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    Information Information Document Transcript

    • Strategic Information Management Information & Communication Technology (ICT) Strategic Plan 2006 – 2011 ‘Building a sustainable future’ Updated: September 2008 Version: 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health Figure 8 –ICT Strategy “At a glance” Drivers ICT Strategy Measurement Outcomes (Why) Group Key Result Area RSP Themes Strategic Objectives Strategy Supporting Programs (Initiatives) KPIs Measures (what) (How) (which will be delivered through) Description • Make prevention everybody’s business. Implement systems that • Better and safer care for patients Use ICT to enable Electronic Medical Record program • Improve major clinical reform • systems needed to manage patients effectively in an acute environment. Clinical Systems • Create better communication, Clinical departments will have access to programs Primary, Community and Outpatient Care program systems that experiences for • Minimise delays, • Clinical Services • systems to support patient care in the community, outpatient & primary care • Improve work flow within the people using health • Improve handover Department Redesign environment, Department services. Program, management • includes referrals and interaction with other human services. Performance % Over/Under • Provide decision support for clinicians; • Provide a more cohesive Against Budget Strengthen primary • Quality and • Statewide integrated Electronic health record accessible by clinicians and • Have rules built in • Significantly Safety initiatives; patient journey; and consumers across the public & private health sectors health & continuing • Provide information needed to support improve and • Support flexible Clinical Support program Progress Earned Value the most effective resource care in the support for • clinical program allocation of resources against plan management • core support systems such as Patient Administration systems and diagnostic community. areas to ensure services meet Clinicians will have access to critical clinicians patient needs systems Use of target Coverage technology by information to make the right decisions for • Build regional & other and patient patients. location partnerships for care Communication between staff in the Corporate Systems program. New systems in the areas of Adoption of Corporate Systems health. Uptake technology by department will be better • Human Resources - Payroll, rostering, L&D, OH&S, Recruitment, • Make smart choices Performance Management business users Reduce the duplication • Information collected once and accessible about the costs and • Finance – General Ledger, Accounts Receivable, Accounts Payable, Fixed to all who need it and cost in Implement the core systems Quality of Customer Assets, Inventory Management, Purchasing and Sales Order benefits of health administrative systems needed to underpin the deliverables Satisfaction • More efficient patient journey • Asset Management - Capital Works Management, Facility Management, services. to increase funds Corporate Shared Services Well integrated core systems across a hospital, Property Management, Maintenance, Cleaning & Security available for frontline reform program. including • Build a sustainable care • e-Procurement - Warehousing, Distribution, Inventory Management, • Results Reporting Hospital Catalogue Management, Supplier Management, Product Management & health workforce. • Order Management Tendering • Patient Administration Systems • Be ready for new • Billing - Standardised billing management • Scheduling; and risks and • Human Resources opportunities. Information Management will minimise problems at handover and allow Business Information Provide a core set of enterprise wide management of human and high quality information Establish Business Information Governance and performance management Availability of Models published other resources to all levels of the Transform operational data • Integration of NSW Health’s strategic and planning frameworks and models Strategic • increase efficiency and Internal organisation in a into management insight developing overall value and cost effectiveness performance measures. % of information • reduce access block as patient’s move alignment to timely, user friendly Integrate NSW health’s Deliver Enabling infrastructure and support Coverage requirements between departments. major NSW way to support strategic objectives with front • Ensure the source systems are capable of providing the major indicators modeled decisions that drive real line service delivery Implementation of • Standardised information from all Health • Standardise the data sets and implement them to provide consistent results for the facilities • Clinical Services Drive management information Uptake standards in core initiatives Department and its accountability systems • Better patient care once they leave Redesign Program stakeholders • Ensure the technical infrastructure is in place to support effective hospital information management Information Use published in • Reduced risk of readmission • Corporate Shared required form Standardised information will support Services reform • more effective resource planning and Area program Infrastructure Management Define and implement the telecommunications and technical infrastructure to demand management • Develop a support the clinical and corporate strategies. % reduction in • Minimum duplication of diagnostic performance culture Develop and maintain Cost savings Infrastructure Specify the enterprise architecture, enterprise integration layer and core technical annual op. cost procedures and delays for patients. Sustainable standards and architecture • Efficient management of patient around information An ICT infrastructure standards required to manage NSW information assets. that is: needed to support state wide Standardisation % non-compliant transfers