Queensland launches 20-year, $1.26 billion health ICT strategy
Queensland Health has developed a strategy for health ICT and eHealth that calls for an investment of more than $1.2 billion over the next 20 years, including $730 million for clinical software such as a new patient administration system, rolling out the Cerner integrated electronic medical record (ieMR) to more hospitals and the replacement of the ageing Auslab statewide pathology system.
Clinical applications represent 58 per cent of the total investment required, with a further $300 million required for ICT infrastructure, $100 million for business systems and $130 million for the “digital future”, including implementing interoperability standards, patient and provider identity systems, clinical terminology services, patient portals and enhancements to The Viewer, the web-based application that provides clinicians with a view of patient information and the PCEHR.
Cerner will be one of the big winners of the strategy, with its ieMR rolled out to 12 more hospitals in addition to the existing nine, and four smaller, rural hospitals to receive the 'lite' version.
Launching the strategy at a Committee for Economic Development of Australia (CEDA) function in Brisbane today, Queensland Health Minister Cameron Dick also announced that one of Queensland's flagship tertiary hospitals, the Princess Alexandra Hospital (PAH) in Brisbane, was set to go digital in November, rolling out the full Cerner EMR and going as paperless as possible.
Mr Dick said he had been briefed on the precarious state of health ICT in Queensland when Labor came into government earlier this year, with 16 ICT systems having a risk profile that was high or extreme. The legacy Auslab pathology results system was rated as one of the highest risks.
It is also well known that the 25-year-old HBCIS patient administration system is on its last legs.
Mr Dick said the briefing told him there had been an increase in significant ICT outages, primarily due to ageing infrastructure, unsupported software versions and “a break/fix approach to asset replacement”.
Before detailing the new strategy, Mr Dick accepted responsibility for the Queensland Health payroll disaster that the previous Labor government presided over and offered an apology.
“As a Labor Minister I am acutely aware of the history of ICT roll-outs in health,” he said. "Put simply, the introduction of a new payroll system under the previous Labor government was a disaster.
“It was a disaster for the department which had its credibility in relation to the delivery of complex IT projects severely damaged. Politically, it was disaster for a government already struggling on a number of fronts. Today, I apologise for this.”
He said that as an organisation Queensland Health now had to move on, and this meant “confronting the fact that we have a significant future role in the delivery of complex system wide ICT changes”.
The eHealth Investment Strategy has been developed in partnership with all 16 of the state's Hospital and Health Services (HHSs) and provided a 20-year investment profile focused on key priorities, he said.
- Replacing or upgrading clinical and business systems, including Auslab and HBCIS
- Investing in digitisation, statewide electronic medical records, and enabling digital hospitals
- Enabling greater workforce mobility with integrated portable devices
- Delivering better systems integration and interoperability.
“The strategy also addresses legacy system risks and ensures a greater level of integration between both public and private health service providers and the community,” he said.
“Strategic investment is particularly important in these times of fiscal constraint and we are moving forward with detailed planning works, with a diligent approach to implementation.
“Queensland Health will over time do the hard painstaking work to develop the business cases, to partner with the industry and to identify savings to help fund this important plan.”
The strategy itself provides a comprehensive view of the collectively identified ICT investment priorities across the health system.
“These priorities have been indicatively costed, and includes contextual information that underpins the prioritisation order and overarching plan, to which each investment priority aligns,” it says.
The strategy has four categories:
- $300m for ICT infrastructure, including infrastructure utility and a contemporary desktop
- $130m for the “digital future”, including information interoperability and eHealth foundations
- $100m for business systems, including a finance system replacement
- $730m for clinical systems, including the PAS, ieMR, pathology, digital imaging and access to primary and community care systems.
One of the greatest areas of investment need is the replacement and enhancement of core infrastructure, the strategy says. This will require an estimated $230m for capital asset replacement, the infrastructure required for digital hospitals, identity management and telehealth provision.
“Years of under investment in ICT and poor ICT project delivery performance has resulted in out- of-date infrastructure, ageing technology, and highly customised and heavily integrated bespoke systems,” it says. “These are costly to replace and difficult to sustainably support.
