eHealth NSW plans to corral acronym soup into eClinical record

eHealth NSW is currently conducting a tender process to create a panel of electronic medications management (eMM) solutions that local health districts will be able to choose from, and is also evaluating responses to a tender for an incident management system (IMS) that will be rolled out statewide.

These are just two of a large number of projects that the new agency is involved in following its official establishment on July 1. In addition to eight complex clinical programs currently in progress, eHealth NSW is also in charge of the corporate ICT program for the NSW health department.

At the moment, it is working on a large infrastructure upgrade to provide all hospitals with a minimum of 1GB of bandwidth, a new rural eHealth strategy involving the six non-metro LHDs, and the single email system that Health Minister Jillian Skinner has wanted since the March 2011 election.

eHealth NSW's new heads – chief information officer Michael Walsh and chief clinical information officer John Lambert – outlined the agency's corporate and clinical strategies at a meeting of the Australian Information Industry Association's (AIIA) NSW Healthcare special interest group in Sydney yesterday.

Mr Walsh, who is also eHealth NSW CEO, has been in the position for less than two months, and Dr Lambert less than two weeks. However, they are building on a great deal of work done over the last few years by former Healthshare CEO Mike Rillstone and former CIO Greg Wells to create and implement the Blueprint for eHealth in NSW, released in December last year.

The blueprint outlines a federated approach to ICT in NSW Health and details how the government expects to spend the $400 million allocated to ICT programs, in addition to its specific plan for eHealth in rural and remote NSW.

“eHealth NSW was an idea that was generated after the last election in NSW and it was the idea that we needed to work in partnership across a federated system,” Mr Walsh said. “eHealth NSW has been in existence for 58 days, since the first of July, and it has an executive council chaired by [NSW Health director-general] Mary Foley that meets monthly to give strategic oversight.

“One of the things people will see next in the public arena around eHealth NSW is a draft strategic plan that will come out later this year for public consultation. That will forecast the next areas of focus and investment that we need to look at into the future.

“What we need to improve is the connectivity between where eHealth was going in relation to its priorities, and the clinical workforce. The appointment of a chief clinical information officer is that start of that strengthened partnership.”

Corporate programs

Mr Walsh outlined some of the corporate programs for eHealth NSW that will also have an effect on clinical systems and clinicians themselves. This includes the establishment of StaffLink, the human resources system that covers the 105,000 people working in NSW Health.

“The important thing about StaffLink as a service-wide HR system is that it has now become the core and the single point of truth for people identity,” Mr Walsh said. “We are now able, across our system, to identify who each individual is, which means that we can now move to a single email system.

“We can move to messaging services that allow us to ensure that the right messages get to the right location. We can connect all of our other systems to the hierarchy of the organisational structure, so we can do permissions and security based on StaffLink. This is a huge step forward, and we can now move some services into the cloud because we can manage single identities.”

Mr Walsh said eHealth NSW was currently finalising the build of a new rostering system that is being piloted at Concord Hospital and should be rolled out statewide next year. This online system will allow staff to view rosters at home and request changes, and for managers to publish rosters electronically.

A single asset management system for NSW's 220-odd hospitals is also close to completion, which will provide a single, consolidated view of all assets, starting with real estate.

A large infrastructure upgrade is currently underway, with the majority of metropolitan and regional LHDs already upgraded to the new Health Wide Area Network (HWAN), which promises a minimum of 1GB of bandwidth in every site. This is now moving to rural sites, which Mr Walsh said was incredibly challenging considering the vast distances between some of those sites.

He said the HWAN would improve reliability for both corporate and clinical systems, but would also enable more video conferencing and collaborative tools to be used to reduce travel. NSW Health has invested in Microsoft's Lync system, which is integrating more closely with Skype, and will roll it out over the next year.

With the single identity system up and running, it is now possible to have a single email address across NSW Health. All staff will have a health.gov.nsw.au extension within the next 12 to 18 months, and this is live in six LHDs now.

