Di Mantel fiona stanley hospital case study


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Di Mantel delivered the presentation at the 2013 eHealth Interoperability Conference.

The 2013 eHealth Interoperability Conference program is a balance between updates on state-wide interoperability projects, health service eHealth project case studies, and discussions of overarching principles such as information governance, data standardisation, and the future direction of eHealth in Australasia.

For more information about the event, please visit: http://www.informa.com.au/eHealth13

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Di Mantel fiona stanley hospital case study

  1. 1. Fiona Stanley Hospital Di Mantell - General Manager Facilities Management 12 September 2013
  2. 2. Fiona Stanley Hospital Agenda • Setting the scene – the uniqueness of WA • WA Health business priorities • Fiona Stanley Hospital • Translating business requirements to architecture requirements • Technology enabling service improvement and how? - Making it easier for users • Coordinating with the State’s eHealth strategy • Questions?
  3. 3. • WA – approx. one-third of the Australian continent • Land Area – 2.5 million square kilometres • Population – 2.3 million Western Australians • 97% of total area of WA has less than one person per sq km • 30% of population lives outside of Perth • Some remote areas are over 3000kms from Perth Source: ABS, “Population Projections, Australia, 2006 to 2101”, September 2008 WA Health (2011) • Approx. 40,000 staff • Handled just under 1 million ED visits • Completed 81,000 elective surgery cases • Carried out over 98,000 breast cancer screenings Source: WA Health, http://www.health.wa.gov.au/about/ Setting the Scene– the uniqueness of WA
  4. 4. • Clinical Information • Patient Administration • Workforce Planning • Activity Based Funding and Reporting • Business Aligned Reporting • Communication and Collaboration • Managing Information Holistically • Transition to new digital operations • Consumer Centric Care • Mobility Strategic Intent Current ICT Issues • History of under-investment • Lack of complete strategy & funding • Ineffective ICT Operating Model • History of poor project delivery • Lack of Change Mgmt & Training Business Priorities National Health Perspective • National eHealth Strategy • Other jurisdictional work programs • Leverage national infrastructure Manage business change and business as usual Emerging Themes Share information across the whole Health sector Drive better clinical outcomes through information Improve management and planning through information Rebuild and enhance ICT foundations Caring for individuals and the community WA Health – Business Priorities Caring for those who need it most Making best use of funds and resources Supporting our team WA Health – Business Priorities
  5. 5. Major tertiary hospital in Perth south metropolitan area Named after Professor Fiona Stanley – 2003 Australian of the Year and specialist in paediatric health Project budget $2 billion, including $255.7 million of Australian Government funding for State rehabilitation service 15kms from the Perth CBD Fiona Stanley Hospital
  6. 6. Fiona Stanley Hospital 783 beds, including 140-bed State Rehabilitation service 6,300 rooms in the main hospital 16 wards (of 24 beds each) 83% single patient rooms in main hospital 29 imaging rooms 15 theatres plus 3 shelled theatres 135,000m2 gross area (excluding car parks)
  7. 7. Scale of the development
  8. 8. State Rehabilitation Service Main Hospital Education Mental Health Decked Car Park Pathology Decked Car Park Map of the site
  9. 9. Key services and facilities Full range of acute medical and surgical services Emergency department with separate adult and paediatric entrances Comprehensive cancer services including radiotherapy treatment facilities, medical oncology and haematology Renal transplantation and dialysis services Cardiothoracic surgery, heart and lung transplant Obstetrics and neonatology services State burns service Paediatric services State rehabilitation service Photo courtesy of Douglas Mark Black (2013)
  10. 10. Key services and facilities Onsite pathology facility Modern medical imaging centre that will provide fast and accurate information to clinicians World-class medical research facility to be built by the Western Australian Institute for Medical Research
