Strategic Information Management




Information & Communication
Technology (ICT) Strategic
Plan
2006 – 2011

‘Building a ...
Information & Communication Technology (ICT) Strategy            Introduction




          NSW HEALTH DEPARTMENT

       ...
Information & Communication Technology (ICT) Strategy                                                Introduction




Tabl...
Information & Communication Technology (ICT) Strategy                                             Introduction




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Information & Communication Technology (ICT) Strategy                       Introduction




1         Introduction
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Information & Communication Technology (ICT) Strategy                         Introduction




          Historic investme...
Information & Communication Technology (ICT) Strategy                       Introduction




          1.2       Key progr...
Information & Communication Technology (ICT) Strategy                         Introduction




          •    Corporate Sy...
Information & Communication Technology (ICT) Strategy                      Introduction




                    Informatio...
Information & Communication Technology (ICT) Strategy                                            The ICT Strategic Managem...
Information & Communication Technology (ICT) Strategy                             The ICT Strategic Management Framework

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Information & Communication Technology (ICT) Strategy    The ICT Strategic Management Framework




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Information & Communication Technology (ICT) Strategy           The ICT Strategic Management Framework




            Apr...
Information & Communication Technology (ICT) Strategy                  Where we want to be in 2011




3         Where we ...
Information & Communication Technology (ICT) Strategy         Where we want to be in 2011




          For example a Nurs...
Information & Communication Technology (ICT) Strategy         Where we want to be in 2011




          minimum duplicatio...
Information & Communication Technology (ICT) Strategy   Key Challenges faced by NSW Health




4         Key Challenges fa...
Information & Communication Technology (ICT) Strategy   Key Challenges faced by NSW Health




          When considered c...
Information & Communication Technology (ICT) Strategy   Strategic Response to Key Challenges




5         Strategic Respo...
Information & Communication Technology (ICT) Strategy                      Strategic Response to Key Challenges




    St...
Information & Communication Technology (ICT) Strategy   Strategic Response to Key Challenges




          •    Make smart...
Information & Communication Technology (ICT) Strategy   Strategic Response to Key Challenges




          providing the i...
Information & Communication Technology (ICT) Strategy   Strategic Response to Key Challenges




          and duplication...
Information & Communication Technology (ICT) Strategy   Strategic Response to Key Challenges




          •    A focus on...
Information & Communication Technology (ICT) Strategy   Strategic Response to Key Challenges




          5.3.1     NSW G...
Information & Communication Technology (ICT) Strategy   Strategic Response to Key Challenges




          5.3.4     NEHTA...
Information & Communication Technology (ICT) Strategy   The Approach to ICT in NSW Health




6         The Approach to IC...
Information & Communication Technology (ICT) Strategy            The Approach to ICT in NSW Health




