Integrated Health System Planning
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Integrated Health System Planning An exclusive Executive Circle Briefing Agenda Overview of BC Healthcare Regionalization Vancouver Coastal Health Transformation • Where we have come from • Where we are going Success Factors Challenges Health Authority Collaboration Projects Lessons Learned Regionalization Overview December 2001 NDP government consolidated 52 regional and community health councils into 6 Health Authorities Created five geographic health authorities to govern, plan and coordinate services regionally, plus the Provincial Health Services Authority to govern specialized province-wide services Each Health Authority consolidated their IT departments into integrated regional service units. i.e. VCHA merged 8 IT departments into 1 corporate IMIS service unit Health Authority Map NHA: (patient population: 300,000) IHA: (patient population: 700,000) VIHA: (patient population: 700,000) VCHA: (patient population: 1,100,000) FHA: (patient population: 1,500,000) PHSA: (provincial population: 4.3 Million) Vancouver Coastal Health VCH IMIS Context VCH 2006/07 Operating Budget: 2.3 Billion IMIS 2006/07 Operating Budget: $63.7 Million % of total VCHA Operations: 2.77 Number of IMIS FTEs: 415 2006/07 IMIS Capital Budget: $66 Million Number of Network accounts: 25,000 Number of PCs: 15,000 98 facilities spread across 58,000 km2 VCH Regionalization Review VCH merged multiple regions with multiple clinical, corporate and technical infrastructure systems. When VCH formed its IT infrastructure: • Lacked cross-site, cross-program, cross-network access to patient data • Lacked a “patient-centric” view of information • Inconsistent data standards and business rules • Silos of clinical information • Resulting in clinical/business issues: – patient safety compromised – inability to implement key strategies – customer dissatisfaction Clinical Systems Journey Clinical Systems - 2002 Providence Vancouver Richmond Coastal Acute Hospital IS Pharmacy Radiology Laboratory PACS Eclipsys SCM HealthVision ADT Health Vision IDX LastWord BDM BDM GE ProgRIS IDXrad LabVision Misys Lab/CoPath Intelerad Agfa CCD McKesson Star CCD Meditech CCD/3G LabVision Agfa DI integration Perioperative GE ORMIS Pyxis GE ORMIS ESI Orbit Per Se ORSOS Cardiology Transcription Dictation Coding and Abs. Community Comm. health MS Word MS Word Dictaph Digital PHSA (unsupported) 3M SoftMed Tape Dictaph PHSA & Tape MS Access In4tek PARIS Digital Express 3M Softmed Procura Momentum Procura Mental health Public health Env. health Primary care MS Word Digital Express 3M Procura Synapse RISE Healthware iPHIS Hedgehog [Various] PCAC/CHC EMRs Practice EMRs Dictaph PHSA [Not supported] HealthSpace Clinical Systems - 2006 Providence Richmond Vancouver Coastal CareConnect Integrated Electronic Health Record Acute Hospital IS Pharmacy Radiology Eclipsys SCM GE CareCast McKesson STAR HealthVision ADT BDM GE ProgRIS IDXrad Laboratory PACS Misys Lab/CoPath Intelerad Agfa DI integration Perioperative Cardiology Transcription Dictation Stentor Web Viewer, Agfa/Sun Deep Archive GE ORMIS GE ORMIS GE MUSE SoftMed SoftMed SoftMed DictaPhone DictaPhone Public health Env. health Primary care PCAC/CHC EMRs Practice EMRs Meditech MS Word Dictaphone 3M Community Mental health Per Se ORSOS ESI Orbit GE MUSE Coding and Abs. Comm. health Stentor Agfa Agfa In4tek PARIS RISE Healthware RISE Healthware Hedgehog Vendor tbd Wolf, Clinicare, OSCAR, etc. Momentum Procura Synapse iPHIS HealthSpace Clinical Systems - 2010 Providence Vancouver Richmond Coastal CareConnect Integrated Electronic Health Record Acute Hospital IS Pharmacy TBD – Review Underway GE Laboratory Misys PACS Agfa DI integration Stentor Perioperative GE ORMIS Cardiology GE MUSE Transcription SoftMed Dictation Coding and Abs. Community Dictaphone 3M Procura (home support) Comm. health Mental health In4tek PARIS Public health Env. health Primary care PCAC/CHC EMRs Practice EMRs Hedgehog IntraHealth Vendors complying to provincial EMR standards Provincial iEHR, PLIS, eDrug, DI, etc. Radiology Infrastructure Journey VCH Infrastructure Challenges Heterogeneous Infrastructure • Inherited every flavour of hardware and OS Inherited a lot of legacy technologies Inconsistent Policies and Processes • Everyone did things differently Different degrees of IMIS Process Maturity Insufficient Infrastructure Budgets Want it all integrated yesterday! Infrastructure - 2002 Providence Vancouver Richmond Microsoft Coastal MS Exchange Novell GroupWise (MS) Exchange Nortel Octel Nortel Octel Compaq Compaq Hewlett-Packard Hewlett-Packard various Compaq Hewlett-Packard Hewlett-Packard HewlettPackard HewlettPackard Hewlett-Packard Lexmark Desktop operating software various Windows NT 4.0 Windows 2000 Windows NT 4.0 Network operating system various Novell NetWare Windows 2000 Novell NetWare Local area network Ethernet Ethernet Ethernet Token ring Wide area network Telus Telus Telus Email Voicemail Workstations Servers & Storage Printers Lotus Notes Healthnet MS Exch Mitel ITSD / Telus HP Various Various HP Various Novell MS Ethernet Infrastructure - 2006 Providence Vancouver Email Voicemail Nortel Octel Nortel Octel Mitel Hewlett-Packard various Hewlett-Packard Printers Various Hewlett-Packard & Lexmark