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DIGITAL STRATEGY 2021 – 2026
Northern Sydney Local Health District
Version 1.1
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Northern Sydney Local Health District would like to acknowledge the Traditional Custodians of the Northern Sydney region, the Gai-mariagal and Dharug peoples. Their spirit can be found across the region and we honour the memory of their ancestors and Elders, past, present and emerging. As we endeavour to serve the health needs within the community, we recognise the importance of the land and the waterways, as an integral part of people’s health and wellbeing.
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Foreword Digital Strategy 2021 - 2026
During my time at Northern Sydney Local Health District (NSLHD), I have always been touched by the exceptional quality of care our staff provide to our patients. NSLHD staff are constantly working towards the best idea or innovation to improve the experience of our patients. While the human aspect of care is the most important, the technology we use also plays a pivotal role in assisting our doctors, nurses and allied health professionals deliver the services people need. The past 18 months have highlighted how integral digital technology has become in healthcare, with the COVID-19 pandemic delivering award-winning solutions like the virtual hospital, and ever-increasing telehealth services. In partnership with eHealth NSW and other statewide NSW Health agencies over the past five years, we have also seen significant expansion to our eMR including the delivery of an electronic medication system. We have also seen an intensive care clinical information system the radiology information system and picture archive and communication system; and numerous other clinical enhancements including advanced care planning, end of life care planning and remote access technology.
However, it’s important we continue to do everything we can over the next five years to continue to deliver the best care, outcomes and patient and staff experience. That is why I am delighted to present the Northern Sydney Local Health District Digital Strategy 2021-2026, a roadmap will support staff and patients better connect with our local health district. In this document you will read about how we plan to harness the power of digital technology to elevate the patient experience with a focus on virtual care; how we can empower our workforce and improve user experience and mobility; and harness the power of data to improve care delivery and operations. We are committed to developing our digital infrastructure in a sustainable way, while strengthening our privacy and cybersecurity capabilities and responsibilities. Thank you to everyone who has contributed to the Digital Strategy. Your continued commitment will be vital to achieving the aspirations set out here over the coming years.
Deb Willcox
This truly is an exciting time, not just for our district, but for healthcare and we all have our part to play.
Chief Executive
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Table of Contents
Foreword Digital Strategy 2021 – 2026
Executive Summary
1. Introduction 1.1 A Digital Strategy to guide future investments 1.2 Macro drivers for change 1.3 Local aspirations further driving change 1.4 Working in alignment with NSW Health 2. Where we are today 2.1 Current state assessment, top down 2.2 Current state assessment, bottom up 3. Where we want to be 3.1 Our Digital Strategy vision 3.2 Our Digital Strategy guiding principles 3.3 Digital Strategy focus areas 4. How we will get there 4.1 Digital Strategy roadmap approach 4.2 Digital Strategy roadmap 5. Executing in partnership 5.1 Implementing the Digital Strategy 5.2 Ongoing considerations 6. Appendices
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Executive Summary | Introduction to the Digital Strategy
The imperatives for continuous digital technology investments
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Our local aspirations 4
Diverse district, distinct challenges Demographic factors, such as a growing and ageing population and distinct socioeconomic differences, mean our communities require a tailored approach to healthcare delivery. Continuing to leverage digital technologies holds the key to providing quality and sustainable services while evolving our models of care.
A great experience for our patients
Digital Strategy Objective
Making virtual care universal where appropriate
The Digital Strategy 2021-2026 sets the technology vision and focus areas for our LHD over the next five years and articulates a roadmap to achieve this vision. This document should be used as a guide for priorities, a way to plan the project pipeline and a reference point for proposed work. Significant improvements in technology have helped NSLHD provide better health outcomes for our population. However, much has changed since the last IT plan released in 2016. By more effectively leveraging technology, we can deliver affordable and accessible patient-centred care, improve the overall health of our communities, engage and develop our workforce and ensure our organisation is agile and insights driven fuelled by real time access to data. To meet these aspirations, and to ensure that future digital investments enable our LHD Strategic Plan in line with the statewide NSW Health strategies, now is the right time to refresh our Digital Strategy.
An empowered and mobile workforce
Technology advancements Technology advancements are causing a fundamental shift in how health services will be provided in the future. Patient and community expectations, digital disruptions, big data, the need for integrated care and personalised medicine will require gradual investments over time to seize the opportunities they each represent. 2
Better Integrated care across care settings
Insights driven organisation fuelled by real time access to data
Sustainability through sound digital investments
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Our staff aspire for more
A technology ecosystem that protects privacy and ensures platform security
Our staff aspire to a greater technology experience that can help them be more empowered, productive and engaged while accomplishing their jobs more effectively. Investments should be made to meet those aspirations and draw upon the innovative thinking of our people.
