Keep Faith and Strive Forward Development on China s Hospital Information Systems

Transcription

1 Keep Faith and Strive Forward Development on China s Hospital Information Systems SHEN TAO Deputy Director Chinese Hospital Information Management Association

2 CHIMA Chinese Hospital Information Management Association Established in 1997, and attached to Chinese Hospital Association The most influential HIT professional association in mainland China Health Informatics Society of Australia Established in 1992

3 Agenda Background HIT Construction Features in China Obstacles and Challenges

4 billion China Healthcare Industry Brief With the development of economy, the public have higher demands for their health and pay more attention to healthcare service quality Change on way of life leads to the result that chronic disease become the main economic burden Continuous growth on urbanization: 54.77% by 2014 Aging problem becomes more serious: 212 million aged 60 and above, account for 15.5% China Total Health Expenditure provinces and municipality cities billion people thousand medical institutions 24.7 thousand hospitals 9790 thousand medical staff 2795 thousand licensed doctors Mainland Source: China Statistical Yearbook, 2014

5 Main Drivers of HIT Development Mar. 2009, the government launched medical reform Nov. 2013, the overall framework of HIT construction is issued by the government Promote HIT construction that focus on hospital management and EMR Promote cooperation of urban hospitals and communities via IT Positively develop telemedicine that oriented on rural and remote areas Rapid growth on healthcare demands Payment model reform (DRGs, zero drug price difference); healthcare service supervision and performance evaluation Medical Institutions Demand Government Policy HIT Cost control and fine management; work process optimization, better patient experience 4 levels of HIT platform 6 applications on public health, family planning, healthcare, medical insurance, drug management and comprehensive management 3 data bases for demographic information, EHR, EMR IT Development 1 private network 2 security systems Rapid development and years accumulation of IT 30 years accumulation on healthcare institutions IT construction Emerging of new technologies: virtualization, cloud computing, big data, IOT, mobile

6 Agenda Background HIT Construction Features in China Obstacles and Challenges

7 Investment Scale Keeps Growing billion % Public Health Healthcare Institutions Growth % 40% % 72.2% 23.8% % 71.7% 22.6% % 70.2% % 21.0% 69.3% 31.4% 22.5% 68.6% 20.0% 68.0% 30% 20% 10% (E) 0% Source:CCW Research (2015)

8 Hospital IT Investment in Latest 3 Years million above below 0.5 Non-response 3.0% 0.0% 12.5% 3.4% 14.0% 0.9% 17.0% 7.7% 18.5% 24.7% 7.8% 14.0% 2.7% 17.0% 2.4% 13.2% 22.1% 19.2% 0% 10% 20% 30% Tertiary Hospitals(N=335) Non-Tertiary Hospitals(N=235) Source: Survey on China Hospital IT Status (CHIMA)

9 Obviously Rising Attention on Clinical Related Applications Government healthcare service supervision and performance evaluation. Real-time monitor on healthcare quality (urgent lab value, HAI). Important data source for clinical research 4 Data utilization is regarded gradually 1 EMR is generally accepted Advocated by healthcare administration bodies, generally accepted by doctors and the public EMR Adoption Higher CIS adoption rate Attention to system integration technology Push forward the whole development of CIS 3 Writing software become mature What see is what get + structured module + free text entry is basically settled. Mainstream products functions become convergence 2

10 National Push on EMR Adoption 1 Feb 2010, The Basic Specification of EMR 2 Sep 2010, EMR Trails Work Plan Dec 2010, The functional Specification of EMR 3 4 Experience based, gradually generalize Oct 2011, Model of EMR Grading(MEG)

11 EMR Adoption Status Implemented 27.1% 71.1% Plan to Implement 7.7% 34.6% No Plans Yet 21.2% 38.3% 0% 20% 40% 60% 80% (N=570) (N=926) Source: Survey on China Hospital IT Status / (CHIMA)

12 Drive All-round CIS Construction Inpatient Nurse Workbench Inpatient Doctor Workbench Outpatient and Emergency Electronic Medical Record(EMR) Laboratory Information System(LIS) Radiology Information System(RIS) Ultrasonography Information Clinical Knowledge Repository ICU Information System Pathology Information System PACS Clinical Pathway Management Physical Examination Endoscopy Information System ECG Information System Clinical Decision Support System Infection/HAI Surveillance System Telemedicine system Anesthesia Information System Regional Health Information 75.3% 74.6% 48.0% 74.2% 45.9% 71.1% 27.1% 71.1% 43.8% 67.7% 31.4% 58.1% 29.9% 56.3% 0.0% 52.6% 9.9% 51.6% 22.6% 45.8% 24.8% 44.6% 3.1% 36.8% 0.0% 36.3% 0.0% 32.6% 29.3% 18.9% 7.9% 23.2% 0.0% 19.7% 0.0% 16.8% 16.3% 24.4% 8.8% 5.6% (N=570) (N=926) 0% 20% 40% 60% 80% Source: Survey on China Hospital IT Status / (CHIMA)

13 Items Roles Items Model of EMR Grading(MEG) Requests and Treatment Records Patient Assessment Appointments Surgery Scheduling, and Management Patient Records Registration and Records Order Execution Report Generation Anesthesia Nurse Documents Images ICU Monitory Data Quality Control Inpati ent Physici ans Inpati ent Nurses Outpa tient Physici ans Ancillar y Dept. and Service s Labora tory Proced ures Other Ancilla ry Dept. Recor ds Manag ement EMR Infrast ructur e Order Entry Order Entry Sample Processing Blood Preparation Data Storage Lab Test Requests Lab Requests Result Records Blood Matching E-authentication and View Lab Reports View Lab Reports Report Generation and Use e-signature Exam Requests Exam Requests Outpatient Data Access Control View Exam Reports View Exam Reports Pharmacy and Auditing Inpatient Reports Clinic Visit Notes Inpatient Pharmacy Backup and Disaster Clinical Knowledge Clinical Knowledge Recovery Bases Bases