          Area Heal...
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  1. 1. Strategic Information Management Information & Communication Technology (ICT) Strategic Plan 2006 – 2011 ‘Building a sustainable future’ Updated: September 2008 Version: 2.2
  2. 2. Information & Communication Technology (ICT) Strategy Introduction NSW HEALTH DEPARTMENT This work is copyright. No part of this publication may be reproduced by any process without the written permission of the copyright owners. SHPN - (HSPI) 090005 ISBN: 978-1-74187-414-3 © NSW Health Department 2008 Prepared by the Strategic Information Management Branch. Copies of this strategy can be downloaded from the NSW HealthWeb site www.health.nsw.gov.au 2
  3. 3. Information & Communication Technology (ICT) Strategy Introduction Table of Contents 1 Introduction............................................................................. 5 1.1 Building a sustainable future for health ...........................................5 1.2 Key programs of work ..................................................................7 1.3 Planned outcomes .......................................................................8 2 The ICT Strategic Management Framework ..............................10 2.1 Strategic Themes ...................................................................... 10 2.2 Describing the ICT Strategic Management Framework ................... 11 2.3 Strategic Planning Process ......................................................... 11 2.4 Criteria for inclusion in ICT Strategy and Investment Plan............... 13 2.5 Upgrade process ....................................................................... 13 3 Where we want to be in 2011...................................................14 3.1 Benefits to the individual patient and clinician................................ 14 3.2 Department level benefits ........................................................... 15 3.3 Hospital level benefits ................................................................ 15 3.4 Area level benefits ..................................................................... 15 3.5 State level benefits .................................................................... 16 4 Key Challenges faced by NSW Health......................................17 5 NSW Health Strategic Response to Key Challenges ..................19 5.1 NSW Health Strategic Framework ............................................... 19 5.2 Results and Services Plan (RSP) ................................................ 20 5.2.1 Strategic Goal 1: To keep people healthy................................. 21 5.2.2 Strategic Goal 2 : To provide the healthcare people need .......... 21 5.2.3 Strategic Goal 3: To deliver high quality health services............. 22 5.2.4 Strategic Goal 4: To manage health services well ..................... 23 5.3 NSW and National ICT Government Drivers ................................. 24 5.3.1 NSW GCIO ICT Strategic Plan ............................................... 25 5.3.2 Council of Australian Governments ......................................... 25 5.3.3 National eHealth program ...................................................... 25 5.3.4 NEHTA ................................................................................ 26 6 The Approach to ICT in NSW Health ........................................27 6.1 Approach to delivery of ICT in NSW ............................................. 27 6.2 Approach to delivery .................................................................. 31 6.3 A Portfolio Management approach ............................................... 31 6.4 Standard processes adopted across the ICT portfolio .................... 32 6.5 A framework for Partnership........................................................ 33 6.5.1 Core, Common and Divergent ................................................ 33 6.6 Integrated governance model...................................................... 34 6.6.1 State based build .................................................................. 36 7 Priority ICT strategies .............................................................39 7.1 Clinical Systems Strategy ........................................................... 39 7.1.1 Objective.............................................................................. 39 7.1.2 Programs supporting this strategy ........................................... 39 7.1.3 Electronic Medical Record...................................................... 39 7.1.4 Primary, Community and Outpatient Care ................................ 41 7.1.5 Clinical Support Systems ....................................................... 42 7.2 Corporate Systems Strategy ....................................................... 42 7.2.1 Objective.............................................................................. 42 7.2.2 Core projects to be delivered .................................................. 43 3
  4. 4. Information & Communication Technology (ICT) Strategy Introduction 7.3 Business Information Strategy..................................................... 43 7.3.1 Objectives ............................................................................ 43 7.3.2 Programs supporting this strategy ........................................... 43 7.3.3 Core projects to be delivered .................................................. 44 7.4 Sustainable infrastructure program .............................................. 44 7.4.1 Objectives ............................................................................ 44 7.4.2 Programs supporting this strategy ........................................... 44 7.4.3 Core projects to be delivered .................................................. 45 8 Outcomes of the ICT Strategy..................................................47 9 Measurement of benefits .........................................................48 Appendix A Additional Reference Material/ Resources ...................50 4
  5. 5. Information & Communication Technology (ICT) Strategy Introduction 1 Introduction 1.1 Building a sustainable future for health Over the next five years, the ICT goal of NSW Health is to ensure the basic systems needed to run an effective and high quality healthcare system are in place. NSW Health is facing a number of major challenges: • An increase in demand for services from an ageing population. • Achieving equity in health to improve health outcomes and life expectancy for Aboriginal people, those in rural and remote communities, homeless people, people with a physical or intellectual disability, refugees and those with a mental illness. • Staff shortages in critical areas such as nursing, requiring the introduction of more innovative approaches to delivering health care, attracting and retaining staff. • Improving health status in the population in the face of rising rates of chronic diseases including heart diseases, pulmonary diseases, diabetes and cancer, and risk factors such as obesity and sedentary lifestyles. • Consumers are becoming more informed, have higher expectations and suffer more complex problems. • Quality and safety standards are challenged as demands increase. • Financial sustainability of the health system. Cost pressures are expected to continue to rise, and already represent more than 27% of the state budget. The Results and Services Plan and Total Asset Management plan establish the framework for NSW Health to meet these challenges. NSW Health has seven key strategic directions – • Make prevention everybody’s business • Create better experiences for people using health services • Strengthen primary health and continuing care in the community • Build regional and other partnerships for health • Make smart choices about costs and benefits of health and health support services • Build a sustainable health workforce • Be ready for new risks and opportunities To meet and prepare for these challenges NSW Health must change the way it delivers services. NSW Health is implementing a major combined clinical and corporate and ICT reform program to address these issues. Implementation of IT solutions to support staff and embed business processes is critical to ensuring change to delivery of services is sustainable. To be successful this requires a change in the way that ICT solutions are procured, designed and implemented. 5
