Fiona Stanley Hospital

Di Mantell - General Manager Facilities Management

12 September 2013

Fiona Stanley Hospital

Agenda

• Setting the scene – the uniqueness of WA

• WA Health business priorities

• Fiona Stanley Hospital

• Translating business requirements to architecture requirements

• Technology enabling service improvement and how? - Making it easier for users

• Coordinating with the State’s eHealth strategy

• Questions?

• WA – approx. one-third of the Australian continent

• Land Area – 2.5 million square kilometres

• Population – 2.3 million Western Australians

• 97% of total area of WA has less than one person per sq km

• 30% of population lives outside of Perth

• Some remote areas are over 3000kms from Perth

Source: ABS, “Population Projections, Australia, 2006 to 2101”, September 2008

WA Health (2011)

• Approx. 40,000 staff• Handled just under 1 million ED visits• Completed 81,000 elective surgery cases• Carried out over 98,000 breast cancer

screenings

Source: WA Health, http://www.health.wa.gov.au/about/

Setting the Scene– the uniqueness of WA

• Clinical Information

• Patient Administration

• Workforce Planning

• Activity Based Funding and Reporting

• Business Aligned Reporting

• Communication and Collaboration

• Managing Information Holistically

• Transition to new digital operations

• Consumer Centric Care

• Mobility

Strategic Intent

Current ICT Issues

• History of under-investment

• Lack of complete strategy & funding

• Ineffective ICT Operating Model

• History of poor project delivery

• Lack of Change Mgmt & Training

Business Priorities

National Health Perspective

• National eHealth Strategy

• Other jurisdictional work programs

• Leverage national infrastructure

Manage business

change and

business as usual

Emerging Themes

Share information across the whole

Health sector

Drive better

clinical

outcomes through

information

Improve

management

and planning

through information

Rebuild and

enhance ICT

foundations

Caring for

individuals and the

community

WA Health – Business Priorities

Caring for those

who need it most

Making best use of

funds and resources

Supporting our team

WA Health – Business Priorities

� Major tertiary hospital in Perth south metropolitan area

� Named after Professor Fiona Stanley – 2003

Australian of the Year and specialist in

paediatric health

� Project budget $2 billion,

including $255.7 million of

Australian Government

funding for State

rehabilitation service

� 15kms from the Perth CBD

Fiona Stanley Hospital

Fiona Stanley Hospital

� 783 beds, including 140-bed State

Rehabilitation service

� 6,300 rooms in the main hospital

� 16 wards (of 24 beds each)

� 83% single patient rooms in main

hospital

� 29 imaging rooms

� 15 theatres plus 3 shelled theatres

� 135,000m2 gross area

(excluding car parks)

Scale of the development

State Rehabilitation ServiceMain Hospital

Education

Mental Health

Decked Car Park

Pathology

Decked Car Park

Map of the site

Key services and facilities

� Full range of acute medical and surgical services

� Emergency department with separate adult and paediatric entrances

� Comprehensive cancer services including radiotherapy treatment facilities, medical oncology and haematology

� Renal transplantation and dialysis services

� Cardiothoracic surgery, heart

and lung transplant

� Obstetrics and neonatology services

� State burns service

� Paediatric services

� State rehabilitation service

Photo courtesy of Douglas Mark Black (2013)

Key services and facilities

� Onsite pathology facility

� Modern medical imaging centre that will provide fast and accurate information to clinicians

� World-class medical research facility to be built by theWestern Australian Institute for Medical Research

Environmental Focus

Phased Opening Schedule

Stage 1 State rehabilitation service October 2014

Stage 2

General

- Planned medical/surgical (1 ward of each)

