tony abbenante - department of health victoria

Statewide Standards and Interoperability In

Victoria

Tony Abbenante

Senior Architect and VCCC ICT lead

Manager Health Design Authority and Integration

Office of the Chief Information Officer

Department of Health - Victoria

My Background

State-wide and national health IT solutions and interoperability:

• 25 years of experience in health IT solutions, acute care, community care, national initiatives

• Predominantly in

Australia, USA, Malaysia, Singapore

• Application design, development and implementation of key healthcare systems

Clinical Systems, Costing Systems, PAS, Radiology, Pathology, Emergency, Scheduling, Theatre, Pharmacy, etc.

• Application integration or integration design of almost every healthcare system

Clinical Systems, Costing Systems, Patient Administration Systems, Radiology, Pathology, Emergency, Scheduling, Theatre, Pharmacy, National eHealth Systems (PCEHR, IHI, etc.)

• National Standards for messaging, NEHTA packages

Input and adoption

• Recently: Manager of the Heath Design Authority for Department of Health Victoria

http://www.health.vic.gov.au/designauthority/

• Currently: Senior Architect - Department of Health Victoria / Parkville VCCC ICT Lead

Agenda

Standards and Interoperability in Victoria

The journey:

• What is interoperability

• Policy and Business Outcome Drivers

• Role of the Design Authority

• The Statewide Interoperability Framework

• Maturity Models

• Key lessons in Interoperability

Interoperability and Integration

What is the definition of interoperability?

“There are two parts to the definition of interoperability:

1) The ability of two or more systems to exchange information.

2) The ability of those systems to use the information that has been

exchanged.

This means that health information exchange is different than health

information interoperability. Exchange is a necessary for interoperability,

but it is not sufficient by itself to achieve health information interoperability.”

(Fridsma, D. 2013)


What is the definition of interoperability?

• The capability to share a common functional capability across two or more software applications

A patient registration replicated from a Patient Administration System to an Emergency Department System

A pathology order from an Electronic Medical Record (EMR) System to a Pathology System

A pathology result from a Pathology System to an EMR

A discharge summary interface from an EMR to the Personally Controlled Electronic Health Record (PCEHR)


To be “Best of Breed” or not?

“Gartner recommends that, whenever possible, Healthcare Delivery

Organisations should favour truly integrated applications where complex

structured clinical detail must match in every detail or the workflow passed

between the two applications very frequently”.

“The need to avoid as much as possible interfacing applications, and not to

embrace a “best of breed” model as a first choice for clinical systems or other

highly complex enterprise applications, as this compromises the practice of

evidence based medicine”.

(Rishel, 2010), (Handler, 2011)

• The Cycle of Interoperability and application adoption

Has almost gone full circle. In the 90’s, many of the application functions were integrated in one

In the 2000’s, we adopted a best of breed approach

Now, we are heading to a solution design approach, centralised for core functions, typically centered around the EMR or Clinical System


How does an interface work? (register a patient)

PatientAdministration

System

EmergencySystem

Semantic Meaning

Terminology1:Male

2:Female

Network

Business Process Change

Integration

Engine


How does an interface really work?

• Business process flows across the organisation: Solution view

• Change in processes: Change management

How does this impact the medical records department?

What is the central registration point?

• Terminology alignment

• Governance: Terminology, policy, ongoing conformance and compliance

• Testing: User, system integration unit

• Data migration

• Application enhancements

• Transporting data

• Ongoing support, ongoing solution design

Policy and Business Outcome Drivers

Department of Health Drivers:

• Health Services in Victoria and Independent Entities

WEIS/NEP funded

Innovation Fund

Control their own expenditure

• Health Services in Victoria: Department Alignment

Statutory Reporting

Interoperability standards

Capital expenditure for large initiatives are via the DH, standards must be followed in any tenders



• Ministers Advisory Council

Statewide ICT Framework

Innovation Fund

• Statewide ICT Framework

Maturity models for the Sector

Strategy

Interoperability

Information

Application and Functional capability

Workforce, Benefits

Sector baselines, capability currently, 2017-18, 2021



• Policy and Funding Guidelines

Conformance to Standards: www.health.vic.gov.au/designauthority. Current and future capability.

