The Road Less Travelled - Clinical IT in the Hospital Authority. Agenda. Healthcare in Hong Kong. Hong Kong

Transcription

1 The Road Less Travelled - IT in the Hospital Authority N.T. Cheung, MBBS Executive Manager, Health Informatics, Hong Kong Hospital Authority Agenda Introduction - Healthcare in Hong Kong The Hospital Authority s Management & Electronic Patient Record Delivering business (clinical) benefits Hong Kong Area 1100 km 2 Population 7 million Tourists 22million / year Healthcare in Hong Kong 3% Primary Care 15% 12% Secondary & Tertiary Care 5% 95% Proximity to likely future health hotspots 70% Private Dept. Health Hospital Authority Others 1

2 Hospitals in Hong Kong Hospital Authority NTW NTE 40 Hospitals with inpatient service 15 Emergency Departments 36 Specialist Outpatient Clinics 14 Integrated Clinics 50 General Outpatient Clinics Public Private KW KC KE HKW HKE Hospital Authority 1,000,000 inpatient admissions 2,000,000 emergency visits 2,000,000 allied health consultations 4,000,000 general outpatient consultations 5,500,000 specialist consultations The Management (CMS) & Electronic Patient Record (epr) The journey - built in-house since 1991 The system - one integrated system for 6.5 million patients 2

3 The Journey 1990 Green fields 1991 Patient Administration 1992 Pharmacy system 1993 Lab results online 1994 Obstetric specialty system 1994 Radiology information system 1995 Management Direct clinician documentation and order entry 2000 CMS Phase II Electronic Patient Record (epr) Generic modules 2003 esars 2005 CMS Phase III CMS Today 6.5 million patient records workstations clinical users Success Factors IT Governance Structure! A strategic vision of clinical IT and top level support! Sustained funding allowing continuous development! Development of informatics and technology capabilities! Engaging the clinicians! Delivering organizational value IT Advisory Committee Head Office Directors Chair: ERP Project Steering Committee Hospital Authority Board Supporting Services Development Committee IT Policy Group Cluster Chief Executives Chair: Informatics Steering Group Chair: IT Technical Reference Group Other Members/Advisors 3

4 IT Governance IT Capabilities Application Development Process Maturity IT GOVERNANCE GROUPS HAHO HKE HKW KC KE KW NTE NTW HA Board Supporting Services Development Committee Information Technology Policy Group Informatics Program Steering Group Enterprise Resource Planning Project Steering Committee Information Technology Technical Reference Group Assessment Scale 0 = Non - Existent / Not Applicable - activity/processes are not applied at all. 1 = Informal 2 = Documented 3 = Formalized 4 = Measured 5 = Leading consulting HKHA Executive Briefing 9 November User Requirements Sourcing Capabilities Maturity Target Skills Application Design Project Management Build & Test HA Results Measures & Metrics Finance & Governance IT Capability >= 35% of Large IT Shops For internal use of HKHA only Gartner, Inc. and/or its affiliates. All Rights Reserved. Page 12 HA s Network Informatics-led Design Operational Layer Database Services Engines Scheduling Front End Messaging and integration Workflow Imaging Rules engine Knowledge Information Architecture Terminology engine Communications GCD (forms) engine Presentation server epr Layer Audit Security User 4

5 Clinician Engagement The Key Success Factor! Overcome skepticism and resistance! Demonstrate success! Gain widespread clinician buy-in! Clinicians become the drivers CIPSG Functional Committees Informatics Program Steering Committee Cluster Informatics Coordinators New s Development Committees Policy Committees Informatics Program Office Co-opt Members Mr Andre GREYLING Technical HAHO Committees A system built by clinicians for clinicians Successful Engagement - PUSH Becomes PULL Single Logon! Pre-2000! Informatics and ITD developed functions! Convince hospitals to use! Intensive training and implementation effort Post-2000! Clinicians demanding more and more! ITD unable to meet all demands! Informatics role increasingly one of demand management 5