- 2-3 theatres

- Partial Intensive Care Unit/High Dependency Unit

capability

• Obstetrics and Neonates

December 2014

Stage 3

Tertiary

- Other planned and unplanned

- Emergency Department

- Intensive Care Unit

- Outpatients

February 2015

Stage 4

Quaternary

- Obstetrics & Gynaecology

- Neonates

- Burns

- Transplant services

April 2015

The facts

� 300,000 people to walk through the main entrance of FSH in the first year

� 1,500 outpatients - average stay a few hours

� 650 inpatients in main hospital - average stay a few days to a few weeks

� 3,500 staff over 24 hours

� 2,000 visitors a day

� 80,000 presentations at the FSH Emergency Department in the first year

The facts

� 29 Non clinical services to be provided by a Facilities Manager including:

� Audio visual - Equipment for clinical, consultative, training, administrative and all telehealth requirements

� Estate Service- integrated building management service

� HRM&CC – scanning paper-based records and provisional diagnosis coding to assist early discharge

� Scheduling and billing – booking elective theatres and other spaces; also patient appointments, reminders and a direct billing service

� PES – bedside access to patients' health records; patient access to multi-media and meal ordering functionality

� ICT Managed Service – significant enabling technology that will establish FSH as a digital hospital and support and complement WA Health systems

� Enabled innovation & technology previously unavailable to WA Health

� The challenge to integrate systems & bring the best of both worlds together

Technology

� Campus Wide Wireless LAN with high density of access points (FSH 1,532) Supporting:� Roaming wireless data servers

and roaming voice over WLAN� Wireless biomedical monitoring

systems� Real Time Location Services

� High Reliability LAN infrastructure (FSH 13,446 LAN ports in the primary building)

Implementing Integrated Services

• How the analyst designed it • How the programmer wrote it • What the customer really needed

Implementing Integrated Services

Translating business requirements to architecturerequirements: what systems to integrate, when and how?

We need to identify what we have now:

� Non-electronic information� Islands of information that are not connected.� Inability to have a consistent and accurate view of a patient.� Duplication of information leading to inaccuracies and synchronisation problems.� Potential patient safety concerns.

� No sharing� Inability to share information between practitioners for a complete continuum of

care.� Lack of shared knowledge base and decision support.� Lack of coordination and utilisation of primary, community and allied health services.� Lack of collaboration between care locations and patients at home.

� Paper intensive environments� Information isolation, duplication, and prone to errors.� High-volume storage of “hard” copy (paper and images).� Overheads through manual handling.� Time lags in movement and retrieval of information

Current Healthcare

‘Analogue’ Journey Board

Patient

Patient

record

Current Healthcare

One of Australia’s most technologically advanced hospitals showcasing how our hospitals will operate into the future.

Telehealth services for clinical, consultative

RTLS – locating people and equipment; monitoring and Duress

Secure and Seamless interoperability

Enabling electronic medical records

Pervasive wireless technology at point of care

Integration of new medical equipment with information systems

Fiona Stanley Hospital

Implementing Integrated Services

� Define what do we actually need?

� What do you need now & what should be done later?� Need to be able to articulate what we need versus want –

this is the hard bit!!� Formalise a governance process with clear delineation of

roles and responsibilities including who has ultimate sign off.� Once something is signed off – lock it down & put a bow on it � There must be a process to eliminate the

“shiny lights” that distract people and scope creep…… � Only then can we translate the scope

to the architecture.

Translating business requirements to architecturerequirements: what systems to integrate, when and how?

Implementing Integrated Services

Technology enabling service improvement and how?• Technology should enable the services – not dictate how the service will function• Clinicians need to able to define their services [DSPs]• There must be an ethos of the “greater good” not silo building• Integrated systems that are deployed as a whole of site or system approach that provides

significant benefits eg; familiarity with the systems which results in better utilization of the system.