between hospitals in the Area Develop and apply uniform Information management standards across state based ICT initiatives achieved infrastructure Improved communication between hospitals • Reliable builds and other systems as appropriate Identify and manage business and clinicians in the community will support • Responsive impact of technology Ensure data quality strategies are in place to ensure maximum value from the Quality of Agreed SLA levels better patient care once they leave hospital; • Available; and information collected across NSW Rationalise the technical Service met and reduce the risk of readmission • Cost effective ICT infrastructure/ EAI - Identity management, EAI strategy and management, External infrastructure telecommunications strategy and desktop consolidation. # severity 1 issues • better utilisation of resources and Business Continuity Planning management of future demand Considerable The full value of ICT will be achieved when • NSW GCIO ICT systems are implemented across all Areas. ICT Management by ICT cost Standardise portfolio Strategic Plan management processes Process Current Maturity Standardised clinical and corporate savings State through collaboration across Maturity Level information, collected as a by-product of • Council of Australian the Department of Health, Implement Processes to determine, develop and manage core, common and patient care, helps NSW Health achieve divergent applications; Health Governments Ensure the maximum Area Health Services, Health Speed of targets set under the RSP by Technology and third party Application of integrated governance models at AHSs and the Department; Effective • Improving patient journeys across the benefit is gained from resolution on • National eHealth the investment in ICT providers State based build approach to core applications to support a faster, more cost Governance health system, proposals program Continuously evaluate, effective implementation and to underpin predictable processes across the whole • More timely access to services; and of NSW. Effective • Better co-ordination and integration prioritise, select, monitor and Expected v/ actual • NEHTA adjust programs and projects Portfolio Portfolio Risk across the health system. Management to achieve business priorities • Improving utilisation of resources and management of demand. 29
    • Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health 6.2 Approach to delivery A portfolio management approach is used as the basis for prioritising, selecting and monitoring programs and projects and making sound investment decisions that provide the greatest benefit to the health system. It is underpinned by common processes across ICT at a Departmental and Area level. The ICT portfolio is managed within a collaborative framework that defines: • Processes to determine, develop and manage core, common and divergent applications • Application of integrated governance models at Area Health Services and the Department • State based build approach to core applications to support a faster, more cost effective implementation and to underpin predictable processes across the whole of NSW. This section provides an overview of how the strategy will be delivered, with a focus on these elements. 6.3 A Portfolio Management approach NSW Health uses a coordinated portfolio approach to the management of ICT. A portfolio management approach provides the basis for evaluating, prioritising, selecting and monitoring programs and projects and adjusting this where necessary to achieve the business priorities. Portfolio Management can be explained in terms of four inter-related frameworks as described in the following diagram. PORTFOLIO MANAGEMENT FRAMEWORK Strategy/Investment Planning Are we doing the The strategic framework used to right projects? determine where investment should be focused to meet strategic priorities, what resources are to be made available and the G anticipated return on investment O V Alignment with architecture E R Are we doing the Ensuring projects are aligned with N projects right? architecture and standards, consistent with A other initiatives, consistent with core, N common and divergent principles C E Project delivery Are we getting Consistent operational processes, planning, projects done well? quality assurance, best practice project management disciplines and methodologies, skilled resources and appropriate tools Benefits realisation Are we getting the Clear definition of benefits and metrics, benefits we processes to measure and report on anticipated? benefits Figure 9 - Portfolio Management Framework 31
    • Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health A portfolio management approach enables NSW Health to: • Establish an ICT structure closely linked to corporate strategy and program areas to ensure that the right programs and projects are undertaken to meet NSW Health’s strategic objectives. • Determine whether business requirements can be met within existing solutions and within existing organisational capability and resources. • Allocate the right resources to the right programs. • Ensure the ongoing alignment of the portfolio and individual projects with the health system’s strategic objectives. • Manage the appropriate distribution of limited resources. • Manage the interdependencies between projects across the portfolio. • Assess and manage risk. • Monitor progress of projects against the intended strategic outcomes. The outcome of this approach is: • A closer alignment between health strategies and ICT projects allowing a greater level of responsiveness to emerging priorities and strategic objectives. • Improved management of ICT risk through an understanding of the business implications of the program, interdependencies and broader ICT context. • Improved understanding of how new business processes and systems will deliver improved performance by defining benefits and linking these to new business processes. • Improved control through a portfolio management framework, addressing compliance with standards and architecture, quality assurance, financial and project management processes. • Development of a framework for the Executive and senior management to use to promote and direct change management. 6.4 Standard processes adopted across the ICT portfolio Core processes and standard guidelines for operation underpin the delivery of the ICT Strategic Plan. The processes relate to the stages of the project lifecycle, while the guidelines identified in the diagram below apply to the portfolio as a whole and to individual projects within the portfolio. Details for each of these processes, guidelines and templates can be found on the SIM website at http://internal.health.nsw.gov.au/sim 32
    • Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health STANDARD GUIDELINES Business case Risk management Program management planning Quality Identify an management Project opportunity Funding Inception Operational allocation service delivery Benefits realisation Solution Risk design and End a project - management State Based KEY PROCESSES acceptance into Build service State based build Construction: Issue development, Manage a program – resolution integration & testing provide capability, deploy to users Supporting innovation Stakeholder management Asset management Communication framework Figure 10 - Core processes and guidelines underpinning the ICT portfolio 6.5 A framework for Partnership For NSW Health to effectively implement this strategy it must be done as a collaboration between the Department of Health, Area Health Services, Health Technology and third party providers. There are three key components of the collaboration framework. These are: • Processes to determine, develop and manage core, common and divergent applications; • Application of integrated governance models at AHSs and the Department; • State based build approach to core applications to support a faster, more cost effective implementation and to underpin predictable processes across the whole of NSW. 6.5.1 Core, Common and Divergent All applications and associated projects are classified as core, common or divergent. This classification will influence how each project will be prioritised, governed, funded, procured, implemented and managed. Core: Applications and projects that are expected to provide all state wide core functions. These will be directed, controlled and funded by the Department. Common: These applications provide common solutions across a collaborative group. They will be controlled collaboratively to achieve the desired outcomes for the group. Divergent: Applications aimed at innovative solutions to localised 33
    • Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health groups to enable design flexibility to explore new solutions to specific requirements. The table below outlines the key characteristics of each category. Core Common Divergent Rule (Directed) (Collaborative) (Localised) AHS Wide or Collaborative Extent of Solution Scope State Wide Solution Local Solution Group Wide Solution Centrally Funded Capital/AHS Central or AHS capital/ Funding Local or AHS Funding recurrent AHS recurrent AHS or Local Department Sponsorship DOH lead (AHS supported) AHS lead (DOH supported) (advised to DOH) Will form the Basis for a Meets local need and can be Repeatability Must be State Based Build State Based Build scaleable Must utilise the Core TSS Must utilise core TSS Will utilise local or AHS Technical Infrastructure Infrastructure Infrastructure infrastructure State or locally Led State Led Deployment with Locally Led Deployment with Deployment Team Deployment with Mixed Mixed Resourcing Local Resources Resourcing Complies to Common IT Architecture Compliance Full Compliance Limited Compliance Architectural Components Collaborative Product Product Selection State Wide Product Selection Local Product Selection Selection Business Case Approval DOH/Treasury DOH-AHS/Treasury AHS/Local if under $250k Priority/Constraints (i.e. funds, Managed as part of State Managed as part of AHS Must not be done at expense of resources etc) ISSP ISSP core/common State or locally led State led governance with Local Governance with formal Governance governance with mixed mixed representation reporting representation PAS, UPI, EMR, OT, ED, ICU, PACS/RIS, Pharmacy, Surgical Audit, JONAH, Examples Corporate systems, EHR, LITI Checklist Community… Detail on the processes in place to determine, develop and manage core, common and divergent applications can be found on the SIM website at http://internal.health.nsw.gov.au/sim . 6.6 Integrated governance model The governance framework for the ICT portfolio has been structured to: • Standardise governance for corporate and clinical initiatives at all levels • Integrate the ICT program with clinical governance at a local level. • Provide an opportunity to reinforce standard Area governance models • Provide a single Governance framework for Area Health Services and the Department – tightly aligning timeframes, business cases, resourcing and outcomes. The purpose of the Project Governance framework is to ensure that projects remain relevant and deliver the stated business benefits. Effective governance should ensure both that the NSW Health focuses on “doing the right projects”, and that the right people focus on “doing the projects 34
    • Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health right”. The governance structure is intended to reduce the risk to the portfolio that would occur if there were to be a complete disconnect between strategy and delivery. The governance approach has been defined to ensure that the ICT portfolio is: • Focussed on supporting the health strategic directions • Based on business outcomes ie improved clinical corporate outcomes • Enterprise wide – encompassing both the Department of Health and Area Health Services • Balanced between strategic and tactical initiatives • Dynamic • Flexible, to accommodate changes in the environment. There are close linkages between the ICT Strategy, the Enterprise Architecture and the governance model. This is articulated in the ICIP Architecture Governance report (http://internal.health.nsw.gov.au/sim). In summary: • The strategy must encompass how the current state constrains or enables strategy options • The architecture must be developed and implemented to support the business strategy • Governance must ensure that the strategy and architecture remain aligned as implementation proceeds. 35
    • Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health The diagram below shows the major elements of the governance model. Executive ICT Stakeholder Groups Department Area SEAB (Senior Executive Advisory Board) Director-General Monthly CEs Reports from SIM, HSPI, DPE, Q&S DD-G Health System ICT Management Committee CIO & CE Health Monthly Support Services Representation from all AHS Directors of Corporate Services Corporate IT Program St CIO Advisory Clinical Advisory Committee Group Group programs Business Corporate Clinical Systems Infrastructure Information Systems ICT Focused Committees Business/operational Focus Executive Positions Figure 11 - Governance framework Details of the Governance model can be found at http://internal.health.nsw.gov.au/sim . 6.6.1 State based build All core applications will be developed using a State Based Build. This will support both interoperability across the state and a faster implementation of core applications. The “Fast Track” methodology is comprised of 2 phases: 1. Content Development This phase is characterised by an intense design and build of a prototype, followed by a series of clinical review sessions. A methodology for the design and build of SBB content has previously been developed and utilised. The Fast Track methodology leverages this approach and adds in the more efficient prototype model. The prototype assists clinicians in gaining a better understanding of the application and offers the opportunity to view the process as part of an integrated workflow. This approach facilitates informed decision-making. 2. Implementation The implementation phase is designed around the State defined content. Although this introduces a large amount of content in a single project, it achieves greater benefit and is more cost effective. The Fast Track Method 36
    • Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health reduces the time, cost and complexity of implementation by using a standard design with State Build content. Resource constraints and the extended learning curve to get AHS staff up to speed that were an inherent part of the old methodology, are minimised by the new approach. The implementation team assigned to the project have the application knowledge to build the database. A rapid implementation also eliminates the inevitable scope creep that occurs during any long IT project. In order to achieve the anticipated benefits from a rapid implementation of a SBB, it is necessary to establish the critical success factors as follows: • In order to ensure that the developed SBB content is applicable and practical in a NSW Health setting, it is important that the development has clinical input and endorsement. Nomination of appropriate clinical representatives and ensuring their attendance at SBB content development workshops is critical to this process. • The implementation of the SBB components must be per the agreed functional stack. Implementing only part of the stack or modifying the implementation to a sequential approach limits the benefits, increases the cost and risk associated with the project. The design of the Fast Track method is based on “more in less time”. • Critical to the success of the Fast Track method is a commitment to adequate, funded, executive-endorsed organisational change. This organisational change should include comprehensive marketing, a positive, public, executive involvement, and a comprehensive training program. With a Fast Track approach, sites will encounter more change in a shorter period of time and therefore managing the change is critical. • The SBB is designed with both mandatory and flexible components. The planned flexibility is to accommodate site specific variations. Modifying the SBB beyond what is accommodated by the design, will introduce additional risks and effort to the project. In addition, it will increase the effort required when adding on future applications. • The implementation of the SBB components will drive change and in many respects tighten many existing manual processes. However, the SBB has not been designed to police errant behaviour, it is designed to support clinicians in their workflow. Adequate training on appropriate use of passwords, privacy policies and procedures etc must be included in the implementation. 3. SBB Maturity Model The SBB uses a maturity model to progressively enhance the functionality of the application as the experience and expectations of users increase. The maturity model is based on the following principles: • All Area Health Services contribute to the development of each version of the SBB. • Version 1.0 of any application is implemented as the SBB. Enhancements can be proposed by any Area Health Service, but must 37
