The ecosystem of the OpenClinic GA open source hospital information management software

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1 The ecosystem of the OpenClinic GA open source hospital information management software HEALTH FACILITY INFORMATION SYSTEMS AND INTEROPERABILITY FRANK VERBEKE, VRIJE UNIVERSITEIT BRUSSEL

2 OpenClinic login login: vub password: guest

3 HIS Models: interfaced systems Best of breed Natural growth path for EHR functionality Populating of Clinical Data Repository by HIS components through Interfaces Clinical Data Dictionary Advantages Progressive system expansion Select best products available Disadvantages High costs of data integration Many interfaces to maintain & support Multiple vendor management Complex backup policy System availability harder to manage

4 Interfaced systems Pharmacy Lab X-Ray ADT MPI Interfaces Clinical Data Dictionary Clinical Data Repository CPOE Nursing system Clinical documentation Reporting Other

5 HIS Models: integrated systems Unified database Single database, not necessarily single vendor = Clinical Data Repository Minimizes/eliminates need for interfaces Becoming more popular in inpatient environments Standard in outpatient/private practice environments Advantages Single vendor No interfaces required Complete data integration Efficient backup management System availability easier to manage Disadvantages Single vendor may not provide best solution for every component

6 Integrated systems Pharmacy Lab X-Ray ADT MPI Clinical Data Repository / shared database CPOE Nursing system Clinical documentation Reporting Other

7 HIS modules & interoperability issues Patient identification Human resource management Health insurance management & universal health coverage Clinical coding Electronic medical record Nursing system Lab information management system Medical imaging Pharmacy management Health reporting

8 Patient identification Unique patient identifiers at different levels: universal, national, subnational, health facility, departmental Universal: biometrics (fingerprints, retina scan) National: national ID registries, ID cards (machine readable) Subnational: health facility groups, health programs, ID cards (machine readable) Health facility: ID cards (machine readable), Health record IDs Departmental: Health record IDs Commonly used weak identifiers Last name, First name, Date of birth, Phone numbers Privacy risks Interoperability issues Shared master patient index at the highest practically achievable level Multi-criteria patient searches

9 Human resource management Keep track of Work contracts Work schedules Skills Leave Training & education Salary & payments Interoperability issues Health worker identification: national registration bodies, professional councils. User ID cards, fingerprint identification (attendance control systems) Single sign on issues, access rights management (account deactivation!) Centralization of (public) health sector workforce data (ihris, NHIS, GIS)

10 Health Insurance Management Health insurer identification Health insurer registry Health insurer coverage plan management Simple reimbursement plans (percentage, lump sum) Complex reimbursement plans Insurer specific reimbursement base (supplements charged to patient) Different reimbursement rules for in- and out-patients Limitations of number of reimbursable health services per period of time or episode of care (e.g. ultrasounds / pregnancy) Complementary health insurance plans (very poor patients, HIV+, public servants ) Multiple health insurance schemes possible for each patient Interoperability issues Health services nomenclature missing or unreliable Verification of health insurance status of a patient Electronic transmission of invoiced items from care provider to health insurer

11

12 Clinical coding Reasons for encounter & diagnostics International classifications: ICD-10, ICPC-2, DSM-4, SNOMED Many local classifications (not standardized) Need for coding aid (insufficiently skilled health workers) Clinical thesaurus (3BT), keyword & clinical concept based) Multi-classification coding (code mapping) Complementary information Certainty Seriousness / gravity (Burden of disease WHO) Problem list management DRG reporting Interoperability issues Code mapping onto national clinical databases (DHIS2, Global Health Barometer, NHIS & GIS) Linguistic issues (lack of translation, different clinical concepts in different languages) Disability Adjusted Life Years DALYx = YLLx + YLDx Where: DALYx = DALY for clinical condition x YLLx = Years of Life Lost due to premature death caused by clinical condition x YLDx = Years Lived with Disability caused by clinical condition x = [Incidence x] x [Average disability duration x] x [weight x]

13 Electronic Medical Record Many different clinical documentation needs for different specialties Specific content for the health care sub-domain (HIV, Diabetes, Stomatology, Gynecology ) Different medical schools & health professional individualism Level and objectives of the health facility Workload Qualifications of care providers Diagnostic capabilities Standardization of clinical content Lots of free text, minimal use of international standards in routine clinical documentation Interoperability issues Electronic transfer of clinical information between health facilities Combining the general medical record with vertical health program records

14 Nursing system Interaction with physicians order entry modules Drug prescriptions Care prescriptions Diagnostic prescriptions (lab, medical imaging) Nursing health record Biometrics & vital signs In-patient follow-up records Limited access to diagnostic & pharmaceutical prescribing Integration with billing modules

15 Lab information management system Identification of lab analyses Internal laboratory codes, exceptional use of internationally standardized LOINC codes Reference values management Result editor management Lab order entry Lab order profiles & lab prescription normalization, integration with billing Hospital wide, departmental or user specific lab order forms SMS & notification of results availability Lab results data entry Specialized editors (numerical, option lists, microbiology) Traceability Interoperability issues Automatic lab analyzers (sample identification, results transmission) Lab results messaging systems (SMS gateway, SMTP gateway) Microbiology reporting (WHONET)

16 Medical Imaging Identification in radiology & other imaging procedures Internal procedure codes, exceptional use of CPT codes Study, series, instance, modality, operator identification Computerized Order Entry Order identification &tracking Radiology workflow management -> efficiency Modality connectivity HL7, DICOM Integration of (DICOM) images in electronic health record (DCM4CHE & WEASIS) Regional PACS solutions ImageHub, AfriPACS

17 Medical Imaging not part of a holistic patient approach today in low resource settings Film & development products costs Supply chain problems Digital imaging offers major opportunities: Cost reduction Computerized Radiology Digital Radiology

18 Pharmacy management Pharmaceutical products management Packaging Dose, dispensing schema Billing International ATC codes Pharmaceutical stock management Multiple stocks Batch management Traceability (pharmacovigilance) Order management Reporting

19 Health reporting Many health data from different information sources Health facility context (level, management, covered population ) Financial activity (income, expenses, capital, investments, immovable) Health insurance & universal health coverage (e.g. free health care programs) Clinical activity (out-patient, in-patient, RFE, diagnostics, target health programs) Operating theatre activity Pharmacy (stock information, pharmaceutical in/out transactions) Lab activity (analyses performed, analysis results distributions) Medical imaging Human resources information (HRH category numbers, recruitments, discharges) Interoperability issues Lack of international/regional standardization of data elements & health indicators DHIS2, ihris, NHIS, Health insurances Different coding systems used for the same data, different aggregation criteria (age classes, gender ) Lack of international aggregate data reporting protocol (SDMX-HD abandoned, DXF2?) DHIS-2 middleware API, IMIA-HELINA CHEDAR initiative, WHO/Unicef initiatives Many different legacy national & health program reporting instruments to support

20 The Global Health Barometer project International datawarehouse for health related information Monitoring & evaluation Financial data Morbidity Mortality Human resources Operational support Nearly real time bed occupancy information Server performance ID card production Integration with other datawarehouse projects based on DHIS-2

21 IMIA Global Health Informatics & Interoperability WG Bring together experiences & identify solutions for the global health sector Share Open Source modules and components Standardize information and methods in healthcare Frank Verbeke,

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