decision Support Decision Support VH QUIST McKesson Case Costing Eclipsys SDSM Corporate Systems – 2002 Providence Vancouver Coastal Richmond

19. Finance Eclypsis VH Custom Eclipsys McKesson CCD CV NewViews CCD CV Billing/AR (clinical) Billing/AR (other) SAP FICO ACCPAC General Ledger Peoplesoft Accounts Payable Purchasing Inventory Asset Management Budgeting Human Resources Peoplesoft Human Resources Payroll Staff Scheduling PHC TCT VH TCT Loki RH TCT Procura/Loki Facilities Space Management Archibus FM Plant Maintenance Pro-Maint Maximo MR CD MM AMMS AMMS Facilities Security Decision Support Decision Support VH QUIST McKesson Case Costing Eclipsys SDSM Corporate Systems – 2006 Providence Vancouver Coastal Richmond

20. Finance TBD IDX McKesson Billing/AR (clinical) Billing/AR (other) Peoplesoft General Ledger Accounts Payable Purchasing Inventory Asset Management Budgeting Human Resources Peoplesoft Human Resources Payroll Staff Scheduling PHC TCT TBD – Project Underway Facilities Space Management Archibus FM Plant Maintenance AMMS MR CD MM AMMS Maximo Pro-Maint Facilities Security Decision Support Decision Support VH QUIST McKesson Case Costing Eclipsys SDSM Corporate Systems – 2010 Providence Vancouver Coastal Richmond

21. Capital Investment 2002 - 2010

22. Operating Costs

23. Operating Trends

24. Success Factors • Cross functional governance models • Within VCHA • eHealth, Corporate & Infrastructure Steering Committees prioritize capital projects • HSDA IMIS Advisory Committees – links HSDA and IMIS operations • IMIS Program Delivery Portfolio – PMO • Inter Health Authority Committees • BC CIO Council • Technical Advisory Group • Network Working Group • Directories and Authentication Working Group • IT Planning • Plan into Action, Application Integration Strategy, Technical Architecture, etc. • Coordinate and balance internal needs, provincial eHealth directions and National initiatives (Infoway) • Collaboration • Internal Stakeholders • Provincial partners – the other health authorities and vendors

25. Regionalization Opportunities • Rationalization of existing services • Reduce duplication • Used savings to drive future IMIS investment • Contract Renegotiation • i.e. Licensing, Network Connectivity, etc. • Health Authority Collaboration • Everyone was solving the same problems – brought together inter-HA teams • i.e. Created a Provincial IP Addressing Scheme

26. Regionalization Challenges • Aligning collective agreements and contract staff • IT department integration • Geographic complexity • System complexity • Lack of investment or strategic prioritization in IT created a tremendous volume of pent-up demand • Participation in multiple projects simultaneously while maintaining daily operations • Balancing VCH needs with Provincial needs

27. Inter Health Authority Collaboration Projects • Private Network Gateway (PNG) • Dedicated, secure network linking all HA • DI Emergency Transfer Grid • Short term (10 day) DI storage partition • 56 facilities capable of pushing images to the Grid • 5250 studies pushed (Oct – Dec. 2006) • Network BC • Broader Public Sector WAN contract negotiation • Data Centre • Broader Public Sector Data Centre Build

28. Lessons Learned • Infrastructure view - focus on the basics • Network Connectivity • Directory and Domain Integration • Email Consolidation • Enterprise Backups • Have dedicated HR and Finance support throughout the transition • Staff consolidation • Teasing out budget details • Its about service delivery, not server delivery

29. Thank you for your attention.