EHealth in South Australia Where Are We Now

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E-Health in South Australia Where Are We Now
Where Are We Going?Tasmanian eHealth Expo11th
July 2007
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Overview

• History of eHealth initiatives in SA
• SA Health Strategy
• IT Vision for SA Health
• Role of the careconnect.sa program
• Role of the HealthConnect SA program
• Lessons learned to date
• Strategies for the future

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About South Australia
South Australia Population 1.5 million Land Area
984,000 sq Km
Adelaide Population 1.1 millionLand Area 750
sq Km
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careconnect.sa - History

• 1995 Pilot implementation of Oacis to connect
  the Renal Units within the 4 major metropolitan
  hospitals
• 2000 SA government approved the extension of
  the system to cover all units within the 8
  metropolitan hospitals through the careconnect.sa
  program
• 2007 - Implemented hospital system provides
• Integrated on-line patient record
• Separation (discharge) summary functionality
• Electronic ordering
• Infection control system
• Clinical reporting system

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careconnect.sa - Today

• In summary
• A patient record is reviewed every 9 seconds
• An electronic order is placed every 53 seconds
• Every 5 minutes a Separation Summary is finalised
• 91 of GPs in the GP Registry has been faxed a
  Separation Summary
• Renal patient paper record volumes reduced by 95

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SA Health Strategy

• The State Government has developed a number of
  strategies in order to meet South Australias
  health care challenges.
• Restructured public hospital system
• Focus on primary health care
• Support for self-management
• Helping clinicians to work together 
• Improving information technology

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SA Health Strategy

• Health Benefits
• Australia's most integrated health system
• Most comprehensive primary health care system
  in Australia
• Most advanced hospital in Australia
• Less pressure on Emergency Departments
• More elective surgery
• Improved staff recruitment retention
• New era in cooperation leadership amongst
  clinicians
• Performance culture that delivers efficiency

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Stepped care where when needed
Clinical Networks
GP, Private, NGO, Commonwealth and Community
Sector
Community individual capacity for own health
and wellbeing
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Achieving the Vision - IT

• Better information systems required for
• Acute setting
• Community and mental health
• Primary care
• Greater level of integration required between all
  systems in all settings
• Importantly, funding has been made available for
  these purposes

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Mental Health
Community Health
Aboriginal Health
Hospitals
PUBLIC
DomCare
Other
Info broker
Care Planning System
Web gateway
GPs
Allied Health Providers
Pharmacies
Patients And Carers
PRIVATE
Specialists
Private Hospitals and Clinics
Aged Care
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careconnect.sa Program

• Further utilisation and development of existing
  hospital clinical information system
• Patient Administration System
• Calls for tender to develop business case closed
  14 May 2007
• Nursing Information System
• Procurement underway
• Mental Health and Community Health Information
  Systems
• In the process of being reviewed as part of an
  initiative called the "Community Systems Review
  Project". High level requirements have been
  defined. The next phase of the Project is
  sending out a request for information and
  development of a business case. This phase is
  estimated to take 9 months
• Pharmacy Management System
• Procurement underway

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HealthConnect SA Stakeholders

• Primary focus is on the following groups in the
  primary health care sector
• Allied Health Professionals (in particular
  Aboriginal Health Workers, Audiologists,
  Chiropractors, Diabetes Educators, Dietitians,
  Exercise Physiologists, Mental Health Workers,
  Occupational Therapists, Osteopaths, Pharmacists,
  Physiotherapists, Podiatrists, Practice Nurses,
  Pscyhologists, Social Workers, Speech
  Pathologists)
• General Practitioners
• Patients and Carers
• Specialists
• Secondary focus is on establishing links between
  the primary health care setting and the community
  health setting
• Links with the acute care setting are also
  desirable

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HealthConnect SA Program

• Infrastructure
• Broadband Security Packages
• Providing secure broadband connections and
  security health checks to health care providers
  to enable them to exchange health information
  electronically and securely.
• Point to Point Messaging
• As an output of our Connectivity Options Study
  we are currently scoping the need, and
  implementation of point to point messaging
• Integrated Health Care Provider Address Book
• Inclusion of allied health providers into the
  existing South Australian Health Provider
  Registry

