Connecting Theatres of Operations

The drive for efficiency has led Australia’s largest private health care provider to institute sweeping changes across its IT infrastructure. Computer Week’s Anna Raciti spoke to the team instigating the changes.

The mammoth cost of providing health care for the nation has been stretching government and corporate hip-pockets for years.

In the growing private health sector, hospitals compete for space and for business. It is in their interests to implement systems that will manage patient care and hospital administration more efficiently and cost-effectively.

One health care provider that’s focused on making IT serve the health care industry more fully is the Mayne Nickless company Health Care of Australia (HCoA). HCoA is the biggest private health care provider in Australia. Including hospital staff, HCoA employs more than 6000 people.

Although only 11 strong, the IT team is charged with managing the IT needs of 35 private hospitals located around the country and overseas in Jakarta and East Java. The company is currently in the process of putting its patient indexing system on-line, installing e-mail throughout the hospitals, and rebuilding its network architecture to link all sites.

Meeting expectations

According to group MIS manager Gary Moss, hospitals have a duty to manage administration efficiently. They must ensure that operating theatres are scheduled, and that inventory such as pharmaceuticals and prosthetics is monitored.

HCoA has begun implementing a new on-line system that the private hospitals under its care will utilise. The system runs on a Sun Ultra host with 512MB of RAM and 28GB of storage (the company plans to upgrade to a Sun Enterprise 4000 in the future).

The system operates from the company’s office in North Sydney, and relies on software developed by Melbourne company IBA. Called Unicare, the software is divided into different modules, each focused on a separate medical and/or administrative function. These functions include financial control, patient management, inventory control, and performance monitoring. The patient management system looks after the functions of admissions, discharges, transfers and billings. It also runs the patient master index. According to HCoA, the system is patient-centred, aimed at providing the best environment for staff and patients.

One practical application for the package is the scheduling and booking of operating theatres, offering staff on the wards on-line access to theatre lists.

“Things happen that can really upset a hospital’s schedule,” said Moss.

“You might have your theatres fully utilised and something comes up, an emergency like a motor vehicle accident…you need an operating theatre and you need one fast, you can’t afford delays, but then it throws out the rest of the day’s schedule because everything needs to be shuffled back.

“The concept with this software is we can manage the whole process all the way through.”

In the past, he added, “you would find hospitals had a booking clerk with an enormous piece of paper all ruled up. The theatre bookings would be put in there and we’d be scribbling around in pencil.”

Moss said people were sometimes left waiting in a corridor because theatre bookings were out of sync and fully booked.

“That’s not the kind of service we want to provide,” he said.

The hospitals depend heavily on the software package and, so far, Moss said, it has performed well for them. HCoA’s Queensland hospitals are all using the software. In New South Wales, the implementation is almost complete, and the company has started implementing the service in its Victorian hospitals.

According to Moss, health care is increasingly about a multi-disciplined approach. New ways of treating patients mean that networks must be established to link patients and all the services they require, so HCoA has networked its hospitals to the central site for access to financials and patient data.

A networked site also means hospitals can access databases for research purposes. Networked doctors can keep in touch with pathology labs and new research by reading it over the Internet. In the future, Moss also envisages patients being able to book themselves into an operating theatre via the Internet.

“What we’ve done in the past 12 months is totally rebuild our network architecture,” said Moss. “We now have a fully-routed network linking all our facilities through a hub site here [in North Sydney]. We’re using Optus data links for our long interstate haul, and were running ISDN tails to link individual hospitals to local state hub sites. At the moment we have no hospitals connected to us at less than 64KB, and we’re already running our core systems across that.”

Testing, testing

The company has just completed a pilot project for e-mail. A proposal to roll out e-mail across all facilities is being assessed by HCoA’s board of directors.

While planning the rollout, Moss encountered problems: the host-based mail system he was planning to implement would not support the GUI mouse-driven interface his staff were demanding.

But Moss was reluctant to set up the LAN infrastructure required for the GUI system, saying “We’re trying to run LAN-free. As a matter of policy, as you roll out and install LANs, the administration costs go up, and the support costs go out. So if you can run on direct point-to-point, it’s probably a lot cheaper.”

A decision was made to allow the larger hospitals under the company’s care to implement LANs, but those LANs run independently of the Sun Ultra host. Moss said if these LAN servers were to crash, the hospitals would still be able to connect to the patient management system and the core financial system.

“At the moment I have a Microsoft Exchange server sitting in North Sydney with remote clients connected to it,” explained Moss.

“We set a low router priority on the e-mail so that in the event that a large e-mail leaves the hospital, the traffic is not holding up customer service. So we’re not holding up customers.”

In contrast to the flourishing private health care system, IT departments in public health care have been challenged by the low priority assigned to innovative IT, and a sheer lack of funds.

A report issued by the KPMG consultancy firm last week confirmed what the health care industry and even the public has long suspected — that the public health system’s IT structure is in turmoil. The report, commissioned by the Victorian Department of Human Services, said the public health care industry is underspending in IT.

“One of the key challenges of the hospital sector is the intelligent use of information in IT,” said John Peoples, systems director for business support and projects at the department of Human Services in Victoria. “But it just hasn’t been seen as a major priority in health care.”

The KPMG report found current hospital IT expenditure is under $1000 per equivalent full-time position (EFP), a figure far short of the recommended best practice expenditure of between $12,000 and $22,000 thousand per EFP.

According to the report, a key way that hospitals can move towards the leading edge is by improving communication between the administrating department and the many hospitals located throughout the country. Human Services in Victoria is implementing just such a service as the first stage of major changes. The HosNet information distribution service is the department’s answer to improved communication with the hospitals it manages.

“HosNet is providing electronic connection between the department and every public hospital in Victoria,” said Peoples.

In most cases, HosNet will simply run over existing connections that were previously used to link the hospitals to HCS Australia, developer of the HIS, and manager of the hospitals’ payroll system. Use of the existing infrastructure has meant significant cost savings.

Completing the circle

The wide area network that is HosNet will connect the hospitals’ chief executives (and other staff, if required) using dialup modems and dialup ISDN connections or permanent ISDN connections.

The central site runs Lotus Notes 4.5 on an NT server for secure e-mail and data interchange between head office, regional offices and the hospitals. Currently, there are 106 connections, with over 140 more expected to be added over the next three months.

“Our aim is over a 12 to 18 month period to phase out the distribution of major communications from hard copy to electronic only. So we won’t be sending out our circulars, our financial reports — they will be sent via the system.”

Notes-based HosNet will hold policies, documents and standards, as well as manuals, procedures and financial reports.

It will also contain details on major press releases issued by the department and the Minister on health matters.