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Department of Health

Statewide Health ICT Strategic Framework

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© State of Victoria, January, 2015

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This work is available at: www.health.vic.gov.au/publications

January 2015 (1409011)

Contents

1. Executive Summary 1

2. Single page view of the draft Framework 5

3. Statewide Health ICT Strategic Framework 6

4. ICT-Enabled Outcomes 8

5. Fit-for-Purpose ICT Capability 17

6. Implementation Enablers 21

7. Governance Model, Roles and Responsibilities 27

Appendix A: Glossary 34

Appendix B: Stakeholder Consultation 38

Appendix C: 2014/15 Draft Implementation Plan 42

Appendix D: Health ICT Investment Selection Criteria and Guidelines 45

Appendix E: Draft Project Assurance Approach 51

Appendix F: High Value/High Risk Reporting Framework 55

1. Executive Summary

1.1 Background to the Framework Victoria’s healthcare system (the system) is sophisticated and diverse. It is funded through multiple sources and operates across a broad range of settings. A consumer’s health journey through the system traverses multiple organisations and multiple providers, and consumers expect a seamless and connected experience.

There are growing trends in personalised medicine, genomics, and greater consumer control and empowerment of their own health.

Further areas of focus include uptake of the Personally Controlled Electronic Health Record (PCEHR), improvements in coordinated care, and ICT enabled productivity.

More broadly, the rapid growth of digital and social technology is reshaping how consumers connect, engage and transact across government and other industries. These shifts are taking place against a backdrop of increasing demand for healthcare services due, in part, to factors that include an ageing population and the increasing burden of chronic disease.

Information management (IM) and information communication technology (ICT) are key enablers for the system to deliver better health outcomes, a more connected and seamless consumer experience, and a more productive and sustainable health system.

The absence of a statewide health ICT strategic framework was identified by the Ministerial Review of Health Sector Information and Communication Technology and the Victorian Auditor-General report on clinical ICT systems in the Victorian public health sector1.

This document seeks to redress the absence of an overarching document to guide health ICT activity and investment; it is not however a detailed strategic plan and does not describe a list of potential health ICT investment initiatives that imply funding commitments from government.

1.2 The Framework This Statewide Health ICT Strategic Framework (the Framework) provides guidance and alignment of direction for the system. Rather than being a specific strategic plan, it enables health services to develop their local strategic plans and operational priorities for IM and ICT using a consistent and common set of considerations. It supports local priority setting while also supporting system wide alignment to key ICT enabled outcomes.

The Framework has been created by senior stakeholders from across the system, including the Department of Health and the Department of Premier and Cabinet. Feedback from stakeholders that were either interviewed and/or attended the workshops has confirmed that the Framework is structured and contains the right level of detail for health services to develop local strategic ICT plans and inform ICT investment business cases.

A full list of stakeholders is contained in Appendix A.

1 http://www.audit.vic.gov.au/reports_and_publications/latest_reports/2013-14/20131030-clinical-ict-systems.aspx


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1.3 Victorian Health Priorities Framework (VHPF) The Victorian Health Plan is Victoria’s plan for a healthier future. The plan reflects the Government’s commitment to delivering the best healthcare outcomes possible and ensuring people are as healthy as they can be. The foundation of the Victorian Health Plan is the Victorian Health Priorities Framework 2012–2022 (VHPF). The VHPF’s purpose is to lay out a clear, coordinated agenda for the future of the entire Victorian health system. It provides principles to guide decision making and set priorities for investment (including ICT investment) and action. The VHPF provides a high level roadmap of what health outcomes the Victorian Government is seeking to achieve from investment in health ICT.

The Framework therefore targets health outcomes that are aligned to the VHPF, and is designed to ensure that IM and ICT play an increasingly important role in helping the system realise those outcomes.

The Framework builds on:

• the Ministerial Review of Health Sector Information and Communication Technology2 (the Ministerial Review) and the Government response3. These two documents have already articulated the priority areas for future health ICT investment4 and categories for allocation of the Innovation, Ehealth and Technology Fund5 together with recommendations in the areas of governance, procurement and interoperability and national ehealth.

• the National eHealth Strategy.

It aligns with the broader Victorian Government ICT Strategy6.

It is also complementary to other initiatives that are underway, including the Victorian Health and Wellbeing Data and Information Management Framework 2014–2022 and the Health Informatics Workforce Strategy Evaluation.

2 http://docs.health.vic.gov.au/docs/doc/9DFDF45D065BCB5BCA257C11006ED2C6/$FILE/Ministerial Review of Victorian

Health Sector Information and Communication Technology - August 2013.pdf 3 http://docs.health.vic.gov.au/docs/doc/0D7A89813BEA7AD4CA257C11006F23A5/$FILE/Health Sector ICT Review Panel

Recommendations.pdf

4 ‘Victoria’s health sector ICT investment should: a. be directed towards building EMR capability that incorporates healthcare identifiers at all health service providers

(private sector investments in healthcare identifiers should be further encouraged)

b. be driven by a patient-centric focus that supports improvements in health outcomes c. emphasise the development of capability in health informatics.’ Ministerial Review , p16

5 ‘The panel recommends allocations from the Innovation, E-Health and Communications Technology Fund be made against the following three major categories: a. critical infrastructure refresh b. development of EMRs across the state c. innovation The panel recommends the highest priority against the development of EMRs across the state should be the broad

utilisation of healthcare identifiers by health service providers in order to drive interoperability between agencies.’ Ministerial Review, p 17

6 http://www.digital.vic.gov.au/wp-content/uploads/2014/05/Victorian-Government-ICT-Strategy-2014-to-2015.pdf.It should be noted that health services (with the exception of Ambulance Victoria) are not in scope for this strategy as they are not listed agencies plus the WoVG strategy is more oriented to ICT decision making rather than strategic planning with ICT as an enabler.

1.4 The Vision The Framework provides a clear vision (the Vision) – Connected knowledge to ensure your best possible health – which encapsulates the future strategic positioning and values to be driven by ICT in Victoria. At its core is the concept that ICT will enable the Victorian healthcare system to be:

• knowledge and information-centric • consumer-centric • empowering of clinicians in clinical decision making • dynamic in both knowledge capture and knowledge application.

The Framework is directional in nature and intent; it is not a detailed and costed plan and additional work is now required to detail actions to realise the Vision. An initial draft of activities over the period 2014–15 has been developed and can be found at Appendix C.

1.5 Realising the Vision Building on the current level of ICT capability in the system, three logical stages have been defined to realise the Vision:

i. Digitise and build core ICT foundations; ii. Connect the system; and iii. Empower through knowledge.

Eight defined strategic principles will guide the system in planning, investment and deployment of ICT to ensure target health outcomes are enabled through IM and ICT.

To help the devolved system achieve the Vision, the Framework provides guidance for health services’ strategic planning processes through the identification of six strategic themes and a number of strategic initiatives.

Based on existing policy and initial consultation, ten priority initiatives have been identified but not ranked in order, as the priority order will differ depending on the health service and its current level of ICT capability.

1.5.1 Maturity Models, Baselines and Standards The system needs agreed maturity models and a minimum baseline of ICT capability to realise the Vision. The target maturity levels and minimum baseline will evolve over time as the ICT capability in the system grows. The minimum baseline is not the target – the intent of the Framework is to encourage all health services to have an ICT capability significantly above the baseline, in line with their local priorities.

The maturity models and a standards based approach will guide the growth in ICT capability across the system. The department will set and manage the maturity models and the minimum baseline, using agreed industry standard models where they exist and statewide standards, including interoperability standards. The maturity models will be applicable to ICT capabilities along the continuum-of-care (including clinical and non-clinical functions), will align with national initiatives, and will evolve progressively over time.


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1.5.2 Enablers One of the priority strategic initiatives is to put in place the foundations for the system to realise better value from ICT investments. Six enablers have been identified to build the foundations. These enablers fall into two broad groups:

• to generate and focus investment into ICT (through exploring alternative commercial models and innovation)

• to improve the realisation of value from ICT investment (through creating a transformational mindset and capability, enhancing benefits realisation, growing the workforce and encouraging sharing and collaboration).

1.5.3 Governance Governance is required to inspire confidence that objectives are being achieved, risks are being managed and resources are being used responsibly.

In Victoria’s devolved model, strong governance mechanisms are needed at both system and organisation levels to create confidence in:

1. ICT choices and investment decisions, by focussing on the investment decision making processes.

2. Implementation of ICT investment decisions, by focussing on managing implementation risk through mechanisms such as monitoring effectiveness and providing quality assurance over projects.

The Health Sector ICT Ministerial Advisory Council (the Council) will advise the Minister on a range of strategic ICT issues for Victorian health care.

Health service boards are accountable for strategy and risk management at a local level.

The department will oversee the promulgation, application, monitoring and effectiveness of the Framework and take on the project assurance role for strategic ICT projects, which are projects of particular interest to Government and the community. In this latter role, the department will provide the sector with clear guidance on assurance and risk management which will link to the Department of Treasury and Finance’s (DTF) high value / high risk process, but not replace it.

2. Single page view of the Framework


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3. Statewide Health ICT Strategic Framework

3.1 Introduction Victoria’s health care system (the system) is sophisticated and diverse. It is funded through multiple sources and delivers healthcare services across a broad range of settings. The Victorian Government, through the department and its funded agencies, is primarily responsible for meeting public health needs across the State. Healthcare is delivered within devolved governance structures, where individual health services are responsible for decisions that effectively and efficiently meet local needs.

It is well understood that a number of forces are placing substantial and increasing pressure on the health system to be responsive to the changing expectations and desires of the community. The community expects the highest quality of care, straightforward access to information and to services, and easy navigation of the health system. In everyday life, consumers are experiencing easier access to information and services, and therefore have similar expectations of the health system. Clinicians are under considerable strain in providing highest quality clinical care, having timely and easy access to all relevant patient information at the moment of care, and maintaining professional knowledge, all while trying to juggle intensive workloads.

In response, the Victorian health system is seeking to support clinicians, consumers and provider organisations to continually improve the efficiency and effectiveness of health services across the continuum of care. A key enabler for achieving these broad objectives in healthcare, as with all industries, is the planning, delivery and management of information management (IM) and information communication technology (ICT) across the system.

