Auckland District Health Board has two important application integration projects underway.
The first is designed to integrate results systems electronically and represent the first phase of a full electronic health record that will ultimately let patient notes be electronically assessed and viewed at Auckland's Grafton Rd and Greenlane sites.
The second project is to improve the information transfer from Auckland's patient management system to GPs, thereby improving the speed and accuracy of information and enable better post-operative care.
The two projects, which both use SeeBeyond's eGate integrator, will help avoid the transfer of enormous amounts of paper between sites.
Auckland DHB business systems manager Barry Kellaway says integration is always an issue in the health sector. The DHB bought a SeeBeyond product called Creame, which scans images of patient records, and replaces paper-based systems.
“We have 30 core systems but no real integration," Kellaway says.
Creame allows the board to do away with paper-based records saving space in the new Auckland hospital for other uses. X-rays can also be scanned digitally and high-quality images presented through a workstation, removing the need for film images.
Meanwhile, a system called Pacs records scanned images from the radiology department and stored a range of patient and demographic information.
By acting as a messaging management system, SeeBeyond’s eGate will allow the patient and demographic information to go through Creame or Pacs, Kellaway says.
The project started three months ago and is nearing completion. The software and related new equipment should cost around $300,000 overall, he says.
Kellaway says the board used to have bespoke point-to-point interfaces. It worked fine but the board did not get the "leverage" from one interface to another. The new system saves in administration, as there is less repeat inputting of data, which also means fewer errors. The new system is also more scalable and less complex to manage.
Previously there was no way of telling that some devices were failing, whereas the improved monitoring means you can tell where the fault is.
“We wanted a proven, mature system, which is why we chose SeeBeyond. It was developed for a health environment,” he says.
Kellaway says it is important to train staff to implement and use such new systems. The development so far has gone “surprisingly smooth”. It is too early to comment on the finished product, he says, but “we sleep at night”.
Big picture, not big bang
Waitemata district health board has used SeeBeyond software -- again eGate -- for the past four years of so, to integrate its patient management system with other core systems such as the laboratory.
“Essentially we move patient information from system to system, so when a new admission comes into the hospital, the laboratory system is updated with their details and any test results are returned to the patient management system giving real-time results information to clinicians,” says SeeBeyond New Zealand general manager Rob Erskine.
Waitemata is also changing its core systems to align with other health boards in the region and has recently gone live with the first two phases of deploying iSoft’s PiMS system as its new patient management system. It's also piloting a new pharmacy system for the distribution of medication in the wards, which will require all current patient information.
This ensured the pharmacy dispensing system had accurate and up-to-date information on every patient who was admitted to, transferred within and discharged from the hospital," Erskine says. "We ensured the right medications were available to the right people at the right time."
Waitemata DHB ITC manager Joanne Bos described the integration of the PiMS system and associated upgrade from SeeBeyond’s Datagate integrator to eGate as “very painless”.
The project started last year and took place over several months. Various legacy systems are being replaced, but the integration engine means there is a single way of messaging the information rather than have a portfolio of point-to-point interfaces, Bos says.
The DHB is currently evaluating the project, but Bos says a further integration to include Oracle financial software is now being considered. The DHB is also looking to integrate patient administration as well. “There’s a lot of integration from new to the legacy -- radiology systems, lab reporting systems, pharmacy. Then we integrate clinical information systems to make it available to the nurses,” she says.
Bos says the cost of the project is not high. She advises IT managers to plan well, and documents everything so people know exactly what they are doing.
“Take a phased approach, not a ‘big bang’ approach. Develop a good working relationship with the vendor. It also pays to invest in training one or two people to take responsibility for the new system and champion it, otherwise staff will skip back to the old point-to-point,” she says.
A common link
Telecom IT team project manager Micki Szikszai says the telco previously had an architecture that allowed systems to talk to each other in a point-to-point fashion.
Using CrossWorlds, the transactions go to one central point and are managed by that. That greatly simplifies its architecture, Szikszai says. "When we added a service platform [previously], we had to add points between the new platform and all the existing platforms. Now, we just connect the new one to the EAI."
CrossWorld's "bus" structure allows the billing systems to talk to each other.
"CrossWorlds allows us to built connectors so it connects these application platforms. It connects the interfaces to a common language -- XML. That allows the applications to talk to each other.
The EAI system also allows changes to be made at the back end without affecting the operation of the telephones.
"There are no changes we have to make to the phones and that's a great advantage," Szikszai says.