e-Health Programme Plan by gyvwpsjkko

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									NATIONAL DEPARTMENT OF HEALTH




           e-Health
    Programme Plan



                          26th November, 2009




             Enabling Better
         Healthcare through
          Better Information

          E-HEALTH   STEERING COMMITTEE
National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009




e-Health File Reference No                     :   25/11/2009/01

Revision                                       :   0.4

Custodian                                      :   e-Health Programme Manager

Effective date                                 :   25th November, 2009

Electronic file                                :   e-Health Programme Plan

Classification                                 :   RESTRICTED




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National Department of Health                                                                                e-Health Programme Plan
CONFIDENTIAL                                                                                    Version Number: 4 | 26th November, 2009
1               Contents
1.    INTRODUCTION ............................................................................................................................. 6
2.    GOAL & OBJECTIVE OF THE DOCUMENT ........................................................................................ 6
3.    BACKGROUND TO THIS PROGRAMME PLAN .................................................................................. 6
4.    e-Health Defined ........................................................................................................................... 8
      PRINCIPLES OF E-HEALTH............................................................................................................................ 8
5.    e-Health vision .............................................................................................................................. 9
      VISION      9
      MISSION 9
      STRATEGIC OBJECTIVES .............................................................................................................................. 9
6.    STRATEGY .................................................................................................................................... 10
      BUSINESS PRIORITIES ............................................................................................................................... 10
      IMPLEMENTATION PRINCIPLES ................................................................................................................... 10
      IMPLEMENTATION APPROACH ................................................................................................................... 10
      ENTERPRISE FOCUS ................................................................................................................................. 11
      ACQUISITION AND PARTNERING ................................................................................................................. 12
      STAKEHOLDER MANAGEMENT ................................................................................................................... 12
      E-GOVERNMENT POLICY........................................................................................................................... 12
      BUSINESS APPROACH............................................................................................................................... 13
      CRITICAL SUCCESS FACTORS ...................................................................................................................... 13
7.    CURRENT ENVIRONMENT ............................................................................................................ 14
      TECHNOLOGY ......................................................................................................................................... 14
      IS/ICT POLICIES ..................................................................................................................................... 14
      IS/ICT TECHNOLOGY AND RELATED PRODUCT STANDARDS ............................................................................ 14
      CONTRACTS 15
8.    Structure and organisation the public entity ............................................................................... 15
      ACCOUNTABILITY .................................................................................................................................... 15
      ORGANISATION ...................................................................................................................................... 16
      ROLES AND RESPONSIBILITIES OF THE PROGRAMME MANAGER ........................................................................ 17
      CHANGE MANAGEMENT .......................................................................................................................... 17
9.    Current Risk Assessment ............................................................................................................. 17
10.   E-HEALTH PROGRAMME DEFINITION .......................................................................................... 19
      E-HEALTH ROADMAP ............................................................................................................................... 19
      ENTITY ESTABLISHMENT WBS 1 ................................................................................................................ 20
                Business Requirement Specification (BRS) ............................................................................................. 20
                DESCRIPTION .......................................................................................................................................... 20
                JUSTIFICATION ........................................................................................................................................ 20
                SCOPE ..................................................................................................................................................... 20
                RESPONSIBILITY ...................................................................................................................................... 20
                PROJECT MILESTONES ............................................................................................................................ 20
                CRITICAL DEPENDENCIES ........................................................................................................................ 20
                COST ....................................................................................................................................................... 20
                WBS SPECIFIC RISKS ................................................................................................................................ 20
                WBS SPECIFIC STANDARDS ..................................................................................................................... 20
                CONFORMANCE MEASUREMENT CRITERIA ........................................................................................... 21
                GOVERNANCE ......................................................................................................................................... 21
      ARCHITECTURE WBS 2 ......................................................................................................................... 21
                Business Requirement Specification (BRS) ............................................................................................. 21
                Description ............................................................................................................................................. 21
                Justification ............................................................................................................................................ 21
                Scope ...................................................................................................................................................... 21
                RESPONSIBILITY ...................................................................................................................................... 21
                Project Manager Shane Rutherford ..................................................................................................... 21
                PROJECT MILESTONES ............................................................................................................................ 21
                CRITICAL DEPENDENCIES ........................................................................................................................ 21
                COST ....................................................................................................................................................... 21
                WBS SPECIFIC RISKS ................................................................................................................................ 21
                WBS SPECIFIC STANDARDS ..................................................................................................................... 21
                CONFORMANCE MEASUREMENT CRITERIA ........................................................................................... 22


