1 This document is protected by copyright. No part of this document may be reproduced manual or otherwise, in whole or in part, without the prior, written consent of Health System Technologies (Pty) Ltd. GLOBAL ICT TRENDS IN HEALTH PRESENTED BY: GERRIT HENNING CEO: AMETHST (PTY) LTD Focus on HIS: Hospital Information Systems
2 Agenda Review of Hospital Information System (HIS) Functionality Global Adoption of HIS Design of Modern HIS Systems EMR (Clinical HIS) EHR / Interoperability ICT in Health Outcomes? Relevance of Modern HIS in the South African Context
3 Hospital Information System (HIS) Comprehensive Information System, designed to manage the Administrative, Financial and Clinical aspects of a hospital and it s services. Generally Modular, allowing hospitals of various levels of maturity, capacity and financial status to implement according to their individual profiles.
4 Traditional HIS Functionality Patient Administration Revenue Management Departmental Systems Clinical Functions Registration (PMI) Billing Pharmacy Physician Workstation Inpatient Flow (ADT) Accounts Receivable Laboratory IS Nurses Workstation Outpatient Flow Claims Management (EDI) Radiology IS Order Entry Emergency Flow Interface to Hospital GL Operating Theatre Results Reporting Medical Records Tracking Blood Bank Charting Diet Management Drug Administration Integration Tool (or point-to-point) Financial Systems, HR & Supply Chain Management Business Intelligence Solution
5 Global HIS Adoption Patient Administration Revenue Management Since 1960 s, driven by Operational and Financial Requirements, adoption of HIS (PAS & Billing & Pharmacy & Lab) across the Globe Relatively High. Similar phenomena for both Public and Private Sector Hospitals. South Africa following similar trend where HIS s are implemented. Selected Departmentals (Pharmacy & Lab & Radiology) Relatively High Adoption Rates Globally Factors: Increasing Medical Costs Emphasis on better administration, management and collection of revenue
6 The Electronic Medical Record (EMR) a Clinical HIS Since mid-90 s Global Emergence of the Electronic Medical Record (EMR) not just in Hospital Settings also in private practices Patient Administration Clinical Departmentals Clinical Functions Patient- centric EMR Patient-Centric view of a patient Mostly Limited to a single facility Mostly adopted by developed countries By Very high EMR adoption rate by physicians in NZ, Australia and UK especially in outpatient settings - almost 100%, US around 60% Limited adoption in SA At hospital level all countries still ramping up to become digital or paperless/filmless This document is protected by copyright. No part of this document may be reproduced manual or otherwise, in whole or in part, without the prior, written consent of Health System Technologies (Pty) Ltd. Electronic Patient Medical Record Unique Patient ID Patient Demographics and Medical History Medication and Drug Administration Interventions (Lab, Radiology, Theatre etc) Clinical Notes & Charting & Procedures Creation of Electronic Visit/Disch Summaries
7 The Clinical HIS (EMR) Digital Hospital Tele Medicine Tele-Radiology I/f WEB Executive WEB Electronic Health WEB Information System Record Modalities Ultrasound Other Clinical Images DICOM DICOM DICOM Imaging PACS Medical Imaging Archiving HL7 WEB RIS LIS Radiotherapy WEB Scheduling Order Management Hospital Information System EMR Clinical Workstation Administration HL7 EMR Pharmacy EXPERT SYSTEMS Critical Care OT System WEB ehr Backoffice (Finance, HR) Clinical & Admin This document is protected by copyright. No part of this document may be reproduced manual or otherwise, in whole or in part,
8 Design of a Good Quality Clinical HIS: Accessibility at Point-of-Care Accessibility at the point-of-care through point-of-care terminals any combination of: Portable workstations (COW s) Laptops Wireless tablets Hand-held computers Personal digital assistants (PDAs) Point-of-care technology obviates the need to re-enter data from notes after rounds are completed. This improves recall and avoids redundancy in the work process, saving time that can instead be devoted to patient care. Reduces the possibility of introducing errors in data capture ensures that the Patient (Citizen) centric EMR is collated in Realtime.