Collaborative ICT services that maximise value
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Impediments to advancing our strategic plan
Healthy communities Major advancements were made in virtual care models during the COVID-19 pandemic, yet more can be done. Significant investment will be needed for our LHD to expand the use of virtual technologies through enhanced models of care, where appropriate, that address health issues or patient deterioration before or post hospitalisation for instance. Connected person-centred care The digital end-to-end patient experience is at its infancy, underpinned by a combination of manual and digital processes. Patients do not have the ability to ‘take control’ of their health journey with self -service tools or services e.g.: electronic bookings, appointment management, digital pre-admission forms etc. Furthermore, the process of unifying records across care settings is still highly disconnected creating the need for the patient to continue being the conduit of information sharing. For example, most referrals from GPs to hospitals are still paper based and the quality of discharge summaries is lacking, if ever delivered back to the referrer. Evidence-based decision making While we collect a lot of data in our day to day work, and while we have many reports and dashboards, it is still very difficult to derive insights from the data to truly drive change. Often, our staff must manually join data across multiple systems and reports to achieve something useful. For example, there are many missed opportunities to use the eMR collected data to help clinicians make better decisions. Responsive and adaptable organisation The ICT team have fostered and built good relationships and partnerships with the clinical, operational and administrative parts of the organisation. To continue responding to the needs of the organisation, the ICT function must improve a combination of existing capacity constraints, capability gaps, a lack of cohesiveness across ICT teams and improve the governance surrounding how demand is managed. Engaged and empowered workforce The usability of many clinical systems requires focused investments to be more intuitive, to enhance staff productivity and improve user experience for example through decision support that goes beyond basic alerts. Our staff should feel empowered in using the eMR and our other tools, rather than feel that it is the laborious part of their job. Mobility is improving, however more focus is needed to enable native mobile applications so clinical, operational and administrative work can be completed on the go using the right device for each job.
Executive Summary | Enabling the Strategic Plan
Advancing our strategic plan
While our LHD has, over the years, utilised technology to improve delivery of care and enhance operations, many opportunities still exist to better enable delivery of our strategic plan and focus areas through digital technologies.
These are the key digital impediments to advancing our strategic plan as articulated by our staff.
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Invest in digital solutions to enable our strategy
We will…
and help us meet our aspirations for the future
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4 5
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Elevate our patients experience and focus on virtual care
Empower our workforce, improve user experience and mobility
Harness the power of data to improve care delivery and operations
Enhance connectedness within the LHD and across care settings
Ensure infrastructure and digital investment sustainability
Continue to optimise the ICT service function
Strengthen privacy and cybersecurity capabilities
The Digital Strategy recognises seven focus areas that will guide digital investments, enable the strategic plan priorities and deliver benefits to the LHD through a set of 27 defined initiatives.
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Executive Summary | Digital Strategy Roadmap
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Elevate our patients experience and focus on virtual care
Empower our workforce, improve user experience and mobility 2.1 Respond to the major eMR gaps in clinical specialty areas
Harness the power of data to improve care delivery and operations
Enhance connectedness
Ensure infrastructure and digital investment sustainability 5.1 Align to the statewide modern infrastructure procurement and management frameworks
Continue to optimise the ICT service function
Strengthen privacy and cybersecurity capabilities
within the LHD and across care settings
4.1 Implement the Single Digital Patient Record (SDPR)
1.1 Elevate the human experience
3.1 Optimise the data and analytics capability
7.1 Uplift cybersecurity and privacy capability
6.1 Review the current ICT operating and service model
2.2 Continue to enhance the eMR
1.2 Introduce a Patient Portal for patients and their families (digital front door)
6.2 Enhance demand management and prioritisation processes
7.2 Build a cyber aware culture
4.2 Refresh the interoperability infrastructure
5.2 Continue to support the capital developments
3.2 Leverage the statewide Data Lake initiative
2.3 Introduce real time peer to peer clinical communication
4.3 Enhance two-way clinical information flow with external settings
3.3 Complete the rollout of Enterprise Data Warehouse (EDWARD)
1.3 Enhance virtual care and supporting systems
7.3 Enhance data privacy management
2.4 Rollout Rapid Access functionality
1.4 Provide tools to support patient remote monitoring
3.4 Align to statewide data governance and stewardship
2.5 Improve clinical mobility
1.5 Leverage statewide Patient Reported Measures (PRMs) and HOPE platform
2.6 Enhance collaboration and unified communications
1.6 Align to the statewide Shared Care Plans investments
2.7 Enhance and mature the feedback and ideas portal
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Executive Summary | Digital Strategy Key Considerations
Partnerships WO R K I N G T O G E T H E R T O AC H I E V E T H E AS P I R A T I O N S O F T H E D I G I T A L S T R A T E G Y
Managing Change
R E D U C I N G D I S R U P T I O N W H I L E M E AS U R I N G O U T C O M E S AN D R E A L I S I N G B E N E F I T S
All of the proposed initiatives require significant change management and benefits realisation focus to ensure the resulting technology is successfully embedded in everyday use, staff are adequately trained, and the expected benefits are realised.
