NSW Health Case Study –
Endoscopy Information
System
eHealth Interoperability
Conference
12th September 2013
Overview
• Project Planning
• Setting Standards
• Sustainable Change
• Interoperability
• Lessons Learned
NSW Health
• 15 Local Health
Districts & 1
Children’s Hospital
Network
• 84 acute public
hospitals
• Approx 1.6 M
hospital...
Endoscopies
• Approx 120,000 endoscopies
performed per year
• Facilities perform up to 7,200
endoscopies per year
Project Planning
• Initiated by Agency for Clinical Innovation
Gastroenterology Network (2008)
– National Bowel Cancer Scr...
Setting Standards
• Minimum data set
– Defined by clinicians (gastroenterology
network)
• Adult
• Paediatric
– National bo...
Prior to EIS
• Largely paper based reporting
– Scanned to medical records
• Siloed hospital unit based systems
– Sharing o...
Sustainable Change
• Program sponsor: Agency for Clinical
Innovation
– NSW Health clinical pillar for clinical
leadership
...
Endoscopy Information
System
• Record clinical procedure documentation
• Capture digital images
• Automated reports, lette...
Procedures
• Upper and lower GI
– Gastroscopy
– Colonoscopy
– EUS: Endoscopic ultrasound
– ERCP: Endoscopic retrograde
cho...
Interoperability
• HL7 v2.3
• Patient administration feeds to EIS
– Demographic feeds
– Episode details
• Scheduling inter...
Data and Message View
ORU
PAS
Appt
eGate/JCAPS
Endoscopy
Information
System
Demographics
Episode Details
Appointment
Proce...
Infrastructure
• 9 Instances
• Prod, Test,
Train
HUNTER
NEW ENGLAND
NORTHERN SYDNEY
CENTRAL COAST
SOUTH-EASTERN SYDNEY
ILL...
PAS/Cerner/EMR
HSS Cumberland data-centre
9 * MS Windows.net
application servers
State-wide EIS Server
Oracle 11g server
w...
HL7 Interfaces:
- Demographics (ADT)
- Procedure Note Results (ORU)
Endoscopy
Procedure with
Image Capture
Doctor’s
Proced...
Procedure Report
Patient Instructions
Nation Bowel Cancer Screen
Program
Results View in PowerChart
Results Text View in
PowerChart
Procedure Note via EMR
Program Rollout
• Goal 33 sites
– 80% procedures
• Currently 25 sites
since Nov 2012
– Plus 14 HNE sites
Benefits
• Improved access to information
leads to time saving
– Discharge summary
– Patient enquiries
– National bowel ca...
Lessons Learned
• Interfaces
– ADT manipulation required
– Legacy MRN pools
– Dropped network connection
– Handling error ...
Lessons Learned (cont)
• Information Technology
– Buy-in
– Citrix
– Limited use of network logins, impacts
LDAP
Lessons Learned (cont)
• Clinical
– Clinical champion
– Endoscopist buy-in, change
management
– Accessing doctors for pre-...
Lessons Learned (cont)
• Lack unique identifier
• Common systems often require
different interfaces
• Different processes ...
Questions
Andrew Young
Program Manager, EIS
Andrew.young@hss.health.nsw.health.gov.au
Tel: 8918 1610
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Andrew Young, Endoscopy Information System, HealthShare NSW - NSW Health Case Study: Leading The Planning, Design And Roll Out Of A Statewide eHealth Application

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Andrew Young 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

Published in: Healthcare, Technology, Business
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Andrew Young, Endoscopy Information System, HealthShare NSW - NSW Health Case Study: Leading The Planning, Design And Roll Out Of A Statewide eHealth Application

