Harnessing the power of IT and research for better Community Elderly Care. Dr WN WONG Senior Health Informatician (Health Informatics)

Transcription

1 Harnessing the power of IT and research for better Community Elderly Care 香 Dr WN WONG Senior Health Informatician (Health Informatics)

2 DEMAND ON HEALTHCARE

3 Elderly is 4.2 times (relative risk) more likely to be admitted in a single year

4 70% unplanned readmission are elderly (70,000 per year)

5 Hospital Authority 41 Public Hospitals 27,000 Beds 48 Specialist Outpatient Clinics 74 General Outpatient Clinics 1.3 m Hospital admissions 2.1 m Accident and emergency attendances 7.8 m Specialist outpatient / AH Clinic attendances 5.0 m Primary care attendances 0.8 m Community nurse visits HK$35billion Annual Operating Budget (~US$4.2 billion)

6 RISK PREDICTION MODEL RIGOROUS RESEARCH WORLD LARGEST MEDICAL RECORD

7 Identify High Risk Elderly Patients

8 A rigorous Research Multiple logistic regression modeling Accurate and update patient data in central database 9.6 million patient records! Readily available Standardized High quality Good performing prediction model AUC 0.83 at derivation dataset (1.2 million) AUC at 4 validation cohorts (0.3 million each) Predication Model was adjusted on yearly basis if needed

9 Risk Predictors Male Old On social security A&E attendance Acute & non acute admission Acute and non acute hospital stays Chronic obstructive airway disease Heart failure Cancer Ever treated with renal dialysis No of different diagnosis groups on records Emergency admission

10 Adoption of risk prediction model in Community Health Call Centre in HK An innovation to create values

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12 Technical Set Up Phone calls Ini2ate request via , fax or user portal (PABX), Voice Recorder PSTN Self care informa2on Fax on demand (IVRS) Health Advice to discharge pa2ent Community Health Call Centre ( 7 days x 24 hours ) User Profile Data base Protocol & Guideline Call Logging Data Base CMS, epr OPAS Knowledge Data Base Call Centre Systems Auto paging, SMS, and Fax GP, NGO, Pa2ent Medical Professions

13 Community Health Call Centre Objectives Promote preventive care and early intervention, thus reducing avoidable A&E attendance and hospitalization Improve linkage between public and community healthcare services Enhance discharge management Tang Siu Kin Hospital Community Health Call Centre Size Computer terminals Call operators Clinical protocols Active cases (elderly) Accumulated cases 458 sq m ,667 54,665

14 It meets reasonable standards April Apr 2012 Total no of calls No. of outbound calls No. of inbound calls Average calls per follow up Average call duration Average time after call work No. of referral made Service level (Answering inbound call within 20 seconds) 118,000 70% 30% min 6.0 min 4.7% 95%

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16 Electronic Pa-ent Record

17 Clinical Documenta-on

18 Protocol- Based Care

19 Communicate with External

20 Knowledge Base

21 Google Map Search

22 Sta-s-cal Analysis

23 Proven values A&E attendance Emergency admission Acute patient days 27% 26% 19%

24 It is an INNOVATION Risk prediction model application Automated risk stratification Link to largest patient record in the world Support targeted patient care and early intervention

25 Making use of TECHNOLOGY Incorporate risk prediction into Call Centre operation using ICT Telephony & Intelligent Call Routing Call Logging System High risk patient list Access and leverage on huge patient medical records Share records over entire network *Corporate large data warehouse for data analysis and rules running

26 It creates VALUES It saves lives as well 25-50% reduction of hospital utilization HK$ 0.2 Billion annual saving! Adoptable model in other places ~ HK$20 million set up and operation costs

27 just Innovation is not about technology Clinical adoption to realize the benefits and create values for IT Data mining Clinical Research Healthcare application

28 Thanks Community Health Call Centre Steering Committee: Dr PY LEUNG Chief Executive Hospital Authority Chairman Hospital Authority Statistics & Workforce Planning Department: Dr SV LO Director (Strategy & Planning) Ms Eva TSUI Chief Manger (Statistics and Workforce Planning) Dr WL CHEUNG Director (Cluster Services) Dr Doris CHONG Senior Statistician (Service Planning & Research) Dr Daisy DAI Chief Manager (Primary and Community Services) Mr Alan CHEUNG Manager (Service Review & Research) Ms Sylvia FUNG Chief Manager (Nursing) / Chief Nurse Executive Mr Raman SHEA Senior Statistical Officer (Service Review & Research) Dr CP WONG Cluster Service Director (Primary and Community Health Care), HKEC Dr Augustine LAM Cluster Coordinator (FM&CHS), NTEC Others: Dr Eva DUNN Cluster Services Director (Mental Health), HKEC Mr Andre GREYLING Chief Information Officer, Information Technology Dr SF HUNG Service Director (Mental Health), KWC Dr SY AU Honorary Consultant, TMH Dr TL LO Chief of Service, Kwai Chung Hospital Ms Joan HO Department Operations Manager (IMS2), RHTSKH Dr HF HO Cluster Service Co-ordinator (Medical), KCC Dr Loretta YAM Honorary Consultant Physician, PYNEH Dr NT CHEUNG Chief Medical Informatics Officer Dr Bennie NG Senior Manager (Elderly Services), Hospital Authority Mr Anthony CHEUNG Chief Systems Manager (Clinical Systems) Community Health Call Centre IT Working Group: Dr CP WONG Cluster Service Director (Primary and Community Health Care), HKEC Chairman Dr Daisy DAI Chief Manager (Primary and Community Services) Co-chairman Dr Christina MAW Senior Manager (Elderly and Community Care) Ms Veronica HONG Manager (Elderly and Community Care) Dr TK WONG Associate Consultant, KEC Dr Y CHOW Associate Consultant, Kwai Chung Hospital Ms Patty KWONG Advanced Practice Nurse I/C (Community Health Call Centre) Dr NT CHEUNG Chief Medical Informatics Officer Dr WN WONG Senior Health Informatician (Health Informatics) Dr Sharon WONG Health Informatician (Health Informatics) Ms Angela LAU Health Informatics Analyst I (Health Informatics) Mr Anthony CHEUNG Chief Systems Manager (Clinical Systems) Ms WY TANG System Manager (Information Technology)

29 Thank You Innovation and Research Grand Award Gold Award (Open & Postgraduate) Commercial value

30 It helps in various ways Types of Call Centre Phone Services Provided (87,938) No. of Referral Made (3,545) Home Safety Advice 9% Medication Management 27% Community Resources 34% Early SOPD 3% NGOs & others 21% Community & Allied Health 4% Emergency Department 52% Health Education 30% Private Doctor 20%

31 Collabora-ve Work NGOs District Elderly Care Center Volunteers Community Allied Health GOPCs GPs Hospital Service Community Nursing Service 31

32 It contributes to the SOCIETY Enhance quality of life of elderly patients Lessen burden to organization Work in more sustainable way collaborating with other healthcare services

33 Going Beyond RESEARCH Research based on clinical needs and leverage on accurate data Prediction model with accuracy Validation before use and continuous finetuning Proven effective to reduce hospital readmission and attendance

34 It makes USER HAPPY It is extremely user friendly It is capable It saves time and effort

35 Extending to Diabetes Mellitus Mental Illness