Transcript EHR Strategic Business Case

EHR Strategic Business Case
Briefing Deck V1.2
22/02/2016
What are the objectives of this briefing?
 Create understanding of the National EHR as a critical enabler of healthcare
reform – its rationale, scale, benefits, costs, dependencies and timeline
 Outline the proposed approach for progressing the programme and
requirements it will place on each area of the health service
 Gather feedback on work done to date and the strategic direction
 Outline governance proposal in line with SRG approach for discussion and
agreement
 Gain agreement to progress with the next steps including:

Acceptance of the overall roadmap and direction of travel

Proceeding with detailed next stages of requirements, readiness and business cases

Commitment to procure elements of the programme

Commitment to resourcing the programme
Delivering eHealth Ireland | Office of the Chief Information Officer
What is the National Electronic Health Record?
4 Components
eHealth Blueprint
National eHealth Blueprint
Stakeholders
Healthcare Providers
Patients
Corporate Administrators and Managers
National
Shared
Record
Clinical Management / Point of Care Environment
Procurement
Health & Safety
Asset Management
Program Management
Contract Management
Human Resources and
Payroll Management
Facilities Management
Rostering Time Recording
Virtual Care
Finance Management
Education &
Awareness
Corporate Setting
Customer Relationship
Management
Self-Health
Management
Scheduling and
Administration
Patient to Provider
Secure Messaging
ePrescribing
National Patient
Portal
Referral Management
Population Health
Management
Consumer Health & Wellbeing
Mobile Clinical Management
Computerized Physician Order
Entry
Case Management
Patient Test Results
Electronic Document
Management
Patient Administration
Clinical Notes and Records
Care Pathways and Decision
Support
ePrescribing
Population Health
Management
Referral Management
Provider Health Portal
Case Management
Electronic Document
Management
Disease Management
Care Pathways and Decision
Support
Electronic Clinical Notes and
Records
Community Healthcare Organisations
Computerized Physician Order
Entry
Hospital Patient
Administration
Hospital Laboratory
Hospital Pharmaceuticals
Hospital Medical Imaging
Hospital Groups
National EHR Integration and Access Layer
Communication
Layer
Message
Queuing
Core
Capabilities
Single Sign On
Message Data &
Transformation
Message
Encoding
Exception Handling
I.A.A.A.
Layer
Service
Management
Context Management
Terminology Services
Certification and
Integration Toolkit
Logging
Record Locator
Services
Legitimate Relationship
Services (LRS)
Identity
Management
Secure
Messaging
Authentication
Orchestration
ETL
Access
Privacy
Secure Audit
Registration
National EHR Registries and Domains
National EHR Registries
Client Registry
National EHR Domains
Provider Registry
Location Registry
Medical Imaging
Laboratory Results
National Analytics
Pharmaceutical
History
Immunization
History
Clinical Document
Repository
Encounter History
Performance
Management
Population Based
Analytics
Moving from paper records
locked in organisations to a
digital patient record shared
across care settings
Business Intelligence
Infectious Disease
History
Examples:
• Order Communications /
Results Reporting
• Medicines Management
• Clinical Notesstems
Examples:
• Single MPI
• Scheduling
• Clinical Notes / Records
• Screening & Surveillance
Community
Operational
Systems
Integration
Acute
Operational
Systems
The “glue” that binds all this together
and maintains integrity and security
across the system
Systems
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The ‘fourth utility’ in healthcare
Globally, there are
more than 400
EHR vendors on
the market
More than 80%
of US providers
use an EHR
Technology has transformed hotel,
transport, retail, banking, communications
………healthcare?
The history of technology as it enters industries is that
people say ‘this is going to transform everything in 2
years’ And then you put it in and nothing happens and
people say ‘why didn’t it work the way we expected it
to?... . And then lo and behold after a period of 10
years, it begins working.
