Hospital Information Systems “ Hospital” as a big complicated healthcare organisation
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Transcript of Hospital Information Systems “ Hospital” as a big complicated healthcare organisation
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Hospital Information Systems“Hospital” as a big complicated healthcare organisation
Danny SolomonSenior Architect, iSOFT [email protected] www.isoftplc.com
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Objectives
Understand information requirements of hospitals and other health-care organisations
Understand issues and challenges in the life-cycle of health-care information-systems
Understand some of the history – and some future directions
Introduce iSOFT
interrupt
challenge
disp
ute
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Agenda
What is a health-care information system? What’s it for?
Issues in their creation and deployment – why is it hard?
Where they have come from – where they are going
iSOFT
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What is a health-care information system? What’s it for?
Requirements
Context
How it all relates to CfH
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Requirements of a health-care information system
Information-systems to run health-care organisations (HCOs)?
OR
Information-systems to manage the records of patients cared for in those organisations? BOTH
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What is an HCO?
StHA
PCTsGPs
Acute
Mental Health
Community
Sites
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.
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.
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LondonNational
. . .
Identity
Clinical informationDirectory and desktop
InfrastructurePopulation record Records AnalysisHRIOut-of hours accessReference dataTerminologySecurity
Service user indexClinical governanceBooking and schedulingKnowledge mgtDigital ImagingPrescribingOrders and resultsDiagnosis and carePathology
Any community service for tactical reasonsEg. PAS, Mental Health, TertiaryNon-federated data
Guys &
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Anatomy of a hospital
Multiple facilities (sites)
Wards
Clinics
Diagnostic services
• Radiology, Pathology, etc
Pharmacy
Treatment
• Theatres, Modalities
Medical Records
Coding
Links to other organisations
• Local: Primary care, Community
• National: DoH, CfH, national information systems
Catering
Portering
Physio
Phlebotomy
Management
• HR, Finance, etc
…
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Information-systems to run health-care organisations
What’s going on?
What’s planned?
Where are my patients?
What reports do I need to generate?
Get my money
Am I about to run out of money?
Run my clinics
Run my waiting lists
Run my wards
Run my theatres
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Information systems to manage patient records
Administrative
• Where do they live
• Booked for a clinic?
• On a ward?
• GP
• Next of kin
• …
Clinical
• What’s wrong with them
• What am I planning to do to them?
• Order a test
• See the result
• Refer them on
• Describe them
• …
Division is not
clear cut Information Governance (IG) issues
• Who can see what?
• Is restricting to demographics safe?
• Who can see clinical?
• Is ward location clinical or demographic?
• How much information is shared? To whom?
• What does the patient expect?
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Issues in the creation and deployment of health-care information systems
Why is it hard?
Total cost of ownership (TCO)
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Why is it hard?
Well, is it hard?• Empirical evidence suggests it is• Beacon examples are generally not reproducible• Productising is an issue
Medicine is not a science
Out of the box, computers are good at numbers, not people
Organisational setting is complex• Different across different markets
Change control and management is always hard
Some specifics…
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Why it is hard
Booking a clinic is like booking a flight?• Slots not constant• Different resources required for different slots/clinics• Recipient has to explicitly accept• Over-booking rules• Patients aren’t predictable …
Clinic booking is the easy bit!
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Why it is hard
Lots of different kinds of users• Clinicians
– Docs– Different grades, specialties, experiences, training, backround
– Nurses– …
– PAMS– …
• Managers• Administrative staff• Patients
– Well– Unwell– Worried well– Vulnerable– Young / old– Expert / non-expert
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Why it is hard
Lots of different kinds of users
Doing different kinds of things• Seeing patients
– Clinics, wards, A&E, telephone
• Planning budgets• Organising resources
– Human, equipment, consumable, locations
In many different settings• Organisational
– Hospital (wards, clinics…), Community, Practice, Lab,
• Specialty– Paed, Geri, Med, Surg, …
Everyone likes to do things their own way
Don’t panic
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Maintaining the balance
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There is commonality we can exploit
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One product, many solutions
Health economy
Care settings
Healthcare services
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Product vs solution
Product = software
Solution = software configured and deployed onto a managed technical architecture
• Many areas to consider: TCO
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Total cost of ownership (TCO)
Forget shelf prices
What will it cost my organisation to procure, contract, implement, run, update and ultimately retire an information system?
What if I do nothing?
