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

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 2

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

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 3

Clinical Programs on Arrival

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 4

Clinical Portfolio Now

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 5

Future State (incomplete)

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 6

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

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 7

Clinical Integration

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 8

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”

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 9

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?

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 10

The Great Divide

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 11

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

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 12

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

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 13

Where is the help?

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 14

ACI

CEC

HET

I

BH

I

NSW

CI

NSW

K &

F

People, Process THEN Tech.

Technology

People

Process

eHealth NSW

LHDs SHNs

Min. HAC

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 15

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…

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 16

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

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 17

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

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 18

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

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 19

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)

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 20

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

CCIO, eHealth NSW - March 2015 john.lambert@health.nsw.gov.au 21

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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