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This is a keynote presentation given to HIMSS Asia Pac 2010
Citation preview
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
Copyright Not for Reproduction 2010
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
Copyright Not for Reproduction 2010
Health is a complex business
Copyright Not for Reproduction 2008
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
Copyright Not for Reproduction 2010
How do we evolve and adapt?
Copyright Not for Reproduction 2008
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
Copyright Not for Reproduction 2010
Evolution
Copyright Not for Reproduction 2008
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
Copyright Not for Reproduction 2010
Something old Constants of health
Copyright Not for Reproduction 2010
• Patient Centred care• History, physical,
investigations• Teams of health care
workers• Care in the Home• Hospital Setting
Team First
Copyright Not for Reproduction 2008
WARD
Team First
Copyright Not for Reproduction 2010
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
Copyright Not for Reproduction 2010
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
Copyright Not for Reproduction 2008
Business Intelligence Systems
Copyright Not for Reproduction 2010
Health IT systems
• Clinical
• Corporate
• Integrated BI systems
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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
Copyright Not for Reproduction 2010
Orders (Order Entry)
Current Applications
Current Applications
PowerChart (Flow Sheet)
Respiratory
Current Applications
Discharge Summary (eDRS)
Current Applications
Layers of information
ClinicalUnitEnterprise
Hospital, Region, Network
Ward
Patient
Patient
Ward Patient
Copyright Not for Reproduction 2008
Copyright Not for Reproduction 2008
Layers of information
ClinicalUnitEnterprise
Hospital, Region, Network
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
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
Copyright Not for Reproduction 2010
Intelligent Health Care
Copyright Not for Reproduction 2010
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
Copyright Not for Reproduction 2008
Evolutionary Pressures
Copyright Not for Reproduction 2010
• 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
Copyright Not for Reproduction 2010
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
Copyright Not for Reproduction 2010
Copyright Not for Reproduction 2010