Implementing this Digital Strategy requires internal and external stakeholders working together in partnership to achieve the envisioned outcomes. This includes LHD executives, staff, the local ICT function, the Central Coast LHD (as we share the ICT function), as well as NSW Health (Agencies, Pillars and Shared Services organisations), the community, and other government agencies.
Funding
E N S U R I N G F I N AN C I A L S U S T A I N AB I L I T Y
Single Digital Patient Record
Funding is an important consideration without which the vision and outcomes outlined in the Digital Strategy cannot be achieved. In many cases, a business case will be required to seek funding support for major initiatives as BAU funding will not be sufficient. Recurrent operational expenditure funding will play an increasingly important role as technology continues to move away from the traditional capital expenditure funding models.
B A L AC I N G I N V E S T M E N T W I T H P AR T N E R S H I P
A significant focus of the Digital Strategy is enhancing and supplementing the eMR, in alignment with the NSW Health vision for a Single Digital Patient Record (SDPR). This is a key consideration that must be continually reassessed to ensure the current decision of aligning to the SDPR continues to be the most viable option for the NSLHD.
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1. Introduction
Setting the Digital Strategy context
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The ‘NSLHD Strategic Plan 2017 - 2022’ highlights five themes
Evidence-Based Decision Making Decisions are made on the basis of best available information and a philosophy of continuous improvement
Connected Person-Centred Care People have a good experience of care, which meets their health needs, in partnership with multiple care providers
Healthy Communities
The objective of the Digital Strategy is to continue to enable our LHD’s strategic plan through targeted investments in technology over the next five years.
Prevention, early intervention and community development strategies will improve health outcomes
Our staff are confident, capable and committed to the support and delivery of good care every day Engaged & Empowered Workforce
Our structure and systems support the delivery of innovative and responsive services in partnership with other providers and our community Responsive & Adaptable Organisation
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1.1 A Digital Strategy to guide future digital investments
Diverse district, distinct challenges
Much has been achieved working together
A Digital Strategy to guide technology investments
Northern Sydney Local Health District (NSLHD) spans nine local government areas across a 9,000 km 2 area. It is home to one million people who access services through ten hospitals, along with affiliated health organisations and public private partnerships. Population and demographic trends create distinct challenges and opportunities that NSLHD must meet, including: ► Our population is growing and ageing . By 2036, 20% of the population will be over 65, the largest growth compared to any other demographic over the next
NSLHD has made big strides in the last five years, not least through the use of digital solutions, to be agile in response to the COVID-19 global pandemic. Key technology achievements beyond the pandemic response include: ► Australia’s first implementation of the Clinical Health Information Exchange product to enable continuity of care with NBH. ► Implementation of COVID-19 vaccination and testing clinics and the award winning Virtual Hospital for monitoring COVID-19 patients. ► Implementation of multiple major eMR enhancements including eMeds, Advance Care Planning and End of Life Care as well as the Clinical Application Reliability Improvement (CARI) program to improve business continuity for the eMR. ► Implementation of the new Intensive Care Clinical Information System (eRIC), an enterprise-wide ICU clinical information system integrated with other systems including the eMR, Radiology and Pathology. ► Rollout of the Radiology Information System and Picture Archive and Communication System (RIS-PACS) to replace the previous medical imagine system.
Significant improvements in technology have helped NSLHD provide better health outcomes for our population. However, much has changed since the last IT plan released in 2016: ► Demographic trends in our population create new challenges and expectations from our communities. ► The local aspirations of our staff have evolved to be more ambitious and demand more from the technology we use in our work environment. ► The ICT organisational design changed to provide greater focus on business relationships, improve service delivery and cyber security. ► Changes in the macro healthcare landscape demand new technology to support emerging models of care. To meet these challenges, and to ensure that future digital investments enable our Strategic Plan and are in alignment with statewide NSW Health strategies, it is the right time to refresh our Digital Strategy. By more effectively leveraging technology, we can deliver affordable and accessible patient-centred care, improve the overall health of our communities, engage and develop our workforce and ensure our organisation is agile and insights driven fuelled by real time access to data. The Digital Strategy 2021-2026 sets the technology vision and focus areas for our LHD over the next five years and articulates a roadmap to achieve this vision. This document should be used as a guide for priorities, a way to plan the project pipeline and a reference point for proposed work.