• Users want • single sign on – not always possible• Mobility – ICT folk tell you - harder than you might think• Smooth transition between applications

•

Photo courtesy of Douglas Mark Black (2013)

Documents and Notes

– Electronic Medical Records– Clinical notes– Document linking

Telemedicine

– More experts in more places– Remote monitoring– Remote consultation

Research

– Medical science– Longitude studies– Disease management

Pathology

– Disease diagnosis– Pathology imaging

Collaboration

– Coordinated decisions– Audited discussion– Immediate action

Scanning/Imaging

– Medical science– Longitude studies– Disease management

Online Access to Information

to any location –on any device –

Point of Care

Clinical –Logistics –

Biotechnology

Gene science –Bacteria science –

Diseases science –

Medications Management

Patient history –Monitoring –

Regimen –

Financials

Enterprise billing –Insurance –

Performance Measurement

KPIs –Data analysis –

Data mining –

• Automate• Integrate• Optimise• Protect• Share• Learn

Common

Services

Common

Objectives

• Processes• Workflows• Scheduling• Messages• Storage

Digital Health

Community

Sources of information to improve patient outSources of information to improve patient outcomes

� Based on clear architecture and standards

� Supports national and industry specific standards and coding

� Leverages Real Time Location Services (RTLS)

� Highly leveraged networks including ipTV

� Campus-wide Wireless LAN - high density of access points

(Fiona Stanley Hospital - 1,532)

� Significant LAN infrastructure

(Fiona Stanley Hospital - 13,446 LAN ports in the primary building)

� Integrated building management linked to services (AGV’s, building maintenance and helpdesk and Integrated Extra Low Voltage Systems –

IELVS

� Integrated and pervasive information flows

� Integrated pervasive Telehealth – all meeting areas, clinical desktops and 4 operating theatres

Fiona Stanley HospitalImplementing Integrated Services

Implementing Integrated Services

The Aim is a (Significant) Shift in Thinking

� More connected than ever before� The ability to share information electronically amongst all providers caring for a

patient (and the patients themselves)

� Shared knowledge� Removing duplication of patient information, particularly within WA Health through

record aggregation and smarter systems.

� Workflow connections between providers to ensure patient information is communicated, received, acknowledged and acted on by providers in a secure and safe manner.

� Better coordination and utilisation of primary, community and allied health services.

� A stronger emphasis on the patient’s own responsibility in self-management, prevention and maintenance of their health.

� Shared body of clinical knowledge that is evidence-based and consistently applied by clinicians.

� Shared information between devices and/or robots (device collaboration)

� Extended collaboration through Telemedicine and Hospital in the home.

Inte

rop

era

bil

ity

HR

Payroll

Rostering

Financials

Procurement

Pathology Systems

PACS/RIS

Information

Management &

Reporting

WAN Hospital LAN/WAN IELVS LAN

SecurityScanned RecordsPAS

Clinical Workbench

EMR

Pharmacy

Clinical Specialities

Helpdesk

Identity Management

Data Centres

Approach to Site

Wide Scheduling

Patient

Entertainment

Equipment Tracking

Audio Visual

Services

Server Rooms

Helpdesk

IELVS

Nurse Call

Structured Cabling

Equipment Racks

Inte

rop

era

bil

ity

HCN

HIN

Other WA Health

Managing Contractor

FM Contractor

Fiona Stanley Hospital – Strategic Framework

Enterprise Service Bus

Applications

Fiona Stanley Hospital – FM Framework

Point to Point

Au

dio

Vis

ual

Real Time location Services

Co

mm

on

Serv

ices

Orchestration/Business Rules

Stand Alone

Capabilities

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Canonical model

FSH

ServicesExternal

AccessPortal

Data transformation, mapping and Routing

Data

Warehouse

ApplicationApplicationApplication

ApplicationApplication

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ApplicationApplicationApplication

ApplicationApplicationApplication

Fiona Stanley Hospital – FM Framework

� The location of any locatable person or equipment in real time� Used for safety management (Duress) � The location and environment monitoring telemetry of fixed plant and

equipment, building infrastructure and plant room environment conditions.

� The location and environment monitoring telemetry of mobile plant and equipment such as food carts used by the patient catering services.

