Impact of ICT on Work Practices and Management of Info ITFM – Outcome 2.
HOW TO MEASURE OUTCOME IN HEALTHCARE, AND HOW HEALTH ICT ...
Transcript of HOW TO MEASURE OUTCOME IN HEALTHCARE, AND HOW HEALTH ICT ...
HOW TO MEASURE OUTCOME IN HEALTHCARE, AND HOW HEALTH ICT CONTRIBUTES
PRINCIPAL ADVANTAGES OF AN EPR
Pr. Philippe KOLH, MD, PhDCIO CHU of Liège
SPEECH OUTLINE
1. Introduction2. EPR project in CHU of Liège3. Investments4. Principal advantages of the EPR5. Conclusions
1. INTRODUCTION
INTRODUCTION
INTRODUCTION
University Hospital of Liège:• Academic hospital• 895 beds• Based on 7 sites, 3 of which are hospitalizations
INTRODUCTION
• May 2003: First Institutional Strategic Plan :– Implementation based on 22 institutional projects, – 4 key work areas:
• Performance of clinical activities• Patient care• Organizational aspects (procedures, competences and motivation)• Financial aspects
Impact on IT: Implementing:
- Institutional software applications- Efficient IT infrastructure- Information mobility for quality of care
EPR is one of the keyinstitutional projects
INTRODUCTION
• September 2014: Second Institutional Strategic Plan :– Implementation based on 32 institutional projects
• Patient‐centered• Efficiency and operational performance• Enhanced supply• Deepened academic dimensions• Involvement of hospital workers
New IT projects and finalizationof ongoing projects, including EPR project
2. THE 6 PARTS OF EPR PROJECT
Implementation planified in 6 parts:– Part 1: Results server (clinical biology, medical imaging, nuclear medicine
and pathology) deployment completed– Part 2: Medical record deployment completed– Part 3 : Resources management with
• Part 3a: management of multi‐sites patient appointments deployment completed• Part 3b: management of beds in real time deployment completed
– Part 4: Drug order and administration deployment in progress (424 beds covered)
– Part 5:Order of clinical biology and medico‐technical examinations– Part 6: Care management
• Part 6 a: nursing record deployment in progress (754 beds, 16 chairs covered)• Part 6 b: paramedical record deployment completed• Part 6 c : meal management deployment planned
THE 6 PARTS OF EPR PROJECT
In parallel of EPR, and in order to support implementation, establishment of:
1. « Paperless » work mode :1. in collaboration with medical archives : scanning documents still produced in paper form)2. Integration of medical devices to EPR
2. « Wireless » in care units
2004 2005 2006 2007 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 20171 – resultsserver sept. oct.2 – medicalrecord jan. march3a – patient appointments oct. june3b – bedsmanagement déc. march
4 ‐ Drugs feb. july5 – clinicalbiology and medico‐technicalexaminationsorders nov. July Dec.6a – nursingrecord april feb.6b –paramedicalrecord sept. june6c –mealmanagement June Feb.
PLANIFICATION
• EPR completeness of coverage and specialized functions (ophtalmology, prescriptions, oncology …)
• Flow optimization (eg. Emergency)• Care paths and clinical routes (holistically and multi‐stakeholders)
• Tools to support medical decision• Linguistic research tools• Integration with billing• Making appointements by Internet• Bring your own device in the hospital• Telecollaborations or data exchange with external care providers
• Telemedecine• Collaborations with other hospitals
EVOLUTIONS OR BEYOND EPR PROJECT
3. INVESTMENTS
Financial commitment to the project
EPR Budget 2012: 5% of investment planEPR Budget 2013: 4% of investment planEPR Budget 2014: 4% of investment planBudget consumed between 2004 and 2013: 10.313.952,03 €
0 €
500.000 €
1.000.000 €
1.500.000 €
2.000.000 €
2.500.000 €
Budget consumed
consommé
Poly. (consommé)
97,7 % of total budget
4. PRINCIPAL ADVANTAGESOF EPR
PRINCIPAL ADVANTAGES OF THE EPR
1. Integration and transmission of information in patient records are facilitated by:
• Integration of the information: – Patient records can be accessed quickly (large number of workstations =
numerous access points)– Protocol help tools: protocol models, voice recognition, state progress and
follow‐up tools for the secretaries ...• Transmission of the information between internal players – multi‐
site context:– Single, horizontal patient record (used by all medical disciplines)– Accessible from outside by the institution’s physicians (Citrix portal)– Possible request for an opinion to a colleague without moving – Patient appointments facilitated
Barcode tube label
ASSOCIATION
=
SAFETY
Patient wristband
with barcode
Eg. Cross‐matching in sample management Security improved