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National Department of Health                                                                                e-Health Programme Plan
CONFIDENTIAL                                                                                    Version Number: 4 | 26th November, 2009
                GOVERNANCE ......................................................................................................................................... 22
      GOVERNANCE WBS 3 ........................................................................................................................... 22
                Business Requirement Specification (BRS) ............................................................................................. 22
                DESCRIPTION .......................................................................................................................................... 22
                JUSTIFICATION ........................................................................................................................................ 22
                SCOPE ..................................................................................................................................................... 22
                RESPONSIBILITY ...................................................................................................................................... 22
                PROJECT MILESTONES ............................................................................................................................ 22
                CRITICAL DEPENDENCIES ........................................................................................................................ 22
                COST ....................................................................................................................................................... 22
                WBS SPECIFIC RISKS ................................................................................................................................ 22
                WBS SPECIFIC STANDARDS ..................................................................................................................... 22
                CONFORMANCE MEASUREMENT CRITERIA ........................................................................................... 23
                GOVERNANCE ......................................................................................................................................... 23
      PROGRAMME MANAGEMENT WBS 4 ...................................................................................................... 23
                Business Requirement Specification (BRS) ............................................................................................. 23
                DESCRIPTION .......................................................................................................................................... 23
                JUSTIFICATION ........................................................................................................................................ 23
                SCOPE ..................................................................................................................................................... 23
                RESPONSIBILITY ...................................................................................................................................... 23
                PROJECT MILESTONES ............................................................................................................................ 23
                CRITICAL DEPENDENCIES ........................................................................................................................ 23
                COST ....................................................................................................................................................... 23
                WBS SPECIFIC RISKS ................................................................................................................................ 23
                WBS SPECIFIC STANDARDS ..................................................................................................................... 23
                CONFORMANCE MEASUREMENT CRITERIA ........................................................................................... 23
                Schedule deviation does not exceed ten working days in any reporting period. ................................... 23
                Actual cash flow is within R30,000 of planned cash flow calculated monthly. ...................................... 23
                BRS completed within approved budget. ............................................................................................... 23
                Deliverables accepted by all role players. .............................................................................................. 23
                GOVERNANCE ......................................................................................................................................... 24
                Steering committee meetings once a month. ........................................................................................ 24
      INFRASTRUCTURE WBS 5 ...................................................................................................................... 24
                Business Requirement Specification (BRS) ............................................................................................. 24
                DESCRIPTION .......................................................................................................................................... 24
                JUSTIFICATION ........................................................................................................................................ 24
                SCOPE ..................................................................................................................................................... 24
                RESPONSIBILITY ...................................................................................................................................... 24
                PROJECT MILESTONES ............................................................................................................................ 24
                CRITICAL DEPENDENCIES ........................................................................................................................ 24
                COST ....................................................................................................................................................... 24
                WBS SPECIFIC RISKS ................................................................................................................................ 24
                WBS SPECIFIC STANDARDS ..................................................................................................................... 25
                CONFORMANCE MEASUREMENT CRITERIA ........................................................................................... 25
                GOVERNANCE ......................................................................................................................................... 25
      CORE SOLUTIONS WBS 6 ...................................................................................................................... 25
                Business Requirement Specification (BRS) ............................................................................................. 25
                DESCRIPTION .......................................................................................................................................... 25
                JUSTIFICATION ........................................................................................................................................ 25
                SCOPE ..................................................................................................................................................... 25
                RESPONSIBILITY ...................................................................................................................................... 25
                PROJECT MILESTONES ............................................................................................................................ 25
                CRITICAL DEPENDENCIES ........................................................................................................................ 25
                COST ....................................................................................................................................................... 25
                WBS SPECIFIC RISKS ................................................................................................................................ 25
                WBS SPECIFIC STANDARDS ..................................................................................................................... 25
                CONFORMANCE MEASUREMENT CRITERIA ........................................................................................... 26
                GOVERNANCE ......................................................................................................................................... 26
      TELEMEDICINE WBS 7                    TELE MEDICINE ................................................................................................. 26
                Business Requirement Specification (BRS) ............................................................................................. 26
                DESCRIPTION .......................................................................................................................................... 26
                JUSTIFICATION ........................................................................................................................................ 26
                SCOPE ..................................................................................................................................................... 26


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National Department of Health                                                                            e-Health Programme Plan
CONFIDENTIAL                                                                                Version Number: 4 | 26th November, 2009
            RESPONSIBILITY ...................................................................................................................................... 26
            PROJECT MILESTONES ............................................................................................................................ 26
            CRITICAL DEPENDENCIES ........................................................................................................................ 26
            COST ....................................................................................................................................................... 26
            WBS SPECIFIC RISKS ................................................................................................................................ 26
            WBS SPECIFIC STANDARDS ..................................................................................................................... 26
            CONFORMANCE MEASUREMENT CRITERIA ........................................................................................... 26
            GOVERNANCE ......................................................................................................................................... 27




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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
DEFINITION OF TERMS
              Term                                       Definition

1.    Board                The Board refers to the e-Health User Board. Its mandate is to
                           give effect to and implement e-Health. As such, it is the
                           Programme Sponsor and the executive body responsible for
                           directing the e-Health Programme.

2.    Cluster              Refers to the Human Development Cluster, which includes the
                           Department of Health, the Department of Social Development.


4.    Issue                An issue is any event or matter arising during the life of the
                           Programme that requires action. Any party or person may
                           identify or raise an issue. Examples of items that are typically
                           initiated as issues are new system requirements, system
                           malfunctioning, requests for information and delaying events.
                           During the resolution of issues, they may be reclassified or could
                           initiate a different process for their resolution such as Risks,
                           Incidents and Requests For Service.

5.    Incident             An incident is an issue or an event that has impacted or is
                           currently impacting the Programme negatively and requires
                           action to prevent a re-occurrence and/or remedy the effect of
                           the incident on the delivery of the Programme.

6.    Messaging            In the context of the document messaging is a generic
                           technology term for an electronic messaging system including
                           but not limited to email and other message technology.

7.    Orchestration        Is a term used to describe the activity of intelligent routing and
                           meta data translation that is performed on an electronic
                           message in accordance to a set of rules based on the content of
                           the message to be orchestrated.

8.    Programme            Refers to the e-Health Programme, which represents the
                           coherent strategy to implement ICT in the National Health
                           System.

9.    Programme            A government official and appointed by the Board to manage the
      Manager              Programme and to coordinate and integrate activities across
                           functional lines within the partner Provinces.

10.   Programme Plan       Refers to the e-Health Programme Plan.



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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009

             Term                                        Definition

11.   Risk                 A risk is something that may happen in the future and requires
                           preventative measures, while an incident is something that has
                           happened and requires corrective measures.

12.   Routing              Routing is a generic term to describe the switching of messages
                           and data to specific destinations across a network.