A useful way of examining areas that make this whole process hard
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Typical TCO model
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Past, present and Future
Health-care information systems: where they have come from & where they are going
History
Drivers
Direction of travel
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Where health-care information systems have been
Organisation often based on physical artefacts• Eg Hospitals• Lots of local autonomy• Need to maintain links with labs• Maintain own coding departments• Maintain own IT infrastructure
Information systems• Local procurement• PAS critical• Clinicals less so
–Lots of local activity at a departmental level – nightmare to manage
• Order-comms typically an early requirement/win• EPR / Prescribing not common in secondary care
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Drivers
Health-care organisation is changing• Everywhere, quite frequently• From the centre
– Reporting requirements– Spine compliance– PBR
• Locally– (some) clinicians demanding better tools– Access to knowledge & best practice, decision support, lose the paper
Procurement model is changing• Local Regional National• Do once and share
– Procurement, configuration
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Drivers
Health-care organisation is changing
Procurement model is changing
Deployment model is changing• Critical data under a GP’s desk?• Critical data in a hospital server-room?• DR-capable data-centre
Information-sharing becoming critical• Support the patient journey• Empower the patient
– Where that’s a good thing
• Avoid unnecessary errors
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Direction of travel
Step 1 – Analyse landscapeQualify legacy systemsPlan the transition
User experience:Mix of modern and legacyOrganisation-focused: little information passed around the community
Step 2 – Install products Legacy replacement commencedService adapters for core services deployedService hubs introducedArchitecture being delivered
User experience:Modern applications becoming pervasiveInformation becoming accessible across the communityLegacy decreasing
Step 3 – Join UpMore uniform landscapeMore information accessCommon services and accessible data Supports shared and coherent care across the community
User experience:Modern applications across the communityInformation accessible across the community
Healthcare community
Integrated healthcare community
GP legacy
Hospital legacy
iSOFT customer
Citizen
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SHSA
SHSA
SA
SA
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iSOFT
Mission
Market leadership
Business strategy
Global healthcare and social reform
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Our mission
To be the global leader in the healthcare software applications market.
iSOFT is working with patients, clinicians, other healthcare professionals, administrators and governments to help transform the delivery of healthcare.
We focus on satisfying the needs of all individual stakeholders, whoever they are, and however they participate in the supply chain of healthcare provision. Our solutions not only meet the current need, they also describe the future of healthcare.
Our inspiration and motivation is to improve the life experience of citizens worldwide
iSOFT: inspired by life.
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Leading the healthcare software applications market
Customers
• 1,700 hospitals
• 6,000 family doctors
• 18 countries in five continents
Employees
• 2,700 healthcare IT specialists
• 1,000 technology and development professionals
• Two dedicated offshore development and solution design centres in India
Scale of business
Fourth largest software and computer services business on the LSE
Market capitalisation of over £900m (US$1,600 million)
Stock market listing in July 2000
• Revenues grown from £17m to £262m
• Profits increased by over 2,000%
Financials
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Our business strategy
Delivergrowth in existing markets
Develop and grow existing market shares for LORENZO
Configure LORENZO
to meet local market requirements
Provide world class references for international expansion
Develop andexecute new market entry strategies
Conduct detailed market analysis and qualification
Establish strong foundation based on significant early wins
Build on initial success through effective promotion of LORENZO
Expand partnershiparrangements
Work with third party technology and service partners on large scale projects and new market entry
Develop existing partnership arrangements
Identify opportunities for new partnerships and collaborations
Target rapidmarketleadership
Establish leading competitive position
Win majority of open market procurements
Accelerate market share through targeted acquisitions
Offer strategic ‘universal’ application set
Continue to invest in development capability and capacity
Promote LORENZO as our new generation software solution
Maintainsoftwareapplicationleadership
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The needGlobal healthcare and social reform
Healthcare is undergoing rapid, unprecedented change
Forward referencing solutions required by citizens, clinicians, policy makers
Work to implement the necessary systems will take place over the next 10 years
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Summary
Successful well managed healthcare applications business
Consistent and focused business strategy
Large and growing international market opportunity
Leader in the supply of advanced application solutions
Strong positive differentiation from small number of credible competitors
Well positioned in respect of future growth opportunity in both existing and new international markets
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Re-cap Objectives
Understand information requirements of hospitals and other health-care organisations
Understand issues and challenges in the life-cycle of health-care information-systems
Understand some of the history – and some future directions
Introduce iSOFT