decade. While we must plan services and meet demand accordingly, we expect that technology will play a role in enhancing the continuity of integrated care and help support our community through irrespective of setting. Our residents compare favourably on most socioeconomic and health indicators against the rest of NSW, including a lower standardised mortality ratio. However, there is a higher mortality for stroke than the NSW average and sub-groups of NSLHD do not enjoy the same socioeconomic or health status. We need to
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continue supporting healthy lifestyles through preventative health interventions and virtual care options, and use data to drive community wellness. Ensuring our services are equitable and accessible is paramount. ► Our residents have, on average, greater access to both public and private health services , with 71% of
► Rollout of the new statewide Incident Management System (ims+).
► Implementation of the Oncology Management Information System.
► Implementation of digital health technology at Hornsby Hospital including the patient queue management system and the pharmacy robot. ► Patient Wi-Fi services for patients and visitors on personal devices.
the population having access to private health insurance. This creates greater opportunities for partnerships.
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Our District covers an area of 900km² and encompasses 9 local government areas (LGAs) including Hornsby, Ku- ring-gai, Northern Beaches, Hunters Hill, Lane Cove, Mosman, North Sydney, Ryde and Willoughby.
Northern Sydney LHD in numbers
25,000 Annual operations (based on 25,620 episodes of care)
515 Patients serviced from COVID-19 virtual ward in 2020
Over 153,000 Annual ED Presentations
20% of the Northern Sydney population will be
71% access to private health insurance (vs 48% NSW average)
45.1% overweight or obese (vs 55.2% NSW average)
Delivered around 4,000 babies annually
aged over 65 years by 2036 (as of 2019)
Sources: Department Planning, Industry and Environment: 2019 population projections NSW Population Health Survey (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health: 2019 Overweight and obese adults by LHD NSW Perinatal Data Collection (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health: 2019 Total births by LHD Bureau of Health Information. Health Observer, NSW Health: 2020 NSLHD Emergency department activity Bureau of Health Information. Health Observer, NSW Health: 2020 NSLHD Hospital admissions activity NSLHD Safety and Quality Account 2019-2020 Report; 2020-2021 Future priorities, https://online.flippingbook.com/view/993762
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We have achieved much together since the last ICT plan
Radiology Information System and Picture Archive and Communication System (RIS-PACS)
Oncology Management Information System (OMIS)
Wi-Fi services for patients and visitors on personal devices
Intensive Care Clinical Information System (eRIC)
Virtual hospital
Clinical Application Reliability Improvement (CARI)
ICT Plan 2016
Digital Strategy 2021-26
Advanced care planning and end of life care planning eMR improvements
eMeds
Skype for Business
Incident Management System (ims+)
ICT Solutions Delivered network communications through effective partnerships, enabling pop-up testing clinics with full electronic access for clinicians; implemented COVID-19 SMS Result Service; and deployed ICT equipment to connect patients with their loved ones.
COVID-19 Virtual Hospital Established a COVID-19 Virtual Hospital to enable remote monitoring and decrease reliance on hospital presentations and admissions.
Combatting COVID-19
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1.2 Macro drivers for change
Technology advancements and changes in the global healthcare sector are causing a fundamental shift in how health services will be provided in the future. Gradual investments are required to accommodate these changes over time and seize the opportunities they present.
Patient, family and carers’ expectations of health care continue to increase due to the availability of information, enhanced health literacy and digital experiences in other areas of people’s lives.
The health consumers are embracing new digital technologies and customised services for their care an wellbeing. For instance, remote monitoring technology such as wearables and smart appliances is being embraced by consumers who are more willing to share personal data for greater service. Service providers will be able to make micro-interventions to keep people healthier, for example through analysis of DNA to predict and target treatment. The past decade has seen rapid development and adoption of technologies that change the way we live and will have a similarly transformative impact on health and care.
Patient, family and carers redefined
Personalised care
Portable diagnostics
Genome sequencing
New patient
Enhanced health literacy
Smart device
An ageing population, increasing burden of disease and greater focus on health prevention results in increased demand for healthcare services and the subsequent workforce implications.
Shifting workforce
Ageing Population
Service Demand
Digital disruption
Health care demands are changing, increasingly requiring the involvement of a multidisciplinary team within and across organisational boundaries.
Integrated care
Digital therapeutics
Machine learning
Implant drug delivery
Greater access to quality data is increasing our understanding of how diseases develop and spread, as well as beginning to enable personalised, precision medicine.
Open information and big data
Connected Health Systems
Patients with chronic and complex support needs
Knowledge increase
Access to Data
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1.3 Local aspirations further driving change (1/2)
Further to the macro trends, our staff have articulated a clear ambition of how technology can improve the way they deliver quality care, optimise operations and improve outcomes.
