Building a Health Systems IT Software
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- Charles Summers
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1 Building a Health Systems IT Software International Conference on Open Source Systems and Technologies 2010, Lahore, Pakistan December 23, 2010
2 Agenda Components of a Health System IT system requirements Self sustaining Health System Mapping onto an IT system Existing Open source IT systems Health IT standards One such integrated system Conclusion Website: [email protected] Page 2
3 Components on Health system Payors Insurers Third Party Administrators: Liaison with hospitals on behalf of insurers Providers: Hospitals, clinics, labs, pharmacies Insurers Hospitals / Clinics Labs / Diagnostic Centers End Consumer In much of developing world payors and providers mostly work independently Third party Administrators Pharmacies Website: [email protected] Page 3
4 IT system requirements Each role has different IT / data requirements: Insurers & Third Party Administrators (TPA): Membership enrollment, renewals Member details demographic details of family & individual members Hospital / provider claim details / breakup Provider rate lists Logic to see if the treatment is covered, amount charged correct Providers: Clinics: Consultation details like patient name, ID, chief complaint, symptoms, physical exams done, diagnosis, medications prescribed Appointments / followups Website: [email protected] Page 4
5 IT system requirements (contd) Providers (contd): Hospitals: Administrative: Admission & discharge, room / bed / inventory availability Medical: Test results, procedures done, prescription changes, review notes Bill details: Items used, amount, rate charged at Labs: Test prescribed, conducted, test results Pharmacies: Prescriptions Drug inventory management drugs sold / dispensed, drugs ordered, order status, current inventory Website: [email protected] Page 5
6 Key questions Is it Ok / enough to look at each of the requirements in silos? If not, how can each of the components be linked? Website: [email protected] Page 6
7 Self-sustaining Health System Consumer adoption & awareness Financially selfsustaining Manage provider network Consumer support services Sales / enrollment agents Financial structuring Doctor Healthcare Quality Control Consumer awareness Basic insurance risk mgmt Hospital / Nursing Home Consumer data mgmt Preventionpromotive techniques Reinsurance Diagnostic Lab Cash flow mgmt Feedback on quality of service Tight operational control Drugs and Pharmacy mgmt Claims mgmt Introducing preventive elements community heath workers (CHW) Website: [email protected] Page 7
8 Mapping onto an IT system Monitoring and Evaluation Create, Conduct Surveys. Add Survey data Export data for analysis CHW Training Activities Followups Sales Counsellings Demographic People and households Geography OPD Medical History Visits by Provider or Location Insurance Preauthorizations Claim line items, reviews Hospitalization Hospitalization details (consultations, tests, medications) Cost items Supply Chain Management Order drugs / health products, manage / track inventory / order status Administration Organization, staff members, schemes Family / individual Enrollment in schemes Website: [email protected] Page 8
9 Looking at System in entirety Some sample health system facts Diarrhoea & pneumonia mostly responsible for Infant Mortality Water borne & communicable diseases - significant portion of primary care morbidity in developing world. Often result in hosptializations Preventive interventions (eg clean drinking water, ORS) reduce morbidit Early primary care for conditions like malaria handle it better for later Affordable health system for developing world => such patterns have noticed and dealt with early Looking at individual components isn't enough! Website: [email protected] Page 9
10 Existing Open source IT systems Consultation management (electronic health records) FreeMED, GNUmed, OpenEMR, OpenVistA, ClearHealth All handle consultation records, appointment scheduling Claim management Trilonis designed for insurance / TPA management. Current status not available. Supply chain management (for drugs, health products) - Enterprise Resource Planning (ERP) softwares: OpenERP, weberp, openbravo, opentaps Website: [email protected] Page 10
11 Existing IT systems (contd) Systems focus on only one part of the functionality => doesn't allow for queries across different parts of the system eg: What is the incidence of diarrhoea amongst those taking in chlorinated water? What is the current inventory of drugs based on prescriptions made by the doctor in EHR? Can standards help overcome the issue? Website: Page 11
12 Health IT standards To enable individual systems to talk to each other Largely focussed on healthcare Clinical standards: Disease codes: Map medical condition into a code Popular standards: ICD-10 CM, SNOMED CT ICD-10 CM 4 levels / hierachical. Eg Level 1: Diseases of the Respiratory System (J00-J99) Level 2: Acute Upper Respiratory Tract Infections (J00-J16) Level 3: Bacterial Pneumoniae (J15) Level 4: Pneumonia due to Klebsiella (J15.0) Website: [email protected] Page 12
13 Health IT standards (contd) Clinical standards (contd): Procedure codes: Procedure performed into a code Popular standards: ICD-10 PCS, HCPCS, SNOMED CT ICD-10 CM 7 levels / hierachical Levels: Section, Body part / system, Root operation, Body part, Approach, Device, Qualifier Clinical Observation codes: Map observations from watching a patient Popular standards: LOINC, SNOMED-CT Factors to consider when selecting a standard Clinical specificity: Accuracy of the condition described Cost of acquisition: Licensing cost eg ICD-10 much cheaper Scope of adaption: Codes have to be adapted for local context Website: [email protected] Page 13
14 Health IT standards (contd) Messaging standards: Exchange data between different health systems Popular standards HL7 (within a hospital), DICOM (images), X12 (between hospital & payors). HL7 eg: MSH ^~\& Sys Hosp HL7Connect Hosp ADT^A01^ADT_A P Website: [email protected] Page 14
15 Are standards sufficient? Standards are a fix not a health systems way of thinking! Health systems approach requires rethinking the use cases hence better user experience / interface Website: [email protected] Page 15
16 One Integrated system Context Developed by Swasth India a social business aimed at ensuring healthcare for the poor Being used for comprehensive health cover for ~3000 families (in ~230 villages), 3 clinics and ~40 village level health workers Design / development team: Swasth India's core team, consisting of Computer Scientists with diverse experience: Ankur Pegu: IIT Bombay Computer Science, KPMG (7yrs) Sundeep Kapila: IIT Bombay Computer Science, McKinsey & Co (7yrs) Arvind Saraf: IIT Kanpur Computer Science, PhD student at MIT, Google (3yrs) Website: [email protected] Page 16
17 One Integrated system Demo Website: Page 17
18 Status / roadmap of the system Currently live, built using open source tools / libraries Developed on ubuntu, hosted on Amazon EC2 Uses LAMP, javascript (jquery) More field testing / refining from Swasth India's / partner sites to refine the system Launch it under dual license - one open-source, for non-commercial purpose (by March 2011) Website: [email protected] Page 18
19 Conclusion Solving health needs of the developing world requires integrated way of looking at Health (health systems approach) Existing open source systems, even combined with standards may not fill the gap Building an Integrated Health IT system possible and done with open source tools Website: Page 19
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