Clinical champion for digital change – reflection on 30 years HIC 2017 Dr Richard Ashby Chief Executive / Chief Information Officer eHealth Queensland Follow us on Twitter @eHealthQLD 1
First there was the green screen 1980s Queensland Health Information System Follow us on Twitter @eHealthQLD 2
Hospital Based Corporate Information System (HBCIS) • McDonnell Douglas • Pick operating system • Comprehensive suite Follow us on Twitter @eHealthQLD 3
HBCIS – outcome! VS SOFTWARE HARDWARE Follow us on Twitter @eHealthQLD 4
1990s Various speciality systems EDIS ORMIS ICU ELMS CARDIOLOGY GE PAC/RIS TELEHEALTH OSIM AUSLAB MOSAIQ + Hundreds of small, bespoke systems and applications Follow us on Twitter @eHealthQLD 5
2000-2005 ieMR 2 • Build system with small Australian company Follow us on Twitter @eHealthQLD 6
2007 EMR 3 ($243m) • “Best of breed” OERR • Interoperability ICU Interoperability • Data warehouse CCU • Local build Data ED warehouse OR etc. Follow us on Twitter @eHealthQLD 7
ieMR – part of the eHealth agenda eHealth – a global focus… Focus of international agendas National agendas • Canada Infoway 2003 – United Nations World Summit on the Information Society • Scottish Care Information (SCI) 2005 – World Health Assembly • NHS Connecting for Health (2003-2011) 2005 – WHO Global Observatory for eHealth (GOe) established • Veterans Health Administration USA 2005 – European Commission eEurope action plan released • Making IT work – UK NHS (2016) 2006 – World Summit on the Information Society • US Department of Defense (2016) 2009 – Obama Health Reform (‘meaningful use’) • US Veterans Health Administration (2017) Follow us on Twitter @eHealthQLD 8
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 Follow us on Twitter @eHealthQLD 9
2009-2011 “Best of breed” ($1.5B cost estimate) NSW strategy and procurement • Off the shelf • Proven product • 90:10 rule Follow us on Twitter @eHealthQLD 10
2012-2014 R1 R2 R3 R4 Follow us on Twitter @eHealthQLD 11
July 2014 “Digital Exemplar” model Follow us on Twitter @eHealthQLD 12
November 2015 Princess Alexandra Hospital go-live Follow us on Twitter @eHealthQLD 13
April 2017 Medication management Anaesthesia Research Follow us on Twitter @eHealthQLD 14
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 Follow us on Twitter @eHealthQLD 15
Internet of Things (IoT) • Definition • Scale – 24 billion devices by 2020 • Ubiquitous sensing and monitoring • Automation, robots etc. • Smart Homes, Smart Cities, Smart Hospitals (?) Follow us on Twitter @eHealthQLD 16
“The biggest threat to the future of the internet is legacy IT systems” Thomas Frey, DaVinci Institute Follow us on Twitter @eHealthQLD 17
2017-2020 Replace Build Integrate • Patient Activity System Digital Collaboration Specialty systems • Platform • Financial System Oncology • Windows 10 / Office 365 • • Laboratory System ICU • Smart Devices • • Interoperability Engine Mental Health • • My Health Record • Legacy network, etc. • processing, storage Apps Follow us on Twitter @eHealthQLD 18
Integrated Care • eReferrals • Clinical Pathways • My Health Record • Community • Consumers – Apps, eConsultation, eIAC, Citizen Science, Remote Monitoring, etc. Follow us on Twitter @eHealthQLD 19
Brisbane Diamantina Health Partners Precision medicine exemplar - Melanoma VACCINE (QIMR Berghoffer) (MSH, MNH, UQ, QUT) TRIENNIAL 3D (QUT) MELANOMA HYBRID IMAGING VECTOR IMAGING (UQ) BRAF Class 1, Class 2 GENOMIC TESTING (HSQ, QGHA) IBM WATSON PRECISION EVALUATION GENOMIC TREATMENT SCREENING WEARABLE TECH AT RISK (QH, UQ, QUT, (AEHRC) MSH, MNH) UV Dosimetry CDKN2A SURGERY Keytruda EPIDEMIOLOGY + - Opdivo SunSmart monitoring Yervoy (QIMR Berghoffer) Zelboraf etc. and behaviour app Follow us on Twitter @eHealthQLD 20
The High Reliability Healthcare Organisation Variation Zero Harm “Can you predict the next harmful incident and prevent it?” Dave Roberts, Leadership Forum May 2017 Follow us on Twitter @eHealthQLD 21
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 Follow us on Twitter @eHealthQLD 22
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! Follow us on Twitter @eHealthQLD 23
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………………………….. Follow us on Twitter @eHealthQLD 24
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