e-Health Interoperability Conference (Sydney, 28/29 October 2014).
ICT
Innovation,
Interoperability
Challenges, AND
BREAK
THROUGHS
Western Health, Melbourne, Victoria, AUSTRALIA
Jason Whakaari, Executive Director – ICT, Capital, & Contracts
(Interoperability)
A system working with at least one other system
to electronically exchange data that can be
interpreted and used by that other system
A Definition
3
ICT Innovation, Interoperability
Challenges & BREAK-throughs
<In the Western Health context>
Hospitals are amongst the most complex service environments in the modern
workplace
Health Care is amongst the most important of human endeavours
Interoperability is enabling an innovation led
transformation of Clinical Workflows & Practice
e-Health <mutual inclusive dependency on interoperability>
Welcome to
Western Health <West Metropolitan Melbourne>
Our Vision Together, caring for the West
Patients – Staff – Community – Environment
7
Our Community
• Unprecedented population growth in the West / Increasing
service demand
• High cultural diversity / low socio-economic status
• High & increasing prevalence of chronic and complex disease
• Higher than average rates of diabetes, obesity, some cancers,
mental health, drug & alcohol addiction and infectious diseases
• Outer West - lowest number of GPs, dental services and
pharmacies per capita of any of the regions across Melbourne
On a typical day at Western Health...
840 patients are cared for overnight (acute and sub-acute)
506 patients see a doctor in an outpatient clinic
350 patients attend one of our three emergency departments
62 surgical operations take place
307 patients are discharged
404 patients are seen by our Community and Care Co-ordination Services
130 patients require the services of an interpreter
40 patients are visited at home by our Hospital in the Home program
30 different volunteer roles offer to patients, visitors and staff
14 babies are welcomed into the world at Sunshine Hospital
3031 meals are served
10
People Matter Survey results below sector average on every item
Results inform Executive consideration of People & Culture strategic priorities
Western Health Strategy 2008-2015 OD Plan developed 2010
Western Health Strategy refresh 2011-2015
0%
2%
4%
6%
8%
10%
12%
14%
16%
2007 2008 2009 2011 2013 2014
We
ste
rn H
eal
th im
pro
vem
en
t ag
ain
st s
ect
or
People Matter Survey: The Journey
People and Culture 75% of survey items rated above average for the sector
13
• 1. Mobile Workforce Infrastructure Layer (BT)
• 2. Digital Medical Record (BT)
• 3a. Intelligent Patient Journey System (BT)
• 3b. Access Glance (bt)
• 4. E-Health Messaging Gateway (c - bt)
• 5a. Patient Context Switching (C)
Where to From Here?
• 5b. CPOE / EMR (C)
ICT Innovation Interoperability Initiatives
@ Western Health
Mobile Workforce Infrastructure Layer
<Link to Video>
Topic 1:
Innovative Interoperability
Initiatives @ Western Health
15
• Oracle/Sun J-CAPS Integration Engine (HL7 V2.4)
• Ubiquitous Wi-Fi (Clinical & Non-Clinical Areas)
• Citrix Access Gateway (Multi-user / Remote Access)
• 2 Factor Authentication Access (P-Wd / SMS Code)
• Bring Your Own Device (Access to Clinical Apps)
Where to From Here?
• Azure MS Cloud? (Primary Vs. Archives)
Pre-requisite Mobility Work Flow
Infrastructure @ Western Health
17
• (Base) Document Scanning Solution
• (Strategic) Clinician culture and transition to e-workflows
Plus:
• Direct system entry for HL7 compliant department systems
• Results viewing (soft landing linked to Pathology change)
• Clinician data entry (e-forms, free text)
• Discharge Summaries / Medication Summary (IP & DC Meds)
Digital Medical Record (DMR)
• Base Document Scanning Solution (PLUS)
18
Digital Medical Record (DMR)
• Interoperability Architecture
Fuji Film
RAD PACS Endoscopy
MIYA DSE
Pathology Emergency
Allied Health
ICU
Pharmacy Dictation
Radiology Fujifilm iCVIS Oncology (iCW)
/ Renal
Birthing Outcomes
3a. Intelligent Patient Journey System (iPJS) (BT)
3b. Access Glance (bt)
Topic 3:
Innovative Interoperability
Initiatives @ Western Health
20
MJ delivers seven different
services in the one app.
Clinical
Assessments Notifications
Internal
Referrals
Queue
Monitoring
Medication
Monitoring Clinical
(Medical)
Ready
Discharge
IPJS
Clinical
Information:
Aggregated &
Analysed
1. Clinical Assessments
2. Notifications
3. Internal Referrals
4. Queue Monitoring
5. Medication Monitoring
6. Clinical (Medical) Ready
7. Discharge (Streamlined)
8. Coding Support (ABF)
Intelligent Patient Journey System
• Made up of a range of (e-Smart/Interoperable) Services
Collaborative Project under VIC Govt. MVP Program:
Funding – Dept. Business & Innovation, Host – Western Health, Vendor – Alcidion Corporation (S.A.)
21
Productivity
Best Practice
Safety
Intelligent Patient Journey System
• Delivering benefits to clinicians & patients at Western Health
22
Connecting the systems...
A range of systems collecting data from
different service areas within the Health
Service environment
IPJS has capacity to talk to
other systems, collecting
and analysing patient
information.