13.   SITA                 SITA refers to the State Information Technology Agency (Pty) Ltd,
                           company registration number 1999/001899/07, a private
                           company duly incorporated in accordance with the laws of the
                           Republic of South Africa, herein represented by the SITA e-
                           Health Programme Manager.


1.
This is the first e-Health Programme Plan. It provides a point of departure and mandate for
the first e-Health Steering Committee. Implementation of this Programme Plan must follow
a Project Management approach and seek to comply with international best or proven
practices.
This Programme Plan has been compiled to represent and give effect to the collective vision
and commitment of all role-players and co-owners of the e-Health Strategy.

2.
The goal of this document is to confirm the approval and support of the National Health
Council for the strategy to realise the incremental establishment of an e-Health System.
The intention of the Programme Plan is to guide the establishment, implementation,
maintenance and continuous improvement of the ICT within the National Health System.
The objective of this document is to define the Programme and to align its constituent parts
to the budgeting process as prescribed by National Treasury.

3.
The aim of the National Department of Health is to promote the health of all people of South
Africa through a caring and effective National Health System based on primary health care.
Since 1994 many initiatives have been undertaken to improve health status for all South
Africans. These include new laws, investment in infrastructure, improve access to services,
enhanced prevention efforts, advances in nutrition and increased availability of medicines.
South Africa's healthcare system consists of a large public sector and a smaller but fast-
growing private sector. Healthcare varies from the most basic primary health care, offered
free by the state, to highly specialised hi-tech health services available in the private sector
for those who can afford it. The public sector is under-resourced and over-used, while the
private sector, run largely on commercial lines, caters for middle and high-income earners

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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
who tend to be members of medical schemes (18% of the population), and to foreigners
looking for quality surgical procedures at relatively affordable prices. The private sector also
attracts most of the country's health professionals.
Although the state contributes about 40% of all expenditure on health (8.5% of GDP), the
public health sector is under pressure to deliver services to about 86% of the population.
Despite this, most resources are concentrated in the private health sector, which sees to the
health needs of the remaining 14% of the population with 5% of the GDP.
The vision of the National Department of Health (NDoH) is that of a caring and humane
society in which all South Africans have access to affordable, good quality health care. There
is a concerted move towards a coherent, unified health system offering financial protection
for all the population in accessing a nationally affordable package of care, at the time of
need, away from a segmented and inequitable health system that burdens the country with
its unaffordable cost.
The Constitution has played a significant role in proclaiming health as a fundamental right
for all. Section 27(1) says everyone has a right to have access to health care services,
including reproductive health care. This particular section further impose on the state the
duty to ensure the realization of these rights through legislative or other reasonable
measures within the available resources. This means no person must be refused health care
based on whatever reason. Acting in accordance with the constitution the National Health
Act was enacted in 2004 to guide the developments in the health sector and clarify the
responsibilities of all three spheres of government.
One of the most serious challenges facing our national health system is its current
fragmentation. This fragmentation manifests itself at all levels of the enterprise. This, in part,
represents one of our biggest obstacles to realising our objective of better health outcomes.
This is not a uniquely South African experience. The world over has recognised the
importance of an integrated health system that is patient centred as a goal.
In response to this the WHO called on its member states in 2005 to develop e-Health
strategies. This Programme Plan represents the first concrete steps as part of the process to
develop and implement one.
There is some urgency to the development and implementation of an e-Health strategy. The
National Health System is confronted with serious challenges, the most serious of which is
our ability to deliver on our commitments made in support of the Millennium Development
Goals.
A critical aspect of providing solutions to this challenge is the need to change the way in
which business is currently done and services rendered and a more efficient management of
our information is a critical part of this. Whilst much progress was recorded in the past 15
                                                            a single national health system is a
major problem. The problem with this is that the longer we allow our health system to
continue in this manner, the more difficult it will be to integrate and the more expensive it is
to take corrective measures.
However, the more urgent demand for the implementation of an e-Health Programme arises
from the election mandate and policy of the ruling party to establish a National Health
Insurance. There is simply no way in which the NHI could be implemented on the current
paper-based and manual working environments. Administering and managing a national


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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
insurance programme fundamentally depends on our ability to know on a national level how
many patients we are treating, what services are being rendered and what this is costing.
The implementation of an e-Health Programme is therefore a mission critical dependency
for the implementation of the NHI.
The NHI is aimed at introducing the necessary funding and service delivery mechanisms to
enable the creation of an efficient, equitable and sustainable health system in South Africa.
During the MTEF period 2009/10-2011/12, the Department must continue to work towards
the design of the NHI system for South Africa that promotes the health system integration
and ensures universal access for all South Africans. The successful implementation of the
NHI must need a very strong ICT infrastructure. It is therefore paramount that an Integrated
Management Information System which must cater for all service providers is developed as
part of an e-Health Strategy.
The Department of Health, through the National Health Information System of South Africa
Committee (NHIS/SA) in 1994 conceived the development of a Comprehensive Health
Information System that begins at the local level and feeds into provincial and national
levels. This would have consisted of basic administrative information that focused on patient
registration, billing, pharmacy and the creation of a Master Patient Index that would allow
access to a database of patient information across all levels of health care and provinces.
The challenge currently is that seven different systems are implemented in about 25% of
hospitals in the Provinces. The systems are implemented on different database management
systems with different IT architecture as well as unavailability of ICT infrastructure in most
Primary Health Care Centres. This has resulted in national incompatibility and non-
interoperability of systems. Therefore sharing of patient data across provinces is not
possible.