    • Information & Communication Technology (ICT) Strategy The Approach to ICT in NSW Health be endorsed by the majority of members of the Application Advisory Group (AAG). • Every Area Health Service has equal weight in the AAG. • Every proposed change must go through a formal change control process and be reviewed by the AAG, even those that are specific to one Area (eg establishing the facility codes for hospitals in that Area). • The primary function of the AAG is to consider and endorse changes for each version of the SBB. New versions will be released on an annual basis. SBB functionality can be classified as: • Required core: required content and functionality to support common business and application functions, including standardised KPIs and reporting and a consistent user interface for mobile staff. Required content must be consistent across all implementations. • Modifiable within guidelines to support area specific clinical processes, assessments and third party applications • Localised content where site specific information is required in the build (eg code table for local facilities). The diagram below demonstrates the SBB maturity model concept: Figure 12: SBB maturity model upgrade upgrade upgrade SBB V3 SBB Maturity SBB V2 SBB V1 f ix/ enhance f ix/ enhance f ix/ enhance AHS 1 AHS 1 AHS 2 AHS 3 AHS 4 6 mth pre deploy AAG Triag e (Note: triage is a process) Build lock down SMEs as required Clin ical Advisory Group (CAG) ICT Management Committee 5 38
    • Information & Communication Technology (ICT) Strategy Priority ICT strategies 7 Priority ICT strategies 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 the broader strategic priorities. These are the Clinical Systems Strategy, the Corporate Systems Strategy, Business Information Strategy, Sustainable Infrastructure strategy and Whole of Government ICT Strategic directions. This section outlines: • the initiatives that are being delivered in this stage of the ICT Strategic Plan (2006-2011) • initiatives scheduled for the second phase of the 10 year plan, between 2012 and 2016. 7.1 Clinical Systems Strategy 7.1.1 Objective The Clinical Systems Strategy will implement the core clinical systems needed to underpin the Clinical Services Redesign Program, Quality and Safety initiatives and clinical program areas. The focus will be on systems to improve communication, minimise delays, reduce handover problems and support the patient journey. Systems will support the flexible allocation of resources to ensure services meet patient needs. 7.1.2 Programs supporting this strategy Three programs support the Clinical Systems Strategy. These are: • Electronic Medical Record program to implement the core departmental systems needed to manage patients effectively in an acute environment. • Primary, Community and Outpatient Care program to implement the infrastructure and systems to support patient care in the community, outpatient and primary care environment. It includes referrals and interaction with other human services, and the pilot for the Electronic Health Record program. • Clinical Support program to implement core support systems such as Patient Administration systems and diagnostic systems. 7.1.3 Electronic Medical Record 39
    • Information & Communication Technology (ICT) Strategy Priority ICT strategies Strategy Phase 1 2006-11 Initiative Functional scope Results reporting Will allow test results and reports from diagnostic services to be viewed at the clinical workstation Order management Enables clinicians to order tests, procedures and services online. 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. Emergency Information specific to Emergency departments to allow the efficient departments management of the Unit and patients. It includes triage information, presenting problem, treatment times, interventions etc. Operating theatres System to manage the co-ordination of patients, surgeons, anaesthetists, equipment and rooms, and report on utilisation. Discharge referral Provides a summary of the patient’s care which can be transmitted electronically to another provider such as a General Practitioner to support ongoing care in the community Enterprise The ability to co-ordinate scheduling across an integrated set of scheduling information systems to provide a single view of appointments and resource requirements. Initiative involves strategy and planning activity as well as development and implementation of the scheduling solution. Assessment of EMR This will assess the functional requirements specification for small requirement for facilities, conduct an options analysis and recommendations on Justice Health, small solution and a transition and implementation plan facilities and ASNSW Electronic Pilot of the Medication management/ePrescribing component of Medication EMR with decision support/alert capabilities. This will be followed by management the state implementation. Transition strategy Assessment of fit between strategic products and specialist for LITI applications requirements, including an options analysis, recommended strategy and migration plan Intensive Care Units Functional specifications, Procurement options and strategy for ICU clinical information feeding into an updated business case system Strategy Phase 2 : 2012 - 2016 Initiative Functional scope Clinical Clinical alerts and pathways for specialist clinical areas. The project documentation involves a planning phase, including development of requirements and a business case. Intensive Care Units Procurement and implementation of an ICU solution. clinical information system Medication State wide implementation of the Medication Management solution. Management Alignment with, and dependencies between, the NSW Hospital Pharmacy initiative will be addressed in the planning for this project. 40