— Robert Wachter
UCSF
FINLAND
100% health centres
with EHRs
International eHealth investment Estimates
•
•
•
•
•
€15.8Bn England – NPfIT over 10yrs
€1.6Bn Canada, Southwest Ontario – 2013-2017
€25Bn – USA – HITECH Act / Meaningful Use
€1.6Bn – Australia – predicted over 10yrs
€5.4Bn – NHS – predicted in next 5 yrs
Ireland lags most developed countries but can
learn from the investments and initiatives
elsewhere
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DENMARK
99% discharge letters,
orders/results,
prescriptions are
electronic
US – VHA
100% primary
care / hospitals
EHR
US – VHA
$3.09Bn in
cumulative net
benefits
NETHERLANDS
All prescriptions
electronic
The goals of Reform cannot be delivered
without a National EHR
Public increasingly demand ‘digital first’ experience
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The Irish Public Expect Digital Access and Services
eHealth Ireland conducted a 2 month public consultation on EHR
Source: Initial Findings from EHR Public Consultation
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Benefits are varied and context specific
A variety of studies provide evidence of benefits in specific care settings,
disease groups, conditions, and care processes
Patient Experience
Patient Safety &
Care
More Efficient
Delivery of Health
Services
↓ 7% reduction in inappropriate testing
↓ 37% reduction in preventable hospitalisations
↓ 20% reduction in LOS (Sepsis clinical pathway)
↓ 32% reduction in Sepsis mortality (early intervention)
↓ 76% reduction in errors in discharge summaries
↓ 68% reduced likelihood of medication errors
↓ 9.66% cost per patient (advanced EHR hospitals)
↓ 28% in transcription costs (Primary Care)
↓ 11% reduction in drug costs
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100,000 yearly inpatient adverse
drug events could be avoided
through Computerised Physician
Order Entry and Clinical Decision
Support. This would in turn free up
700,000 bed-days yearly, an
opportunity for increasing throughput
and decreasing waiting times,
corresponding to a value of almost
€300 million.
— Gartner
eHealth for a
Healthier Europe
2009
Building engagement and direction
Dec 2013
The eHealth
Strategy
identified the
EHR as a key
requirement
Q4 2014 – Q1 2015
The HSE conducted
an intensive
engagement with the
global eHealth
industry. This
informed the HSE on
the feasibility of
creating a National
EHR and the
optimum approach for
Ireland
May 2015
The Knowledge
and Information
Plan through
extensive
stakeholder
engagement
identified EHR
capabilities
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August 2015
The EHR
Vision and
Direction set
out the case for
change and
rationale for
introducing and
EHR received
ministerial
support
Q1 2016
Significant
ongoing public
engagement
The publication of
the National EHR
Strategic Business
Case in Q1 2016
will set the direction
of travel and define
the overall delivery
programme
We worked with stakeholders to define our approach
EHR Vision and Direction
Community Focused
Workshop
Key Questions Addressed
at each workshop
National Integration
Workshop
•
•
•
•
•
Policy drivers
Strategies
Issues
Benefits
Constraints
•
•
Practicalities
Funding phase
Priorities
What are HSE trying to
achieve? Why?
What trade-offs are they
prepared to make?
Plan
How long? How much?
And When?
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Acute Focused Workshop
Solution
Building Blocks
How to divide up the overall
solution into deliverable
chunks. What interim steps
might be needed.
Procurement /
Commercials
What commercial model is
preferred. How to drive
competition and value.
•
•
•
•
•
Organisation
Pathways
Existing Systems
Available systems
“Steeping stones”
•
•
•
•
Current suppliers
Available suppliers
Supplier models
Procurement approach
The National EHR Suite
The implementation of a National Shared Record can progress in single
implementation but solutions for Hospital Groups and CHOs must be
phased given the scale and complexity
Innovative Solutions
National Extended
Solutions
National
Core
Solutions of
Record
National Children’s
Hospital will have a
focused core based on
paediatric requirements.