The Statewide Health ICT Strategic Framework (the Framework) has been developed using a highly collaborative engagement process, providing directional guidance for health ICT strategic planning for the entire Victorian health system. The Framework will:

• Inform service planning for health services to deliver priority ICT enabled outcomes. • Provide consistency within, between and across the system for sequencing the planning

and implementation of ICT solutions to progress the maturity of ICT capability.

• Enable rational and targeted funding choices and decisions to be made by health services, the department and central agencies.

• Provide direction for demonstrable improvements in safety and quality of care, consumer experience, system efficiency and productivity, and knowledge capture and application.

The Framework is intended to be used collaboratively by leaders and other stakeholders in health services. It will also be used at a system level as a guide and point of reference for system wide health ICT planning and implementation.

This Framework is complementary to a number of other initiatives in progress. These include the Victorian Health and Wellbeing Data and Information Management Framework 2014–2022 and the Health Informatics Workforce Strategy Evaluation.

The Framework also builds on the Government response to the Ministerial Review, and does not seek to change future directions in health ICT that have already been agreed.

3.2 Approach to developing the Framework The Framework has been developed in consultation with a diverse range of stakeholders from across the Victorian health system. A key component of the approach involved using two intensive design sessions. These were informed and supported by a number of targeted interviews, and built on a comprehensive fact base. The design sessions were structured to provide accelerated iteration of the core content of the Framework, and involved participation of key decision makers, sector leaders, clinical and technology subject matter experts, budget holders and academics. This intensive and collaborative design process resulted in a high degree of alignment regarding the overall shape of the Framework, its key components, and the practicality of its content and applicability.

Understand and frame

Iterate and design

Report and refine

Socialise and finalise

Con

sulta

tive

appr

oach

• 27 stakeholders interviewed with representatives across the system

• Discussions at community health, metropolitan and regional health service Chief Executive fora

• High level review of literature and international examples for framework best practice

• Presentation to the Health Sector ICT Ministerial Advisory Council (the Council)

• Ongoing Framework iteration and development

• Design Session One, with 35 representatives from across the health system in a collaborative design environment

• Presentation to the Council

• In-depth content development for the Framework

• Design Session Two

• Interviews with Council members

• Finalise draft strategic Framework and supporting findings from development process

• Presentation to the Council

• Finalise • Receive approval

from the Minister • Present to

Government • Publish

Appendix B details the stakeholders consulted throughout the Framework’s development.

> > >


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4. ICT-Enabled Outcomes

4.1 Realising VHPF 2022 Outcomes Achieving improved health outcomes for consumers is one of the overarching objectives of the health system, and drives all other activities.

Each health service strives to improve the health outcomes of the population in their catchment area. Their annual targets and activities are articulated in their annual Statement of Priorities (SoPs), which in turn are aligned to guidelines published by the Victorian Department of Health. Targets for the medium term are set out in the Victorian Health Priorities Framework 2012–2022 (VHPF) (for both rural and metropolitan settings), which outlines the key priorities that all Victorian health services are focused on delivering for 2022, including the associated priority outcomes.

The VHPF provides a high level roadmap of what health outcomes the Victorian Government is seeking to achieve.

The specific outcomes articulated in the VHPF are set out below:

a). Responsive to People’s Needs:

1. People are as healthy as they can be (optimal health status)

2. People are managing their own health better

3. People enjoy the best possible health care service outcomes

b). Rigorously Informed and Informative:

4. Care is clinically effective and cost effective and delivered in the most clinically effective and cost effective service settings

5. The health system is highly productive and health services are cost effective and affordable

It is in this context that the Framework has been developed.

Key points:

ICT will be a key enabler in realising the outcomes of the Victorian Health Priorities Framework 2012–2022, providing both near-term and long-term guidance on how this will be achieved.

ICT unlocks benefits for consumers, clinicians, and the sector (including its executives and managers) such as improved quality, efficiency and experience of health care, through providing greater access to meaningful information, connectivity across the system and facilitating improved decision making.

4.2 ICT unlocks benefits for consumers, clinicians and the sector as a whole ICT will enable positive changes for all system participants and provide significant benefits. By using ICT to facilitate the achievement of the VHPF outcomes, a broad range of benefits will flow across the health system. These include:

Stakeholder Groups Benefits For Consumers, ICT will empower

consumers with information and tools to better navigate the health system, to facilitate understanding and proactive management of their health and wellness, and where appropriate, to enable consumers to collaborate with clinicians and other consumers.

Access to care appropriate to needs, for example: • Improved access to providers according to

clinical and personal need • Increased consumer participation Quality and safety of care, for example: • Improved assessment and treatment

outcomes • Reduced errors • Better health and wellness

For Clinicians, ICT will help clinicians to deliver the best possible care, enabled by timely access to relevant, high quality clinical information. This includes solutions that support seamless continuity of care and enable highest quality care with sophisticated clinical decision support. A key success factor will be implementation of solutions that simplify and support clinician workflow, and provide access to best practice knowledge, and therefore empowering clinicians to deliver great care.

Efficiency of care and services, for example: • Improved access to relevant information • More efficient assessment and diagnosis • Greater clinical efficiency, such as timely

and well informed decision making Access to health services and information, for example: • Improved preventative care and pathways

helping reduce unwarranted presentations • Increased responsiveness of service Quality and safety of care, for example: • Improved outcomes for patients • Reduced errors • Increased ability to deliver health promotion

and wellness information

For the Health System and an organisation’s Managers and Executives, ICT will provide trusted information and tools to help balance demand and supply, and efficiently deliver sustainable, high quality and safe health services.

Sustainability of health sector, for example: • Optimised use of funds and infrastructure • Increased support for priority initiatives • Improved return on investment (such as

productivity improvements) Access to health services and information, for example: • Improved management of demand and

supply • Increased responsiveness of service • Improved capacity via avoidable

hospitalisation


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4.3 Vision and Stages of ICT Capability

ICT Vision – Big Vision, Logical Steps The ICT Vision is an articulation of the future strategic positioning and value to be driven by ICT for healthcare in Victoria. It is informed by policy direction, such as the VHPF, has been shaped with input from the system, and will be brought to life through a set of strategic principles and strategic themes.

The Vision for ICT across the Victorian health system is:

‘Connected knowledge to ensure your best possible health’

At its core is the concept that ICT will empower the Victorian healthcare system to be:

• knowledge and information centric • consumer centric • empowering of clinicians and clinical decision making • dynamic in both knowledge capture and knowledge application.

Key points:

The Vision ‘Connected knowledge to ensure your best possible health’ will be realised through three stages of change:

1. Digitise and build foundations: move from manual to digital processes and create the ability to analyse and share information across the system.

2. Connect the system: move towards a consumer centric system that is connected, shares information and takes advantage of different care delivery models.

3. Empower through knowledge: move towards predictive, personalised and preventative health care that is knowledge driven.

The Vision is supported by strategic themes and an initial set of priority strategic initiatives that will progress its realisation.

The Vision will build on the current level of ICT capability in the system and be realised progressively. The following are indicative stages and objectives for ICT deployment:

• Stage 1: digitise and build core ICT foundations. This includes enhancing automation of core functions (for example, operating theatres), delivering clinical information systems for all key parts of the system, and ensuring key foundations are in place (for example, Wi-Fi in facilities, computers available as required, universal use of identifiers).

• Stage 2: optimise connectivity across the system. This includes a ‘step change’ in improvements in continuity of care, facilitating collaboration and building a strong base of clinical decision support. A culture of trusted information will be further enhanced.

• Stage 3: empower through knowledge. All stakeholder groups will routinely have access to timely and trusted information to transform their experience in the health system. Consumer knowledge to support choices for self-care and provider effectiveness. Clinician access to best practices and current knowledge wherever and whenever they need it. Executive knowledge to support optimising the efficiency and effectiveness of local organisations, as well as understanding their impact on the system as a whole.

• Continue the transition from manual to digital enablement: – Share information to enable productivity and initial outcomes – Use the information and analytics to drive ongoing improvement

• Set the foundations and enablers for the sector to realise benefits from ICT investment

• Increase trust in quality of information

• Drive a connected and informed consumer experience

• Improve efficiency of continuity of care through standards based interoperability

• Build advanced capabilities including clinical decision support across diverse data sets

• Encourage greater digital connectivity across care settings and the home, including: - Telehealth, Home Monitoring, Social Media

• Encourage broad adoption of national eHealth initiatives (such as value in future deployment of PCEHR)

• Continue to leverage trusted information

• Realise ubiquitous Health (uHealth) by supporting consumer engagement and self management

• Harness the exponential growth of data, including from smart sensors, wearable technology and advanced genomics

• Converge diverse data sources (such as genomic and clinical) to drive outcome improvements

• Use knowledge to deliver predictive, personalised and preventative healthcare

• Use knowledge to help minimise unwarranted clinical variation

• Use advanced secondary research to drive clinical and systemic improvement

• Embed an information and knowledge driving culture change and systemic transformation


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Day in the Life in 2022

In 2022, the journey for people with a heart condition through the system will be well defined and responsive to the person’s needs, making patient care easier to coordinate and to navigate. Health literate consumers will be able to make individual choices, and participate in decision making about their care when it is appropriate to do so. The future experience will include: • Early identification of ‘at risk’ consumers, and improved delivery and monitoring of primary and

secondary prevention information, activities and effectiveness. • Well defined and personalised cardiac care pathways, including collaboration between health service

providers, to optimise and simplify care planning. Clinicians having access to up-to-date evidence and receiving support for real time decision making. Clinicians knowing how effectively the patient is tracking to their care pathway, and being able to make timely interventions or changes as required.

• Patients having access to their own personal information and availability of tailored health knowledge relevant to their cardiac condition as an integral part of their care plan. This facilitates a person’s involvement in their care, whether it is planning, coordination, or decision making. Information is within the person’s control and with consent, easily transferred between providers, resulting in improved communication, safety of care and optimal health care choices and decisions.

• Single point of care coordination, either with their own GP or with the most clinically and geographically appropriate health provider, is integral to their care, ensuring cost effective and efficient care management.

