The district health boards of Taranaki and Wellington’s Capital and Coast have outlined the likely shape of their shared services IT model.
The recently released draft IS strategic plan for 2003-2008 for HealthIntelligence, the body which will deliver the shared services pending the health minister’s approval, identifies goals such as rationalising databases, migrating Wellington to Taranaki’s Citrix thin client environment and delivering most applications via the web by 2008.
The plan notes that at Capital and Coast in particular, the array of databases is less than ideal and simplifying the number of platforms is a key priority.
“Capital and Coast runs SQL Server 6.5, 7.0 and 2000, Oracle, Pervasive SQL 7, Paradox, Sybase and Cache databases for core business applications and there are numerous Access databases for local applications.”
Taranaki, in contrast, has standardised on SQL Server 2000, Oracle and Informix. HealthIntelligence will be looking to rationalise further, most likely to Oracle and SQL Server.
The shared services environment will be Microsoft-centric, with Exchange, Active Directory, Windows XP, Visual Studio, Microsoft Project Server 2003 and other Microsoft products in the mix. It will have an annual operating budget of $18 million.
Andre Snoxall is now CIO of both Taranaki DHB and Wellington’s Capital and Coast and will become chief executive of HealthIntelligence.
Capital and Coast has already announced plans to move its 1600 user seats to the Citrix thin-client environment in place at Taranaki. The report notes this will effectively reduce the number of desktop computing environments across the two DHBs from 1601 to two and, ultimately, one.
“Legacy infrastructure at Capital and Coast allows users to create, manipulate and store patient data locally on their PCs. As the thin-client model is rolled out, data will be moved to centrally managed file servers where it can be secured, backed up and managed more efficiently.”
The plan is critical of the present situation in Wellington. “Some information is stored centrally where it is backed up, managed and a level of security can be assured, but much of the information is stored on local devices that are geographically dispersed and in most cases neither backed up nor manageable.
“There is also little control over the configuration of these devices or the software being run [and] there have been instances of users obtaining data from individual workstations that they should not have had access to.”
All new devices added in the wake of the Citrix rollout, including portables, must employ a web browser or be Citrix ICA-capable. While Citrix is to be a vital part of the two DHBs’ infrastructure, web-based delivery of applications is the final goal.
“Strategically, web access to all applications is preferred [and] over the next five years most shared ICT services will be web-delivered, although a small number may be installed locally on the client device or deployed using Citrix Metaframe where web delivery is inappropriate or unavailable,” the plan notes.
Andre Snoxall says Citrix is “theoretically an interim solution, but pragmatism tells us it’s likely to be with us for as long as we can see into the future.
“If all things were equal and Citrix were free, we’d deploy everything via Citrix, but that’s not the case. For example, if we wanted to make electronic health records available to a patient, to do that via Citrix we’d have to pay for a Citrix link for every patient.”
The DHBs’ internet and intranet sites are being redesigned in preparation for the delivery of applications via Citrix and the web.
The goal is pervasive web access with “connectionless and stateless transaction processing”, the plan notes, which means XML likely to play a part.
Other plans for the joint services include an SQL Server 2000 data warehouse and a new authentication framework, to be provided in the form of and implementation of Microsoft’s Active Directory.
“At present, no authentication is required to access the Capital and Coast data network, although authentication is required to access some core facilities such as email, file servers and printers,” the plan notes. “Few applications use the network authentication mechanism that is in place, Novell NDS.”
Other systems will be integrated with Active Directory so that, ultimately, users will have one user name and password for all data they’re authorised to access. The system allows for an audit trail if access is later questioned. Another authentication layer, Delegated Authorities, will simplify access to systems accessed through the DHB portal but which don’t belong to the DHB.
Another goal is to have electronic health records implemented by mid-2004, giving patients and caregivers access to a patient’s history. An allied goal is to ditch paper records by the end of 2005. Other plans are to have a single patient management system running across the two DHBs by the end of 2006 and a common e-prescribing system using the same data.
Despite being Microsoft-centric, the door isn’t shut on open source, according to the plan.
“The stability and reliability of the Citrix Metaframe and web deployment models is anticipated to free up technical resources to investigate options for the future around the use of open source software in preference to proprietary products.”
Snoxall says the DHBs are trying not to strategically align themselves with one vendor, but for practical reasons a single source for authentication, office automation and the like is the most cost-effective way.
“However, we’ll definitely be exploring options to look at open source solutions.”