Information & Communication Technology (ICT) Strategic Plan

Strategic Information Management Information & Communication Technology (ICT) Strategic Plan 2006 2011 Building a sustainable future Updated: September 2008 Version: 2.2

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

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

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

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

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

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

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

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

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 Standardised data sets Available to clinicians & decision makers Business Information (BIS) Embedded in operational systems Provided in a timely & user friendly manner Clinical Systems Corporate Systems Investment Management Enable Clinical Services Redesign Program Deliver Statewide integrated Electronic Statewidehealth integrated record Electronic Medical Health record Record Community Electronic Medical & Primary Record Care Community & Primary Clinical Care Support (PAS, Diagnostic) Clinical Support (PAS, Diagnostic) Patient High Quality Services Better systems Human Resources Finance Asset Management eprocurement Billing EAI Identity Management Telecommunications Desktop Consolidation ICT Asset Management 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

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 Documents Internal Corporate Plan State Health Plan Health RSP External State Plan TAM PeopleFirst (GCIO) Level 1 Whole of NSW Health ICT Strategy ICT Strategy at a Glance ICT Strategic Plan NSW Government ICT Strategy alignment Level 2 Enabling plans ICT Asset Management Strategy NSW Health Enterprise Architecture ICT Governance Framework ICT Communicatio n Strategy ICT Portfolio Investment Plan Level 3 Action Plans SIM Business Plan Clinical Systems Architecture Corporate Systems Architecture AHS ICT Strategic Plans Program 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

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

The ICT Strategic Management Framework April / July July August October Review of Agreed TAM with schedule of changes and preliminary business cases, including strategy gateway Results and Services Plan sets strategic direction Treasury forecast of 10 year budgets Proposed TAM; Asset Strategy aligned with RSP and including final business cases; 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

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 Reporting Order Management EHR ED System Theatre System Electronic Prescription Support ICU Community Health PACS/RIS Discharge Referral PAS UPI 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

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

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 coordination and integration across the health system. Accurate information will allow better utilisation of resources and management of future demand. 16

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

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

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

Strategic Response to Key Challenges Strategic Context NSW Health Strategic Response Broader Healthcare Environment Health Needs of NSW Population: Demographics Medical Technologies Disease Patterns & Trends Consumer Expectations Service Delivery Challenges: Staff Shortages Hospitals Running at Max. Capacity Quality & Safety Challenges Geographic Challenges Health Futures Demand & Supply Opportunities Risks Partnerships Future Service Delivery Concepts Infrastructure Needs Information Needs Outlook 20 Years Clinical Services Plans Statewide & AHSs RSP Corporate Strategic Plans Statewide & AHSs Enabling Plans Workforce; Safety & Quality; Asset Mgt; Research & Teaching; Procurement; Financial Mgt; IM&T Outlook 5 Years Annual Operational Plan Burden of Disease Challenges (Pop. Health; Primary & Community; Acute) Risks & Priorities Current Year Programs Enabling Programs Annual Goals Annual Budget; Capital Asset; Recruitment & Development; Goods & Services; IM&T Outlook 1 Year Broader IT Environment Govt. CIO Strategic Plans Whole-of-Govt Plans Treasury TAM Policy Health IT Other health jurisdictions NEHTA Current State - NSW Health IT ICT Portfolio Portfolio Approach for: 1. Strong Alignment with the RSP, TAM & Whole -of-govt IT 2. Improved Integration, Cost Control & Risk Management 3. Improved Transparency of Planning & Implementation 4. Coordinated Approach to Implementation, Change Management, Architecture, Security & Privacy Statewide Approach to: 1. Ensure Consistent IT Capabilities and Support Across AHSs 2. Leverage off Common Knowledge, Skills & Methodologies (SIM, State Builds & HSS) 3. Eliminate Redundancies, Ensure Integration & Standardise Reporting and Cost Control New Funding Model: 1. To Meet the Specific Needs of IM&T Investments 2. To Meet Strategic Goals within the Proposed Timeframe 3. For Economies of Scale, Network Benefits & State Buying Power Goals NSW Health Goals Common Goals Keep People Healthy Provide Needed Health Care Deliver High Quality Services Manage Services Well Common Strategic Directions Govt. CIO Goals ICT Strategic Executive Plan Reporting Treasury Goals 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

