The operating model established to deliver NSW Health’s single digital patient record will be reworked as the troubled program moves through its statewide rollout.
NSW Health is reworking the organisational and operating model behind its $2 billion Single Digital Patient Record program following lessons from its first major rollout.
Giving evidence at NSW budget estimates on Thursday, Ministry of Health deputy secretary for health system strategy and patient experience, Elizabeth Wood said the model established at the beginning of the SDPR program could not remain unchanged as implementation progressed.
“The operating model that we had in place at the start of this, obviously, we’ll need to look quite different,” Ms Wood told the hearing.
She said NSW Health was considering how the program should be governed and operated across the health system, as well as how the SDPR would eventually be embedded into business-as-usual operations.
The evidence came as NSW Health also confirmed outstanding issues remained after the intensive two-month support period following the Hunter New England Local Health District implementation earlier this year, and that workforce concerns had helped shape decisions to rephase subsequent rollouts.
However, several questions about the program were not answered directly during the hearing, including whether additional staff had been brought in to address reported workload pressures.
Neither the SDPR Implementation Authority nor eHealth NSW had responded by publication time to more detailed questions from Health Services Daily today about staffing, changes to the operating model, outstanding technical and clinical issues, and the revised rollout schedule.
Rollout rethink
Ms Wood said the first SDPR tranche included Justice Health, NSW Health Pathology, and Hunter New England LHD, which she described as “the largest EMR rollout Australia’s ever done”.
Hunter New England’s rollout was followed by a two-month period of intensive 24-hour “hypercare” support.
“We got to the end of that, and we still had some outstanding issues,” Ms Wood acknowledged.
“We felt it was really important to focus our attention on HNE and pathology and really make sure that we resolve those issues before we started to push forward into the next tranche.”
Some of those were technical build issues that could potentially flow through to later implementations, she said.
NSW Health secretary Susan Pearce told the hearing the rollout had “needed to be refined” as the health system learned from the initial implementations.
“We’re taking some decisions as we go as to how the tranches will evolve over time, which we’ve done again recently,” Ms Pearce said.
The next targeted implementation will be at Northern Beaches Hospital in November, followed by Northern Sydney LHD and Central Coast LHD at a yet to be announced date.
Ms Wood said the privately operated Northern Beaches Hospital presented additional complexity that “perhaps wasn’t anticipated” when the original rollout was developed.
Ms Pearce said Northern Beaches had also become particularly important because of ICT issues identified through inquiries into the hospital.
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Workforce concerns
Greens MP Dr Amanda Cohn asked whether additional workforce resources had been put into the program following reports that implementation staff were overworked.
Ms Wood did not directly answer whether additional staff had been added.
Instead, she pointed to lessons learned from running consecutive hypercare periods and said feedback from staff had influenced decisions about the future rollout.
“We’ve listened to that, and that’s certainly helped us in making the decisions that we’ve made about how we phase some of these things,” Ms Wood said.
Another NSW Health official told the hearing that a psychosocial risk assessment, undertaken following employee feedback, had identified workload issues.
“We’re looking at things like rostering, workload, work allocation,” the official said.
“We’ve also set up a small team working within the authority that are working to address issues as they arise.”
The official said NSW Health remained in regular contact with the Health Services Union.
HSD understands a co-design process involving NSW Health/SDPRIA and HSU representatives remains at an early stage, with terms of reference established and work continuing to agree on controls. Acting SDPRIA chief executive Wendy Hoey is involved in the process.
Outstanding issues
Dr Cohn also questioned officials about problems reported following the Hunter New England implementation, including unreliable fluid-balance functionality and errors in the drug formulary.
Ms Wood said a complete log was maintained of issues identified across the implementation.
“We have a weekly meeting where we go through that issues log,” she said.
Issues were risk-rated so the program could determine which fixes needed to be prioritised.
The evidence did not establish whether the specific fluid-balance and drug-formulary problems raised by Dr Cohn remained unresolved.
The timing and composition of the remaining SDPR rollout tranches are still being worked through, officials said.