ACHSE An Area Perspective of the NSW Health Technology Strategies November 2007

1. ACHSEAn Area Perspective of the NSW Health Technology StrategiesNovember 2007 Dr Jean Evans DHSM, MSc (Computing) Chief Information Officer SESIH

2. Agenda • iPART & Accenture Architecture Reviews, Galt Report • SESIH and its Information Systems • Progress to Date • State-wide Service Desk (SWSD) • Electronic Medical Record (eMR) • Project Categorisation – SESIH Priorities • Challenges • Benefits of NSW HealthTech Strategies

3. iPART, Accenture ICIP Review, Galt Report Feb 2004 • “Establish a standard governance model for all ICIP projects accommodating different deployment and support models, aligning programs and funding with clinical outcomes and recommendations of the iPART and Galt Report” Accenture ICIP Architecture Review • Increased collaboration including: • Consolidated purchasing of hardware, software & maintenance • Establishment of a centralised architecture, planning & strategy group, supported by a centralised PMO • Consolidation of applications design & development activities • Introduction of procurement best practices within participating AHS etc

4. iPART, Accenture ICIP Review, Galt Report Feb 2004 (continued) • Benefits as per Galt Report • More efficient and effective deployment of IM&T systems • Enhances project delivery success and the targeting of funds to strategic initiatives • Releases captive resource value by resolving duplication of both effort and infrastructure while leveraging economies of scale and best practice • Savings from detailed technology changes eg maintenance, operating costs, software licensing, telecommunications • Provides a stable base of resources and capabilities from which AHS with more-developed IM&T capabilities can continue to lead and demonstrate value in IM&T deployment

5. SESIHS Public Hospitals & Facilities • Bulli • Calvary • Coledale • David Berry • Garrawarra • Gower-Wilson • Kiama • Milton-Ulladulla • Prince of Wales • Waverley War Memorial • Royal Hospital for Women • Sacred Heart Hospice • St George • St Vincent's • Shellharbour • Shoalhaven • Sutherland • Port Kembla • Sydney/Sydney Eye • Sydney Children's • Wollongong

6. SESIHS • 13 local government areas • Population: • 1.162M (2006) representing 18% of NSW population. • Projected to reach 1.24M by 2011 • Area: • 6,331 square kilometres • highly urbanised areas of eastern Sydney, southern Sydney, Wollongong and Port Kembla, • rural areas of Kiama and Shoalhaven

7. SESIH Information Services - Statistics • Approx 16,000 users across 132 sites including Community Health units • 320 Windows servers, 20 VMS servers, 18 Unix servers • 4,500 printers • 140 applications (approx.) • No. of SESIH internet visits per month: 30,000 • No. of Intranet visits per week: 65,000 • 1,200 web pages including Hospitals and Services pages • 100,000 files which include web pages & documents on the Intranet • 1 million messages handled per week • 550 VPN users logged in remotely

8. Progress to Date • Statewide Service Desk (SWSD) • Sutherland venue • Originally SESIH’s areawide Help Desk • Previous challenges: staffing, responding to all calls within accepted period of time • Transitioned to HT SWSD 15 months ago • Obvious challenges as a result of change: change of procedures for users, introduction of ITIL and expectations of Area staff to be available for training etc., different software • But – improvements in % of calls answered, standardisation in procedures etc., and • Establishes a model for the State for the future

9. DDG CE ICT Mgmt Committee Monthly DCS CIO Forum Escalation point as appropriate for the issue Monthly CIO CAG State Escalation Monthly DCO EMR Steering Committee • Katherine McGrath (as reqd) • Mike Rillstone (Chair) • Frank Cordingley • Matt Gollings • Rick Heise • Paul Goetzheimer Local Committee Fortnightly EMR Leadership Group Local Committee Weekly Local Escalation AHS EMR Reference Group EMR AHS Project Management Meeting • Paul Goetzheimer (Chair) • Olivia De Sousa • John Baulderstone • Robyn Wright • Linda Watson • Sheetal Ram • AHS Business Lead (as required for AHS Changes) Local Committee EMR AHS Project Management Meeting EMR AHS Project Management Meeting EMR AHS Project Management Meeting EMR AHS Project Management Meeting EMR AHS Project Management Meeting Weekly (on per AHS) Application Focus Groups Weekly EMR AHS Project Management Group Program CCB Project Manager (Cerner) • Paul Goetzheimer (Report) • Matt Gollings • Robyn Cook • 1 x CIO (tba) • 1 x Senior Clinician (tba) Program RRB Monthly PMO Client Liaison Officer AHS Business Lead AHS Change Manager AHS CSRP Rep AHS Education Co-ordinator AHS Integration Architect AHS Level (PROJECT) State Level (PROGRAM) State Approach to eMR: Management & Governance The following is the agreed high level Governance structure, as presented to the ICT Management Committee on 19 July 2007.

10. State Approach to eMR • Electronic Medical Record (eMR) • Relationship between Cerner, HT, SIM and SESIH • Project commenced February 2007 • SESIH is first area to implement “full-stack” – Emergency Department, Operating Theatres, Order Management & Results Reporting, Enterprise-wide Scheduling, E-Discharge Referral • Hardware hosted from HT • First site to “go-live” expected to be Jul 08 • All Area sites to be live within 12 months

11. State Approach to eMR Supporting the patient journey Equity of access to information systems State based build approach to: Reduce the cost of building the eMR Reduce the costs and effort of upgrades Build once and deploy state wide Rapid deployment methodology Limited funds available Phase one to realise benefits before additional Treasury funding provided

12. The Electronic Medical Record Clinical Workstation - PowerChart • Assessment • Past History • Current Illness • Examination • Diagnosis • Orders • Diagnostic tests • Diet • Medications • Treatment • Consultations • Referrals • Results • Review • Diagnostic tests • Text reports • Trends • Graphs • Progress Notes • Record • Interventions • Change in status • Outcomes • Charting • Vital signs • Fluid balance • Urinalysis • Other • physiological • measures • Care Pathways • Prescribe Treatment • Clinical guidelines • Variance reports • Outcome analysis • Discharge Summary • Discharge • Referrals • Summary of Rx • Medications • Follow-up Care Decision support, state based build with standardised codesets Clinical Repository Clinical Measures Food Services Clinical Specialty Allied Health Operating Theatres Emergency Pathology Radiology Pharmacy Clinical Support Systems Patient Administration & Enterprise Scheduling

13. Key Benefits of the eMR Integration of clinical information at the desktop A reduction in information silos A reduction in errors and duplication Ability to track orders and results online Improved ordering practices Better planning and resource utilisation in outpatient clinics Improved theatre utilisation Improved processes in ED as information is integrated with orders, results and scheduling

14. Project Categorisation Prioritisation - Core Common Divergent: SESIH Priorities

15. Challenges • Establishing boundaries • Agreeing who has overall responsibility for delivering • Understanding each other’s priorities, and working with these – Areas often impacted with priorities outside of those in HT Plans • 80/20 rule in SESIH • Operational activities always take priority • Funding requirements • Resourcing availability • Flexibility in model to support changing NSWH priorities, eg: recent Integrated Primary and Community Health Policy: Implementation Plan

16. Benefits of NSW HealthTech Strategies • Funding availability • Shared knowledge and experience (Benefits Realisation, Change Management etc) • Standardisation • Methodologies: Method-M, Project implementation, • Sharing of documentation • Equity across Areas for project implementations • Service Partnership Agreements • Rationalisation