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South Australia Health

The Operational Business Intelligence system gives our hospitals unprecedented visibility of bed availability, patient flow and waiting times, in near real-time. Staff feedback has been overwhelmingly positive.

Eleanor Royle
Project Manager, Department of Health, South Australia

South Australia (SA) Health is responsible for the provision of public health care to more than 1.5 million residents. The department was seeking to replace two underperforming workflow management systems in its metropolitan hospitals to provide clinical staff and hospital management with better visibility of bed availability, patient flow and waiting times in its emergency departments. The department chose a combination of Sybase Adaptive Server Enterprise and Sybase IQ to create a powerful analytic connection between its data source and SAP Business Objects business intelligence solution.

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South Australia Health Gears Up with Sybase Analytics for Next Level of eHealth
South Australia (SA) Health is committed to protecting and improving the health of more than 1.5 million residents by providing leadership in health reform, public health services, health and medical research, policy development and planning, with an increased focus on wellbeing, illness prevention, early intervention and quality care. In metropolitan Adelaide, SA Health has in excess of 2,000 public hospital beds under management. At any time, 250 to 300 patients are being treated in emergency departments, and 10,000 patients are on the elective surgery waiting list.

As early as the 1990s, SA Health recognized how the transition from manual processes to electronic record keeping would create the foundation for greater streamlined work flow processes and planning. Only if past and present patient flow pattern can be sufficiently captured and presented to the right decision-makers in a timely fashion, hospital networks in South Australia can predict future bottlenecks and thus improve performance, reduce waiting times and improve quality of patient care. The need was ever more pressing in the hospitals’ emergency departments, where minutes can mean the difference between life and death.

Early workflow management systems struggle with technology and manual processes
SA Health had previously developed 2 operational workflow systems to help manage patient flow more effectively.

The EBMS (Electronic Bed Management System) and OPA (Operational Patient Activity) systems managed data relating to inpatient and emergency department activity. The EBMS and OPA aggregated patient data on a bi-hourly and nightly basis respectively. The idea was to provide clinical staff with better visibility and allow management to track hospital performance against key performance indicators.

Despite being designed with the best intentions, the project did not live up to expectations. The two systems were too siloed and hospital staff found it difficult to consult the reports.

According to Eleanor Royle, project manager, Department of Health, South Australia, the technology proved to be a limiting factor. “It was too hard to get through to the data. The reports were complicated, and the hospital staff, working under great pressure, didn’t trust the information and would still pick up the phone.”

Neither system had reached the maturity of being able to be used for more in-depth analysis by the department, meaning that monthly data collections were still being used as the main source for this analysis.

Sybase IQ allows real time reporting
In urgent need for a reliable database / data warehouse combination to power workflow management in their organization, SA Health was considering Microsoft SQL or Sybase. Both database technologies were in use in the department at the time.

“We selected Sybase Adaptive Server Enterprise as our major source of data and Sybase IQ to power our data warehouse. The aggregations and processing of data is very important for clinical systems, and Sybase’s ability to analyze very large sets of data in real time was one of the main reasons for our decision,” Royle said.

The data warehouse is where transactional OACIS (Open Architecture Clinical Information System) data is being gathered and organized so that it can be easily analyzed, extracted, synthesized, and otherwise used for the purposes of further understanding the data and decision-making process.

SA Health also uses Sybase Replication Server to source data from OACIS. PowerDesigner, Sybase’s popular modeling and metadata management solution, is frequently being deployed to manage the migration between applications and database and synchronize data before applications go live.

For the crucial Business Intelligence application, the link that enables users to access the information, SA Health supplemented SAP’s WebIntelligence with SAP’s Xcelsius product. Xcelsius provides frontline staff and management with easy-to-understand dashboards and performance reports. Together, the Sybase and SAP technologies, along with data integration from Informatica, form the Operational Business Intelligence (OBI) system.

Operational Business Intelligence system gives hospitals and ambulances unprecedented visibility
Eight emergency departments, 12 public hospitals in metropolitan Adelaide, 12 regional hospitals and SA Ambulance Services have been connected to OBI, with a large number of users across Health as well as the general public accessing the system regularly.

While patients presenting to emergency departments are SA Health’s top priority when it comes to bed availability, they don’t exist in isolation from the rest of the hospital. To provide optimal care for emergency patients in the emergency departments, it is vital to transfer patients to other wards as quickly as possible once emergency treatment has been performed. Hospitals in Adelaide also tend to work together as networks, with hospitals in the South, center and North of the city transferring patients to other emergency departments and wards in their area.

Before data on bed capacities, patient flow and waiting times was centralized in OBI, staff had to make phone calls to see if a patient can be transferred to another hospital or ward. Now, with Sybase IQ’s column-based architecture, data can be loaded so quickly into BusinessObjects that critical data is being displayed in near real time. Furthermore, ambulances have access to the same system, enabling paramedics to choose a hospital on the basis of current capacity.

“The OBI system gives our hospitals unprecedented visibility of bed availability, patient flow and waiting times, in near real-time” Royle said. “Staff feedback has been overwhelmingly positive, they find the system really useful.”

OBI allows hospitals to tackle ‘4-hour rule’
OBI enables SA Health not only to manage patient flow significantly better in its hospital network but Sybase’s superior reporting properties allows the department to track and validate performance improvement against key performance indicators, such as the four-hour rule.

Introduced in 2009, the rule seeks to overhaul emergency departments so that no patient spends more than four hours being treated.

Instead of having to wait three weeks for a summary of monthly performance metrics, details can now be accessed almost instantaneously, allowing SA Health and hospital management to be more pro-active and plan ahead to avoid bottlenecks.

Encouraged by the initial success of OBI, SA Health is planning to extend the system to 17 of South Australia’s country hospitals.

Public website to take transparency to new levels
SA Health has now made the information sourced from OBI available to the public. An external site provides information on bed capacities and waiting times for emergency departments and elective surgery procedures, updated every 30 minutes.

According to Royle, this would be the most comprehensive health care information site available to the public on the Internet in Australia.

“We want to educate the public on how emergency departments operate. For example, emergency departments tend to be very busy with long waiting times on Monday afternoons, but near empty on Wednesday mornings. By taking peak times into consideration, patients with non-life threatening health issues can drastically reduce their wait by coming to the hospital at an appropriate time,” Royle said.



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