4.4 Strategic Principles Strategic principles will guide the system in the planning, investment and execution of IM and ICT enabled health outcomes. These complement the principles defined in the Victorian Government ICT Strategy 2014–157, the Ministerial Review and the Victorian Health Policy and Funding Guidelines8.

7 http://www.digital.vic.gov.au/ict-strategy/ 8 http://www.health.vic.gov.au/pfg/ From 2011 to 2013 the Office of the Chief Information Officer (OCIO) has provided input to

the Victorian health policy and funding guidelines (VHPFG) so that they align with continuity of care interoperability standards, and future alignment with national initiatives. In addition, the 2014-15 VHPFG will also reference the statewide ICT strategic framework. Funded organisations must adhere to the specified standards when planning or implementing ICT projects.


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4.5 Agreed Strategic Initiatives To help the devolved system achieve the ICT vision, the Framework provides guidance to health services for local strategic planning processes through the identification of six strategic themes and a number of strategic initiatives. Each health service will embed these strategic initiatives alongside their local initiatives as part of their strategic planning process.

Based on existing policy and initial consultation with the system, ten priority strategic initiatives9

have been identified:

9 Priority initiatives are not in a specific order as the order will differ depending on the health services and its current

ICT capability.

• Consumer Centricity and Empowerment: Provide support to consumers, patients and their carers via information and tools to enable them to better navigate the health system, to support understanding and management of their health and wellness, and to collaborate with others including clinicians and other consumers, where appropriate. An example initiative could be a Patient Portal, which provides access to the patient’s own record, tailored health and wellness content and decision support tools for the individual. This strategic theme also includes initiatives to better understand and balance demand. The initial priority is to enable consumer access to a consumer’s personal health information.

• Continuity of Care: Capture and communication of summary clinical information to enable efficient handover and continuity of care between relevant clinicians and health service providers. Example areas of future focus include electronic discharge summary, electronic referrals, collaboration tools, telehealth, and access to national shared electronic health records (EHRs) and electronic shared care plans. The initial system priorities include interoperable clinical documents, such as eDischarge Summary and eReferral.

• Clinical Excellence: Assist clinicians to provide the highest possible quality of care. Priority initiatives are clinical information systems including improved medications management, and various forms of advanced clinical decision support.

Continuity of care

A patient arrives at their local hospital emergency department experiencing dizziness and fatigue. After an initial assessment, the patient is admitted for a series of investigations and clinical management. Throughout the hospital experience, the patient’s Electronic Medical Record (EMR) is continuously updated with each clinical note, investigation and result. After three days, the patient is discharged with instructions to follow up with their general practitioner (GP) in one week’s time.

• As the patient leaves the hospital, an eDischarge summary is automatically sent to the patient’s GP notifying them of the patient’s discharge.

• The eDischarge summary is automatically incorporated into the GP’s desktop practice management system. It includes the patient’s admission details, diagnosis, procedures, summary diagnostic results, medications on discharge, and any follow up care plans and actions.

• Post discharge prescriptions can be routinely accessed by the patient’s preferred pharmacy. • An eDischarge summary is also sent to the patient via their preferred mode of communication (for

example, their PCEHR). • When the patient visits their GP for the scheduled follow up visit, the GP is fully informed and able

to ensure that the ‘transfer of care’ has been successful, including the delivery of the patient’s post discharge care plan.

• The patient is encouraged to check in with the GP every four weeks using the ubiquitous telehealth consultation network which is able to be accessed via their mobile device, computer or pharmacy kiosk.


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• Teaching and Research: Support and empower highest quality teaching and training. Support and enable high quality research, including clinical, bench and epidemiological research. The priority strategic initiatives include a focus on high quality research, teaching and training, and evaluation of de-identified clinical data to help improve clinical care and patient outcomes.

• Support Services: Efficiently and effectively manage the supply chain, including procurement, inventory management and utilisation. Support and provide data analytics to enable operational insights for key corporate functions such as human resources and finance, and to better understand how to improve service delivery. The initial system priority is to deliver core business intelligence capabilities, including for broad system-wide insight and deeper capabilities to improve the supply chain.

• Foundations: Deliver technology and non-technology foundations to enable the system to efficiently capture and communicate trusted information. A key priority is to deliver and sustain the enablers described in Section 6 (Implementation Enablers). Further priorities are to deliver the mandatory infrastructure and associated common standards and architecture.

Regular review and refinement of strategic initiatives will be embedded in the ongoing management of this Framework. The ongoing creation of priority strategic initiatives will involve consultation with clinicians and other stakeholders to ensure these are in line with clinical and business priorities.

As part of the approach to allocating funds from the Innovation, EHealth and Technology Fund, a range of criteria has been established to help determine the selection and phasing of priority strategic initiatives. These include benefits and impact, national fit and stages of development of required enablers. An overview of the process can be found at Appendix D.

4.6 Use of priority strategic initiatives in local strategic planning Health services will develop and maintain their own ICT strategic plans that will define the role of ICT in helping deliver their local strategic objectives and target outcomes. Health service ICT strategic plans will address the priority strategic initiatives, where these have not already been realised by the health service, in addition to their local initiatives. These master strategic plans developed by health services will be shared with the department and major initiatives will be referenced in local SoPs.

Clinical Excellence – Diabetes Discovery Project

At a Victorian public health service, the implementation of a clinical information system has provided an opportunity to screen the hospital population to improve health outcomes for patients with diabetes. Routine HbA1c measurement can identify patients with undiagnosed diabetes, as well as patients with suboptimal diabetes management who therefore require review, and an improved management plan.

Identification of patients with diabetes at admission is important to facilitate improving glycaemic control, reduction of wound infection rates, early detection and intervention of diabetic complications, a reduced length of stay, and a reduction in unplanned readmissions. Over a six month period, admission HbA1c levels were screened, with the following results:

• 6,716 admissions qualified under the automated rules and underwent HbA1c testing. • 1,719 had HbA1c values over the diagnostic cut off for diabetes of 6.5%. • 380 (22%) of the 1,719 patients did not have a previous diagnosis of diabetes. This

information was included in the discharge documentation (via the automated rule) to the patient’s GP, suggesting that the patient be further investigated and treated. Patients were also contacted by the hospital to offer diabetes follow up in the outpatient clinics.

• 364 (21%) of the 1,719 patients had HbA1c values over 8.5% suggestive of poor glycaemic control. These patients were reviewed as inpatients by the endocrinology registrars to optimise diabetes management and facilitate long term diabetes management.

5. Fit-for-Purpose ICT Capability

The following will be put in place to help the system achieve the Vision:

• a future state view of ICT capabilities to inform the direction of ICT in the system • a minimum baseline to provide guidance on the minimum capability required for each health service

in the system over time • a standards-based architecture to ensure interoperability and connectivity within the

system, and • an agreed maturity model to provide commonality of language and ability for health services

to more easily share and collaborate in ICT.

5.1 Defined ICT future state The ICT future state definition will be time bound and progressive:

• In two years: (baseline capabilities). For example, this may include the universal capability to send eDischarge summaries.

• In five years: (more mature capabilities). For example, universal capability for closed-loop medication management.

• In eight to ten years: (aspirational). For example, universally enabling and demonstrating greater patient clinical outcomes.

The future state will be inspirational and aspirational. It will help set priorities and key capabilities, and will guide which areas are to be delivered by various parties, including the department and health services.

The future state will be associated with key targets relative to agreed maturity models. For example, the department together with the health services could recommend health system plans for HIMSS Electronic Medical Record Adoption level (EMRAM) to be set at a minimum agreed target level by the year 2022 for all acute health services.

Key points:

To support the vision, an agreed ICT future state will be defined for the system in 2022 for all participants to work towards. It will be realised incrementally, over two year (baseline), five year (mature) and eight to ten year (aspirational) stages. It will be underpinned by a minimum baseline of ICT capability which will evolve as the health system matures.

All priority strategic initiatives will form part of the minimum baseline over time and be delivered by each of the health services. The minimum baseline is not the target – the intent of the Framework is to encourage all health services to have ICT capability significantly above the baseline in line with their local priorities.

ICT investment will be standards based, with the department continuing to play a key role in their management and evolution.

To help drive greater commonality in how the system approaches ICT, an agreed maturity model will be generated and promulgated by the department. A common maturity model will allow the department and health services to have a shared understanding of ICT maturity, which also includes organisational and workforce maturity considerations.


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5.2 Agreed minimum baseline capability To help the system deliver on the strategic priorities, public health services will need to meet an agreed minimum baseline capability. The objective is to ensure that the whole system meets an agreed minimum capability commensurate with policies and priorities that exist at a point in time. It is intended that the minimum baseline capability will move to higher levels of maturity in future years.

The initial ten priority strategic initiatives identified in this framework will form the basis of the minimum baseline over time as shown below:

The first minimum baseline will also include agreed:

• Core benefits • Mandatory standards as defined by the department • Baseline capabilities for infrastructure • Capabilities for information access and communication • Levels of integration • Core enablers, including baseline delivery capabilities, and to attract, retain and develop appropriately

skilled health informaticians.

The minimum baseline is an ‘at least’ target – the intent of the Framework is to encourage all health services to have ICT capability significantly above the baseline in line with their local priorities.

Each health service will be assessed against the minimum baseline.

Some health services will be below that level and some are already at a capability maturity level that is more advanced than the minimum baseline capability. The objective is to help identify targets and gaps to achieve the minimum across the system. For health services that are above the minimum, there should be no constraint on them continuing to develop and implement more advanced capabilities.

5.3 Agreed architecture and standards-based approach to interoperability The department will set and manage statewide standards which will include interoperability standards.10 The department will also manage the common view of the Victorian health system enterprise architecture, including:

• A business architecture, along with a clear description of business capabilities, and processes, and how they align to ICT capabilities. This will include a ‘current state’ and a ‘future state’ view and depict how health services across the health system fit into the architecture.

• ICT applications, and the associated information flows. • Technology foundations including a description of the statewide common components, such

as statewide identifiers, terminology and other hardware and software foundations.

It will be a requirement for all Victorian public health services to understand and align to the state based architecture and utilise the agreed statewide standards.

A simple guide written in layperson’s terms is being developed to help communicate the relevant aspects of the architecture for healthcare organisations. This is helping to optimise communication and understanding of the architecture, and what it means to stakeholders, such as health service executives, clinicians and ICT professionals. In turn, this is helping guide local ICT strategic planning activities.