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 coordinated 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

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

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

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

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

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

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

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

The Approach to ICT in NSW Health Figure 8 ICT Strategy At a glance Drivers (Why) ICT Strategy Measurement Outcomes RSP Make prevention everybody s business. Create better experiences for people using health services. Strengthen primary health & continuing care in the community. Build regional & other partnerships for health. Make smart choices about the costs and benefits of health services. Build a sustainable health workforce. Be ready for new risks and opportunities. Internal Clinical Services Redesign Program Corporate Shared Services reform program Develop a performance culture around information External Themes Significantly improve support for clinicians and patient care Strategic alignment to major NSW Health initiatives Strategic Objectives Clinical Systems Corporate Systems Business Information Sustainable Infrastructure (what) Use ICT to enable major clinical reform programs Clinical Services Redesign Program, Quality and Safety initiatives; and clinical program areas Reduce the duplication and cost in administrative systems to increase funds available for frontline care Provide a core set of high quality information all levels of the organisation in a timely, user friendly way to support decisions that drive real results for the Department and its stakeholders An ICT infrastructure that is: Reliable Responsive Available; and Cost effective Strategy (How) Implement systems that Improve communication, Minimise delays, Improve handover management Provide a more cohesive patient journey; and Support flexible allocation of resources to ensure services meet patient needs Implement the core systems needed to underpin the Corporate Shared Services reform program. Transform operational data into management insight Integrate NSW health s strategic objectives with front line service delivery Drive management accountability Develop and maintain standards and architecture needed to support state wide ICT initiatives Identify and manage business impact of technology Rationalise the technical infrastructure Supporting Programs (Initiatives) (which will be delivered through) Electronic Medical Record program systems needed to manage patients effectively in an acute environment. Primary, Community and Outpatient Care program systems to support patient care in the community, outpatient & primary care environment, includes referrals and interaction with other human services. Statewide integrated Electronic health record accessible by clinicians and consumers across the public & private health sectors Clinical Support program core support systems such as Patient Administration systems and diagnostic systems Corporate Systems program. New systems in the areas of Human Resources - Payroll, rostering, L&D, 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 & Security e-procurement - Warehousing, Distribution, Inventory Management, Catalogue Management, Supplier Management, Product Management & Tendering Billing - Standardised billing management Establish Business Information Governance and performance management Integration of NSW Health s strategic and planning frameworks and developing overall value and cost effectiveness performance measures. Deliver Enabling infrastructure and support Ensure the source systems are capable of providing the major indicators Standardise the data sets and implement them to provide consistent information Ensure the technical infrastructure is in place to support effective information management Define and implement the telecommunications and technical infrastructure to support the clinical and corporate strategies. Specify the enterprise architecture, enterprise integration layer and core technical standards required to manage NSW information assets. Develop and apply uniform Information management standards across state based builds and other systems as appropriate Ensure data quality strategies are in place to ensure maximum value from the information collected across NSW ICT infrastructure/ EAI - Identity management, EAI strategy and management, telecommunications strategy and desktop consolidation. Business Continuity Planning KPIs Measures Performance % Over/Under Against Budget Progress Earned Value against plan Use of target Coverage technology by location Adoption of Uptake technology by business users Quality of Customer deliverables Satisfaction Information Management Availability of Models published models Coverage Uptake Use % of information requirements modeled Implementation of standards in core systems Information published in required form Infrastructure Management Cost savings Standardisation achieved % reduction in annual op. cost % non-compliant infrastructure Quality of Agreed SLA levels Service met # severity 1 issues Group Department Hospital Area Key Result Area Description Better and safer care for patients Clinical departments will have access to systems that Improve work flow within the Department Provide decision support for clinicians; Have rules built in Provide information needed to support the most effective resource management Clinicians will have access to critical information to make the right decisions for patients. Communication between staff in the department will be better Information collected once and accessible to all who need it More efficient patient journey Well integrated core systems across a hospital, including Results Reporting Order Management Patient Administration Systems Scheduling; and Human Resources 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. Standardised information from all facilities Better patient care once they leave hospital Reduced risk of readmission Standardised information will support more effective resource planning and demand management Minimum duplication of diagnostic procedures and delays for patients. Efficient management of patient transfers between hospitals in the Area Improved communication between hospitals and clinicians in the community will support better patient care once they leave hospital; and reduce the risk of readmission better utilisation of resources and management of future demand NSW GCIO ICT Strategic Plan Council of Australian Governments National ehealth program NEHTA Considerable ICT cost savings ICT Management by Health Ensure the maximum benefit is gained from the investment in ICT Standardise portfolio management processes through collaboration across the Department of Health, Area Health Services, Health Technology and third party providers Continuously evaluate, prioritise, select, monitor and adjust programs and projects to achieve business priorities Implement 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. Process Maturity Effective Governance Effective Portfolio Management Current Maturity Level Speed of resolution on proposals Expected v/ actual Portfolio Risk State The full value of ICT will be achieved when systems are implemented across all Areas. Standardised clinical and corporate information, collected as a by-product of patient care, helps NSW Health achieve targets set under the RSP by Improving patient journeys across the health system, More timely access to services; and Better co-ordination and integration across the health system. Improving utilisation of resources and management of demand. 29

