HEALTH CARE AUTOMATION AT ASIAN INSTITUTE OF GASTROENTEROLOGY Pradeep R MS, M.Ch., D Nageshwar Reddy MD, DM, Dsc, FAMS, FRCP.
About AIG Tertiary care single specialty referral center for Gastrointestinal (GI) diseases Offers GI services to national and international patients Trains specialists in the field of Gastroenterology Exclusive research wing - research in various areas of GI Telemedicine project to cover GI healthcare to rural areas
Magnitude of problem Increasing health care costs, patient demands, need for improving health care standards is a must Possible only by IT and Automating processes Integrating the various technologies Major problem Health care personnel acceptance? Fear Refusal to learn and change
Investigations Laboratory Endoscopy Us, CT. X-ray, ERCP, Capsule, Colonoscopy. Manometry, Magnification Endoscopy, Operation Theater, Pathology P A C S Inventory Purchase Indenting Pharmacy HIS Patient appointment Clinical case Entry (OP and IP) EMR Reports Case sheet Discharge Summaries Financial Billing Insurance Telemedicine Rural Health Project Research Projects
PROPOSED SOLUTION A SCHEMATIC OVERVIEW OF 21 st CENTURY HEALTH SOLUTION Asian institute of Gastroenterology * Pharmacy * Materials Management * Kitchen/Diet * Linen/Laundry * CSSD * Finance * Doctor Honorarium * MIS * Equipment Maintenance HOSPITAL ADMINISTRATION / ACCOUNTING MODULES * Appointment Scheduling * Out Patient Registration * Out Patient Billing * Casualty Registration * Casualty Billing * Indoor Patient Regn * Indoor Patient Billing * A D T * Wards Management * OT Management * MIS INTERFACE TO Health and Hospital Information Network PATIENT ADMINISTRATION MODULES CLINICAL MODULES Management Information Systems Business intelligence Backbone Health and Hospital Information Network Health and Hospital Information Network Output Templates: EMR LIS IMAGING * General Medicine * Medical Internal Medicine * Dermatology * Gastroenterology Gynaecology * Paediatrics * Surgical Obstetrics * Gastroenterology Urology * ENT * other specialties * Consultation Summary * Surgeon Notes * Anaesthetist Notes * Discharge Summary * Referral letters * Certificates * Biochemistry * Haematology * Microbiology * Clinical Pathology * Immunoassay * Histopathology * Serology Document Spreadsheet XML * Pathology Reports Gastroscopy * 2D / Stress Echo * ECG Colonoscopy * CathLab EUS * Endoscope * C-Arm Capsule * OT Imaging * Central Station Enteroscopy ERCP C Arm Cath Lab ESWL US CT ECG Endoscopy Reports CT * ECG Reports Waveforms US * Cath Reports Lab Reports * Cath Lab Loops ERCP * Endoscopy Reports films Capsule Endoscopy Reports Magnification Endoscopy Elastography OT Scanner Pathology
OUT PATIENT
OP Workflow Patient Portal FRONT OFFICE BACK OFFICE Reception / Regn / Billing Corporate Billing / Insurance / Doctors Honorarium Relative Patient EMERGENCY CONSULTING Service Departments Diagnostic Imaging CENTRAL DISPATCH Pathology Lab Ambulance Consulting Day Care procedures Other services Reports Dispatch ADMISSIONS PHARMACY ADT
OP Workflow Patient Portal FRONT OFFICE BACK OFFICE Reception / Regn / Billing Corporate Billing / Insurance / Doctors Honorarium Relative Patient Service Departments EMERGENCY CONSULTING Diagnostic Imaging CENTRAL DISPATCH Pathology Lab Ambulance Consulting Day Care procedures Other services Reports Dispatch ADMISSIONS PHARMACY ADT
IN PATIENT
REGISTRATION IP Workflow Indoor Registration Relative Patient Service Departments Diagnostic Imaging ADMISSION WARDS / ICU / NICU Pathology Lab OPERATION THEATRE Admission, Transfers Nursing Station Intensive Care IP MIS BACK OFFICE IP BILLING PHARMACY Corporate Billing / Insurance / Doctors Honorarium Indoor Billing
LABORATORY INFORMATION SYSTEM
