New South Wales, the most populous state in Australia (capital: Sydney), encompasses 7.24 million citizens, or 32 percent of Australia’s total population. Healthcare IT leaders there are working on some very exciting initiatives these days. The state-managed health system, NSW Health, involves over 200 hospitals and clinics connected to a statewide vendor-neutral archive. What’s more, the broader architecture NSW Health created is this: a statewide enterprise imaging repository, as part of a statewide health information exchange (HIE) architecture.
In July 2012, NSW Health began the statewide rollout of its enterprise imaging repository, engaging a Fujitsu-led consortium, including the Milwaukee, Wis.-based TeraMedica to help them develop and implement the solution. Managed under eHealth NSW, the enterprise imaging repository program pursued a rolling rollout across 2012 and 2013. Among the goals of the overall initiative: to reduce repeat procedures as patients move from hospital to hospital for care; to provide better access to medical imaging information by connecting different health services; and to innovate better models of care through multi-disciplinary collaborations.
Recently, HCI Editor-in-Chief Mark Hagland interviewed a number of key players from the eHealth NSW team: Tony Lopes, enterprise architect; Freeman Wong, program manager; and Neil Frantz, service manager, regarding their team’s groundbreaking initiative, and their perspectives on their progress so far. Below are excerpts from that interview.
Tell us about the impetus and strategy behind this initiative.
Freeman Wong: We’ve focused on implementing a statewide enterprise imaging repository, as well as a range of supporting ehealth elements. The medical imaging program in New South Wales consists of two streams—implementing RIS [radiology information systems] and PACS [picture archiving and communications systems] throughout the state, and creating an enterprise imaging repository. We have a federated model, meaning each district or hospital network has its own implementation of electronic medical record, RIS, and PACS. End result is that NSW Health has a number of disparate RIS and PACS implemented across the state with no real means of communication with each other. That’s where the enterprise imaging repository comes in; it’s not only linking all EMRs through a patient registry, but also provide universal access to the state image repository.
So that means you have a statewide patient registry, too?
Wong: Yes, supporting the statewide enterprise imaging repository, requires linking of patient records across all health jurisdiction. Essentially, at the back end of that the enterprise imaging repository solution is the enterprise patient registry. Every patient treated in each jurisdiction is given a patient number and the enterprise patient registry provides linkage to these identities.
Tony Lopes: We’re mainly publicly funded, and as a result, each local health district has implemented its own systems. So for example, if a patient visited a facility in far northwest New South Wales and then got transferred into Sydney, they were transferring across local health system boundaries; so one key piece of infrastructure we implemented was the statewide patient registry. It’s a statewide master patient index or registry project. But essentially, it receives real-time patient feeds from all the systems from all the districts, and then that enables the subsequent linking of any information from an EMR or any other system. And that allows us to link radiological studies.
Like an HIE?
Lopes: It’s similar to an HIE, but the difference between an HIE model and what we’ve got is that NSW Health adopted a repository model where all medical imaging studies are now stored in a statewide repository. And we are storing clinical documents also; we’re going to store pathology information moving forward. It’s all about having the patient at the center of care, and making the information available to providers irrespective of where information on the patient was collected. And one objective has been to be as little disruptive to the 15 local health districts as possible.
Wong: From a local workflow and clinician and radiologist perspective, they will continue to use their local identifiers.
Is New South Wales the first Australian state to have achieved this?
Lopes: Yes, and the only other organization that has done this in the Asian region is Singapore Health. But the New South Wales implementation is unique.
What kind of volume of data is involved?
Lopes: 17,000 people spend a night in a hospital on a typical day; 6,500 ED patients daily; 5,000 daily admission to a public hospital; 5,000 babies are born every day… more broadly, on a yearly basis, there are about 1.2 million admissions per year, about 1.9 million ED visits; NSW Health employs 150,000 employees, we are the largest health services in Australia. We manage the public health system that is publicly funded. NSW Health doesn’t operate private hospitals or primary care or GPs.