An empowered and mobile workforce
A great experience for our patients
“Systems must simplify and add value to our workflow by automating mundane tasks, provide insights to support decisions, enable real time collaboration between teams, and support remote work.”
“A great end -to-end experience for patients through enhanced digital means, just as we all experience in other industries, including electronic appointments, two- way notifications, patient portals and mobile apps.”
Better Integrated care across care settings
Making virtual care universal where appropriate
“Improve the connectedness of information and systems within the LHD and across care providers, whether private or public, to provide better and more holistic care for our patients.“
“Improving care outcomes by providing accessible options for early and ongoing, at-home services including telehealth and remote monitoring.”
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1.3 Local aspirations further driving change (2/2)
Further to the macro trends, our staff have articulated a clear ambition of how technology can improve the way they deliver quality care, optimise operations and improve outcomes.
Sustainability through sound digital investments
Insights driven organisation fuelled by real time access to data “We must turn the endless amounts of data collected on a daily basis into insights that guide and support decisions on how to improve care delivery and optimise operations.”
“Our investments are sustainable because we strategically select new systems, we plan for the replacement of ageing assets and deploy technology to improve the overall equipment lifecycle management.”
A technology ecosystem that protects privacy and ensures platform security
Collaborative ICT services that maximise value “Our ICT function delivers effective technology solutions to our challenges, transparently and effectively prioritising work with the organisation, and providing high quality support through well resourced and capable teams and effective partnership with eHealth NSW.”
“We must foster a cyber aware culture and improve our security technologies to continue to protect our patients, staff and organisation.”
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A Digital Strategy created with our staff, through broad and wide consultation
172
68
31 ICT Staff
50
23
Stakeholders consulted
Clinical Staff
Operational Staff Executive Staff
The Digital Strategy consultation approach included six key phases
The Digital Strategy was developed in partnership with staff across the districts that our ICT function serves, spanning the full geography and incorporating the voices of more than 170 staff members. It is by understanding their experiences and canvassing their ideas for improvement that focus areas were established, initiatives were formed and investments were aligned to the strategic themes.
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Exploring the impact of megatrends
Determining the vision & guiding principles
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3
Obtaining the executive team’s perspective
Assessing the maturity of ICT Capabilities
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Identifying challenges and aspirations
Prioritising the initiatives into a roadmap
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1.4 Working in alignment with NSW Health
Our Digital Strategy
NSW State Health Plan
eHealth Strategy for NSW Health
A10-year program of innovation, investment and implementation identifying key NSW Health goals. The LHD Digital Strategy has considered statewide initiatives to ensure investments are strategically aligned.
The NSW State Health Plan places a big emphasis on patient- centred integrated and connected care that is supported by local- decision making that creates an innovative, sustainable culture.
► The objective of this document is to define the five year Digital Strategy for our LHD in alignment to the strategic plan and the statewide NSW Health strategies.
Other NSW Health Documents
► To achieve this, the Digital Strategy process
The Digital Strategy has also considered several other important documents including:
considered our Strategic Plan as well as a number of other strategies, some of which are listed on the left, to ensure alignment with investments being made at state level.
Identity and Access Management Strategy
Information Security Management Strategy
Virtual Care Strategy Roadmap (DRAFT)
Patient Engagement Platform Strategy (DRAFT)
Unified and Clinical Communications Strategy
Integration and Interoperability Strategy
Note: While in its development phase at the time this document was written, the Future Health Strategy was also considered through consultation with eHealth NSW stakeholders.
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2. Where we are today Current state assessment
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2.1 Current state assessment, top down approach (1/2)
While our LHD has, over the years, utilised technology to improve delivery of care and enhance operations, many opportunities still exist to utilise digital technologies to better enable delivery of our strategic plan and focus areas. These are the key digital impediments to advancing our strategic plan as perceived and articulated by our staff.
Healthy communities
Connected person- centred care
Evidence-based decision making
► The technology required to keep our communities healthy is quickly maturing, for example by detecting and intervening in community health settings. ► While major advancements were made in virtual care models during the COVID-19 pandemic, more can be done. Significant investment will be needed for our LHD to expand the use of virtual technologies through enhanced models of care, where appropriate, that address health issues or patient deterioration before or post hospitalisation for instance. ► It is recognised that the community is ready to access and use virtual care mechanisms. Investments however need to be made to ensure the communities digital and health literacy as well as equitable access. ► Furthermore, opportunities exist to utilise data and predictive analytics to help our LHD identify community trends and issues that can be addressed by social and target interventions.