  6. 6. Information & Communication Technology (ICT) Strategy Introduction Historic investment decisions and decision-making have resulted in Area Health Services developing disparate clinical and corporate applications, supporting mixed infrastructure and integration approaches. This has resulted in: • Very high integration cost and difficulty gaining a comprehensive clinical or management information; • Duplication of effort and little reuse of technology assets; • Existence of information gaps and overlaps; • Different clinical specialty systems making it difficult to effectively manage the patient journey and give clinicians a single view of their patients; • Twenty-nine systems support basic HR functions; • Systems that are more than 20 years old and have limited support. As a result it is difficult to share patient information and coordinate patient care. From a management perspective, it is difficult to obtain accurate information on system performance. From a financial perspective, the systems are expensive to maintain. This situation will undermine the long-term sustainability of the Clinical Services Redesign and Corporate Shared Services reform programs. The ICT program has been realigned and refocussed to meet the long terms needs of the reform program. The focus will be on connecting islands of information and technology and rapidly supporting clinical and corporate reform. The Integrated Clinical Information Program (ICIP) was established in 2000 as a result of recommendations of the NSW Health Council and its objective is to deal with the issues outlined above in a defined forward strategy. The program aims to address these issues by providing core clinical functionality across NSW. Significant progress has been made in the implementation of patient administration, clinical and corporate systems. The ICT Strategy has been realigned with the core reform strategies of Clinical Services Redesign and Corporate Shared Services. Five major ICT strategies have been defined to support these broader strategic priorities. These are the: • Clinical Systems Strategy • Corporate Systems Strategy • Business Information Strategy • Sustainable Infrastructure strategy and • Whole of Government ICT Strategic directions. 6
  7. 7. Information & Communication Technology (ICT) Strategy Introduction 1.2 Key programs of work Within these strategies, the following core programs will be implemented over the period 2006 - 2011: • Electronic Health Record pilots implemented and evaluated to support the patient journey across acute, community based and private health services. • Electronic Medical Records across the state, as a key enabler for clinical reform through Clinical Services Redesign and improved quality and safety. This will provide clinicians with: Results reporting: to allow test results and reports from diagnostic services to be viewed at the point of care Order management: capacity to order tests, procedures and services online at the bedside. This includes laboratories, imaging, allied health, dietary, catering and other departments. Order management provides decision support to improve patient safety, reduce over servicing and reduce costs. Discharge Referral: an electronic summary of the patient’s care which can be sent to another provider, directly or via the Electronic Health Record, such as a General Practitioner to support ongoing care in the community. Emergency Department: information specific to Emergency Departments to allow the efficient management of the Unit and patients. It includes triage information, presenting problem, treatment times, interventions etc. Operating Theatres: a system to manage the co-ordination of patients, surgeons, anaesthetists, equipment and rooms, and report on utilisation to ensure maximum utilisation to reduce delays and access block. Scheduling: the ability to co-ordinate scheduling across an integrated set of information systems to provide a single view of appointments and resource requirements. • Community Health Systems across NSW that support improved management of patients in the community, particularly aged, chronic disease and mental health patients • Picture Archival Communication Systems/Radiology Information Systems A standardised statewide approach to procurement and implementation to support the implementation of new service delivery models to address critical workforce issues. This includes the implementation of a centralised image server and storage. • Patient Administration Systems fully implemented across NSW for more effective and efficient patient management, administration and scheduling and as the foundation for core clinical systems. • State Unique Patient Identification System fully operational to enable linkage of records across NSW to improve co-ordination of care, underpin the Electronic Health Record and provide the capacity for improved public health information. 7
  8. 8. Information & Communication Technology (ICT) Strategy Introduction • Corporate Systems, a suite of systems including Finance, e- Procurement, Human Resources, Asset Management and Billing, to underpin the Corporate Shared Services reform and support the management and resourcing of clinical services. • Business Information Strategy to ensure that accurate, timely, accessible and appropriately presented information is available for to support decision making by frontline clinicians, health service managers and the Executive. This strategy includes an assessment of the replacement of the data warehouse and business Information infrastructure. • Infrastructure Strategy which will address the immediate needs to support the key programs of work. The strategy will include short-term requirements such as the replacement of obsolete telecommunications network equipment, telephony systems and data centre hardware, acquisition of additional floor space at the Liverpool data centre, the establishment of a Network Operations Centre and the implementation of supporting ICT management processes in Health Support Services. The strategy will be further developed to address longer-term data centre requirements, additional essential equipment replacement and the extension of supporting management processes (ITIL) across the public health system. • Other systems within the ICT Portfolio, such as ICU, Medication Management, Hospital Pharmacy and Clinical Documentation are scheduled for the second half of the 10 year investment cycle. • An integrated Enterprise wide architecture for clinical and corporate systems to enable secure, accurate exchange of information to support transition to new service models. • An enterprise wide governance model to ensure an integrated approach to governance, investment, planning and change management across the ICT programs in NSW Health. 1.3 Planned outcomes This ICT Strategy supports close strategic alignment to major NSW Health and broader whole of Government initiatives. The Strategic Plan has been developed to support the strategic directions outlined in the NSW Health Results and Services Plan, and the core reform programs designed to underpin the plan, such as Clinical Services Redesign and Shared Corporate Services. The ICT Strategy aims to improve rural coverage to support rural and remote strategies, and improved support for public health, health promotion and preventative strategies to better predict and manage future demand This strategy will deliver the following key outcomes: • More patient focused and informed care leading to better patient outcomes ie : the right information is available at the right time and in the right place 8
