Authors
James Malycha, Jake White, Adam Phillips, Lukah Dykes, Lukasz Wiklendt, Paul Lambert, Adelaide Boylan, Justin Beilby
Published in
JMIR medical informatics. Volume 14. Pages e86564. Sep 01, 2026. Epub Sep 01, 2026.
Abstract
Following 2 decades of electronic medical record (EMR) adoption, most large public health systems hold comprehensive digital clinical data but lack the complementary informatics capability to return those data to clinicians, coders, and operational teams in a usable form. In South Australia (SA), the statewide Sunrise (Altera Digital Health) EMR system has digitized documentation and ordering since 2017; however, tools for back-end data extraction and enriched clinical information displays were not prioritized, and clinical, operational, and research users have reported ongoing difficulties accessing timely data.
The aim of this study is to describe the development, governance, and deployment of a cloud-native health informatics system (HIS) in the Central Adelaide Local Health Network (CALHN), which serves approximately 40% of SA public patients, and to report implementation outcomes in accordance with the iCHECK-DH (Guidelines and Checklist for the Reporting on Digital Health Implementations) guidelines.
The HIS comprises 6 architectural layers deployed on Microsoft Azure with Red Hat OpenShift (IBM), extracting Sunrise EMR data in near real time under a read-only model in which all patient data remain within the SA Health network at all times. Implementation proceeded through 5 overlapping phases (2021-2026), governed across 4 domains: technical (security impact assessment, information asset classification, and independent cybersecurity review), clinical (a clinical governance committee that has met quarterly since May 2022), corporate (incorporation of HeartAI Pty Ltd in 2022, with conflicts of interest declared and managed under SA Health policy), and ethical (human research ethics committee [HREC], reference 18079 with subsequent amendments). Development was funded through approximately Aus $1.84 million (Aus $1=US $0.72 as of August 24, 2026) in competitive and institutional grants under a public-private model with CALHN and AusHealth.
Three applications have reached deliberately different stages of maturity. The CALHN Critical Care Informatics System (CCCIS) has been implemented and evaluated: it has been deployed across the 2 CALHN intensive care units (ICUs; 54 beds, approximately 5000 admissions per year) since 2022, is in daily clinical use, and automates the submission of 115 variables to the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) registry. In a formal evaluation by 8 senior intensivists, its mean System Usability Scale score was 76 of 100, and the overall workload was low (NASA Task Load Index: 21/100). CODEXA, an AI-assisted clinical coding application, is in operational validation: models trained on 500,000 episodes and tested on 50,000 held-out episodes achieved a pooled F1-score of 71% across the full case mix and 57.86% (precision 64.72%; recall 55.53%) on complex acute episodes, in line with published benchmarks of 58% to 61% obtained from curated research datasets. The Patient Flow application is in co-design with CALHN's Network Operations Centre, with interface prototype evaluations completed in July 2026. In May 2026, the platform received unconditional endorsement from Digital Health SA's Technical Design Review Committee, the highest technical governance approval in SA Health, concluding a 5-year governance pathway.
A locally developed informatics platform can be governed, deployed, and validated in a public health system; demonstrating clinical outcomes and transitioning to operational status are the next priorities.
PMID:
42679057
Bibliographic data and abstract were imported from PubMed on 02 Sep 2026.
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