Driving the vision for standards-based interoperability: An interview with the Chief Executive of eHealth NSW

As a specialist agency within NSW Health, eHealth NSW is responsible for bringing to life the vision of a digitally enabled healthcare system. Integral to that objective, says Zoran Bolevich, Chief Executive of eHealth NSW, is to have a sustainable health system that delivers patient-centred outcomes that encourage empowerment and wellbeing for patients.

“To enable that vision to happen, we recognise the importance of information and data, and clinical information in particular, being accessible at all points of care and increasingly also by patients and families themselves. Standards-based interoperability is key to making that happen,” Zoran said in a recent interview with HL7 Australia.

“However, we must also always remind ourselves that there is a lot at stake in healthcare, because we’re dealing with human lives. We have to be safety minded. Interoperability is an incredible enabler, but we also need to make sure that we do it in a way that is proven, with good risk management practices in place,” Zoran added.

HL7: Can you share with our members some background on eHealth NSW and its role in implementing and supporting digital capabilities across the state?

Zoran: We work with our partners across the public health system in New South Wales to strengthen the state’s digital infrastructure and enable NSW Health to adopt digital technologies in a meaningful and effective way in order to achieve the best health outcomes and deliver the best tools for clinicians and patients.

We have both strategic responsibility, in terms of developing and coordinating digital health strategy, as well as responsibility for implementing programs across the state. In fact, we run quite large implementation programs across the state, coordinating with the many hospitals adopting platforms. Once the platform is in active use, we are responsible for supporting its ongoing performance, functionality and security, in conjunction with our ICT industry partners and suppliers. We do all that in collaboration with our local health districts and other agencies.

HL7: Can you describe eHealth NSW’s relationship with HL7 Australia and what in particular is important to the agency?

Zoran: NSW Health has a long and proud history of being a user and beneficiary of the original HL7 standard, and we have adopted it in many applications across our health systems. Our technical information systems talk to one another exchanging HL7 messages. Our diagnostic systems talk to our EMR using HL7 and our EMR is able to communicate with other systems using HL7 messages. That includes a platform we developed to enable us to connect better with community health and primary care clinicians, which lets us share summary information with clinicians across the state.

It’s also important that standards are governed, and that Australia is connected to the international standards community because, despite some differences, there are many process similarities to other health systems.

We are working with HL7 Australia to adopt those standards here, including some of the newer standards like FHIR.

HL7: What do you believe are the barriers that make it hard to achieve interoperability?

Zoran: While we have made good progress over the past 20 years, there’s still a lot of work to do. One of the biggest challenges is the sheer complexity of healthcare systems, processes, different stakeholders and funding arrangements that we are dealing with. When adopting new technologies from different vendors, it often means dealing with different approaches and methodologies.

Standards are the best way to support this complex environment and move towards interoperability.

Having clinical information systems seamlessly exchange clinical information in a way that is efficient, safe, and also semantically true to the original meaning, is a significant technical problem but it is also a clinical and human problem.

For instance, in areas where there is handover of care, we need to understand how clinicians share and exchange information with one another in order to determine the best technology to support that handover.

To better understand the underlying clinical needs, we start with people and clinical process. What are the problems that need to be solved? By engaging with clinicians, we get an understanding of the typical pieces of information that need to be available at different points in the care process. That allows us to start thinking about how technology can enable this to happen, which systems need to talk to one another, and how we can best move that information around.

Not all technology platforms or vendors are equally mature in their adoption of standards. That means we often end up with quite time-consuming, bespoke projects to overcome these interoperability issues. We are making progress, but interoperability remains very hard.

HL7: How do we get to that next step of overcoming these issues to build a connected healthcare system?

Zoran: Engagement with the right stakeholders is an important first step. If we are working to resolve an interoperability issue inside our hospital systems, we will convene design working groups, where we engage clinicians to co-design solutions that account for their processes and key safety issues.

In addition, while we are guided by HL7 and by what our vendors have in their toolkits, over the years we’ve gained greater clarity about the key standards that we believe need to be adopted. We’ve built an enterprise architecture function within eHealth NSW as a custodian of those standards and have branded that function as an interoperability office. That function’s role is to work with our colleagues across the health system to create a catalogue of standards that we will be adhering to when implementing new digital capabilities in NSW Health.

Once we are clear on that, we can start working with our vendor community to give them clarity about the interoperability framework, the set of standards, and the patterns we expect them to work with and comply to when we are procuring new systems. Those standards are often connected with the HL7 agenda because we don’t want to be in the business of inventing standards; we want to be in the business of understanding them and being part of the development process in partnership with HL7.

HL7: What takeaways or calls to action from this interview you would like to give to the broader healthcare community?

Zoran: The first is that the healthcare industry needs to make a collective commitment to a modern, standards-based, API-enabled technology of the future. That will be key to securing a seamless flow of information. Everyone has a responsibility to bring interoperability to life because it’s a safety issue, it’s a quality-of-care issue, and it’s a patient-centred care issue.

The other call to action is to do with the workforce. The digitalisation of healthcare is progressing at pace, but we’re often challenged by a lack of resources and access to a workforce with the right types of skills to bring their digitally enabled healthcare future to life. How do we train the next generation of health IT professionals? Are they conversant with the standards? Do they understand the importance of interoperability? Are we equipping them with the right skills to be effective in these projects? Have we got enough people able to participate in that API-enabled future industry? I think the answer probably at the moment is that we don’t, which means that we have to redouble our efforts in the areas of workforce development, training and education.