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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

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integrated health system planning

Integrated Health System Planning

An exclusive Executive Circle Briefing

agenda
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
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
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)
vch imis context
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 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 2002
Clinical Systems - 2002

Richmond

Providence

Vancouver

Coastal

Acute

Eclipsys SCM

IDX LastWord

Health Vision

McKesson Star

Meditech

CCD

CCD

Hospital IS

HealthVision ADT

Pharmacy

BDM

BDM

Radiology

GE ProgRIS

IDXrad

Laboratory

CCD/3G

LabVision

Misys Lab/CoPath

LabVision

PACS

Intelerad

Agfa

Agfa

DI integration

Perioperative

GE ORMIS

GE ORMIS

Pyxis

ESI Orbit

Per Se ORSOS

Cardiology

Transcription

MS Word

SoftMed

MS Word

MS Word

DictaphPHSA

Digital(unsupported)

Tape Dictaph PHSA & Tape

Digital Express

DictaphPHSA

Digital Express

Dictation

Coding and Abs.

3M

MS Access

3M

Softmed

3M

Community

In4tek PARIS

Procura

Procura

Comm. health

Momentum

Procura

Mental health

Synapse

Public health

RISE Healthware

iPHIS

Env. health

Hedgehog

[Various]

HealthSpace

Primary care

PCAC/CHC EMRs

[Not supported]

Practice EMRs

clinical systems 2006
Clinical Systems - 2006

Richmond

Providence

Vancouver

Coastal

CareConnect Integrated Electronic Health Record

Acute

Eclipsys SCM

GE CareCast

McKesson

STAR

Hospital IS

Pharmacy

HealthVision ADT

BDM

Radiology

GE ProgRIS

IDXrad

Laboratory

Misys Lab/CoPath

Stentor

Agfa

Intelerad

Agfa

Agfa

PACS

DI integration

Stentor Web Viewer, Agfa/Sun Deep Archive

Perioperative

GE ORMIS

GE ORMIS

ESI Orbit

Per Se ORSOS

Cardiology

GE MUSE

GE MUSE

Transcription

SoftMed

MS Word

SoftMed

SoftMed

Meditech

Dictation

DictaPhone

DictaPhone

Dictaphone

Coding and Abs.

3M

Community

In4tek PARIS

Momentum

Comm. health

Procura

Mental health

Synapse

RISE Healthware

Public health

iPHIS

RISE Healthware

Env. health

HealthSpace

Hedgehog

Primary care

PCAC/CHC EMRs

Vendor tbd

Wolf, Clinicare, OSCAR, etc.

Practice EMRs

clinical systems 2010
Clinical Systems - 2010

Richmond

Providence

Vancouver

Coastal

CareConnect Integrated Electronic Health Record

Acute

TBD – Review Underway

Hospital IS

Pharmacy

Radiology

GE

Laboratory

Misys

PACS

Agfa

DI integration

Stentor

Perioperative

GE ORMIS

Cardiology

GE MUSE

Provincial iEHR, PLIS, eDrug, DI, etc.

Transcription

SoftMed

Dictation

Dictaphone

Coding and Abs.

3 M

Community

Comm. health

In4tek PARIS

Procura (home support)

Mental health

Public health

Env. health

Hedgehog

Primary care

PCAC/CHC EMRs

IntraHealth

Practice EMRs

Vendors complying to provincial EMR standards

vch infrastructure challenges
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!
slide14