Blood products administration
IT solution for data scanning at the bedside with mobile device (cross matching blood bag/patient identity)
Security improved
PRINCIPAL ADVANTAGES OF THE EPR
2. Integration and transmission of information in patient records are facilitated by:
• Transmission of the information outside : – Protocols sent to the GP via secure messaging– Possibility of integration into an information exchange system (eg. Réseau
Santé Wallon, www.RSW.be )– Telecollaborations (exemple : remotely, several people, on the same
data/image)
2. Quality of the patient record and performance• RHM (minimum hospital summary) entered = RCM
(min. clinical summary), DI‐RHM (nursing record‐min. hospital summary), ADT data, staff data, administrative data ... a high level of coherence required between all these data
• Advantages for DI‐RHM: structure in episodes of care, created on the basis of bed management; Electronic Nursing Record and automatic extractions …
PRINCIPAL ADVANTAGES OF THE EPR
2. Quality of the patient record and performance
PRINCIPAL ADVANTAGES OF THE EPR
Finalisation of deploymentMedical record (March 2007)
Number of « justified beds »
Justifiedbeds
A single, global, easy‐to‐access patient record, is likely contributing to the hospital’s performance: justified activity
2. Quality of the patient record and performance
PRINCIPAL ADVANTAGES OF THE EPR
A single, global, easy‐to‐access medical record is likely contributing to the hospital’s performance: decrease in average length of hospital stays
Finalisation of deploymentMedical record (March 2007)
Average hospital stays observed, over all locationsAverage hospital stays observed, over all University hospital locations
Average length of hospital stays
3. Information management
Transition from a word processing system to a structured data entry system:
horizontal search for information in the patient’s record
use of the data
PRINCIPAL ADVANTAGES OF THE EPR
Eg. Hospital statistics Mother ‐ Child
3. Information management
PRINCIPAL ADVANTAGES OF THE EPR
4.Structuring ‐ harmonisation of departmental procedures
• Multi‐site harmonisation• Use of standard protocols (models of multiple choice surgery protocols, list of treatments, shared order forms)
• Systematisation of data entry• Use dependent on training
PRINCIPAL ADVANTAGES OF THE EPR
5. Global view on patient care• Patient’s “history”: clinics, hospitalizations, technical interventions, surgery protocols, medication, nursing, …
• Possibility of isolating some information (medical history, allergies, etc.)• Electronic patient record organised in a precise way, common to each department Filing of events in the records of all hospitalised patients checked every day.
• Visibility of the list of exam requests and those performed• View of scheduled appointments (past and future)
PRINCIPAL ADVANTAGES OF THE EPR
Assigning an appointment
transmission to medical file software
Eg. Medical Imaging order and appointments management visible in EPR
Appointmentsvisibility in the medical file
PRE = Prescrit (prescribed)
ATT = Attendu
(expected)
Eg. Medical Imaging order and appointments management visible in EPR
6. Adhering to the code of ethics: access traceabilityActions: User identification system by a login and personal password access logging Elaboration of an “Ethics and Data Security” convention whose signature is
needed for access to the EPR For external access: signature of convention + use of the Belgian eID (strong
authentication)Possibility, at any moment, to ask the medical management for the list of
people who have consulted a patient recordCreation of an access control unit to avoid any misuseAwareness‐raising/reminders during training sessions
PRINCIPAL ADVANTAGES OF THE EPR
5. CONCLUSION
• 4 % CHU investment effort on EPR project• A projet of around 10,5 million €• Financial ROI not easy to assess • But qualitative benefits for security and access to information
CONCLUSION
Organisational training
Patients
Internal process
Funding
Secure single record, accessible to everyone in real time throughout the institution
Patient record, order: Reduction in waiting times and copying out information, contribution to the coordination and continuity of care, structured and coordinated collective approach (quality approach), improvement in organisation
Saves time (tel., moving around, etc.) and prevents redundancy, reduction in length of stays,…
Use dependent on proper training
EMR
CONCLUSION
EPR project has a direct action on 4 key areas:
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