A State-Wide EHR for NSW Health New South Wales Health, NSW, Australia New South Wales (NSW) Health provides healthcare to the most populous state in Australia, covering an area of 800,000 sq km and a population of 6.5 million people. There are eight area health services (AHSs) operating throughout the NSW region: Hunter/New England, Greater Southern, Southeast/Illawarra, Wentworth, Northern Sydney/Central Coast, Sydney South West, Greater Western and North Coast. Within each AHS there are a number of hospitals and health services. Integrating Islands of Data State-Wide In 2000, the NSW Department of Health identified information technology (IT) as a key to improving healthcare services. Disparate islands of information across the AHSs, combined with a lack of integration, had traditionally prevented NSW Health from improving the delivery of health care. Service providers lacked the ability to access a full record of their patient s medical history. This meant that resource and tests were often duplicated across the various care settings. The lack of integration and accessibility was costly and impaired each service provider s ability to deliver the most effective patient care. NSW Health identified a state-wide Electronic Health Record (EHR) as the means for making patient information more integrated and accessible across the state. A state-wide EHR would provide them with: A summary view of patient information: A summary containing every patient s longitudinal medical history, from all public and private health service providers in all care settings. Information on health services provided for each patient: Key information on all health services provided to that patient, regardless of the location of the service e.g. General Practice, Inpatient, Outpatient, Emergency Department, and Community Health. Consumer access to their own health record: Consumer access to their health record via an Internet browser. This enables the consumer to be involved in creating their health record as well as enabling them to add additional details. Overview New South Wales (NSW) Health provides healthcare to the most populous state in Australia, covering an area of 800,000 sq km and a population of 6.5 million people. NSW Health identified a state-wide Electronic Health Record (EHR) as the means for making patient information more integrated and accessible across the state. Customer Profile New South Wales Health, NSW, Australia Customer Website www.health.nsw.gov.au Scenario Integration System Business Situation Lack of integration and accessibility was costly and impaired each service provider s ability to deliver the most effective patient care. NSW Health identified a state-wide Electronic Health Record (EHR) as the means for making patient information more integrated and accessible across the state. Business Solution NSW Health decided to implement the CareJunction EHR solution, called health e link, comprised of software from Orion Health and HealthLink. Business Benefits Easier access to comprehensive information, region-wide Closer collaboration of primary and secondary care Improved data quality for better decision making Reduced costs of health care Consumers have an active involvement in the management of their health care
Selecting Experience At the end of 2003, NSW Health issued a request for tender (RFT) to a number of vendors. In March 2004, a shortlist of vendors was put together to perform product demonstrations and site visits. CareJunction was selected as the successful consortium. CareJunction is a partnership of three companies: Orion Health, Logica CMG and HealthLink. CareJunction stood apart from other vendors because of their experience implementing similar solutions elsewhere. Orion Health had previously implemented the Capital Health EHR in Alberta, Canada and the Integrated Disease Management solution for the HealthConnect initiative in Tasmania, Australia. Setting SMART Milestones Detailed project planning began immediately following the announcement of CareJunction as preferred contractor. Critical to the success of the project was developing a set of realistic milestones against which progress could be measured: July to August 2003: Initial Implementation Planning Study workshops held for eight weeks to confirm understanding of requirements and business process. Oct to end November 2003: Solution design workshops over an eight week period. Led by CareJunction, the workshops included key stakeholders: clinicians, administrators, AHSs and NSW Health representatives. July 2004: Project begins. A long term vision is set for the state-wide rollout to be complete by 2010. Mid October 2005: User Acceptance Testing begins. March 2006: Training and pilot sites go-live. Pilot sites are the Hunter AHS Chronic Disease population and Western Sydney AHS Paediatric population. These pilot sites cover 11 hospitals, 9,000 clinical users and 16,000 registered consumers. Other sites throughout NSW that are not included in the pilot will go live at a date still to be determined. Still to come: In the future, the EHR will be used to support more complex types of patient information, including referrals and care plan management. Key plans include shared work lists and disease management with decision support and notifications. Technology Benefits Single Accurate Source of Information Improved Clinician Satisfaction Easy to Use, Easy to Implement Lower Cost of Ownership Scalable Enterprise Wide Information Foundation Ready to Be Extended Technology In Use Concerto Medical Applications Portal Concerto Clinical Data Viewer Concerto Clinical Data Repository Concerto Clinicals Medical Templates Concerto Clinicals Forms Concerto Enterprise Master Patient Index (EMPI) Concerto Provider Index Rhapsody Integration Engine HealthLink For further information, contact: Orion Health Ltd. www.orionhealth.com International Head Office Auckland, New Zealand Phone: +64 9 638 0600 USA Headquarters Phone: +1 800 905 9151 EMEA Headquarters Phone: +44 870 432 9580
