Himss 2010 Asia Pac 2010

The Future of Health is in Our Hands

Intelligent Health

Steven C. Boyages

Copyright Not for Reproduction 2010

Summary• We are on the verge of a great era of transformation in health care

through health IT– Intelligent Investment

• The future will be spearheaded by a better understanding of workflow

– Intelligent Work

• Better access to real time information about patient care and health system performance underpinned by sustained investment in technology

– Business Intelligence Systems

• This transformation will lead to a sustainable, flexible and safer health system where the patient is at the center of care as an active participant

– Intelligent Health Care

Intelligent Investment


Challenges to the health system

• Rising demand– Growing & ageing population– Chronic illness rising– High levels smoking, obesity,

stress– High consumer expectations

• Constrained capacity– Patient Safety– Workforce shortages and

attitudes– Manage demand within finite

resources– Cost vs investment– NSW spends about 28% of

budget on health care– 1.3 million dollars per hour

4

Investing In Health IT

Benefits– Improved automation– Improved productivity– Reduced duplication– Improved safety– Improved patient and staff

experience– Improved reach of

information and service

Risks– Financial investment not

realised– Poor connectivity– Lack of common standards– Increased risk to patients– Increased staff frustration and

lower morale– Staff expectations not

realised

5

Investing in Health IT

Transformation steps• Build the case for Why?• Build the case for What and

in what order (sequence)?• But most importantly:• Build the case for How?• Value proposition• Patients, payers, providers,

places of care (4Ps)

Execution is the key• Evolution as opposed to

revolution• Engagement with key staff

in design• Integration with key legacy

systems• Understand complexity and

complex systems


Health is a complex business


The organisational goals fundamental to Sydney West Area Health Service are clearly outlined in CAREFirst1, to:

• Provide accessible and appropriate clinical services

• Design safe, effective and innovative models of care

• Invest in services that are value for money

• Advocate a culturally appropriate model of service and community participation

• Promote a culture of knowledge through teaching and research

• Develop a highly skilled workforce.

Sydney West delivers

On a typical day in Sydney West…

• 2,334 people receive inpatient care

• 546 people are seen in emergency departments

• 8,753 out-patient services are provided

• 1,488 primary care and community health occasions of service are provided, with 129 new referrals

• 266 occasions of service are provided by community mental health teams.

Health Operating System-HOS

Complex and Connected

9

Current Strategy

Background

Wednesday, 19 May 2010

SWAHS Information Technology Services Client Base

Greater Western

Greater Southern

Hunter &New England

NorthCoast

North Sydney &

Central Coast

South EasternSydney &Illawarra

SydneySouthWest

Portland

Goodooga

Lightning RidgeCollarenebri

WalgettBrewarrina

Bourke

BaradineCoonamble

Gulargambone

Nyngan

Trangie Gilgandra Coolah

Narromine

Wellington Gulgong

Mudgee

Rylstone

Bathurst

Oberon

Orange

Cowra

Forbes

Parkes

Condobolin

Lake Cargelligo

TottenhamTullamore

Trundle

Cobar

White Cliffs

Wilcannia

Ivanhoe

Menindee

Broken Hill

Tibooburra

Wentworth

Balranald

Hay

BarhamDeniliquin

Griffith

Leeton

Narrandera

Temora

Finley

Urana

Jerilderie

Tocumwal

Coolamon

Young

Lockhart

Culcairn

Corowa Holbrook

Albury

Wagga Wagga

Gundagai

Cootamundra

BoorowaCrookwell

Goulburn

Yass

Moruya

Cooma

Delegate

Bega

Pambula

West Wyalong

Hillston

Quirindi

GloucesterMerriwa

Denman

Wingham

ManningBase

Bulahdelah

Muswellbrook

Dungog

Singleton Maitland

Cessnock

Morriset

Nelson Bay

JohnHunter

Belmont

Gunnedah

Tamworth

Walcha

Armidale

ManillaBoggabri

BarrabaNarrabri

BingaraWeeWaa

Tingha

Moree Warialda

GlenInnes

Vegetable Creek

Tenterfield

Kurri Kurri

Tweed Heads

MurwillumbahUrbenville

Byron Bay

KyogleNimbin

BallinaCasino

Coraki

Maclean

Grafton

Coffs HarbourDorrigo

Bellingen

MacleayValley

Kempsey

Wauchope PortMacquarie

Lithgow

Springwood

Penrith AuburnBlacktown

CumberlandWestmead

Mt Druitt

Ryde

Hornsby

Royal North Shore

Mona Vale

Manly

Gosford

WyongEntrance/

Long Jetty

Woy Woy

ConcordRozelle

BalmainFairfield

CanterburyLiverpool Bankstown

CamdenCampbelltown

BowralWollongong

Sydney Hospital/ Sydney Eye HospitalSt Vincent’sWar Memorial HospitalRandwick (Prince of Wales,

