The healthcare sector is struggling to cope with the demand for services, driven by an increase in the burden of chronic, disease, an ageing population and rising costs.“If you take that into account along with the wave of digital transformation that is happening in healthcare delivery, eHealth Queensland had no choice but to step up,” says eHealth Queensland’s CIO and IT veteran, Malcolm Thatcher.The key challenge has been to make the right investments in capabilities, service and people and ensure these investments are valuable, he says.“That’s part of the tyranny of healthcare, everything you do costs a lot of money. You can’t get away with a small investment, not at the scale of an organisation like Queensland Health with 90,000 employees.“We have to ensure we spend that money wisely and we are actually focused on outcomes for patients. Our journey is taking into account the fact that the obligations on us are much more significant with the rising costs of health and demand, and that technology is now a big disruptor in healthcare delivery. You’re either on the bus or under the bus,” he says.The eHealth Queensland Investment Strategy – released in September 2015 – sets system-wide ICT priorities for Queensland Health over the next 20 years, representing a $1.26 billion investment and creating 1,000 jobs.Through an integrated electronic Medical Record (ieMR), clinicians and support staff can securely access a single view of a patient’s medical record, making it easy to share information about each person’s history.To date, ieMR solutions have been rolled out at: Cairns Hospital, Mackay Base Hospital, Royal Brisbane and Women’s Hospital, Lady Cilento Children’s Hospital, Princes Alexandra Hospital, and The Townsville Hospital.These solutions aim to increase the quality of care and safety for patients and promises to provide a sustainable health system, something that Thatcher is passionate about.Thatcher recently completed his PHD thesis titled, ‘A framework for information governance controls in acute healthcare’, with a focus on eHealth governance.His research explored theories supporting organisational decision-making and behaviour, focusing on the conduct of doctors associated with the implementation of clinical systems. The research has established a framework of the factors that give rise to risk in eHealth adoption and the governance controls required to manage those risks.“I am fortunate to be in a position of authority where I am able to implement my research findings. It was about establishing what are the appropriate controls for IT governance in an acute care setting,” he says.Thatcher said his research identifies the risks that need to be managed around a clinician’s journey through the adoption of technology.“That’s been very useful in terms of what I have been able to implement to improve governance of both investment decision making, recognising, ‘are we actually capturing the drivers and the barriers to success?’“Then when we are implementing systems, ensuring that the ‘sense-making’ journey clinicians go on is adequately covered from a governance perspective.”This has brought a new focus and attention to eHealth Queensland’s governance practices. He likens patient safety in healthcare to an analogy used by the airline industry where to ensure the wellbeing of passengers, ‘you have to make sure that all the holes in the swiss cheese never line up.’“That’s the analogy we are trying to bring into this environment – making sure that our ‘pre-flight’ checks are comprehensive, fit for purpose, repeatable and reliable so that when we go live, particularly with clinical information systems, that we are not exposing patients or clinicians to harm.”Thatcher says the data is very clear across the Western world that people have a ‘one in ten’ chance of receiving harm when they visit a hospital.“And in implementing computer systems, you have to make sure you are not going to make it any worse, you actually have to make it better. It’s a significant obligation to get it right because the outcomes are very significant.”Good governance brings a much-needed focus on making sure that Queensland Health is resilient in the way it delivers solutions.“This hasn’t always happened in healthcare because sometimes IT systems have been led by well-intentioned clinicians who have no idea what software engineering and IT delivery is about and that’s provided less than optimal outcomes.”Innovations in healthcareIn November 2015, Brisbane’s Princess Alexandra Hospital became Australia’s first public digital hospital, providing clinicians with one patient record. The project required training nearly 6,000 staff and integrating more than 1,600 new digital devices across the hospital.Since going live in November 2015, more than 3.5 million electronic charts have been opened, 75,744 clinical notes documented, 38,284 diagnoses documented and 29,955 allergies documented.In February, Cairns Hospital went digital and was the first Australian healthcare institution to use maternity digital records.“We are also investing in telehealth – using technology to improve patient access to healthcare to reduce travel and inconvenience for patients, carers and health professionals,” says Thatcher. “Clinical consultations via telehealth have almost doubled since 2012.”An Integrated Oncology Management System is now delivering improved cancer care through vital information sharing. Around 364 staff had easy access to data of about 5,510 cancer patients as at December 2015. Meanwhile, Princes Alexandra Hospital is using innovative 3D printing to reduce unnecessary surgeries for complex trauma patients.Thatcher says ICT innovations implemented across the Queensland health system go through a rigorous quality control and testing regime to ensure they provide maximum benefit.“But to ensure we continue to push the boundaries of technical innovation to improve clinical and patient care, we collaborate with the wider industry, technical innovators, startups and other organisations using a variety of means. This includes events such as the inaugural eHealth Queensland Expo this year.”Getting board support, changing cultureIt’s less of a challenge now than it was 10 years ago to convince healthcare boards about the need for technological change, says Thatcher.“What is so obvious today that you can’t continue to run a health system on paper was less obvious 10 years ago. It’s less about the conversation around ‘do we need to do it?’ It’s more ‘how do we do it to ensure we get the outcomes that we want?’Getting the clinical workforce to understand the role they play in a technology-enabled healthcare system is a difficult conversation, he says. This is because clinicians are trained to think autonomously, to use their judgement rather than rely on computers to make decisions for them, he says.“Electronic medical records give them the ability to bring a lot of disparate information together to provide a decision support at the point of care and that goes against what is ingrained in clinician training.“So it’s really the workforce and the change management that’s the bigger challenge. It’s not the decision to invest because the decision makers know it’s inevitable; it’s the risk involved in a failed implementation that is probably front of mind.Thatcher admits that the healthcare sector has had some ‘bumpy rides’ when it comes to technology implementations which reflects ‘the complexity of what we are doing.”“And the outcomes, the prize if you like is so significant in terms of both the quality and experience of care for the individual and their families.”Byron Connolly