Information Technology and Electronic Medical Records

Transcription

1 Healthcare Reform in China and the US Similarities, Differences and Challenges Information Technology and Electronic Medical Records Wang Caiyou Center for Health Statistics & Information, MOH Atlanta Contents 1. The Vision of HIT & EMR 2. Where we are? 3. Where we go? 4. Similarities and differences

2 The EMR can take an important role In 2-Jun,a newspaper reporter interviewed,to discuss the difficulty in front of EMR January 20 th 2004 the President George W.Bush announce 10 year' plan, to set every having EMR, to improve health care 3 The benefit for HIT adoption Accurate and complete information of patient's health, can give the best possible care, but it is distributed in different place; Continuous of EMR can improve coordinate of care, but it is separated; Patients and their families can take part in decisions about their health care, but can not access. HIT can improve efficient, reduce medical errors, and provide safer care at lower costs. 4

3 The Gartner forecast in 2005 Full Gen 5 The Mentor A context-aware systems Can guide clinicians Gen 4 The Colleague Can be decision support and workflow capabilities Functionality Gen 3 The Helper To bring evidence-based medicine Gen 2 The Documentor To integrated clinical data Gen 1 The Collector To accessing simple clinical data Minimal Source: Gartner (December 2005) Generations of EHR Capabilities End of Reduction in Preventable Errors Gen1 (Collector) 15% Gen2 (Documentor) 25% Gen3 (Helper) 30% Gen4 (Partner) 20% Gen5 (Mentor) every preventable error will never happened Data from GARTNER TELECONFERENCE, Tom Handler, MD 13 June

4 But the situation is no as forecasted EMR Adoption Model SM Q Q Stage 7 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0.7% 0.7% Stage 6 Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 1.6% 1.8% Stage 5 Closed loop medication administration 3.8% 5.0% Stage 4 CPOE, Clinical Decision Support (clinical protocols) 7.4% 7.7% Stage 3 Stage 2 Stage 1 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries Lab, Rad, Pharmacy All Installed 50.9% 50.0% 16.9% 16.5% 7.2% 6.9% Stage 0 All Three Ancillaries Not Installed 11.5% 11.4% Data from HIMSS Analytics TM Database N = 5235/ HIMSS Analytics Top 10 barriers to successfully deploying EHR 10. Usability - products are hard to use and not well engineered for clinician workflow. 9. Politics/naysayers - every organization has a powerful clinician or administrator who is convinced that EHRs will cause harm, disruption, and budget disasters. 8. Fear of lost productivity - clinicians are concerned they will lose 25% of their productivity for 3 months after implementation. Administrators are worried that the clinicians are right. 7. Computer Illiteracy/training - many clinicians are not comfortable with technology. They are often reluctant to attend training sessions. 6. Interoperability - applications do not seamlessly exchange data for coordination of care, performance reporting, and public health. 5. Privacy - there is significant local variation in privacy policy and consent management strategies/ 4. Infrastructure/IT reliability - many IT departments cannot provide reliable computing and storage support, leading to EHR downtime. 3. Vendor product selection/suitability - it's hard to know what product to choose, particularly for specialists who have unique workflow needs 2. Cost - the stimulus money does not flow until meaningful use is achieved. Who will pay in the meantime? 1. People - it's hard to get sponsorship from senior leaders, find clinician champions, and hire the trained workers to get the EHR rollout done. February 02, 2010 John Halamka, MD, CIO, CareGroup Health System, Harvard Medical School

5 2. Where we are? CHINA: 1. Hospital information system more then 20 years 2. Public health information system since Health insurance claim and payment since Regional health information system since Current Situation of HMIS Application of hospital [N=826] N (%) Fees on outpatient % Pharmacy store management % Pharmacy management in outpatient % Pharmacy management in inpatient % Registration system % ADT % Medical Record Room % Accounting System % Medical Material Management % Capital Assets Management % Economic Accounting % Human resources management system % From CHIMA s Annual Survey Report 2009/