  11. 11. Environmental Focus
  12. 12. Phased Opening Schedule Stage 1 State rehabilitation service October 2014 Stage 2 General - Planned medical/surgical (1 ward of each) - 2-3 theatres - Partial Intensive Care Unit/High Dependency Unit capability • Obstetrics and Neonates December 2014 Stage 3 Tertiary - Other planned and unplanned - Emergency Department - Intensive Care Unit - Outpatients February 2015 Stage 4 Quaternary - Obstetrics & Gynaecology - Neonates - Burns - Transplant services April 2015
  13. 13. The facts 300,000 people to walk through the main entrance of FSH in the first year 1,500 outpatients - average stay a few hours 650 inpatients in main hospital - average stay a few days to a few weeks 3,500 staff over 24 hours 2,000 visitors a day 80,000 presentations at the FSH Emergency Department in the first year
  14. 14. The facts 29 Non clinical services to be provided by a Facilities Manager including: Audio visual - Equipment for clinical, consultative, training, administrative and all telehealth requirements Estate Service- integrated building management service HRM&CC – scanning paper-based records and provisional diagnosis coding to assist early discharge Scheduling and billing – booking elective theatres and other spaces; also patient appointments, reminders and a direct billing service PES – bedside access to patients' health records; patient access to multi-media and meal ordering functionality ICT Managed Service – significant enabling technology that will establish FSH as a digital hospital and support and complement WA Health systems Enabled innovation & technology previously unavailable to WA Health The challenge to integrate systems & bring the best of both worlds together
  15. 15. Technology Campus Wide Wireless LAN with high density of access points (FSH 1,532) Supporting: Roaming wireless data servers and roaming voice over WLAN Wireless biomedical monitoring systems Real Time Location Services High Reliability LAN infrastructure (FSH 13,446 LAN ports in the primary building)
  16. 16. Implementing Integrated Services • How the analyst designed it • How the programmer wrote it • What the customer really needed
  17. 17. Implementing Integrated Services Translating business requirements to architecture requirements: what systems to integrate, when and how? We need to identify what we have now: Non-electronic information Islands of information that are not connected. Inability to have a consistent and accurate view of a patient. Duplication of information leading to inaccuracies and synchronisation problems. Potential patient safety concerns. No sharing Inability to share information between practitioners for a complete continuum of care. Lack of shared knowledge base and decision support. Lack of coordination and utilisation of primary, community and allied health services. Lack of collaboration between care locations and patients at home. Paper intensive environments Information isolation, duplication, and prone to errors. High-volume storage of “hard” copy (paper and images). Overheads through manual handling. Time lags in movement and retrieval of information
  18. 18. Current Healthcare ‘Analogue’ Journey Board
  19. 19. Patient Patient record Current Healthcare
  20. 20. One of Australia’s most technologically advanced hospitals showcasing how our hospitals will operate into the future. Telehealth services for clinical, consultative RTLS – locating people and equipment; monitoring and Duress Secure and Seamless interoperability Enabling electronic medical records Pervasive wireless technology at point of care Integration of new medical equipment with information systems Fiona Stanley Hospital
  21. 21. Implementing Integrated Services Define what do we actually need? What do you need now & what should be done later? Need to be able to articulate what we need versus want – this is the hard bit!! Formalise a governance process with clear delineation of roles and responsibilities including who has ultimate sign off. Once something is signed off – lock it down & put a bow on it There must be a process to eliminate the “shiny lights” that distract people and scope creep…… Only then can we translate the scope to the architecture. Translating business requirements to architecture requirements: what systems to integrate, when and how?