OPD COLLECTION ROOM WARDS / ICU / OT Consultation & Service Registration Consultant Sample Collection Barcode Generation Service Registration Sample Collection Barcode Generation OPD Reception Relative Patient OPD Phlebotomist Nursing Station Nurse Patient IPD / ICU / OT Batch Printing DISPATCH Centralized Printing Centralized Dispatch LABORATORY HEM/AB00123456-P (14-Mar) Ajit Srivastav 26Y/M /AB00 101123456 Sample Verification Sample Segregation Worksheet Generation Sample Distribution Work Sheet Lab Tech Reporting Printing Reporting View WARDS / ICU / OT Final Report Ward Printing Dispatch Desk Final Report Ward View Nursing Station BIOCHEM/HEMAT/ SEROLOGY/OTHERS MICRO-BIOLOGY HISTOPATHOLOGY/CYTO BIOCHEMISTRY / HEMATOLOGY / SEROLOGY / OTHER DEPTS MICROBIOLOGY DEPT HISTOPATHOLOGY DEPT
ELECTRONIC MEDICAL RECORDS
Holistic EMR Sources of data capture Clinical aspects of data capture
IMAGING Pathology Back Holistic EMR
Rural Health Camp Telemedicine
Rural Health Camp Telemedicine
Data Generated - Gastroenterology 2005-2010 Modes Clinical Data Number Out Patients 3,45,960 In Patients 54, 634 Imaging Images Upper GI Endoscopy 1,64,693 4,94,079 Colonoscopy 50,905 1,52,715 ERCP 36,011 1,44,044 5 GB/Day EUS 9347 37,388 US 2,60,280 5,20,560 CT 19,822 Capsule Endoscopy 633 Rural Programme & Telemedicine Patients Treated 1,47,263 Endoscopy 4,640 US 3,244
HIS Implementation Difficulties & Limitations Software: Integration of Different modules Cost and Maintenance Version upgrade related User Acceptance: Administrators Good Paramedical Fair Medical Bad
Data Acquisition History, Physical etc Text based Predefined Templates Data fields Images DICOM & Non DICOM Lab Data Integration with HIS
Data Usage - Present Retrieval Patient Management Analysis : Retrieved by user defined coding and third party program for analysis Research To evaluate pattern of diseases Geographical, Seasonal Genetic study Hospital infections Alerts Auditing Quality care Images PACS Diagnostic Automation
Data Usage - Present Limitations of Manual analysis: Large Data bases Hidden and Potential relationships of data may not be recognized
Data Usage - Future These tools and techniques bring out the hidden patterns in the data which will help us in making decisions
Data Usage - Future Diagnostic Dilemma Evaluating Treatment Choices
Inflammatory Bowel Disease Data: No of Subjects: >1100 No of Fields / Subject: 78 Data Components: Clinical, Investigations, Genetic, Drugs, Surgery, Follow up. Data Format: Text, Tables, Excel, Images
PATIENT HISTORY
Case scenario Crohns Disease Diagnosis Problem: Intestinal TB Common in India Crohns Disease Incidence increasing in India Differentiation: Difficult Critical Treatment is different
Case scenario Crohns Disease Diagnosis Question: In a given number of patients (>4000) (TB & Crohns): Can we diagnose the disease accurately? Predict the outcome of treatment? Recommend best treatment based on previous treatments?
Chronic Pancreatitis: Prevalence France 26/100000 USA 41.7/100000 Japan 27.4/100000 South India 126/100000
Chronic Pancreatitis Data: 5 Years No of Subjects: >5000 No of Fields / Subject: 58 Data Components: Clinical, Investigations, Genetic, Drugs, Endoscopic Procedure, Surgery, Follow up. Data Format: Text, Tables, Excel, Images
Chronic Pancreatitis - Proforma
Data of Chronic Pancreatitis (1 st Aug 2011 to 8 th Dec 2011) N= 313 3.4 0.9 0.8 5.1 3.4 6.8 34.8 44.9
Case scenario Chronic Pancreatitis Treatment Problem: Chronic Calcific Pancreatitis Heterogeneous group of disease Different modalities of Treatment - Available Controversy : Which modality in Which Patient?
Case scenario Chronic Pancreatitis Treatment Question: Stent ESWL Drainage Resection Success % 50-70 60-80 65-90 87-95
Data Usage - Future Decision Tools Knowledge Bases Outcomes of Evidence Based Medicine Patient Records Knowledge Refinement