► The digital end-to-end patient experience is at its infancy, underpinned by a combination of manual and digital processes. Patients do not have the ability to ‘take control’ of their health journey with self -service tools or digital services e.g.: electronic bookings, appointment management, digital pre-admission forms etc. ► Furthermore, the process of unifying records across care settings is still highly disconnected creating the need for the patient to continue being the conduit of information sharing. For example, most referrals from GPs to hospitals are still paper based and the quality of discharge summaries is lacking, if ever delivered back to the referrer. ► This fragmentation continues to make providing holistic clinical care difficult especially in cohorts where it is needed the most, for example, when aged care residents move between hospital and residential care. ► Many specialist clinical systems have been enabled outside the core clinical application (eMR) resulting in a hybrid medical record for patients, something that has the potential to undermine care.
► While we collect a lot of data in our day to day work, and while we have many reports and dashboards, it is still very difficult to derive insights from the data to truly drive change. Often, our staff must manually join data across multiple dashboards and systems to achieve something useful. For example, many opportunities exist across the eMR to use the data entered to help the clinician drive better decisions. ► Furthermore, many dashboards are a few weeks or months behind further hindering the usefulness of the data. Data must be live and always available and accessible. ► Predictive analytics, Machine Learning and Artificial Intelligences capabilities for service planning, demand management and clinical decision support are still developing. ► Clinical research and trial management is highly manual or fragmented across multiple systems. Generally, it is difficult for researching clinicians to access the data they need. ► IT equipment is not tracked and managed through its lifecycle using automated means, resulting in lost inventory, a lack of visibility of what is available and frequently outdated equipment frustrating and disempowering our staff.
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2.1 Current state assessment, top down approach (2/2)
While our LHD has, over the years, utilised technology to improve delivery of care and enhance operations, many opportunities still exist to utilise digital technologies to better enable delivery of our strategic plan and focus areas. These are the key digital impediments to advancing our strategic plan as perceived and articulated by our staff.
Responsive and adaptable organisation
Engaged and empowered workforce
► The ICT team has developed good relationships and partnerships with the clinical, operational and administrative parts of the organisation. However, they are limited by a combination of capacity constraints, capability gaps (e.g. IT operations, project management, business analysts etc) and lack of automation for example within the IT operations team. Furthermore, better integration between the ICT teams is needed to be able to provide more holistic support. ► Governance surrounding demand management, project work and service prioritisation could be enhanced. This creates a perceived lack of transparency with the business, who aren’t prepared for the impact of any technology changes or investments and don’t often see visible progress on their requests. It also stops the ICT function from providing maximum value to the business by aligning their pipeline to business objectives. ► Additional focus and continuous investment is needed to foster a more cyber aware culture and continuously improve our cyber security posture. Continuing to advance our partnerships with eHealth NSW in this area is critical. ► The relationship between eHealth NSW and the local ICT function works well but can be improved. For example, more representation of local clinicians is needed so eMR workflows are designed with as many representatives as possible. Another example is service management, and inefficiencies of a two-tier support process; ideally support tickets between the local and the statewide service desks should be automatically transferred to the relevant team to action, so the end user does not need to repeat the entire process when a ticket is transferred between service desks.
► The usability of many clinical systems requires focused investments to be more intuitive, to enhance staff productivity and improve user experience. For example, many eMR forms ask for the same information previously entered, instead of reusing data. They also ask many silly questions (e.g. pregnancy for male patients) instead of using basic logic to skip things. In the future, interactions with the eMR should feel more streamlined, less demanding on users for data entry, and enhanced with decision support that goes beyond basic alerts. Our staff should feel empowered in using the eMR rather than feel that it is the laborious part of their job. ► Mobility is improving, however more focus is needed to enable native applications so clinical, operational and administrative work can be completed on the go using the right device for each job. In some settings (e.g. mental health), smart mobile tools (e.g. voice dictated notes) is the only way to remove the hybrid paper record that currently exists due to the nature of the setting. In addition, real time clinical collaboration, including the ability to attach images is an ongoing issue that must be resolved urgently. ► There is a need for continuous training including an uplift in digital literacy across the LHD so people can become more comfortable with technology. Training is rolled out during the system implementation, but evaluation of the effectiveness of this training is seldom undertaken. More work is needed in diagnostics around culture and capability and then on focused training plans to those issues. ► Empowering our staff also means listening to their feedback, and responding promptly. This builds trust, confidence and an engaged workforce trying to solve problems collectively.
► Improvements are also needed in the area of benefits realisation.
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2.2 Current state assessment, bottom up approach (1/2)
To assess the maturity of our LHD’s digital capabilities, the NSW Health ICT Capability Blueprint was utilised as a framework. Assessing the maturity of each area helps identify gaps and thus opportunities for improvement. The assessment uncovered the following findings against the 6 high level blueprint areas.