The department, in collaboration with the system, will continue to deliver and enhance its Design Authority capabilities and, where appropriate, align and integrate with other ICT governance mechanisms at national, state and local levels.

Capabilities for integration and information exchange between the public and private systems will be evaluated, and opportunities for alignment identified and developed. This includes alignment to national eHealth priorities and standards. It also includes improved integration between the Victorian public health system and private providers such as specialists in private practices, private hospitals, allied health professionals and other health service providers in the private sector.

10 Refer to the department’s policy and funding guidelines


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5.4 Maturity Model Maturity models provide organisations with guidance for their strategic direction and priorities for investment. They are used to formulate options regarding the pragmatic order in which capability can be adopted and served as a mechanism for comparing capability between organisations.

An example of a maturity model is the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM), which has been considered by the department’s Health Design Forum (HDF) and endorsed as a suitable model to assist health services. The department has been working closely with health services on an interoperability maturity model, drafts of which have been reviewed and supported by the Council.

The department will continue to develop appropriate ICT maturity models, which will include further development of the Interoperability Maturity Model (IMM) and expansion into new areas (for example, non-clinical systems). Known industry measures of maturity will be used as much as possible, such as, the HIMMS EMRAM model.

Within the health system, capability maturity will include, but may not be limited to:

• Technology maturity (applications, technical foundations). • Information maturity (for example, mandatory data sets, data governance, data quality).

This is a key area, as the system needs to achieve a culture of trusted information. • ICT delivery maturity (for example, program management, change management capability maturity). • Organisational maturity to assess, plan and implement ICT capabilities. • Workforce competency maturity.

Statewide common maturity requirements will be clearly identified and published. Health services will have their ICT solutions and capabilities (ICT and workforce) mapped to the statewide maturity model. This mapping will be a collaborative effort between the department, health services and third parties, where appropriate.

The maturity model will be applicable for all health services regardless of areas of operation and scale. Although there will be one overarching model, it is expected there will be different measures for metropolitan, rural and community health services depending on their operations and capabilities. The model will apply to ICT capabilities along the continuum-of-care, to clinical and non-clinical functions, and will align with national initiatives.

A mechanism for accreditation and/or conformance of key ICT related capabilities will be developed for the system, including delivery capabilities. For example, a ‘good practice’ guide for Implementation Planning Studies (IPS) and accreditation for ICT related resources in delivering an IPS.

A quality assurance capability will be developed to examine how organisations are aligned to maturity models. This will provide a clear understanding of the ‘current state’ of Victorian public health services’ ICT alignment, and assurance regarding how health services plan to migrate towards the ‘future state’.

The position of health services on the maturity model and their plan(s) for migrating up the maturity curve will be a core function of the relevant governance bodies. For example, each health service should be accountable for planning how they deliver their agreed ‘target state’. The governance bodies would share common templates, knowledge, processes and methodologies. Victoria’s knowledge sharing capabilities will need to be further developed, and may include enhancements to the Design Authority.

Where appropriate, the Minister, the department and health services will agree to the position of health services on the maturity curve. For example, inclusion of an EMR at particular EMRAM levels within the SoP for each health service.

6. Implementation Enablers

There are a number of key enablers that will be fundamental to delivering the Vision and desired outcomes, driving and achieving the strategic ICT priorities, and successfully building the local and system-wide required ICT capability.

Key points:

One of the priority strategic initiatives is to put in place the foundations to realise better value from investment in ICT. This will be through implementation enablers. The enablers fall into two broad groups:

• to generate and focus investment into ICT through exploring alternative commercial models for ICT investments and accelerating local and sector-wide innovation.

• to extract value from that investment through adoption of a transformational mindset and capability, benefits realisation, growing a sustainable health IM and ICT workforce, and encouraging collaboration and knowledge sharing across the system.


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6.1 Create a transformational mindset and supporting capabilities ICT is a core enabler to realise significant change at both an organisation and system-wide level; however, technology is only one factor and a holistic approach is required. The system needs to build deep transformational capabilities to manage the volume and complexity of change that will be required over the next decade. This will ensure that the system is able to:

• Integrate ICT into clinical and administrative reform to deliver outcomes at both an organisation level and at a system level. A holistic approach to reform is required with a focus on process re-engineering, cultural and behavioural change, organisational change, as well as the technology that underpins the reform. Where possible, ICT-enabled reform should be aligned with existing change capability within organisations (such as continuous improvement teams).

• Cultivate ‘transformational leadership’ capabilities across the system, including executive, clinical and ICT professionals to help improve leadership in, and navigation of, clinical and ICT reform projects. For example, deliver structured leadership development programs, events and process redesign mentoring during key projects.

• Empower clinicians to drive change. Enhance clinical governance structures and engagement, and ensure each group has effective and knowledgeable clinical leadership, and clinical change agents. Further develop the leadership role of informaticians to bridge the gap, and help optimise alignment between clinical care and ICT. Close the loop on end-user clinician feedback by ensuring post-implementation feedback from clinicians is captured and incorporated into the development cycle, and that clinicians play a part in contributing to further enhancements.

• Where appropriate, engineer projects to be more modular with iterative delivery of capability to enable early and regular delivery of tangible, demonstrated business values while also mitigating risk. The ability to incrementally demonstrate success will further encourage targeted investment in ICT as an enabler of clinical and administrative change.

• Develop a robust foundation of program, project and change management capability. By supporting transformation leaders, the system will ensure high quality program management, project management and change management capability. This will be underpinned by a set of rules that include a pre-requisite level of project funding be dedicated to program and change management based on project scope and risk. The ‘delivery capability’ of the implementation teams will be measured according to an agreed maturity model (possibly supported via a pragmatic accreditation scheme). Skilled resources will be developed at a health service level, and be sourced from the private sector where appropriate.

6.2 Enhance the benefits realisation capabilities The Victorian public health system will adopt a more sophisticated approach to benefits targeting, tracking and realisation. This system will:

• Ensure a focus on outcomes (making a difference – such as health improvement or behaviour change) rather than outputs (the activities or actions that are completed).

• Define, measure and track benefits for different stakeholders, including the health system, broader economy and consumers. These benefits will align to desired system outcomes and delivery outcomes will be assessed relative to the original business case.

• Consider a shared resource pool of benefits realisation resources that can support ICT delivery teams across the system and help aid skills transfer to those teams.

• Communicate ‘best practice’ benefits realisation capability, including processes and tools for the tracking and communication of key performance indicators (KPIs) for ICT project implementation, stakeholder feedback and delivered benefits and outcomes.

• Establish efficient and effective communication processes regarding the true status and benefits of ICT project delivery in order to regularly inform government, executives, clinicians, consumers and other stakeholder groups.

• Provide assurance and risk management guidance to help understand progress, mitigate risk in ICT projects and promote benefits realisation.

6.3 Grow a sustainable health IM and ICT workforce The system will further develop an appropriately skilled health IM and ICT workforce, with sufficient capacity to support key ICT delivery programs across the system. The system will:

• Shape and deliver an IM and ICT capability model that addresses priority capability requirements, from ICT planning through to ICT delivery. Initial areas of focus include Chief Medical Information Officers (CMIO), Chief Clinical Information Officers (CCIO), health informaticians, ICT business analysts, systems integration and program and change management specialists.

• Improve data and information management capabilities: A key area of focus will be helping the system improve its information management capabilities, including data governance and data quality, to improve accurate insight from health system data.

• Create a model for sharing resources across organisational boundaries, including resources employed by health organisations, and by external partners. The capability model will be established to help keep up-to-date with the rapid pace of changing skill requirements, and will ensure agility when responding to system needs.

• Attract and retain skilled health informaticians. To ensure success, ICT projects must have skilled health informaticians working alongside ICT and clinical teams. Until the informatics workforce is substantially larger, organisations should identify people in the current workforce who can contribute their clinical and process knowledge to the planning, implementation and adoption of ICT.


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6.4 Encourage collaboration and knowledge sharing across the system The ability to collaborate and adopt ideas, knowledge and solutions between organisations will be a critical success factor achieving the greatest return on investment in ICT. To help achieve this, the system will:

• Develop a strong culture of collaboration across the health system. Share and disseminate important information, and local and international trends via collaborative environments such as webinars, seminars, conferences and workshops. Realise economies of scale through collaboration, including common collaboration platforms, collaborative buying arrangements to meet similar needs and shared services.

• Build incentives for collaboration and knowledge sharing, including non-fiscal incentives (for example, recognition of leaders and significant achievements) and fiscal incentives (for example, seed funding for knowledge management initiatives).

• Improve knowledge sharing tools and capabilities to help facilitate collaboration. Develop a knowledge exchange platform, such as a portal, providing reference to ‘good practice’ initiatives and templates, reusable assets, case studies of successful projects both within and outside the system. Leverage existing platforms, people, and sources of information as much as possible.

• Improve ICT knowledge leadership. Consider assigning a statewide knowledge lead role to be responsible for driving the knowledge management strategy, developing the shared capabilities across health services, and further developing an improved culture of collaboration across the system. Leverage existing clinical, technology and management leadership to publicise and communicate success stories and examples of effective collaboration and knowledge sharing.

6.5 Explore alternative commercial models for ICT investments There is a need for ICT funding to support a diversity of approaches to ICT delivery, ranging from complex change programs to the deployment of specific capabilities as a service. Given the mixed ICT maturity of the sector, and the need for progressive implementation of ICT capabilities to meet the baseline requirement, there is a need for a model that balances both capital and operational funding. To help achieve this, the system will:

• Explore alternative funding models. Develop a ‘toolkit’ and principles for approved sources of funding to help provide transparency for the system. Some key types of funding to be considered, include: Self-funding by the health service. Cash flow support, such as a loan from the department based on recoverable cashable benefits. Grants from the department. This might include seed funding for innovative (pioneering) projects that have statewide applicability.

• Reform the barriers between ICT and capital investment. Reform how health ICT is financed across the system, including moving away from funding ICT via capital expenditure and capital approval processes toward funding through operating expenditure. Where possible, health services will have greater capacity to leverage operational funding to invest in ICT, particularly where there are productivity benefits.