EMR Standards

PAS Standards

Patient Queuing Standards

Solution Architecture and other

MOU with DoHA commitment to implement NEHTA packages and standards

• The Victorian Health Priorities Framework (VHPF)

Acknowledges these challenges and has a target that by 2022 the health system should be responsive to people needs and describes an exemplar vision for a patient journey.

• The Health Design Authority and Health Design Forum

Next page

http://www.health.vic.gov.au/designauthority

Health Design Authority

Strategy

Plan and Design

BuildImplement

Govern and Sustain

Strategy:

• Health Design Authority

Strategy and approach

Overall design responsibility, interoperability

and health application solution design

Interoperability and standards

Interoperability framework

Set and monitor design principles

• Strategy and vision

Significant focus in last 2 years enabled via

Health Design Forum using Active approach


Strategy

Plan and Design

BuildImplement

Govern and Sustain

Strategy:

• Health Design Authority – Key Role

• Identify Key standard, and principles for Victoria

• Solution view

Assess and Identify Standards that

apply to our environment

Assess and Identify Principles for Victoria

Set and research relevant standards for Vic

International Standards

National Standards and Initiatives

Local policies and standards

E.g. Delivery of Discharge sum to GP is

A key requirement (HL7 first then NEHTA)


Strategy

Plan and Design

BuildImplement

Govern and Sustain

Strategy - Active:

• Environment

Independent health services

Variety of health applications

Governed by interoperability standards

National and local initiatives

• Vision

Health Design Forum – sector

Design Authority and DH

• Artifacts

International and local research

Interoperability framework

Standards

Benefits, vision


Strategy – Health Design Forum:

• Health sector representation

• International representation (Gartner)

• DH representation

• Combined research (DH & Gartner)

• Jurisdiction representation

• Research, knowledge and direction

• Topics

Continuity of Care

EMR Adoption

Medications Management

Benefits, Change and Adoption

etc.

Investigate Assess

ApproveCommunicate


Strategy

Plan and Design

BuildImplement

Govern and Sustain

Govern and Sustain:

• Future introduction of conformance

processes

• Anticipated to be in the form of vendor

accreditation to Victorian interoperability

standards usage

• DH funding and Policy Guidelines sets

direction and funding requirements via

Quality Assurance for ongoing funding

and tenders

The Statewide Health Interoperability Maturity

Model

Health Design Authority Victoria Web page:

• www.health.vic.gov.au/designauthority.

Elements of the Maturity Model

• Functional Model

• Interoperability Roadmap vs HIMSS and NEHTA capability

• B2B Model

• Messaging Flows

• Interoperability Assessment

• Logical Model

http://www.health.vic.gov.au/designauthority

The Statewide Health Interoperability Maturity

Model – Functional Model

Sector Maturity Models

Department of Health Maturity Models and Baselines

• Strategic Maturity Model

• Interoperability Maturity Model

• Functionality Maturity Model

• Information Maturity Model

• Work Force Maturity Model

• Other…..

• Baselines for Each Model and across Models: 2017 – 2019 - 2021

Capability 5

Proactive:A proactive and adaptive framework for

organisational strategic direction, business change and associated IM&ICT planning that is reactive and transformational and aligned with

environmental change

5.1 There is evidence that the IM&ICT Master Plan is a collaborative, iterative and interdependent. A long term future state solution and vision is targeted. Currency is commensurate with the

organisations appetite and pace of transformational change

5.2 Predictive transformation and adoption toward environmental opportunities is factored into strategy and planning

Capability 4

Evidence Based:IM&ICT Master Plan includes evidence based

methodologies for emerging initiatives

4.1 The IM&ICT Master Plan shows evidence that informed choices have been made and best practicemethodologies have been adopted in reference to the following key enablers:- architecture, benefits, programme management, enterprise system and solution adoption,

governance, quality assurance and standards

4.2 Evidence that the methodologies are being actively utilised and put into practice. Evidence that theorganisational strategic plan takes into account/leverages activity/capability of other organisations caring for the same patient population