4.        -
The World Health Organisation offers the following more detailed definition: "e-Health is the
cost-effective and secure use of information and communications technologies in support of
health and health-related fields, including health-care services, health surveillance, health
literature, and health education, knowledge and research".
This Strategy subscribes to the definition of e-Health as provided by the World Health
Organisation as its point of departure. However, for purposes of this Strategy, this definition
also recognises that we need to change the way in which we deliver our services to obtain
the maximum advantage that technology is able to offer. Very practically, e-Health in South
Africa is the ICT strategy supporting the business of the National Health System and will be a
strategic enabler of the National Health Insurance implementation.
This Strategy is guided by the vision and mission of the Department of Health. The vision of
the DOH is to have an accessible, caring and high quality health system. The mission is to
improve the health status through the prevention of illnesses and the promotion of healthy
lifestyles and to consistently improve the health care delivery system by focussing on access,
equity, efficiency, quality and sustainability.

Principles of e-Health
The following service planning principles guide the development of the e-Health Strategic


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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
Overview:
          Integration: Our National Health System must function as one integrated health
          system.
          Improved population health outcomes: Improving the health and wellbeing of the
          whole population;
          Patient-focused: Integration within and across the public, private, non-government
          and other sectors to facilitate continuity of care;
          Empowerment: Supporting greater health self-management.
          Quality services: Ensuring clinical practice and models of service delivery are
          consistent with good practice and our health system policy.
          Accessible services: Addressing barriers to service access (e.g. geography, cultural
          factors, market forces) while preserving the safety and quality of health service
          provision.
          Sustainable services: Developing, configuring and delivering services in a way that is
          sustainable, making efficient and effective use of scarce resources to maximise
          capacity to respond to change.

5.         -

Vision
Enabling better healthcare through better information.
The logic embedded in this vision statement is as follows:-
Our key objective must be to enable better healthcare. ICT can only enable better healthcare
and it does not deliver it. ICT enables better healthcare through the provision of better
information

Mission
To deliver a comprehensive, accessible, sustainable patient-centred e-Health system that will
enable improved patient care and their knowledge on health, through:
          Innovation;
          Development of partnerships; and the
          Use of appropriate and relevant technologies.

Strategic Objectives
The following Strategic Objectives have been
and Mission:-
          Strategic Objective 1: e-Enablement of Healthcare
          Strategic Objective 2: Delivering Health and Management Information




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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009

6.

Business Priorities
The NDoH adopted a Ten Point Plan outlining the key strategic priorities for the next five
years, 2009 to 2014. These key priorities are: -
         Provision of strategic leadership and creation of Social compact for better health
         outcomes
         Implementation of National Health Insurance (NHI)
         Improving the Quality of Health Services
         Overhauling the health care system and improve its management
         Improve Human Resource Planning, Development and Management
         Revitalization of the health infrastructure
         Accelerated implementation of the HIV and AIDS strategic plan and the increased
         focus on TB and other communicable diseases
         Mass mobilisation for better health for the population
         Review of drug policy
         Strengthening Research and Development

Implementation Principles
The following principles are discernable from international best practice and experience in
developing e-Health Strategies for implementation. These are:
         National infrastructure       A critical success factor and enabler of an E-Health
         programme is developing the national infrastructure once rather than duplicating
         development costs and efforts in each Province and increasing the likelihood of
         rework
         Stakeholder engagement Actively engage key health care stakeholders in the
         design and delivery of E-Health solutions
         Incremental approach - Build long term national E-Health capability in an
         incremental and pragmatic manner, focusing initial investment in those areas that
         that deliver the greatest benefits for consumers, care providers and health care
         managers
         Recognising different starting points - Balance active support for care providers
         with less developed capability, while not constraining the ability for more advanced
         participants to progress
         Relevant skills Ensure sufficient numbers of skilled practitioners are available to
         support delivery of the national E-Health strategy.
         Integrated approach Technology by itself will solve nothing. It will only serve as an
         effective strategic enabler if it is utilised as one of a series of strategic interventions
         to transform the NHS.

Implementation Approach
The value of the incremental approach is that it decouples information from functionality
separating information required to meet business needs from the applications that process
that information. Rather than delivering large and complex applications to meet the


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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
informational needs of stakeholders, these informational needs are met by the integration
of existing information sources to an Enterprise Information Repository. In this way,
capability can be delivered earlier and more incrementally than a traditional large-scale
systems implementation.
                                                                                 o the
e-Health Strategy and supports the implementation principles described earlier in the
following ways:
         The approach builds on existing capabilities and relevant projects to leverage
         information and functionality that already exists to build a solution that combines
         existing and new capabilities. This is based on the understanding that much of the
         information that care providers need already exists in our health system systems
         but is not easily accessible or integrated with other information
         The approach builds incrementally, providing an increasingly rich repository of
         consolidated and integrated information to support care delivery while delivering
         increasingly advanced capabilities over time
         The approach is based on building solid foundations for information and
         functionality through a focus on robust systems integration and data consolidation
         processes that promote data integrity and quality
         The approach focuses on delivering simple capabilities first to meet high priority
         needs and then extending these capabilities over time
         The approach focuses on implementing capabilities that improve care quality and
         patient outcomes by providing improved information on which to base decision
         making and treatment planning while at the same time providing tools and
         information to automate menial tasks allowing care providers to focus on care
         delivery
         In addition, the suggested approach provides a highly flexible implementation path

         framework for making decisions about technical and architectural directions to

         needs. As such, this approach embraces the notion of health care as a complex
         adaptive system, allowing the strategy to evolve and adapt as further evidence
         emerges and requirements change.

