Presentation on the Oacis PowerPoint Template and its use

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Oacis Programme Future Directions for the
Linkage of Data in the South Australian Health
System Overview Presentation
27 October 2003 Presenter Scott Germann
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Oacis Programme Drivers

• Improved patient safety and higher standard of
  patient care
• Better clinical decision making through timely
  and complete information availability through
  continuity of information across facilities
• Increased patient satisfaction owing to reduced
  duplication of information collection and
  services
• Improved efficiency of health care delivery
• Decrease in the number of duplicate pathology and
  radiology tests undertaken
• Enhanced communication between service providers
  

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Scope of Deployment
Oacis is being deployed across eight Adelaide
metropolitan public hospitals, enabling real
time sharing of clinical information.
15Km
50Km
Value
1,524,148
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The Oacis Programme
The Oacis Programme comprises a series of
integrated projects connecting hospitals, health
professionals and the community to benefit health
service delivery in South Australia via
information technology.
Clinical Reporting Repository complements Oacis,
providing the capability to query, analyse, and
explore the substantial clinical data held across
the patient population in the Oacis Data
Repository (the data store for Oacis).
Clinical Display provides a single point of
access to integrated patient demographics,
patient encounters, outpatient appointments,
patient medications, laboratory results and
radiology reports.
Clinical Order Management is an electronic
ordering system for pharmaceutical, diagnostic,
therapeutic, medical and surgical patient
services and incorporates best practice
information into multi-disciplinary order sets.
Separation Summary communicates information from
Oacis to General Practitioners and other
referring providers about a patients hospital
encounter to ensure continuity of ongoing
healthcare.
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Oacis in South Australia
Major Accomplishments since March 2000 -
Infrastructure

• Re-mediated Hospital Infrastructure
• Power and data cabling installed
• Campus technology infrastructure (backbone
  switches, distribution switches, interface
  servers, authentication servers) upgraded
• Hospital based training facilities investment
• 1,000 workstations installed in 4 months
• Greater than1,500 workstations to date

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Oacis in South Australia
Major Accomplishments since March 2000 -
Applications

• Oacis Clinical Display Extended Implementation
• Clinical Display extended from the original Renal
  Units of 4 sites to a total of 72 clinical units
  across the 8 metropolitan sites
• Increased the number of clinical users from 250
  to over 9,000
• Clinical Order Management
• Standard enterprise service catalogue developed -
  currently 4,000 to 5,000 orderable services.
  These include laboratory, imaging, pharmacy,
  gastroenterology, respiratory and cardiology
• Redefined process flows incorporating Oacis
  ordering capability
• Tested application at RAH (renal) LMHS (AE)
• Rollout commenced
• Separation Summary
• Involved GP Divisions across the State for
  functional requirements
• Developed and currently running application at
  WCH rollout commenced
• GP Registry due for commissioning in September
  2003

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Oacis Architecture
Admissions
Clinical Display
Clinical Reporting Repository
Laboratory
Order Management
Cloverleaf
Radiology
Oacis Gateway
Data Entry
Pharmacy
Oacis EMPI Matches and links patient demographic
information
Oacis Data Repository
Theatre
Separation Summary
Stores relevant information from departmental
systems and clinicians
Emergency
Query Analysis
Other Systems
38 interfaces currently in place
80,000 transactions per day
2,500 enabled workstations
Over 260 million patient service records Over
270Gb database growing at 1.4Gb per week
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CRR Overview
The Clinical Reporting Repository
complements the Oacis application suite,
providing the capability to query, analyse, and
explore the substantial clinical data held across
the patient population in the Oacis Data
Repository (the data store for Oacis).
RAH FMC WCH LMHS TQEH RGH NHS MPH
ADT
Oacis Data Repository (ODR)
Pathology
Clinical Reporting Repository (CRR)
Radiology
Emergency
Clinical Data Entry (Renal)
Clinical Order Management
Separation Summary
Pharmacy Order Management
Future
Operating Theatre
OACIS DATA SOURCES
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CRR Drivers
Specific drivers were identified in the
Implementation Planning Study as key to the
development of a Clinical Reporting Repository.


