NSW Health

NSW Health – the New South Wales Government Department responsible for the provision of public health services throughout Australia’s most populous State – is progressively reforming its information systems as part of an ongoing wider program to raise the overall quality of health care.

Background
NSW Health is one of the State’s largest Departments and accounts for 28 percent of all NSW government expenditures – some AUD$11.26 billion in the 2005-06 financial year.

The Department’s service infrastructure comprises 230 public hospitals in eight geographic Area Health Services, together with many other radiology and specialist departments and independent units.

During 2004-05, NSW hospitals, including emergency departments, admitted some 1.3 million bed-allocated patients and treated or otherwise addressed about 10 times that number of non-admitted patients.

As part of the progressive reform of its information systems the Department embarked, in 2005, on a series of initiatives designed to improve the flow of information for what the department calls its “front line” – the more than 55,000 nurses, doctors and others who look after patients around the clock.

For these busy professionals, accurate and timely information is vital if the wards are to operate at optimum efficiency and the highest possible standard of care.

Performance Management
One such initiative in this series has involved the use of SAS Strategic Performance Management including data integration and aggregation tools to develop and deploy WAND – a Ward Activity and Nursing Display for the Orthopaedic, Trauma and Post Natal wards of Westmead Hospital in the Sydney West Area Health Service.

The initiative was led by Tony Dunn, who is the Sydney-based Director of the Department’s Demand & Performance Evaluation Branch, together with input by systems and software experts from SAS Australia and from the global manage­ment consulting, technology services and outsourcing company, Accenture.

The decision to select SAS Strategic Performance Management was arrived at through a process whereby Performance improvement programs underway throughout NSW Health were evaluated.  The strong level of success and sophisti­cation of the Hunter New England Balanced Scorecard Program empha­sized both SAS' technical completeness and the type of commitment required to deliver the new program.

In considering the technical require­ments for the program, NSW Health also sought to ensure the Business Information Strategy Pilot deliverables could be elegantly integrated with other critical performance initiatives. SAS Strategic Performance Management fitted all these criteria.

As Tony Dunn explains, “This is a very big and complex organisation. We have lots of data systems and lots of different information systems. It is a very disparate environment, and this has made it difficult to deliver quality information to the front line in a timely manner.”

WAND was first deployed as a proof-of-concept project – one of a dozen such – and was found so successful in those first few wards that the word quickly spread and Tony Dunn’s team is being pressured to industri­alize it and provide it across the State.

Outlining the background, he said, “The wards were dependant on manual processes – whiteboards, post it notes, pagers – being fed by information from numerous sources which, when they received it, was already a day or more out of date.

“Worse, whiteboard writing gets accidentally rubbed out, old information can be over­looked, pagers don’t get answered – there is lots of potential for mistakes.

“The majority of the information the wards need was there electronically but it was on numerous, non-integrated systems – some of them very old.

“The reports the wards were getting were based on information that was often too old to be worth correcting if it was wrong and too late to act upon for things like optimum bed allocation and the scheduling of doctors for pre-discharge procedures. 

“This could easily mean a patient might be kept in hospital a day longer than necessary, with all the inconvenience to the patient and wastage of Departmental resources that implies.  At the other end of the process – ad­missions – staff can now see when a patient is expected and prepare things accordingly.”

Eliminating outdated information
“In addition, wrong information was not always being corrected, which impacts the Department’s statutory reporting obliga­tions to the NSW Treasury, to the Premier’s Department and to the Commonwealth.”

One very tangible benefit of being able to plan ahead relates to the scheduling of ambulanc­es. The cost of a NSW ambulance journey is significantly discounted if it is scheduled with 24 hours notice and, thanks to WAND, this is now much more commonly the case.  

The proof-of-concept solution was a dash­board – displayed on a large screen in the middle of the ward – providing aggregated information from multiple sources and up­dated every 15 minutes.

WAND is fed from the “listening” software specially developed by SAS to monitor the traffic on the Department’s own HL7 technology – Health Language communica­tions protocol. This software monitors all the traffic passing backwards and forwards across the infrastructure and recognizes and grabs what it needs to present for display on the dashboard.

Tony Dunn said this approach was very significant. “We no longer manually interrogate the vari­ous systems or replicate data in order to get the appropriate information and this is a huge advantage.

“By avoiding interrogation we face much less risk of the systems being slowed down and therefore potentially crashing.  And replica­tion can be clumsy.

“The approach is totally passive.  It’s just listening to the data that is going around, picking up what it wants, and contributing it to the dashboard display. This is cost effec­tive, low impact, high result.”

Tony Dunn said the undertaking was com­plex with many difficult technical issues. “It wasn’t just plug-and-play, and SAS and Accenture must have found it very tough due to our tangled environment.

“At the end of the day, what started out as a proof-of-concept is now something that, in the wards that are using it, has greatly improved patient flow with staff telling us how it provides for greater efficiencies. And there is pressure for us to roll it out, generally.”

Tony Dunn and his team and the SAS and Accenture people who have played a part are naturally happy with the way things have turned out.

The users speak
But with any new system, of course, the people whose views carry the most weight are the ones who use it on a day to day basis – the people in the front line. And the praise has not been stinted. For example: “This tool has the potential to save me hours a day answering phones and chasing pagers and pieces of paper. It gives me more time to care for patients,” Nurse Unit Manager - D4A, Westmead Hospital.

Which says it all.

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