9 Design of a Good Quality Clinical HIS(EMR): Clinical Functionality Modern UI Design allowing Physicians, Nurses and other Healthcare Professionals to interact with the HIS productively; must not be an obstacle Patient (Citizen) Centric with all relevant patient demographics and mechanisms to reduce duplicate identities. (ID Cards Smart or not?) (Use of Biometrics) Record History and physical exam documentation and progress notes. Workflow driven, rather than menus/functions. Role-based. Order Entry & Results Reporting Available as part of HIS (Realtime) Doctor and Nurses Documentation (Progress Notes & Charts); automated Summaries and out-of-limit reports. Critical Event detection and automation Alerts; Integrated Infection Control Capabilities; Integrated Business Intelligence Capabilities Electronic Referral Capabilities. Good news...?
10 Design of a Good Quality Clinical HIS(EMR): Critical Event Detection HIS Allows Event Detection and Alerts to be deployed rapidly. An Example:
11 HIS and Infection Control Critical for an HIS to be integrated into an Infection Control System or HAI (Healthcare Associated Infection) Surveillance and Case Management System HIS (ADT) and EMR Laboratory Inf System Infection Control System Pharmacy System Automates data collection required by Hospital s Infection Control Team Provides Realtime Alerts and early detection of potential outbreaks enabling pro-active measures to prevent Infections spreading in hospitals Freeing up beds typically blocked by HAI patients Reducing Medical Costs Reduce Antimicrobal misuse and decrease resistance patterns
12 HIS and Business Intelligence Critical questions about the quality of patient interactions need to be answered, such as: What treatment regimen yields the best outcomes for patients with this genetic profile? What insidious drug interactions are we likely to see in a patient with these risk factors? How well does this combination of therapies help patients undergoing this procedure? What protocol produces the best rehabilitation results for this target population? Now, with new sources of digital data BI can be employed not just to improve medical practices, but also the practice of medicine. (e.g Analysis of alternative treatments)
13 HIS and the Organisation Implementation of HIS, specifically as it pertains to clinical modules, is a major challenge. Main obstacles are organisational and cultural, rather than technological. Have to involve all stakeholders, senior management, ICT Staff, vendors, all user communities such as physicians, nurses and support service professionals. Users need to feel that they own the system and that they are deriving benefit. Ownership ensures buy-in from various stakeholders. Physician/Healthcare Professional s buy-in is of critical importance.
14 The Clinical HIS (EMR) NOT sufficient on it s own Silo s of data at different institutions Patient-centric information (EMR) limited to facilities Sharing of EMR s are critical to achieve: A Longitudinal Patient-Centric Record of Care Across institutions Allowing for collaboration Sharing according to standards This leads to an EHR Electronic Health Record
15 Primary/Community Secondary and Tertiary Healthcare Electronic Medical Records (EMRs) at Primary Health Information Systems Electronic Medical Records (EMRs) at Hospital Information Systems without the prior, written consent of Health System Technologies (Pty) Ltd.
16 EHR Definition The electronic health record (EHR) is defined as a longitudinal collection of electronic health information about individual patients. ehealth portal Health Information Sharing ehealth portal Citizens View information Health Information Creation Primarily, it will be a mechanism for integrating health care information currently collected in both paper and electronic medical records (EMR) for the purpose of improving quality of care. Transcending the Silo s of information. Healthcare Providers, Specialists & Hospitals Patient Summary (allergies, chronic diseases, ) Prescriptions, dispensed drugs & current medication Referrals Lab results Hospital Episodes Government Agencies Input for key performance indicators Public Health Surveillance EHR (Longitudinal Record) Integration Healthcare Enterprise (IHE) Medical Emergency Existing IT systems Research Home Care Hospital/Clinic HIS/CIS Patient Summary Prescriptions Discharges summaries Lab Results Radiology Images Pharmacies Primary care systems Radiology Labs This document is protected by copyright. No part of this document may be reproduced manual or otherwise, in whole or in part,
17 HIS and EHR and Interoperability Interoperability is a Key Criteria for modern HIS Systems (applies across the board for all EMR s) Interoperability of Modern HIS Systems based upon compliance to standards: HL7, DICOM, ebxml, Web Services Clinical terminologies services ICD, LOINC, SNOMED,... Product certification IHE compliance
18 HIS and EHR and Electronic Referrals Electronic referral management (e-referral) provides an alternative to the cumbersome paper-based referral processes. Only through e-referral can healthcare organizations improve information exchange. Multiple benefits: enhanced provider collaboration more efficient care coordination improved care quality and safety reduced no-shows higher satisfaction rates from clinicians, patients and community health partners.
