Business Needs

NSW Health wanted to obtain holistic patient data across the continuum of care and provide hospital and area health managers with relevant views of data. They also wanted to improve patient care and flow by providing up-to-date information at the point of care. New South Wales Health wanted to transform the way it looks at patient information – from a system-centric view to one that is patient centric. They wanted to analyse information in terms of individual patient journeys across the spectrum of care and in relation to the business needs of health organisations, rather than in terms of the systems the data came from. At the hospital level, they also wanted to provide staff and clinicians with accurate and timely patient information at the point of care.

Situation

 NSW Health comprises eight Area Health Services (AHS), 232 public hospitals, the Ambulance Service of NSW, as well as many other radiology and specialist departments and independent units. It has an annual budget of A$15 billion and is tasked with providing healthcare to a population of approximately 7 million. NSW hospitals treat approximately 1.5 million bed-allocated patients per year and around ten times that number of non-admitted patients. NSW Health has a focus on providing high-quality, effective patient care and recognises that timely access to accurate, relevant information plays a key role in enabling managers and clinical teams to provide this. Therefore, in 2007, NSW Health commenced a four-year business intelligence (BI) program to improve the quality of data and analysis capabilities. At the time they had a ten-year-old data warehouse solution in which it was becoming increasingly difficult to adapt to the changing needs of Health’s business. In particular, Health’s BI solutions were predominantly based on a system-centric data model. Data reporting was also siloed, making it more difficult to obtain an end-to-end, patient-centric view of information across the continuum of care, an essential requirement for effective tracking, comparison and measurement of healthcare and the basis for future electronic patient health records. Greg Wells, Director Strategy & Architecture, Strategic Information Management Branch, NSW Health, explains: “It wasn’t just about replacing our old data warehouse. It was about looking at how we intended to use data over the next ten years and deploying a system which would fit our business needs, rather than the other way around.” Michael Ducie, Program Director, Health Support Services, NSW Health, was focused on the reporting layer that would sit on top of the system. “One of the key drivers for improvement was knowledge sharing. We wanted to turn all of the raw data in our disparate systems into valuable business intelligence that would provide people at all levels in NSW Health with timely, accurate insights into performance through role-relevant end-to-end views of data.” The team recognised that two independent, but complementary architectures were needed; firstly, a ‘near-real-time infrastructure’ to support decision-makers at the front line through dashboards and tools; and secondly, a ‘batch infrastructure’ to support mandatory reporting to Government, service planning and complex analysis. Like most healthcare organisations, NSW Health hospitals had numerous databases in play and Greg Wells and his team were faced with an array of Oracle, Microsoft and other systems operating independently of each other. They recognised that if they could find a way of extracting and aggregating relevant information from the existing Emergency Department, Patient Administration, Community Health, Financial and other operational systems, they could obtain two key benefits: a smooth transition with minimal impact at the user level; and considerable savings by leveraging their existing investment.

