Professor Dato Dr Jai Mohan, FRCP (Lon), FAMM

Transcription

1 Professor Dato Dr Jai Mohan, FRCP (Lon), FAMM Professor of Health Informatics & Paediatrics, International Medical University President, Malaysian Health Informatics Association

2 Accurate, Timely Health Information Saves Lives

3 Information Technology can reduce Errors and Poor Quality Care It is impossible to practice medicine without Information Technology. The quantity of medicine we are now handling is simply overwhelming, and it cannot be kept in a paper record. The more you try doing it by paper record, the more you risk errors and poor quality care. David Lawrence (as quoted in Ziff-Davies, CIO Insight)

4 Just-in-time Medical Knowledge Management Doctors need to stay current on 10,000 diseases, 3,000 medications, 1,100 lab tests and 400,000 articles added to the literature each year.

5 Population: 28.9 mil GDP: US$ Billion GDP per capita: US$ (2011) 17 th largest trading nation Healthcare expenditure: 4.9% of GDP

6 Selected Health Indicators (2010) Under-5 mortality rate* Infant Mortality Rate* Life expectancy* China Germany India Japan Malaysia UK US *UNICEF

7 Number of deaths for selected conditions in govt hospitals (1999) Organ System Disease No of deaths Rate per 100,000 population Cardiovascular Ischaemic Heart disease Cerebrovascular Disease Malignancies Trachea, Bronchus & Lungs Female Breast Leukaemia Stomach Cervix Endocrine Diabetes Infections Measles AIDS

8 Leading causes of death (2010)

9 Deaths/year 1999 Institute of Medicine Report 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Medical error Traffic Breast cancer AIDS $9 billion in annual costs

10 There are more than 100,000 potential drug interactions. Asking an individual doctor to rely on his memory is like asking travel agents to memorize airline schedules. Berwick, D. Escape Fire, pg. 47

11 Computerized Physician Order Entry (with interactive drug decision support) reduces: Serious medication errors Prescribing errors Transcription errors Dispensing errors Administration errors Preventable ADE s Non-intercepted potential ADE s 55% 19% 84% 68% 59% 17% 84% Bates DW. JAMA 1998;280:

12 Kaiser Permanente : Diagnostic delays & failures significant patient safety & medical-legal challenges Medication 6% Surgical 18% Birth 10% Treatment 22% Diagnosis- Related 44% They represent the most frequently seen risk case type in our organization which account for medical-legal costs** of over $380 million from (n= 856) Risk cases that occurred between 1/1/2000 to 9/30/2005 Risk cases include: Sentinel Events/PCEs, Demands for Payment, and Legal Action Cases ** indemnity payouts + total legal costs Source: PPL-RM

13 Information Technology can reduce Errors and Poor Quality Care It is impossible to practice medicine without Information Technology. The quantity of medicine we are now handling is simply overwhelming, and it cannot be kept in a paper record. The more you try doing it by paper record, the more you risk errors and poor quality care. The second part is that the rate at which knowledge is being created is simply beyond the the capacity of any human being or small group of human beings to keep up with. The only way you can manage it is with information technology. David Lawrence (as quoted in Ziff-Davies, CIO Insight)

14 AHRQ 2006 report, USA December

15 Information Technology is the linchpin for medical care that is high quality, safe, timely, affordable and equitable. David Lawrence Change Drivers Rising Costs Rising Expectations Health Facilities Hospitals, Health Clinics, others Health Objectives Improve Health Outcomes Facilitate Continuity of Care Enhance Decision-making Processes Improve Quality Of Management and Reduce Variation Maintain Health & Manage Risk Tools Information Technology

16 Choose Your Strategy Driven by health care vision, not IT vision Focus on health care goals and health outcomes Involve all stakeholders from the beginning* *Detailed change management strategy

17 Malaysia s Health Vision Malaysia is to be A NATION OF HEALTHY INDIVIDUALS, FAMILIES AND COMMUNITIES through a health system that is equitable, affordable, efficient, technologically appropriate, environmentally adaptable and consumerfriendly, with emphasis on quality, innovation, health promotion and respect for human dignity and which promotes individual responsibility and community participation towards an enhanced quality of life.

18 Health Services Goals 1. Wellness focus Services to promote individual wellness throughout life 2. Person Focus Focus services on the person and ensure services are available whenever & wherever required 3. Informed person Provide accurate & timely information and promote knowledge through personalised education services to enable individuals to make informed health decisions 4. Self help Increase ability of individuals & families to manage own health through knowledge transfer and interactive networkbased health management tools

19 Health Services Goals 5. Care provided at home or close to home Distributed multimedia networks to provide physical and virtual services into homes, health settings and community centres 6. Coordinated, continuous, seamless care Manage and integrate care across different settings and episodes of care throughout life 7. Services tailored as much as possible Customise services to needs of individuals and groups with special circumstances 8. Effective, efficient affordable services Enhanced access, integration and timely delivery of quality services at affordable cost.

20 e/mhealth An nationwide health information system to facilitate data and knowledge sharing amongst healthcare providers in the same or different healthcare settings designed to provide support for continuous, seamless, borderless healthcare to individuals throughout their lifetime.

21 Choose Your Strategy Build the right integrated information architecture Governance, policies, processes, legal and security issues addressed Monitoring and evaluation incorporated *Detailed change management strategy

22 Scenario of integrated health services Step 1:Access myhealth & perform HRA PLHP created Step 2, choice 1: Contact call centre Step 2, Choice 2: Appointment to see doctor Step 3:Consultation, EMR created LHR Individual My Kad M y Seeking advice at point of care Step 4:LHR repository CME for decision support Step 5: Data Warehousing- Support Health & Financial Planning.

23 Choose Your Strategy Do not reinvent the wheel Top-level leadership critical Protect project from changes in leadership *Detailed change management strategy

24 Choose Your Strategy Good project management essential (independent) Do not succumb to pilotitis Make use of WHO-ITU ehealth Strategy Tool *Detailed change management strategy

25 WHO-ITU National ehealth Strategy Toolkit Systematic method to help countries define their ehealth strategy

26 Alignment is Important for e/mhealth National e/mhealth Strategy Enterprise Architecture Standards Applications