Capability 3

Operational:The organisation has defined a clinical

(business) services operating models (current and future) that drive the IM&ICT Master Plan

3.1 The organisation has defined a clinical services operating models3.2 The organisation has defined a clear link between the IM&ICT Master Plan and the clinical operating models3.3 The organisation drives and measures its IM&ICT direction in relation to Victorian Department of Health

maturity models and has adopted activity to move toward the relevant maturity model baselines

Capability 2

Formative:IM&ICT Master Plan has been defined and

aligned to the organisational Strategy

2.1 The plan has clear link organisational outcomes, and aligns with organisational and IM&ICT principles- The plan defines a risk based asset plan- The plan articulates the IM&ICT business as usual governance structure

2.2 The plan references the current state view of the organisation architecture (application, information,interoperability, standards, etc.)- The plan references a high level future state solution architecture

2.3 A medium term approach and plan has been endorsed and adopted

Capability 1

Aware:An achievable organisation strategic direction has been defined. The strategy articulates an

IM&ICT direction

1.1 The organisation has a clearly defined vision, and direction that is currently being operationalised1.2 The organisation strategy includes IM&ICT direction

Capability 0

Unstructured and Unmanaged Environment:No strategic business direction or capacity to

move forward strategically

0.1 No organisational plan and strategy defined0.2 Organisation plan has been defined however capacity or capability to operationalise the plan is limited

Sector Maturity Models

Strategic Maturity Model

Unstructured and Unmanaged Environment:

No strategic business direction or capacity to move forward strategically

Aware:

An achievable organisation strategic direction has been defined. The strategy articulates an IM&ICT direction

Formative:

IM&ICT Master Plan has been defined and aligned to the organisational Strategy

Operational:

The organisation has defined a clinical (business) services operating models (current and future) that drive the IM&ICT Master Plan

Evidence Based:

IM&ICT Master Plan includes evidence based methodologies for emerging initiatives

Proactive:

A proactive and adaptive framework for organisational strategic direction, business change and associated IM&ICT planning that is reactive and transformational and aligned with environmental change

Key Lessons

Principles and Practice

Product selection:

• Round hole, square peg

• Vendors don’t understand your environment well, you need to take ownership of the solution design as a whole

Interoperability across organisations vs internal to an organisation:

• Very different principles apply

• Very different benefits apply

e.g. Continuity of Care benefits

• Very different design and functional capabilities apply

e.g. Limited CDS

Integrate when you can, don’t interface:

• Interfaces always reduce functional capability

Key Lessons


Select the master system for each function in your environment:

• e.g. Two systems performing patient registration is not good practice and does not work

• Select the master for each key function; CDS from EMR, patient registration from PAS, etc.

Interoperability is a key requirement:

• Interfacing is unavoidable and is almost always required typically via an integration engine

Key Lessons


Interoperability requires strong distributed governance:

• Terminology consistent across applications

• Conformance and compliance process

Information technology projects need strong sponsorship:

• Key stakeholder must be involved as required

Clinicians, Nursing, Executive Directors, etc.

• Victorian EMR implementations have adopted CMIOs fully allocated to the project

• Project resources should be fully allocated to do two jobs

Key Lessons


Vendor relationships:

• Ongoing communication – Strategic Directions

• Change management approach – Influencing with the needs of the VPHS

• Clear vision of direction and interoperability standards

• Time to adopt and change

Localising standards – guide to use of standards in Victoria:

• There are many standards. Need to choose the standards that suit your environment, reporting requirement. Lead toward future vision and national directions

• Local guide for implementation

e.g. Use Australian Standards and determine local use (HDA web page)

• Underpinned by Government Policy and Funding Guidelines

• Aligned with Government Quality Assurance Processes

Statewide Standards and Interoperability

In Victoria

Questions?