IPJS then shares the right
information, with the right
person at the right time.
IPJS
PAS / PMI
DMR / Msg
Gateway
LABS /
PACS
EDIS, +
Intelligent Patient Journey System
• (Smart) Electronic Patient Journey Board
Alcidion MIYA Platform DSE: Underpinning iPJS; and, Access Glance
25
Access Glance
• (Smart) Mobility Bed Access Management Tool
• Increased transparency about capacity and
demand
• Reduces the ‘noise’ associated with bed
management
• Provides management with real time data
• Process of discharge planning
• Why discharge is delayed
E-Health Messaging Gateway (c – bt)
Topic 4:
Innovative Interoperability
Initiatives @ Western Health
27
• Development of a messaging platform that includes a GP directory and
increased reporting capacity
• Uses messaging vendor <Healthlink> to securely deliver notifications
from WH Systems, via WH e-Messaging Gateway, directly into GP
desktop Practice Management Systems
• Can reduce clinical risks related to communication breakdown at the
acute/primary care interface and improves continuity of care by ensuring
adequate and timely follow up of patients in the community
< Workflow Efficiencies – Reduction in Errors – Speed of GP Access to Info>
E-Health Messaging Gateway
• (SMD Compliant) Acute -to- Primary e-Messaging Gateway
28
GPs involved in pilot <in collaboration with Medicare Locals>
• 22 practices overall
• 162 GPs = 19.6% of GPs in the area1
1 Based on ML Stats from June 2013.
E-Health Messaging Gateway
• (SMD Compliant) Acute -to- Primary e-Messaging Gateway
Phase 1 – Scope of Work <Std Notifications: from Dec 2013>
• Admission, Discharge, Transfer
• Deceased notification
• OP Appointment, Receipt of Referral
• Same day Admission / Discharge
• Women’s & Children’s
29
Pilot practice demographics SWMML
MRNWMML
Practice
No. of
GPs
Medical software No of GPs Medical software
1 5 MD 17 Best Practice
2 4 MD 1 MD
3 8 Zedmed 6 MD
4 7 MD 28 Best Practice
5 9 Zedmed 6 Zedmed
6 6 MD 6 MD
7 7 MD 1 MD
8 3 MedTech 10 MD
9 6 MD 12 MD
10 7 MD 7 MD
11 3 MD - -
12 3 MD --
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Typical day
Notification type Fax Electronic % sent electronically
Admission 87 13 13%
Discharge 67 11 14%
Deceased 2 0.2 9%
Outpatient
appointment 367 42 10%
Receipt of referral
(outpatients) 44 6 12%
Same day
admission/discharge 35 6 15%
Women's Clinic 3 0.2 6%
Total 605 78 Average: 11%
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E-Health Messaging Gateway
• (SMD Compliant) Acute -to- Primary e-Messaging Gateway
Phase 2 – Scope of Work <Add more complex message content: from Nov 2014 (target)>
• Discharge Summary
• Outpatient Letters
• Medication Summary (IP & DC Meds)
Next Steps • Phase II Roll Out to Pilot GP Cohort
• Roll out of full Phase I & II Functionality to full WH GP Cohort
• Add any additional high value content to GP Cohort
<Explore viable options for in-bound e-referrals from GP to Acute>
5a. Patient Context Switching (C)
<In Development>
5b. What Next / Where to From Here (C)
<Under Consideration>
• CPOE
• EMR Visioning
Topic 5:
Innovative Interoperability
Initiatives @ Western Health
33
Vendor Pitch:
Vergence unifies single sign-on, role-based application access, context management, multi-factor authentication and centralized auditing capabilities into a fully integrated, out-of-the box clinical workstation solution.
Patient Context Switching
• Vergence (Caradigm) <formerly Sentillion & then MS>
Australian Deployments:
The Macquarie University Hospital, Sydney (AUS)
34
• Enables automatic alignment of Patient details across multiple
systems when changed in other bridged systems that are open
• Vendor Bridge Integration (Development in WH environ)
• P&CMS / PAS (CSC iPM), Digital Medical Record (BossNet CMS),
Radiology PACs (Fuji Film), Allied Health (HMS), EDIS (CSC)
• Includes Single Sign-On solution in WH deployment
Patient Context Switching
• Vergence (Caradigm) <formerly Sentillion & then MS>
35
• Enables automatic alignment of Patient details across multiple
systems when changed in other bridged systems that are open
• Vendor Bridge Integration (Development in WH environ)
• P&CMS / PAS (CSC iPM), Digital Medical Record (BossNet CMS),
Radiology PACs (Fuji Film), Allied Health (HMS), EDIS (CSC)
• Includes Single Sign-On solution in WH deployment
Where to From Here
36
• Engaged PWC to support an organisation wide e-Heath
Visioning & EMR Options Assessment
• Working through CPOE / EMR Options Discussion with WH
Executive & Board
• Watch this space?
Patient Context Switching
• CPOE / EMR
38
• 1. Mobile Workforce Infrastructure Layer (BT)
• 2. Digital Medical Record (BT)
• 3a. Intelligent Patient Journey System (BT)
• 3b. Access Glance (bt)
• 4. E-Health Messaging Gateway (c - bt)
• 5a. Patient Context Switching (C)
Where to From Here?
• 5b. CPOE / EMR (C)
ICT Innovation Interoperability Initiatives
@ Western Health