The EMR & PHR. Dalia Idar Director of Clinical Systems Development

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1 The EMR & PHR Dalia Idar Director of Clinical Systems Development

2 Maccabi Film

3 The Maccabi Information System 5000 physicians 31 Imaging Centers 300 Lab Collection Points 36 Physiotherapy Clinics Central Laboratory 95 Nurse Stations 140 Primary-care clinics 32 Hospitals 700 Pharmacies

4 Integrated Care Through ICT Every transaction with the patient is computerized Every provider uses the Maccabi Electronic Medical Record Maccabi EMR includes the whole patient record E-Laboratory E- Prescription E- Consultation Telemedicine Alerts and Reminders Physician Portal on web and mobile Patient Website also on mobile

5 IT at the physician s service Billing & Claims

6 EMR Summary (30 different applications) Robert Smith Active Health Problems Chronic Medication Last Visit Dr. Jones - FP Allergies Risk Factors

7

8

9 9

10 Embedded guidelines Drug interaction warnings Prescription prioritization recommendations Mandatory data fields (BP, smoking) Recommended laboratory test alerts Diagnosis-related lab test panels Organizational alerts Rules engine based alerts

11 Print List Recommendations for present visit: recommended referrers delay to next visit Cancel Refer for Cholesterol test Refer for Diphtheria/tetanus Document results & blood pressure measurement Action delay all next visit Confirm Reason Patient suffers from hypertension. No documented Blood Pressure Measures in the last year

12 Less frequent tests

13 Doctor Portal - Patient EMR Main App enabled doctors to view patient s records and respond to immediate issues Launched: December 2011 Platforms:iPhone, Android Patient results Medication Visits Medical Knowledgebase

14

15 Virtual Visits Virtual services in Maccabi : 1. Patient - Doctor 2. Family Doctor Specialist 3. Family Doctor Medical board

16 Virtual Visit- Doctor- Patient Subjects for virtual visit: Request for Medications renewal Referrals for Lab tests Health Information sheets Different medical certificates

17 Create A New Request Requests to doctor Member;Israel israel ID Dr. Leah Lorbin Requests to doctor Member;Israel israel ID Dr. Leah Lorbin You can make a request only if you visited this doctor in the last year OK Create a new request Create a new request

18 Create a New Request cance l MY DRUGS ok New Request Member;Israel israel ID Dr Ido Jacobs Family Physician Member;Israel israel ID Prescription? Choose from your list of drugs Phone : Send request

19 Create a New request Requests to doctor Member;Israel israel ID Dr. Leah Lorbin Your request has been sent successfully. Response within 5 days Close Close Create a new request

20 View of the Request With Response Requests to doctor Member;Israel israel ID Response from Dr Gidi Lorben Dear Israel, Attached are the 3 prescriptions you requested. Sincerely, Dr. Gidi Lorben Prescription: Valid Prescription Valid Prescription Not Valid My request Renew Request

21 Pharmacy WF Request for medication renewal Prescription Patient Web Site/ Mobile Doctor s Clinic Check for Interaction, Over Dose & Eligibility HQ (TA) Pharmacy Check for Interaction, Over Dose & Eligibility

22 Telemedicine

23 Telemedicine Services Service from a Distance (cost, time) Need for 24/7 response Tele-Diagnosis Tele-radiology Tele- ECG/Holter monitoring Tele- multidisciplinary center for chronically ill patients Tele- ophthalmology Tele- US Gynecology Tele-Treatment/ Consultation Video Conference care giver patient Video Conference- home care Video Conference- service station Video Conference-Specialist-Primary Care Tele-dermatology: skin ulcers

24 Tele-Diagnosis Tele E.C.G. Tele Radiology Tele Ultrasound Tele Holter

25 Tele-Treatment & Consultation Tele-dermatology Multidisciplinary center Video Conference Tele-ophthalmology Tele-consultation

26 Empowerment of the Patient (PHR)

27 PHR Personal Health Record (Maccabi On-Line) Personal and secured web site for Maccabi members Includes medical and administrative data Our member can view personal data from Maccabi s systems mainly his medical record Do Online administrative actions Enter his own data

28 Number of Subscribers to Maccabi Online ,600,000 1,400,000 1,384,351 1,462,465 1,252,573 1,200,000 1,130,183 1,000, , , , , , , , , , , , *

29 Administrative Data Test Reports Personal follow up Pregnancy follow up PHR Disease History Calculators History of Treatment Personal Reminders