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Key capabilities based on minimum viable
solution for all organisations from a single
vendor
Enhanced capability of core solutions are
extended from the core in first instance
unless there is a strong rationale for an
alternative
Emerging and innovative solutions from
the marketplace introduced in a controlled
manner
Core Solutions of Record
NATIONAL SHARED RECORD
National
Shared
Record
Community
Operational
Systems
COMMUNITY CORE
• Patient Administration System (PAS)
• Referral Management
• Population Health Management (Screening and
Surveillance)
• Mobile Clinical Management
• Test Results
• Clinical Notes and Record
Existing Primary Care-GP Systems
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Integration
• A national portal with key patient summary
care data drawn from the operational
solutions within the health service
• A longitudinal view of the patient’s care
• Access to specific elements of records for
different user groups
Acute
Operational
Systems
ACUTE CORE
• Patient Administration System (PAS)
• Order Communications
• Medications Management (ePrescribing,
Medications Administration and Pharmacy)
• Clinical Notes and Records
Features of our approach
 Focused on digital services for the provision of care to the public, not tied to
organisations
 A phased and modular approach delivers benefits at each phase
 Detailed deployment planning will take into account the particular and/or
urgent needs of any specific area
 Differentiating between core and extended capabilities allows us to leverage
investments made to date including NIMIS, MEDLiS and MN-CMS
 Leverages the existing and pan-government infrastructure while recognising
need for additional investment
 Based on a ‘cloud first’ policy
 Supports innovation whilst maintaining the integrity and stability of the core
National EHR
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Dependences, pre-requisites and risks
Pre-requisites
 Stakeholders Engaged (CCIOs,
HGs, CHOs, etc.)
 Privacy Impact Assessment(s)
 Strategic Business Case
 National Approach
 Building Baseline Data
Risks
 Privacy Concerns
 Size and complexity of
Programme
 Resources
 Expectations
Key Success Factors
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Dependencies
 Reform Alignment
 Individual Health Identifier
 Resources – funding and
people (clinical, technical, etc.)
 Lighthouse Projects
 Readiness assessment
 Policy alignment
Implementation
Preparation
Design
Readiness
Implementation
Procurement
Delivery
There are key preparation activities that must be completed over the next 12
months including:
 Defining the requirements
 Confirming the readiness to proceed
 Securing funding and completing procurement activities
As per the outline schedule in the Strategic Business Case, delivery of
elements of the National EHR would commence in Q2 of 2017. The roll-out
across the CHO’s and HG’s would be as per the deployment strategies agreed
during the preparation phase. The National Children’s Hospital will be a priority
implementation within the roll-out plan.
Delivering eHealth Ireland | Office of the Chief Information Officer
EHR Programme Roadmap 2016 - 2018
June 2016
Strategic
Business
Case
Jan 2017
June 2017
Jan 2018
Communications and Engagement
Programme
Governanc
e
Programme Management
Procurement
Office
National Requirements
Decision point involving
agreement with party outside
HSE, e.g. DoH, DPER
Portal & integration Requirements
Decision point involving
agreement with HSE
stakeholders such as Hospital
Groups or CHO’s
Acute Requirements
Community
Requirements
Deployment
Strategies
HG Readiness Assessment
Prepare to deploy
CHO Readiness Assessment
Prepare to deploy
Portal & Integration Procurement
Portal & Integration Implementation
Community Procurement
Community Implementation
Acute Procurement
Acute Implementation
CHG Implementation
Business Cases
Privacy and Data Sharing
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EHR Programme Roadmap 2016 - 2018
June 2016
Jan 2017
June 2017
Jan 2018
Programme, Communications and Engagement Management
Stakeholder Readiness and Preparation
Requirements Definition
(National, Portal, Integration,
Community & Acute)
Business Cases
Procurement (Portal, Integration,
Community, Acute)
Implementation (Portal, Integration, Community, Acute)
CHG Implementation
Privacy and Data Sharing
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Path to Single Solution Set
