Major General Paul Alexander Commander Joint Health Surgeon General Australian Defence Force Address to C3i's Government Watch Division ehealth Seminar National benefits arising from Defence s ehealth system National Press Club Monday 12 April 2010
MAJGEN Alexander s Responsibilities All garrison health-care (as CJHLTH) Technical control of all ADF health services (as SGADF)
JHC s Mission Develop, deliver and sustain a military health system that supports and enhances Defence s capability.
JHC s Strategic Objectives 2010-2011 Among JHC s objectives to deliver effective and efficient healthcare, and supporting Defence operations is to provide : Required health knowledge is provided through ehealth system. (JHC Strategic Objectives 2010-2011, number 2)
Implementation of an ehealth system Electronic health records Capable of operational use Health Management Research tool Other National agency involvement Individual ownership of health JOINT HEALTH COMMAND
Joint ehealth Data and Information System May your healthcare records be with you Clinicians and administrators will be asked to become JeHDI Masters.
Defence and DVA provides healthcare throughout Australia across jurisdictional boundaries. Therefore JeHDI, despite being a relatively small (in dollar terms) e- health project, has the potential to influence all the state and territory health jurisdictions and most of the private providers of healthcare. JeHDI s breadth and depth of penetration of the healthcare industry in Australia could be significant.
JeHDI s Purpose: To implement an ADF electronic health information system linking health data from recruitment to discharge by December 2013
JeHDI functional priorities: Care delivery enablement Health records management Care delivery management Health care capability governance
Where does JeHDI fit nationally? National ehealth Strategy - whole of government information and communications technology paradigm - a strategic framework for national coordination and collaboration in ehealth National ehealth Transition Authority (NEHTA) - to develop ehealth infrastructure specifications DVA and DoHA - ehealth capability for a national interoperable ehealth infrastructure Autumn 2010 - Enabling ehealth legislation for unique health identifiers will be passed
National Health and Hospitals Reform Commission - A Healthier Future for all Australians, Final Report June 2009 (www.health.gov.au) Recommendation 115 states: "115. We recommend that, by 2012 every Australian should be able to: have a personal electronic health record that will at all times be owned and controlled by that person; approve designated health care providers and carers to have authorised access to some or all of their personal electronic health record; and choose their personal electronic health record provider. Defence and JeHDI will play a key role.
A National Health and Hospitals Network for Australia's Future - March 2010 (www.health.gov.au) Page 21: "Over the coming weeks and months, the Government will announce additional reforms that will build on existing investments and the structural reforms outlined in this document. These reforms will be made across a range of areas, including in:... e-health, to take further steps towards the introduction of a personally controlled electronic health record for all Australians. Defence is a major stakeholder in ensuring the Commonwealth delivers on this announcement and meets the national objectives.
JHC and JeHDI will: use the national standards being developed by NEHTA leverage existing e-health activities (led by NEHTA, the Commonwealth and the states and territories etc) use technology to support better health care work with the healthcare and health software industries to make it happen.
JHC and JeHDI will: Link health data from recruitment to discharge, and subsequent management in other agencies. Complement the Strategic Reform Program (SRP) - allowing identification and remediation of inefficiencies
The road to developing JeHDI: Defence s existing ehealth systems are two primary discrete ehealth systems - HealthKEYS and MIMI Alexander Review identified a lack of an electronic clinical health informatics application at point of care to allow: Easy entry of individual clinical information to populate an electronic health record Easy retrieval of a member s clinical information by diagnosis or clinical encounter Ability to view de-identified aggregated health data to allow commanders to view the readiness of individuals or units.
