Gold Coast Hospital and Health Service shares its digital workflows

Gold Coast Hospital and Health Service is using an internal "innovation ecosystem" structure to build internal capability and drive the next phase of its digital transformation.

It is also partnering with other Queensland health services to share, scale and port internally developed solutions, with ambitions to also take them beyond the state border as well.

“We've internalised the ability to do problem discovery, problem design, change management, solution development, solution release through product-based teams,” executive director of strategy, transformation and major capital Sandip Kumar told the iTnews Podcast.

“It's an innovation ecosystem that really puts us at the leading edge in driving digital health transformation. I think it's an important construct that we've built.

“This is about driving different speeds of digital transformation inside the health system.

“This agenda is as much macro-transformation, as it its about scaled micro-transformation inside the health system.

“In a way that we can solve problems end-to-end, so that when we build solutions that are right for Gold Coast, we can refactor them and port that to other hospital and health services so they can benefit from our innovation ecosystem as much as we can.”

Some of the digitised workflows that could be scaled and ported to other health services or hospitals have been developed in ServiceNow’s Healthcare and Life Sciences (HCLS) Service Management platform.

Gold Coast is one of the first users in Asia Pacific of the HCLS platform and has collaborated with ServiceNow to localise it for the Australian market.

One opportunity is to take digital workflow applications built on HCLS, refactor them for broader use, and to offer that through the ServiceNow Store, a ‘marketplace’ for workflow apps.

“We're working with a few selected use cases on a set of applications that we've built to validate that we can really refactor and port solutions [developed for Gold Coast] out,” Kumar said.

“What I mean by that is, solution features that are rich for Gold Coast may work in our context, but we appreciate that the world and how different systems work are not static and binary and that [other] organisations may deliver services unique to their community environment, and so they may not want the same feature set that we have.

“So how do we refactor to meet the needs of another customer?”

Kumar said that a generalised workflow app “mightn't have all the features” used in the Gold Coast implementation, but could allow “another customer to come along, grab the out-of-the-box application, and then implement it themselves, with local amendments but a commitment to a core Common Application Model.”

"We are continuing to learn from our development exercises and channelling all those lessons into the overarching operating model at Gold Coast health.

"The next few months will then see example applications shared with other Queensland health services that will also bring new learnings, from a portability perspective."

Lessons from that exercise will be channelled into the way that Gold Coast develops digital workflows, meaning that design decisions can be taken that make reuse down the track much simpler.

“We're actively committed to portability-by-design construct right at the front, and that's the space where we're learning towards,” Kumar said.

“In the next six months, we hope to have a number of use cases that we can showcase that have …[been] ported to a number of other hospital health services in Queensland.

“And then, our long term ambition is to take all those initiatives beyond our own state border.”

One of the reasons Kumar is keen to share some of Gold Coast’s digital solutions is that he sees the challenges he faced locally and reflects that as a “microcosm” of those being experienced across the sector.

He sees what he calls a “poly-crisis” in healthcare, with staffing, funding, access, equity, quality, and demand imbalances affecting all hospital and health services to varying degrees.

“The system's facing exponential challenges that are compounding and they're happening at the same time,” he said.

“With exponential challenges, we need an exponential response.

“The biggest way that we can respond as a health system is to take advantage of technology advancements, to really drive new ways of working to respond to the scale of the challenges and make sure that exponential challenges have the response of exponential opportunities and an exponential transformation agenda.”

Digital environment simplification

Kumar joined the transformation in August 2020. One of the key changes on his watch is the simplification of the digital app estate, with ServiceNow one of the platforms being used to host multiple apps and workflows.

“Prior to my time, we saw an explosion of digital applications on-premises across the whole organisation - hundreds of applications that at times do hundreds of very similar things,” Kumar said.

“That was great [but it was also] the error of the old [way of digitising], which is ‘we've got a problem, we can solve it using technology, how do we invest in an application that meets the need, and drives a little bit of efficiency and improvement in a silo?’

“A great amount of processes in our organisation have been digitised [like this].”

The result, however, was a broad app estate with duplicated or overlapping capabilities.

“Our digital foundations were strong but we had a really complicated technology landscape - we had tens of applications doing the same thing,” Kumar said.

Kumar said the situation had been eased by focusing on developing apps that were interoperable across internal domains, in part by building them on a common technology foundation.

“My concept going forward is that we use platforms so that staff only really have to use one, two or three systems to do all their work,” he said.

“It's great that we digitised in the past, but I think we can drive a lot more value now going forward by using single re-useable platforms that can drive a lot of this work back to those systems and release a lot of value back to our staff.”

Health applications

One of the health workflow apps running on ServiceNow HCLS - which Gold Coast has branded ‘Care Now’ - is a clinical photography application.

When clinicians consult on wound care, images are typically taken of the wound and stored in an electronic medical record.

Through Care Now, a clinician can launch the app, find the patient’s record, take a new image of a wound and - with the patient’s permission - upload it to the record “with a single click”.

“That's driving significant uptake across our clinical community as it's being released, because it's simplifying that whole process and they don't have to deal with multiple systems,” Kumar said.

“They take the photo, make a diagnosis and the technology deals with the rest and it's imported back to the medical record.”

Kumar said that a second application was built in two days at the request of an executive to help them “understand escalations in the emergency department.”

The ability to stand up new applications in days was “not an experience that's common in public health systems or in the public sector,” Kumar noted.

However, the internally innovation structure meant the work could be performed locally.

In addition, the use of “modularised code” means that developers “can rely on a smorgasbord of all the work that’s been done previously … in a fashion that makes us faster and faster.”

“We are working in a world where in years to come, it will only take us days of short sprints to spin up new solutions and have them implemented and tested through our organisation,” Kumar said.

“That's what really excites me about our agenda, and really also excites me about our partnership with ServiceNow.”