Welcome to Maccabi Healthcare Services. Varda Shalev MD MPA ISRAEL

Transcription

1 Welcome to Maccabi Healthcare Services Varda Shalev MD MPA ISRAEL

2 Maccabi s Vision Israel's leading and most advanced healthcare organization aims to achieve Total Health for its members, providing integrative and personallytailored health care to each and every member, and encourages excellence in the quality of medical care, knowledge and service.

3 The National Health Law of 1995 Health funds provide a uniform legally defined basket of services to which every citizen is entitled Every citizen must be a member of one of four nationwide health funds Citizens are free to choose and move between health funds Health funds must accept all applicants for membership Health funds are financed by government via age-related capitation payments (90% of total), patient charges and other income (10%)

4 Maccabi Healthcare Services Maccabi is now a health fund which functions within the framework of the National Health Insurance Law, and as such, functions within the constraints imposed by the Law. Maccabi is the second largest health fund in Israel.

5 Maccabi Statistics May ,750,000 members (24% of total membership of all funds) 9,150 employees, of whom 7,438 are full-time positions. 3,560 physicians. Most of them are independent physicians under contract at 3,109 clinics. Maccabi's income budget (capitation) 1billion euro

6 The Maccabi Health Fund

7 Clinic Extranet IDC IDC IDC Maccabi s Architecture Members Members Members Members Doc. Clinic Pharmacy Firewall Main Computer Internet Medical Control Specialist Consultant CMR Backup Computer ERP Intranet Admin Control Payment Control Paramedic Diagnostic Center Drug consumpti on control Labs control Tele radiology Web Services Mgmt. of Service Providers Mgmt. of the Fund Reimbursement Control Mgmt. of Insured People

8 A local EPR (15 years) A local EPR with a minimal data set portal (5 years) A central Medical Record

9 New Developments in Maccabi Health Care Delivery System Reorganization of primary care Personal physician Group practice The changing role of the nurse Emphasis on prevention and health promotion New structures and processes of chronic illnesses Disease management Integrated care Increased community orientation; less hospital care

10 challenges Computers don t talk to each other Different (private) way of documenting Busy Doctors (shortage of time) Low motivation dealing with ICT Flooding of data Updating medical issues Updating computers technical skills Access control (privacy and confidentiality) The patient is the center Which data should the patient see?

11 IT at the physicians services

12 Pharmacy

13 CPOE

14 Drugs & Medicine

15 Pharmacies communication

16 Lab

17 Lab Systems Lab physician orders are digital. Lab test results are sent to the doctor in the shortest time possible. Lab results are integrated into the CMR. The patient has a full access to the information. The information cycle, from start to finish, is fully automated

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22 Telemedicine

23 Telemedicine Definition...the use of electronic information and communication technologies to provide and support health care when distance separates the participants... from: Institute of Medicine: Telemedicine: A Guide to Assessing Telecommunications in Health Care

24 Rational & Feasibility in Maccabi Equality all over the country. On-Line diagnosis. Extension of service hours. Reliable diagnosis due to digital tools. Improved quality control and assurance. Archiving capabilities for future comparison. Sharing information among physicians for treatment and consultation. Lower cost.

25 Telemedicine Applications Tele E.C.G. Tele Radiology Tele Ultrasound Tele Holter

26 Tele E.C.G Number of Exams.: 17,000 per month Number of Branches: 150 Number of Physicians: 1,000 Average Time for Diagnosis: 10 minutes

27 Tele-ECG Analysis Center דוח א.ק.ג Website Self-Service Station Referral Doctor אבחנה: Maccabi Central דוח א.ק.ג דוח א.ק.ג אבחנה: אבחנה: Referral for ECG at nursing station Win2000 AS/400 APP. Service UNIX דוח א.ק.ג אבחנה: SQL Server EGK Archive Nurses Room ECG Performed in office

28 TeleRadiology Diagnostic Center Haifa Diagnostic Center Tel Aviv

29 Tele-Radiology Workflow Internet Ref. Phys. Self Service Clinic with Radiologist HQ (TA) Clinic without Radiologist Rpt WIN2000 RIS Rpt PACS Diagnostic Center

30 Examples Zoom

31 Examples Window Width and Level

32 Tele Holter File size: 20 MB Number of Exams.: 1,200 per month Number of Branches: 30 Number of Diagnostic centers: 1 Waiting time prior to project: 3-8 weeks Waiting time in Today: up to 1 week Waiting time for diagnosis prior to project: 3 weeks Waiting time for diagnosis now: 2-3 days

33 Tele U.S Gynecology Number of exams.: 10,000 per month Number of branches: 22 Data is transferred along side the images. Images and data are centrally archived. Available connection to 10 different types of Ultrasounds.

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35 Medical Consultant + Virtual

36 CONSULTATION

37 VIRTUAL CONSULTATION

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39 Rule Engineand DSS

40 Decision Support System Rule Engine :Alerts and Reminders Info Buttons

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43 Decision Support System Drug Allergies and Interactions

44 Rule Engine Platform Independent On line Short way between medical news and live

45 Examples: Health Promotion A person above 35 that is not diabetic and does not have heart disease and did not have a cholesterol test for the 5 last years.. Sick Populations A diabetic patient that did not have an Ophthalmologic eye exam in the last year refer to.

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47 Less frequent tests

48 Information and Physician Profile

49 Maccabi Medical Registries Types of computerized data available for patient s tracing and follow-up Demographic parameters Medical History Family History Visits & Hospitalization Lab Results Imaging Treatments Medications

50 Maccabi Medical Registries (Disease Management) * Data collected since 1998

51 Percent of goal Cholesterol in 3 different branches

52 Incidence of Cancer by Type Among Cancer Patients Maccabi Registry Data vs. USA Data (American Cancer Society 2005 surveillance research) 35% 30% 25% 20% 15% 10% 5% 0% Breast* Prostate** Colorectal Lung Melanoma Urinary Bladder USA 2005 MHS 2004 Ovary* Thyroid Kidney and renal Pelvis * Females only ** Males only

53 Status Prevalence of Digestive System Malignancies Homecare Age Registries Sex District Disease Female Male No of patients Colon Rectum Stomach Pancreas Esophagus Anus

54 Doctor s Profile Use of Antibiotics Usage of Antibiotics

55 Usage of First and second line Antibiotics Usage of First and second line Antibiotics

56 Influenza Shots

57 Patients at Risk that did not get Influenza Shots Patients at Risk that did not get Influenza Shots

58 List of Diabetics

59 Diabetics Statistics Diabetics Statistics

60 Occult Blood Test Performance per Doctors Clinic (% of designated population) Preventive medicine Occult blood

61 HVA Health Value Added

62 % of registry patients Diabetes Registry

63 Education

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67 Physicians forums

68 Educational Aid

69 Framingham Risk Ruler

70 מצב לאחר הפסקת עישון- הערכת סיכונים מהפורטל

71 Diabetic Profile

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73 Appointments

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77 Health Promotion

78 Lessons learned Tailor the system to the organization Each profession needs its own approach: Physician are very different from nurses. Physician hate stiff guidelines and pathways. Try to be flexible

79 Support different problems with different tools

80 Lessons learned Users should be part of the design

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82 Lessons learned On going dissemination is the biggest challenge Do it gradually Not too many reminders

83 Sometime you have to refresh their memory that past was not so great

84 Lessons learned Language barriers should be minimized Old users should be treated with forgiveness

85 Lessons learned Reimbursement on time and money on hardware and software

86 Access control (privacy and confidentiality)

87 Thank you!

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