    • Information & Communication Technology (ICT) Strategy Priority ICT strategies 7.1.4 Primary, Community and Outpatient Care Strategy Phase 1 : 2006 - 2011 Initiative Functional scope PCOC Strategy Development of an information strategy for Primary, community and outpatient care PCOC business Development of a business case for the IT infrastructure to support case this sector Community health & Development of a state wide data set that contains a record for each Outpatient Care service provided to patients in primary, community health and Information Project outpatient care settings. This includes projects to standardise data across collections. CHIME Strategic and tactical management of the CHIME system, including end of life strategic planning Cerner community Alignment of Cerner developments with community health requirements Outpatient Units EMR for Outpatient Clinics (extension of PAS) Electronic Health Provider and consumer access to integrated health record Record – pilot containing summary level information from public hospitals, ED, community health, outpatients, diagnostic services, dental clinics and GPs Electronic Health Policy, technical, functional and business outcome evaluation of Record evaluation pilot implementation Electronic Health Assessment of effectiveness of project management, budget, Record post resourcing, process and scope management for implementation of implementation the pilot review Ambulance Development and implementation of an Ambulance Electronic Electronic Patient Patient Record (AEPR). This will give ambulance officers access to Record a sophisticated system for Emergency Clinical Information using mobile technology. Strategy Phase 2: 2011-2016 Initiative Functional scope Electronic Health Provider and consumer access to integrated health record Record – Phase 2 containing summary level information from public hospitals, ED, state implementation community health, outpatients, diagnostic services, dental clinics, GPs, private hospitals, aged care facilities and pharmacies. This phase will extend the rollout to all Area Health Services. Outpatient Clinics Implementation of advanced clinical decision support for Outpatient stage 2 services Community Health Implementation of an Integrated Community Solution for Community solution – CHIME Health Services replacement Mental Health Transition of mental health requirements from SCI-MHOAT, migration MHOAT, MAJIC and FISCH to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support. Drug and Alcohol Transition of D&A requirements from FISCH, MERIT, ICIS and migration FISCH to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support Allied Health Transition of Allied health requirements from AHMIS to the Integrated Community Solution and Outpatient EMR solution, 41
    • Information & Communication Technology (ICT) Strategy Priority ICT strategies including Clinical Decision Support Aged and Chronic Transition of aged care requirements from ACE (and other MH Care applications) to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support Sexual Health Transition of sexual health requirements from SHIP to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support Oral Health Development of migration strategy for oral health requirements from ISOH 7.1.5 Clinical Support Systems Strategy Stage 1: 2006 - 2011 Initiative Functional scope/deliverables Complete Replacement of legacy HOSPAS and WINPAS products with implementation of Cerner/iSoft Patient Administration systems PAS PACS/RIS Procurement strategy, establishment of hubs, statewide picture archive Review of pathology Development of strategy for pathology system replacement. systems Pharmacy migration Migration planning and timeframe established for migration from AMFAC to iPharmacy. Migration from single site to multi site implementations hosted in clinical hubs. Incident Information Planning for IIMS upgrade including strategy, business case and Management EOI and implementation. System Bed management Assessment of strategies to provide IT support for improved strategy capacity management. This includes options for enhanced Bedboard functionality Strategy Stage 2: 2012 - 2016 Initiative Functional scope/deliverables Hospital pharmacy State wide implementation of a replacement hospital pharmacy rollout system. 7.2 Corporate Systems Strategy 7.2.1 Objective The Corporate Systems Strategy will implement the core systems needed to underpin the Corporate Shared Services reform program. This program aims to reduce the duplication and cost in administrative functions to increase funds available for frontline care. This strategy is underpinned by the Corporate Systems program. 42
    • Information & Communication Technology (ICT) Strategy Priority ICT strategies 7.2.2 Core projects to be delivered Strategy Stage 1: 2006 - 2011 Corporate Systems Functional scope Business case – Development of a business case for new rostering software, corporate systems Recruitment, Education and training, Workforce Management, phase 2 OH&S Human Resources Payroll, rostering, learning and development, OH&S, Recruitment, Performance Management Finance General Ledger, Accounts Receivable, Accounts payable, Fixed Assets, Inventory Management, Purchasing and Sales Order Asset Management Capital Works Management, Facility Management, Property Management, Maintenance, Cleaning and Security e-Procurement Warehousing, Distribution, Inventory Management, Catalogue Management, Supplier Management, Product Management and Tendering Billing Standardised billing management ICT infrastructure/ Identity management, EAI strategy and management, EAI telecommunications strategy and desktop consolidation. 7.3 Business Information Strategy 7.3.1 Objectives The Business Information Strategy aims to make a core set of high quality information available at all levels of the organisation in a timely manner and to develop a performance culture around it. This has the potential to transform operational data into management insight, and support decisions that drive real results for the Department and its stakeholders. Business information must integrate NSW health’s strategic objectives with front line service delivery, drive management accountability and be driven by the overall program and change management approach. 7.3.2 Programs supporting this strategy There are three major programs under the Business Information Strategy. These are: Create value for The primary aim of this program is to provide decision makers at timely, relevant information in a user friendly way the front line to clinicians and decision makers in front line services. Governance and Aimed at integrating NSW Health’s strategic and performance planning frameworks and developing overall management value and cost effectiveness performance measures. Enabling Making sure that the source systems are capable infrastructure and of providing the major indicators, that the data support sets are standardised and implemented to provide consistent information and the technical infrastructure is in place 43
