“ICT projects are, in fact, complex change management processes with often profound impacts on the business,” said NSW Health’s chief information officer, Dr Zoran Bolevich.
“As such, they need to be strongly owned and governed by the business.”
Dr Bolevich is leading the digital transformation of Australia’s largest public health system, which employs more than 140,000 staff and cares for 7.8 million people across NSW. The massive project involves moving from a system that relies heavily on paper to a digitally-enabled and integrated system.
An example of the complexity associated with this project is how the implementation of electronic medical records and electronic management solutions across 200 hospitals in a large healthcare system brings significant change to the way that clinical care is organised and delivered, Dr Bolevich tells CIO Australia.
“This has downstream implications to the way in which clinicians practice, communicate with each other and interact with patients. All of these changes require a deep and enduring engagement with clinicians, managers and policymakers right across the health system,” he says.
There are three ways Bolevich and his team have learnt to overcome this challenge: involve clinicians in the planning, design and implementation of solutions; co-ordinate, fund and oversee projects centrally, through eHealth NSW, but ensure that the actual implementation is owned and run locally by local health districts and individual hospitals within them.
The last way is to establish and operate effective and inclusive governance structures at project, program and portfolio levels, he says.
eHealth NSW has developed a clinical design framework with working groups that drive planning and design of new digital products and enhancement of existing ones. These are staffed by experts from across NSW Health who have appropriate clinical, health informatics, data analytics, policy and technical expertise. They work together to ensure that solutions are fit for purpose, safe and able to meet requirements and expectations.
“Central coordination of ICT projects enables eHealth NSW to take a planned, system-wide approach, drive consistency and share learnings from one implementation site to another, and from one project to other similar projects. Local ownership and project delivery ensures that each organisation is ready to implement and able to prioritise and resource the effort in ways that best suit their local needs and circumstances,” Bolevich says.
Finally, strong and effective governance is critical to success because it introduces appropriate disciplines for monitoring progress, managing risks and issues, and removing barriers, Bolevich says.
Each program run by eHealth NSW has a statewide steering committee, which is chaired by a senior executive from the health system – often a chief executive or CIO from a local health district. Programs are then clustered into three portfolios – infrastructure, clinical and corporate – each with its own portfolio governance committee with extensive representation across the system. These committees report to the overarching governance group called the eHealth Executive Council, which is chaired by the secretary of NSW Health.
“The governance model has played a key role in the successful implementation of the eHealth Strategy for NSW Health to date. It has enhanced engagement with clinicians and executives across the system, fostered ownership of ICT by the business and helped manage enterprise-wide risks and issues,” he says.
Innovation in healthcare
Bolevich and his team have introduced a raft of innovations over the past year. A Health Grade Enterprise Network (HGEN) is a new approach to commissioning and providing hospital networking infrastructure ‘as-a-service’. A HGEN pilot is now underway at the Westmead Redevelopment Precinct with potential to go statewide, making it one of the largest networking modernisation projects in Australia.
A new PACS/RIS digital radiology system, provided as a service, is transforming the way more than two million medical imaging studies are captured, used and archived every year; and a ‘Patient Reported Measures’ system enables patients to provide real time feedback on the experiences and outcomes of care they received.
They also rolled out a risk trigger monitoring tool, based on a rules-based algorithm applied to clinical data harvested from the electronic medical records systems in real time; and a sepsis detection solution that is supported by artificial intelligence and internet of things.
Digital workforce development initiatives are focused on upskilling and training clinicians to optimise their use of digital technologies while increasing the number of trained health informaticians, health data analysts and data scientists.
NSW Health’s Electronic Medical Record (EMR) system securely shares information from all NSW Health clinicians involved in a patient’s care to provide a more integrated picture of patient health across care settings. By the end of the 2018-19 fiscal year, the EMR was live at 177 hospitals, covering 21,500 hospital beds, supporting safer and smarter care for 1.8 million patients annually. This is up from 750,000 patients last year.
“Every day, on average, 45,000 clinicians open almost 1.03 million patient charts, order 110,000 tests and book more than 36,500 appointments digitally. Nine new modules that enhance the functionality of the EMR were also introduced in 2018-19.
“Building on these successes, a range of new capabilities are being introduced, using an outcomes-based model of commissioning ICT services at a scale unprecedented in the Australian public sector.”
Finally, NSW Health has also deployed a ServiceNow ICT service management platform across eHealth NSW and HealthShare NSW shared service operations (ICT, finance, HR, payroll and procurement services), modernising one of Australia’s largest shared service operations.
Bridging the divide
Bolevich tackled structural challenges of this project by overcoming organisational boundaries (17 local health districts and specialty health networks), as well as the different physical infrastructure that exists due to historical arrangements and investments.
“Culturally, our team bridged the divide between technical and clinical, which was no easy feat and is something that continues to be built upon. ICT and digital were not seen as a business-critical enabler, whereas now they are,” he says.
Bolevich has also advocated for NSW Health to act as one system, gaining buy-in for the longer-term vision and encouraging disparate districts to think about technology in terms of the broader patient journey and what works for clinicians.
He has designed project implementation processes to involve clinicians at almost every step of the design and delivery process and has broken down historical silos that were in place between technical and clinical communities.
Crucially, he is transforming eHealth NSW to consider itself as more than just an IT shop but rather a digital health organisation that plays a critical role
Crucially, he is transforming eHealth NSW to consider itself as more than just an IT shop, but rather a digital health organisation that plays a critical role in the delivery of patient care.