E-Health An overview

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1 E-Health An overview

2 Definition

3 Vision Clinicians and patients receiving and recording the right information, at the right time, in the right place, on the right device and with the right view to facilitate optimal patient care

4

5

6 Why is it so hard? Like designing and building a house with 50 different people who don t or can t talk to each other

7

8 Scope and Types of applications in a Digital Hospital

9 End Users Scope and Type of applications in a Digital Hospital (another view) Other Govt Health dept Staff Hospital Staff Patients Families Partners/ Service Providers Public Knowledge, Information and Data Physical / Electronic ICT Investment Management & Service Delivery End User Environment Connectivity Identity & Access Applications Radio ICT Devices No Physical Boundaries Internet Telecoms (Fixed & Mobile) Authorisation & Authentication Internal / External PACS Digital Theatres Wide Area Network Wireless Directory Services Biomedical Technology Systems Clinical / Non Clinical Building & Security Systems Local Area Networks Administration Servers and Storage Local (e.g. Theatre) Server Room Data Centre/s External Network Infrastructure Cabling Network Equipment (Switches, Routers, Firewalls, IPS) Physical Infrastructure Organisational Change Server Room Comms Rooms Carrier Entry Rooms Campus Roadmaps Distributors Power, UPS, Generators Air Conditioning Fire Suppression

10 How do we make sense of this Clinical applications: Medications management systems Pathology systems Radiology systems Electronic clinical notes Electronic transfer and discharge summaries Patient information/education systems Clinical knowledge repositories Clinical audit databases Clinical research databases

11 How do we make sense of this Administrative systems: Patient booking systems Patient identification systems Business analysis systems Governmental reporting systems Billing systems

12 So how do we make sense of this? Hardware techie stuff : End-user devices: pc s, bar-code readers, cameras, dataphones IP Phones / PBX Reserve IP wireless Phones / Pager PDAs Patient Entertainment Tablets Mobile Phones WiFi Tags Notebooks Fixed Devices Mobile Devices

13 So how do we make sense of this? Hardware techie stuff Data storage devices: servers and server rooms etc Information transfer devices and systems: Cabling, wireless networks, switches etc

14 So how do we make sense of this? Software techie stuff Encryption protocols Messaging protocols Security/identification protocols Integration layers

15 Unpacking Clinical Applications Laboratory systems: Electronic ordering Results reporting Test scheduling Electronic Decision support: Alerts Normal ranges Ordering protocols others

16 Unpacking Clinical Applications Radiology systems: Digital imaging Digital storage Digital viewing Computer aided digital manipulation Digital ordering and result reporting Electronic scheduling Decision support

17 Unpacking Clinical Applications Medications management Electronic prescribing Electronic pharmacy validation Electronic /robotic dispensing Inventory control PBS/S100 billing Electronic discharge medications Electronic medications administration systems Decision support variable dose regimes integrated to laboratory/ clinical measures

18 Unpacking Clinical Applications Discharge and hand-over summaries Discharge summaries range from entirely manual data entry with print to fax to automatic data extraction and messaging. Hand-over summaries often contain many common data elements. Summary electronic health records shared between public and private sectors

19 Unpacking Clinical Applications Specific Clinical area applications Emergency department Operating theatre and anaesthetics records Intensive care records Community Health records Mental Health records

20 Figure 1. EMR Adoption Model 2007 and 2008 Final: United States Stage Cumulative Capabilities 2007 Final 2008 Final Stage 7 Medical record fully electronic; HCO able to contribute CCD as a byproduct of EMR; data warehousing in use 0.0% 0.3% Stage 6 Physician documentation (structured templates), full CDSS (variance and compliance), full R- PACS 0.8% 0.5% Stage 5 Closed loop medication administration 1.4% 2.5% Stage 4 CPOE, CDSS (clinical protocols) 2.2% 2.5% Stage 3 Clinical documentation (flow sheets), CDSS (error checking), PACS available outside radiology 25.1% 35.7% Stage 2 CDR, CMV, CDSS inference engine, may have document imaging 37.2% 31.4% Stage 1 Ancillaries - lab, rad, pharmacy - all installed 14.0% 11.5% Stage 0 All three ancillaries not installed 19.3% 15.6% Total Hospitals n = 5,073 n = 5,166 CCD = Continuity of Care Document; CDR = Clinical Data Repository; CDSS = Clinical Decision Support System; CMV = Controlled Medical Vocabulary; CPOE = computerized practitioner order entry; EMR = electronic medical record; HCO = Health Care Organization; Lab = laboratory; Rad = radiology; R-PACS = Radiology - Picture Archiving and Communication System. Source: HIMSS Analytics Database.

21 Scope and Types of applications

22 The pathway to comprehensive e- Health

23 Implementation challenges Where do we start? Comprehensive suite of applications, department by department Individual applications, throughout facilities and across facilities Individual applications department by department (current commonest Strategy)

24 Views on Benefits of digital Hospitals

25 Cost/benefit Benefits increase exponentially with e-health automation, while costs increase incrementally

26 Cost/Benefit: the need for change management

27 Process mapping

28 NeHTA: Establishing the basis for e-health

29

30

31 If Medical teams on ward rounds are provided with bedside patient information, they will be more likely to use that information in making good diagnostic and management decisions Hypothesis

32 Motion C5a Tablet PC connected to wireless LAN

33 Project Methodology 1. Baseline priority clinical processes 2. Apply technology framework 3. Measure the impact

34 Methodology Team observation on multiple occasions at Baseline to track workflows and establish indicative times spent on tasks Introduction of C5as with a short orientation to the PC (extra capabilities such as bar-code reading, camera deliberately not used). No extra training in use of standard applications Repeat observation of multiple teams on multiple occasions, including same team with and without tablet in use (tablet software glitch)

35 Baseline applications Synapse: web viewer for radiology images HBCIS: Patient administration system (Black screen) Auslab: Pathology results (Black screen) Clinicians Knowledge network (CKN): web based access to electronic journals, some electronic texts, Cochrane, Medication guidelines and formulary including e-mims

36 Robina Hospital How to improve the quality of care I provide spend more time with patients and less time doing paper work Impact that mobility can have on clinical processes Ward rounds and discharge introducing clinical mobile tablets Emergency Department, Medical Ward, ICU and Outpatients New Partnership Model Commenced July 2007 December 2008

37 Project FIDO Results

38 Project FIDO Results

39 Project FIDO Results

40 Results

41 Conclusion There were significant differences observed in the frequency of access to patient specific information and to clinical information databases. There was a reduction in time spent logging into desk-top PCs, with this time spent discussing diagnosis and management with the patient. The observational team noted a change from an error prone, linear repetitive process of diagnosis formulation to a rapid, data driven patient centric hypothesis driven diagnostic process

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