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 right projects? Are we doing the projects right? Are we getting projects done well? The strategic framework used to determine where investment should be focused to meet strategic priorities, what resources are to be made available and the anticipated return on investment Alignment with architecture Ensuring projects are aligned with architecture and standards, consistent with other initiatives, consistent with core, common and divergent principles Project delivery Consistent operational processes, planning, quality assurance, best practice project management disciplines and methodologies, skilled resources and appropriate tools G O V E R N A N C E Are we getting the benefits we anticipated? Benefits realisation Clear definition of benefits and metrics, processes to measure and report on benefits Figure 9 - Portfolio Management Framework 31

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

The Approach to ICT in NSW Health Risk management STANDARD GUIDELINES Business case management Program planning Quality management Project Inception Identify an opportunity Operational service delivery Funding allocation Benefits realisation State based build Solution design and State Based Build Supporting innovation Construction: development, integration & testing Asset management KEY PROCESSES Manage a program provide capability, deploy to users Communication framework End a project - acceptance into service Stakeholder management Issue resolution Risk management 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: Common: Divergent: Applications and projects that are expected to provide all state wide core functions. These will be directed, controlled and funded by the Department. These applications provide common solutions across a collaborative group. They will be controlled collaboratively to achieve the desired outcomes for the group. Applications aimed at innovative solutions to localised 33

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. Rule Extent of Solution Scope Funding Sponsorship Repeatability Technical Infrastructure Deployment Team IT Architecture Compliance Product Selection Core (Directed) State Wide Solution Centrally Funded Capital/AHS recurrent Common (Collaborative) AHS Wide or Collaborative Group Wide Solution Central or AHS capital/ AHS recurrent DOH lead (AHS supported) AHS lead (DOH supported) Must be State Based Build Must utilise the Core TSS Infrastructure State Led Deployment with Mixed Resourcing Full Compliance State Wide Product Selection Will form the Basis for a State Based Build Must utilise core TSS Infrastructure State or locally Led Deployment with Mixed Resourcing Complies to Common Architectural Components Collaborative Product Selection Divergent (Localised) Local Solution Local or AHS Funding AHS or Local Department (advised to DOH) Meets local need and can be scaleable Will utilise local or AHS infrastructure Locally Led Deployment with Local Resources Limited Compliance Local Product Selection Business Case Approval DOH/Treasury DOH-AHS/Treasury AHS/Local if under $250k Priority/Constraints (i.e. funds, resources etc) Governance Examples Managed as part of State ISSP State led governance with mixed representation PAS, UPI, EMR, OT, ED, Corporate systems, EHR, Community Managed as part of AHS ISSP State or locally led governance with mixed representation ICU, PACS/RIS, Pharmacy, LITI 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 Must not be done at expense of core/common Local Governance with formal reporting Surgical Audit, JONAH, Checklist 34