  9. 9. Information & Communication Technology (ICT) Strategy Introduction Information available to support the patient journey reducing adverse events Improved discharge referral planning improving the transition of care from acute to community settings and reducing risk of adverse events. • Improved quality and safety by ensuring that clinicians have access to information they need to provide safe care and by providing systems to embed consistent, predictable processes across the state to improve quality and safety • Information to support the more effective management of health services and improved clinical and corporate processes. Improved theatre utilisation and use of resources, reducing waiting times and patient delays Reduced access block in Emergency Departments Enterprise wide scheduling allowing better matching of resources to demand, planning and more effective resource usage • A highly skilled workforce with access to the information and tools they need to manage their work • Improved collaboration within health and other related agencies within NSW, with the private sector and nationally to increase interoperability and better information flow to support improved patient outcomes and increased efficiency. • Significant savings – new structures, governance arrangements and development and deployment methods Rapid deployment of core programs will reduce overall project management costs, which are the major cost component Potential to integrate with the change management activities already in train with CSRP and Corporate Shared Services, reducing cost and increasing value of the change management process. This will also help to embed the ICT processes within the clinical and corporate reform programs to ensure that the change is sustainable. Minimises duration of impact on clinicians in AHS’ and increases the speed to delivery of benefits for clinical care Reduced training costs (can train once for all components, not multiple times for each individual component) 9
  10. 10. Information & Communication Technology (ICT) Strategy The ICT Strategic Management Framework 2 The ICT Strategic Management Framework 2.1 Strategic Themes In summary, the ICT Strategy revolves around three strategic themes: • Significantly improved support for clinicians and patient care • Strategic alignment to major NSW Health initiatives; and • Considerable cost savings. These themes are expressed in terms of five Strategic Objectives 1. Use of ICT to enable major clinical reform programs; 2. Reduce the duplication and cost in administrative systems 3. Deliver a core set of high quality information to all levels of the organisation 4. Build an ICT Infrastructure that is available and responsive and supports the requirements of the clinical and corporate systems reforms; and 5. Adopt a coordinated, portfolio approach to the management of ICT to ensure that the maximum benefit is gained from NSW Health’s investment in ICT These central concepts to the strategy are expanded out in the body of the document and are summarised in Figure 1. ICT Governance Integrated Governance Models across AHS’ and the Department Business Information (BIS) Standardised data sets Embedded in operational systems Available to clinicians & decision makers Provided in a timely & user friendly manner Clinical Systems Corporate Systems Investment Management ICT Asset Management Enable Clinical Services Better systems Redesign Program • Human Resources Patient • Finance • Statewide integrated Deliver •Electronic health record Statewide integrated • Asset Management • Electronic Medical record Electronic Health Record • eProcurement • •CommunityMedical Record Electronic & Primary • Billing •Care Community & Primary • EAI • Clinical Support (PAS, Care High Quality • Identity Management •Diagnostic) Clinical Support (PAS, Services • Telecommunications Diagnostic) • Desktop Consolidation Sustainable Infrastructure Support clinical & corporate systems Uniform Information Management Data quality Standards Business Continuity Build enterprise architecture ICT Portfolio Management Processes for Core, Common & Divergent Applications Figure 1 –Core elements of the NSW Health ICT Strategy 10
  11. 11. Information & Communication Technology (ICT) Strategy The ICT Strategic Management Framework 2.2 Describing the ICT Strategic Management Framework This document provides the central description of NSW Health’s ICT Strategy for the period 2006-2011. It is supported by a number of more specific documents covering: • The ICT Asset Management Strategy; • NSW Health’s Enterprise Architecture. This document forms the core of NSW Health’s ICT Architecture documents, that are specific to: The Clinical Systems Architecture The Corporate Systems Architecture and Strategy The Business Information Strategy The Infrastructure Strategy; and The Integration architecture strategy • The ICT Governance Framework • The ICT Portfolio Management and Program of work • The ICT Investment Plan 2006-2017. This collection of documents describes NSW Health’s ICT Strategic Management approach. Figure 2 provides a graphical illustration of these documents and their hierarchical organisation. Level 0 Input Internal External Documents Corporate State Health Health RSP State TAM PeopleFirst Plan Plan Plan (GCIO) Level 1 Whole of NSW Health ICT Strategy “at a ICT Strategic Plan NSW Government ICT Strategy Glance” ICT Strategy alignment Level 2 ICT Asset NSW Health ICT ICT ICT Enabling plans Management Enterprise Governance Communicatio Portfolio Strategy Architecture Framework n Strategy Investment Plan Level 3 Action Plans SIM Clinical Corporate AHS ICT Program Business Systems Systems Strategic Plans Plan Architecture Architecture Plans Figure 2 –The Documents that describe NSW Health ICT Strategic Management Approach 2.3 Strategic Planning Process The ICT Strategic Plan forms one level of a planning hierarchy that encompasses the following levels: 11
  12. 12. Information & Communication Technology (ICT) Strategy The ICT Strategic Management Framework State Plan Results and Services Plan Total Asset Management Plan NSW Health Plan ICT Strategic Plan Enabling plans Figure 3: Planning hierarchy The ICT Strategic Plan is driven by the overarching priorities of NSW Health as defined by the Results and Services Plan and NSW Health Plan. To ensure that the ICT portfolio is closely aligned with the RSP and Corporate Plan, NSW Health has taken the following steps: From the RSP: • Selected those results and associated services which will be dependent on the ICT assets working well • Identified ICT asset-related risks which may prevent achievement of services and results • Identified those services and service measures which will depend on the ICT assets working well. From the NSW Health Corporate Plan identified: • The ultimate goal or vision for the community • The contribution NSW Health will make towards achieving this goal or vision • The focus for achieving the goal or vision, including intended outcomes, risks and strategies • Strategies for measuring where performance targets have been met • The cost of achieving the goal or vision and meeting performance targets. The outcome of this has informed the development of the ICT portfolio aimed at effectively supporting services needs. Key dates in the strategic planning cycle are shown below. For more detail see the SIM Strategic Planning Framework. 12