Patient Health and Engagement
Clinical Applications
Business Management
The introduction of the eMR has created a good technology foundation for clinical functions. However, functionality gaps exist in the areas of anaesthesia, outpatient, medical device integration, nursing care plans, second level clinical decision support and others. These gaps directly inhibit the organisational goal of reaching a HIMSS EMRAM stage 6 maturity.
► The workforce engagement and business management functions utilised by the LHD are provided by statewide bodies (HealthShare NSW and eHealth NSW) and have a high degree of maturity. ► Misalignments exist in some areas between supported processes and local nuances resulting in perceived
► Patient engagement and population health are major gaps for the LHD. There are a series of technology gaps (e.g. digital bookings, appointment management, consumer entered data) that stop patients taking a more proactive role in their care. ► Majority of patient and population health functions are undertaken manually. This is undermining the LHD’s ability to achieve its strategic ambition of supporting a healthier community. ► No standardised technology capability exist to support research and trials, the management and execution of which are done through a mix of point systems and manual processes. ► Education and training capabilities are well supported by technology. However, staff identified issues with creating on-demand content and multimodal material, as well as giving the public access to quality education materials.
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maturity gaps. Systems can be integrated and interlinked further to ensure more efficient and
► A number of specialties are not covered by a single integrated eMR e.g. haematology, oncology, anaesthesia. This has resulted in a hybrid patient medical record creating risk in quality of care and inefficiency for staff. ► The Patient Administration System is functioning well but, in its current form, does not meet the growing expectations of consumers and patients in enabling a better patient experience. For example, an electronic integrated request for admission solution.
seamlessly automated processes. For example, SARA, StaffLink and HealthRoster could be better integrated to support end-to-end human capital processes. ► Reporting across the board can be improved, for example to track and measure the success of investments and commissioned services. ► Supporting functions such as ethics management, legal services and project accounting require dedicated tools.
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2.2 Current state assessment, bottom up approach (2/2)
To assess the maturity of our LHD’s digital capabilities, the NSW Health ICT Capability Blueprint was utilised as a framework. Assessing the maturity of each area helps identify gaps and thus opportunities for improvement. The assessment uncovered the following findings against the 6 high level blueprint areas.
The ICT Function
Access and Information
Security and Infrastructure
► Capacity is the major challenge associated with devices and channels at our LHD. Staff do not always have access to the right equipment in each clinical situation and many systems have not been designed or rendered for use on mobile devices. ► The lack of tools to track and manage devices through their lifecycle creates an administrative and financial burden. ► Analytics and reporting is embedded well within the organisation but further optimisation is needed as extracting data from systems, particularly statewide systems, is difficult and not timely. Data must be live and always available and accessible. ► Data literacy across the LHD must be enhanced to allow people to better utilise data and analytical tools. ► The Integration and interoperability function has ageing infrastructure that should be refreshed. Multiple integration engines across clinical and building management exist.
► While the security and infrastructure capabilities are generally mature, technology infrastructure must evolve to align with the greater demand for internet and cloud services. ► There is a need to upgrade ageing and outdated on- premises hardware. Continuous investigation and alignment is needed in the area of As-a-Service offerings be it from the state or cloud vendors. This will also have the impact of moving costs away from the traditional Capital expenditure model to a recurrent Operational expenditure model. ► Capacity constraints and loss of redundancy pose challenges for the LAN and WAN, respectively. ► Cyber security is a top-priority area for the LHD. Work is underway to lift maturity against state and national policies (e.g.: the “Essential 8” and “mandated 25”). More could be done to improve security tools, enhance encryption, and to foster cyber aware processes and culture.
► The ICT team has over the years developed a good partnerships with the clinical, operational and administrative parts of the organisation. However, they are limited by gaps: ► In capability (e.g. DevOps, immature Virtualisation and configuration management) and capacity ► In capacity issues are caused by a lack of staff in high demand areas such as in program and project management roles, service integration, application management, business analysis ► Processes that are still maturing. For example, release and deployment does not occur in a defined or transparent way. ► Management of health facilities is highly manual, which make the management of equipment and assets difficult, undermining financial sustainability and effectiveness. Even though asset management systems exist, they are not mature and lack integration with other corporate systems. ► Communication tools such as nurse call and paging are in need of modernisation. ► Wayfinding is limited and not rolled out effectively across all facilities.
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3. Where we want to be
Looking to the future
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3.1 Our Digital Strategy Vision
With our partners, we will connect our communities and staff through intuitive digital technologies that deliver trusted, quality and safe health experiences.