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

The Approach to ICT in NSW Health The diagram below shows the major elements of the governance model. Executive ICT Stakeholder Groups Department Director-General DD-G Health System CIO & CE Health Support Services SEAB (Senior Executive Advisory Board) Monthly Reports from SIM, HSPI, DPE, Q&S CEs ICT Management Committee Monthly Representation from all AHS Directors of Corporate Services Area Corporate IT Program St Committee CIO Advisory Group Clinical Advisory Group programs Business Information Clinical Systems Corporate Systems Infrastructure 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

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

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 V1 fix/ enhance SBB V2 fix/ enhance fix/ enhance AHS 1 AHS 1 AHS 2 AHS 3 AHS 4 Build lock down 6 mth pre deploy AAG Triage (Note: triage is a process) SMEs as required Clinical Advisory Group (CAG) ICT Management Committee 5 38

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

Priority ICT strategies Strategy Phase 1 2006-11 Initiative Results reporting Order management Emergency departments Operating theatres Discharge referral Enterprise scheduling Assessment of EMR requirement for Justice Health, small facilities and ASNSW Electronic Medication management Transition strategy for LITI applications Intensive Care Units clinical information system Functional scope Will allow test results and reports from diagnostic services to be viewed at the clinical workstation 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. 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. System to manage the co-ordination of patients, surgeons, anaesthetists, equipment and rooms, and report on utilisation. 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 The ability to co-ordinate scheduling across an integrated set of 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. This will assess the functional requirements specification for small facilities, conduct an options analysis and recommendations on solution and a transition and implementation plan Pilot of the Medication management/eprescribing component of EMR with decision support/alert capabilities. This will be followed by the state implementation. Assessment of fit between strategic products and specialist requirements, including an options analysis, recommended strategy and migration plan Functional specifications, Procurement options and strategy for ICU feeding into an updated business case Strategy Phase 2 : 2012-2016 Initiative Clinical documentation Intensive Care Units clinical information system Medication Management Functional scope Clinical alerts and pathways for specialist clinical areas. The project involves a planning phase, including development of requirements and a business case. Procurement and implementation of an ICU solution. State wide implementation of the Medication Management solution. Alignment with, and dependencies between, the NSW Hospital Pharmacy initiative will be addressed in the planning for this project. 40

Priority ICT strategies 7.1.4 Primary, Community and Outpatient Care Strategy Phase 1 : 2006-2011 Initiative Functional scope PCOC Strategy PCOC business case Community health & Outpatient Care Information Project CHIME Cerner community Outpatient Units Electronic Health Record pilot Electronic Health Record evaluation Electronic Health Record post implementation review Ambulance Electronic Patient Record Development of an information strategy for Primary, community and outpatient care Development of a business case for the IT infrastructure to support this sector Development of a state wide data set that contains a record for each service provided to patients in primary, community health and outpatient care settings. This includes projects to standardise data across collections. Strategic and tactical management of the CHIME system, including end of life strategic planning Alignment of Cerner developments with community health requirements EMR for Outpatient Clinics (extension of PAS) Provider and consumer access to integrated health record containing summary level information from public hospitals, ED, community health, outpatients, diagnostic services, dental clinics and GPs Policy, technical, functional and business outcome evaluation of pilot implementation Assessment of effectiveness of project management, budget, resourcing, process and scope management for implementation of the pilot Development and implementation of an Ambulance Electronic Patient Record (AEPR). This will give ambulance officers access to a sophisticated system for Emergency Clinical Information using mobile technology. Strategy Phase 2: 2011-2016 Initiative Electronic Health Record Phase 2 state implementation Outpatient Clinics stage 2 Community Health solution CHIME replacement Mental Health migration Drug and Alcohol migration Allied Health Functional scope Provider and consumer access to integrated health record containing summary level information from public hospitals, ED, 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. Implementation of advanced clinical decision support for Outpatient services Implementation of an Integrated Community Solution for Community Health Services Transition of mental health requirements from SCI-MHOAT, MHOAT, MAJIC and FISCH to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support. Transition of D&A requirements from FISCH, MERIT, ICIS and FISCH to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support Transition of Allied health requirements from AHMIS to the Integrated Community Solution and Outpatient EMR solution, 41