Solution

 After investigating a range of business intelligence options, the tender was awarded to Microsoft who signed an agreement for Microsoft® SQL Server® 2005 to cover around 90,000 employees, across 40,000 desktops and 2,500 servers. Microsoft SQL Server 2005 would deliver on two important cost-saving goals: it would enable NSW Health to retain existing systems and to create a simple, familiar user experience. Greg Wells explains: “Microsoft SQL Server was chosen for our BI solution because it was a friendly, familiar platform and we knew that our IT team could develop solutions rapidly. This was very important because we wanted the flexibility to add new functions and capabilities easily ourselves, rather than being locked into a one-off solution, which might have entailed costly support”. The technical team were particularly impressed by the integration of Microsoft® Visual Studio® into SQL Server, which enables them to test, debug and view their designs in a window right within the program, making it quick and easy to test prototypes. Michael Ducie adds; “Microsoft SQL Server 2005 was seen as a low-risk choice, being industry standard, and we were comfortable with respect to security, access and scalability. A big distinction was the availability of skilled Microsoft resources to support the build, implementation and ongoing upgrades to our BI system. “We also saw that, post-implementation, when we would be ready to provide reporting on the desktop, it would be easier for staff and minimise training if the interfaces were already familiar to them.” In terms of approach, NSW Health started with the ‘near-real-time infrastructure’ – databases that captured existing real-time messages from clinical systems so information could be aggregated and analysed for managing patient journeys. This deliberate approach was chosen to demonstrate that existing information could be better used to manage the health system; and get it in front of the people that are running it – Hospital General Managers, Patient Flow Units, Directors or Clinical Operations and, most importantly, Nurse Unit Managers (NUMs) at a ward level. Using the Operational Data Stores (ODS) now deployed in all Area Health Services, the BI program developed a number of dashboards, reports and decision support tools in Business Objects. This architecture will enable staff to obtain real-time reports at the point of care. One BI tool that has already been designed and trialled is called Ward Activity and Nursing Display (WAND). Greg Wells explains: “In one screen, ward staff can see accurate, up-to-date information including: which patients are occupying which beds, their referring doctors and specialists; who is working on which shifts; and they can view bed-board, a state-wide application that manages transfers between hospitals.” By aggregating the information to a state level, the program has also deployed a Critical Care Resource management System. CCRS gives the state an up-to-date view of all Intensive Care and High Dependency beds across the state. The tool will be used by hospitals, crucial care units and the Ambulance retrieval service to manage transfers and beds – a tool that has been critical to managing the demands of the swine flu epidemic in NSW. However, these solutions are simply the first set of ideas on which the BI program will build. Michael Ducie comments: “Our aim is to build competency in the business around creating their own reports. This is in line with our philosophy of moving towards the 21st century enterprise in which people are empowered with a much more accurate view of where they fall in the business and what their role means.” The intent is to empower users and innovative teams as close to the business as possible to develop new solutions and share them with the state. For this reason, NSW Health’s Business Intelligence Competency Centre (BICC) will be run by innovative AHS, rather than by the Program or groups at a state level. Using Microsoft SQL Server the NSW Health BI team are also building the ‘batch infrastructure’, which they plan to complete by 2011. This solution will support mandatory reporting to Government, service planning and complex analysis. It comprises an integration architecture created using Microsoft SQL Server Integration Services to facilitate the loading of batch files extracted from a large number of separate source systems.

Benefits

With simple, efficient access to the right information in the right place and at the right time, the NSW Health Department anticipates a number of important benefits from their BI solution.

Patient-centric data analysis

No longer confined to a system-centric view of individual patient interactions, such as a one-off admission to the Emergency Department, staff will be able to build up an informed picture of a complete patient journey from admission to discharge and beyond. This essential data can be used to deliver individual patient e-health records. It also has great value in terms of analysis that will enable staff to track and manage issues across the continuum of care. For example, authorised individuals can compare average lengths of stay or outcomes from different treatments in order to improve patient outcomes and discover best practice.

Powerful decision support

The executive dashboards now deployed in AHS will provide an invaluable support tool for chief executives, general managers, directors and department heads. They will be able to track hospital performance more closely, analyse information in relation to performance, set and monitor performance targets, and align resources with demand for services. Greg Well’s comments: “With reliable, current information, managers will be able to address issues proactively rather than finding out about them months later. With a complete picture they can quickly escalate issues and put in place action plans based on performance thresholds.”

A flexible solution

From an IT management perspective, Microsoft SQL Server provides an extremely agile Business Intelligence (BI) platform that enables staff to continually innovate and improve. New systems can be added cost-efficiently down the track – for example, from allied health organisations – to provide useful data that can be incorporated. Equally, tools, scorecards and dashboards can be designed to assist managers and staff in many ways. Solutions are already planned to assist in managing state-wide budget and workforce planning and configuration; population health analysis.

Simplified reporting

The ability to generate and print accurate real-time reports will also make it easier for healthcare organisations to fulfil their statutory reporting obligations to the NSW Treasury, the Premier’s Department and the Commonwealth. Improved communication and collaboration With information continually updated and available to all, staff will be able to collaborate more effectively to provide services across organisations and facilities – critical care solutions at Health NSW are already proving this. Microsoft Business Intelligence Microsoft Business Intelligence is delivered through tight integration between Microsoft SQL Server 2005 or 2008, Microsoft® Office SharePoint® Server 2007, and Microsoft® PerformancePoint® Server. Together this suite of programs provides a business intelligence platform, a delivery platform and the tools and performance management applications needed to deliver the right information to the right people to support decision-making across healthcare organisations.

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