Integrated Health System Planning

1
Integrated Health System Planning

• An exclusive Executive Circle Briefing

2
Agenda

• Overview of BC Healthcare Regionalization
• Vancouver Coastal Health Transformation
• Where we have come from
• Where we are going
• Success Factors
• Challenges
• Health Authority Collaboration Projects
• Lessons Learned

3
Regionalization Overview

• December 2001 NDP government consolidated 52
  regional and community health councils into 6
  Health Authorities
• Created five geographic health authorities to
  govern, plan and coordinate services regionally,
  plus the Provincial Health Services Authority to
  govern specialized province-wide services
• Each Health Authority consolidated their IT
  departments into integrated regional service
  units. i.e. VCHA merged 8 IT departments into 1
  corporate IMIS service unit

4
Health Authority Map
NHA (patient population 300,000) IHA (patient
population 700,000) VIHA (patient population
700,000) VCHA (patient population
1,100,000) FHA (patient population
1,500,000) PHSA (provincial population 4.3
Million)
5
Vancouver Coastal Health
6
VCH IMIS Context

• VCH 2006/07 Operating Budget 2.3 Billion
• IMIS 2006/07 Operating Budget 63.7 Million
• of total VCHA Operations 2.77
• Number of IMIS FTEs 415
• 2006/07 IMIS Capital Budget 66 Million
• Number of Network accounts 25,000
• Number of PCs 15,000
• 98 facilities spread across 58,000 km2

7
VCH Regionalization Review

• VCH merged multiple regions with multiple
  clinical, corporate and technical infrastructure
  systems.
• When VCH formed its IT infrastructure
• Lacked cross-site, cross-program, cross-network
  access to patient data
• Lacked a patient-centric view of information
• Inconsistent data standards and business rules
• Silos of clinical information
• Resulting in clinical/business issues
• patient safety compromised
• inability to implement key strategies
• customer dissatisfaction

8
Clinical Systems Journey
9
Clinical Systems - 2002
Richmond
Vancouver
Coastal
Providence
Acute
Eclipsys SCM
IDX LastWord
Health Vision
McKesson Star
Meditech
CCD
CCD
Hospital IS
HealthVision ADT
Pharmacy
BDM
BDM
Radiology
GE ProgRIS
IDXrad
Laboratory
CCD/3G
LabVision
Misys Lab/CoPath
LabVision
PACS
Intelerad
Agfa
Agfa
DI integration
Perioperative
ESI Orbit
GE ORMIS
Pyxis
Per Se ORSOS
GE ORMIS
Cardiology
Transcription
MS Word
SoftMed
MS Word
MS Word
Dictation
DictaphPHSA
Digital(unsupported)
Tape Dictaph PHSA Tape
Digital Express
DictaphPHSA
Digital Express
Coding and Abs.
3M
MS Access
3M
Softmed
3M
Community
Comm. health
In4tek PARIS
Procura
Momentum
Procura
Procura
Mental health
Synapse
Public health
iPHIS
RISE Healthware
Env. health
Hedgehog
Various
HealthSpace
Primary care
PCAC/CHC EMRs
Not supported
Practice EMRs
10
Clinical Systems - 2006
Richmond
Vancouver
Coastal
Providence
CareConnect Integrated Electronic Health Record
Acute
Eclipsys SCM
GE CareCast
McKesson STAR
Hospital IS
Pharmacy
HealthVision ADT
BDM
Radiology
GE ProgRIS
IDXrad
Laboratory
Misys Lab/CoPath
Stentor
Intelerad
Agfa
Agfa
Agfa
PACS
DI integration
Stentor Web Viewer, Agfa/Sun Deep Archive
Perioperative
GE ORMIS
GE ORMIS
ESI Orbit
Per Se ORSOS
Cardiology
GE MUSE
GE MUSE
Transcription
SoftMed
MS Word
SoftMed
SoftMed
Meditech
Dictation
DictaPhone
DictaPhone
Dictaphone
Coding and Abs.
3M
Community
In4tek PARIS
Momentum
Comm. health
Procura
Mental health
Synapse
RISE Healthware
Public health
RISE Healthware
iPHIS
Env. health
HealthSpace
Hedgehog
Primary care
PCAC/CHC EMRs
Vendor tbd
Wolf, Clinicare, OSCAR, etc.
Practice EMRs
11
Clinical Systems - 2010
Richmond
Vancouver
Coastal
Providence
CareConnect Integrated Electronic Health Record
Acute
TBD Review Underway
Hospital IS
Pharmacy
Radiology
GE
Laboratory
Misys
PACS
Agfa
DI integration
Stentor
Perioperative
GE ORMIS
Cardiology
GE MUSE
Provincial iEHR, PLIS, eDrug, DI, etc.
Transcription
SoftMed
Dictation
Dictaphone
Coding and Abs.
3 M
Community
Comm. health
In4tek PARIS
Procura (home support)
Mental health
Public health
Env. health
Hedgehog
Primary care
PCAC/CHC EMRs
IntraHealth
Practice EMRs
Vendors complying to provincial EMR standards
12
Infrastructure Journey
13
VCH Infrastructure Challenges

