Tasmania lays foundations for e-health overhaul

The state's 2012-2016 Connected Care strategy is laying the basis for better integration with national e-health programs, such as the PCEHR, according to the health department's deputy CIO

Tasmania's Department of Health and Human Services has gone to market seeking foundational building blocks for an ICT strategy that will drive better outcomes and options for patients, according to the department's deputy CIO.

The department is currently guided by a multi-year ICT strategy which it put in place last year and labelled 'Connected Care', explains Tim Blake.

"We decided when we started developing [Connected Care] about 12 months ago that we needed a new brand – something that spoke powerfully to what we wanted to achieve," he says.

"Connected Care I think is fairly clear: It's the idea we need to co-ordinate or integrate the way that we care for our patients across the whole health system. So that's from primary care, into emergency departments, in-patient contexts, outpatients, community health – all of those things, over time, we need to integrate."

This push for an integrated approach to healthcare that can take into account the different contexts in which an individual may receive care is underpinned by the increasing complexity of people's healthcare needs.

"There's a lot of chronic disease – diabetes, obesity, heart disease," Blake says. "Caring for people with those conditions requires teams of people who work together," he explains.

"It's not just a problem for hospitals or just a problem for GPs – there are teams of people and caring for [patients] safely and that requires information to underpin that."

ICT can also make new models of care possible, he adds. "A model of care is the process by which people go through particular pathways in the health system. A lot of our models of care today require that people go straight to hospital and the emergency department. As you might imagine, that's not a very efficient way of caring for people."

One example he cites where technology can have deliver outcomes for patients and the health system is palliative care. A dying patient may want to die at home, and technology can make it possible for this to occur safely. Another example is creating tools that can be used by GPs and people who work in aged care homes to safely manage powerful opioid drugs.

The Connected Care strategy, which reaches through to 2016, already has five projects in play. The department has already gone to market for two components of a core e-health infrastructure upgrade.

The first part of the infrastructure project is replacing the department's current Java CAPS-based e-health integration engine. "Part of this strategy [Connected Care] has identified the need to provide for a single view of a patient or client across multiple applications, and a desire to support health providers and non-health clients as part of a long-term strategy for the future," the department's tender document states.

"This RFT seeks a vendor able to deliver a replacement for the Java Caps engine used across DHHS and implement workflows on the replacement engine to support existing business processes and those required for connection to national Infrastructure."

"What we have today, whilst it's actually quite good and quite solid, is reaching the end of its life and needs to be replaced with something that will be robust for a number of years to come – another 10+ – supportable and a bit more capable in its ability to support some of the national standards that are emerging," Blake explains.

The department is also seeking to replace the technology that supports the Tasmanian Health Client Index in order to offer enhanced enhanced functionality and connectivity to the national healthcare identifiers.

"It's a tool for managing patient identifiers and being able to match identifiers in different systems that might use different ways of identifying patients," Blake says.

Another foundational project for the department's strategy is funded by NeHTA and dubbed "Connected Care Foundations". That project is to put in place a portal for Tasmanian clinicians – "a single place where they can get their clinical information," Blake says.

The other projects include two in the medications space and one to build a child- e-health record.

The projects are all "tracking reasonably well" and on target to be completed by the end of the current financial year, Blake says.

The department's e-health strategy is based around an incremental approach. "I think gone are the days where, certainly for most health departments, [they] are given tens of millions of dollars at a time and the luxury of couple of years to go and deliver something," Blake explains.

"I think now we have to achieve incremental benefits with incremental funding," he says.

"The whole idea behind the Connected Care strategy is to build an information platform that we can increment every time we get some more funding.

"Funding is a little sparse in the health system right now, particularly because of falling GST revenues in the vast majority of the states. So that means we have to be wise, and what we're trying to do in the Connected Care strategy is decouple long and arduous procurement cycles from implementing new functionality.

"We're trying to have a platform that has provisioned hardware, provisioned software, so that when we get some more money we can focus on the labour of building something new and not buying hardware, buying software. Because if you do that every time you have a project – buy another system, by more hardware to go with it – it takes an awful long time in the public sector and it doesn't deliver quick and useful outcomes."

The Connected Care strategy defines five major work programs and each has a number of activities and projects that stretch well beyond the current financial year. "Some of them we know when we're going to do; others will be tackled more opportunistically as funding arises," Blake says.

"So we don't know exactly when that will be for everything, but some of them are ready to go and some of them will build on the foundations that we're building now."

Tasmania's e-health strategy isn't unfolding in a vacuum, with e-health projects underway in other states as well as the high-profile Personally Controlled Electronic Health Record rollout at the national level.

Blake says that there is a spirit of collaboration among state health CIOs that's stronger than it has ever been before. "There's a desire to not only learn lessons from one another but even share intellectual property and product, which is great," he says.

"It's great for taxpayers that we have that desire to not solve the same problems over and over again."

Despite the smaller size of the Tasmanian health care system compared to those in other states, there are elements of the Tasmanian experience that other health systems may be able to learn from.

"The beauty of Tasmania is that it's in what I'd call the 'Goldilocks zone'," Blake says: It's not so large that it's "politically unwieldy", but it's not so small that it's not a genuine health system.

"There are some things that Tasmania can prove faster than other states and that's what we've been seeking to do," Blake says. "To show that Tasmania has a clear plan, and when you have a clear plan and a clear strategy that can help in getting the confidence of people who can provide funding."

Tasmania has eschewed a 'big bang' approach to its e-health strategy, Blake says, and the approach of laying a foundation for e-health and then building out systems incrementally is something that may be applicable to other health systems.

"There are some areas where I think Tasmania has done a really good job," he says. One of those areas is the incremental approach of Connected Care.

"We're forced down that path because we have incremental funding, but having an incremental approach can be really effective because you don't bite off more than you can chew and you just focus on doing a little bit and doing it successfully," he says.

"You have to do it within your funding constraints and then you do the next bit, and then you do the next bit."

Connected Care is "a many year journey of changing, not only the way we use technology, but clinical practice," Blake says.

"Australia's got one of the world's great health systems but there's always a lot of room to be better," he adds.

Contact Rohan Pearce at rohan_pearce at idg.com.au or follow him on Twitter: @rohan_p

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