Seventh Meeting of the U-IHIS Project Steering Committee Dr eng Branko Marović Project Manager bma@who.org.rs Belgrade, 15 April 2015 www.eu-ihis.rs
Adoption of the Minutes of the previous meeting Introductory Remarks Law on Medical Documentation and Records on November 8, 2014 In accordance with the Law, lectronic Health Record (HR) is now called lektronski medicinski dosije (MD) Description of activities for the final evaluation of the Project
October 2014 February 2015: Overview HIS implementation status Implemented in 17 hospitals: Pirot, Kikinda, Čačak, Kruševac, UCH, IORS, Pančevo, Smederevo, Ćuprija, Paraćin, Sombor, Prokuplje, Specialized Hospital for Rehabilitation and Orthopaedic Prosthetics Belgrade, Institute for Rheumatology Belgrade, Institute for Orthopaedic Surgery Banjica, CHC Zvezdara and CHC Bežanijska kosa On going in CHC Zemun and CC Kragujevac branches of internal medicine Development and testing of the HR Conceptually rounded up and developed, incorporated IH framework for interoperability, exchange and storing of digital documents HL7 CDA ereferral specification HL7 CDA patient econsent specification based on IH BPPC (Basic Patient Privacy Consents) profile Support to National Cancer Screening Office in defining the informational content of the screening documents, development of HL7 CDA forms is in progress Integration of HIS and HR tested in 8 hospitals: Kikinda, Smederevo, Kruševac, Pirot, Pančevo, Paraćin, Prokuplje i CHC Zvezdara Further improvement of the software and technical documentation
HIS Implementation (1) Institute for Orthopaedic Surgery Banjica Implementation continued on 8 December 2014 Implementation completed on 27 March 2015 Donation of additional equipment covered needs of the Institute Significant progress in use of the system is evident, it is expected that within the short period of time system begins to be used in the full scale Specialized Hospital for Rehabilitation and Orthopaedic Prosthetics Belgrade Implementation began on 1 December 2014 Implementation completed on 27 February 2015 Using of the system in the full scale achieved in very short period of time in two months registered more than 10000 contacts in the system Impressive speed of acceptance of the system with the strong support of the IT team and management
HIS Implementation (2) CC Kragujevac branches of internal medicine Implementation began on 8 December 2014 Donation of the additional equipment partially covered needs of the CC, additional procurement is in progress implementation shortly interrupted on March 6, 2015 to the procurement of the necessary equipment Continuation of the implementation agreed for April 20, 2015 In cooperation with the CC team, about 500 workers (of about 800) trained through workshops institution is currently purchasing additional computers Users in all ambulates with technical preconditions trained on their workplaces, training started in inpatient CHC Zemun Implementation continued on 2 March 2015 Strong support of the management to HIS implementation Users on admission and admission department of the central building trained in their workplaces Polyclinic and gerontology are not connected with the main building! Donation of the additional equipment covered needs of the Centre
HIS Usage Contacts Number of contacts * KBC Zvezdara in March reached 80.000 contacts U donation of workstations
HIS Usage Hospitalizations Number of hospitalizations * KBC Zvezdara in March reached 4.300 hospitalizations
HISImplementation Plan Y1 Year 2 / 2013 Y2 Year 3 / 2014 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 J F M A M J J A S O N D J F M A M J J A S O GH Kruševac GH Čačak GH Pirot GH Kikinda GH Pančevo GH Smederevo University Children s Hospital IORS GH Ćuprija GH Paraćin CHC "Zvezdara" GH Sombor CHC "Zemun" Institute for Orthopaedic-surgery "Banjica" CHC " Bežanijska kosa" GH Prokuplje Special hospital for Rehabilitation Belgrade Institute for Rheumatology-Belgrade Clinical Centre Kragujevac Team 1 Team 2 Team 3 Team 4 HR Summer xtended support Termination LIS 34 35 Y2 36 37 38 N D J F M NC 39 40 41 42 A M J J
nd Users Satisfaction Survey nd user satisfaction survey conducted so far in eight institutions So far it is filled by over 420 healthcare professionals Majority agrees that HIS user screens are clear and well organized and that the data recorded in the system are more reliable than those in paper form Over 90% respondents think that use of HIS improves data quality and availability Majority agrees that use of HIS can reduce multiple entry of the same data (92% doctors and 80% nurses) Over 95% respondents believe that all health institutions should be connected to the HR Lower degree of consensus about whether patients and healthcare professionals should have access to the HR over the internet portal
nd Users Satisfaction Survey I use HIS independently and am familiar, in most part, with its content and functionalities.
