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Sunday, 20 April 2014
ESSAYS: Introduction

This page has been reorganised from 4th March 2011.

1.     QUPP report on Annotation of Melanoma Pathology Reports  Feb 2009   

2.      Submission to the NNHRC  15th June 2009

3.    A study of an Enterprise Health information System. (released 4th March 2011)

     This is a study into the roll-out of Cerner FirstNet into EDs in NSW. The original study was issued in Dec 2009 (Part 3.1). This has been added to with a new study in 2010 consisting of discussions with 7 ED Directors (Part 3.2), discussions with software experts who do performance evaluations on Cerner sites (Part 3.3), and reviews of Entity-Relationship Diagrams (Part 3.4), Schema descriptions and data tables from customer installations (Part 3.5 & 3.6). All this information is coalesced to establish a much more detailed picture of a Cerner installation (Part 3.7). A number of weaknesses are identified in the design and implementation and risk assessments are recommended for organisations using this software or intending to use it. Regulations that might minimise the risks to users of health software are recommended (Part 3.8). An alternative architecture and method for constructing clinical information systems is presented (Part 3.9). I would like to acknowledge the postgraduates who assisted in collecting the data and colleagues who offered advice and edited the written materials.

The bibliographical citation for this report is: 

Patrick, J. A Study of a Health Enterprise Information System. School of Information Technologies, University of Sydney. Technical Report TR673, 2011, pp 190. 

3.0  Part 0 - Executive Summary

3.1  Part 1 - A Critical Essay on the Deployment of an ED ClinicalInformation System ‐ Systemic Failure or Bad Luck?   First published here in Oct 2009, revised Dec 2009.

3.2  Part 2 - Discussions with ED Directors: Are we on the right track?

3.3  Part 3 - Discussions with Software Performance Experts.

3.4  Part 4 - Conceptual Data Modelling.

3.5  Part 5 - Database Relational Schema and Data Tables.

3.6  Part 6 - Coalescing the Analyses of the ER Diagrams, Relational Schemata and Data Tables.

3.7  Part 7 - The Integrated Assessment.

3.8  Part 8 - Future HIT Regulation Proposals.

3.9  Part 9 - Ockham's Razor of Design. Published at the IHI conference, Nov 2010 Washington.

      Download the whole study Parts 3.0 to 3.9 (12.3MB)

3.10 Over the last few days there has been considerable interest from the press and colleagues on the future pathways that are indicated by this report. I have composed a number of strategies that we need to implement to move onto the next phase of e-Health in the state. The list is intended to be brief as a full case for its justification will require a longer  essay. The proposals developed in this statement are not altogether my own but collected from the many people I have spoken to and worked with over the last few years.

      The Future Pathways for e-Health in NSW

3.11  Analysis of FirstNet Problems defined by ED Directors 

3.12 Revision of Conclusions and New Recommendations (released 15th April 2011). New information has been provided since the first release of the report above (4th March 2011) which paints a much more serious picture of the issues with the roll-out of Firstnet in NSW. This new evidence requires re-evaluation and revisions of the previous conclusions and recommendations.

3.13 Statement on 22nd August 2011. I attended the HIC conference in Brisbane in the beginning of  August and at a dinner hosted by IBM on the 2nd August I met Mr Greg Wells, the CIO of HSS, and the person responsible for the FirstNet roll out in NSW. He stated that Cerner had provided new software that would solve all of the User Interface problems and it was being rolled at the present time in the Northern Area Health Service region. He said all installations across the state would have this solution by Christmas this year. We shall watch with interest. 

3.14 Statement on 3rd September 2012. There has been no improvemetn in the services to the Sydney basin hospitals, although there is now a team from the HSS ostensibly commissioned to investigate the problems with Firstnet. ED clinicians have reported to me that there is no interest in disucssing Firsnet anymore, they don't belive it will improve and their best strategy is to work around it.

 
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