1. Integrated Health System Planning An exclusive Executive Circle Briefing

2. Agenda Overview of BC Healthcare Regionalization Vancouver Coastal Health Transformation Where we have come from Where we are going Success Factors Challenges Health Authority Collaboration Projects Lessons Learned

3. Regionalization Overview December 2001 NDP government consolidated 52 regional and community health councils into 6 Health Authorities Created five geographic health authorities to govern, plan and coordinate services regionally, plus the Provincial Health Services Authority to govern specialized province-wide services Each Health Authority consolidated their IT departments into integrated regional service units. i.e. VCHA merged 8 IT departments into 1 corporate IMIS service unit

4. Health Authority Map NHA: (patient population: 300,000) IHA: (patient population: 700,000) VIHA: (patient population: 700,000) VCHA: (patient population: 1,100,000) FHA: (patient population: 1,500,000) PHSA: (provincial population: 4.3 Million)

5. Vancouver Coastal Health

6. VCH IMIS Context VCH 2006/07 Operating Budget: 2.3 Billion IMIS 2006/07 Operating Budget: $63.7 Million % of total VCHA Operations: 2.77 Number of IMIS FTEs: 415 2006/07 IMIS Capital Budget: $66 Million Number of Network accounts: 25,000 Number of PCs: 15,000 98 facilities spread across 58,000 km 2

7. VCH Regionalization Review VCH merged multiple regions with multiple clinical, corporate and technical infrastructure systems. When VCH formed its IT infrastructure: Lacked cross-site, cross-program, cross-network access to patient data Lacked a “patient-centric” view of information Inconsistent data standards and business rules Silos of clinical information Resulting in clinical/business issues: –patient safety compromised –inability to implement key strategies –customer dissatisfaction

8. Clinical Systems Journey

9. Clinical Systems - 2002 Richmond VancouverCoastalProvidence Acute Community Hospital IS Pharmacy Laboratory Radiology PACS Perioperative Comm. health Mental health Env. health Public health Primary care PCAC/CHC EMRs Cardiology Practice EMRs DI integration Transcription Dictation Coding and Abs. ESI Orbit GE ORMIS Pyxis Per Se ORSOS GE ORMIS In4tek PARIS Procura [Not supported] Hedgehog[Various]HealthSpace iPHISRISE Healthware Synapse Procura Momentum Procura 3MMS Access3MSoftmed3M Dictaph PHSA Digital (unsupported) Tape Dictaph PHSA & TapeDigital Express Dictaph PHSA Digital Express MS Word SoftMed MS Word InteleradAgfa LabVisionMisys Lab/CoPathLabVision GE ProgRIS IDXrad BDM HealthVision ADT Eclipsys SCM IDX LastWord BDM Health Vision McKesson StarMeditech CCD CCD/3G CCD

10. Clinical Systems - 2006 Richmond VancouverCoastalProvidence Acute Community Hospital IS Pharmacy Laboratory Radiology PACS Perioperative Comm. health Mental health Env. health Public health Primary care PCAC/CHC EMRs Cardiology Practice EMRs DI integration Transcription Dictation Coding and Abs. RISE Healthware Hedgehog HealthSpace HealthVision ADT Wolf, Clinicare, OSCAR, etc. Vendor tbd RISE Healthware In4tek PARIS iPHIS Synapse Procura Momentum 3M SoftMed DictaPhone Dictaphone SoftMed Meditech MS Word GE MUSE GE ORMIS ESI Orbit Per Se ORSOS Stentor Web Viewer, Agfa/Sun Deep Archive Intelerad Agfa Stentor Misys Lab/CoPath GE ProgRISIDXrad BDM Eclipsys SCMGE CareCast McKesson STAR CareConnect Integrated Electronic Health Record

11. Clinical Systems - 2010 Richmond VancouverCoastalProvidence Acute Community Hospital IS Pharmacy Laboratory Radiology PACS Perioperative Comm. health Mental health Env. health Public health Primary care PCAC/CHC EMRs Cardiology Practice EMRs DI integration Transcription Dictation Coding and Abs. Vendors complying to provincial EMR standards IntraHealth Hedgehog In4tek PARIS Procura (home support) 3 M SoftMed Dictaphone GE MUSE GE ORMIS Stentor Agfa Misys GE TBD – Review Underway CareConnect Integrated Electronic Health Record Provincial iEHR, PLIS, eDrug, DI, etc.

12. Infrastructure Journey

13. VCH Infrastructure Challenges Heterogeneous Infrastructure Inherited every flavour of hardware and OS Inherited a lot of legacy technologies Inconsistent Policies and Processes Everyone did things differently Different degrees of IMIS Process Maturity Insufficient Infrastructure Budgets Want it all integrated yesterday!

