HIA

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• Towards an Electronic
• Patient Record
• Integrating Information Systems
• at N C H

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Overview

• Introduction
• Rapid growth of IS at NCH
• Infrastructure
• Clinical Flagships - PACS, CCIS, NCHAPPS OCF
• Challenges

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Introduction The Hospital and the Move

• Where the Children are
• 25 km West of Sydney
• Opened 6 November 1995
• 350 Beds Parent Beds
• 110 Departments
• 3000 Staff (1700 FTEs)
• Free Standing

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Introduction Strategic goals
GOAL 1 Information - Access and Sharing
Information to be accessible as an
organisational resource to support quality -
care delivery - resource management and
service planning - research - education
GOAL 2 Data and Technology - Technical
Infrastructure, Standards Policies
Comprehensive data and technology infrastructure,
standards and policies to support
information access and integration GOAL 3
Education and Training A continuous
process of comprehensive staff support and
training GOAL 4 Health Services Linkage
Promotion of linkages and information sharing
between healthcare services
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Rapid growth of IS at NCH What have we done ?

• Implementations
• Materials Management (Oracle)
• Diets Catering (Cbord)
• Radiology (Cerner Radnet)
• Imaging ( Siemens PACS Cerner RVS)
• Critical Care (Emtek CCIS)
• Interface Engine (HCI)
• Clinical Costing (MDIS Trendstar)
• Pathology (Cerner Pathnet)
• Clinical Repository (Cerner OCF)
• Windows 95 Upgrade

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Rapid growth of IS at NCH What are we doing ?

• Current Implementations
• Intranet/Internet (Local Development)
• Discharge Summaries (Local Development)
• Orders Management (Cerner Phase I)
• Year 2000 problem
• Pharmacy
• NCH APPS (CATS/Outpat, Dept DBs)
• Major Upgrades Oracle, Trendstar, CCIS, HCI, etc.

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Rapid growth of IS at NCH What will we be doing
?

• Future Implementations
• Cerner phases II, III IV (Bookings, Doc,
  Pathways)
• Patient Administration System (PAS)
• Health Information Exchange
• Document Pathology Imaging Workflow
• Electronic Data Interchange
• Interfaces

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NCH - Application Architecture
NCH Based Clinical Workstation
Community Based Clinical Workstation
Health Info Exchange (HIE)
Legend

• Integreted Clin Info.
• at the Point of Care
• Results ?
• Orders
• Images ?
• Careplans
• Critical Pathways
• Documentation
• Decision Support
• Intranet/Internet ?
• Medline/Cinahlü
• Mims/Nch Handbook
• Email ?

Future Direction
NEW BORN SCREENING
Planned
Current
NURSING (Pat Dependency)
?
Already available on line
CRITICAL CARE (Emtek)
HL7
Local Development

BILLING (Bilclin)
THEATRES (Orsos)
FINANCIALS (Oracle)
Clinical Repository (OCF)
FOOD SERVICE (CBord)
Pathology Results
AE Summaries
Critical Care Summaries
Document Pathology, Imaging Workflow
Orders Management Phase I
Provider Doc Phase III
CLIN. COSTING (Trendstar)
CLINICALS AE, Outpat, Discharge Sum, Dept DBs
e.g Ozgow, etc (NCH APPS)
Diag. Imag RVS Results
Discharge Summaries, O/P Letters
Other Clinical Data, Summaries
Scheduling Phase II
Clinical Pathways Phase IV
HL7
O/P BOOKING (NPR/Cerner?)
INTERFACE ENGINE (HCI)
DEPARTMENT CLINICAL DB.s
HL7
HL7
PHARMACY (Amfac-gt New)
PATHOLOGY (Pathnet)
PATIENT Admin (Hospas-gt New)
RADIOLOGY (Radnet)
PC Plus (Kodak Microfilm)
PACS (Siemens) via ISI Spooler
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PACS, CCIS, NCHAPPS OCFPACS - Definition

• Picture
• Archive
• Communication
• System
• The Acquisition, Archival and Retrieval of
  Digital images over a Computer network, for
  Diagnosis and Review at dedicated workstations

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PACS, CCIS OCFPACS - Workstation
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PACS, CCIS, NCHAPPS OCF PACS - Benefits

• Principal Benefits
• Constant, reliable and online access
• Faster turn around times
• Enhanced image manipulation
• Greater accuracy in reporting
• Images are sorted
• Cost per exam has decreased

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PACS, CCIS, NCHAPPS OCF CCIS - Definition

• Critical
• Care
• Information
• System
• Patient Monitor Information, Notes, Pathology
  Results, etc. in one unified view

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PACS, CCIS, NCHAPPS OCF CCIS Network Diagram

Decision Support System
23 PICU Central printer
Workstations
Administrative Server with Printer Modem
To EMTEK Support
Interface Server
16 NICU Central printer
Workstations
To Interface Engine HP Monitors
N e t w o r k
Tutorial 1
Jumbo Monitor
Tutorial 2
17 Review VIP printer
Workstations
Jumbo Monitor
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PACS, CCIS, NCHAPPS OCF CCIS Benefits

• Principal Benefits
• Interfaced to the pathology system, blood gases,
  ventilators, patient monitors etc.
• Information is
• EMR online - structured and can be searched
• more accurate, complete legible
• unified view
• Multiple users Multiple access

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PACS, CCIS, NCHAPPS OCF NCHAPPS - Definition

• Locally developed applications
• Discharge Summaries
• CATS - Computer Aided Triage System (ED)
• Patient dependency system
• Departmental databases (centrally developed)
• Meet requirements not met by major applications

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PACS, CCIS, NCHAPPS OCF OCF - Definition

• Open
• Clinical
• Foundation
• Pathology Radiology Results, Orders, Discharge
  Summaries, etc. in one unified view

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CHALLENGES

• Strategic Plan - (Developing Trust)
• Management Executive - Buy In - (ownership)
• Meeting user needs mgt expectations
• Capital Recurrent Costs
• IS vs Clinical
• Recognise recurrent costs up front
• Benefits Realisation
• Vendor management and alliances

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CHALLENGES

• Development of EMR - getting the mix right
• Cerner Clinical Repository
• Vendor systems
• Local/Consortium development
• Application Management Data Quality
• Formalise the roles
• Coordinated Central management
• Policy Procedure Development
• e.g. privacy confidentiality

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CHALLENGES

• Constant change Change management
• Ongoing education of staff
• User
• Support
• Developing retaining knowledge
• Making use of new technology (CORBA, Java, etc)

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Q u e s t i o n s
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Thank you.
www.nch.edu.au