This document discusses the development of a web-based access portal to improve clinician access to oncology information systems. The previous system, which required use of a VPN, was unreliable and difficult to use. A new system was implemented using Citrix Gateway to provide secure, remote access. Early results showed improved reliability, speed and usability. The system was expanded to additional applications and districts. Evaluation found it improved patient care, safety, and multidisciplinary meetings.

2. ONCOLOGY INFORMATION
SYSTEM WEB BASED ACCESS
PORTAL DEVELOPMENT
Enabling Clinician Access to Improve Care
Anthony Arnold
Director of Cancer Services, Illawarra Shoalhaven Local Health District
Anthony.Arnold@sesiahs.health.nsw.gov.au

3. AIM
• To develop a reliable and secure access portal to
patient care applications;
• to improve clinician accessibility
• facilitating improved patient management
• more efficient support for clinical decisions
-- Illawarra Shoalhaven Cancer & Haematology Network --

4. NATURE OF THE PROBLEM
• The current healthcare environment demands real time
access for clinicians;
• clinical decision support systems
• enable routine management of patient care
• Historically, accessed via a Virtual Private Network
(VPN)
• VPN unintuitive, time consuming, frustration and
reluctance to persist with use
• Prevented other simultaneous network connections
-- Illawarra Shoalhaven Cancer & Haematology Network --

5. EXTENT OF THE PROBLEM
• Increasing feedback regarding problems;
• time to access
• instability, disconnection
• restriction of devices
• An undesirable consequence of VPN access was an
inability for staff once connected, to access additional
networks
• This prevented clinicians accessing the oncology
information system (OIS) whilst connected to their
private practice network
-- Illawarra Shoalhaven Cancer & Haematology Network --

6. EXTENT OF THE PROBLEM
• Multiple site visits and troubleshooting determined issues
were not able to be overcome within the current VPN
• An alternate solution was necessary in order to improve
clinician access to the OIS
“Old way required use of VPN tag. The reliability was
poor, the environment was buggy, hard to use, had
frequent outages and introduced unpredictable errors.”
-- Illawarra Shoalhaven Cancer & Haematology Network --

7. PLANNING &
IMPLEMENTING SOLUTIONS
• An opportunity existed to purchase an add-on Citrix
Gateway Server for the cancer system
• Provide ability to connect remote users adhering to the
key foundations of access, security and usability
• CINSW Quality Improvement Grant submission
-- Illawarra Shoalhaven Cancer & Haematology Network --

8. PLANNING &
IMPLEMENTING SOLUTIONS
• A small team was assembled consisting of staff from
medical oncology, radiation oncology, medical
imaging, ICT and Citrix
• The gateway was installed within the ICT demilitarized
access zone and initial pilot testing began within
Cancer Services
-- Illawarra Shoalhaven Cancer & Haematology Network --

11. PLANNING &
IMPLEMENTING SOLUTIONS
• Early indications positive
• Prompt expansion
• Further expansion included
• eMR
• iPM
• Centricity PACS
• Inteleviewer
• ISLHD Exec
• ISLHD Finance
• ISLHD Intranet
• Remote Desktop
• Microsoft Outlook
-- Illawarra Shoalhaven Cancer & Haematology Network --

12. OUTCOMES AND
EVALUATION
Cancer Services
IMACS
Surgery
ComHealth/PalCare
Renal
Theatres/Anaesthetics
Neurology
Radiology
Other
TOTAL NO. USERS / SERVICE (N=119)
-- Illawarra Shoalhaven Cancer & Haematology Network --

13. OUTCOMES AND
EVALUATION
ISLHD
86%
SESLHD
14%
TOTAL NO. USERS/DISTRICT
-- Illawarra Shoalhaven Cancer & Haematology Network --

14. OUTCOMES AND
EVALUATION
Dr
Admin/Manager
Physics
Nurse
RT
Other TOTAL NO. USERS/PROFESSION
-- Illawarra Shoalhaven Cancer & Haematology Network --