Innovative Specialist
Solutions
Critical Tactical
Solutions
5 Years
10 Years
PAS
Replacement
Other Future
Projects
Other Future
Projects
Order/Comms
Single
Solution Set
Other Future
Projects
BiPolar Lighthouse
Project
Epilepsy
Lighthouse Project
Evolving to a single
solution set will require
agility and a governance
approach that supports a
dynamic environment
Haemophilia
Lighthouse Project
Initial National Shared
Record
Portal
(Organisation)
National Shared Record Development
Community Operational Components – Phased Implementation in CHO’s
Acute Operational Components – Phased Implementation in HG’s
NCH Implementation
National Solutions
NIMIS
Other
Other
MEDLis
Other
MN-CMS
NICIS
National Solutions
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Proposed Programme Governance – HSE / SRG
 Clinical representation at EHR Programme Board level will be provided through a senior CCIO
representative, two clinical representatives for Acute and a clinical representative for Community
 In addition to the EHR Programme Board, clinical leadership and guidance will be a core
component to the constituent project boards operating under the EHR Programme Board
 eHealth Ireland has input to advisory groups - to include clinical, technical, information governance
SRG Leadership
EHR Programme
Advisory Groups
(CCIO, eHI Committee)
EHR
Programme
Board
EHR
Programme
Team
Acute
Programme
Board
Acute Project #1
Project Board
Acute Project #2
Project Board
EHR
Programme
Design Authority
Community
Programme
Board
….
Community
Project #1
Project Board
Community
Project #2
Project Board
Project Teams
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EHR Portal
Project Board
….
EHR Integration
Project Board
….
What are the next steps?
The key next steps are:
 Gain agreement on this strategic direction
 Agree the governance relationship with SRG
 Mobilise the programme fully with active governance and stakeholder
engagement to gain broad support
 Develop national requirements and standards that underpin the National
EHR – resources will be required across the health system to help with the
definition
 Conduct readiness assessments in CHO’s and HG’s to identify and progress
any actions required to ensure everyone is on a firm footing for success
 Create outline and full business cases for each of the four elements in order
to secure funding
 Commence procurement activities
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Discussion – Programme Leadership and Support
 What people need to be committed?
 Clinical
 Managerial
 Project Resources
 Business Change
 How do we recognise this is not simply an ICT Programme and that active
collaboration with Reform (SRG) is needed to optimise resource demands on
the system and coordinate change?
 How do we create cross-system “Sponsorship” and the need for whole
system “Ownership”?
 Do we all agree to be involved in helping to overcome barriers (e.g. policy
around the sharing of information)
 What is the optimum vehicle for delivering this programme?
 Who can pose barriers to the programme and how do we engage them?
Delivering eHealth Ireland | Office of the Chief Information Officer
Appendix
Briefing Deck V1.2
22/02/2016
Context
 The Vision and Direction for a National Electronic Health Record published in
August 2015 outlined the ambition and imperative to act strategically in the
delivery of a long term transformation in the delivery of care.
 The delivery of reform is fundamentally dependent on a transformation in
how we use technology – we can not deliver on Clinical, Structural and
Financial reforms in the absence of a National EHR.
 The National EHR programme is envisaged as a 15 year journey to move
from a position where Ireland is at a low level of technology adoption and
maturity to one where it compares favourably with other developed countries.
 Delivering on such an ambitious programme of work presents significant
challenges to the HSE and a significant emphasis on the preparatory work
has been focused on how to deliver this in a way that delivers discrete
benefits in a phased manner, minimises risk, and recognises the constraints
across the Irish health system
 The Strategic Business Case provides more detail on this journey including,
the target end stage, the benefits that will be delivered, the approach to
delivery, and the outline costs
Delivering eHealth Ireland | Office of the Chief Information Officer
What is the National EHR Solution Strategy?