Desktop operating software Network operating system Coastal Microsoft (MS) Exchange Workstations Servers & Storage Richmond Microsoft Windows Microsoft Active Directory Novell NetWare Microsoft Active Directory Local area network Ethernet Wide area network Telus Novell NetWare Microsoft Active Directory Infrastructure - 2010 Providence Vancouver Email Voicemail Workstations Servers & Storage Printers Richmond Microsoft (MS) Exchange Nortel Octel Nortel Cirtix, Thin Client, PC Blades, etc. Hewlett-Packard Hewlett-Packard Desktop operating software Microsoft Windows Network operating system Microsoft Active Directory Local area network Wide area network Coastal Ethernet Telus Octel Mitel Corporate Systems Corporate Systems – 2002 Providence Vancouver Richmond Coastal Finance Billing/AR (clinical) Billing/AR (other) General Ledger Accounts Payable Purchasing Inventory Asset Management Budgeting Eclypsis Eclipsys VH Custom McKesson CCD CV New Views CCD CV ACCPAC Infinium GL Inf. GL McKesson SAP FICO VH Peoplesoft GL VH Peoplesoft AP Ormed PHC Custom Ormed ESI VH Peoplesoft CCD Ormed Comvida (CV) Ormed CV SAP MM Systems Union SAP FICO Human Resources Human Resources Payroll Eclypsis Staff Scheduling PHC TCT VH Custom Telus PeopleSoft VH TCT Loki SAP HR SAP PAY Blaeberry Ormed CV RH TCT Procura/SAP Procura AMMS SAP PM Pro-Maint Facilities Space Management Plant Maintenance Facilities Security Archibus FM AMMS MR CD MM Decision Support Decision Support Case Costing VH QUIST Eclipsys SDSM McKesson Corporate Systems – 2006 Providence Vancouver Finance Billing/AR (clinical) Eclypsis Billing/AR (other) Eclipsys VH Custom Coastal Richmond McKesson CCD CV New Views SAP FICO ACCPAC General Ledger Accounts Payable Purchasing Peoplesoft Inventory Asset Management Budgeting Human Resources Human Resources Peoplesoft Payroll Staff Scheduling PHC TCT VH TCT Loki RH TCT Procura/Loki Facilities Space Management Plant Maintenance Facilities Security Archibus FM AMMS MR CD MM AMMS Maximo Decision Support Decision Support Case Costing VH QUIST Eclipsys SDSM McKesson Pro-Maint CCD CV Corporate Systems – 2010 Providence Vancouver Coastal Richmond Finance Billing/AR (clinical) IDX TBD McKesson Billing/AR (other) General Ledger Accounts Payable Purchasing Peoplesoft Inventory Asset Management Budgeting Human Resources Human Resources Peoplesoft Payroll Staff Scheduling PHC TCT TBD – Project Underway Facilities Archibus FM Space Management Plant Maintenance AMMS MR CD MM AMMS Maximo Facilities Security Decision Support Decision Support Case Costing VH QUIST Eclipsys SDSM McKesson Pro-Maint Capital Investment 2002 - 2010 Clinical Corporate Infrastructure 2002-2006 $48M $28M $14M 2006-2010 $153M $34M $20M Total $201M $62M $34M Operating Costs ($Million) IMIS Operating Budget VCH Total Operating Budget IMIS % of Total 2003/04 2004/05 2005/06 2006/07 58.5 58.8 58.7 63.7 2,126.1 2,142. 9 2,237.3 2,300.0 2.45% 2.74% 2.62% 2.77% Operating Trends Operating Budget Analysis 45.0 38.5 40.0 35.0 30.0 31.3 27.2 30.5 32.8 28.3 $Million 26.0 25.2 2005/06 2006/07 25.0 20.0 15.0 10.0 5.0 0.0 2003/04 Labour 2004/05 Non Labour (excluding depreciation) Success Factors Cross functional governance models • Within VCHA – eHealth, Corporate & Infrastructure Steering Committees prioritize capital projects – HSDA IMIS Advisory Committees – links HSDA and IMIS operations – IMIS Program Delivery Portfolio – PMO • Inter Health Authority Committees – – – – BC CIO Council Technical Advisory Group Network Working Group Directories and Authentication Working Group IT Planning • Plan into Action, Application Integration Strategy, Technical Architecture, etc. • Coordinate and balance internal needs, provincial eHealth directions and National initiatives (Infoway) Collaboration • Internal Stakeholders • Provincial partners – the other health authorities and vendors Regionalization Opportunities Rationalization of existing services • Reduce duplication • Used savings to drive future IMIS investment Contract Renegotiation • i.e. Licensing, Network Connectivity, etc. Health Authority Collaboration • Everyone was solving the same problems – brought together inter-HA teams • i.e. Created a Provincial IP Addressing Scheme Regionalization Challenges Aligning collective agreements and contract staff IT department integration Geographic complexity System complexity Lack of investment or strategic prioritization in IT created a tremendous volume of pent-up demand Participation in multiple projects simultaneously while maintaining daily operations Balancing VCH needs with Provincial needs Inter Health Authority Collaboration Projects Private Network Gateway (PNG) • Dedicated, secure network linking all HA DI Emergency Transfer Grid • Short term (10 day) DI storage partition • 56 facilities capable of pushing images to the Grid • 5250 studies pushed (Oct – Dec. 2006) Network BC • Broader Public Sector WAN contract negotiation Data Centre • Broader Public Sector Data Centre Build Lessons Learned Infrastructure view - focus on the basics • • • • Network Connectivity Directory and Domain Integration Email Consolidation Enterprise Backups Have dedicated HR and Finance support throughout the transition • Staff consolidation • Teasing out budget details Its about service delivery, not server delivery Thank you for your attention.
