ACSIS Health Information System...within the context of a Harmonised Caribbean Regional Platform
Today s objective Explore ACSiS within the context of harmonised Caribbean Region HIS Share our Caribbean experience Introduce ideas that may help minimise risk and maximise value Contribute to the understanding of the risks and benefits
Why are we here? In our opinion: Because health care has reached a tipping point neither existing cost or outcomes are acceptable Start to define a process that will enable improved health outcomes & resource utilization
Why are EHR s critical to the Caribbean? Capturing longitudinal intervention data enables evidence based decision making The bridging of clinical and financial data enables us to truly effect: Health outcomes Continuous quality improvement Performance measurement Via Utilization management
The need for historical patient data Only longitudinal data can reveal long term effects of Interventions Other health determinants Environmental & natural hazards Disease management- diabetes It is also critical to empower/educate the citizen
Convince me that Health Sector performance can be improved Fair question- projects are almost universally over-budget, behind schedule and even politically embarrassing UK 24b, ehealth Ontario... Rand, Gartner $300/EHR! Response evidence is among us
Belize only country in the world to increase health encounters and reduce overall expenditure Capture 80% national encounters/90% intended users certified Reduced vertical transmission of HIV to <5% Reduced tide of hypertension
you are the 150 th HIS Vendor I've met what can you say that I haven't heard before. Actual quote- CIO NDoH South Africa nb; ACSiS was just accredited under Tender 609 for use in the SA National EHR grid will link 50m people, 4000 Primary Care Centers, hundreds of hospitals across 9 Provinces Our response ACSiS is differentiated by results and 3 rd
Recent words about ACSiS Most advanced HIS in the world Vital Wave, Landscape Analysis on Developing World HIS Outstanding...EMR based HIS Health Metrics Network (N. Orobaton) Most advanced HIS in the Americas PAHO (Dr. Guillermo Troya)
What is ACSIS? Accesstec Capacity Strengthening Information System Sector wide 1 patient: 1 record system Patient centric- EHR is the hub EHR data enables a comprehensive range of modules A clinical process improvement
ACSiS Goals To Improve: Individual and Public health outcomes Improve policy, planning, operations Organisational sustainability - HR and Fiscal Adherence to evolving international standards Operations in a hostile computing environment Information based decision making Transparency!
What does ACSiS do? Provides every citizen with an EHR Seamlessly supports individual and public health Links the government with hospitals, clinics, pharmacies and lab across the nation Ensures that relevant data is immediately and appropriately available Uniquely addresses the global requirement for evidence based management Enables experts to improve policy, planning, operations
A Comprehensive System that is constantly upgraded and expanded ACSiS-EHR Patient Registration and Tracking ACSiS-ADT Admissions Discharge and Transfer ACSiS - COE Clinician Order Entry ACSiS MCH Maternal Child Health ACSiS-FIN Supports Billing and Accounting interface ACSiS-SCM Supply Chain Management/Inventory Control ACSiS-DIST Deployment and software distribution ACSiS-Net Network and Connectivity ACSiS-Reports Reporting engine ACSiS PH Public Health ACSiS HIV M&E compliant with WHO Staging Criteria
Why does ACSiS work while most HIS projects fail? Many reasons including Software License Structure, Networking Technologies, Hardware as an Appliance, Disaster Recovery, Comprehensive Functionality, but 2 stand out: Correct Data Structures Capacity Strengthening
Data Structuresthe ACSiS Approach The central transaction in any health care sector is between patient and clinician ACSiS collects detailed encounter data at point of contact Essentially all other functions utilize this data: example: Accounting and finance Pharmaceutical Planning and policy Supply Chain Management National Health Fund From a process perspective this is the common denominator: thus the hub of ACSiS is the EHR/ADT -
ACSiS Capacity Building The commitment to sustainability includes the use of Open Source components and extensive user training as a core element The Capacity building objective is to enable the client to: Maximize autonomy and utilization of the system Minimize dependence on third party vendors Enable user to evolve and institutionalise the HIS
Capacity Building We invite the client team to directly engage in: Requirements gathering Documentation Deployment Support The user is empowered to leverage the HIS and minimize life cycle costing
ACSiS Certified Within 6 weeks of contracting we have demonstrated the ability to enable users to: Install ACSiS at new facilities Deliver support and maintenance Deliver end-user training Create custom Reports
Our experience with HIS Spans more than 30 Years Spans Africa, Caribbean, Canada, Asia and the USA Extensive roles including: project manager, capital works, special advisor, strategic planner. Most fail The actors and subject matter experts that manage the health sector do not have adequate, timely data. Furthermore, most existing health software solutions are not effective, particularly in developing economies.» Third party licensing costs are unsustainable» Implementation and support requirements rapidly render them less than ideal.
Historical Findings Lack of an effective U.P.I. Data didn t enter the system at point of acquisition reduces quality creates unneeded overlap Data entry viewed as a burden Data was gathered up to 3 times! Data wasn t turned into information conjunctivitis
Typical issues Systems were disparate Manual merger Data integrity issues More duplication Limited data transfer to central because of technical limitations Limitations on database capability No network System did not reliably produce standard reports and NO custom reports
Challenges Poor infrastructure: power and network Inadequate hardware Limited HR capability Hurricanes Leadership: this is the only deal breaker!
The Foundation for Success The ultimate requirement for success is understanding, and defining the strategic requirements of the organization The choice of software components is critical but subsequent
Software License Considerations Annual renewals, obligations and exit Can I add facilities and users w/o cost Is it scalable Can I develop in the system Can we share our developments Open source/open standards
Open Source Benefits The use of open source components alleviates third party licensing fees and our unique capacity building approach enables: Increased MoH autonomy Sustainable cost of ownership Self-direction Self-support Minimal reliance on outside vendors
HIV and the National System HIV is often managed as a silo Led to HIV systems parallel and competing with the larger sector HIV is distinct, important and inseparable from the sector as a whole Patients use the same labs, facilities, pharmacies, clinicians...
Health Partners The System must be capable of leveraging Health Partners: PAHO: WinSIG HMN CDC: EPI INFO RHI s e.g.carec Do not duplicate efforts but leverage other s expertise and experience
Multi perspective synergies Monitor for Infectious Diseases country-wide in real time Track compliance with the Disease Management Programs Belize Diabetes Management Program (visits, lab tests, pharmaceuticals) for all Diabetics Identify patients who have received medicine from recalled lots Systematic Country-Wide PMTCT program Belize is the only country in the world that has achieved the CDB WHO/PAHO 070909 target of ~5% vertical HIV transmission
Future Steps a user driven evolution Each release seeks to improve the digital experience of users Reflect user feedback Dashboards as a conduit to manage through information Increased utilization of the system's integrated Flags Specifically, a few of the things we are working on- Lab Machine interface, API development, wireless handhelds, EDI, SMS, vital stats and assessment of evolving standards, classificationse.g. SnoMed
Rationale Having delivered 2 Caribbean National systems, the rationale is unchanged: improve individual health outcomes public health performance Fact based policy, planning, operations Health Ministries require visibility: Systems must enable accountability Systems in effect introduce Actuarial analysis to
Caribbean Context ACSiS application is built upon a radically customizable, rapidly configurable software architecture: ACSiS improves every day ACSiS can rapidly reflect the individual datasets of any nation The architecture can support a Regional HIS today. Infinite technical scalability Replication features are perfectly suited for
Thank you If there is anything you don t see-» Please ask us. We have a demo machine here if you wish to see more. We know ACSiS suits the Caribbean You need to define your goal technology is then easy CDB A 070909 wonderful opportunity use it!