E-Health An overview

E-Health

Definition

Vision

• Clinicians and patients receiving and

recording the right information, at the right

time, in the right place, on the right device

and with the right view to facilitate optimal

patient care

Why is it so hard ?

• Like designing and building a house with

50 different people who don’t or can’t talk

to each other

Scope and Types of applications in

a “Digital Hospital”

Scope and Type of applications in a

“Digital Hospital” (another view)

End Users

Organisational Change Roadmaps

Hospital Staff Patients Families Partners/ Service Providers Health dept Staff

Other Govt

Connectivity

Identity & Access

Public

Wireless Internet Wide Area

Network

Local Area Networks Authorisation & Authentication Directory Services Administration

Telecoms (Fixed & Mobile)

Applications Internal / External Clinical / Non Clinical

Servers and Storage Local (e.g. Theatre) Server Room Data Centre/s External

Network Infrastructure Cabling Network Equipment (Switches, Routers, Firewalls, IPS)

Physical Infrastructure

Server Room Comms Rooms Carrier Entry Rooms Campus Distributors Power, UPS, Generators Air Conditioning Fire Suppression

IC T I n v e s tm e n t M a n a g e m e n t & S e rv ic e D e liv e ry Radio

Knowledge, Information and Data Physical / Electronic

End User Environment Biomedical Technology Systems Building & Security Systems ICT Devices No Physical Boundaries PACS Digital Theatres

How do we make sense of this

• Clinical applications:

– Medications management systems – Pathology systems

– Radiology systems

– Electronic clinical notes

– Electronic transfer and discharge summaries

– Patient information/education systems – Clinical knowledge repositories

– Clinical audit databases

• Administrative systems:

– Patient booking systems

– Patient identification systems – Business analysis systems

– Governmental reporting systems – Billing systems

So how do we make sense of this?

• Hardware “techie stuff”:

– End-user devices: pc’s, bar-code readers, cameras, dataphones

Fixed Devices Mobile Devices

Patient Entertainment Mobile Phones IP wireless Phones / Pager WiFi Tags IP Phones / PBX Reserve PDAs Tablets Notebooks

So how do we make sense of this?

• Hardware techie stuff

– Data storage devices: servers and server rooms etc

– Information transfer devices and systems: Cabling, wireless

So how do we make sense of this?

• Software “techie stuff”

– Encryption protocols – Messaging protocols – Security/identification

protocols

Unpacking Clinical Applications

Unpacking Clinical Applications

• Radiology systems:

– Digital imaging – Digital storage – Digital viewing

– Computer aided digital manipulation

– Digital ordering and result reporting

– Electronic scheduling – Decision support

Unpacking Clinical Applications

• Medications management

– Electronic prescribing

– Electronic pharmacy validation – Electronic /robotic dispensing – Inventory control – PBS/S100 billing – Electronic discharge medications – Electronic medications administration systems – Decision support

– variable dose regimes integrated to laboratory/ clinical measures

Unpacking Clinical Applications

• Discharge and hand-over summaries

– Discharge summaries

range from entirely manual data entry with print to fax to automatic data

extraction and messaging. – Hand-over summaries

often contain many

common data elements. – Summary electronic health

records shared between public and private sectors

• Specific Clinical area applications

– Emergency department

– Operating theatre and anaesthetics records – Intensive care records

– Community Health records – Mental Health records

CCD = Continuity of Care Document; CDR = Clinical Data Repository; CDSS = Clinical Decision Support System; CMV = Controlled Medical Vocabulary; CPOE = computerized practitioner order entry;

EMR = electronic medical record; HCO = Health Care Organization; Lab = laboratory; Rad = radiology; R-PACS = Radiology - Picture Archiving and Communication System. Source: HIMSS Analytics Database.

n = 5,166 n = 5,073

Total Hospitals

15.6% 19.3%

All three ancillaries not installed

Stage 0

11.5% 14.0%

Ancillaries - lab, rad, pharmacy - all installed Stage 1 31.4% 37.2% CDR, CMV, CDSS inference engine, may have document imaging Stage 2 35.7% 25.1% Clinical documentation (flow sheets), CDSS (error checking), PACS available outside radiology Stage 3 2.5% 2.2% CPOE, CDSS (clinical protocols) Stage 4 2.5% 1.4%

Closed loop medication administration Stage 5 0.5% 0.8% Physician documentation (structured templates), full CDSS (variance and compliance), full R-PACS Stage 6 0.3% 0.0%

Medical record fully electronic; HCO able to contribute CCD as a byproduct of EMR; data warehousing in use Stage 7 2008 Final 2007 Final Cumulative Capabilities Stage

Figure 1. EMR Adoption Model 2007 and 2008 Final: United States

The pathway to comprehensive

e-Health

Implementation challenges

•Where do we start?

•Comprehensive suite of applications, department by department •Individual applications, throughout facilities and across facilities

•Individual applications department by department (current commonest Strategy)

Views on Benefits of digital

Hospitals

Cost/benefit

Benefits increase exponentially with e-health automation, while costs increase incrementally

Cost/Benefit: the need for change

management

NeHTA: Establishing the basis for

e-Health

Hypothesis

• If Medical teams on ward rounds are

provided with bedside patient information, they will be more likely to use that

information in making good diagnostic and management

Project Methodology

1. Baseline priority clinical processes

2. Apply technology framework

Methodology

• Team observation on multiple occasions at Baseline to track workflows and establish indicative times spent on tasks

• Introduction of C5as with a short orientation to the PC (extra capabilities such as bar-code

reading, camera deliberately not used). No extra training in use of standard applications

• Repeat observation of multiple teams on

multiple occasions, including same team with and without tablet in use (tablet software glitch)

Baseline applications

• Synapse: web viewer for radiology images

• HBCIS: Patient administration system

(Black screen)

• Auslab: Pathology results (Black screen)

• Clinicians Knowledge network (CKN): web

based access to electronic journals, some

electronic texts, Cochrane, Medication

Robina Hospital

• Impact that mobility can have on clinical processes

• Ward rounds and discharge – introducing clinical mobile tablets • Emergency Department, Medical

Ward, ICU and Outpatients • New Partnership Model • Commenced July 2007 –

December 2008

How to……

• improve the quality of care I provide • spend more time with patients and • less time doing paper work

Conclusion

• There were significant differences observed in the frequency of access to patient specific

information and to clinical information databases.

• There was a reduction in time spent logging into desk-top PCs , with this time spent discussing diagnosis and management with the patient.

• The observational team noted a change from an error prone, linear repetitive process of

diagnosis formulation to a rapid, data driven patient centric hypothesis driven diagnostic process