Royal Hospital for Women & Sydney Children's Hospital)

St George

Calvary

Sutherland

Garrawarra

Bulli

Shellharbour

Shoalhaven

Milton-Ulladulla

Dubbo

Symbols Key:

Application - live

Application - proposed

Service Desk

Hosbil

Oracle

e*Index

i.PM

Hosbil

Oracle

e*Index

i.PM

Service Desk

Hosbil

Oracle

e*Index

i.PM

Hosbil

Oracle

e*Index

i.PM

Bateman'sBay

Braidwood

Bombala

Berrigan

Henty

Tumbarumba

Service Desk

Pathnet

Pathnet

SydneyWest

BlueMountains

Pathnet

QueenslandISOH

Lismore

ISOH

Service Desk

Hosbil

Oracle

e*Index

i.PM

Pathnet

ISOH- Dental Application

Pathnet- Pathology Application

Service Desk- I.T. Call Centre

Hosbil- Patient Billing

Oracle- Financial System

E*Index- Record Numbering

i.PM- Patient Administration

Service Desk

HosbilOracle

e*Index

i.PM

Junee

Tumut

Batlow

Queanbeyan

Hawksebury

RPA

Newcastle

Scone

Guyra

Macksville

Inverell

Dunedoo

CURRENTAS AT

JAN 2005

Application - live Pathnet

Application - Interstate

Area Health Service-Area Office

Public Hospital / Health Facilities-

Greater Western AHS

Greater Southern AHS

Hunter New England AHS

North Coast AHS

Sydney South West AHS

North Sydney & Central Coast AHS

South Eastern Sydney & Illawarra AHS

Sydney West AHS

Infrastructure Complexity

Intelligent Work


How do we evolve and adapt?


Evolution• In biology, evolution is the process of change in the

inherited traits of a population of organisms from one generation to the next– Natural selection, adaptations – Genetic drift, random

• The concept of evolution may be applied to an organisation– Traits are the genetic code or constants in health, patient

care– Adapting to external environmental factors


Evolution


The Process of Adaptation

– Models of Care– Safety– Redesign– Information and Innovation– Technology Investment– Team First

• Understanding the way we deliver care at the level of the “cellular unit”, what, how and who

• Strong focus at the ward level


Something old Constants of health


• Patient Centred care• History, physical,

investigations• Teams of health care

workers• Care in the Home• Hospital Setting

http://camwest.pps.com.au/heritage/images_pop/img_P9010206.html

Team First


WARD

Team First


COMPASS

Collaboration Tools

RSS, Sharepoint, Groove

FITBIT

ReFITAudio-video Recording

RolesSOPsPolicy

Redesign Social NetworkingWiki, Blogs

WARD Ver

tical

Pro

cess

ProfessionalSpecialist

Teams

Horizontal Process

GeneralistTeams

CollaborativeTeams

Technology PlatformsSurface Computing, Bedside

WAND Display

TeamFirst Workflow


Inflight(DON)

Outbound(CNU)

Inbound(CNU)

• Bed Allocation

• Hospital Avoidance

• Load Management

• Hospital Bypass

• Monitoring

• LOS

• EUR

• E-consults • Dashboard

• Referrals to HealthOne & GP

Care Navigation Unit

Patient Flow Manager

How do we evolve and adapt?Something new


Business Intelligence Systems


Health IT systems

• Clinical

• Corporate

• Integrated BI systems


Layers of information

ClinicalUnitEnterprise

Hospital, Region, Network

Ward

Patient

Patient

Ward Patient

Clinical Systems

• Patient Administration Systems

• Electronic Medical Records

• Electronic Records• PACS/RIS• Pathology Systems• These are key building

blocks or genetic code


Orders (Order Entry)

Current Applications


PowerChart (Flow Sheet)

Respiratory


Discharge Summary (eDRS)





Ward

Patient

Patient

Ward Patient

Mix of Patient & Performance Management tools to support clinical care

• EMR

• Electronic Health Records

• Bed Board (including LOS enhancements)

• Ward Activity and Nursing Display (WAND)

• eConsults

• iHandover

• Transport booking

• Infectious Diseases Alerts

• Pharmtrack

• Uses up to date (near real time information)

through CareFirst Dashboard – which

includes:

• Subject Area Dashboards (Patient

Safety, Mental Health, Surgery,

Nursing, Costing, ED etc.)

