Tuesday, September 17, 2013

It Will Be Very Interesting To See The Progress That Is Made In SA Over the Next Few Years. Going Well And So Far So Good!

This interesting and detailed article appeared a little while ago.

Inside South Australia's e-health transformation project

SA Health CIO David Johnston talks about the biggest e-health project the state has ever undertaken
Rolling out a state-wide electronic health record system is no mean feat for the CIO of SA Health, David Johnston. The government organisation last month switched on enterprise patient administration system (EPAS) that is set to transform 12 hospitals across South Australia.
“This would be the largest IT-enabled project that the state has ever undertaken,” Johnston told CIO Australia. “It’s a significant initiative because it means that if it works here then it’s completely applicable to other states or countries, other jurisdictions.
“It’s basically leaping the industry forward by about 40 years; health is where manufacturing used to be back in the 1960s. It’s one of the last industries that has held out in terms of its usage of technology.”
The e-health system launched on August 25 at Noarlunga Health Service, with more than 2000 electronic medical orders placed in the first day. The system has been configured for about 30,000 users, and around 1200 people who have been trained to use the system at the Noarlunga hospital. The complete rollout across all hospitals is to take place over the next two years.
SA Health customised the Allscripts’ Sunrise Clinical Manager system to create the EPAS. It can be used for both clinical and administrative hospital functions, assisting in 80 per cent of healthcare workers’ activities.

A complex, lengthy project

Johnston is seven years into $422 million, 10-year project, having spent five years implementing the underlying infrastructure to support EPAS and two years developing the e-health system.
“It was very clinically-oriented so it wasn’t the IT department going out and choosing a system. Less than 20 per cent of the budget was on technology so it’s a massive business change project; it’s not a technology project.”
More than 50 projects were executed in the lead up to EPAS. These included creating a mirror copy of its Adelaide-based data centre for failover and backup/recovery, having redundant fibre optic cables between all the hospitals and data centres, and standardising the PC fleet by moving to a rental model rather than purchasing disparate PCs.
The system is configured to work with the federal government’s personally controlled electronic health records (PCEHR) scheme, with eight metropolitan hospitals and one regional hospital now sending discharge summaries to the PCEHR.
“The PCHER has gotten a bit of criticism but I think that’s a bit short sighted. If you look longer term it’s going to be extremely useful. We’ve had no issues in terms of connecting to it,” Johnston said.
“There’s a lot of work that goes on behind the scenes because it has to translate patient numbers into individual healthcare identifiers, which are allocated by the federal government. But for us it’s seamless, it’s just simply a checkbox.”
Integration of systems is one of the biggest challenges in getting an e-health project of this size and scale up and running, Johnston said. Using an electronic master patient index, Johnston was able to standardise patient numbering to send information electronically to GPs though a secure messaging system.
 Lots more here:
The details found here are really worth reading and thus far we seem to have a large Australian e-Health project which has been undertaken pretty well. Time has been taken, planning has been careful, consultation seems to have been broad, training has been a focus and the infrastructure has been got into place in a sensible sequence.
Here is the background to the health service that is the first implementation site.
“Noarlunga Health Services (NHS) is a 91 bed regional health service located approximately 45 minutes south of the Adelaide central business district and within five minutes’ drive of picturesque hills, vineyards and a spectacular coastline.”
See here:
For me it is from now on that the rubber will really hit the road. The reason I say that is based on the fact that implementing a small - under a 100 bed hospital with a system like this is a challenge but not an especially big one. Both the Flinders Medical Centre and the Royal Adelaide Hospital are 550+ bed research and teaching hospitals and will be major implementation challenges I suspect. Size and complexity really matter in these situations and the large hospital users are much more demanding and assertive than in smaller facilities.
Some messy major Hospital Projects in NSW and Victoria have shown just how big these challenges can be. As the title says so far so good. It will be fascinating to see what happens next.


Bernard Robertson-Dunn said...

I'm somewhat confused.

If you are taking a holistic or national approach to eHealth then you have a number of options.

1) A single, national, centralised system.

2) A single decentralised system implemented multiple times in various locations with data interchange to allow to patient mobility.

3) A federated system comprised of multiple, decentralised implementations, but with a centralised function to facilitate patient mobility and issues of nation health monitoring/research etc.

Correct me if I'm wrong, but we don't seem to have any of those options.

It seems we have each state doing its own thing, with multiple, but different systems at different stages of development and the Federal Government doing its own thing which requires translation of patient numbers into individual healthcare identifiers and a whole lot of effort to integrate disparate system.

If I'm correct, does anyone actually expect all this to work efficiently and effectively?

Is the root cause state federal politics? And this is the best we can do?

Of course, one way to improve things and get to option 3) would be for all other states to implement the SA system, even if it requires a lot of effort to integrate the PCEHR, but I'm not sure what the PCEHR would add, not in terms of health outcomes. They will all happen at the state level and below.

Anonymous said...

Perhaps they should also ask the clinicians at Noarlunga Hospital what the experience has been so far. As a consumer, it was certainly less than optimal and certainly delayed the admission and transfer process.