19 ICT in Health outcomes? Well-documented studies since mid-90 s in developed countries, specifically with regard to HIS indicate significant positive changes in relation to: Increase efficiency and effectiveness of healthcare Avoiding duplicate / unnecessary diagnostic or therapeutic interventions Enhanced communication possibilities between healthcare providers Making Electronic Health (Medical) records accessible at point-of-care Enhances Professional productivity and efficiency of interventions Not looking for lost folders / data Quality of care and reduction in medical errors No transcription errors ICT deployment a unique opportunity to improve work processes by the reassessment of work processes that must be changed to accommodate system impacts.
20 HIS / EHR and Cost Saving EHR implementations contribute to cost saving. In a U.S. large east coast hospital it was found that EHRs saved $9,000 to $19,000 annually per physician FTE. Savings achieved through a decrease in costs for record retrieval, transcription, non-formulary drug ordering, and improvements in billing accuracy. In radiology, storage of digital pictures and the use of a picture archival and communication system significantly decreased the turnaround time for radiology image interpretation from 72 hours to only 1 hour. However, there is significant front-loading of costs prior to achieving such savings. Ensure that HIS systems are standards-compliant to reduce the costs of integration.
21 HIS/EHR and Medical Error Reduction (US Experience) In the U.S., the Institute of Medicine (IOM) has estimated the number of annual deaths from medical error to be 98,000. Most errors are the result of communication, transcription, and lack of access to evidence. Between 6.5% and 20% of hospitalized patients will experience an adverse drug event (ADE) during their stay. Both quality and cost of care suffer. The cost for each ADE is estimated to be about $2,000 to $2,500, mainly resulting from longer lengths of stay and the U.S. National Committee on Vital and Health Statistics (NCVHS) reported that about 23,000 hospital patients die annually from injuries linked specifically to the use of medications. Estimated that over 500,000 fewer adverse events will occur over the next 20 years, a result of an expected 50% decrease in drug dispensing and administration errors. The decrease in pain, suffering, and length of stay from drug errors is estimated to result in $93 billion in savings over 20 years. Furthermore, besides the improvement in quality and efficiency of care, avoidance of litigation, decreased malpractice premiums, and reduction in inventory carrying costs will be added benefits accrued from improved information management. Manual entry of orders, use of non-standard abbreviations, and poor legibility of orders and chart notes contribute to medical errors. Since the late 1990s, there has been increasing pressure for hospitals to develop processes to ensure quality of care. The Joint Commission and the Leapfrog Group, a voluntary consortium of large employers, have pushed patient safety as a high priority aiming at the reduction of preventable medical mistakes, encouraging health providers to publicly report their quality and outcomes, and promoting the idea of rewarding professionals and hospitals for improving the quality, safety and affordability of health care.
22 Summary: Global Trends in Health ICT General Global Trends
23 Relevance of Modern HIS / EMR / EHR in SA Context (Focus on NHI) Both public and private sector Healthcare Institutions will benefit from the transition to Clinical HIS Solutions (EMR S) based on NHI Requirements: Patient care to be collaborative Patient Care to be patient-centric Focus on Primary Healthcare (Schools and Communities) Focus on Infection Control Referrals strictly managed Protocols to be adhered to strictly Implementation of DRG s All of the NHI objectives closely resemble global trends much of which Clinical ICT is playing a significant role in helping to manage : COLLABORATION, PATIENT-CENTRIC HEALTHCARE, PREVENTATIVE CARE ( WELLNESS )
24 In the News... On March 10, 2012, the Los Angeles Times published an article with the following heading: "US Government pushes healthcare providers to share records electronically" The article goes on to make the following points: Medical Providers must have the capability for exchanging patient data by More than USD27Bn has been spent (by govt) since 2009, "to computerise the healthcare system buried in paper" The aim is: to improve care by providing instant access to vital patient information help control costs by eliminating unnecessary and duplicative tests and procedures.
25 Q & A? THANK YOU FOR ATTENDING. Popular Mechanics: March 2012 Please contact us for any further information: Gerrit Henning Leon Wolmarans Andrew Connold -
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