• Explore alternate commercial models for ICT investment. This includes more innovative commercial models, such as Public-Private Partnerships (PPP) and more pragmatic ‘risk/reward’ agreements to help attract private sector investment and expertise, and to help mitigate risk.

• Increasingly capture opportunities associated with ‘as a service’. Health organisations, including the department and the health services, will have increasing opportunities to procure ICT capability ‘as a service’. This would include models that begin with a smaller initial footprint that can be scaled up as demand increases.

• Consider rewarding meaningful use. Health services could utilise a funding model that, at least partially, pays the organisation based on adoption, and/or meeting certain achievable outcome criteria. For example, perhaps part ‘block’ funding, and part ‘meaningful use’ funding based on agreed targets.


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6.6 Accelerate local and system-wide innovation Innovation is a key enabler for the system to realise value from ICT investment and an opportunity for organisations to dramatically improve their capability. Innovation is more than just technology. It is a highly creative process and distinctive culture. To enable innovation to flourish, the system will:

• Structure innovative opportunities for ICT to evaluate cost/benefit potential, conduct pilots, and test and determine value. This includes ‘pioneering’ projects to be developed and tested locally that would potentially have statewide applicability.

• Provide access to targeted seed funding for innovative technologies or opportunities. Explore innovation in commercial models to help encourage broader ICT innovation and investment.

• Showcase attempts of bold, innovative projects, by celebrating attempts at innovative initiatives and sharing lessons learned, irrespective of outcome.

• Engage and partner with the private sector, such as vendors, to explore ‘win-win’ partnerships and innovative ICT opportunities.

• Continue to ensure appropriate contestability of government funds to help promote accessibility to innovative, cost effective solutions from the vendor community.

• Consider how to leverage consumer generated data from diverse technologies such as public cloud, wearable devices and smartphones, to be used to supplement health service data. Where appropriate, with industry players, consider opening access to de-identified data and applications for appropriate and high value use. An appropriate privacy, security and risk assessment would be required.

7. Governance Model, Roles and Responsibilities

Key points:

Governance is instrumental in facilitating the achievement of objectives, managing risks and resources.

In Victoria’s devolved model, strong governance mechanisms at both system and organisation levels are needed to create confidence in:

1. ICT choices and investment decisions, by focussing on the investment decision making processes.

2. Implementation of ICT investment decisions, by focussing on managing implementation risk through mechanisms like monitoring effectiveness and providing quality assurance over projects.

Defined roles and responsibilities drive accountability and responsibility at both the system and organisation levels for each of these processes.

The Health Sector ICT Ministerial Advisory Council (the Council) will advise the Minister on a range of strategic ICT issues for Victorian healthcare. Health services are accountable for strategy and risk management at a local level.

The department will oversee the promulgation, application, monitoring and effectiveness of the Framework and will take on the project assurance role for strategic ICT projects, which are projects of particular interest to Government and the community.


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7.1 ICT Governance model and principles In practice, governance is a set of accountabilities, processes and auditable and measurable controls that ensure that an organisation is on track to achieving its objectives.

In Victoria, public healthcare is delivered through a federated model with devolved governance, in which individual organisations are responsible for decisions that meet local needs11. Local boards govern the activities of the health services and are primarily responsible to the Victorian Minister for Health for the safe, efficient and cost effective delivery of high quality health care.

ICT governance is not corporate governance. However, it must be aligned to the business objectives and overall risk management framework of an organisation.

7.1.1 Governance model The following figure sets out the ICT governance model in Victoria’s devolved health care system:

ICT Governance in the Victorian Healthcare System A set of accountabilities, processes, and auditable and measurable controls that drive alignment of ICT with provider organisation and health system strategies to ensure objectives are achieved, risks are managed and resources are allocated effectively.

11 Department of Health, 2012, The Victorian health services governance handbook: A resource for Victorian health services and

their boards, State Government of Victoria, Accessed 27 May 2014, State Government of Victoria

In realising the above model, the following should be considered:

• Detailed processes supporting ICT governance will align with the Victorian Public Service Commission’s (formerly the State Services Authority (SSA)) good practice guide for governance and the department’s The Victorian health services governance handbook.

• Health services already have mature mechanisms in place for managing corporate and clinical governance. A key consideration of the Framework will be to determine the most appropriate and effective system-wide ICT governance architecture. This will include mechanisms to maintain and review the Framework from time to time.

• While this ICT governance framework is focussed on the governance of ICT across health services, it is acknowledged that interaction with the broader health system is critical throughout the planning, implementation, deployment and ongoing management of ICT.

7.1.2 Governance principles A useful reference for identifying key principles for good governance of ICT is the International Standard ISO/IEC 38500: Corporate Governance of Information Technology. The Standard informs detailed ICT governance arrangements in practice, at both the system and organisation levels. It sets out six principles, described as preferred behaviours, to guide decision making:

• Principle 1: Responsibility. Individuals and groups understand and accept their responsibilities in respect to both supply of, and demand for ICT. Those with responsibility for actions also have the authority to perform those actions.

• Principle 2: Strategy. Broader corporate strategy takes into account the current and future capabilities of ICT; the strategic plans for ICT satisfy the current and ongoing needs of the broader health service and sector strategy.

• Principle 3: Commissioning. Commissioning of ICT is undertaken for valid reasons, on the basis of appropriate and ongoing analysis, with clear and transparent decision making. There is appropriate balance between benefits, opportunities, costs, and risks, in both the short-term and the long-term.

• Principle 4: Performance. ICT is fit-for-purpose in supporting the health service or broader system in meeting current and future need.

• Principle 5: Conformance. ICT complies with all mandatory legislation and regulations. Policies and practices are clearly defined, implemented and enforced.

• Principle 6: Human Behaviour. ICT policies, practices and decisions demonstrate respect for human behaviour, including the current and evolving needs of all the ‘people in the process’. At its core, this principle considers the importance of consumers, clinicians and business users in the development and provision of ICT.


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7.2 Creating confidence in ICT choices and investment decisions In creating confidence in the ICT choices and investment decisions undertaken at a system and local level, the following is required:

• Clearly defined roles and responsibilities for investment decision processes, which reflect that: the department has responsibility for policy regarding decisions about priorities for publicly funded ICT

investment12, and local health service boards and management are responsible for the development and management

of their individual ICT strategic planning and investment decision making processes, irrespective of sources of funding.

• Clearly defined risk management framework and decision making processes to underpin investment decision making at both system and organisation levels.

• Visible and robust project assurance mechanisms to provide confidence in project delivery according to project cost, benefit and timeline parameters13.

Key responsibilities identified at a system and organisation level include:

System Level Organisation Level

• Defining minimum standards • Setting rules on compliance • Defining business case requirements • Setting parameters for funding options • Establishing funding criteria

• Establishing ICT strategies aligned to service plans

• Creating clinician leadership in design • Aligning ICT choices, planning and

investment with organisational risk appetite

12 A series of documents have been developed and approved for submitting applications against the Innovation Fund, including

primary and secondary selection criteria (Appendix D) 13 The draft project assurance approach, to be used with projects funded from the Innovation Fund is at Appendix E

7.3 Monitoring implementation effectiveness and outcomes At both a system and health service level, there is a need to monitor the effectiveness of the implementation of ICT to ensure outcomes are being delivered in a cost effective and high quality manner, and that risk is being monitored and managed.

Once an investment decision is made and funding sources are identified, it is good practice to set up mechanisms that monitor and manage implementation risk. This will be undertaken through quality assurance mechanisms that assess, at specified points, and according to an agreed framework (where appropriate, DTF’s high value / high risk framework), the ‘health’ of a project based on core criteria, including:

• Scoping documentation and project management and rigorous implementation planning • Benefits and program management mechanisms, including change and stakeholder management

plans, and post implementation benefits evaluation • Project resource capability and capacity • Risk registers and risk management • Change and quality control mechanisms. Benefits must be effectively monitored and managed at all three levels – system, program and project. In this context, the following key responsibilities include:

System Level Organisation Level

• Monitoring sector-wide compliance with standards

• Evaluating and reporting on benefits realised • Monitoring and reporting on maturity state

of the sector • Enabling cross-sector learnings • Project assurance of strategic ICT

investment activities

• Tracking project quality assurance • Evaluating ICT enabled outcomes • Establishing collaboration initiatives • Monitoring and reporting ICT related

risk management strategies


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7.4 Defining governance roles and responsibilities The responsibilities identified above require clear definition of accountable and responsible roles to realise effective governance. The proposed roles are identified below:

7.4.1 System-level roles and responsibilities For publically funded health services, in the context of ICT:

1. In line with the Health Services Act 1988 (HSA) (and in accordance with the department’s Governance Handbook), the Minister for Health is accountable to Parliament for the delivery of healthcare by health services across the State. In the context of ICT, the Minister is required to maintain appropriate accountabilities and controls to ensure ICT facilitates the delivery of healthcare services in a high quality and cost effective manner.

2. Under the HSA, the Secretary, Department of Health, supported by the Deputy Secretaries and the CIO, has prime responsibility to the Minister in providing:

a. Strategic direction, policy and operational advice in relation to health ICT at a statewide level, including: Aligning with national and statewide ICT strategies and priorities Setting minimum standards for ICT and rules for compliance with health ICT Monitoring and reporting on health ICT maturity across the system

b. Recommendations on priority areas of health ICT investment across Victoria, including: Defining business case requirements Setting parameters around funding options and funding criteria

c. Oversight and quality assurance of health ICT, including: Monitoring compliance with standards Monitoring ICT projects that are publicly funded and others considered high risk to the

department

d. Reporting on performance and benefits delivered through ICT, including: Managing learnings across the system Monitoring benefits realisation across the system

7.4.2 Organisation-level roles and responsibilities Health services have a range of accountabilities and responsibilities in relation to ICT:

1. Developing their local master ICT strategy and reporting outcomes as part of health service SoP.

2. Establishing a capable and available workforce, including appropriate clinical leaders, informaticians and ICT technicians.

3. Aligning ICT investment priorities and choices within local risk parameters and risk management framework.

4. Managing and monitoring the delivery of ICT.

5. Undertaking individual ICT project evaluation and benefits realisation and reporting on progress to the statewide advisory body.