Enterprise Focus
It is critical that the point of departure for implementing a national e-Health Programme
must be an Enterprise Focus. The NHS must be viewed as one business enterprise and
supported by an integrated enterprise solution and not nine different enterprises trying to
share information.
An enterprise focus must also necessarily mean that we require a common Network
infrastructure and an Enterprise Information Repository. While the common network must
provide
talk to one another an Enterprise Information Repository (or data warehouse) would allow
for the integration of information from various feeder systems.
The basis of this focus is to ensure that we are able to draw together information from key
source systems to provide an integrated view of patient information. Enhanced functional


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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
capabilities around ordering, scheduling and decision support could then be incrementally
developed in parallel, and delivered over the medium to longer term.

Acquisition and Partnering
International experience has it that the development of an e-Health Programme is incredibly
expensive and has been fraught with many failures. In the UK, they spent more than

Because of the risk involved, it is essential that Technology partners of local and of
international standing and repute should be chosen on the basis of the essential technology
components identified as critical to the solution. This could assist us in avoiding the
expensive mistakes previously made.
The acquisition process to be followed must exclude the approach of merely procuring
licenses from vendors without securing basic assurances, with a shared risk and reward
strategy consistent with a programme of this magnitude.
The e-Health Programme requires reputable and experienced project management
resources to facilitate effective management of e-Health-specific and Provincial e-Health
projects.
The inclusion of black economic empowerment entities needs little motivation. Acquisition
of resources from new and existing contracts must pertinently address this requirement.

Stakeholder Management
One of the areas identified for focussed attention during the next cycle is that of stakeholder
management. The importance of maintaining every level of management, involved,
informed and motivated cannot be underestimated. It is therefore important that the
Provinces take joint and common ownership of the Programme and constituent projects.
The value of this approach is underscored by the experiences of the UK NHS. In that country,
one of the reasons why their Connecting for Health Programme did not enjoy the desired
success was because of the lack of buy-in from General Practitioners. We should seek to
learn from this lesson and avoid this happening.

e-Government Policy
The e-Health Programme must promote the government commitment to an e-government
strategy. The Programme should be committed to the e-government policy and as depicted
in figure 1 below, to ensure lower costs, increased productivity and greater citizen
convenience. We should therefore also commit ourselves to complying with the
Government Wide Enterprise Architecture Framework and principles.




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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009




Figure 1 - e-Government "House of Values" policy

Business Approach
The e-Health Board should be an executive body. To succeed, it must adopt a business
approach to its work. The intention is to recognise the importance of information technology
as a strategic enabler and force multiplier in the achievement of the collective e-Health
vision. The importance of technology is that it adds value to services rendered and generates
efficiencies and cost-benefits that could not otherwise be realised.
In this regard, the e-Health Board must recognise the need to establish an appropriate
governance model and partnerships with service providers addressing the programme
requirements.
e-Health is a business process and not simply a matter of technology. Change Management
and Business Process re-engineering are essential ingredients to the success of the e-Health
Programme and need meaningful Provincial commitment.

Critical Success Factors
The following factors are critical to the successful execution and delivery of e-Health, and
should be given the necessary attention by the members of the e-Health Board:
         Sustained political will and finance to implement e-Health.

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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
         A structure on a national and provincial basis, which takes responsibility for the
         development, implementation and continuous improvement of the system.
         Appropriate infrastructure e.g. office space and ICT technology, etc.
         Skilled subject matter experts who have the necessary influence and executive
         support within their Provinces to act as Provincial change agents.
         Appropriate methodology that is supported by a toolset in order to capture and
         maintain the necessary architectures.
         Ensure sustainability and expansion of the current programme team.
         Adequate capacity established to ensure critical mass is achieved and maintained,
         with the permanent allocation of skilled Provincial representatives and subject
         matter experts to and other relevant resources.
         The implementation of a comprehensive and integrated Change Management
         Programme as part of the implementation plan.

7.

Technology
The various Provinces and Local Authorities are currently on different levels of maturity with
regard to technology infrastructure. Their architectures and deployment strategies differ.
The current technology environment must be improved and updated in order to suit the
requirements of the Programme.

IS/ICT Policies
There is no coherent and coordinated IS/ICT policy across the various Provinces. This
Programme Plan recognises the importance of the establishment of common integration,
security and information exchange standards as a prerequisite to achieving the goals of e-
Health. The development of these policies is a continuous effort the impact of which must
be realised as the programme progresses.
The Minimum Information System Security (MISS) document, approved policies within the
Provinces and other governances e.g. COMSEC Act/Promotion to Access of Information
Act/Electronic Communication and Transaction Act must be taken into consideration in
defining the shared policies.
The Intellectual Property (IP) developed within the context of the Programme must be the
collective property of the NHS. 3rd Party utilisation of the IP must be subject to prior
approval of the Board.

IS/ICT Technology And Related Product Standards
The need to follow due process to establish various ICT-related technology and product
standards for e-Health is recognised as a continuous process as developments are
concluded. To date certain preliminary standards have been identified and have still to be
consolidated into an e-Health ICT standards document.
Where the need for specific standards arise, those standards must be documented and
compiled addressing both technology and product standards. Where such product-specific
standards are identified, the Technology Reference Models (TRM) in Provinces will have to

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CONFIDENTIAL                                            Version Number: 4 | 26th November, 2009
be amended.

Contracts
Contracts for the acquisition of product and product systems, and the in-sourcing of
personnel should follow the approved acquisition processes. The Board must draw on and
leverage existing agreements with industry as and when needed.
In the event of any need arising that cannot be provided for through the use of the SITA DoH
BA or SLA/s, the PMT must establish the necessary procurement mechanisms subject to the
policies and procedures of government.

8.