Regional EHR Software Solutions The CareJunction EHR solution, called health e link, comprised of software from Orion Health and HealthLink. Concerto Medical Applications Portal (MAP): for secure, single sign on access to patient records. Concerto MAP allows users to gain a summary of the most up to date information from any location and at any time Concerto Clinical Data Viewer: for instant online access to a patient's laboratory and radiology reports. Concerto Clinical Data Repository: for storing patient s laboratory and radiology reports. Concerto Clinical Medical Templates: to produce and manage a broad range of medical documents in legible electronic templates Concerto Clinical Forms: To provide a data capture mechanism for recording measurements such as body weight, height, diabetes measurements, spirometry readings, etc Concerto Enterprise Master Patient Index (EMPI): for the creation and maintenance of an authoritative central repository containing patient demographic information and identifiers. Concerto Provider Index: for the creation and maintenance of a comprehensive and trusted directory of information about facilities, health professionals, organizations and the services they provide. Rhapsody Integration Engine: for the integration of information across all of the systems and AHSs HealthLink: for secure messaging network/infrastructure Functional Aspects of an Effective Regional EHR Consumer search: All consumers enrolled in the program are able to access their own records over the Internet. They are able to view documents, pathology and radiology reports stored against their record. They are also able to contribute to the electronic record by adding in valuable clinical information such as their symptoms, blood glucose measurements and weight.
Clinician work lists: Clinician work lists are manually maintained and individually customized. Work lists help clinicians to manage their work routine. Work lists also display any new information on their patients, such as test results. Notifications based on incoming data: Notifications are displayed on the clinicians work list as new information comes in. Notifications display information such as when their patients are admitted, when test results arrive and any abnormal results. User to user messaging: This feature allows clinicians to send secure messages to one another regarding the care of their patients. These messages contain hyperlinks to the relevant patient s record as well having the ability to contain document attachments. Results viewing: Users can gain instant access to all patient results including radiology reports, pathology reports and laboratory test information. The user can view these results in a cumulative and graphical view. Growth charts: Charts illustrate height, weight and head circumference of a child. The data can be sent to the system via the messaging interface or it can be entered in online. Online data entry and problem lists: The system supports the entry of data into specifically designed templates. These templates are a combination of disease specific and generic discharge summary templates for providers who cannot enter this information via their own systems. There is also an online problem list template for maintaining a patient s problems. This list can be managed and updated by authorized users. Aggregate lists: The system provides the ability for users to view up-to-date, dynamically generated lists of important patient information. These lists include current medications, problem lists, allergies and alerts, immunizations and encounters a patient has had with any healthcare organization (e.g. inpatient admission, family physician visits etc). Opt-Out Feature Ensures Clinician and Patient Buy-in Implementing a successful state-wide EHR is dependant on gaining buy-in from both healthcare providers and patients. A high volume of registered consumers (patients) is needed to assure clinicians that all information needed is available to them. The CareJunction solution recognized that an opt-out model was the key to gaining community acceptance. The opt-out model works by automatically registering all consumers to ensure that there is a high level of participation and therefore patient information. Consumers must actively opt-out if they do not want to take part in the program. Prior to go-live, NSW Health ran a media campaign informing consumers of the benefits of the system and how they can deactivate their account if they do not want to take part. Consumers wanting access to their own record need to apply for permission. Consumers can determine their own access policy, which allows them to deny or permit access to individual users or organizations. Consumers are given the ability to specify which data types are sensitive and can t be viewed by a provider. This enhances consumer control over their medical record and improves consumer confidence in the EHR system. The system links parents and/or guardians to dependents, so they can control consent for their children s record. They may also be issued with logins to their children s record online. This allows parents to enter milestones for their baby (e.g. walks at 11 months) and chart their height, weight and head circumference against national averages.
When a child turns 15, consent status and access to the record passes to them. Reports are run regularly to identify such children so they may be contacted by letter. The child decides whether to continue to allow their parent or guardian to view their record. Benefits Easier access to comprehensive information, region-wide: The system provides a single point of access to multiple sources of up-to-date information. This saves providers the time that they would normally spend looking for information across multiple systems. Closer collaboration of primary and secondary care: The EHR gathers information from all care settings across the community. The EHR enhances the communication between health services by making the complete view of patient data widely available. Improved data quality for better decision making: The EHR provides each health provider, in each AHS with a complete view of the patient s medical history. This facilitates health provider decision making by giving them all necessary information. Reduced costs of health care: Access to summary information reduces the likelihood of duplicated diagnostic tests and prescribing errors Consumers have an active involvement in the management of their health care: The ability for patients to access their own medical information means that they can play a greater role in the management of their health.