    • Information & Communication Technology (ICT) Strategy Priority ICT strategies 7.3.3 Core projects to be delivered Strategy Stage 1: 2006 - 2011 Business Functional scope Information Strategy Decision making at Decision support toolkit and portal developed; the front line Decision support tools rolled out and consolidated through the portal. Integrated transactional, analytic and decision support tools, with staff skilled in using information and the tools available. Governance and Evolve indicators and build business information governance. performance Map strategy through balanced scorecard and report annually. management Create a single performance framework Enabling Build information standards infrastructure and Streamline common reports support Create inventory of information assets Develop knowledge networks Track compliance to mandatory training Create single source of truth for clinical and corporate data Streamline mandatory collections 7.4 Sustainable infrastructure program 7.4.1 Objectives This program aims to rationalise the technical infrastructure and develop and maintain standards and architecture needed to support state wide ICT initiatives and to ensure the maximum benefit is gained from the investment in ICT. 7.4.2 Programs supporting this strategy The infrastructure strategy incorporates the following programs: Infrastructure Defining and implementing the telecommunications and technical infrastructure to support the clinical and corporate strategies. Architecture and Providing the enterprise architecture enterprise Standards integration layer and core technical standards required to manage NSW information assets. Information Ensuring that uniform data standards are management developed and applied across state based builds and other systems as appropriate and that data quality strategies are in place to ensure maximum value from the information collected across NSW. 44
    • Information & Communication Technology (ICT) Strategy Priority ICT strategies 7.4.3 Core projects to be delivered Information Management Strategy stage 1: 2006 - 2011 Project Functional scope / deliverables Development of a Data Data quality review from core source systems Quality Strategy for NSW Health Principles and responsibilities, maturity model Analysis of data quality issues affecting BIS, clinical care and performance management Development of data quality improvement strategies Data Governance Strategy Development of a data governance strategy for data Collections Data Standards Development Maintenance and enhancement of NSW Health Data and documentation Dictionary (Leveraging from work done in PCOC: Ambulatory Care Data Standards Development BI, Corporate Systems, KPI development Clinical Systems Programs) HIRD Repository Knowledge Sharing DPE Web pages Data Analyst’s Workgroup – WIKI / Forum SNOMED CT Clinical terminology and its fit to e-health Education and training Analysis of SNOMED CT data HERO Implementation and maintenance of state wide facility for registration of Health facilities Architecture and standards Strategy stage 1: 2006 - 2011 Project Functional scope / deliverables Review of NSW Health Register of current technical standards Technical Standards Process established for maintenance of technical standards Identity Management Agreed framework for consistent, consolidated authentication and Strategy access control. Maintenance of Ongoing maintenance of clinical and corporate architecture, Enterprise Architecture Architectural reviews of compliance of systems; Management of Application Systems Knowledgebase and Health Information Resources Directory Establish and Development of message and data exchange standards; implement Enterprise Development of integration layer services; Integration governance; Integration layer Alignment with NEHTA standards Establish regular audit Improved knowledge of current state of IT across NSW to improve of state wide IT accuracy of forward planning environment Establish and maintain Document and publish approach to State baseline build State Baseline Build methodology 45
    • Information & Communication Technology (ICT) Strategy Priority ICT strategies Infrastructure Strategy Stage 1: 2006-11 Project Functional scope Development of Definition of, and implementation of Telecommunications Telecommunications infrastructure to underpin ICIP and Corporate Systems Strategy Strategy Infrastructure Strategy Phase 1 addresses the most critical sites in relation to: Stage 1 • Consolidated data centres and system hardware equipment • Data centre floor space expansion • Telecommunications hardware • Supporting management systems and processes Infrastructure business Development of a forward strategy and business case for phase 2 case - phase 2 Establish IT Asset Identification of IT data centre assets Registe Strategy Stage 2: 2006 - 2011 Project Functional scope Infrastructure phase 2 Incremental upgrade to state data centres, telecommunications -5 hardware 46