Accountability
The line of accountability of the Public Entity will be as follows:-

                                                Executive Sponsor
                                                 Minister of Health


                                         Executive Leadership Group
               Ministers of Health                    Finance                        DPSA


                                       National Leadership Group - NHC
              Minister        Deputy Minister          MEC's              DG                HoD's


                                                Steering Committee
                                                 Public Entity Board


                                             Implementation Team
                                            Public Entity Organisation
                 Executive Sponsor - The Minister of Health is the Executive Sponsor of the
                 Public Entity. The Minister will sign off the Programme Plan, Budget and
                 Strategy of the Public Entity. The Minister will do this after consulting with the
                 Executive Leadership Group and on the recommendation of the National
                 Leadership Group.
                 Executive Leadership Group The Minister will sit in Committee with the
                 Ministers of Finance and Public Service to seek their advice and council
                 regarding the direction of the Entity.
                 National Leadership Group The National Health Council (NHC) will serve
                 as the national leadership Group and consider the Programme Plan and
                 Strategy of the Entity for recommendation to the Minister of Health.
                 Steering Committee       The Public Entity Board of Directors will serve as the




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               and delivery as against the Programme Plan and Strategy. The Board of
               Directors have representation from the following bodies:-
               o       National Department of Health
               o       Provincial Departments of Health
               o       Medical Research Council
               o       National Laboratory Services
               o       SANDF medical services
               Public Entity     The Entity will operate against an approved Programme Plan
               and Strategy.

Organisation

       The organisation of the Public Entity will be as follows:-


                                                           Programme
                                                            Manager


                                                        Corporate Services
                                                            Manager


                                                        Business & Health
                   CEO                                    Information
                                                            Manager


                                                         Systems Manager



                                                        Accounts Manager



       CEO      The organization will be led by a Chief Executive Office who is
       appointed by the Minister of Health and is directly accountable to a Board of
       Directors. The CEO will have the following direct reports:-
               o       Programme Manager;
               o       Corporate Services Manager;
               o       Business and Health Information Manager;
               o       Systems Manager;
               o       Accounts Manager;
               Programme Manager          will be responsible for the Development of all
               business and information management solutions and systems. The
               programme will consist of a number of sub-programmes and projects.
               Corporate Services Manager          The corporate services manager will also be
               the CFO of the Entity.

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               Business and Health Information Manager will assume responsibility for
               the development of all Health, Business and Information Management
               products.
               Systems Manager         will assume responsibility for the management of all
               systems after they have been developed by the Programme Manager and
               duly signed off by the customer.
               Accounts Manager will assume responsibility for the management of all
               business relationships with the partners and customers that the Public Entity
               interacts with.

Roles and Responsibilities of the Programme Manager
The appointment of a Programme Manager by the Board is aimed at ensuring that the
Programme is managed in the best interests of the Board.
The Programme Manager is primarily responsible for co-ordinating and integrating
programme activities across multiple functional lines within the Programme. In this regard, it
is the responsibility of the Programme Manager to ensure that the Programme is being
executed within time, budget and at the proper performance levels.
This does not preclude constructive communication between role-players provided that it
does not impact on time, budget and performance levels.
A series of Management Plans are to be prepared which collectively must enable the
execution of this Programme Plan. The work defined in the WBS must be launched through
appropriate Charters and Plans, which in turn must provide the metrics required for
reporting to the Board.
A critical responsibility of the Programme Manager is the timely identification and
management of risks.

Change Management
Change Management is a very important dimension of any endeavour to improve business
capabilities in the Provincial context in that, it extends well beyond the traditional user
orientation and training associated with IS/ICT implementation projects.
Change Management must be addressed through several mechanisms, starting with this
Programme Plan, and must be extended to the individual project life cycles with the aim of
ensuring that all the stakeholders remain motivated and are informed of appropriate
changes to the environment they operate in.

9.
Some of the most probable and high impact risks that may affect the success of the
programme have been identified below. This assessment has been reviewed and reflects the
current perspective in this regard.
      A                   B                                   C
     No            Risk description               Risk containment measure
     1  Programme delays due to protracted Clear empowerment of the programme
        approval processes.                management structure.


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    A                     B                                              C
   No             Risk description                         Risk containment measure
   2  Unavailability of key Provincial staff Assignment of committed and mandated
      (SME).                                     Provincial key staff to the programme as
                                                 timely identified with the Board before the
                                                 requirement arises.
   3  Operational delays caused               by The Programme must identify contingency
      infrastructure               deficiencies, plans and measures to implement in the
      malfunction,       response         times, event of a failure incident.
      compatibility or capacity.
   4  Unavailability     of      skilled     and Plan for recruitment/assignment period
      knowledgeable programme team and place priority on selection/ assignment
      members.                                   process.       Establish     a  satisfactory
                                                 recruitment process to match the needs of
                                                 the Programme.
   5  The non-availability of infrastructure The timely allocation of funds and
      according to plan to execute the appropriate                 management     for     the
      programme and its various projects.        establishment of proper infrastructure e.g.
                                                 office accommodation, networks, e-mail,
                                                 JAD-facilities etc.
   6  Inadequate alignment of depart- Active promotion and demonstration of
      mental priorities to those of the commitment to the agreed Programme
      Programme.                                 imperatives.
   7  A diffusion of political must to Demonstrate tangible business benefits
      implement the Programme.                   through a structured process of delivery
                                                 and ensure active change management on
                                                 the programme.
   8  A delay in the establishment of an Convince Provinces to support and appoint
      approved and resourced structure & the required resources on National and
      infrastructure on a National and Provincial level.
      Provincial/local     level      for    the
      implementation and maintenance of
      the e-Health System.
   9  Provincial       disagreement           on Establish an architecture and methodology
      appropriate methodologies.                 framework that is marketable to
                                                 participating Provinces.
   10 The non-acceptance of any developed Ensure acceptance of any solution provided
      system or process by the participating by the Programme through an effective
      Provinces and end-users.                   change management programme prior to
                                                 final roll-out.
   11 Loss of technical expertise.               Establish an appropriate succession and
                                                 skills transfer plan.