  13. 13. Information & Communication Technology (ICT) Strategy The ICT Strategic Management Framework April / July July August October Review of Agreed Results and Services Treasury forecast of Proposed TAM; TAM with schedule of Plan sets strategic 10 year budgets Asset Strategy changes and direction aligned with RSP preliminary business and including final cases, including business cases; strategy gateway completed business case gateway Figure 4: Planning cycle 2.4 Criteria for inclusion in ICT Strategy and Investment Plan ICT priorities are set and reviewed annually. Each initiative is evaluated against 5 principles to determine the priority of the project and its position in the investment program. The principles are: • Level of contribution to major service reform agendas and alignment with planned NSW Health Results and Services, priorities and plans. • Extent to which the project supports the patient journey across multiple care settings and improves the quality and safety of health care for the largest number of people. • Capacity to deliver improvements in efficiency and effectiveness in healthcare delivery and workforce utilisation. • Degree of conformance with state ICT strategic planning requirements. • Level of potential to generate a positive return on investment. 2.5 Upgrade process It is intended that only new initiatives should be included in the forward investment program. The ongoing requirement to replace existing systems should be addressed through the procurement and contractual process to ensure NSW Health has access to future product upgrades through the support and maintenance agreements formulated with vendors. 13
  14. 14. Information & Communication Technology (ICT) Strategy Where we want to be in 2011 3 Where we want to be in 2011 By 2011 we plan to have implemented the core clinical and corporate systems across NSW to support patient journeys through the health system and to provide the corporate systems and management information needed to manage the health system efficiently. Implementation of the ICT Strategy will deliver benefits at five levels – individual patients and clinicians, Clinical Departments, Hospital, Area wide and State. 3.1 Benefits to the individual patient and clinician From a clinical perspective, the end-goal of the strategy is to achieve a ‘single view of the patient’. The single view of the patient means that every clinician involved in the patients care (doctors, nurses, pharmacists, physiotherapists etc…) have a full understanding of the patients complete care needs and medical history. They can understand what other practitioners’ roles and contributions are and can work together effectively as a team across all parts of the system. Corporate systems are in place to effectively support the delivery of clinical care and support s single employee view. The strategy benefits the patient as it means that all the information clinicians need to deliver the best possible care, with an optimal outcome is easily available whenever and wherever it is needed. This helps clinicians by reducing the time they spend trying to locate information or unnecessarily repeating tests, increasing the time they have available for direct patient care. The following figure illustrates this concept. Single View of Patient Results Order ED EHR Reporting Management System Electronic Theatre Community Prescription ICU System Health Support Discharge PACS/RIS PAS UPI Referral Supporting Systems HR-Payroll Rostering Asset Mgt eMarketplace Billing FMIS BedBoard Provider Directory Connectivity (Simplified diagram) Figure 5: Single view of patient There are also significant benefits to frontline managers from a fully integrated suite of systems that will allow improved business intelligence. 14
  15. 15. Information & Communication Technology (ICT) Strategy Where we want to be in 2011 For example a Nursing Unit Manager (NUM) on a ward can more effectively plan and care for patients with a full understanding of all demands, such as patients waiting in the ED, coming from surgery and being transferred in, and of ward capacity such as current available beds, pending available beds, quarantined beds and staff availability and skills sets. At Hospital, Area and Department executive levels, a complete portfolio allows an integrated analysis of health outcome indicators, demand for services, resource availability, clinical and support services performance and financial management. The ICT Strategy is focused on the priority areas or activities required to underpin these and will be addressing them in its forward strategy as resources and funding become available. Other initiatives will only be added to the ICT work plan if they do not compromise delivery of these core functions, or to address an urgent issue. 3.2 Department level benefits By 2011 clinical departments will have access to systems that improve work flow within the Department, provide decision support for clinicians and access to information needed to support the most effective management of resources. This will mean that clinicians will have immediate access to critical information to make sure that the right decisions are made for patients. This, combined with rules built into clinical systems and better communication between staff in the department, will mean better and safer care for patients. 3.3 Hospital level benefits The implementation of well integrated core systems across a hospital, including for example Results Reporting, Order Management, Patient Administration Systems, Scheduling and Human Resources means that information can be collected once and be accessible to all who need it. This will minimise problems at handover and allow enterprise wide management of human and other resources to increase efficiency and reduce access block as patient’s move between departments. Good information allows the patient journey to be more efficient allowing time to see more patients. 3.4 Area level benefits Areas will benefit from the implementation of these systems as they will have access to standardised information from all facilities to manage their resources more effectively, support planning and demand management and management of patient transfers between hospitals in their Area with 15
  16. 16. Information & Communication Technology (ICT) Strategy Where we want to be in 2011 minimum duplication of diagnostic procedures and delays for patients. Improved communication between hospitals and clinicians in the community will support patient care better once they leave hospital and reduce the risk of readmission. 3.5 State level benefits Implementation of core systems across NSW will deliver significant benefits. While benefits are derived at each level, the full value of ICT will be achieved when these systems are implemented across all Areas. Standardised clinical and corporate information, collected as a by product of patient care, provides support for NSW Health to achieve the targets set under the Results and Services Plan by improving patient journeys across the health system, improving timely access to services, strengthening co- ordination and integration across the health system. Accurate information will allow better utilisation of resources and management of future demand. 16
