ehealth nsw clinical portfolio · clinical engagement / leadership • ensuring clinicians are...
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eHealth NSW Clinical Portfolio
RICH Forum, ACI March 2015
Chief Clinical Information Officer • My role
– 2 densely written A4 pages – Stuff of nightmares
• Simply – Manage the “Clinical Programs” – Clinical Leadership in the eHealth space – Engage Clinicians – Improve productive use – Connect, communicate, collaborate, influence
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Clinical Programs • “Create the new stuff” • Don’t really have anything to do with stuff that is “already
out there” • The term used for “stuff already out there” is “BAU” or
“business as usual” • My role with respect to BAU is still evolving • BAU includes PAS, FirstNet, Surginet, PowerChart
(eMR1), EIS, EIR, EPR, CBORD, Ferret, CHIME (parts), and many other state supported clinical systems
• There are also many locally managed systems
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Clinical Programs on Arrival
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Clinical Portfolio Now
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Future State (incomplete)
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Integration – Clinical Information • Atomised Data
– Demographics – Allergies / Alerts – Diagnoses / Problems / Family History / Social History – Immunisations – Medications (Current / Past / Prescribed / Dispensed) – Measurements / Observations (height, weight, BP) – Pathology Results, including prose – Imaging Results, including images (e.g. photos, ECGs) – Events (appointments, bookings, waitlists)
• Documents – Discharge Summaries – Management Plans / Care Plans – Procedure Reports – Letters / Other correspondence – Referral documents / RFAs
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Clinical Integration
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Why is Integration so Important? • Innovation • Assists data management for Clinical
Analytics • Boundary issues
– Inter LHD – Inter State – Hospital and Community – Public and Private Hospitals – Patient and Provider
• Hence “Integrated Care”
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Whilst eHealth is being sorted… • How do I “engage” with 140,000 staff
and contractors? • How do we ensure appropriate clinical
engagement and leadership of our Clinical eHealth initiatives?
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The Great Divide
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Clinical Engagement / Leadership • Ensuring clinicians are working shoulder to shoulder with
eHealth • History has been less than ideal but not for want of trying
– Natural tensions • Clinical Needs • Financial Realities • Technical Realities • Public Enterprise vs. Unit level governance
– Have we invested enough in the past? • Senior clinicians don't come cheap – sometimes the "free" ones aren't the
ones that need to be involved…
• We have models that seem to be working well – ICCIS is a good example
• Clinical Pillar Network leading the requirements • eHealth guiding and educating
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Clinical Engagement / Leadership • Improving Communication
– Governance Structure • How do we fit clinicians and others into our governance?
– LHD CCIOs? – Clinical Portfolio Governance Structures? – Use the Pillars and their networks?
– Membership • Who should be involved directly and indirectly?
– Education • Ensuring there is a minimum set of common language
– Facilitation • Subject matter experts for specific conversations with facilitation/
interpretation skills
– Content • Content appropriate for the recipient
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Where is the help?
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ACI
CEC
HET
I
BH
I
NSW
CI
NSW
K &
F
People, Process THEN Tech.
Technology
People
Process
eHealth NSW
LHDs SHNs
Min. HAC
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How this might work • ACI Intensive Care Network
– ICCIS • ACI Emergency Care Institute
– FirstNet • ACI Surgical Services Taskforce
– SurgiNet, eRFA, EIS • CEC
– Clinical Handover, BTF, DVT, CLAB
• But we need some agreed principles or an agreed framework for engagement…
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Principles / Framework example • Managing Variability
– Core Variability – Administrative • Facility names and numbers • Unit names and numbers • Bed names and numbers • Staff identity, roles, responsibilities, contact details • Unit flows • Rostering • Etc.
– No system could be implemented without supporting this customisation
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Principles / Framework example • Managing Variability
– Clinical Variability – Warranted • Casemix • Peer grouping • Volume • Craft Group/ Specialty • Research/ Innovation Projects • Physical Workflow related
– Clinical Variability – Unwarranted • Personality • Post Code • Political Boundary • Preference
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Principles / Framework example • Need for consistency
– Workflow and transient information Vs – Patient specific and perpetual information
– Whole of system user access Vs – Specific and focussed group of users
– Creating one thing 8-17 times Vs – Creating 8-17 times more functionality
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Rural eHealth • The Collaboration – Rural eHealth Program
– Western NSW – Far Western NSW – Southern NSW – Murrumbidgee – Northern NSW – Mid North Coast
• Some Gaps – Hunter New England – Boundary Zone - (Illawarra Shoalhaven, Nepean
Blue Mountains, Central Coast)
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Rural eHealth - Current • SWIS – statewide Identity / eMail / Stafflink / (Rostering) • Rural Health WAN • Wireless Networks • Open Internet Access • Conferencing and Collaboration • Downtime Minimisation • eMR2 / CHOC (CHIME) / eMM • HealtheNet / CR/ PCEHR / Integrated Care • PFP / EPJB • Lots of “fixing up” – Discharge Summaries, PACS / RIS,
EIR, FirstNet remediation, eMR Dictation, complete roll-outs, fill holes
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Rural eHealth –Future? • ECGs • Scanning • Small Site solution (Aged Care, GP) • Specialist Outpatient Clinics • Obstetric eMR / e Blue Book • Ambulance eMR • PFP / EPJB / CCRS / PPRS / Retrieval • eRFA / eReferral • Critical Care Advisory Service Portal • Anaesthesia eMR
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Where did TeleHealth go? • Awaiting outcome of review • John’s personal view..
• Every good eHealth solution is a TeleHealth solution
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TeleHealth
The upshot • eHealth is doing a lot of stuff… • There is a lot of stuff to be done… • Focus is on all areas from basic networking
infrastructure, to clinical applications, and the integration of systems
• Rural areas are going to benefit greatly • The Pillars will be a key part of the clinical
engagement / leadership model • Governance of the boundaries is a challenge • Keep in touch!
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