The Capability Gap of current Defence health systems: Unable to universally meet Defence clinical user needs or management requirements Below clinical contemporary Australian practice Unable to provide aggregated governance data, such as the cost of fee for services delivery or after hours care Unable to provide data aggregation to identify delivery efficiencies, or to identify early disease and injury trends
Progress and status of JeHDI: Key to reforms currently lacking Concept development and testing commercial-off-the-shelf products provide a fast-track interim solution Committee approval Working with ADF Chief Information Officer Group
Progress and status of JeHDI: Project Manager and Project Team recruited in November 2009. Tender released 17 February 2010 Industry briefing 24 February 2010 Tender closed 9 April 2010 Working with ADF Chief Information Officer Group
Progress and status of JeHDI: Significant number of staff being seconded indicates level of interest: 2 x Department of Veterans Affairs 2 x Department of Health and Ageing 1 x National E-Health Transition Authority (NEHTA)
JeHDI Timeframes Stage 1: Planning and Design 1 Dec 09 18 Jan 10 Stage 2: Prototype 4 Jan 10 31 Aug 10 Stage 3: Pilot 1 Oct 10 31 May 11 Stage 4: Controlled Implementation and Enhancements (Partnering) Ongoing Maintenance and Support Representing 5 years 1 Jul 11 31 Dec 13 To Sep 2015
JeHDI System Scheduling 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 Paper-based Health Records Full transition to EHRs HealthKEYS Continued Rollout Solution Selection Solution Part Functionality Solution Full Functionality JP2060 Ph 3 Options Investigation First Pass JP2060 Ph 3 Acquisition Planning Second Pass JP2060 Ph 3 Solution Selection JP2060 Ph 3 Roll-Out NEHTA Activities: Unique Identifiers, Terminology, Messaging Limited Rollout of National Individual Electronic Health Record Full Rollout of National Individual Electronic Health Record
JeHDI Project Stages JOINT HEALTH COMMAND Stage 1 Planning and Design Project initiation and establishment Tender drafting process for a service provider commencement Stage 2 Prototype (current) Service provider procurement Further JeHDI business analysis Prototype build, assessment and review for Stage 3 viability
JeHDI Project Stages JOINT HEALTH COMMAND Stage 3 Pilot Expansion to multiple sites Functionality enhanced Pilot build assessment and review for Stage 4 viability Stage 4 Continuous Implementation and Enhancements Controlled and phased roll out of the JeHDI System across the Area Health Services (proposed five) at Garrison level Project Closure
JOINT HEALTH COMMAND JeHDI - Technical aspects Current Health Garrisons:
JeHDI - Technical aspects Future Regional Construct: JOINT HEALTH COMMAND
Garrison Delivery Model CONCEPTUAL Major ADF Base Off-Base Contracted GPs Base Personnel Off-Base Contracted Imaging Off-Base Contracted Pathology Primary Medical Care Off-Base Contracted Specialists ADF and/or Contracted: General Practitioners Medics Nurses Pharmacists Clinical Psychologists Physiotherapists Other Allied Health Dentists Dental Technicians Dental Hygienists Primary Dental Care Rehabilitation Services Low Dependency Inpatient Care Mental Health Services Central Dispensing Off-Base Contracted Allied Health Off-Base Civilian Hospitals, including embedded Defence wards Off-Base Personnel
Garrison Delivery Model JOINT HEALTH COMMAND Key Features: Focus on integrated primary healthcare in the on-base environment Where bases currently have a number of smaller medical centres hubbed into a single primary healthcare centre Primary healthcare centres will be staffed by ADF and contracted healthcare providers
Garrison Delivery Model JOINT HEALTH COMMAND Key Features: Benchmark and outsource other services Further develop Strategic Alliances 1-2 additional centres of excellence/embedded ADF wards along the lines of the St Vincents model in Sydney may be developed (eg Brisbane, Darwin or Perth)
Acute Care Patient Combat First Aid CONCEPTUAL Operational Delivery Model Combat Operations Primary Care Patient Medic Potential migration sites for Initial e-health System JOINT HEALTH COMMAND Primary Medical Care Forward Operating Base ADF General Practitioners ADF Medics ADF Nurses ADF Surgeons ADF Anaesthetists ADF Intensivists ADF Radiographers ADF Scientific Officers ADF Pathologists ADF Radiologists ADF Pharmacists ADF Clinical Psychologists ADF Physiotherapists ADF General Practitioners ADF Medics ADF Nurses ADF Surgeons ADF Anaesthetists ADF Intensivists ADF Pharmacists ADF Physiotherapists Advanced en-route Care Major Warfare Vessel Resuscitation Surgery Advanced en-route Care Stabilisation Holding LPA Resuscitation Surgery Primary Dental Care Dentist Dental Tech Advanced en-route Care Point of Entry Advanced en-route Care ADF General Practitioners ADF Medics ADF Nurses ADF Dentists ADF Dental Technicians ADF Dental Hygienists National Support Area Medic GP Advanced en-route Care
Operational Delivery Model JOINT HEALTH COMMAND Key Features: In land environment, health service assets from units in Forward Operating Bases (FOB) will be hubbed into a single health facility on each FOB. FOB health facility will provide integrated healthcare services including primary medical care, resuscitation and damage control surgery (Levels 1 & 3 care). When units deploy from FOB, integral health service assets will deploy with them. Low dependency care (Level 2)including stabilisation & holding, and primary dental care will be provide at a health facility further back at or near the Point of Entry (POE).
Operational Delivery Model JOINT HEALTH COMMAND Key Features: Advanced en-route care will be available along the evacuation chain for acute care patients. No change to health service support in the maritime environment, with primary medical care provide on major warfare vessels & resuscitation, surgery, stabilisation & short term holding on the LPAs & their replacements. Definitive care & rehabilitation services for acute patients sourced from major civilian hospitals in NSA.
