Clinical champion for digital change reflection on 30 years
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1 Clinical champion for digital change reflection on 30 years HIC 2017 Dr Richard Ashby Chief Executive / Chief Information Officer ehealth Queensland 1
2 First there was the green screen 1980s Queensland Health Information System 2
3 Hospital Based Corporate Information System (HBCIS) McDonnell Douglas Pick operating system Comprehensive suite 3
4 HBCIS outcome! VS SOFTWARE HARDWARE 4
5 1990s Various speciality systems EDIS ORMIS ICU ELMS CARDIOLOGY GE PAC/RIS TELEHEALTH OSIM AUSLAB MOSAIQ + Hundreds of small, bespoke systems and applications 5
6 iemr Build system with small Australian company 6
7 Interoperability 2007 EMR 3 ($243m) Best of breed Interoperability Data warehouse Local build OERR ICU CCU ED OR etc. Data warehouse 7
8 iemr part of the ehealth agenda ehealth a global focus Focus of international agendas 2003 United Nations World Summit on the Information Society 2005 World Health Assembly 2005 WHO Global Observatory for ehealth (GOe) established 2005 European Commission eeurope action plan released 2006 World Summit on the Information Society 2009 Obama Health Reform ( meaningful use ) National agendas Canada Infoway Scottish Care Information (SCI) NHS Connecting for Health ( ) Veterans Health Administration USA Making IT work UK NHS (2016) US Department of Defense (2016) US Veterans Health Administration (2017) 8
9 Digital Hospital part of the ehealth agenda ehealth in Australia 2003 Victoria invests in HealthSMART ($232m) 2004 ehealth Western Australia program ($334m) 2005 NeHTA established 2005 HealthConnect South Australia begins 2007 Queensland iemr Project ($243m) 2008 Australian ehealth Research Centre opened in Brisbane (CSIRO/QH) 2009 Queensland iemr (v2) commenced 2012 PCEHR (My Health Record) launched ($628m) 2014 First L6 HIMSS hospital St Stephen s 2015 First large scale digital hospital PAH 9
10 Best of breed ($1.5B cost estimate) NSW strategy and procurement Off the shelf Proven product 90:10 rule 10
11 R1 R2 R3 R4 11
12 July 2014 Digital Exemplar model 12
13 November 2015 Princess Alexandra Hospital go-live 13
14 April 2017 Medication management Anaesthesia Research 14
15 Digital disruption and healthcare The Digital Hospital Health record always available Evidence based care pathways Structured documents with voice analysis Active and passive decision support Monitoring device and ECG integration Early warning systems Electronic order entry and results RFID tracking patients, staff, equipment P2P communication/location Business intelligence and analytics 15
16 Internet of Things (IoT) Definition Scale 24 billion devices by 2020 Ubiquitous sensing and monitoring Automation, robots etc. Smart Homes, Smart Cities, Smart Hospitals (?) 16
17 The biggest threat to the future of the internet is legacy IT systems Thomas Frey, DaVinci Institute 17
18 Replace Patient Activity System Financial System Laboratory System Interoperability Engine Legacy network, processing, storage Build Digital Collaboration Platform Windows 10 / Office 365 Smart Devices My Health Record Apps Integrate Specialty systems Oncology ICU Mental Health etc. 18
19 ereferrals Integrated Care Clinical Pathways My Health Record Community Consumers Apps, econsultation, eiac, Citizen Science, Remote Monitoring, etc. 19
20 Brisbane Diamantina Health Partners Precision medicine exemplar - Melanoma (QIMR Berghoffer) (QUT) VACCINE TRIENNIAL 3D VECTOR IMAGING (UQ) MELANOMA BRAF Class 1, Class 2 HYBRID IMAGING (MSH, MNH, UQ, QUT) (HSQ, QGHA) GENOMIC TESTING GENOMIC SCREENING EPIDEMIOLOGY (QIMR Berghoffer) AT RISK CDKN2A IBM WATSON WEARABLE TECH UV Dosimetry SunSmart monitoring and behaviour app (AEHRC) PRECISION TREATMENT SURGERY + - Keytruda Opdivo Yervoy Zelboraf etc. EVALUATION (QH, UQ, QUT, MSH, MNH) 20
21 The High Reliability Healthcare Organisation Variation Zero Harm Can you predict the next harmful incident and prevent it? Dave Roberts, Leadership Forum May
22 The Intelligent Healthcare Enterprise Evidence into practice in a day, not a decade Predictive, prescriptive, streaming analytics Cognitive Computing /Desktop Learning/NSP/Augmented Intelligence Big Data/Small Data Visualisation/Virtualisation 22
23 Prediction: Changes to healthcare in the next 30 years, caused or enabled by digital technology, will be an order of magnitude greater than in the past 30 years! 23
24 30 year digital journey Travel tips The road is long and hard! Be persistent, consistent and resilient Focus on superordinate goals Beware of political cycles, toxic cultures and ethical challenges Stay in the race.. 24
25 25
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