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      National Department of Health                                                e-Health Programme Plan
      CONFIDENTIAL                                                    Version Number: 4 | 26th November, 2009

      10.         -

      e-Health Roadmap
      The following projects are envisaged in the implementation of the programme
Activity          Year 1                  Year 2                Year 3                 Year 4             Year 5
Entity            Establishment of the    Development of        Optimisation of
Establishment     Structure - WBS 1.1     Capabilities and      Organisational
WBS 1                                     Capacity WBS 1.3      Structure WBS 1.4
                  Recruitment of staff
                  and procurement of
                  capacity WBS 1.2
Architecture      Enterprise              Architecture of       Architecture of        Architecture of
WBS 2             Architecture WBS        Core Solutions        Core Solutions -       Core Solutions -
                  2.1                     WBS 2.4               WBS 2.5                WBS 2.6
                  Architecture and
                  Design of network
                  and Infrastructure -
                  WBS 2.2
                  IT Plan - WBS 2.3       IT Plan               IT Plan                IT Plan            IT Plan
Governance        Development of          Development and       Development and        Development and    Development and
WBS 3             standards - WBS 3.1     maintenance of        maintenance of         maintenance of     maintenance of
                                          standards WBS         standards              standards          standards
                                          3.2
Programme         Programme               Programme             Programme              Programme          Programme
Management        Management              Management            Management             Management         Management
WBS 4
Infrastructure    Infrastructure audit,   Infrastructure        Infrastructure         Infrastructure     Infrastructure
WBS 5             planning, design and    Deployment High       deployment             deployment         deployment
                  procurement - WBS       priority areas        secondary priority     other areas        other areas
                  5.1                     WBS 5.2               areas WBS 5.3          WBS 5.4            WBS 5.5
                                                                Infrastructure         Infrastructure     Infrastructure
                                                                maintenance WBS maintenance               maintenance
                                                                5.6
Core Solutions    Procurement - Comprehensive HIS (Priority     Comprehensive hospital information        Business
WBS 6             modules Billing, Patient Administration,      system ( Clinical modules, electronic     Intelligence
                  Pharmacy management/ Dispensing, Ward         patient record) WBS 6.2                   Specify other
                  Module) WBS 6.1                                                                         required modules
                                                                                                            WBS 6.3
Telemedicine      Tele medicine            Phased in approach   Phased in approach     Phased in          Phased in
WBS 7             Strategy                 (Tele-radiology)     (Tele-radiology)       approach (Tele-    approach (Tele-
                  development - WBS        WBS 7.2                                     radiology)         radiology)
                  7.1
Other solutions   Other priority           Other priority       Other priority         Other priority     Other priority
 WBS 8            solutions WBS 8.1        solutions.           solutions.             solutions.         solutions.
Quick Wins        Consolidate (PAAB) WBS 9.1
WBS 9             Develop PAAB solution
                  Deployment of PAAB - 100 Hospitals + 500
                  Clinics
                  Chronic Disease Mod - TB WBS 9.1
                  Web-Based Surveillance - WBS 9.2
                  Map of medicine WBS 9.3
                  forensics - All Provinces WBS 9.4
                  Laboratory Services WBS 9.5




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National Department of Health                                      e-Health Programme Plan
CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
Entity Establishment WBS 1
Business Requirement Specification (BRS)
The specific requirement will be best defined by a work study report.
DESCRIPTION
The precise description of the structures and posts in the entity will be developed in an HR
organisational development report.
JUSTIFICATION
The justification of the various posts and structures will be assessed from the work study and
HR Organisational Development report.
SCOPE
The scope includes posts and structures necessary to the functioning of the Entity.
Establishment of the Structure - WBS 1.1
Recruitment of staff and procurement of capacity WBS 1.2
Development of Capabilities and Capacity WBS 1.3
Optimisation of Organisational Structure WBS 1.4
RESPONSIBILITY
Project Manager To be determined
PROJECT MILESTONES
         Approval of legislation
         Approval of Budget
         Definition of organisational structure and post requirements
         Recruitment of people
         Training of people.
CRITICAL DEPENDENCIES
         Approval of legislation
         Budget
         Political support
COST
R43m - 2010
WBS SPECIFIC RISKS
Budget
Speed of Procurement
Logistical and infrastructural support
WBS SPECIFIC STANDARDS
None



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CONFORMANCE MEASUREMENT CRITERIA
Schedule deviation does not exceed ten working days in any reporting period.
Actual cash flow is within R30, 000 of planned cash flow calculated monthly.
BRS completed within approved budget.
Deliverables accepted by all role players.
GOVERNANCE
Steering committee meetings once a month.

Architecture WBS 2
Business Requirement Specification (BRS)
The development of the NHS Enterprise Architecture and Architectural artefacts necessary
to develop e-Health.
Description
Architectural artefacts
Justification
The architecture is critical to the e-Health strategy.
Scope
Enterprise Architecture WBS 2.1
Architecture and Design of network and Infrastructure - WBS 2.2
IT Plan - WBS 2.3
Architecture of Core Solutions WBS 2.4
RESPONSIBILITY
Project Manager Shane Rutherford
PROJECT MILESTONES
         Architectural Blueprint
         Architectural artefacts
         Definition of Components
CRITICAL DEPENDENCIES
         Budget
COST
This is a deliverable of the eHR project.
WBS SPECIFIC RISKS
None
WBS SPECIFIC STANDARDS
TOGAF Open Standards


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CONFORMANCE MEASUREMENT CRITERIA
Schedule deviation does not exceed ten working days in any reporting period.
Deliverables accepted by all role players.
GOVERNANCE
Steering committee meetings once a month.

