A Sybase and SAP BusinessObjects project has given South Australia Health greater visibility of bed availability, patient flow and waiting times in hospital emergency departments. By Freya Purnell.
South Australia (SA) Health is responsible for the provision of public health care to more than 1.5 million residents. In metropolitan Adelaide, SA Health has in excess of 2000 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. SA Health had previously developed two 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.
The department was seeking to replace these systems to provide clinical staff and hospital management with better visibility of bed availability, patient flow and waiting times in its emergency departments.
The solution
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 BusinessObjects business intelligence solution. In urgent need of a reliable database/data warehouse combination to power workflow management in their organisation, 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 aggregation and processing of data is very important for clinical systems, and Sybase’s ability to analyse very large sets of data in real time was one of the main reasons for our decision,” Royle says. The data warehouse is where transactional OACIS (Open Architecture Clinical Information System) data is being gathered and organised so that it can be easily analysed, extracted, synthesised, 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 modelling and metadata management solution, is frequently being deployed to manage the migration between applications and database and synchronise 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, and was also chosen for its ability to refresh data from the source without user intervention. Together, the Sybase and SAP technologies, along with data integration from Informatica, form the Operational Business Intelligence (OBI) system.
The most challenging part of the project, according to Royle, was the process analysis, “getting agreement between the hospitals about a common business flow and getting the data to conform to that agreed flow”.
The system was designed to be easy to use and intuitive so that very little training of staff would be required. “The training that is involved is to understand what the data is telling users, and we’ve achieved that by publishing comprehensive user guides that are accessible from the same place in the system,” Royle says, adding that when users were surveyed, they indicated they didn’t need training to use the system.
Having an easily understood system has helped with its adoption amongst staff.
“It is something that has just gradually grown from day one and there has been a continued increases [in usage]. If you make something that is useful to people in their daily role, then people will use it.”
Benefits
Connecting eight emergency departments, 12 metropolitan public hospitals, 17 regional hospitals and SA Ambulance Services, the Operational Business Intelligence (OBI) system is accessed by a large number of users across Health as well as the general public.
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, centre and north of the city transferring patients to other emergency departments and wards in their area. With data on bed capacities, patient flow and waiting times centralised in the system, using Sybase IQ’s columnbased architecture, information can be loaded so quickly into BusinessObjects that critical data is being displayed in near real-time in the wards and emergency departments. It reduces the lag in access to performance metrics from weeks to minutes.
Ambulances also have access to the same system, and can use it to inform decisions of where to take patients 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 says. “Staff feedback has been overwhelmingly positive, they find the system really useful.”
Importantly, the information is now available from a single source and is tailored to the way that hospitals are actually run. OBI enables SA Health not only to manage patient flow significantly better in its hospital network but the system’s 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 proactive 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.
Making information public
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.
“This is about making data transparent, which leads to a better understanding of how the service is operating,” Royle says.
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 says.
“GPs can also use this information to make decisions about where to send their patients, if they have to advise
them to visit an emergency department.”
This article was first published in Inside SAP Winter 2012.