Priority ICT strategies Aged and Chronic Care Sexual Health Oral Health including Clinical Decision Support Transition of aged care requirements from ACE (and other MH applications) to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support Transition of sexual health requirements from SHIP to the Integrated Community Solution and Outpatient EMR solution, including Clinical Decision Support Development of migration strategy for oral health requirements from ISOH 7.1.5 Clinical Support Systems Strategy Stage 1: 2006-2011 Initiative Complete implementation of PAS PACS/RIS Review of pathology systems Pharmacy migration Incident Information Management System Bed management strategy Functional scope/deliverables Replacement of legacy HOSPAS and WINPAS products with Cerner/iSoft Patient Administration systems Procurement strategy, establishment of hubs, statewide picture archive Development of strategy for pathology system replacement. Migration planning and timeframe established for migration from AMFAC to ipharmacy. Migration from single site to multi site implementations hosted in clinical hubs. Planning for IIMS upgrade including strategy, business case and EOI and implementation. Assessment of strategies to provide IT support for improved capacity management. This includes options for enhanced Bedboard functionality Strategy Stage 2: 2012-2016 Initiative Hospital pharmacy rollout Functional scope/deliverables State wide implementation of a replacement hospital pharmacy 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

Priority ICT strategies 7.2.2 Core projects to be delivered Strategy Stage 1: 2006-2011 Corporate Systems Business case corporate systems phase 2 Human Resources Finance Asset Management e-procurement Billing ICT infrastructure/ EAI Functional scope Development of a business case for new rostering software, Recruitment, Education and training, Workforce Management, OH&S Payroll, rostering, learning and development, OH&S, Recruitment, Performance Management General Ledger, Accounts Receivable, Accounts payable, Fixed Assets, Inventory Management, Purchasing and Sales Order Capital Works Management, Facility Management, Property Management, Maintenance, Cleaning and Security Warehousing, Distribution, Inventory Management, Catalogue Management, Supplier Management, Product Management and Tendering Standardised billing management Identity management, EAI strategy and management, 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 decision makers at the front line Governance and performance management Enabling infrastructure and support The primary aim of this program is to provide timely, relevant information in a user friendly way to clinicians and decision makers in front line services. Aimed at integrating NSW Health s strategic and planning frameworks and developing overall value and cost effectiveness performance measures. Making sure that the source systems are capable of providing the major indicators, that the data sets are standardised and implemented to provide consistent information and the technical infrastructure is in place 43

Priority ICT strategies 7.3.3 Core projects to be delivered Strategy Stage 1: 2006-2011 Business Information Strategy Decision making at the front line Governance and performance management Enabling infrastructure and support Functional scope Decision support toolkit and portal developed; 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. Evolve indicators and build business information governance. Map strategy through balanced scorecard and report annually. Create a single performance framework Build information standards Streamline common reports 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 Architecture and Standards Information management Defining and implementing the telecommunications and technical infrastructure to support the clinical and corporate strategies. Providing the enterprise architecture enterprise integration layer and core technical standards required to manage NSW information assets. Ensuring that uniform data standards are 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

