How will eHealth NSW ‘walk and chew gum at the same time’? How long until things get FHIR-y? How does an expanding system keep clinicians protected?
The new boss of eHealth NSW says keeping those with frontline knowledge front and centre will be key to crafting a sustainable healthcare system. And then there’s learning how to switch things off.
Speaking at Australian Healthcare Week in Sydney today, CEO Richard Taggert, just nine weeks into the job, said three of the biggest systemic challenges ahead were cybersecurity, legacy systems and resource constraints.
“Already this year, we are seeing more cybersecurity activity than we did the year before … it is becoming a major focus and a major priority for the health system,” he said.
“The other thing that’s been really good over the last 30 or 40 years is we’ve added more and more tech into the health system, [but] we’ve very rarely switched things off.
“What that means over time is that you have this tail of legacy, this tail of older hardware, older applications, that then create a burden on the system.
“So as well as the new, exciting, shiny AI stuff, you’ve also got some of those older things that are just as important to keep running and that can create a challenge for resources investment.
“And as with all parts of the health industry, we are resource constrained.
“There are a limited number of people with the unique expertise that can combine technology expertise with healthcare expertise, implement it and maintain it in a safe environment, and there are more and more demands on their time.
“So those resource constraints mean that we have to prioritise quite carefully, all while dealing with new expectations.”
When asked how he planned to “walk and chew gum at the same time” to roll out a new single electronic medical service across 228 already functioning hospitals and other health services, Mr Taggart said the state was well equipped.
“When you take on a large project like an EMR project, it is a centre of gravity for your digital health strategy,” he said.
“But the good thing about the work that we’ve done across NSW Health is that this is not our first rodeo. We’ve had multiple very large-scale EMR rollouts.”
Mr Taggart said the state’s governance model brought clinicians to the forefront of the rollout.
“We’re working collaboratively across the system to manage the existing systems as they roll into the new one,” he said.
“It’s an ambitious program, but I think one of the things about these programs is if you move at the right pace with the right governance model, that’s probably a better way of doing it than trying to do it in smaller pockets over time.
“So that’s why we’re going the speed that we are.”
In another session at AHW, CEO of Amplar Health Home Hospital Dr Sarah McRae said interoperability was key to the success of outside-of-hospital care, a cornerstone of any future healthcare system.
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SA Health has provided Amplar with read-only access to the public hospital electronic medical records for the operation of its at-home hospital program.
“We have our own EMR, for our two programs that we run in SA,” said Dr McRae.
“The contract with SA Health requires us to be at the same standard [of care] as what they are at.
“That data, because these are public patients that they’re caring for, are owned by SA Health as well.”
But, at present, the interoperability was unidirectional, said Dr McRae.
“It’s great for us because we have access to [SA Health’s] EMR. It’s not necessarily great for the clinician who’s referring because they don’t have access to our EMR, but we’re working on that.
“We need to demonstrate that we’re still delivering the same quality of care at the same level that [SA Health] are wanting.”
Dr McRae said Amplar used AI bot technology to ask standard questions, that would otherwise be delivered by a nurse, when a patient was looking to use their service during covid.
“We screened over 180,000 people over [covid], and then were able to direct their health pathway, whether it be that they were really unwell and they needed to be treated, or whether they just had covid and they were managing and they didn’t need an intervention,” she said.
“We need to get smarter about that. There’s technology out there … [that] can screen 10,000 people in an hour.
“I’m not saying that we need to replace clinicians, I’m just saying we need to be smarter about how we use that technology.”
Chief Medical Information Officer at Monash Health Lynden Roberts said the uptake of FHIR – which looks to turn healthcare data into a common language to facilitate interoperability – was already well under way in Australia.
“The federal government, to its great credit, has been funding a program to get FHIR rolled out right across the country, and I know Monash Health are having that turned on now … in the next month or two,” he said.
“That is going to open up incredible opportunities for us.”
CEO of South West Hospital and Health Service Dr Anthony Brown said that as the digital expansion continued, it was important to protect clinicians.
Dr Brown, who’s been a rural generalist for most of his career, said that his scope had been slowly reduced over the last 40 years without evidence.
“We need to have a reconfiguration of how we approach scope and the legal ramifications of it, and the way that our professional bodies handle it,” he said.