    • Information & Communication Technology (ICT) Strategy Outcomes of the ICT Strategy 8 Outcomes of the ICT Strategy Implementation of this strategy will deliver the following outcomes by 2011: • Significantly improved support for clinicians and patient care by improving access to diagnostic test results reducing time to diagnosis and treatment. This, combined with systems to support improved theatre utilisation and use of resources, will reduce waiting times, patient delays and access block. Enterprise wide scheduling will allow resources to be better matched to demand and more effectively used. Improved discharge referral planning, integrated departmental systems and the Electronic Health Record will support the patient journey improving the transition of care within acute settings and from acute to community settings. Quality and safety will be improved through the use of systems to embed consistent, predictable processes across the state. • The realignment of ICT programs will deliver significantly closer strategic alignment to major NSW Health initiatives allowing greater speed to delivery of benefits. The strategies outlined above will support sustainable clinical and corporate reform as well as Quality and Safety, Chronic Disease Programs, Mental Health, Aged care and other key program areas. There is also close strategic alignment with the national and NSW whole of government ICT strategic priorities. • The new approach to delivery of the strategy will result in considerable cost savings. The rapid deployment of core programs will reduce overall project management costs, which are the major cost component. This approach will provide the opportunity to align with the change management activities already in train with the Clinical Services Redesign Program and Corporate Shared Services, reducing cost and increasing the value of the change management process. The outlined approach will minimise the duration of the impact on clinicians in Area Health Services and will increase the speed to delivery of benefits for clinical care. • The strategy has been developed to support NSW Health to deliver against the Results and Services Plan and the State Plan. 47
    • Information & Communication Technology (ICT) Strategy Measurement of benefits 9 Measurement of benefits Benefits will be driven by the quality of the patient flow between different entities in the health system. Benefits will be delivered at four levels – at the clinical department level, hospital level, Area level and state level. The table below highlights the level at which benefits will become noticeable. Level Benefit type Benefit Department Access Reduced time to diagnosis Quality and safety Reduced adverse events Cost Fewer tests Hospital Access Reduced waiting times Improved patient flow Quality and safety Reduced length of stay Reduced readmissions Improved monitoring of credentials Cost Reduced clinician administration time Improved asset utilisation Improved management of staff resources Area Access Improved equity of service Quality and safety More accurate data capture Cost Improved control of Area finances State Cost Reduced reporting overhead IT consolidation savings Reduced training costs The framework used to derive the benefits realisation strategy is shown below. Strategic Current Data Governance Aims Performance Requirements Process Benefit Applications Functionality Benefits Benefit KPIs Realisation Figure 13 –The Benefits Realisation Framework The software applications to be implemented in this strategy will provide functionality that enables benefits. When put in the context of NSW Health’s current performance and strategic aims, this functionality will result in benefits to the organisation. Many of these benefits can be measured using specific Benefits Key Performance Indicators (KPIs). In order to measure these KPIs data will be required and potential data 48
    • Information & Communication Technology (ICT) Strategy Measurement of benefits sources will be identified. Owners for these benefits will be identified and made visible through the governance process. Three groups will have a responsibility for tracking benefits. These are: 1. Deputy Director General for Health System Performance and the CIO : responsible for managing delivery of benefits across the whole state. 2. ICT Management Committee (Director of Corporate Services) : responsible for ensuring benefits are being managed and recorded at the Area level. 3. Program Management Office : responsible for reporting performance and performing first level diagnosis of under/over performance as input to these groups. 49
    • Information & Communication Technology (ICT) Strategy Measurement of benefits Appendix A Additional Reference Material/ Resources Reference Overview Portfolio Investment Strategy Capital investment strategy for ICT for NSW Health, covering the period 2006/07 to 2016/17 Integrated Clinical Information Clinical systems architecture for stage 1 of ICIP Program architecture stage 1 (EMR, EHR, PAS, Provider Directories, patient flow tools) Integrated Clinical Information Clinical systems architecture, stage 2, with focus on Program Architecture, stage 2 PACS/RIS, ICU, Operating Theatres, ED, UPI and Discharge referral ICT Governance model Overview of the governance model for ICT across NSW Health Corporate Systems Architecture Corporate Systems Architecture, covering Human Resources, Finance, Asset Management, eProcurement, Billing, enterprise integration NSW Health Data Dictionary Data standards, definitions and classifications that underpin core NSW data collections and systems Business Information Strategy The Business Information Strategy incorporates strategies to integrate NSW Health’s strategic objectives with front line service delivery, drive management accountability and be driven by the overall program and change management approach. Core ICT business processes Documented processes to be adopted by SIM and HealthTechnology to support the effective delivery of the ICT Strategy Health Information Resources An online tool to identify existing information Directory resources across NSW Health Application Systems An online repository providing information about Knowledgebase applications operating across NSW Corporate Systems Strategy Sets direction for corporate systems across NSW, addressing scope, implementation plan, budgets and infrastructure ICT Governance Establishes the framework, principles, processes and structures for ICT governance in NSW ICT Asset Management Strategy Outlines the principles and key elements of the management of the ICT assets in NSW Health 50