Governance WBS 3
Business Requirement Specification (BRS)
Governance requirements will consist of the following areas:-
         IT Procurement
         IT Management
         Financial Management
         ICT Standards
         Health Information Standards
         Management Information Standards
DESCRIPTION
Development of the appropriate capacity and capabilities to manage the above governance
requirements.
JUSTIFICATION
The management of governance is critical in ensuring that we obtain value for money.
SCOPE
Development of standards - WBS 3.1
Development and maintenance of standards WBS 3.2
RESPONSIBILITY
Project Manager To be determined
PROJECT MILESTONES
         Establishment of Structure
         Appointment of appropriate staff
         Constitution of bodies with appropriate rules
CRITICAL DEPENDENCIES
Budget
COST
To be determined
WBS SPECIFIC RISKS
None
WBS SPECIFIC STANDARDS


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King Report
CONFORMANCE MEASUREMENT CRITERIA
Deliverables accepted by all role players.
GOVERNANCE
Steering committee meetings once a month.

Programme Management WBS 4
Business Requirement Specification (BRS)
A Programme Management Office and capability
DESCRIPTION
Establishment of a Programme Management Office and function
JUSTIFICATION
SCOPE
Development of standards - WBS 3.1
Development and maintenance of standards WBS 3.2
RESPONSIBILITY
Project Manager To be determined
PROJECT MILESTONES
         Recruitment of Programme Manager and staff
         Establishment of a Programme Management Function
         Development of a Programme and Project Management methodology and
         templates
CRITICAL DEPENDENCIES
Budget
COST
To be done
WBS SPECIFIC RISKS
None
WBS SPECIFIC STANDARDS
To be determined
CONFORMANCE MEASUREMENT CRITERIA
Schedule deviation does not exceed ten working days in any reporting period.
Actual cash flow is within R30,000 of planned cash flow calculated monthly.
BRS completed within approved budget.
Deliverables accepted by all role players.


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GOVERNANCE
Steering committee meetings once a month.

Infrastructure WBS 5
Business Requirement Specification (BRS)
The business requirements for the following are yet to be determined for all the potential
users within the NHS
         Physical infrastructure
         Wide and Local Area Networks
         Disaster Recovery
         Redundancy
         Operating System Software determination
         Messaging and Communications
DESCRIPTION
This is the Digital Nerve System of the NHS. It includes the access infrastructure, networks
and software. There are two international examples of this in the UK (the Spine) and Canada
(Infoway).
JUSTIFICATION
The physical infrastructure required to implement e-Health does not exist and needs to be
implemented. It is the foundations to all the e-Health solution.
SCOPE
Infrastructure audit, planning, design and procurement - WBS 5.1
Infrastructure Deployment High priority areas WBS 5.2
Infrastructure deployment secondary priority areas WBS 5.3
Infrastructure deployment other areas WBS 5.4
Infrastructure deployment other areas WBS 5.5
Infrastructure maintenance WBS 5.6
RESPONSIBILITY
Project Manager to be determined.
PROJECT MILESTONES
To be determined.
CRITICAL DEPENDENCIES
To be determined.
COST
To be determined.
WBS SPECIFIC RISKS
To be determined.

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CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
WBS SPECIFIC STANDARDS
To be determined.
CONFORMANCE MEASUREMENT CRITERIA
Schedule deviation does not exceed ten working days in any reporting period.
Actual cash flow is within R30,000 of planned cash flow calculated monthly.
BRS completed within approved budget.
Deliverables accepted by all role players.
GOVERNANCE
Steering committee meetings once a month.

Core Solutions WBS 6
Business Requirement Specification (BRS)
To be determined.
DESCRIPTION
To be determined.
JUSTIFICATION
These solutions include all our core systems. These will however have to be prioritised based
on business needs.
SCOPE
Procurement - Comprehensive HIS (Priority modules  Billing, Patient Administration,
Pharmacy management/ Dispensing, Ward Module) WBS 6.1
Comprehensive hospital information system ( Clinical modules, electronic patient record)
WBS 6.2
Business Intelligence WBS 6.3
RESPONSIBILITY
Project Manager - To be determined.
PROJECT MILESTONES
To be determined.
CRITICAL DEPENDENCIES
To be determined.
COST
To be determined.
WBS SPECIFIC RISKS
To be determined.
WBS SPECIFIC STANDARDS


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To be determined.
CONFORMANCE MEASUREMENT CRITERIA
Schedule deviation does not exceed ten working days in any reporting period.
Actual cash flow is within R30,000 of planned cash flow calculated monthly.
BRS completed within approved budget.
Deliverables accepted by all role players.
GOVERNANCE
Steering committee meetings once a month.

Telemedicine WBS 7 Tele medicine
Business Requirement Specification (BRS)
To be determined.
DESCRIPTION
To be determined.
JUSTIFICATION
The value of telemedicine has already been established in the NHS and it holds the promise
of great value.
SCOPE
Strategy development - WBS 7.1
Phased in approach (Tele-radiology) WBS 7.2
RESPONSIBILITY
Project Manager - To be determined.
PROJECT MILESTONES
To be determined.
CRITICAL DEPENDENCIES
To be determined.
COST
To be determined.
WBS SPECIFIC RISKS
To be determined.
WBS SPECIFIC STANDARDS
To be determined.
CONFORMANCE MEASUREMENT CRITERIA
Schedule deviation does not exceed ten working days in any reporting period.
Actual cash flow is within R30,000 of planned cash flow calculated monthly.

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CONFIDENTIAL                                          Version Number: 4 | 26th November, 2009
BRS completed within approved budget.
Deliverables accepted by all role players.
GOVERNANCE
Steering committee meetings once a month.




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