JeHDI core requirements: JOINT HEALTH COMMAND Integrated Calendars Bookings Reminders Treatment Events Prioritisation/Flagging Coding Options Clinical Notes Cross-linkages Observations, Vitals General Functionality Independence from DRN E-prescriptions & referrals E-orders & results Questionnaire management Demographics linkage Clinical terminology Reports, letters & printing Clinical & Administrative Portal Tailored to role Ergonomic Summary & detail views Template-based configuration Clinical Information Medications Allergies Immunisations Treatment Events Clinical Notes Imaging, path results Medical Employment Classification (MEC) Casework Support Clinical pathways Rehabilitation Musters, deployment Administrative Workflow Support Failure to attend (FTA) Bookings Triage Prescriptions, Referrals, Orders & Results Recalls Reviews & approvals Clinical Decision Support Triage Drug interactions ADF protocols Management Reporting Cost capture, profiling & analysis Management alerts Clinical & OHS coding Reporting against clinical pathways Trend analysis Adverse event reporting & analysis
JOINT HEALTH COMMAND JeHDI Architectural Overview This diagram represents the High Level Operational Concept Graphic. Air Force Army Navy Area Queensland It shows the central node at Joint Health Command inside the Defence Restricted Network (DRN) and the regional hosted nodes outside of the DRN. Air Force Army Navy Air Force Army Area orth SW Navy Area Central & West JHC Air Force The service provider will supply both the central node system (deployed inside the DRN by Dept of Defence) and the regional hosted system (deployed outside the DRN by the service provider). Army Navy Area South SW (including Shoalhaven) Air Force Army Navy Area VIC & TAS
JeHDI Solution Architecture This diagram represents the connectivity between the central node inside the DRN and the regional hosted nodes outside of the DRN via the DOSD.
JOINT HEALTH COMMAND JeHDI System Concept
JeHDI Benefits Benefits Defence DVA ADF Customers Defence Health Claims Assessment Veterans Health Health Readiness Productivity Productivity Quality of Care Population Health
ADF Customers JOINT HEALTH COMMAND Health Readiness Reduced morbidity through improved personal health management Increased personnel available for deployment through more accurate & timely reports Faster MEC upgrades through better coordinated care Faster force health preparation through better availability of information Productivity Reduced waiting time for individual consultations Reduced cancellation & re-bookings Reduced time lost through shorter episodes of care Reduced time lost through more effective rehabilitation programs
Defence Health JOINT HEALTH COMMAND Productivity Quality of Care Population Health Reduced clinician time spent on administration Reduced clinician time spent on recording patient history Reduced administrative time spent on bookings, patient administration, referrals & reports, invoicing Improved practice workflow More efficient use of pharmaceuticals & medical consumables More efficient external contractor sourcing More effective & efficient response to ministerial & other external enquiries Reduced storage requirements for paper-based records Earlier identification & management of individual health problems Improved clinical decisions Fewer adverse drug events & clinical errors Fewer duplicated tests & referrals Shorter episodes of care Faster rehabilitation Faster health record access More effective clinical compliance monitoring More effective & efficient professional accreditation & provider credentialing Earlier identification & control of infectious disease outbreaks Earlier identification & management of noncommunicable disease clusters Earlier identification & control of occupational injury hazards More effective, evidencebased health policies & programs More effective & efficient health research
DVA Claims Assessment Faster health record access Faster & more accurate entitlement assessment Reduced storage requirements/ handling costs for paper-based records Veterans Health More effective & efficient veterans studies health
JeHDI Costs Costs Investment Costs Operating Costs Infrastructure Costs Business Process Costs Change Management Costs Data Migration Costs
Investment Costs Program coordination & management Systems integration Hardware & networking for all participants Application development & software for all participants Hardware for central services Application development & all relevant software for central services Data centre facilities & maintenance System pilot testing Roll-out including PR & training
Operating Costs JOINT HEALTH COMMAND Infrastructure Costs Business Process Costs Change Management Costs Data Migration Costs Maintenance & replacement of infrastructure components Authentication device maintenance Communications Central services hardware & software licenses Software support & maintenance Central services personnel Call centre/hotline Program management Business process modelling Business process reengineering Portal re-configuration User engagement User centred design activities External stakeholder engagement HealthKEYS migration & decommissioning MIMI migration & decommissioning Maintenance of duplicate paper-based records Production of electronic summaries of paper-based records Digital scanning of paperbased records User centred design activities External stakeholder engagement
Thank you Questions?