Major Australian EHR rollout approaches halfway mark

The digitization initiative in the remote and rural Northern Territory is implementing InterSystems technology to improve quality and access for the area's underserved population.
By Lynne Minion
11:10 AM
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intersystems EHR booth at HIMSS

Intersystems booth at HIMSS18.

It contains some of the most remote areas on earth and communities of people suffering from diseases that have no place in a developed nation, but despite colossal challenges, the Northern Territory is on track to deliver its digital health record on time and on budget.

As the $259 million five-year project approaches its halfway mark, it is readying to reach a population distributed throughout more than 1.35 million square kilometers and significantly improve care outcomes, according to Chris Hosking, Deputy Chief Executive with the Northern Territory Government's Department of Corporate and Information Services.

With InterSystems TrakCare being implemented at every point of care across public health facilities – including six hospitals, 54 remote health centers and all community-based health services – Hosking said the sickest Territorians stand to benefit most from what is a transformation.

"It's such a bloody overused word but I think this really will be transformational for the Northern Territory and really enhance our ability to deliver care in real time to people, as much as possible, close to their homelands," Hosking told Healthcare IT News Australia.

The Core Clinical Systems Renewal Program will see the delivery of a single integrated patient administration and clinical information system, and despite transient patients, complex cases and cultural naming practices it will provide "one patient/one record" for the 250,000 people in the NT.

"All our reputations are on the line here but we are committed to delivering it on time, on budget and within scope."

Ranging from the outback to the tropical north, over 43 percent of the population live in remote or very remote areas of the vast territory, including in more than 600 communities and remote outstations.

Indigenous people make up a third of the Northern Territory's population, with a rate of avoidable hospitalizations four times the Australian average. In 2016 the median age at death for NT residents was 67.6 years, 14.4 years fewer than the national average.

Added to that is an aging population and the highest premature death rates in Australia.

For many reasons, this is a project with ambitious goals.

"The complexity is in the fact that we're trying to implement a single digital health record across the entire spectrum of care, which is everything from Royal Darwin hospital, which is a large teaching hospital in Darwin affiliated with Flinders Uni, and does all the things that you'd expect in a major, acute centre to do," Hosking said.

"[Then] down to the smallest primary care clinics in the bush that might only have a couple of nurses in a very remote location, servicing a really small community of a couple of hundred people many miles from anywhere, and generally with very poor access to services and basic infrastructure.

"Right across that whole spectrum, we're trying to implement this one solution with every clinician, no matter where they are when they treat a patient, and they'll touch that one patient record in real time, all the time."

Hosking said the current legacy systems – despite being "just about held together with sticky tape" – position the territory well for the new implementation.

"We have acute primary and community service by different systems, and we have another one in the acute space, so we're going from four systems down to one, which in itself is pretty complicated, but we've already got that whole of jurisdiction take up. And being a small jurisdiction, it probably gives us the agility to do this, it would just be too hard in somewhere like New South Wales or Queensland."

But in the territory, the stakes are higher.

The NT has the highest burden of disease among all jurisdictions in Australia – 5.7 per cent of the population suffers diabetes, about 60 percent of Indigenous males and almost 50 percent of Indigenous women are smokers, and the highest rate of renal failure in the world could see the need for dialysis treatments in clinics rise by 70 per cent by 2022.

Hosking, who spoke at the InterSystems event at last week's HIC18, said two years into the largest technology endeavor the NT Government has ever embarked on, the project was on track.

"We're where we need to be in terms of timeframe and budget and all those other things that you get measured on, and I'm really confident we'll deliver it within that five years."

Tech projects haven't always been so seamless in the territory.

"We had several major IT projects some years back that didn't go so well, and I think every jurisdiction's had a few of those. You don't have to walk too far to find an IT project that got itself into strife," Hosking said.

Following some troubled implementations including a tech project that the then Deputy Chief Minister David Tollner described as a "diabolical mess", a parliamentary inquiry in 2014 into the NT's management of IT projects led to the tightening of governance.

As a result, according to the straight-talking Hosking, this project is rightly being held to a tough yardstick.

"Because we did have several projects that didn't go so well, including one which was a $70 million asset management project that had to be set aside, there's very little appetite for things going wrong. So I guess we're measured against that yardstick of things that haven't gone so well in the past, so the governance and the scrutiny that is applied to the project is very rigorous."

As the rollout ramps up, InterSystems, which has partnered with a local IT supplier, is recruiting tech professionals who are prepared to relocate to the NT.

Building up the territory's capacity in clinical system expertise is another intention of a venture that will leave behind a lasting legacy.

"InterSystems have got a whole bunch of obligations on them in their contract, which it appears they're living up to," Hosking said. "They're doing a bloody good job of it, and we want to see that survive the project. The project will finish but we see that as continuing to grow, enhancing the skills base in the Northern Territory."

This article first appeared in Healthcare IT News Australia.