nd Users Satisfaction Survey HIS usage enhanced data quality and availability.
nd Users Satisfaction Survey Support by the team that performed HIS training and implementation was satisfactory.
nd Users Satisfaction Survey How would you rate HIS in your institution.
nd Users Satisfaction Survey Codes of external causes of injuries taken from the Hospitalization Report used since 2014 are suitable for routine work with patients.
nd Users Satisfaction Survey What is your opinion on the HR content? Less than 7% of the participants gave feedback about possible changes
HR Health Reports Important for MoHand public health insight into the HR content, analysis of the collected health data, population characteristics and work of the health system General quantitative reports Number of patients (for period, per institution) Number of diagnoses (for period) Number of contacts (for period) Number of medicaments (for period) Number of relevant health interventions (for period)... Standardized analytical reports Most frequent final diagnoses (for period) Most frequent prescribed medicaments (for period) Most frequent procedures (for period)... Combined reports. g. number of hospitalizations + number of different hospitalized patients Specific reports Most important cancers, day hospital, deliveries, mortality, readmission (for period, for specific diagnoses) Most frequent final diagnoses in which as an additional occurs L89 (Decubitus) (for period)
HR Technical Reports For HR operators and administrators monitoring and management of the system Audit log reports Number of HR accesses (for period) Number of different users who accessed the HR Number of patients who forbade access to their data Number of patient requests for change of the HR data Document repository reports Number of received documents (for period) Number of logically deleted documents Number of changed registration data
HR Portal Reporting
xample of HR Report: Most Common Diagnoses Table
xample of HR Report: Most Common Diagnoses Chart
xample of HR Report: Most Often Prescribed Medicaments Table
xample of HR Report: Most Often Prescribed Medicaments Chart
xample of HR Report: Percentage of Day Surgery Table
xample of HR Report: Percentage of Day Surgery Chart
Future Steps Implementation completion in two healthcare institutions Additional support where necessary Testing of HIS-HR integration in remaining hospitals Further HR development within the scope of the Project Improvements of security mechanisms for wider utilization within the ehealth context Implementation of patient consent functionality HR migration to the post-project environment Support to the MoH ehealth Unit stablishment of standards ehealth Strategy Study tour ngland, beginning of June 2015
Current Challenges HIS Insufficient number of healthcare workers / doubled work To avoid duplication of data and clinicians work through rulebooks, standards and future technical solutions of central services if the same data is entered in several places, collision and confusion is inevitable! Lack of IT staff and their financing Lack of budget lines allocated to IT maintenance Automated electronic reporting from HIS, related instructions to hospitals HR utilization outside and after the U-IHIS Project Further development of legal framework, rulebooks and standards Responsibilities at institutional and national level stablishment of permanent operational infrastructure for production work data centre for ehealth services Continuation of HR implementation through linking of all healthcare institutions Utilization of achieved developments in new ventures.g. HIS can track available dates for scheduling in case of scheduling in other institutions, systems should be connected
Proposed PSC Conclusions 1. The MoH support for testing of the HIS-HR integration in order to include all healthcare institutions in the Project an official letter to the hospitals on the final project activities 2. Additional support on HIS use in Institute for Orthopaedic Surgery Banjica, CHC Zemun and CC Kragujevac 3. HIS sustainability MoH guidelines for hospitals on legal basis posting, maintenance and improvement, determination of longterm budget lines 4. Central coordination and prioritisation of future activities based on the necessity and proposals of the healthcare institutions 5. Necessity for including ehealth in the egovernment strategy that will be finalised during May 2015 6. Determination of the institution that will be in charge for the central services of ehealth and the HR 7. Temporary or permanent location for the HR developed through the U-IHIS Project 8. The U-IHIS proposals as inputs for the rulebooks and standards and final legal analyses with recommendations