6. Undertaking effective and efficient lifecycle management of ICT.

7.5 Ensuring oversight of the Framework The Council has responsibility to be informed on a range of relevant health ICT issues, and to inform and advise the Minister accordingly.

Health service boards are accountable for strategy and risk management at their local level.

The department will oversee the promulgation, application, monitoring and effectiveness of the Framework and take on the project assurance role for strategic ICT projects, which are projects of particular interest to Government and the community. In this latter role, the department will provide the sector with clear guidance on assurance and risk management which will link to the Department of Treasury and Finance’s (DTF) high value / high risk process, but not replace it.


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Appendix A: Glossary14

Term Definition

Baseline capability A minimum set of ICT capabilities required within health services to support agreed healthcare service delivery mechanisms, for instance EMRs, eDischarge Summaries, eReferrals.

Clinician Any health professional

Clinical decision support (CDS)

Clinical decision support provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered and presented at appropriate times, to optimise health and healthcare. This includes computerised alerts and reminders, clinical guidelines, focused patient data reports and summaries, documentation templates, diagnostic support and contextually relevant reference information, amongst other tools.14

Cloud Cloud computing is the use of hardware and software delivered as a service over a network (typically the internet). The name comes from the common use of a cloud-shaped symbol as an abstraction for the complex infrastructure it contains in system diagrams. Cloud computing entrusts remote services with a user’s data, software and computation.

Continuity-of-care The delivery of a ‘seamless service’ through integration, coordination and the sharing of information between different healthcare providers through a focus on new models of service delivery and improved patient outcomes.

Department of Health One of the nine state government departments in Victoria; the lead portfolio agency overseeing all health services, mental health, ageing and aged care and preventive health.

Department of Treasury and Finance

One of the nine state government departments in Victoria; its role is to provide economic, financial and resource management advice to assist the Government delivery of its policies.

Design Authority The Health Design Authority provides information and communication technology advice, guidance, best practice principles, methodologies and standards across the Victorian Public Health Sector.

Digital processes The process of moving from paper-based workflows to digital (electronic) workflows, for instance, from paper discharge summaries to electronic discharge summaries.

eDischarge Summary A clinical document produced when a patient is discharged from a health service; usually generated by the clinical system or an EMR which is then electronically transmitted to the patient’s GP and/or updated in the PCEHR.

eHealth A term for a healthcare practice supported by electronic processes and communication.

14 Based on http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds

Term Definition

EHR Electronic Health Record. A systematic collection of electronic health information about individual patients or populations. It is a record in digital format that is theoretically capable of being shared across different healthcare settings. In some cases, this sharing can occur by way of network connected enterprise-wide information systems and other information networks or exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunisation status, laboratory test results, radiology images, vital signs and personal statistics, such as age and weight.

EMR Electronic Medical Record, a computerised medical record created in a health care organisation, such as a hospital or clinicians’ office. EMRs tend to be part of a local stand-alone health information system that allows storage, retrieval and modification of records.

eReferral Electronic referral – an electronic means of achieving a care handover from one provider in the continuum of care to the next provider.

Governance The processes to assure that investment in health ICT delivers benefits, mitigates risk and achieves agreed timelines and outcomes within an agreed budget.

GP General Practitioner

Health sector Public and private health service providers, funders and suppliers

Health Sector ICT Ministerial Advisory Council

An independent advisory council providing independent advice to the Minister on strategic health ICT matters.

Health system Components of the health sector that are funded by the Victorian Department of Health

Health Service A registered funded agency, multipurpose service or health service establishment; or a registered community health centre; or a women’s health service listed in Schedule 6 of the Health Services Act 1988; or any other person, body or organisation that provides, delivers, funds, facilitates access or provides insurance in relation to health services as described in the Health Services Act 1988.

High Value / High Risk15 Within Victoria, high value / high risk projects are projects that require greater scrutiny and oversight due to their investment value and/or risk profile (further detail is available from the DTF website). The objective of the increased scrutiny is to provide greater confidence in project delivery according to project costs, benefits and timeline parameters.

HIMSS Health care Information and Management Systems Society

HIMSS EMR Adoption Model (EMRAM)

An internationally recognised eight-step model that allows health service providers to assess status and progression towards becoming paperless.

HIRC Health Innovation and Reform Council: an independent advisory body providing independent advice to the Minister on the effective and efficient delivery and management of quality health services and the continuing reform of the public health system.

HL7 A framework and related standards for the exchange, integration, sharing and retrieval of electronic health information.

15

15 Refer Appendix F


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Term Definition

ICT Information and Communication Technology

IM Information Management

IPS Implementation Planning Study

Informatician An informatics practitioner

Informatics The study of how to design a system that delivers the right information to the right person in the right place and time, in the right way. In health, this refers to resources, devices and methods required to optimise the acquisition, storage, retrieval and use of information in health and biomedicine.

Interoperability The degree to which information systems are capable of sharing data in a meaningful way.

Interoperability Framework An interactive model that guides and supports health services to achieve a higher level of EMR and other key application capability. An example is the Victorian Statewide eHealth Interoperability Maturity Model (SEIMM).

Knowledge management How information and knowledge is managed – that is, collected, stored, analysed, shared and used.

KPI Key Performance Indicator

Maturity model ‘Maturity model’ and ‘capability model’ are often used interchangeably. Such models allow an organisation to assess its maturity in a particular area via quantitative assessment against an agreed benchmark, for example the HIMMS EMR Adoption Model.

Meaningful use The set of standards defined by the Centres for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria.

PCEHR Personally Controlled Electronic Health Record: a secure, electronic record of a person’s medical history; stored and shared in a network of connected systems.

PPP Public–Private Partnership: a government service or private business venture which is funded and operated through a partnership of government and one or more private sector companies.

Shared-care plan A comprehensive and coordinated care plan (usually electronic) developed for patients with long term conditions in partnership with the patient’s care team. Examples are maternity patients, diabetic patients, cancer patients. Such plans increase the patient’s participation in their care.

SoP Statement of Priorities: SoPs are the key accountability agreements between health services and the Minister for Health. SoPs for rural Victorian public hospitals are agreed with the Secretary, Department of Health. The annual agreement ensures delivery or substantial progress towards the key shared objectives of financial stability, improved access and waiting times and quality of service provision.

The Framework The Statewide Health ICT Strategic Framework

Trusted information Information that has integrity, reliability, currency and usability and which is subject to governance and life-cycle management from trusted environments such as repositories of records, for example, Australian Medicines Terminology (AMT).

Term Definition

VHA Victorian Healthcare Association

Victorian Health Policy and Funding Guidelines

These guidelines articulate the performance and financial framework within which state government funded health sector entities operate. They are a reference for funded organisations regarding the parameters they are expected to work to and within, as well as the funding linked to various services, in order to achieve the expected outcomes of the Victorian Government.

VHPF Victorian Health Priorities Framework


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Appendix B: Stakeholder Consultation

A number of stakeholders were consulted throughout the development of the framework. In addition to the individuals listed below, broader discussions were also held at the Victorian Healthcare Association’s regular Chief Executive fora for metropolitan, regional and community health services.

Steering Committee Members Position Organisation

Dr Andrew Howard CIO Department of Health

Carlos Arribas CIO Eastern Health

Professor David Ashbridge CEO Barwon Health

Lance Wallace Deputy Secretary, Corporate Services


Peter Williams Principal Advisor, eHealth Policy and Information Management


Terry Symonds Director, Sector Performance, Quality and Rural Health Branch


Trevor Carr CEO/Member, Health Sector ICT Ministerial Advisory Council

Victorian Healthcare Association

Stakeholders Consulted Position Organisation

Alexandra Hurley Senior Analyst, Portfolio Team, Portfolio Analysis


Dr Andrew Perrignon GP/Chair, Health Sector ICT Ministerial Advisory Council

Ann Larkins CIO Barwon Health

Dr Brendan Murphy CEO Austin Health

Professor Chris Brook Chief Advisor Innovation Safety and Quality


Dale Fraser CEO Goulburn Valley Health

David Anderson Acting CEO Peninsula Health

Eugenia Voukelatos Director, Health Strategy Department of Health

Professor Fernando Martin Sanchez Chair of Health Informatics University of Melbourne

Fiona Webster Executive Director, Acute Operations

Austin Health

Frances Diver Deputy Secretary, Health Service Performance and Programs


Stakeholders Consulted Position Organisation

Garry Druitt CEO/Chair, Victorian Heath CIO Group

South West Alliance of Rural Health

Grantly Mailes Chief Technology Advocate Deputy Secretary/Member, Health Sector ICT Ministerial Advisory Council

Department of State Development, Business and Innovation

Ian Quick Consultant/Member, Health Sector ICT Ministerial Advisory

Jane Chapman Assistant Director, Infrastructure Advice and Delivery


Jenny O’Brien Chief Clinical Information Officer Epworth Health



Marguerite Lituri Policy Officer, Human Capital & Social Policy Branch

Department of Premier and Cabinet

Megan Main CEO Health Purchasing Victoria

Paula Wilton Assistant Director Human Capital and Social Policy Branch

Department of Premier and Cabinet



Terry O’Bryan CEO ISIS Primary Healthcare

Tony Abbenante Manager, Design Authority Department of Health

Tony Dunn Director Hume Region Department of Health

Trevor Carr CEO Victorian Healthcare Association

Dr Vishaal Kishore Director, Office of the Secretary Department of Health

Zoltan Kokai Executive Director, Corporate projects and Sustainability

Eastern Health


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Design Session Attendees Position Organisation

Adam McLeod Director, Strategy and eHealth Inner East Melbourne Medicare Local

Dr Andrew Howard CIO Department of Health

Ann Larkins CIO Barwon Health

Anne Doherty Executive Director Mental Health Monash Health

Carlos Arribas CIO Eastern Health

Dale Fraser CEO Goulburn Valley Health

David Anderson Acting CEO Peninsula Health

Professor David Ashbridge CEO/Member, Health Sector ICT Ministerial Advisory Council

Barwon Health

David Ryan CIO Grampians Alliance

Dr Diana Badcock Chief Medical Information Officer/Member, Health Sector ICT Ministerial Advisory Council