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3.2 Our Digital Strategy guiding principles
The guiding principles act as a foundation upon which executives, the ICT function and the LHD can make decisions about digital investments and architectural design. These principles have been decided locally but leverage heavily on NSW Health technology principles.
Principles guiding our user’s experience…
…Principles guiding the delivery of the strategy
Patient Centred Approach
Interconnected Health Communities
Delivery Through Partnerships
Ensuring that technology investments support new models of integrated care and deliver a quality, patient centred, health experience.
Using technology to promote connectedness across health providers, equipping clinicians with holistic patient information so they can provide better quality and safe care.
Forging strong partnerships – considerate of strategic priorities, cost, resources, value for money, service need and technology – to implement innovative models of care enabled by technology.
Clinical Engagement
Secure, Usable, Quality and Safe Systems
Strategic Commissioning and Procurement
Supporting the creation of technology systems that are fit for purpose and align to clinical processes by ensuring clinicians take an active role across all steps of the system lifecycle including the design, implementation and roll out.
Driving quality, safety and privacy in the design and development of technology systems by measuring and addressing safety concerns at the intersection of patient data, health ICT and statewide ICT systems, particularly as information shifts to ‘paper - lite’ digital systems.
Driving efficiencies in the funding, procurement and management of external provider arrangements to achieve a more adaptive approach to vendor management.
Proactive & Responsive Care
Fostering Innovation and Research
Robust Governance and Investment Management Agile governance models that respond to integrated care models and changes across the state, allowing stakeholders to coordinate and plan effectively at local and state levels.
Focusing on using digital predictive capabilities to provide preventative, quality and safe care for health consumers so health issues are mitigated before they become acute.
Identify and support the development, implementation and adoption of local innovation and research activities to better meet future expectations and improve the delivery of quality and safe care.
Support the mobile workforce
Flexibility & Openness to Change
Standards Based Environment
Enable our clinical and administrative workforce to undertake their crucial work easily, regardless of the device they choose to use or whether they are operating within our facilities, in the community setting or remotely.
Embedding a culture of innovation driven by leadership on the adoption of emerging technologies, investing in effective change management and service provision to promote a universal approach to the redesign of healthcare.
Adopting health information standards to facilitate and streamline the interoperability of technology systems, reducing integration costs while improving the overall quality of delivered components.
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Focus areas for the Digital Strategy
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The Digital Strategy recognises seven focus areas that will guide digital investments, enable the strategic plan priorities and address current state challenges. These focus areas are underpinned by a set of guiding principles to support decision-making.
Elevate our patients experience and focus on virtual care
Empower our workforce, improve user experience and mobility
Harness the power of data to improve care delivery and operations
Enhance connectedness within the LHD and across care settings
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Ensure infrastructure and digital investment sustainability
Continue to optimise the ICT service function
Strengthen privacy and cybersecurity capabilities
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3.3 Digital Strategy focus areas
The Digital Strategy recognises seven focus areas that will guide digital investments, enable the NSLHD strategic plan priorities and address current state challenges.
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Elevate our patients experience and focus on virtual care Elevating the experience for our patients, families and carers to empower them to make informed decisions about their care outcomes and wellbeing Enhancing the virtual care digital capabilities to support virtual models of care and to provide patients with a platform in which they can contribute to their own care.
Empower our workforce, improve user experience and mobility Improving the user experience through systems that are accessible, easy to use and add value to our workforce through automating the mundane, streamlining workflows, providing the real time information to support
Harness the power of data to improve care delivery and operations Optimising our ability to derive meaningful insights from data in a timely manner to guide and support decisions on how to improve care delivery and optimise operations. Using these insights to drive a culture of evidence based decisions for our operations as we do with the way we provide care.
Enhance connectedness
Ensure infrastructure and digital investment sustainability Ensuring sustainability of digital investments by strategically selecting new systems, planning for the replacement of ageing assets and deploying technology to improve the overall equipment lifecycle management. Covering all asset categories from network infrastructure through to servers and end user computing.
Continue to optimise the ICT service function
Strengthen privacy and cybersecurity capabilities
within the LHD and across care settings
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It is envisioned that the current hybrid medical record scattered across paper and fragmented speciality systems, will be integrated together to form a single digital patient record across our district and the state, enhancing connectedness within and outside the LHD.
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Delivering effective technology solutions, transparently and effectively prioritising work in alignment with the organisation, providing high quality support through well resourced and capable teams and effective partnership with statewide organisations. Continue to foster clinical engagement via the optimisation of clinical digital health roles such as CXIOs.
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Investing in our cyber security capability to improve our security posture and build a cyber aware culture for the protection of our patients, staff and organisations Strengthening our data security capabilities to ensure
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the privacy of our patients records.
decisions, and supporting user mobility.
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