15. OUTCOMES AND
EVALUATION
Patient Safety
“The easiest thing for someone with the usual dodgy
ADSL or 3G to get to the Centricity web. It was all I used
this morning at 3.00am to look at a bleeding rectum at
The citrix gateway has enabled patients to receive their
treatment in a more timely manner
(where 1 = Strongly disagree and 5 = Strongly Agree)
SGH that I was being told needed embolisation
The citrix gateway has had a positive effect on patient safety
I was able to conclude that the patient was
The citrix gateway has allowed me to communicate more
effectively with other clinicians
haemodynamically stable, and had bleeding low in
rectum
The citrix gateway has allowed me to work more efficiently
= Colposcope + stitch. Result!”
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
The citrix gateway has allowed me to save time spent
chasing patient results
The citrix gateway has improved my ability to access medical
information relevant to patient care
-- Illawarra Shoalhaven Cancer & Haematology Network --

16. OUTCOMES AND
EVALUATION
Reliability of Gateway
“Answer to prayers
(where 1 = Strongly disagree and 5 = Strongly Agree)
The VPN was buggy, hard to use, had frequent outages
and introduced unpredictable errors
The speed at which I can remotely access clinical services
has improved since the intorduction of the citrix gateway
Citrix receiver allows me to access thin slice CT data on
any platform. Also fixes most of the remote access for
outside practice issues, something previously not
addressed”
The reliability of remote access (access from location other
“Timely access = timely treatment”
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
than hospital) clinical services has improved since the
introduction of the citrix gateway
-- Illawarra Shoalhaven Cancer & Haematology Network --

17. OUTCOMES AND
EVALUATION
“It streamlines viewing MDTs
external images which is very
(where 1 = Strongly disagree and 5 = Strongly Agree)
important when you have 20 people at an MDT”
“Citrix provides easier and more flexible access to
The citrix gateway has improved the quality of the
patients' data”
deliberations that take place in multidisciplinary meetings
“Allows external viewing of radiology images”
“Delivers what clinicians need to deliver patient care,
transparent non-restrictive information technology”
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
The citrix gateway has streamlined the running of
multidisciplinary meetings
-- Illawarra Shoalhaven Cancer & Haematology Network --

18. OUTCOMES AND
EVALUATION
• One of the most relevant indicators of success was the
expansion of the initial project pilot far beyond initial
scope to include the testing of other systems
• Recently extending to
• Pharmacy
• IP Wards
• Wollongong Hospital Bed Managers
• LHD Executive
• LHD Finance
-- Illawarra Shoalhaven Cancer & Haematology Network --

19. SUSTAINING CHANGE
• A sustainable enterprise level solution
• Citrix is a well-established information technology
service provider already heavily integrated with NSW
Health
• The success of this pilot project will transform the entire
ISLHD remote access portal to this same system, thus
further providing sustainability into the future
-- Illawarra Shoalhaven Cancer & Haematology Network --

20. SUSTAINING CHANGE
• This demonstrates a steady growth in data transfers
• The vertical drop at Jan-14 reflects a system reboot
• A single reboot over 12 months demonstrates
sustainable reliability
-- Illawarra Shoalhaven Cancer & Haematology Network --

21. TRANSFERABILITY &
FUTURE SCOPE
• Provides every service in NSW a method of increasing
mobility and remotely accessing their critical
applications anytime, anywhere
• Benefits to the way care was delivered became
immediately apparent to other departments
• ICT have now adopted this solution for the enterprise
and are providing this service to their cluster of LHDs
• Any system deployed by Citrix infrastructure can be
added to this access gateway
-- Illawarra Shoalhaven Cancer & Haematology Network --

22. INTEGRATED HEALTH
CARE
• Aligns with both the strategic direction of the NSW State
Health Plan and eHealth Blueprint;
• Integrate care with the goal of ensuring the patient
timely access to safe care and an efficient service
• Ensure that technology remains a crucial partner in
transforming seamless patient care and service delivery
by the integration of care
-- Illawarra Shoalhaven Cancer & Haematology Network --

23. CORE VALUES
• The pilot has promoted CORE values in clinical
operation, by empowering staff, respecting clinician
requirements, collaborating together on solutions,
altogether improving our patient care
Special Thanks and Acknowledgements:
Ken Masters
Gabriel Beedles
Dr Elias Nasser
Flora Karanfilovski
Graeme Bell
Rod Cummins
-- Illawarra Shoalhaven Cancer & Haematology Network --

24. “Cancer Services is a light in the darkness
when it comes to innovation in patient care
As a result of this work the barren plain of
ICT development has sprung back to life
Thankyou”