Our smallest state choosing the biggest enterprise EMR solution to hub its whole healthcare system transformation may not be as awkward as it initially sounds
The recent announcement that Tasmania is entering into contract negotiations with Epic to deliver a statewide EMR solution to its four major regional hospitals, 14 district hospitals and a series of community centres would have raised a few eyebrows in certain circles of the digital health community.
It’s not that Epic isn’t a well-rated EMR solution. It’s operating globally in some of the highest ranked and biggest hospitals for digital capability in the world, has been chosen by our biggest state, NSW, for its new statewide solution, and is up and running in the ACT and three major Victorian hospitals.
It’s that it’s a big and complex product with a huge centre of gravity from a whole-of-system viewpoint from an organisation that is renowned for the operational term “The Epic Way”.
Tassie has just three years of funding runway to tame and roll out this tiger and while an EMR is a key base component for overall system transformation, the 2022 Tasmanian Digital Health Strategy is as much about a wholly integrated and interoperable system encompassing seamless sharing between all points of the healthcare provider compass, including GPs, aged care, specialists, allied providers and pathology and imaging, as it is about the core EMR.
So how do you balance that act with only $476 million to spend, of which probably only about 60% will go on the EMR, including all the training and people change management programs that would need to go with it?
A good way to start might be to have a project lead who has a pretty good sense of just what they might be getting themselves into, maybe one who staunchly believes in connected models of care outside of a hospital setting as a key to the future of care systems, and ideally, one who has the ear of politicians that count.
Tasmania’s chief clinical information officer, Dr John Lambert, who is that project lead, so far seems to tick all of those boxes, with the possible CV gap of not having worked on an Epic installation or dealt directly with Epic before.
He’s only been in the role in Tasmania for five months so the choice of Epic was finalised before his arrival, but when asked about it he wasn’t particularly perturbed by the decision.
“Epic is widely regarded as one of the more user-friendly solutions out there by clinicians in particular and the evaluation process was rigorous,” he told TMR’s sister publication Health Services Daily.
“Of course, there’s a very strong gravity around EMRs. But this [project] is a lot more complicated than an EMR.
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“Essentially we’ve got to work out how to wrangle an acute care system into a strategy that really is trying to address the needs outside of the acute care space.”
Dr Lambert, in essence, is suggesting that the choice of EMR is a first-base hygiene problem for the grander vision of what Tasmania is aiming for in its system transformation.
He’s deliberately underplaying the myriad of difficulties that other jurisdictions have reported in building out Epic instances in Australia. He wants the emphasis from the outset to be on the importance of what is going to happen outside of Epic (a connected Epic of course), a position that you suspect he feels will provide him with an appropriate framework to build on the EMR as an enabler of the broader system, rather than having to build a system around the state’s EMR.
He’s also pragmatic about timing and cost, and he feels that the wind is behind his back in terms of the rollout of national policy and infrastructure that is going to support his broader remit to deliver whole-of-system interoperability, not just a system in which hospitals can share their patient data.
He says that the initial negotiations with Epic will need to be very clear on scope, timing and cost, that some things may well have to give on scope in order to get it done in a manner that lands within the funding window he has, and which remains practical for the bigger part of the plan: sharing data effectively between all points of the system outside the acute care setting and getting the patient far more to the centre of care.
Once he has that scope clear and agrees on it, he says it’s incumbent on his team and on the various stakeholders in Tasmanian health, including the clinicians, administrators, patient advocates, and more, to deliver their side of the bargain.
And although he acknowledges that his timing is tight – he needs to complete the EMR instance by the end of 2028 – he also says the timing is great because so many external factors are aligning – Sparked, Sharing by Default, the MyHealthRecord upgrade and the national HIE – at the right time for Tasmania to actually be able to pull the plan off.
He also points out that we now have quite a few other groups building out Epic across the country which he can call upon, and, that he’s probably starting from a better place than most because Tasmania is largely “greenfield” in terms of a modern EMR. It has a form of paper digital EMR system called InfoMedix, which is likely to be more helpful than a hindrance under the circumstances.
Dr Lambert isn’t dismissing the complexity and difficulty he’s likely going to have getting the EMR part of the state’s plan in place.
He’s just trying to keep everyone’s eyes on the real prize that he thinks has been identified in the state’s 2022 digital health strategy. He thinks that if he keeps that ultimate endpoint in mind always, he’s less likely to get lost in the initial but vital process of taming the EMR tiger.
“If we aren’t engaging with, connecting with and ensuring as much as we can that those people that take care of the patient when they’re not in acute care facilities are facilitated as best as possible, then we’re not really addressing the real problem,” he says.
“One of the things I did before I took the job was I read the strategy and the strategy, I believe, is one of the few that seriously focuses on that part of healthcare that’s outside acute care, which I thought was great.”
One of the things Dr Lambert did when he got the job was to change the branding of the project from Digital Health Transformation to BlueGum Health Transformation, a deliberate attempt to downplay the term digital and take the focus off the technology (the EMR even) side of things and give the project a broader human-centred focus.
In this respect Dr Lambert says what everyone seems to say these days when faced with a massive software infrastructure platform project.
“This transformation isn’t about technology, it’s about people.”
It’s an on-trend meme for any big technology transformation.
But when you dig into the percentages of how he thinks that $476 million is going to be spent, splits which he didn’t want to be made public at this point of time, he’s of the view that a large proportion of the entire spend will be on facilitating people change, and importing, training and developing new skillsets and mindsets across the whole Tasmanian health system.
The other thing Dr Lambert did sensibly before taking the job was to check that the key state health bureaucrat he’d be reporting to – Dale Webster – who previously headed up community mental health and wellbeing in the state – was reading into the strategy what he was reading in it, and so were the political minders above them both.
The next Tasmanian election isn’t until June 2028.
Given the size and demographics of Tasmania – it’s small and reasonably compact, neater in many respects than a small greenfield Scandinavian country – and a now stable, willing and aligned federal Department of Health, Disability and Ageing, maybe he has a chance to pull it off.
If you’re interested in contributing in any way to the BlueGum Health Transformation, there is more information and way to participate here.