14. Infrastructure - 2002 RichmondVancouverCoastalProvidence Email Voicemail Workstations Desktop operating software Printers Network operating system Local area network Wide area network Servers & Storage various Compaq various Telus Ethernet Hewlett- Packard Nortel MS Exchange Novell NetWare Compaq Hewlett- Packard Windows NT 4.0 Compaq Octel Novell GroupWise Telus Ethernet Hewlett-Packard Windows 2000 Hewlett-Packard Telus Nortel Microsoft (MS) Exchange Ethernet Novell NetWare Hewlett-Packard Lexmark Windows NT 4.0 Hewlett-Packard Octel Lotus Notes Mitel ITSD / Telus Token ring Healthnet MS Exch HP Various HP Various Ethernet NovellMS

15. Infrastructure - 2006 RichmondVancouverCoastalProvidence Novell NetWare Octel Novell NetWare Hewlett-Packard Mitel Microsoft Active Directory Microsoft Windows Nortel Microsoft (MS) Exchange various Microsoft Active Directory Telus Ethernet Hewlett-Packard & Lexmark Nortel Various Microsoft Active Directory Octel Email Voicemail Workstations Desktop operating software Printers Network operating system Local area network Wide area network Servers & Storage

16. Infrastructure - 2010 RichmondVancouverCoastalProvidence Hewlett-Packard Microsoft Windows Cirtix, Thin Client, PC Blades, etc. Microsoft Active Directory Microsoft (MS) Exchange Telus Ethernet Nortel Octel Nortel Octel Mitel Email Voicemail Workstations Desktop operating software Printers Network operating system Local area network Wide area network Servers & Storage

17. Corporate Systems

18. Corporate Systems – 2002 Richmond VancouverCoastalProvidence Finance Billing/AR (clinical) Billing/AR (other) General Ledger Accounts Payable Purchasing Inventory Asset Management Budgeting Human Resources Payroll Staff Scheduling Facilities Space Management Plant Maintenance Facilities Security Decision Support Case Costing CCD PHC Custom Mc- Kesson Inf. GL Ormed PHC TCT Eclypsis Or- med Infinium GL Systems Union VH Peoplesoft VH Peoplesoft AP ESI Eclipsys VH TCT VH Custom RH TCT Procura/SAP SAP PAY SAP HR Eclipsys SDSM VH QUIST McKesson VH Peoplesoft GL ACCPAC EclypsisVH Custom Loki Telus PeopleSoft SAP FICO SAP MM SAP FICO McKesson CV New Views CV Ormed Com- vida (CV) Procura Ormed CV Blae- berry Or- med CV CCD AMMSMRCDMMAMMSSAP PMPro-Maint Archibus FM

19. Corporate Systems – 2006 Richmond VancouverCoastalProvidence Eclipsys RH TCT Procura/Loki Peoplesoft SAP FICO McKesson AMMS MRCDMMAMMS Maximo Pro-Maint Archibus FM Eclipsys SDSM VH QUIST McKesson ACCPAC EclypsisVH Custom CCD CV New Views CV PHC TCT VH TCTLoki Peoplesoft Finance Billing/AR (clinical) Billing/AR (other) General Ledger Accounts Payable Purchasing Inventory Asset Management Budgeting Human Resources Payroll Staff Scheduling Facilities Space Management Plant Maintenance Facilities Security Decision Support Case Costing

20. Corporate Systems – 2010 Richmond VancouverCoastalProvidence TBD – Project Underway Peoplesoft TBD IDX AMMSMRCDMMAMMSMaximoPro-Maint Archibus FM Eclipsys SDSM VH QUIST McKesson PHC TCT Peoplesoft Finance Billing/AR (clinical) Billing/AR (other) General Ledger Accounts Payable Purchasing Inventory Asset Management Budgeting Human Resources Payroll Staff Scheduling Facilities Space Management Plant Maintenance Facilities Security Decision Support Case Costing

21. Capital Investment 2002 - 2010 ClinicalCorporateInfrastructure 2002-2006$48M$28M$14M 2006-2010$153M$34M$20M Total$201M$62M$34M

22. Operating Costs ($Million)2003/042004/052005/062006/07 IMIS Operating Budget58.558.858.763.7 VCH Total Operating Budget2,126.12,142. 92,237.32,300.0 IMIS % of Total2.45%2.74%2.62%2.77%

23. Operating Trends

24. Success Factors Cross functional governance models Within VCHA –eHealth, Corporate & Infrastructure Steering Committees prioritize capital projects –HSDA IMIS Advisory Committees – links HSDA and IMIS operations –IMIS Program Delivery Portfolio – PMO Inter Health Authority Committees –BC CIO Council –Technical Advisory Group –Network Working Group –Directories and Authentication Working Group IT Planning Plan into Action, Application Integration Strategy, Technical Architecture, etc. Coordinate and balance internal needs, provincial eHealth directions and National initiatives (Infoway) Collaboration Internal Stakeholders Provincial partners – the other health authorities and vendors

25. Regionalization Opportunities Rationalization of existing services Reduce duplication Used savings to drive future IMIS investment Contract Renegotiation i.e. Licensing, Network Connectivity, etc. Health Authority Collaboration Everyone was solving the same problems – brought together inter-HA teams i.e. Created a Provincial IP Addressing Scheme

26. Regionalization Challenges Aligning collective agreements and contract staff IT department integration Geographic complexity System complexity Lack of investment or strategic prioritization in IT created a tremendous volume of pent-up demand Participation in multiple projects simultaneously while maintaining daily operations Balancing VCH needs with Provincial needs

27. Inter Health Authority Collaboration Projects Private Network Gateway (PNG) Dedicated, secure network linking all HA DI Emergency Transfer Grid Short term (10 day) DI storage partition 56 facilities capable of pushing images to the Grid 5250 studies pushed (Oct – Dec. 2006) Network BC Broader Public Sector WAN contract negotiation Data Centre Broader Public Sector Data Centre Build

28. Lessons Learned Infrastructure view - focus on the basics Network Connectivity Directory and Domain Integration Email Consolidation Enterprise Backups Have dedicated HR and Finance support throughout the transition Staff consolidation Teasing out budget details Its about service delivery, not server delivery

29. Thank you for your attention.