CLINICAL DECISION SUPPORT Facilitate better
informed clinical decision making and patient
care. Cross-patient Analysis Patient History
Reporting Best Practice Analysis
CLINICAL RESEARCH Development and evaluation of
protocols, treatments and drugs. Outcomes and
Quality Care Analysis Epidemiology and Public
Health Data Mining
CRR


CLINICAL REPOSITORY Volume and content of the ODR
make reporting potential impressive. Optimised
Query Capabilities Data Trend Analysis Historical
Reporting
PRODUCTIVITY IMPROVEMENTS Automation of reporting
processes and enhanced reporting capabilities.
Timely Data Analysis Cross-functional
Reporting Automated Statistical Analysis
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CRR Overview - High Level Data Sets
Eg. Patient Demographics, Mortality
Eg. Inpatient Admission, Outpatient Booking
Eg. Admitting Doctor, Consulting Physician
Eg. Ordering Information for Results
Eg. Ward, Clinical Unit, Patient movements
Eg. Pathology, Radiology, Dialysis information
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CRR Overview - Metrics

• The CRR
• Holds approximately 1.3 billion Clinical
  information records.
• Grows by approximately 900 thousand records per
  day.
• Consists of 180 Gigabytes of information.
• CRR Key Data Holdings as at September 2003
• Record count excludes
  additional low level information and linkages

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CRR Overview - Patient

• Patient data includes
• Patient Demographics, eg. Address, Age, Sex,
  Religion, Racial Origin, etc. (relating to approx
  1.4 million individual patients).
• Medical Record Number information for Patients at
  each Hospital Site (Approximately 12 million
  records). Each patient may have multiple Medical
  Record Numbers.
• Patient Alias information (Approximately 800
  thousand records).
• Potential exists for Patient Allergy information,
  however standards for coding need to be
  developed.
• Data originally loaded from hospital source
  systems in 1997, actual records may predate.
  Historical tracking of demographic data available
  from July 2003.

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CRR Overview - Encounter

• Encounter data includes
• Admission and Discharge information for
  Inpatients, Outpatient appointments and Emergency
  attendances (Approximately 8 million records).
• Diagnosis Coding information including Primary
  Diagnosis on Discharge, Procedure and
  Complication information (Approximately 7 million
  records).
• Data available from as early as 1997 depending on
  the date the ADT interfaces were implemented.

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CRR Overview - Location

• Location data includes
• Clinical Unit and Ward Location information
  within a Hospital Site during the course of a
  Patients Encounter (Approximately 1.6 million
  records).
• Patient movements (transfers) between locations
  within a hospital.
• Data available from 1998, however tracking of
  movement within a site available from July 2003.

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CRR Overview - Results

• Result data includes
• Pathology results, Imaging results, and Dialysis
  information (including Regime and Transplant) -
  Approximately 220 million records.
• Text Based Reports for Pathology and Radiology -
  Approximately 130 million records. Free text
  search capability exists.
• Microbiology information - Approximately 4
  million records.
• Data available from 1997. Data may be staggered
  depending on when Renal, Pathology and Radiology
  systems started sending information to Oacis.
  Earlier data is present but has some data quality
  issues.

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CRR Overview - Orders

• Orders data includes
• Orders information for Radiology and Pathology
  Services (Approximately 3 million services).
• Data is limited to those placed by Clinical Order
  Management in 2002.

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CRR Overview - Provider

• Provider data includes
• Clinician contact details, site affiliation, and
  a link to the patients where they are the
  admitting or consulting physician (Approximately
  140 thousand clinical providers).
• External Identifier information such as Provider
  Numbers at different sites (Approximately 100
  thousand records).
• Data available from 1997 depending on when each
  hospital ADT systems started providing this
  information to Oacis.

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Example Reports

• Query "Across Hospital sites, how many Patients
  over 65 years old were discharged in Year XXXX?"

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Example Reports

• Query "Across Hospital sites, how many Patients
  where discharged with a Primary Diagnosis of
  Fractured Neck of Femur?"

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CRR Key Challenges

• Data Quality and Standards Data Quality and
  lack of Enterprise Standards affect the
  performance and usability of the CRR. The
  majority of these are inherited from the source
  systems in the hospitals and pathology providers.
• Privacy and Access There is at present no
  Enterprise Access Model or Framework for the CRR.
  This is currently being driven through the CRR
  Steering Committee. Complexity for approval of
  access increases as the population for
  investigation increases e.g. running queries at
  the clinical unit level vs. running queries at
  the enterprise level for QA or Research purposes.
• Enhancing the usability of the reporting toolset
  for ad-hoc queries (Business Objects WebI)
  Sophisticated ad-hoc queries require technical
  up-skilling for users and intimate knowledge of
  the data and data structure. Advanced statistical
  functionality not currently present in toolset
  but has ability to download to other packages to
  perform these tasks.
• Rigorous data validation needs to be performed
  before data can be used across the enterprise.