• Links to hundreds of pre-populated

Business Objects Reports (no

performance issues)

35

(a) Patient Care (b) Performance Mgmt

36

(b) Performance Mgmt

Enterprise Level

http://localhost/dashboard/carefirst.htm

37

“Traditional” KPI Dashboards

Ad-hoc Reporting

Published / Static Reports

- Controlled Business Objects Universes

- SQL Server Reporting / Analytic Services

- Bed Reporting- Health Entity

Registration

Mix of Dashboards, Reports and Queries through an AHS Portal

Admin

Operational / Subject Area Dashboards and Drilldowns

(b) Performance Mgmt

38

Bed Board

39

(a) Patient Care

Real Time Health Systems

Definition

• Responsive• Agile• Available• Flexible• Timely

– Real time– Near Real time

Capability

• Patient Care– Safety– Decision support– Outcomes Research– Patient Logistics

• Performance Management– State– Area based– Hospital/cluster/network– Modality (scheduling)– Bedside

40

VIEWERS FUNCTIONSDATA CORE

Microsoft Amalga is the new way to capture, consolidate, store, access and quickly present data in meaningful ways

Labs Cardiology Procedure Documentation

Medication Administration

Hemodynamics CPOEPharmacy Dictation Medication Dispensing

PACS

Mobile Data ICU/Critical Care

Advanced Analytics

Contract Management

Claims Management

Revenue Management

Bed Management

Financial/ERP

Enterprise Scheduling

Business Decision Support

Inventory

Registration Staff/Nurse Scheduling

Outcomes Management

Transcription

Electronic Medical Record

OR Management

Emergency Department

Image Distribution

Purchasing Access Management

Nursing Workflow/

Documentation

Charting Clinical Notes

Pathology

Document Imaging

Medical RecordsCoding

Orders

Call Management

Physician Practice

Imaging

RIS

Amalga

Amalga

Amalga

Unified | …To Data FUSION

Business Intelligence Systems

• Allows leveraging of existing investment in legacy systems

• Integrates patient level and performance level information

• Allows Flexibility and Agility

• Real Time

• Rapid development

• Culture

• Governance


Intelligent Health Care


Patient Experience

We weren’t given any information during the 12 hours we waited in ED

The ambulance was called and came quickly. The ambulance officers were exceptionally good

Home13-08-07

Ambulance

Presented to ED10:15 hrs

Home 25-09-07

Community based rehabilitation

Admitted to Ward X 20:15 hrs

21-08-07 Transfer to

Ward Y

30-08-07 Transfer back

to Ward Y

Transfer of care process 22-08-07 Transfer back

to Ward X

15-08-07 Developed diarrhoea, moved to

isolation room

That was a bad day when I went for my CT scan - we were referred to as “it” or “that one” –

not as people

I found out everything about mum’s process by default. It would have been so helpful

to have been told at the very beginning where to go for

information

The post dischargeplan just evolved

I only found out mum had an eye test because

she wasn’t in her bed when I came to visit

They suspected gastro- enteritis – but I’m sure it was because of antibiotics to prevent infection in mum’s

left arm.

They put a needle in mum’s left arm 3 times despite my telling them not to and putting a sign

above her bed.

Initially the prognosis-which was overheard-

was all doom and gloom… they speak

about you, not to you.

Obtaining information was like pulling teeth –especially in the first

2 weeks

The community based rehab program has

been excellent

Elizabeth’s Story


Evolutionary Pressures


• Patients as partners in health• Health information and navigation• Personal health records• Greater expectations of citizens

Desktop

Computer On Wheels (COW)Vocera

Thin Client

Improving Staff Experience

TelephoneMobile

Intranet, tablets, blogs and wikis


Improving Staff Experience

Lithgow Hospital Wireless LAN

Summary• We on the verge of a great era of transformation in health care

through health IT– Intelligent Investment

• The future will be spearheaded by a better understanding of workflow

– Intelligent Work

• Better access to real time information about patient care and health system performance underpinned by sustained investment in technology– Business Intelligence Systems

• This transformation will lead to a sustainable, flexible and safer health system where the patient is at the center of care as an active participant– Intelligent Health Care

Future Health Care

• Understanding the way we do our work• Technology simplifying work flow• Improving patient experience• Assuring patient safety


Himss 2010 Asia Pac 2010

Health & Medicine

Transcript of Himss 2010 Asia Pac 2010