  1. 1. NSW Health Case Study – Endoscopy Information System eHealth Interoperability Conference 12th September 2013
  2. 2. Overview • Project Planning • Setting Standards • Sustainable Change • Interoperability • Lessons Learned
  3. 3. NSW Health • 15 Local Health Districts & 1 Children’s Hospital Network • 84 acute public hospitals • Approx 1.6 M hospital admissions (2010/11) • 26.3 M non-admitted visits • 2.5 M emergency department attendances
  4. 4. Endoscopies • Approx 120,000 endoscopies performed per year • Facilities perform up to 7,200 endoscopies per year
  5. 5. Project Planning • Initiated by Agency for Clinical Innovation Gastroenterology Network (2008) – National Bowel Cancer Screening recommended EIS – Required for patient safety, quality, productivity benchmarks • Implement standardised local, district and state level
  6. 6. Setting Standards • Minimum data set – Defined by clinicians (gastroenterology network) • Adult • Paediatric – National bowel cancer screening data • Capture billing codes (MBSE)
  7. 7. Prior to EIS • Largely paper based reporting – Scanned to medical records • Siloed hospital unit based systems – Sharing of data via USB, scanning, email • Manual counting – Procedure numbers – Endoscopist accreditation
  8. 8. Sustainable Change • Program sponsor: Agency for Clinical Innovation – NSW Health clinical pillar for clinical leadership – Project and BAU sponsorship • Implemented by HealthShare NSW – Corporate arm of NSW Health
  9. 9. Endoscopy Information System • Record clinical procedure documentation • Capture digital images • Automated reports, letters and follow-up instructions • Used by endoscopist consultants, fellows and registrars – Gastroenterologists and surgeons • Structured data for research
  10. 10. Procedures • Upper and lower GI – Gastroscopy – Colonoscopy – EUS: Endoscopic ultrasound – ERCP: Endoscopic retrograde cholangio pancreatography
  11. 11. Interoperability • HL7 v2.3 • Patient administration feeds to EIS – Demographic feeds – Episode details • Scheduling interface to EIS – Appointment details – Procedure information • Results interface to eMR – Procedure notes and URL
  12. 12. Data and Message View ORU PAS Appt eGate/JCAPS Endoscopy Information System Demographics Episode Details Appointment Procedure ADT / SIU eMR Results
  13. 13. Infrastructure • 9 Instances • Prod, Test, Train HUNTER NEW ENGLAND NORTHERN SYDNEY CENTRAL COAST SOUTH-EASTERN SYDNEY ILLAWARRA SHOALHAVEN WESTERN SYDNEY NEPEAN BLUE MOUNTAINS NORTHERN NSW MID NORTH COAST WESTERN NSW FAR WEST SOUTH-WESTERN SYDNEY SYDNEY CHILDRENS NETWORK WESTMEAD SYDNEY HSS IT SITES SOUTHERN NSW & MURRUMBIDGEE TRAINING Bateman’s Bay Goulburn Wagga Wagga Health Network LHD eMR LHD PAS PC: Citrix client DATA BASEDATA BASE DATA BASE Application Server DATA BASE Application Server DATA BASE Application Server Application Server Citrix Farm PVMD Terminal PVMD session Application Server Citrix Client Citrix session PRODUCTION TEST ENDO PC: Thick client PVMD Terminal PVMD session
  14. 14. PAS/Cerner/EMR HSS Cumberland data-centre 9 * MS Windows.net application servers State-wide EIS Server Oracle 11g server with 9 DB instances MS SQL Server 2008 R2 ProVation image capture workstation in the procedure room Accessing application servers via ProVation ‘thick client’ application installed on PC Citrix Server Farm (5 servers) Workstations other than image capture workstations can access application servers via Citrix System Architecture
  15. 15. HL7 Interfaces: - Demographics (ADT) - Procedure Note Results (ORU) Endoscopy Procedure with Image Capture Doctor’s Procedure Documentation Immediate Electronic Data Retrieval IBM Patient Report Hospital eMR Past Procedure Notes Previous Procedure Images Data Reports Information Architecture
  16. 16. Procedure Report
  17. 17. Patient Instructions
  18. 18. Nation Bowel Cancer Screen Program
  19. 19. Results View in PowerChart
  20. 20. Results Text View in PowerChart
  21. 21. Procedure Note via EMR
  22. 22. Program Rollout • Goal 33 sites – 80% procedures • Currently 25 sites since Nov 2012 – Plus 14 HNE sites
  23. 23. Benefits • Improved access to information leads to time saving – Discharge summary – Patient enquiries – National bowel cancer screening forms – Common reporting, data capture, processes
  24. 24. Lessons Learned • Interfaces – ADT manipulation required – Legacy MRN pools – Dropped network connection – Handling error messages – Scheduling: Single procedure codes only – Results: mismatch episode
  25. 25. Lessons Learned (cont) • Information Technology – Buy-in – Citrix – Limited use of network logins, impacts LDAP
  26. 26. Lessons Learned (cont) • Clinical – Clinical champion – Endoscopist buy-in, change management – Accessing doctors for pre-training – Ideally reduce list on first use • 1.5 times longer at the end of first list – Nursing buy-in
  27. 27. Lessons Learned (cont) • Lack unique identifier • Common systems often require different interfaces • Different processes exist – Pathology ordering – Booking, arrival / check-in
  28. 28. Questions Andrew Young Program Manager, EIS Andrew.young@hss.health.nsw.health.gov.au Tel: 8918 1610

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