Cairns and Hinterland Hospital and Health Service (CHHHS) is one of the large networks of regional health services that help to maintain Australia’s proud reputation for high-quality healthcare.

As one of Queensland Health’s 15 Hospital and Health Services (HHS). CHHHS manages public health and hospital facilities that serve more than 250,000 people in and around Cairns, northeast Australia. It’s also responsible for a broad and highly diverse geographical area of nearly 143,000 km2, ranging from urban and coastal locations to remote and often difficult–to–access inland areas. This dispersion makes vital operations such as logistics, communication, and service coordination challenging.

The health service’s population is also diverse, ranging from an aging demographic to younger individuals, as well as indigenious communities. CHHHS’s facilities include nine hospitals, 11 primary health sites and nine community health centers, plus mental health facilities and other specialist services.

“Our service area includes remote communities in the outer western region, highlighting our commitment to providing healthcare access to all residents,” explains Tate Jones, Senior Software Engineer at CHHHS. “These factors necessitate adaptive and innovative solutions to provide integrated, high-quality care across the region.”

To deliver high quality care in such a complex environment CHHHS turned to MongoDB to power a growing number of innovative tools that enable it to deliver services more effectively while keeping costs and staffing levels under control. These include the Enterprise Budgeting System, a solution that delivers high-quality, accurate reporting and efficient, cost-effective processes across CHHHC’s operation.

CHHHS’s responsibilities stretch well beyond healthcare. As a publicly funded institution, it needs to meet key compliance and service standards while managing a tight and highly scrutinized budget. Doing so requires strong processes and even stronger monitoring.

“We obviously have to run a tight budget because it’s taxpayers’ money,” explains Jones. “And with around 7,000 employees, a vast majority of our budget is consumed by labor.”

Keeping track of training, compliance, labor costs, and multiple other non-labor expenses involved labor-intensive processes that were prone to mistakes. Monitoring budgets against actual expenditure was also a cumbersome task.

“It was spreadsheets on steroids,” Jones says. “Everyone had different copies of different documents that applied to different aspects of the organization. Data was rarely current, and keeping track of over 2,000 unique job types in 12 organizational streams was becoming almost impossible.” Being able to provide an accurate snapshot of the organization's mandatory training compliance requirements and the ongoing budgeting demands became an expensive administrative activity.

The initial approach CHHHS took was to develop a series of dedicated tools that would streamline three critical systems; Human Resources, Finance, and Enterprise Budgeting. Using Microsoft SQL Server for both was a step in the right direction, but the hybrid approach of using both local and central data sources came under strain as the number of attributes and records grew due to the need to capture both real-time and historical data.

“Supporting dynamic changes to the budget became increasingly difficult,” Jones adds. “One year’s budget model would look slightly different from the next year’s, for example. It was almost impossible to make anything other than very high-level comparisons.”

After years of struggling with a SQL server and multiple schemas, Jones realized that CHHHS was using the fundamentally wrong tool for the job. The team was spending more time dealing with technical and data maintenance issues than developing new solutions. A significant volume of the data was being stored in JSON documents, so Jones began to investigate whether a document-based database would allow for much greater flexibility in the types of data stored, and enable configuration-based schema enforcement— all while meeting the rigorous security requirements necessary for a hospital.

“As a health service, data privacy and confidentiality are monitored very carefully, so we needed something that was tried and tested,” Jones explains. “When we looked at MongoDB, we saw solutions, we saw answers – and a thriving community with open-source and third-party solutions and drivers.”

The second iteration of the Enterprise Budgeting System was built on MongoDB Enterprise Advanced to take advantage of its agility, security, and enterprise-level support. With the out-of-the box capabilities, the new mandatory compliance and training dashboard, Sirtboard, can handle over half a million individual records, while Enterprise Budgeting now manages as many as 700,000 budget lines.

“MongoDB also handles integrations with all our HR, financial systems, and training systems, because it pulls in data from those external systems and produces a merged consolidated view,” Jones says. “We can now import the siloed data sources into the MongoDB environment because the schema is so much more flexible. We didn’t throw anything away; we kept it all and wrote aggregation pipelines to bring all the data together into single views.”

CHHHS has now moved from a slow, unreliable reporting environment to enterprise-wide tools that deliver accurate and immediate results.

“MongoDB has enabled us to achieve real-time analytics for Enterprise Budgeting,” Jones notes. “Previously people would request the report and wait until the end of the month; now it happens in real time in front of them. The same thing goes for our compliance and training dashboard. You get to see the compliance of the whole health service instantly when you go to the portal that’s querying against MongoDB.”

For Jones, the most significant benefit is the speed at which CHHHS can now develop new budgets and use ‘what if?’ forecasting to assess the impact of proposed changes.

“We can also compare and copy budgets year by year, because it’s seamless,” he notes. “Previously we always had to go for the lowest common denominator, so we didn’t break the model in SQL Server, but with MongoDB we have the flexibility to build mappings through configurations instead of back-end schema changes. It’s far more efficient.”

Jones estimates that at least two full-time staff who previously processed data manually can now focus on higher-value priorities. MongoDB is also enabling greater productivity with a relatively lean team of just four developers, which has remained unchanged during wider organizational growth.

“We’re producing more and more applications and solutions,” Jones says. “If we had to bring in a SQL administrator, for instance, that would require more resourcing and costs to produce or maintain any solutions.”

The efficiency is set to increase further as CHHHS completes final testing and moves its MongoDB instance away from an on-premises environment to MongoDB Atlas on Azure. It’s a move that will free up Jones and his team from managing internal infrastructure and security, with Atlas’s automations enabling them to focus on developing even more solutions and use cases while reducing operational overheads.

“One step we’re looking at for the future is moving patient data to MongoDB Atlas,” he concludes. “We’re really looking forward to taking those reporting capabilities to a wider user base.”

Tate Jones, Senior Software Engineer, CHHHS