Network speed and connectivity across the regions will need to be improved and standardised, and Queensland Health's current immobile technology platform improved to cater to an increasingly mobile workforce.
“Mobile devices, remote monitoring of patients, integration with biomedical devices at the bedside and improved access to online patient information and clinicians requires high grade, high availability digital connectivity, supported by appropriate mobile, point of care technologies,” it says.
An investment is also required in improved identity management, which will allow QH to integrate better with the Healthcare Identifier (HI) Service, the National Health Service Directory (NHSD) and the PCEHR.
It also forecasts the need for about $30m for a contemporary desktop, including a replacement of the current Windows XP desktop environment which the strategy says inhibits upgrades to existing clinical and system support applications.
Cloud-based solutions need to be investigated as they will offer an integrated device and user productivity suite that enables the connectivity of information and functionality.
“Queensland Health has conducted a pilot of cloud- based services and now needs to provision the connectivity, access and integration of the user productivity suite across the ICT system.”
It forecasts that $100m will be needed for business systems to rationalise the more than 30 enterprise-wide support systems across the ICT portfolio currently used and the total replacement of the customised SAP finance system.
This system is used by all HHSs but has been unsupported by the vendor since 2006. The strategy emphasises that the replacement of this system will be a significant investment, so prior to statewide deployment, the solution will be initially implemented at two HHSs and at the department itself.
eHealth architecture foundations will require about $100m of an overall $130 investment in “the digital future”. The foundations include clinical data repositories and business intelligence solutions to support new patient, community and clinician portals and to help manage large datasets.
Another $30m will be needed for information interoperability to support sharing of information between HHSs and other healthcare providers, along with enhancements to The Viewer.
“Queensland Health needs a scalable, information-sharing capability that is open-standards based, reliable, flexible and allows interoperability between new and existing systems (preferably as ‘plug-and-play’ components),” it says.
“This needs to have minimal fragile and expensive integrations that is also highly secure to ensure data integrity and protect patient privacy.”
Queensland Health has more than 55 enterprise clinical systems across the ICT portfolio, the strategy says, so QH has prioritised five distinct areas for investment:
- PAS replacement
- ieMR and digital hospital enablement
- pathology management system replacement
- primary and community care capability development
- digital imaging and transmission.
HBCIS, the current PAS, has been “extensively tailored” to meet Queensland Health requirements but can no longer support a modern patient administration system. QH says $210m will be required to replace the current system with a modern solution that builds on the current clinical and supply chain capabilities.
A further $376m will be required to roll out the ieMR, which is currently installed in nine hospitals. Queensland Health is planning to invest in 21 digital hospitals and four ‘lite’ implementations.
“Digital hospitals are proven to deliver a wide spectrum of benefits in terms of increased patient safety, healthcare quality, early detection and monitoring of possible adverse clinical events, reductions in readmissions, improved patient flow and realisable cost savings,” it says.
“The long-term strategy for Queensland is a digital HHS. This vision offers a fully integrated healthcare system across care settings enabling our HHSs to work seamlessly together and with healthcare providers and partners across the state.”
It estimates that $75m will be needed for a new pathology system to replace Auslab, which is at the end of its life and is unable to meet the current needs of Pathology Queensland.
“The timing of the pathology information system replacement lends itself to an opportunity to fully integrate with the ieMR and digital hospital initiative. The HHS benefits will be realised through the integration of pathology, medical imaging and medications interactions.”
$7m will be required to improve access to electronic health records from primary and community care sites and to support care being delivered remotely through telehealth or other similar technologies. It foresees the need to rationalise disparate ICT systems into a single solution at multiple primary and community care sites.
And $62m will be required for a digital imaging and transmission platform that is integrated with the ieMR.
"Investment in the safe and secure exchange of digital information provides opportunities to leverage a broader spectrum of health services and provide opportunities to share [lessons] and solutions with healthcare partners," the strategy says.
“Complementing the ieMR, this investment enables a complete view of the patient history, including medical imaging and diagnostics, and results reporting, irrespective of location.”
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