andrew young, endoscopy information system, healthshare nsw - nsw health case study: leading the...

NSW Health Case Study –

Endoscopy Information

System

eHealth Interoperability Conference

12th September 2013

Overview

• Project Planning

• Setting Standards

• Sustainable Change

• Interoperability

• Lessons Learned

NSW Health

• 15 Local Health

Districts & 1

Children’s Hospital

Network

• 84 acute public

hospitals

• Approx 1.6 M

hospital admissions

(2010/11)

• 26.3 M non-admitted

visits

• 2.5 M emergency

department

attendances

Endoscopies

• Approx 120,000 endoscopies performed per year

• Facilities perform up to 7,200 endoscopies per year

Project Planning

• Initiated by Agency for Clinical Innovation

Gastroenterology Network (2008)

– National Bowel Cancer Screening

recommended EIS

– Required for patient safety, quality,

productivity benchmarks

• Implement standardised local, district and

state level

Setting Standards

• Minimum data set

– Defined by clinicians (gastroenterology

network)

• Adult

• Paediatric

– National bowel cancer screening data

• Capture billing codes (MBSE)

Prior to EIS

• Largely paper based reporting

– Scanned to medical records

• Siloed hospital unit based systems

– Sharing of data via USB, scanning, email

• Manual counting

– Procedure numbers

– Endoscopist accreditation

Sustainable Change

• Program sponsor: Agency for Clinical

Innovation

– NSW Health clinical pillar for clinical

leadership

– Project and BAU sponsorship

• Implemented by HealthShare NSW

– Corporate arm of NSW Health

Endoscopy Information

System

• Record clinical procedure documentation

• Capture digital images

• Automated reports, letters and follow-up

instructions

• Used by endoscopist consultants, fellows

and registrars

– Gastroenterologists and surgeons

• Structured data for research

Procedures

• Upper and lower GI

– Gastroscopy

– Colonoscopy

– EUS: Endoscopic ultrasound

– ERCP: Endoscopic retrograde

cholangio pancreatography

Interoperability

• HL7 v2.3

• Patient administration feeds to EIS

– Demographic feeds

– Episode details

• Scheduling interface to EIS

– Appointment details

– Procedure information

• Results interface to eMR

– Procedure notes and URL

Data and Message View

ORU

PAS

Appt

eG

ate

/ JC

AP

S

Endoscopy

Information

System

Demographics

Episode Details

Appointment

Procedure

ADT / SIU

eMR Results

Infrastructure

• 9 Instances

• Prod, Test, Train

HUNTER

NEW ENGLAND

NORTHERN SYDNEY

CENTRAL COAST

SOUTH-EASTERN SYDNEY

ILLAWARRA SHOALHAVEN

WESTERN SYDNEY

NEPEAN BLUE MOUNTAINS

NORTHERN NSW

MID NORTH COAST

WESTERN NSW

FAR WEST

SOUTH-WESTERN SYDNEY

SYDNEY

CHILDRENS NETWORK WESTMEAD

SYDNEY HSS IT SITES

SOUTHERN NSW

& MURRUMBIDGEE

TRAINING

Bateman’s Bay

Goulburn

Wagga Wagga

Health Network

LHD

eMR

LHD

PAS

PC: Citrix client

DATA

BASEDATA

BASE

DATA

BASE

Application

Server

DATA

BASE

Application

Server

DATA

BASE

Application

Server

Application

ServerCitrix

Farm

PVMD

Terminal

PVMD

session

Application

Server

Citrix

Client

Citrix

session

PRODUCTIONTEST

ENDO

PC: Thick client

PVMD

Terminal

PVMD

session

PAS/Cerner/EMR

HSS Cumberland data-centre

9 * MS Windows.net

application servers

State-wide EIS Server

Oracle 11g server

with 9 DB instances

MS SQL Server 2008 R2

ProVation image capture

workstation

in the procedure room

Accessing application servers via

ProVation ‘thick client’

application installed on PC

Citrix Server Farm

(5 servers)

Workstations other than

image capture workstations

can access application servers

via Citrix

System Architecture

HL7 Interfaces:

- Demographics (ADT)

- Procedure Note Results (ORU)

Endoscopy Procedure with Image Capture

Doctor’s Procedure Documentation

Immediate Electronic Data Retrieval

IBM

Patient Report

Hospital eMR

� Past Procedure Notes� Previous Procedure Images� Data Reports

Information Architecture

Procedure Report

Patient Instructions

Nation Bowel Cancer Screen

Program

Results View in PowerChart

Results Text View in

PowerChart

Procedure Note via EMR

Program Rollout

• Goal 33 sites

– 80% procedures

• Currently 25 sites

since Nov 2012

– Plus 14 HNE sites

Benefits

• Improved access to information leads to time saving

– Discharge summary

– Patient enquiries

– National bowel cancer screening forms

– Common reporting, data capture,

processes

Lessons Learned

• Interfaces

– ADT manipulation required

– Legacy MRN pools

– Dropped network connection

– Handling error messages

– Scheduling: Single procedure codes

only

– Results: mismatch episode

Lessons Learned (cont)

• Information Technology

– Buy-in

– Citrix

– Limited use of network logins, impacts

LDAP

Lessons Learned (cont)

• Clinical

– Clinical champion

– Endoscopist buy-in, change

management

– Accessing doctors for pre-training

– Ideally reduce list on first use

• 1.5 times longer at the end of first list

– Nursing buy-in

Lessons Learned (cont)

• Lack unique identifier

• Common systems often require different interfaces

• Different processes exist

– Pathology ordering

– Booking, arrival / check-in

Questions

Andrew Young

Program Manager, EIS

Andrew.young@hss.health.nsw.health.gov.au

Tel: 8918 1610