  22. 22. Implementing Integrated Services Technology enabling service improvement and how? • Technology should enable the services – not dictate how the service will function • Clinicians need to able to define their services [DSPs] • There must be an ethos of the “greater good” not silo building • Integrated systems that are deployed as a whole of site or system approach that provides significant benefits eg; familiarity with the systems which results in better utilization of the system. • Users want • single sign on – not always possible • Mobility – ICT folk tell you - harder than you might think • Smooth transition between applications • Photo courtesy of Douglas Mark Black (2013)
  23. 23. Documents and Notes – Electronic Medical Records – Clinical notes – Document linking Telemedicine – More experts in more places – Remote monitoring – Remote consultation Research – Medical science – Longitude studies – Disease management Pathology – Disease diagnosis – Pathology imaging Collaboration – Coordinated decisions – Audited discussion – Immediate action Scanning/Imaging – Medical science – Longitude studies – Disease management Online Access to Information to any location – on any device – Point of Care Clinical – Logistics – Biotechnology Gene science – Bacteria science – Diseases science – Medications Management Patient history – Monitoring – Regimen – Financials Enterprise billing – Insurance – Performance Measurement KPIs – Data analysis – Data mining – • Automate • Integrate • Optimise • Protect • Share • Learn Common Services Common Objectives • Processes • Workflows • Scheduling • Messages • Storage Digital Health Community Sources of information to improve patient outSources of information to improve patient outcomes
  24. 24. Based on clear architecture and standards Supports national and industry specific standards and coding Leverages Real Time Location Services (RTLS) Highly leveraged networks including ipTV Campus-wide Wireless LAN - high density of access points (Fiona Stanley Hospital - 1,532) Significant LAN infrastructure (Fiona Stanley Hospital - 13,446 LAN ports in the primary building) Integrated building management linked to services (AGV’s, building maintenance and helpdesk and Integrated Extra Low Voltage Systems – IELVS Integrated and pervasive information flows Integrated pervasive Telehealth – all meeting areas, clinical desktops and 4 operating theatres Fiona Stanley HospitalImplementing Integrated Services
  25. 25. Implementing Integrated Services The Aim is a (Significant) Shift in Thinking More connected than ever before The ability to share information electronically amongst all providers caring for a patient (and the patients themselves) Shared knowledge Removing duplication of patient information, particularly within WA Health through record aggregation and smarter systems. Workflow connections between providers to ensure patient information is communicated, received, acknowledged and acted on by providers in a secure and safe manner. Better coordination and utilisation of primary, community and allied health services. A stronger emphasis on the patient’s own responsibility in self-management, prevention and maintenance of their health. Shared body of clinical knowledge that is evidence-based and consistently applied by clinicians. Shared information between devices and/or robots (device collaboration) Extended collaboration through Telemedicine and Hospital in the home.
  26. 26. Interoperability HR Payroll Rostering Financials Procurement Pathology Systems PACS/RIS Information Management & Reporting WAN Hospital LAN/WAN IELVS LAN SecurityScanned RecordsPAS Clinical Workbench EMR Pharmacy Clinical Specialities Helpdesk Identity Management Data Centres Approach to Site Wide Scheduling Patient Entertainment Equipment Tracking Audio Visual Services Server Rooms Helpdesk IELVS Nurse Call Structured Cabling Equipment Racks Interoperability HCN HIN Other WA Health Managing Contractor FM Contractor Fiona Stanley Hospital – Strategic Framework
  27. 27. Enterprise Service Bus Applications Fiona Stanley Hospital – FM Framework Point to Point AudioVisual Real Time location Services CommonServices Orchestration/Business Rules Stand Alone Capabilities ChildCare Cleaning EPM EnergyandUtilities EstateManagement ExternalTransport FleetManagement GroundsMgmt. HRM&CC Helpdesk&Comms. InternalLogistics Linen ManagedEquipment Mgmt.&Integration PatientCatering PatientEntermt. PestControl POTS PropertyMgmt. Reception Safety&Inc.Mgmt. Scheduling&Billing Sterilisation SuppliesMgmt. Vehicle/TrafficMgmt. WasteManagement HRManagement ICT SolutionLeadership&Governance RequirementCapture& Elaboration OperationalManaged Services DesignandBuild Deploymentand Transition Canonical model FSH Services External Access Portal Data transformation, mapping and Routing Data Warehouse Application ApplicationApplication ApplicationApplication ApplicationApplication SecurityAuditLoggingOSS Application ApplicationApplication Application ApplicationApplication Fiona Stanley Hospital – FM Framework