30 Test Reports

31 Upper limit Results Lower Limit Units Test Name Blood Chemistry Online line functions Personal data Lifestyle General information Personal health record Hematology blood count

32 Lab Results Test Results Test Results Lab X-ray/US Gyn US SKG/Holter PAP First Trimester fetoprotei genetics Test Name Blood Chemistry Online Functions Personal data Lifestyle General information Personal health record Hematology blood count

33 -Referring doctor - Date Lab Results

34 Patients Web Site

35 Drugs List

36 Hello Rachelle Kaye I.D Request for Prescription/ referral Print Prescription Request for Prescription Dr. John Smith Choose Doctor Requests Telephone

37

38 Radiology Results

39 40 E.K.G

40 Personal Reminders

41 תיק רפואי Clinical Support Alerts תיק רפואי תקשורת עם הרופא זימון תור פעולות ומידע מינהלי בתי מרקחת Personal medical recommendations תקציר המלצות אישיות הרופאים והמטפלים שלי תוצאות בדיקות נתונים רפואיים אישיים חיסונים מסמכים ורשומות רפואיות טיפולי בריאות הנפש דף מידע למבוטח סוכרתי כמוני Following are specific recommendations for you according to your age, sex and health status and additional information in our system. Based on this information you can know what you need to do and what you have not done to promote your health Occult Blood in stool Hemoglobin AIC Lab tests This test is recommended annually over age 50. You have not done this test in over a year. We invite you to come to the lab. For patients with diabetes, its very important to measure the level of hemoglobin AIC in the blood annually. Please contact your physician for referral to the test Vaccinations Pneumovax This is a vaccination for preventing pneumonia for people 65+ please go to the nurses clinic in your branch to get vaccinated

42 Calculators

43 Framingham Risk Ruler 44

44 Framingham Risk Ruler 45

45

46 Disease History

47 Diabetic patient s PHR Dear Joseph Kern ID# Data last updated 31/5/2009 Dear member, We are presenting you with your personal data with regard to your Diabetes, The control of your diabetes is largely dependent on your understanding and your cooperation with your doctor. Here is your personal information with respect to several items critical to your health HBA1C Information These data are based on your blood test results and indicate the extent to which your diabetes was under control for the 3 months prior to the test. It is recommended to do this test twice a year or according to your doctor's recommendation. The recommended level for this test is less than 7% Date: 30/9/2009 most recent HbA1C value:8.4% According to our records, your last HbA1C test was more than a year ago, Please contact your doctor for a referral for this lab test Recommended Value 7% LDL Cholesterol Information This is the type of cholesterol that is known to be a risk factor for cardiovascular disease. It is important that a diabetic patient do this test once a year or according to his doctor's recommendation. The recommended value for this test is less than 100/dl

48 PHR Diabetic Profile Eye Examination: this is not a test that can be performed by an optometrist or a test for a driver's license but rather an in-depth eye examination by a qualified ophthalmologist. This test is very important for the early detection of eye problems as a result of diabetes. There are excellent methods for treating these problems if they are detected at the early stages. It is recommended that this test be done once a year Urine protein test: The objective of this test is to identify potential damage to the kidneys as a result of diabetes. If the discharge of protein or albumen in the urine is high, it can be treated by medication. It is recommended to do this test (micro-albumen/creatnine or 24 hour urine collection for micro albumen or protein) once a year. Here are the results over time of the test results in our system

49 Disease management Send Data to

50 Self follow up

51 PHR Applications Documentation and tracking after: Weight Blood pressure Steps Smoking Vaccinations Scan Personal documents

52 Vaccinations

53 Smoking monitor Steps Monitor Tips for reducing Blood Pressure Blood Pressure Monitor Weight Monitor Enter Information: :Date :Systolic / BP Diastolic/ :BP Diastolic Systolic Date Measured

54 Smoking Monitor Steps Monitor Blood Pressure Monitor Weight Monitor

55 Physical Fitness Smoking Monitor Steps Monitor Blood Pressure Monitor Weight Monitor Your weight is less than Recommended. Please consult your Doctor. Enter the following information: Desired weight Height date Current Weight weight

56 Pregnancy Follow Up

57 Main Physicians Urgent Care Clinics Pharmacies Maccabi Branches Labs and diagnostic tests Protected accommodation and hospitalization Maccabi natural

58 Pregnancy Diary A unique application dedicated to Israeli pregnant women needs. Pregnancy scheduling Timeline Tests needs to be done through Pregnancy Explanations for each week Tests results Personal experience

59 Real Time Information for Patient & Provider Leads to Better Health

60 Thank You

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