The Mission-Critical

Foundations for a
Digital Landscape in
NSW Health. Where
to Next?

NSW Medical Leadership

Forum
2 March 2018

Dr Zoran Bolevich
Chief Executive, Chief Information Officer, eHealth NSW
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 Overview
• eHealth Strategy for NSW Health

• Progress Update

• Where to Next?

• Key Challenges and Considerations

• Q&A

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Patient Story – Mrs P.
 eHealth Strategy for
NSW Health 2016-2026
• A 10-year program of innovation, investment and
implementation identifying key eHealth goals

• Vision of a digitally enabled and integrated health

system delivering patient-centred health
experiences and quality health outcomes

• Providing the direction for eHealth initiatives to

ensure NSW Health organisations harness
innovations and digital solutions in clinical care,
patient engagement, business services and smart
infrastructure to meet future demands

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NSW Health reform

NSW Health’s top 5 Strategic Priorities

1. Patient Safety First

2. Leading Better Value Care
3. Systems Integration
4. Digital Health and Data Analytics
5. Strengthening Governance and
Accountability
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 Three Horizons of the eHealth Strategy

Horizon 1 Horizon 2 Horizon 3

Years 1– 3 Years 1– 7 Years 1– 10

Consistent Integration Personalisation

Foundations
“Patients experience
“Patients have “Patients benefit customised healthcare
consistent interactions from strong partnerships and education available
with healthcare that provide coordinated when and
systems that address and integrated where needed.”
their health health services.”
and wellbeing.”

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 eHealth Strategy Progress – January 2018
% Progress by January 2018
% Progress in 2016

Focus Area Current Initiatives Current Progress NSW Health Coverage Basis

Electronic Medication Management 14%

Systems (eMeds) of facilities
0%

Electronic Medical Record 87%

of facilities
35%

Intensive Care Systems 17%

of ICU beds
0%

Pathology Lab Results 55%

of pathology laboratories
0%

HealtheNet 100%
of facilities
73%

Health Wide Area Network 76%

of facilities
29%

State-wide Infrastructure Services 99%

(Identity & Access Management) of staff
66%

Wireless 60% of facilities

30%

Finance Systems* 100%

of organisations*
100%

Asset & Facilities Management* 100%

of organisations*
100%

Rostering 75%
of staff
25%

* The technical system is fully deployed for use by all LHDs. Further work required to implement the system consistently across the state required for usability and adoption uptake.

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 Clinical Programs

• Electronic Medical record (EMR2) live in 156 hospitals

• Electronic Medication Management (eMeds) live in 30 hospitals

• Electronic record for Intensive Care (ERIC) live in 8 hospitals

• New PACS/RIS system (10 LHDs and NSW Pathology) – moving

towards implementation phase

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 NSW Health: Our Digital Presence
(Daily Usage Statistics)

48,000 259,000
Clinicians use Tests Ordered
eMR

725,000
Charts opened

120 130 40,000

eLearning eMR Quick Appointments
modules Reference booked
available Guides in
across NSW Learning Live

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 Corporate Programs

• HealthRoster:
– 18 NSW Health entities and over 100K (75%) of in scope
staff are now using the system
– HealthRoster (9.0) deployed in December 2017,
incorporating multiple enhancements and improved
functionality

• Recruitment and Onboarding (ROB):

– 28 Health entities now using the system
– 2,700 recruitment campaigns managed using ROB,
attracting 240,000 online views
– More than 700 candidates hired and onboarded using
ROB
– Next stage will be design and development of additional
functionality
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 Infrastructure Programs

Clinical Applications Reliability Improvement (CARI) Program

– increasing the reliability and availability of essential clinical applications for NSW
Health
– Migrating all eMR domains to the Government Data Centre
– Providing eMR disaster recovery service

Conference, Collaboration & Wireless (CC&W) Program:

– Deploying Patient Wi-Fi, Skype for Business and core wireless capability across
NSW Health

State Wide Infrastructure Services (SWIS) Program

– Over 120,000 users are now on the State-Wide email platform with over 160,000
identities matched and deployed

Health Wide Area Network (HWAN) Program

– At end 2017, 50 per cent of all NSW Health sites were connected to the HWAN
network including most hospitals
– Rural HWAN program connects 184 sites across the state
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– Rollout to metropolitan LHDs is continuing throughout 2018
 Where to next?

• Complete Horizon 1 implementations

• Improve use and usability of systems
• Progress clinical decision support
• Advance data analytics
• Progress Systems Integration and
Integrated Care
• Engage patients and consumers
 Ongoing Investment in Digital Health Solutions

• NSW State Budget 2017-2018 saw a record $536 million additional

investment (over eight years) in eHealth which will see the “phasing out of
paper patient files”. The investment includes:

– $286 million for the Whole of System Digital Platform, enhancing the
digital infrastructure supporting the clinical and other health-related
systems across NSW

– $236 million for Digital Patient Records extending the Electronic

Medications Management (eMeds) roll out and ensuring patient
records are easy to read, accurate and instantly accessible whenever
needed

– $14 million for the HealtheNet Pathology Results Repository, giving

clinicians easier access to public hospital pathology results no matter
where tests originally happened
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 Total capital allocation $536M
Total Achieving Integrated Digital Patient Records* $236.2m
Full implementation of EMR2 including Cancer integration (Aria/Mosaic) $32.6m
eMeds to a total of 178 sites and Master Drug Catalogue $87.6m
Community Health Reporting and optimised functionality $5.0m
Security and Auditing $7.1m
Rural Wireless $10.0m
End point Clinical Document Scanning $3.0m
Analytics $6.0m
Innovation $2.0m
Ambulance EMR improvements, Emergency Department integration and resilient CAD platform $20.5