Email

MS Exchange

Novell GroupWise

Microsoft

(MS) Exchange

Lotus Notes

Healthnet

MS Exch

Voicemail

Nortel

Octel

Octel

Mitel

Nortel

Workstations

Compaq

Compaq

Hewlett-Packard

Hewlett-Packard

HP

Various

Servers & Storage

Various

Hewlett-Packard

Compaq

Hewlett-Packard

various

Hewlett-Packard

Lexmark

Various

HP

Printers

Hewlett-Packard

Hewlett-Packard

Desktop operatingsoftware

Windows NT 4.0

Windows NT 4.0

Windows 2000

various

Network operating system

Novell NetWare

Windows 2000

Novell NetWare

Novell

MS

various

Ethernet

Ethernet

Ethernet

Token ring

Ethernet

Local area network

Wide area network

Telus

Telus

Telus

ITSD / Telus

Infrastructure - 2002

Providence

Vancouver

Richmond

Coastal

slide15

Email

Microsoft (MS) Exchange

Voicemail

Nortel

Octel

Nortel

Octel

Mitel

Workstations

Hewlett-Packard

Servers & Storage

Various

various

Hewlett-Packard

Hewlett-Packard & Lexmark

Printers

Desktop operatingsoftware

Microsoft Windows

Network operating system

Microsoft

Active Directory

Microsoft

Active Directory

Novell NetWare

Microsoft

Active Directory

Novell NetWare

Ethernet

Local area network

Wide area network

Telus

Infrastructure - 2006

Providence

Vancouver

Richmond

Coastal

slide16

Email

Microsoft (MS) Exchange

Voicemail

Nortel

Mitel

Nortel

Octel

Octel

Workstations

Cirtix, Thin Client, PC Blades, etc.

Servers & Storage

Hewlett-Packard

Hewlett-Packard

Printers

Desktop operatingsoftware

Microsoft Windows

Network operating system

Microsoft Active Directory

Ethernet

Local area network

Wide area network

Telus

Infrastructure - 2010

Providence

Vancouver

Richmond

Coastal

corporate systems 2002

Finance

Eclypsis

VH Custom

Eclipsys

McKesson

CCD

CV

NewViews

CCD

CV

Billing/AR (clinical)

Billing/AR (other)

SAP FICO

ACCPAC

General Ledger

Infinium GL

VH Peoplesoft GL

Ormed

CCD

Ormed

Com-vida(CV)

Accounts Payable

Inf. GL

Or-med

VH Peoplesoft AP

ESI

Purchasing

SAP MM

Mc-Kesson

VH Peoplesoft

Inventory

Asset Management

PHC Custom

Systems Union

Budgeting

SAP FICO

Human Resources

Eclypsis

Telus PeopleSoft

SAP HR

Blae-berry

Or-med

CV

Ormed

CV

Human Resources

VH Custom

Payroll

SAP PAY

Staff Scheduling

PHC TCT

VH TCT

Loki

RH TCT

Procura/SAP

Procura

Facilities

Space Management

Archibus FM

Plant Maintenance

AMMS

MR

CD

MM

AMMS

SAP PM

Pro-Maint

Facilities Security

Decision Support

Decision Support

VH QUIST

McKesson

Case Costing

Eclipsys SDSM

Corporate Systems – 2002

Providence

Vancouver

Coastal

Richmond

slide19

Finance

Eclypsis

VH Custom

Eclipsys

McKesson

CCD

CV

NewViews

CCD

CV

Billing/AR (clinical)

Billing/AR (other)

SAP FICO

ACCPAC

General Ledger

Peoplesoft

Accounts Payable

Purchasing

Inventory

Asset Management

Budgeting

Human Resources

Peoplesoft

Human Resources

Payroll

Staff Scheduling

PHC TCT

VH TCT

Loki

RH TCT

Procura/Loki

Facilities

Space Management

Archibus FM

Plant Maintenance

Pro-Maint

Maximo

MR

CD

MM

AMMS

AMMS

Facilities Security

Decision Support

Decision Support

VH QUIST

McKesson

Case Costing

Eclipsys SDSM

Corporate Systems – 2006

Providence

Vancouver

Coastal

Richmond

slide20

Finance

TBD

IDX

McKesson

Billing/AR (clinical)

Billing/AR (other)

Peoplesoft

General Ledger

Accounts Payable

Purchasing

Inventory

Asset Management

Budgeting

Human Resources

Peoplesoft

Human Resources

Payroll

Staff Scheduling

PHC TCT

TBD – Project Underway

Facilities

Space Management

Archibus FM

Plant Maintenance

AMMS

MR

CD

MM

AMMS

Maximo

Pro-Maint

Facilities Security

Decision Support

Decision Support

VH QUIST

McKesson

Case Costing

Eclipsys SDSM

Corporate Systems – 2010

Providence

Vancouver

Coastal

Richmond

success factors
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
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
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
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
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