14 2014 MEG Result Eastern Middle Western Grade 4 Grade 5 Grade 6 Inpatient 5.6% Grade % 0.3% 0.2% Grade % EMR Infrastruct ure Records Manageme nt Physicians Inpatient Nurses Outpatient Physicians Grade % Grade 1 Other Ancillary Dept. Ancillary Dept. and Services 10.4% Procedures Laboratory Source: National Institute of Hospital Administration

15 2014 MEG Result Gra des Description Percenta ge, 2013 Amou nt Percenta ge, 2014 Amou nt Fully-featured EMR and regional healthcare information sharing Close-loop medical data management and advanced CDS Centralized data management and consolidation of data from different depts. Hospital-wide information sharing and intermediate CDS Interdepartmental data exchange and primary clinical decision support(cds) 0.04% 1 0% % % % % % % % % Departmental data exchange 22.33% % Departmental data collection 11.1% % EMR not available 49.21% % 1216

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17 M-Health Application Continuous Active Wireless network 20.7% 45.8% PDA Tablet PC 7.1% 10.9% 20.2% 27.2% RFID 6.2% 15.3% Cloud Computing Internet of Things 0.0% 0.0% 9.5% 14.6% 0% (N=570) 20% 40% (N=1028) 60% Source: Survey on China Hospital IT Status / (CHIMA)

18 Mobile Ward Round Typical M-Health Applications Mobile Nursing Outpatient Infusion Management

19 Medical Waste Management Equipment Positioning Typical M-Health Applications APPs: Appointment Query Guidance Payment

20 Data Value Gradually Showed Compliance Check of Medical Insurance Use Control of Antibiotics Clinical Pathway Management Reminder of RDU

21 Data Value Gradually Showed HAI Monitor Lab Urgent Value Alert DRGs Expense Analysis Clinical Research

22 Focus on Improving Medical Experience Self-Service One-Card Service Model WeChat, Smart Phone

23 Example of Regional HIT Construction HIT private network in Fujian province: 5 levels province, city, county, township and village 86 healthcare administration bodies 1356 public healthcare institutions 10 military hospitals 37 private healthcare institutions village clinics in the future Shanghai

24 Push Forward Residents Health Card Regional trials in 29 provinces Blood Collecting and Supplying organizations MCH Organizations Communities CDC Comprehensive Hospitals New Village Cooperation Healthcare Institutions First-Aid Centers

25 Agenda Background HIT Construction Features in China Obstacles and Challenges

26 Obstacles of HIT Development in China Lack of Adequate Financial Support Lack of Staffing Resources Vendors Inability to Deliver Product Difficulty Proving ROI Lack of Medical Data Standards Lack of Strategic IT Plan Lack of Top Management Support Difficulty Achieving End-User Acceptance Lack of Clinical Leadership Lack of Legal or Policy Support Unsuccessful Implementation of IT Plan Others 3.3% 3.7% 26.7% 25.6% 25.3% 20.4% 17.2% 51.1% 41.8% 41.1% 38.4% 67.9% 0% 20% 40% 60% 80% Source: Survey on China Hospital IT Status (CHIMA)

27 Rapid-growth but Insufficient Investment 20% 15% Total Health Expenditure as % of GDP 17.1% 10% 9.4% 5% 5.6% 0%

28 Imbalance of Regional Development Different regions and hospitals present different HIT development level Economy Leadership Talents Eastern Middle Western Inpatient Physicians EMR 4 Inpatient Infrastruct 3 Nurses ure 2 Records Managem ent 1 0 Outpatien t Physicians Inpatient Physicians EMR 4 Infrastruct 3 ure 2 Records 1 Manageme nt 0 Other Ancillary Dept. Inpatient Nurses Outpatient Physicians Ancillary Dept. and Services Non-Tertiary Hospitals Tertiary Hospitals Other Ancillary Dept. Procedure Ancillary Dept. and Services Laborator Procedures Laboratory s y

29 Lack of IT Talents Critical shortage of multi-disciplinary talents in healthcare institutions Average IT FTEs in Chinese hospital is 9 (tertiary 12, below tertiary 5) Survey on China Hospital IT Status (CHIMA) Average IT FTEs in American hospital is th Annual HIMSS Leadership Survey Difficulty in breaking through system dilemma in short term Unsatisfactory in education system Long training cycle, Insufficient pay in return, Lots of temptation from outside

30 Vendors Incapability to Meet Users Needs Lack of clear understanding on the complexity and difficulty of HIT industry needs for products development Lack of professional talents Low market concentration 2622 hospitals attended MEG, EMR vendors Total users number of top 10 vendors is 796, account for 30.4% Top 1 vendor s user number 149, account for 5.7%

31 Number of Users Average Grade Top 10 Vendors, Number of Users, C62 C1 C17 C11 C15 C6 C19 C10 C13 C16 EMR Vendor Code 0.00 Source: National Institute of Hospital Administration

32 Low Degree of Standardization ICD % 72.7% DICOM3 ICD9 38.3% 37.7% 28.5% 52.5% HL7 21.8% 37.7% SNOMED LOINC Others Non-response 6.1% 5.4% 5.4% 3.8% 11.4% 18.6% 3.3% 5.6% 0% (N=570) 20% 40% 60% (N=1028) 80% Source: Survey on China Hospital IT Status / (CHIMA)

33 Conclusion Developing Is an Unyielding Principle May this conference be a complete success! Qui cherche trouve Whoever seeks shall find