Queensland's Health's CEO and CIO Dr Richard Ashby wasn't around in 2013 when a payroll system implementation disaster led to a Commission of Inquiry. But he has taken one lesson learned during this debacle to heart and he applies it to all current and future tech projects at the organisation.
“One thing we have learned is that having the applications and the hosting and the managed services undertaken by one organisation is proving to be very beneficial. I won’t pick on payroll, in particular, but some of those sorts of examples where things haven’t gone well, you end up with large multinational companies pointing at each other, and pointing at government.”
Certainly, as the chief executive of eHealth Queensland and CIO of Queensland Health, Ashby has a big remit. In his combined role, he said he is focused on the business outcomes and the transformation of care for individual patients and for groups of patients for hospitals, and for the system.
“It’s how do we make care safer, how do we make it more efficient, more productive, more sustainable? And coming from a big health service, I’ve got a pretty close view on what needs to happen with the enabling technology of eHealth,” he told CIO Australia. “So what can eHealth bring to the table that will assist the business, rather than existing just for our own sake.”
Called a “digital hospital evangelist” by peers, Ashby, who’s the former Queensland Metro South Hospital and Health Service CEO and awarded a Member of the General Division of the Order of Australia for service to emergency medicine and medical administration - is knee deep in strategic projects - most notably the digital hospitals program.
“A major project is the digital hospitals program, where we are rolling out the digital hospital to the 24 hospitals in Queensland over 100 beds by 2020.”
He noted the project was initially started in 2011, was re-baselined in 2014 when there was a change from a progressive implementation to a digital exemplar implementation, and the Princess Alexandra Hospital (PAH) went live in 2015. It was finalised with a medication management implementation in April 2017.
“The PAH was the exemplar hospital in that project. It was completed successfully and is running along well. We expect to be going live in Mackay in October, Logan in November, and with Lady Cilento Children's Hospital in the first quarter of next year. It is quite an ambitious project with tight timelines, but we’re satisfied that we’ve got fit-for-purpose product, and we’ve now worked out how to implement it successfully.”
Ashby said while the tentacles of the project are many, he outlined a number of modules including the fact the PAH is now paperless.
“It is a fully digital hospital. All of its vital signs, monitors, for example, all of its ECG machines, anesthesia machines, are all integrated with the electronic medical record. And the hospital did achieve Stage 6 EMRAM validation in May, which is an external validation of your levels and status. So the outcomes are very good.”
Stage 6 EMRAM is a result of focus, good direction and a steadfast commitment from leadership.
Ashby said the results from going digital are already measurable and tangible.
“We have seen a significant improvement in productivity, in other words, our throughput in the hospital. Our physical waiting lists at the PAH is at a record low. Outpatient waiting list is at a record low. Emergency department performance is at a record high.
"We’ve seen significant improvements in quality across all indicators, so reduced serious falls, reduced medication errors, and reduced incidence of VTE (venous thromboembolism). Essentially, the benefits are proving to be matching the business case - if not bettering the business case.”
Admittedly, he said the hospital project since 2014 has taken up about half of his time, but that should ease off now that the project is well underway.
“The rollout is more stabilised now because we were building a system with the vendor. But now the heavy lifting has been done so we expect the rollout to be easier. We will take the lessons learned and apply them.”
Meanwhile, other notable large projects taking place at Queensland Health include replacing the financial system with SAP S/4HANA; and replacing the laboratory system. “They are two big projects worth over $50 million. The financial system replacement is in excess of $100 million.”
Additionally, he said the department is also implementing Windows 10 Office 365 across the organisation to 90,000 staff.
“That’s also a very big project," he says. "There’s also a big infrastructure refresh on the cards. This year we’ll probably be working on about $60 million or $70 million worth of infrastructure maintenance and refreshment [projects].”
Digital love at the heart of healthcare
Thoughts about digital transformation are ever-present and permeates Ashby's daily thinking.
“The digital transformation in healthcare is accelerating. I think it’s inexorable and it is absolutely necessary. We cannot address the major agendas in healthcare with our health services not being digitised," he says.
"If we are going to address integrated care, we need to be digital; if we’re going to address precision medicine, we have to be digital. If we’re going to have high reliability healthcare organisations, we have to be digital. If we want to have intelligent healthcare systems, we have to be digital,” he said.
‘We also have to match the transformation and the digital world of our consumers. So the internet of things, the mobility, smart devices -- all of those things are happening in consumer world, and consumers expect the health system to be matching in the way they interact with other businesses like industry, banking and commerce. They want to interact with the health system in that way as well.”
He said he is relying on his past roles to help him steer the ship at his current post, which is both rewarding and challenging in his combined CEO/CIO role.
“The key thing is strategy. Because I have a fairly deep understanding of the healthcare industry, and particularly hospitals, I can bring that emphasis into the world of eHealth. And, in particular, creating an understanding in our business, the eHealth business, of the dependency now of the health system on us. We cannot fail. Because if we fail, it can bring down a hospital, or it can bring down a system.
“There are very few things that can stop a big hospital or a health system, but a failure in these key digital systems now would be capable of causing that kind of impact. So we have a much higher obligation now in terms of our uptime and preventing any interruption to the business,” he said.
So what keeps him up at night? Some of his main challenges include dealing with large scale projects and staying ahead of the curve, and addressing market trends particularly digitisation.
“The challenge is always keeping the momentum going in big projects that run over very many years. Maintaining clinical engagement in the process is a challenge, and advancing the analytics agenda because lots of the benefits that we now see from digitisation of our health system will come from advanced analytics, which didn’t exist before and could not exist in the paper world.
“So we’re doing a lot of work on rapid translation of evidence into care. A lot of work on prescriptive and predictive analytics. We’re doing more work around augmented intelligence and a lot of work around business intelligence and big data.”
On the augmented intelligence front, he said the department uses it in the management of melanoma at the Princess Alexandra Hospital, whereby health experts are using 3D vector imaging to take high definition photographs of suspicious skin lesions. The data is then analysed by IBM Watson and using cognitive capabilities to make a prediction about the likelihood of a mole being melanoma or not.
“We’re using that kind of technology and machine learning and augmented intelligence to assist our dermatology specialists to more rapidly and more accurately diagnose melanoma.”
The prospect of these emerging, futuristic technologies is exciting for the healthcare industry, he noted, adding there’s going to be “an explosion” of that type of technology.
“Certainly, if you’re looking at diabetes care, there are new apps for patients. There are over 100,000 health related apps out there. And the interaction between apps and sensors and the Internet of Things (IOT) and all of that converging around healthcare information that we’re producing in our hospitals is fusing with consumer generated information, which is precision medicine.”
As CEO and CIO, he’s also pleased with the fact he is able to weave and blend business outcomes with the world of ICT.
‘It’s being able to bring the business focus into the ICT domain. To focus all of our staff from architects through to technical support people - to focus everybody on, ‘so what are we doing for the business today?’ And if you can’t draw a line of sight between what you do in eHealth Queensland (the business), and how you’re enabling better healthcare, more efficient healthcare, then you’re probably in the wrong place.
“We’re not here to play around and put new desktops in and new servers and networks and all of that. We have a higher order than doing those things. They are all important, absolutely important and they need to be reliable and resilient, and we need to protect them, but the key thing is making care better for individual patients.”
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