Mobile Control Management Engine

Mobile Controllers

Wireless Switch

Tag Access Wireless Access

Person and Equipment Tags

WirelessDevices

Real Time Location Services (RTLS)Real Time Location Services - RTLS

� Building and Car Park Management� Intelligent Parking systems – directions to available parking bays� Integrated security and access control with automated security policies

for a safer patient environment

� Fire Alarm System� Closed Circuit TV� People Flow Counting System� Guest Room Management System� Lighting Control� IP Telephony …

� Integrated Management (benefits)� Reduced operating costs� Improved maintainability, less administration� Better control of critical systems� Improved facility value� Less “components” and complexity� Limit (possibly eliminate) Vendor lock-in

Integrated Extra Low Voltage Systems – IELVSIntegrated Extra Low Voltage Systems - IELVS

� Access terminal on a flexible arm by the bedside

Greatly enhanced Patient Entertainment and information access:Greatly enhanced Patient Entertainment and information access:

Used by patients:• Order meals• Telephone• TV and video-on-demand• Education of medical

procedures/condition• Internet• Contact clinical staff

Used by staff to:• Access clinical functionality• Order services (cleaning, dressing

change etc.)• Track bed/room readiness (cleaners)• Contact other staff• Track the patient

Patient Entertainment Service

Enable Electronic Medication Management at FSH:

� Automated Medication Units

� Pharmacy Robots

� Intensive Care Clinical Information System

� System integration and iPharmacy upgrade

� Link to State systems: webPAS, RIS, LIS and iPharmacy

� Plan for further systems post go live……

Electronic Medication Management System

WA Health Strategic Framework

Coordinating with the State’s eHealth strategyand standardisation

WA Health is undergoing unprecedented infrastructure development:• Fiona Stanley Hospital• New Children’s Hospital• Albany Health Campus• Midland Health Campus

• ICT is being pushed to align new ICT systems and processes to support the physical infrastructure

• FSH has been able to procure systems that will be managed onsite – with other sites being able to leverage off this process

Program Management and Change Management

Interoperability

Interoperability

User Access (Portals)

Infrastructure

Electronic Medical Record

Identity and Access Mgt

Fiona Stanley

Albany Health Centre

Other new facilities

Master Schedule Change Management

1

7

8

9

11

10

6

Schedule s– PDL Compliant MS Server Implementation SMAHS Integrated Program

Refresh

End User Computing

Refresh

CIS R3F CPOE Pathology Rollout

CIS R3A Internal Referrals

SID R3D Cardiology

CIS R3B Results Acknowledgement

Laboratory (LIS)

MMEx Transition

WA Health Online

Health Identifiers NaCS

Breastscreen WA PACS

Patient Admin Systems Corporate Systems

PAS

PAS (Billing)

HR (Lattice)

ABM Decision Support System

3 4

Data Centre

PMO Services PMO Scheduling Services P2

New Children’s Hospital

Clinical Workbench

Scanned Medical Records

Order Entry

Existing Systems Remediation

New Core Systems

ESB

WA Health eHealth Strategy

� Comprehensive, pervasive IT infrastructure

� Expanded digital footprint

� Extend process improvements the community

� Stronger collaboration between all healthcare providers

� Stronger collaboration between metropolitan and remote locations

� Extended reach into patient homes and emergency medical services

� Everything/everyone is “connected”

A move to digital healthcareWA Health eHealth Strategy

Summary

Information driven healthcare in Western Australia

• Meeting the challenges of vast distances

• Encourage the sharing of information electronically between healthcare providers and patients

• Removing duplication of patient information

• Secure workflow connections between providers

• Coordinated used of resources

• Patients actively involved in their own healthcare

Summary

ResourcesResource Location

WA Health Networks http://www.healthnetworks.health.wa.gov.au/home/

Fiona Stanley Hospital project http://www.fionastanley.health.wa.gov.au/home/

Animated fly-through - Fiona Stanley project http://vimeo.com/lassoproductions/thefionastanleyhospital

Media statement from WA Health Minister http://www.mediastatements.wa.gov.au/Pages/Results.aspx?ItemID=150787

National e-Health Transition Authority http://www.nehta.gov.au/about-us

Fiona Stanley Hospital

Thank you