  17. 17. Information & Communication Technology (ICT) Strategy Key Challenges faced by NSW Health 4 Key Challenges faced by NSW Health NSW Health is facing a number of major challenges: • A steady increase in demand for services from an ageing population. In NSW, the proportion of people over 65 is increasing rapidly. In every year between 2012 and 2028, the aged share of the Australian population is projected to increase by more than 0.35 percentage points – an increase around 4 times the long term average. • Staff shortages in critical areas such as nursing and medicine • Hospitals running at maximum capacity • The rate of chronic diseases including heart diseases, pulmonary diseases, diabetes and cancer is increasing. The rate of obesity in our younger population is on the rise and our increasingly globalised society increases the risk of pandemics. • An increasing body of medical knowledge that staff cannot manage and use without advanced IT systems • Health services are increasingly challenged by more expensive medical technologies and pharmaceuticals • Consumers are becoming more informed, have higher expectations and more complex problems. • Quality and safety standards are challenged as demands increase and there are fewer staff to manage them. For example, from 2000 to 2005 the average occupancy for NSW hospitals stood at a high 93%. Some metropolitan hospitals’ surgical and medical wards average 95-98%, when 85% is generally considered a much safer working capacity for these beds. • In the period July to December 2007 57,808 incidents were reported. The key factors that cause these adverse events are: Communication Policies and procedures Knowledge, skills and competence issues Work scheduling • Clinical ICT is becoming an increasingly important enabler of health system reform, yet the core systems to underpin reform are not currently in place. • Constraints in capital and recurrent funding, skilled project management and implementation resources and capacity of the health systems to accommodate large scale change all restrict the potential speed of implementation of core systems. • There are many competing demands for the funds that are available for ICT. Determining priority and scheduling projects into the forward program is complex and requires ongoing review to ensure funds continue to be allocated in areas of greatest potential benefit. 17
  18. 18. Information & Communication Technology (ICT) Strategy Key Challenges faced by NSW Health When considered collectively, the convergence of issues creates an environment of significant risk that must be addressed. The only way NSW Health can realistically meet these challenges is to change the way it delivers services. NSW Health has embarked on a major clinical and corporate reform program to address these issues. The implementation of appropriate IT solutions to support staff and embed business processes is critical to ensuring this change is sustainable. 18
  19. 19. Information & Communication Technology (ICT) Strategy Strategic Response to Key Challenges 5 Strategic Response to Key Challenges 5.1 NSW Health Strategic Framework There are a number of key drivers that are influencing NSW Health strategic directions. These relate to both the demand for health services, driven by factors such as the aging population, and supply within health, for example workforce shortages in key areas of the health system. The wider government priorities and directions, such as the Council of Australian Government priorities around Mental Health and Health workforce and whole of government ICT strategies also drive the strategic directions and investment decisions of NSW Health. At the highest level, the Results and Services Plan sets the strategic directions for all NSW Health Programs. This is supported by a number of strategic programs aimed at delivering the Results and Services Plan. The ICT Strategic Plan aims to support the Results and Services Plan by ensuring close alignment with the reform programs and strategies underpinning the Results and Services Plan. All levels of NSW Health planning take into consideration the NSW whole of government and National strategies. Figure 6 provides a schematic overview of the context of the ICT Strategic Plan. 19
  20. 20. Information & Communication Technology (ICT) Strategy Strategic Response to Key Challenges Strategic Context NSW Health Strategic Response Health Clinical Services Annual Operational Plan Broader Healthcare Futures Plans • Burden of Disease Environment • Demand & Supply Statewide & AHSs • Challenges (Pop. Health; • Opportunities RSP Primary & Community; • Risks Corporate Acute) Health Needs of NSW Strategic Plans • Partnerships • Risks & Priorities Population: Statewide & AHSs • Current Year Programs • Future Service • Demographics Delivery Concepts • Medical Technologies Enabling Plans Enabling Programs – • Disease Patterns & Trends Workforce; Safety & • Infrastructure Annual Goals • Consumer Expectations Quality; Asset Mgt; Needs Annual Budget; Capital Research & • Information Needs Asset; Recruitment & Teaching; Development; Goods & Service Delivery Challenges: Procurement; Services; IM&T • Staff Shortages Financial Mgt; IM&T • Hospitals Running at Max. Capacity Outlook Outlook Outlook • Quality & Safety Challenges 20 Years 5 Years 1 Year • Geographic Challenges ICT Portfolio Goals Portfolio Approach for: Broader IT 1. Strong Alignment with the RSP, TAM & Whole -of-Govt Environment IT NSW Health Goals 2. Improved Integration, Cost Control & Risk Management Govt. CIO Strategic Plans 3. Improved Transparency of Planning & Implementation Whole -of-Govt Plans Common Goals 4. Coordinated Approach to Implementation, Change Keep People Healthy Management, Architecture, Security & Privacy Provide Needed Health Care Treasury Deliver High Quality Services TAM Policy Statewide Approach to: Manage Services Well 1. Ensure Consistent IT Capabilities and Support Across AHSs Common Strategic Health IT 2. Leverage off Common Knowledge, Skills & Directions Other health jurisdictions Methodologies (SIM, State Builds & HSS) 3. Eliminate Redundancies, Ensure Integration & Standardise Reporting and Cost Control Govt. CIO Goals NEHTA ICT Strategic Executive Plan New Funding Model: Reporting 1. To Meet the Specific Needs of IM&T Investments 2. To Meet Strategic Goals within the Proposed Timeframe Current State - NSW Health 3. For Economies of Scale, Network Benefits & State Treasury Goals IT Buying Power Monthly Reporting and RSP Figure 6 - Context of the ICT Strategic Plan. The sections below overview the NSW Health strategic response to the challenges outlined above and identifies the relationship between the ICT programs and the broader Health priority areas. 5.2 Results and Services Plan (RSP) The RSP represents NSW Health’s primary strategic response to the challenges faced by NSW Health. NSW Health has four primary goals: 1. To keep people healthy 2. To provide the health care that people need 3. To deliver high quality services 4. To manage health services well These are underpinned by seven key strategic directions: • Make prevention everybody’s business • Create better experiences for people using health services • Strengthen primary health and continuing care in the community • Build regional and other partnerships for health. 20
