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Clinical thinking

Bill Vargas has been working for The Children's Hospital at Westmead for more than two decades. When he started, its use of IT was primarily concerned with corporate functions such as patient billing and demographics. Today, as the CIO of its Information Services division, Vargas and his team increasingly deploy solutions designed to improve clinical processes. He chatted with BRIAN CORRIGAN about the changing role of technology in the healthcare industry.

How is Westmead incorporating technology into its practices?

We are a fair way down the track in relation to using IT within health - we have an electronic medical record, there are combinations of systems in some areas that are totally paperless, we have medical imaging like radiology and MRI [magnetic resonance imaging] scans online, we have implemented document imaging in the ward areas so we have a full record available to our clinicians, we have electronic ordering, and some do clinical documentation so all of their notes are captured.

What are the major functions of your role?

It's mainly concerned with looking strategically at where the organisation wants to go. We look at new technology and how we can implement it but the main focus has been on patient care. It's not about the technology itself but about how we can help the clinicians and nursing staff improve their processes.

The Vocera communications solution we've implemented is a prime example. It's a voice-activated, hands-free, Wi-Fi communications system that lets medical staff find and talk to each other. We have more than 50 of them in emergency and outpatients already with wireless moving progressively through the rest of the ward areas in the next year, depending on other projects.

We've created work process issues for the clinicians because they have to go back to a desktop so we're also looking at mobile technology and have implemented computers on wheels (COWs) in some areas. We looked at putting things through PDAs but we're dealing with legacy applications that don't lend themselves to that technology currently.

How to integrate existing clinical systems onto new devices is one of the things vendors coming into the market have to consider. Open systems are something vendors have to deal with so, for example, a PDA can place an order securely through that environment without replicating or having a multitude of systems talking to each other.

What is your main focus for the next 12 months?

Wireless would be one but we are also replacing some of the existing systems within emergency because they currently run separately from the core electronic medical records system that we're running. As part of that, we are also moving towards medications management and hope to be the pilot for NSW Health. This would cover the full medication process from prescribing to dispensing and there are lots of patient benefits.

General work includes revitalising our current technology. We have a three-year replacement cycle and continue to roll out PCs. We've also centralised printing and introduced Trim, which is a document management system. We're looking at [Microsoft] SharePoint. On the corporate side, the NSW [Health] strategy is to replace some legacy payroll with full ERP systems and we also want to work, as an organisation, with the new Health Technology body for shared services computing. We have our own facilities here but the long-term aim is to have it centralised.

Do you have any concerns about going to a centralised system when this hospital is further advanced than some in terms of using IT?

We've just got to ensure that we protect the organisation and maintain our momentum. It hasn't happened overnight, it's been more than 10 years, but we're now being driven by the consumer and their expectations are probably beyond the timeframes we can meet. We have a very large group of clinicians that have taken to technology and are constantly pushing the boundaries, then you have those in the middle that are working towards it, and the number who are resisting it is reducing because they see the benefits. The Vocera communications system I mentioned, for example, is saving 20 working hours per day in emergency alone.

If you could implement any single technology solution tomorrow, regardless of cost, what would it be?

I think the fundamental solution is some sort of directory authentication. So if we're talking globally it would be for a person to be able to authenticate, regardless of where they are in the system, and have access to all relevant information. As an individual you would have access to a multitude of applications based on whether you are a clinician or a member of the accounts department. In the future this will underpin everything we do.

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