He said there were a large number of building blocks already in place, both corporate and clinical, but there are also other programs that are currently in progress. One is the pooling of eHealth resources between the six rural LHDs, which Mr Walsh said was an innovative model that was still in its early stages.

There is also the integrated care strategy announced by Ms Skinner earlier this year, which will attempt to ensure primary and community care is more closely aligned with acute care in order to provide better, more streamlined healthcare.

“We clearly have to support the integrated care strategy for the department,” he said. “eHealth has a big role to play there. As soon as you talk about integrated care, it is a huge challenge. NSW Health doesn't have any jurisdiction in primary healthcare, and yet what happens in primary healthcare has a big impact on us as a service.

“The other interesting challenge as we create greater reliance on our electronic systems is the ability to provide support almost instantaneously for a clinician.”

Clinical programs

Although he has only been in the job since August 18, new CCIO John Lambert has quickly come to grips with the acronym soup that represents the clinical systems he is now responsible for.

An intensive care specialist at Orange Hospital and director of intensive care for the Western NSW Local Health District for almost 13 years, Dr Lambert has also been involved in his family's IT firm, Deltra, for almost three decades.

Deltra's software development arm, Jaffle Software, coined from Dr Lambert's nickname, produces the Practice Pro brand of clinical software.

In his new job, Dr Lambert is responsible for a huge investment in existing and new clinical systems, including the electronic medical record (EMR), electronic medications management (EMM), the enterprise image repository (EIR), the outpatient medical record (CHIME, soon to become CHOC), the intensive care clinical information system (ICCIS), the PCEHR-linked HealtheNet and its enterprise service bus (ESB), the incident management system (IMS) and the clinical information access portal (CIAP).

While these acronyms are a mouthful, they do not represent just one system each but a number of clinical software packages and systems. Dr Lambert hopes to bring them all under the umbrella term of eCR – electronic clinical record.

“Although we use one name to reflect the electronic medical record, it is not one system,” he said. “We have multiple systems providing electronic medical record functionality across the state and we are in the middle of a tender process to create a panel of electronic medication management solutions.

“These programs run essentially independently. My hope is that soon we will be dealing with a slightly different arrangement. I've used use eCR – electronic clinical record – deliberately because no one else uses that term. I'd like to think that the various programs that we currently have running are going to work as a unified view of the world.

“As far as the clinicians are concerned, they don't care what software packages they are using. There is one patient and there is one record about that patient. They don't care how architecturally we deliver that. Given we are going to have these systems for a long time, we want to be able to deliver that unified view. If we don't have an overview or a vision that groups those entities together, then I don't think we can provide that view.”

Dr Lambert said the EIR, which was built in-house by NSW Health, is an impressive project that also involves an enterprise patient registry (EPR) and now allowed clinicians to cross the boundaries between LHDs to enable access to patient images throughout the state.

He praised the clinical engagement that had gone into the selection of ICCIS – which will be provided by iMDSoft's well-respected MetaVision system – and will be rolled out to all ICUs in NSW over the next few years.

The tender process for a new state-wide IMS has closed and bids are currently being evaluated. While it will also include the corporate side, Dr Lambert said IMS was essential in understanding where incidents were occurring and in which clinical domains.

“HealtheNet is another very important structure,” he said. “This is our internal version of the PCEHR and it is allowing an interface between different parts of the system to the PCEHR. It will be wonderful to see what can happen with the PCEHR when it is populated with a high level of information.”

He said HealtheNet was going to be a useful tool to cross interstate lines as well for the interface with the PCEHR and other outside systems.

“It will allow various elements of the electronic medical record, which in some cases might be inside an application and in some cases it might be split between different applications, and it will cross the boundaries between the LHDs and the area health services which all do things differently in a federated model,” he said.

“HealtheNet and the enterprise service bus will be the glue that sticks all of these elements of the electronic medical record together. It will allow a lot of things that are currently happening separately to come together.

“Mike Rillstone used to talk about 'EMR first' – I agree with that principle, that the clinicians have to have somewhere they know to find all of the different information – but 'EMR first' does not mean everything in the EMR. There may be a pool of systems and they have to work together.”

Posted in Australian eHealth

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