  21. 21. Information & Communication Technology (ICT) Strategy Strategic Response to Key Challenges • Make smart choices about costs and benefits of health services • Build a sustainable the health workforce • Be ready for new risks and opportunities The ICT Strategic Plan will provide essential support to all four goals and seven strategic directions. These are being supported by a number of core reform programs and strategic initiatives. ICT is a critical enabler for each of these programs to support long term sustainable change. The section below summarises the relationship between the health strategic goals and enabling IT initiatives. 5.2.1 Strategic Goal 1: To keep people healthy Reducing risk factors in the population is a major strategic objective for NSW Health. NSW Health is increasing the focus on health promotion and preventing illness and implementing strategies to increase immunisation rates, reduce the impact of chronic disease, reduce diabetes through interventions for people at high risk. ICT can support many of these strategies by providing automatic alerts about risk factors, such as gaps in immunisations, or overdue screening or check ups. What we will do: • Implement Electronic Medical Records to flag health risk factors so patients can be given early advice and referred for preventative care. • Implement Community Health systems to support monitoring of patient in the community including automatic reminders of screening, implementation of care plans to improve management of chronic disease. • Improve information through the Business Information Strategy to support evidence based research to target health promotion activities more effectively. • Implement Outpatient scheduling systems and discharge/referral components of the EMR to encourage more proactive outpatient care for the prevention of acute care admissions. 5.2.2 Strategic Goal 2 : To provide the healthcare people need Health services need to be available when needed, are effective and co- ordinated to meet each individual’s needs. ICT plays a major role in providing the tools that are needed to underpin new models of care and make clinical reform sustainable. Supporting information flow along the patient journey plays a large part in improving the experience of people as they move along the journey, and making sure that the care they receive is appropriate. NSW Health is striving for a health system that helps people access the healthcare they need through an integrated network of primary and community health services. ICT supports this strategic direction by 21
  22. 22. Information & Communication Technology (ICT) Strategy Strategic Response to Key Challenges providing the infrastructure and systems needed to support communication across health services What we will do: • Implement Patient Administration Systems and the Electronic Medical Record to support efficient admission, elimination of redundancy in entry of demographic information and patient history taking allowing a more informed and efficient experience. • Extend implementation of community health systems, with a major focus on aged care, chronic disease and mental health. • Extend the implementation of the discharge referral component of the EMR to ensure GPs have access to information from hospital stays to make sure patients get the care they require when they are discharged. • Support quality and safety with medication management tools, prescription support tools, clinical pathway capabilities, prompts and individualized patient safety alerts and full patient information and activity archiving. • Implement scheduling, waiting list management and theatre systems to manage surgical demand and capacity. • Implement integrated PAS and patient flow tools to increase visibility of areas of delay and constraint. • Implement PACS/RIS technology to support remote diagnostic reporting minimise delays and travel for patients in rural and remote areas. • Enhance the Incident Information Management System to identify and manage incidents effectively. • Implement the Business Information Strategy to give clinicians and frontline managers the tools and information they need to provide care more effectively. 5.2.3 Strategic Goal 3: To deliver high quality health services There are currently three levels of government and multiple agencies involved in funding and delivering health services, resulting in complexity 22
  23. 23. Information & Communication Technology (ICT) Strategy Strategic Response to Key Challenges and duplication. Improved collaboration within and beyond the health system is vital to improve the links and improve co-ordination and the quality of services provided across the health system. ICT provides the infrastructure and tools needed to improve this level of collaboration. Quality and safety will also be enhanced through decision support tools for clinicians through the Electronic Medical Record, and by more appropriate use of resources through rostering and other HR tools. What we will do • Implement the Electronic Medical Record and Medication Management to provide decision support to reduce the risk of adverse events and improve the quality and safety of care. • Implement Electronic Discharge Referral Systems to improve the communication between hospitals and General Practice to ensure appropriate ongoing care in the community. • Collaborate with other Human Service agencies in the implementation of HSNet to improve co-ordination of different types of services that may be accessed by one person. • Implementation of state wide PACS/RIS, and particularly the establishment of a state image archive, will allow reporting on images from specialists anywhere in the state, regardless of the patient’s location. This will reduce unnecessary travel and help to address some of the significant workforce shortages NSW Health is facing. It will also provide the technical support for new models of service provision. • Improve Community Health systems to support mental health, aged care and chronic disease services in the community. • The establishment of Area wide clinical repositories to underpin results reporting, order management and clinical documentation will support much more streamlined care across all services within an Area Health Service. Shared access to information will improve collaboration between hospitals and providers across an Area. • Implementation of standardised corporate systems to ensure that resources with appropriate skills are available when and where needed. 5.2.4 Strategic Goal 4: To manage health services well The health system needs to be able to make the most effective use of finite resources and manage costs effectively to ensure long-term sustainability. What we will do: • A renewed focus on the information needed to manage the health system well, at all levels from state to individual managers and clinicians, has seen the development of the Business Information Strategy. The projects recommended in this strategy will be implemented over the next 3 years providing a robust basis for decision making, performance monitoring and patient care. 23
  24. 24. Information & Communication Technology (ICT) Strategy Strategic Response to Key Challenges • A focus on consolidating IT services and infrastructure across NSW Health to reduce expenditure on infrastructure and back end systems and services. This will enable a greater focus on implementation of information technology to directly support patient care. • Implementation of Finance, Asset management and procurement systems to ensure our resources can be managed effectively enterprise wide. • Implementation of a state wide Human Resources Information System to replace the current 29 systems will provide the basis for informed decisions about the health workforce. It will support more effective management of rostering, learning and development and qualifications, improving the quality and safety of care provided to patients and the working environment of staff. • State wide implementation of systems like PACS/RIS will provide opportunities to implement new service delivery models to address workforce shortages. 5.3 NSW and National ICT Government Drivers The NSW Government IT environment feeds into, and, to some extent, constrains the NSW Health ICT strategic plan. This program aims to ensure that NSW strategic initiatives align with, and where possible have the opportunity to inform, national and broader state initiatives. The government ICT principles and strategies with which NSW Health needs to demonstrate alignment are: • NSW GCIO ICT Strategic Plan • Council of Australian Governments • National eHealth program • NEHTA These are discussed in the following sections. 24