Total HealtheNet Pathology Results Repository* $13.8m

Integrating 4 hubs $8.5m
Clinical Access to state-wide Pathology Results (mobile App) $0.2m
Pathology Results reporting and Analytics $0.7m
Strategy Development for additional Hubs (e.g. Forensic, Kids) $0.3m
Strategy Pathology orders $0.8m

Total Whole of system digital platform* $286m

State wide Infrastructure Services (SWIS) $52.7m
Health Wide Area Network (HWAN) $26.5m
Data Centre Reform (DCR) - LHD and NSW Health Data Centre Migration $31.6m
Clinical Systems Reliability Improvements $7.7m
Hardware Refresh $109.5m
15 *Note Total figures include change management, overheads, contingency and funding allocated in 2016/17
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CORE EMR FUNCTIONALITY
BY 2020
• eMR2 – Completion of the electronic medical record solution implementation and increasing
consistency across NSW to support further reduction of the hybrid medical record
• eMeds – Expansion and acceleration of the electronic medication management
implementation across NSW and investigation of the feasibility of additional functionality,
including high risk and complex medications and the next phase of the Master Drug Catalogue
• Community and outpatient documentation – Delivery of enhanced reporting functionality
• Security – Enhancement of the digital patient record security to monitor compliance to the
Health Privacy and State Records Act
• Scanning – Delivery of software and devices to enable single page document scanning of
prioritised documents at point of interaction between clinicians and patients
• Integration – Increased integration between core EMR and ‘best of breed’ systems, e.g.
Oncology Information Systems (Mosaiq and Aria)
 Improving Use and Usability of Systems

• Clinical engagement and training

• Use of ‘Lights On’ data

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Time spent per doctor per month per patient in the eMR

Individual doctors
Monthly summary for a doctor
Summary view of a clinician’s activity on 12th Jan
Analysis of decision
support alerts

Drill down is available

to the doctor level
Examples of trends over time
 Improving Use and Usability of Systems

• Clinical engagement and training

• Use of ‘Lights On’ data

• Single sign-on
• ‘Tap on – Tap off’
• Mobile forms
• Performance enhancements
• Medical device integration (strategic procurement)
• User-centric design (human factors)

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 Clinical Decision Support

• Order sets
• Pathways
• Active clinical decision support (e.g.
recommended diagnostic tests; dosing of
complex meds)
• Artificial intelligence (future)

• How should we approach introduction of these

tools?

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 Data Analytics

• New governance model

• ‘Data Lake’ approach
• Real time analytics for safety
and quality (electronic version
of ‘Global Trigger Tool’)
• Defining opportunity areas for
clinical analytics

http://www.ehealth.nsw.gov.au/publications/nsw_health_analytics_framework

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 Systems Integration and Integrated Care – Focus Areas

• Statewide integration of electronic patient records

– HealtheNet (discharge summaries, pathology, imaging, dispensed meds)
– Cerner Health Information Exchange (new!)
– EMR ‘Superdomain(s)’ (early discussions and conceptual work only)
– Integration between Ambulance EMR and Hospital EMR (funded)

• Working with the Australian Digital Health Agency to enable successful

implementation of My Health Record

• Working with the Agency for Clinical Innovation (ACI) to accelerate progress in
Patient Reported Measures

• Designing statewide approaches for active Shared Care Planning

• Designing statewide approaches for active eReferrals

• Building on previous proof-of-concept investments and lessons from evaluation

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HealtheNet and My Health Record
 National Children’s Digital Health
Collaborative

• A new national initiative we’re leading on behalf of

the Australian Digital Health Agency

• Has moved into an implementation phase with five

initiatives

• The Child Digital Health Record initiative (led by

NSW and VIC) has commenced and is in an early
design phase

• Child Digital Health Record pilot sites are currently

being confirmed (Western NSW LHD, Western
Sydney LHD and the Children’s Hospital
Westmead)

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Engaging Patients and Consumers
(incl. Personalisation)

• Big promise of ‘digital transformation’

• Explosion of health apps
• Proactively and intelligently identifying needs and
responding with tailored solutions for patients and
providers
• Home monitoring
• Smart devices and implantables
• Genomics and proteomics
• Artificial intelligence

• Importance of Innovation Framework to actively

manage innovation
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 Key Challenges and Considerations

• Clinical engagement – role of the CCIO

• Workforce (clinical informatics, data analytics etc.)

• Sustainable funding models and support models

• Benefits realisation

• Cybersecurity

• Interoperability of systems

• Safety of health information technology

• Clinical solutions design governance

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 The Clinical Solutions Design Governance Framework

The CSDG Framework will help eHealth NSW build better, safer clinical
tools by:

• governing the design of all digital clinical solutions built

by eHealth NSW
• ensuring that design decisions are made by the best
possible team of clinicians and other staff
• ensuring all clinical solutions are developed using
appropriate human-centred design (HCD) methods

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 The Framework at a glance

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 Important Aspects of the Framework

• Provides a balance between clinician involvement and the technical

expertise that is required to ensure that eHealth NSW builds safe, secure,
scalable, robust and usable digital clinical solutions

• Continue to be adjusted based on lessons learnt along the way, especially

where resource implications are significant

• Testing using prototype elements has commenced in

• End of Life Management DWG
• Mental Health DWG
• Secure Image System

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 Thank you

Dr Zoran Bolevich
Chief Executive, Chief Information Officer
eHealth NSW
zoran.bolevich@health.nsw.gov.au

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