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HealthConnect SA Program

• Change Management
• Care Planning Communication Trial...A 12 month
  trial (to Nov 07) involving 3 Divisions of
  General Practice
• Awareness Raising Activities
• State-wide roadshow covering care planning,
  Medicare CDM items and e-health readiness
• Supporting Applications
• South Australian Care Planning System (SACPS)
  developing an electronic care planning system
  to help health care teams manage patients with
  chronic conditions collaboratively

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SA Care Planning System

• NEHTA standards based (Service Oriented
  Architecture, web services model, Identity
  Management Model)
• Interoperability with a number of key State and
  National systems (eg. Health Provider Registry
  -gtNational UHI Service, Oacis, Medical Director
  etc.)
• Internal client index initially, potentially
  migrating to an external client index in due
  course
• /cont.

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SA Care Planning System

• Internal provider directory populated by the
  Health Provider Registry
• Web portal for access into the system
• Templates for disease specific care plans
  including best practice guidelines
• Support for self-management
• Decision Support functionality to implement best
  practice guidelines

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Infrastructure - Learnings

• The case for managed health networks in the
  primary care setting is far from clear.
• Progressing point-to-point communications in the
  meantime will
• Provide secure connectivity and streamlined
  workflow for transmission of referrals and
  receipt of letters and discharge summaries
• Enable connectivity of providers not part of any
  managed health network as well as geographically
  dispersed providers
• Provide a workable alternative to managed health
  networks

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Infrastructure - Learnings

• Consideration should be given to developing an
  agreed standard for determining the overall
  security levels of e-health sites
• Consideration should be given to funding regular
  security health checks and introducing IT
  security education and awareness programs for
  providers
• Consideration must be given as to how health care
  providers can be funded to remediate and address
  the security problems identified during the
  health checks and
• An analysis and identification of what is the
  best IT support model to ensure IT security
  within the e-health provider sites should be
  undertaken.

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Change Management - Learnings

• Uptake of new initiatives amongst primary health
  care providers is conditional on being able to
  actually demonstrate the following
• Financial benefit
• Improved health outcomes for patients
• Improved workflow (or at the minimum, no
  detrimental impact to workflow)

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Financial Benefit

• Medicare rebates for care planning for GPs can be
  financially rewarding
• Business models and tools exist to demonstrate
  how care planning can be financially viable for
  GPs. CPD events to demonstrate these to groups
  as well as support within Divisions for
  individual GP practices
• Currently there are problems with medicare
  rebates for allied health professionals.
• New systems which involve change in practices
  need to be introduced at low (or no) cost

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Improved Health Outcomes

• Be careful of the claims that you make .
  evidence of how care planning improves health
  outcomes needs to be documented
• Use Clinical Champions to present the evidence
  via
• Dedicated education and awareness raising
  sessions
• Existing communication channels
• Extensive communications component involved

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Workflow

• Key requirement is ensuring interoperability of
  disparate clinical systems
• There is also a need to implement business
  process change to modify existing workflows in
  order to introduce efficiencies
• Business process change requires executive
  support to have any chance of success and needs
  to relate to an overarching strategic direction

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The Future

• HealthConnect SA is working in partnership with
  its stakeholders to ensure all programs targetted
  at primary health care workers are working
  together to achieve the overarching strategy of
  SA having the most comprehensive primary health
  care system in Australia
• These initiatives include
• GP Practice Nurse Initiative
• Allied Health Systems in General Practice
• Health care provider education and awareness
  raising
• Self-management programs (planned roll-out of
  Stanford Lorig internet based program)

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The Future

• Technically, the sharing of clinical information
  between public sector and the private sector will
  be enabled through the use of an information
  broker
• Looking to ALRC Privacy Review and NEHTA to
  provide the way forward regarding privacy
  considerations
• South Australia will be well placed to
  participate in national initiatives

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How to stay informed
Subscribe to the regular HealthConnect SA
newsletter HealthClix or contact the Care
Planning Project Manager Eleanor Royle Tel
[phone] Mob [phone] Or visit
www.healthconnectsa.org.au