6 Medication Order Entry Operating Theatre Record Data Framework Electronic Patient Record (epr) 6

7 epr Laboratory Results epr Digital Image Distribution Project! Make use of the existing CMS/ePR infrastructure! View digital radiological image in the HA wide network using ordinary clinical workstations! Images can be viewed wherever the patient presents! 7 major hospitals joined by year end! Cost - US$2m Central Archive for Corporate- Wide PACS Delivering business benefits epr Visually lossless compression Cost effective use of storage and network Cost savings Risk management Quality improvements Infection control (the SARS experience) Sharing the patient record (creating the EHR) 7

8 Annual Planning process Govt Policy HGC HA Strategic Plan Community Set Programs COC Needs Assessment Overall Services Effectivenes Appropriate Identify Service Efficiency Volume + + Allocation + Appropriate and Quality to Hospitals Resources Indicators Hospital and HA Annual Plans Head Office and Hospital Suggestions Different Service Areas HA Service Programs HA Strategic Plan Consultation Needs Assessment and Prioritized Schedule Work Out Resource Allocation with Hospitals IT Costs Benchmark vs Peers External Service Providers Disaster Recovery Occupancy Personnel Telecommunications consulting HKHA Executive Briefing 9 November 2004 Software Hardware $0 $1,154 $12,959 $10,779 $0 $56,307 $9,798 $102,466 $103,548 $101,317 $175,451 $256,502 HK$753.9 million Savings $365,106 $524,576 $0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 Annual Expenditure ($ Thousands) Peer HKHA For internal use of HKHA only Gartner, Inc. and/or its affiliates. All Rights Reserved. Page 15 Risk Management Registries! Medication checking! High risk patient alert! Flagging elderly patients at-risk! Notifying on admission/discharge! Diabetes monitoring! Infection risk alert! Implanted device recalls! Medication recalls! G6PD deficiency flag The Registry is Dead! (Long Live the Registry!) epr Standard forms Departmental data Disease documentation Decision support Workflow Communications Alerts & Reports 8

9 Surgical Audit (1995) Surgical Audit (2004) Audit Scope Definition Management Operation Records Coding Patient Master Index 3 1 Data Analysis Datawarehouse 2 Data Analysis Reporting (CDARS) 4 Data Analysis (CDARS) 9

10 esars! Managing the SARS outbreak in real time! Suspect, confirmed and not SARS! Updated clinical status! Data entry by clinicians at the wards! Created and deployed Hong Kong wide in 3 days! Built upon the CMS/ePR infrastructure! Possible because of the informatics culture already in place esars Architecture HA CMS Situation Reports esars epr esars PMI Labs DM Zone SARS- CTS Contacts esars PMI Dept Health Telephone interviews Police MIIDSS SARS-CCIS Hotspot Alert HKU Data Warehouse Firewall Firewall eflu Communicable Disease Information Decisio Cross Reports Disseminate to CDIS collaborators and partners n Police (MIIDSS) HA E-disease Other Department Emergency Response Centre Planning & Evaluation Data Warehouse Query Emergency Hotline Centre Outbreak Intelligence Centre E-disease interf ace Incident Logging Sy stem Data Warehouse Reports Disseminate to CDIS collaborators and partners Data Data Data Data Data Data Data Data Data Data Real-time Data Monitoring Centre Aberration Detection and Early Warning Module (Alert Tools), Modeling Tools, Decision Support Tools, GIS (Analysis and Presenting Tools) Data Media Monitoring Laboratory Surveillance Notifiable & Hospital Hospital AED Pharmacy Sentinel TB STD Reportable Discharge Outbreak Surveillance Surveillance Surveillance Surveillance Surveillance Disease Surveillance Surveillance Surveillance CENO Report Situation Report & Lab Enquiry Newspaper, Internet 4 July 2005, by CHP PHLSB (LIS) Hospital Authority Private Sector Designated Community Pharmacy Designated RCHE/CCC/ GP/GOPC PHSB CHP PHSB CHP RCHE/CCC GP/GOPC PHIS Hospital 10

11 epr Sharing with Private Sector Integrating Healthcare Sectors HA CMS epr Patient key DM Zone epr subset Private Doctor Patient key Secure Token! Addressing the imbalance between public and private care! Communicating with private practitioners! Courtesy note on receiving referrals! Reply letter on discharge! Sharing HA s electronic patient record! Creating the shared EMR! Enhancing the sustainability of the health care system Firewall Firewall Summary! Leadership and support from the top! Engage clinicians! Deliver clinical and organizational value Thank you 11