Priority ICT strategies 7.4.3 Core projects to be delivered Information Management Strategy stage 1: 2006-2011 Project Development of a Data Quality Strategy for NSW Health Functional scope / deliverables Data quality review from core source systems 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 Data Standards Development and documentation (Leveraging from work done in BI, Corporate Systems, Clinical Systems Programs) Knowledge Sharing SNOMED CT HERO Development of a data governance strategy for data Collections Maintenance and enhancement of NSW Health Data Dictionary PCOC: Ambulatory Care Data Standards Development KPI development HIRD Repository DPE Web pages Data Analyst s Workgroup WIKI / Forum Clinical terminology and its fit to e-health Education and training Analysis of SNOMED CT data Implementation and maintenance of state wide facility for registration of Health facilities Architecture and standards Strategy stage 1: 2006-2011 Project Review of NSW Health Technical Standards Identity Management Strategy Maintenance of Enterprise Architecture Establish and implement Enterprise Integration layer Establish regular audit of state wide IT environment Establish and maintain State Baseline Build methodology Functional scope / deliverables Register of current technical standards Process established for maintenance of technical standards Agreed framework for consistent, consolidated authentication and access control. Ongoing maintenance of clinical and corporate architecture, Architectural reviews of compliance of systems; Management of Application Systems Knowledgebase and Health Information Resources Directory Development of message and data exchange standards; Development of integration layer services; Integration governance; Alignment with NEHTA standards Improved knowledge of current state of IT across NSW to improve accuracy of forward planning Document and publish approach to State baseline build 45

Priority ICT strategies Infrastructure Strategy Stage 1: 2006-11 Project Development of Telecommunications Strategy Infrastructure Strategy Stage 1 Functional scope Definition of, and implementation of Telecommunications infrastructure to underpin ICIP and Corporate Systems Strategy Phase 1 addresses the most critical sites in relation to: Consolidated data centres and system hardware equipment Data centre floor space expansion Telecommunications hardware Supporting management systems and processes Infrastructure business case - phase 2 Establish IT Asset Registe Development of a forward strategy and business case for phase 2 Identification of IT data centre assets Strategy Stage 2: 2006-2011 Project Infrastructure phase 2-5 Functional scope Incremental upgrade to state data centres, telecommunications hardware 46

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

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 Cost Reduced adverse events Fewer tests Hospital Access Reduced waiting times Quality and safety Cost Improved patient flow Reduced length of stay Reduced readmissions Improved monitoring of credentials Reduced clinician administration time Improved asset utilisation Improved management of staff resources Area Access Improved equity of service Quality and safety Cost More accurate data capture 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 Aims Current Performance Data Requirements Governance Process Applications Functionality Benefits Benefit KPIs Benefit 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

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

Measurement of benefits Appendix A Resources Additional Reference Material/ Reference Portfolio Investment Strategy Integrated Clinical Information Program architecture stage 1 Integrated Clinical Information Program Architecture, stage 2 ICT Governance model Corporate Systems Architecture NSW Health Data Dictionary Business Information Strategy Overview Capital investment strategy for ICT for NSW Health, covering the period 2006/07 to 2016/17 Clinical systems architecture for stage 1 of ICIP (EMR, EHR, PAS, Provider Directories, patient flow tools) Clinical systems architecture, stage 2, with focus on PACS/RIS, ICU, Operating Theatres, ED, UPI and Discharge referral Overview of the governance model for ICT across NSW Health Corporate Systems Architecture, covering Human Resources, Finance, Asset Management, eprocurement, Billing, enterprise integration Data standards, definitions and classifications that underpin core NSW data collections and systems 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 Health Information Resources Directory Application Systems Knowledgebase Corporate Systems Strategy ICT Governance ICT Asset Management Strategy Documented processes to be adopted by SIM and HealthTechnology to support the effective delivery of the ICT Strategy An online tool to identify existing information resources across NSW Health An online repository providing information about applications operating across NSW Sets direction for corporate systems across NSW, addressing scope, implementation plan, budgets and infrastructure Establishes the framework, principles, processes and structures for ICT governance in NSW Outlines the principles and key elements of the management of the ICT assets in NSW Health 50