 Progress with four distinct elements
• National Shared Record – delivered via a portal
• Community EHR Operational Systems – to provide the core functions
necessary to deliver modern community services
• Acute EHR Operational Systems – to provide the core functions necessary
to deliver modern acute services
• Integration Platform – to securely share information between all the
systems, maintain integrity of information and integrate across care settings
 The National Shared Record, Community System and Integration Platform are
new elements on the eHealth landscape. There will only be one national
version for the core components of each solution
 There are some existing EHR capabilities in the acute setting. The strategy
aims to evolve to a situation over several years to a point where there is only
one solution for the core EHR components
 All four elements need to be underpinned by national requirements and
standards to ensure that they achieve the ambition of the National EHR
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Context
Delivering eHealth Ireland | Office of the Chief Information Officer
Context
Delivering eHealth Ireland | Office of the Chief Information Officer
What is the National Electronic Health Record?
The National EHR is a fundamental cornerstone for the delivery of high quality,
comprehensive and accurate information in a timely manner for the provision of patient
centred, effective and efficient care.
The National EHR
comprises:
Community
Operational
Systems
Acute
Operational
Systems
Integration
National Shared Record
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What does the National EHR do?
• Transforms patient experience
• Delivers greater patient safety and more
effective care
• Drives efficient delivery of health services
• Makes the wider reform programme
possible:
Underpins integrated care
Provides the information for
proactive health and wellbeing
initiatives
Provides the operational systems to
realise CHO’s and Hospital Groups
Captures accurate information on
activities that show the true cost of
treating a patient
Evolving focus of IT Governance
IT the new world
Traditional ‘core’ IT (CTO)
Suppliers
Rationalize/
Innovate
Governance focus
II. Rationalise
‘traditional IT’
Plan
IV. Innovation
‘digital world’
Partnerships
Broker
Long Term focus
Base Product
Self supporting
Short cycles
Run & maintain
Stable
Governance focus
Patient driven
Build
Orchestrator
Integrator
Health specific
Co-sourcing
Run
I. Run & maintain
‘traditional IT’
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III. ‘Maintenance
‘digital Healthworld IT’
Indicative Delivery Timeframe – 5 Year Acute
Delivery Scenario
Indicative Delivery Timeframe – 5 Year Acute Delivery Scenario
2016
2017
2018
2019
2020
2021
2022
National Shared Record (Portal)
Integration
CHO 4
CHO 7
CHO 2
CHO 5
CHO 8
CHO 3
CHO 6
CHO 9
CHO 1
Acute HG 1 - CHG
Acute HG 4
Acute HG 2
Acute HG 5
Acute HG 3
Acute HG 6
Acute HG 7
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2023
2024
2025
2026
Indicative Resources – 5 Year Acute Delivery Scenario
EHR Programme Resource Usage 2016 - 2026
500
450
400
350
300
250
200
150
100
50
0
2016
2017
2018
2019
2020
Portal
Delivering eHealth Ireland | Office of the Chief Information Officer
Integration
2021
2022
Community
2023
Acute
2024
2025
2026
Indicative Delivery Timeframe – 9 Year Acute
Delivery Scenario
Indicative Delivery Timeframe – 9 Year Acute Delivery Scenario
2016
2017
2018
2019
2020
2021
2022
2023
2024
National Shared Record (Portal)
Integration
CHO 4
CHO 7
CHO 2
CHO 5
CHO 8
CHO 3
CHO 6
CHO 9
CHO 1
Acute HG 1 - CHG
Acute HG 2
Acute HG 4
Acute HG 6
Acute HG 3
Acute HG 5
Acute HG 7
Delivering eHealth Ireland | Office of the Chief Information Officer
2025
2026
Indicative Resources – 9 Year Acute Delivery
Scenario
EHR Programme Resource Usage 2016 - 2026
450
400
350
300
250
200
150
100
50
0
2016
2017
2018
2019
2020
Portal
Delivering eHealth Ireland | Office of the Chief Information Officer
Integration
2021
2022
Community
2023
Acute
2024
2025
2026