  28. 28. The location of any locatable person or equipment in real time Used for safety management (Duress) The location and environment monitoring telemetry of fixed plant and equipment, building infrastructure and plant room environment conditions. The location and environment monitoring telemetry of mobile plant and equipment such as food carts used by the patient catering services. Mobile Control Management Engine Mobile Controllers Wireless Switch Tag Access Wireless Access Person and Equipment Tags Wireless Devices Real Time Location Services (RTLS)Real Time Location Services - RTLS
  29. 29. Building and Car Park Management Intelligent Parking systems – directions to available parking bays Integrated security and access control with automated security policies for a safer patient environment Fire Alarm System Closed Circuit TV People Flow Counting System Guest Room Management System Lighting Control IP Telephony … Integrated Management (benefits) Reduced operating costs Improved maintainability, less administration Better control of critical systems Improved facility value Less “components” and complexity Limit (possibly eliminate) Vendor lock-in Integrated Extra Low Voltage Systems – IELVSIntegrated Extra Low Voltage Systems - IELVS
  30. 30. Access terminal on a flexible arm by the bedside Greatly enhanced Patient Entertainment and information access:Greatly enhanced Patient Entertainment and information access: Used by patients: • Order meals • Telephone • TV and video-on-demand • Education of medical procedures/condition • Internet • Contact clinical staff Used by staff to: • Access clinical functionality • Order services (cleaning, dressing change etc.) • Track bed/room readiness (cleaners) • Contact other staff • Track the patient Patient Entertainment Service
  31. 31. Enable Electronic Medication Management at FSH: Automated Medication Units Pharmacy Robots Intensive Care Clinical Information System System integration and iPharmacy upgrade Link to State systems: webPAS, RIS, LIS and iPharmacy Plan for further systems post go live…… Electronic Medication Management System
  32. 32. WA Health Strategic Framework Coordinating with the State’s eHealth strategy and standardisation WA Health is undergoing unprecedented infrastructure development: • Fiona Stanley Hospital • New Children’s Hospital • Albany Health Campus • Midland Health Campus • ICT is being pushed to align new ICT systems and processes to support the physical infrastructure • FSH has been able to procure systems that will be managed onsite – with other sites being able to leverage off this process
  33. 33. Program Management and Change Management Interoperability Interoperability User Access (Portals) Infrastructure Electronic Medical Record Identity and Access Mgt Fiona Stanley Albany Health Centre Other new facilities Master Schedule Change Management 1 7 8 9 11 10 6 Schedule s– PDL Compliant MS Server Implementation SMAHS Integrated Program Refresh End User Computing Refresh CIS R3F CPOE Pathology Rollout CIS R3A Internal Referrals SID R3D Cardiology CIS R3B Results Acknowledgement Laboratory (LIS) MMEx Transition WA Health Online Health Identifiers NaCS Breastscreen WA PACS Patient Admin Systems Corporate Systems PAS PAS (Billing) HR (Lattice) ABM Decision Support System 3 4 Data Centre PMO Services PMO Scheduling Services P2 New Children’s Hospital Clinical Workbench Scanned Medical Records Order Entry Existing Systems Remediation New Core Systems ESB WA Health eHealth Strategy
  34. 34. Comprehensive, pervasive IT infrastructure Expanded digital footprint Extend process improvements the community Stronger collaboration between all healthcare providers Stronger collaboration between metropolitan and remote locations Extended reach into patient homes and emergency medical services Everything/everyone is “connected” A move to digital healthcareWA Health eHealth Strategy
  35. 35. Summary Information driven healthcare in Western Australia • Meeting the challenges of vast distances • Encourage the sharing of information electronically between healthcare providers and patients • Removing duplication of patient information • Secure workflow connections between providers • Coordinated used of resources • Patients actively involved in their own healthcare Summary
  36. 36. Resources Resource Location WA Health Networks http://www.healthnetworks.health.wa.gov.au/home/ Fiona Stanley Hospital project http://www.fionastanley.health.wa.gov.au/home/ Animated fly-through - Fiona Stanley project http://vimeo.com/lassoproductions/thefionastanleyhospital Media statement from WA Health Minister http://www.mediastatements.wa.gov.au/Pages/Results.aspx?ItemID=150787 National e-Health Transition Authority http://www.nehta.gov.au/about-us
  37. 37. Fiona Stanley Hospital Thank you