• Heterogeneous Infrastructure
• Inherited every flavour of hardware and OS
• Inherited a lot of legacy technologies
• Inconsistent Policies and Processes
• Everyone did things differently
• Different degrees of IMIS Process Maturity
• Insufficient Infrastructure Budgets
• Want it all integrated yesterday!

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Infrastructure - 2002
Richmond
Vancouver
Coastal
Providence
15
Infrastructure - 2006
Richmond
Vancouver
Coastal
Providence
16
Infrastructure - 2010
Richmond
Vancouver
Coastal
Providence
17
Corporate Systems
18
Corporate Systems 2002
Vancouver
Coastal
Providence
Richmond
19
Corporate Systems 2006
Vancouver
Coastal
Providence
Richmond
20
Corporate Systems 2010
Vancouver
Coastal
Providence
Richmond
21
Capital Investment 2002 - 2010
Clinical Corporate Infrastructure
2002-2006 48M 28M 14M
2006-2010 153M 34M 20M
Total 201M 62M 34M
22
Operating Costs
(Million) 2003/04 2004/05 2005/06 2006/07
IMIS Operating Budget 58.5 58.8 58.7 63.7
VCH Total Operating Budget 2,126.1 2,142. 9 2,237.3 2,300.0
IMIS of Total 2.45 2.74 2.62 2.77
23
Operating Trends
24
Success Factors

• Cross functional governance models
• Within VCHA
• eHealth, Corporate Infrastructure Steering
  Committees prioritize capital projects
• HSDA IMIS Advisory Committees links HSDA and
  IMIS operations
• IMIS Program Delivery Portfolio PMO
• Inter Health Authority Committees
• BC CIO Council
• Technical Advisory Group
• Network Working Group
• Directories and Authentication Working Group
• IT Planning
• Plan into Action, Application Integration
  Strategy, Technical Architecture, etc.
• Coordinate and balance internal needs, provincial
  eHealth directions and National initiatives
  (Infoway)
• Collaboration
• Internal Stakeholders
• Provincial partners the other health
  authorities and vendors

25
Regionalization Opportunities

• Rationalization of existing services
• Reduce duplication
• Used savings to drive future IMIS investment
• Contract Renegotiation
• i.e. Licensing, Network Connectivity, etc.
• Health Authority Collaboration
• Everyone was solving the same problems brought
  together inter-HA teams
• i.e. Created a Provincial IP Addressing Scheme

26
Regionalization Challenges

• Aligning collective agreements and contract staff
• IT department integration
• Geographic complexity
• System complexity
• Lack of investment or strategic prioritization in
  IT created a tremendous volume of pent-up demand
• Participation in multiple projects simultaneously
  while maintaining daily operations
• Balancing VCH needs with Provincial needs

27
Inter Health Authority Collaboration Projects

• Private Network Gateway (PNG)
• Dedicated, secure network linking all HA
• DI Emergency Transfer Grid
• Short term (10 day) DI storage partition
• 56 facilities capable of pushing images to the
  Grid
• 5250 studies pushed (Oct Dec. 2006)
• Network BC
• Broader Public Sector WAN contract negotiation
• Data Centre
• Broader Public Sector Data Centre Build

28
Lessons Learned

• Infrastructure view - focus on the basics
• Network Connectivity
• Directory and Domain Integration
• Email Consolidation
• Enterprise Backups
• Have dedicated HR and Finance support throughout
  the transition
• Staff consolidation
• Teasing out budget details
• Its about service delivery, not server delivery

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Thank you for your attention.