The success of an electronic medical records (EMR) project will depend on a level of high-velocity, mission-critical ICT not seen before in the sector, says the NSW Department of Health's director of e-health and ICT strategy branch Ian Rodgers.
Rodgers began in the new role in March and is tasked with strengthening the department's e-health and ICT strategy and governance.
"Our journey started way back in 2006 when my predecessors established the NSW Health ICT strategic plan from 2006 though to 2011 [and] the key theme was a sustainable future," Rodgers said.
"To build an EMR system we need to decide what the necessary building blocks are to achieve that goal."
In 2009 the NSW government committed $100 million over two years to the development of an e-health system to replace paper-based health records.
Rodgers admitted the current ICT strategy hasn't been touched since 2006 so there is an "obvious need to refresh that strategy", which will be an area of focus over the next six months.
There was no "e-health document" as it was embodied into the original ICT strategy so Rodgers is developing a state e-health strategy which will, in turn, influence the overall ICT strategy.
"We have four main focus areas of clinical infrastructure, a corporate stream, a business information stream to take terabytes of data and do analytics; and, of course, the IT systems and infrastructure," he said.
"You better make sure there is good IT plumbing in place to connect these systems and make sure they are robust and scalable."
Speaking at this year's CeBIT e-health conference in Sydney, Rodgers said if governments are going to talk about doing an EMR system they need "hospital grade" networks to support the important functions of clinical systems.
See photos and all the action from the event.
"We need a state-wide, health-grade network for collaboration, particularly when pushing EMR out of hospitals and into the community," he said. "The project here is making sure the infrastructure is all updated and current by replacing ageing servers and switches. It's an ongoing investment until we can describe it as a health-grade network."
"For IT there is a clear warning or heads-up. We are moving to an environment where health IT will involve critical delivery of EMR which needs to run 24-by-7. IT needs to provide best practice support for those users. You cannot replace paper records and not have them available all the time. Gartner describes it as high-velocity ICT."
Rodgers borrowed another quote from Gartner on the definition of e-health. According to the research firm, e-health embraces the full continuum of care, not just what happens in hospitals. And the technology must be optimised for clinicians and focussed on tasks and events.
"E-health projects are not ICT projects, they are business clinical transformation projects and should be run as such," Rodgers said. "IT people can't do that without proper engagement of clinicians and other stakeholders. We are dealing with a complex set of stakeholders and their engagement is critical. So is change management and the training that comes with that."
The state of electronic health records in NSW
Rodgers said he is pleased to be the first director of NSW Health's e-health and ICT strategies, but the challenge for NSW Health's EMR program was "where do we start?"
"There is a complex network of bespoke systems among the hospitals," he said.
NSW Health adopted the HIMS (healthcare info management society) EMR maturity model (8 levels) and has adapted and refined it.
"That's how we approached the 'where do we start' and we are now reasonably well advanced," Rodgers said.
NSW Health then went through an application procurement processes and selected a suite of products with the functionality it required. Some hospitals which were mature users of products like iSoft haven't been touched by the roll out, some are finished and some are due for completion this calendar year. It is expected 10 more hospitals will be completed this year.
"The patient administration project is completed and the application is installed everywhere except in existing iSoft sites," Rodgers said.
"Also important are the corporate systems and there is a financial system, a HR system project underway and a billing project doing well for bill processing."
There is also a rostering project scheduled to go live this month and a large asset management project still in the planning phase.
The business information systems project for health information exchange is about 75 to 80 per cent complete and is "progressing well", Rodgers said.
Taking the HIMS model from stage three to stage five at NSW Health involves a number of e-health initiatives still subject to state budgeting process, but, if approved, they are earmarked for commencement in the next financial year. These involve:
- Intensive care system. Extend the reach of the EMR to high dependency areas including 45 intensive care units (ICUs) and other high-dependency units. Provide clinicians with necessary plug-in monitoring and decision support systems.
- Electronic medications management. On track for commencement next year for a period of four to five years. This will manage prescriptions and dispensing of medications.
- EMR phase two: Extends the reach of apps into wards and clinics.
- ICT infrastructure phase two: Healthcare grade networks.
- Corporate initiatives: e-recruitment, training and the occupational health and safety of the program
Where to from here? There is still a lot happening around e-health and ICT governance, according to Rodgers said.
"Deciding who is making the decisions and a restructure has been going on for some time. We have re-engineered the government structure. You need to have meaningful engagement, it is a critical success factor so we have put together a number of governance bodies."
There is now an e-health and ICT strategic council which includes independent consumers -- people who "use the system" -- and people who "understand" e-health.
A clinical advisory group and a corporate advisory group represent medical staff senior management, respectively.
"NSW Health had to exercise the 'Wisdom of Solomon' to decide who went on the committee due to the level of interest," Rodgers said.
"Is the governance structure right? It's hard to say. It's currently being reviewed and likely to make changes to way we do clinical projects."
Rodgers said the national e-health agenda also has a "strong agenda" and NSW Health supports it.
"We have a wave two sites in NSW (Greater Western Sydney e-health consortium) is a collaboration between the Western Sydney and Blue Mountains health networks."
A community health systems project will also extend reach of the EMR program beyond state hospitals and clinical facilities.
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