Bendigo Health

Associate Professor Erwin Loh Chief Medical Officer Monash Health

Felicity Topp COO Peter MacCallum Cancer Institute

Professor Fernando Martin Sanchez Chair of Health Informatics University of Melbourne

Frances Diver Deputy Secretary, Health Service Performance and Programs


Dr Gareth Goodier CEO Melbourne Health

Garry Druitt CEO/Chair, Victorian Health CIO Group

South West Alliance of Rural Health

Grantly Mailes Chief Technology Advocate Deputy Secretary/Member, Health Sector ICT Ministerial Advisory Council

Department of State Development, Business and Innovation

Janette Gogler Chief Nursing Information Officer Bendigo Health

Associate Professor John Rasa CEO General Practice Victoria

Professor John Wilson Cystic Fibrosis Service Alfred Health

Julian Josem Consultant/Member Health Sector ICT Ministerial Advisory Council

Josem Consulting

Kathy Campbell Project Director Victorian Comprehensive Cancer Centre

Design Session Attendees Position Organisation



Libby Owen-Jones Project Manager, Clinical Systems Austin Health

Lyn Jamieson Project Manager, EMR Peninsula Health

Megan Main CEO Health Purchasing Victoria

Professor Mike South Chief Medical Information Officer Royal Children’s Hospital



Russell Harrison Executive Director Western Health

Shelly Park CEO Monash Health

Terry O’Bryan CEO ISIS Primary Healthcare

Tom Niederle Director, Health and Aged Care Department of Health

Tom Symondson Director, Policy and Strategy Victorian Healthcare Association

Tony Abbenante Manager, Design Authority Department of Health

Dr Tony Bartone President Australian Medical Association (Victoria)

Zoltan Kokai Executive Director, Corporate projects and Sustainability

Eastern Health


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Appendix C: 2014/15 Draft Implementation Plan

Statewide Health ICT Strategic Framework: Implementation Plan 2014/15

Issue Action Due Governance Review Governance Approval

Governance: creating confidence in ICT choices and investment decisions

Finalise the description of roles and responsibilities of the department and public health services in relation to health ICT. Define a sector governance process to enable accountable and strategic investment decisions. Define best practice ICT project governance structures.

Oct 2014 • Victorian Health Chief Information Officers (VHCIOs)

• Health service CEOs • Departmental

Executive

• The Secretary

Enablers: enhancing the benefits realisation capabilities

Develop a benefits realisation framework that defines measurable health sector outcomes for ICT projects.

Nov 2014 • Health Service Subject Matter Experts (SMEs)

• Health Sector ICT Ministerial Advisory Council (the Council)

• Health service CEOs • The Department

Creating a transformational mindset and supporting capabilities

Develop a project that profiles assurance models for health sector ICT projects.

Nov 2014 • VHCIOs • The Council

• Health service CEOs • Departmental

Executives

Develop a clinical transformation leadership approach that addresses cultural, clinical and administrative reform to support ICT initiatives.

Mar 2015 • Health service CEOs and SMEs

• The Council

• The Department • Health Services

Growing a sustainable health IM and ICT workforce

Develop a health informatics workforce action plan. Sept 2014 • Health service CEOs • Departmental

Executive • The Council

• The Department • Health services

Encouraging collaboration and knowledge sharing across the sector

Establish a collaboration and knowledge sharing environment.

Nov 2014 • VHCIOs • The Council



ICT Capability: standards-based ICT capability

Develop a list of best practice maturity models, frameworks and standards required for sector ICT. Develop a plan to deliver the ICT best practice maturity models, frameworks and associated standard for these items.

Sept 2014 • VHCIOs • Department of Health

OCIO (DH OCIO) • Health Design Forum

(HDF) • The Council

• The Department

Develop a Continuity-of-Care Information Model. Jan 2015 • VHCIOs • Health service CEOs • DH OCIO • Departmental



Assess and register current sector ICT application and infrastructure capability and maturity against agreed maturity assessment models, e.g. HIMSS for EMR. Document a minimum set of ICT baselines for the sector, e.g. sending electronic discharge summaries to general practitioners.

Feb 2014 • VHCIOs • DH OCIO • HDF • The Council

• The Department • Health Services •

Define local ICT strategy for health services, including directions toward minimum statewide ICT baselines.

June 2015 • VHCIOs • Health Service CEOs • The Council

• The Department

Establish a working group to develop a health informatics workforce maturity model approach.

Sept 2014 • VHCIOs • The Council

• The Department

Establish an adoption plan for the implementation of national ICT initiatives. Identify priority items and local health service adoption roadmap, including vendor enhancement approaches, e.g. IHIs HPI-I/Os, PCEHR, Secure Message Delivery, AMT, Discharge Summaries, National Prescription and Dispense Record, NESAF, etc.

• The Department • VHCIOs • Health Service CEOs • The Council



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Extend the adoption of the National Health Services Directory across the sector and vendor applications. Extend the adoption of the associated HDA interoperability standards.

Ongoing • The Department • VHCIOs • Health Service CEOs


Consult with other jurisdictions and international trends to keep abreast of best ICT practice and associated maturity models. Consolidate and communicate this knowledge to the sector. Utilise existing HDF processes for knowledge management and distribution.

Ongoing • The Department • VHCIOs • HDF • The Council

• The Department

Principles: consumer-centric Develop options for increasing consumer engagement. Feb 2015 • Health service CEOs • HDF • Departmental


• The Department

Framework: driving benefits across the system for consumers, the community, clinicians, managers and executives by building on the ICT capability in the system

Develop a projected work plan for years 2015/16 and 2016/17.

March 2015 • Health service CEOs • HDF • Departmental


• The Department

Appendix D: Health ICT Investment Selection Criteria and Guidelines

Innovation, eHealth and Communications Technology Fund – Submission Process

Inpu

ts

Concept Brief Development

Age

ncy

CEO

EOI Concept Brief

Min

iste

r / S

ecre

tary

Preliminary Business Case

Min

iste

r / S

ecre

tary

Funding

• Victorian Health Priorities Framework

• Statewide Health ICT Strategic Framework

• Fund categories and selection criteria

• Templates: Concept Brief and Covering Attestation

• Project Attestation Checklists • CEO Endorsed Concept

Brief Proposals

• Shortlisted concept briefs • Approved business case or fast-tracked submission

Proc

ess

Act

ions

Opportunity (Idea)

• Department prepares covering assessment and summary material for all submissions for consideration by the Ministers Advisory Council

• Agency develops Preliminary Business Case and submits with endorsement by an appropriate financial delegate

• Department evaluates Business Cases regarding the need for further information/detailed assessment prior to funding agreement

• Agency completes templates • Sector ICT Advisory Committee reviews Department assessment and submissions for comment

• Department prepares covering assessment and summary material for all business cases for consideration by the Ministers Advisory Council


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Innovation, eHealth and Communications Technology Fund – Submission Process

Eval

uatio

n

• Internal to Agency

Age

ncy

CEO

(con

t.)

• Department collates the advice from ICT Advisory and provides the recommendations for submission to the Secretary and Minister, including any fast tracked submissions received

• Sector ICT Advisory Committee provides any direct advice as required to the Minister and Secretary

Min

iste

r / S

ecre

tary

(con

t.)

• Sector ICT Advisory Committee reviews Department assessment and business cases for comment

Min

iste

r / S

ecre

tary

(con

t.)

• Department Develops a funding agreement

Exit

Crit

eria

• Completed Attestation Checklist

• CEO Endorsed Concept Brief Proposal

• Secretary/Minister review and approve a list of concepts to be short listed and any to be fast tracked

• Fast tracked submissions engage with the department regarding funding

• Short list of EOI concept briefs to progress to preliminary business case

• Target that the shortlist will mean that at least 50% of business cases will be able to be funded

• Department collates the advice from ICT Advisory and provides the recommendations for submission to the Secretary and Minister

• Sector ICT Advisory Committee provides any direct advice as required to the Minister and Secretary

• Secretary and Minister review and approve a list of successful business cases

• Financial delegates executed funding agreement

• Successful business cases • Executed funding agreement

Victorian Government Innovation eHealth and Communications Technology Fund

Program Guidelines The effective use of Information and Communication Technology (ICT) is essential to creating better health services for Victorians.

1. Overview There is a total of $37.5 million in ICT funding available in the current call for submissions, which closes 31 July 2014.

2. Program objectives These funds are available to support health system innovation and information communication technology projects, including system and software upgrades and installations16.

In particular, these funds seek to support the following categories of health sector ICT initiatives:

i. Critical infrastructure refresh; ii. Development of Electronic Medical Records (EMRs) across the state; and iii. Innovation17.

3. Fund grants

3.1 Eligible organisations Eligible Victorian health sector organisations that may access these funds are:

• public health services, hospitals and multi-purpose centres • rural health ICT alliances • community health services

3.2 Available support Grants are available for one-off project costs, with projects expected to be costed at a minimum of $250,000. This is an indicative figure and should be used only as a guide.

16 Victorian health policy and funding guidelines 2012–13, Part one: Key changes and new initiatives, p. 15 17 Government response to the Ministerial Review of Health Sector ICT, p.10


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3.3 Accessing the Fund To access these funds, health services must initially prepare and submit to the Department of Health, a concept brief and attestation checklist (refer attachment 1 and 2 respectively). Both documents must be signed by the health service’s Chief Executive Officer (CEO).

When completing the concept brief, the following items must be specifically referenced:

• proposed initiative’s alignment with Government policy, including the Victorian Public Health Framework (VHPF). The proposed initiative must target one or more of the seven priority areas described within the VPHF.

• assertion that the health service has submitted a current ICT master design and plan to the department.

For projects that are common within the health sector, applicants are expected to inform themselves through inquiry with local and other case studies and discuss with the department whether there is a position on an expected efficient price.

3.4 Assessment criteria Submissions will be assessed against the assessment criteria.

At a minimum, projects must satisfy the primary assessment criteria.

The weighting or priority of the assessment criteria may change over time to reflect the needs of government.

Submissions may be assessed on a competitive basis.

3.4.1 Primary Assessment Criteria

Project proposals will be assessed against the following:

• Return on investment/productivity gains including strength of evidence of the cost/benefit claim. • Strength of alignment with the VPHF. • Quality of the local ICT master design and plan. • Potential breadth of future applicability, for example, the potential that other health services could

more easily adopt the function/system as a replicable solution; that is, the approach has been developed in consultation with other health services and/or a procurement approach will be undertaken that can easily be leveraged by other agencies.