6 The bar code with PDA is used in Xiamen Hospital Current Situation of CIS Application of hospital Subsystem Have done under construction [N=926] (%) (%) Nurses station at inpatient 74.62% 9.40% Doctor workstation at inpatient 47.95% 25.49% Doctor workstation at outpatient 45.90% 27.54% Laboratory Information System (LIS) 43.84% 22.57% Radiology Information System (RIS) 31.43% 28.62% Ultrasound imaging information system 29.91% 28.94% Electronic medical record (EMR) System 27.11% 34.56% PACS System 24.84% 31.21% Anesthesia Information System 24.41% 28.83% Pathology Information System 22.57% 27.21% ECG Information System 18.90% 29.37% Intensive Care Unit System 9.94% 30.67% Clinical decision support systems 7.88% 30.78% Regional Health Information System 5.62% 19.11% clinical pathway 3.13% 19.98% From CHIMA s Annual Survey Report 2009/

7 The doctor workstation at inpatient in Fujian hospital The doctor workstation at outpatient in county hospital

8 Web Based National Disease Surveillance System in ,000 medical units have the ability of using the system; 6000 users every day; An average of 12,000 case per day; 3,499,582 cases per year. Lab rt repo nfirm, cated, co de-dupli Check, Case report Case repo rt 15 Health insurance claim in village clinic

9 Shanghai-Minhang RHIN EHR for 1.28 million resident ID cards for doctor 17 Lab, ECG, Image, Medicine etc can be accessed 门诊病历 药品溯源 主页面 心电图 检验报告 18 心电图 PACS- 远程调阅

10 HIT situation in China HMIS were accepted by most of hospital, that can improve efficient, control expense. Clinical information systems begin to been accepted by most of the hospital, the EMR begin to be accepted. The information sharing between more then one hospital with RHIN was kicking off. 19 But the challenges in front of 1. Leadership and management Harmonization of various stockholders Constitute Laws/Regulations/Policies 2. Investment What is the public goods for HIT Investing return for information sharing 3. Technologies Lack of Health Information Standard Lack of Correct Methodologies What is the new generation interoperable infrastructure? 4. Lacking of High Quality Human Resource Education Quality Team Organization 20

11 3. Where we go? The Guideline on Deepening the Reform of Health Care System vision: the government will establish a practical and shared medical information system Guidelines for the Healthcare System Reform of ( ) Guidelines for the Pilots Public Hospital Reform EMR-RHIO 21 HIT in national next 5 years plan strength grass root HIT; Telemedicine hospital information 22

12 Recent task for HIT Blueprint : National HIT strategy plan in the next 5 years, object, milestone, task; Information standard infrastructure, information privilege and safety infrastructure; Pilot of RHIO based on Resident Health Record and EMR Information system of M & E for health care reform 23 The HIT project in 2010 The budget from central government is about 2.7 billion Yuan for HIT adoption. 1. Information exchange center in 5 pilot province for the information sharing and cooperation for health care, public health, health management 2. To support government hospital reform with HIT in 16 cities; 3. HIT adoption in rural area, support 0.43 million village clinic; 4. To strengthen 2130 county hospital PACS or HIS, 5. Telemedicine pilot project in 12 west province. 24

13 4 Similarities and Differences China American Vision Support health care reform Every one have EHR, reduce cost and error, improve quality Domain Information sharing Public health, medical care, insurance, pharmacy, and resident service Integration + interoperability Investment Local government + Central government support middle and west province Information standard Government driving Medical care Interoperability Meaning full use Driven by American Recovery and Reinvestment Act Mix with market, HL7, NOMED, IHE, LONIC,DICOMM Environment A lot of new system Many old system upgrating HIT Vendor In developing Large scale and specialization 25 * EHR 2015 advancing Canada s next generation of healthcare 26

14 The road of EHR Adoption Knowledge NHIN Information Data RHIO HIS EHR Thank you 28