  25. 25. Information & Communication Technology (ICT) Strategy Strategic Response to Key Challenges 5.3.1 NSW GCIO ICT Strategic Plan The NSW Government has set new directions for IT through the NSW Government CIO Executive Council. Primary goals include: • Using IT to reduce back-end service costs while maintaining frontline services • Increasing investment in frontline service technologies • Delivering savings through IT strategies in both capital costs and recurrent costs • Reducing the total cost of IT The Government has proposed a number of new measures to achieve its primary goals including: • A single capital fund for IT • A statewide IT plan A focus on fewer software applications, shared infrastructure, common processes and aggregated purchasing 5.3.2 Council of Australian Governments The Council of Australian Governments (COAG) has identified significant areas of national interest including mental health, health workforce, action plans for influenza pandemics and progress towards electronic health records. ICT is an enabler for many of the COAG priorities. COAG has an ambitious health and ageing reform agenda proposed for implementation from 2009. This includes a program of hospital reform, improvements to Indigenous health, chronic disease management and preventative health care. The ICT program outlined in this strategy directly supports the COAG reform agenda, through its focus on the implementation of systems that will enable clinical reform in both acute and community settings. 5.3.3 National eHealth program The eHealth initiative is a State, Territory and Australian Government initiative, originally established in 2000 to promote and provide the foundation for e-health across Australia. Since its inception, the Australian Government has contributed $128m to e- health projects in various locations across Australia. A further $10m was committed in December 2005 for managed health network grants. The program has overseen a number of Electronic Health Record trials, but in 2006 expanded the scope to encompass a wider eHealth focus. The aim of the eHealth program is to increase collaboration across jurisdictions and to support consistency in approaches to eHealth to underpin a national health information network. The eHealth Program is also responsible for establishing the appropriate regulatory frameworks to enable ehealth intiatives. 25
  26. 26. Information & Communication Technology (ICT) Strategy Strategic Response to Key Challenges 5.3.4 NEHTA NEHTA’s primary goal is the development of national health information management and communications technology standards and specifications. NEHTA is progressing a number of work programs that will have a direct impact on NSW Health’s ICT strategic plan. These include: eHealth interoperability: developing a Framework for Interoperability to enable efficient and secure electronic exchange of information between health organisations. Clinical communications: NEHTA is undertaking a program of standardisation of key clinical information. It is intended that the format of, and data contained in, clinical communications such as patient referrals and hospital discharge summaries will be standardised across all health IT systems, according to the specifications set by NEHTA. These specifications will be built upon existing standards, extending these as necessary. This work includes the establishment of a common, coded clinical language (clinical terminology). Unique Healthcare Identifiers – This program is developing a single National identifier for individuals accessing healthcare services, providers within the public and private healthcare systems and health organisations. At least initially, the individual identifier is not expected to be used as the primary identifier by most jurisdictions. Individual Electronic Health Record: NEHTA are preparing the data and interoperability standards and business case for the development and implementation of a national electronic health record. Identity management: Standards to ensure the accurate identification and secure access of individuals to clinical information. Secure messaging: NEHTA is working to define national standards and shared infrastructure to ensure that the electronic exchange of clinical information between healthcare providers is reliable and secure. Supply chain: NEHTA has established a National Product Catalogue (NPC) to provide a central source of data for the purchase of healthcare products within health departments in each State and Territory. 26
  27. 27. Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health 6 The Approach to ICT in NSW Health 6.1 Approach to delivery of ICT in NSW To meet and prepare for the challenges it faces NSW Health is implementing changes to the way it delivers services. NSW Health has embarked on a major combined clinical and corporate and ICT reform program to address these issues. Implementation of IT solutions to support staff and embed business processes is critical to ensuring change to delivery of services is sustainable. This section provides an overview of the approach that Strategic Information Management uses to deliver the ICT portfolio and the core strategies, programs and projects that will be delivered over the 5 years of this ICT strategy. There are three primary bodies responsible for delivery of ICT: Strategic Information Management (SIM) SIM is responsible for the development of ICT strategy, working with stakeholders to determine investment priorities, budget negotiation and ensuring overall program delivery. SIM’s role includes: • Development and maintenance of the NSW ICT Strategic Plan and investment program • Interface with Area Health Services and other key stakeholder groups • Business case development and review of Area IM&T proposals • overseeing the delivery of the IM&T strategy, • Ensuring compliance with government, Departmental and Branch standards, architecture and policies • Identify, assess and address the enterprise architecture needs of NSW Health by developing and maintaining appropriate policies, standards and procedures for information management. • Managing, planning and developing integration strategies, architecture, standards and policies to enable effective and consistent integration of a wide range of systems throughout NSW Health. Health Support Services Health Support Services is responsible for the implementation and ongoing support and maintenance of core clinical and corporate systems. Health Support Services are responsible for providing specific clinical and corporate IT services to the Area Health Services as defined under s126G of the Health Services Act 1997. This includes the provision of hardware and hardware asset management, software, application support systems and system implementation management. 27
  28. 28. Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health Area Health Services Area Health Services are responsible for the management of local implementations, change management and training of staff and benefits realisation. Accountability shifts from SIM to Health Support Services as the projects move across the project lifecycle as shown below. Figure 7: Project lifecycle The NSW Health ICT Strategy is illustrated in summary form in figure 8. 28

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