• Appropriate international, national and state standards, interoperability guidelines and design principles are being adopted (refer to Health Design Authority material on the Department of Health website).

• Extent to which the submission draws on evidence based best practice • Extent to which the submission is supported by other funding, for instance:

Co-contribution from the submitting health service; this may include loans or advances from the department.

Other funding sources, for example, Commonwealth or National EHealth Transition Authority (NEHTA) funding for national ehealth activity.

The health service’s previous record in delivering benefits from health ICT projects. Breadth of participation (number of health services covered).

3.4.2 Secondary Assessment Criteria

• Application of technology – uses technologies such as health analytics, cloud computing, mobile technology and/or high capacity broadband.

• Community expectations – reflects community expectations regarding the health sector’s use of ICT.

• ICT leadership, governance and skills – demonstrates health service commitment of appropriate organisational resources; aligns with Victorian Government policies, such as VICTAC.

• ICT market engagement – analyses options, including off-the-shelf technology; leverages market expertise and opportunities.

• Solution sharing and re-use – clearly indicates how the proposed solution can be shared, re-used or scaled up; facilitates information sharing across the health sector.

• Project design and management – takes a staged approach that facilitates early delivery of benefits; clearly identifies risks and mitigation strategies.

• Collaboration – clearly describes the contributions and roles of relevant stakeholders; appropriate collaborative and governance arrangements.

• Benefits to regional Victoria – improves health service delivery for Victorians living in rural and regional areas; leverages existing high capacity broadband infrastructure in rural and regional areas.

3.5 Application and assessment process18 The closing date for this initial call for applications against the Fund is 31 July 2014.

Submissions must use the templates available on govdex and then be sent to: mailto:[email protected]

3.5.1 Stage 1 – Concept Brief19

The concept brief is designed to provide the department with an outline of the initiative, its indicative project value and level of financial support requested, and how the initiative acquits against the assessment criteria.

Concept briefs must be accompanied by an attestation sheet20, signed by the health service’s CEO.

Submissions that do not satisfy the primary assessment criteria will not proceed to Stage 2.

Applicants may indicate whether they believe their project is eligible for a fast-tracking process.

Projects eligible for fast-tracking are those considered high value / low risk cost with broad applicability.

As a guide, fast-track projects are projects less than $500,000 with a low risk profile that address a common productivity or service quality issue.

3.5.2 Stage 2 – Concept Brief Assessment

The department will review submissions and prepare a shortlist for consideration by the Health Sector ICT Ministerial Advisory Council (‘the Council’).

A final list will be then be identified by the Council, which will then be forwarded to the Secretary, Department of Health and the Minister for Health for review and approval.

Once the shortlist has been approved, the relevant health services will be invited to submit a preliminary business case.

18 Refer Innovation EHealth and Innovation Fund – Submission Process for overview 19 Refer attachment 1 20 Refer attachment 2


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3.5.3 Stage 3 – Preliminary Business Case

The health service will now develop a preliminary business case for the nominated initiative, with the final document being endorsed by the appropriate health service’s financial delegate prior to submission to the department.

The department will then prepare a covering assessment and summary material for all business cases prior to consideration by the Council.

Once advice is received from the Council, the department will prepare a briefing for the Secretary and the Minister on the supported business cases.

After the Secretary and Minister have reviewed these recommendations and approved the successful business cases, health services will be advised of the result.

Funding agreements will then be prepared for the release of funds to health services.

3.5.4 Stage 4 – Funding Agreement21

Successful applications for grants against the Fund will require health services to enter into a funding agreement with the department.

The funding agreement will identify the purpose for which money is being made available and the undertakings required of the health service, for instance, the acquittal of defined benefits.

4. Contact Office of the Director Department of Health Level 13, 50 Lonsdale Street Melbourne Victoria 3000

E: mailto:[email protected]

T: 03 9096 0532 or 9096 0480

21 Copy of generic funding agreement is available at attachment 3.

Appendix E: Draft Project Assurance Approach

Victorian Health Sector Profiling and Assurance Approach for Projects Delivering ICT Enabled Outcomes

Introduction This document provides guidance regarding the profiling and assurance of Victorian health sector projects delivering ICT enabled outcomes. These strategic projects present complexities related to the substantial organisational change required by the deployment of sophisticated ICT applications and supporting infrastructure. Profiling such projects provides a standard approach to project assurance and the visibility of risk and risk management. The provision of a central projects register will facilitate a sector-wide view of such strategic projects and their progress.

This approach to project assurance will need ongoing collaboration between the health services and the department to improve its utility and effectiveness.

Purpose To provide a consistent approach to project profiling and assurance that can be adopted by the health sector for strategic ICT investment projects. This will:

• Help improve the successful deployment of Victorian health sector projects delivering ICT enabled outcomes.

• Facilitate collaboration and knowledge sharing between health services on project key success factors and lessons learned.

• Facilitate a sector-wide view of strategic ICT projects and their progress.

Approach Project assurance, sometimes called quality assurance, is used widely in the management of all projects, including ICT projects. Project assurance should be performed by an independent advisor who has no role within the project structure or governance. The assurance role collaborates with the project team and helps the project sponsor throughout the project lifecycle to:

• Assure the achievement of project outcomes is aligned with the acquittal of the associated business case, including allocated funding.

• Assure the success of the project through proactive identification of risks/issues and provision of recommendations where required.

In this context, project success can be described as the:

• Project team delivering a working solution and outcomes to the quality required. • Governance team delivering the resultant business outcomes, benefits and value, based on the work

the project team has delivered. • Business efficiently and effectively implementing the outcomes and operating in the new end state on

an ongoing basis, realising the articulated and agreed benefits. • Business performing its functions efficiently and effectively.


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Project Assurance Requirement Parameters such as patient care impact, stakeholders, value, dependencies, mission criticality and implementation risk will inform the decision on the required level of project assurance. Over time, the data provided through the use of the assessment tool and success, or otherwise of projects, will create a knowledge base that will inform future project assurance approaches and methodology.

Possible scenarios for determining the required level of project assurance include:

• Projects with one-off costs of $5–20 million to be registered and have a completed assessment tool.

• All projects with one-off project costs greater than $20 million require full project assurance. • All health service electronic medical record (EMR) projects require full project assurance. • All enterprise system deployments/replacements (for example, finance systems, patient management

systems) require full assurance. • Smaller scale clinical systems (for example, departmental systems, such as theatre systems) to be

assessed, registered and evaluated to assess the appropriate level of project assurance.

Exceptions to these scenarios might include a project (for instance, staged network replacement) that is relatively high value (in excess of $5 million) but assessed as low risk, as both the technology and project processes are mature.

Conversely, a small scale inpatient medication management project may be relatively low cost but have a relatively high clinical and change management risk, thus calling for full project assurance.

Where a project has one or more of the above characteristics and a health service self-assessment shows that the risk profile does not warrant project assurance, then the department will review that decision.

Where the project has a profile that requires formal project assurance, it will be placed on the register. Notwithstanding this, health services will be invited to register all projects delivering ICT enabled outcomes in the secure health sector collaboration environment to facilitate knowledge sharing.

Project Assurance Principles • Regular reports available to the project board and regular, documented consultation with the

project team. • The level of project assurance to be agreed at the start of the project and detailed in the supporting

business case. • Project assurance to be funded by the health service, with any costs included in the business case. • Project assurance to apply and continue throughout the project lifecycle. • Project assurance to be independent of the project team to ensure that advice offered is impartial

and objective. • Project assurance is not responsible for project team decisions but is available to be consulted, to

inform and to advise. • Project assurance to have full and unfettered access to all project information and stakeholders. • Project assurance will, where feasible, provide proactive advice to the project team to enhance the

project team’s ability to better address matters raised by the assurer and avoid potential rework. • Project assurance will provide a consistent equitable approach to project assurance across health

services with key documentation provided for department review/oversight and maturing of a knowledge bank for lessons learnt.

Levels of Project Assurance The assurer provides both audit and advisory services depending on the risk profile of the project, as described below and as outlined in the attachment (second worksheet).

Project Assurance Involvement Quadrant

Ad Hoc: assessment of project health upon request by project

Internal or external assurance may be sought on an ‘as required’ basis by the project during the life of the project to audit key stages and/or review key project artefacts, with an average agreed assurance commitment throughout the project life cycle.

Light: assessment of project health upon request by project and at some key stages/events

The assurer is included in some key project meetings, milestones, events and undertakes summary paper based assessments of the major project artefacts. The assurer also conducts interviews with the executive sponsor, technical architect, project manager and senior users at select key decision points in the project life cycle and produces an audit report with recommendations for tabling within the project governance structure.

Project assurance audit reports are loaded in the register for the department to review.


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Medium: assessment of project health upon request by project and at all key stages/events

An independent assurer is included in all key project meetings, milestones and events, undertakes detailed paper based assessments of all the major artefacts and interviews the executive sponsor, technical architect, project manager, senior users and senior suppliers at pre-determined key points in the project life cycle. The findings are verified through targeted interviews with other stakeholders and project team members as required. An audit report with findings and recommendations is presented and tabled within the project governance structure.

The assurer will also provide advice throughout the project life cycle, where such advice is intended to assist the project team to proactively address any issues or risks identified by the assurer. The department may be a member of the project board or may attend the meetings where project assurance reports are presented.

Full: assessment of project health throughout project life cycle

An independent external assurer is embedded in the project and attends regular project team meetings as required and provides advice on key project matters as they arise, including review/advice on key project artefacts as well as all project controls. The assurer attends project board governance meetings and presents detailed audit reports of findings and recommendations at key project stages and as required, tables such reports within the project governance structure.

The department will be represented on the project board and any other committees as required. The department may also separately establish a dedicated Project Assurance Board independent of the local project governance structure.

Governance The following diagram depicts a typical project governance structure with project assurance involvement:

Example VPHS ICT Project

Appendix F: High Value/High Risk Reporting Framework

statewide health ict strategic framework final jan2015docs2.health.vic.gov.au/docs/doc...page 3 1.4...

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