faculty of tropical medicine, mahidol university's site visit at ramathibodi

WelcomeBiomedical and Health Informatics Students

Faculty of Tropical Medicine

April 1, 2013© Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

• A medical school in Mahidol University• Established 1965, Operational 1969• Vision: To be an internationally-recognized

leading medical institution• Mission: Integrating education, research,

and healthcare services for the society’s health

• Determination: To be the country’s guiding light on health

About Ramathibodi

Ramathibodi’s Organization Chart

Item RamathibodiHospital

QSMC SDMC

Strategic Segmentation

Super-tertiary care for wide variety of patients (public &

private)

Excellence center in advanced,

complex cases (e.g.

transplantation) with integrated

wards, ICU, OR, and private care

Customer-focusedpremium services targeting patients

with private insurance,

corporate security, out-of-pocket &

some government officials

Inpatient Beds 896 Beds 177 Beds

Ramathibodi’s Healthcare Services

• 1073 Total Beds• 68 Wards (Rama1=44; QSMC=7; SDMC=17)• 115 Inpatient admissions/day (+11 newborns)• 5,600 Outpatients/day

– Regular (Office Hours) 4,400 patients/day– Special (Non-Office Hours) 1,200 patients/day– Premium (SDMC) 880 patients/day

• 1,062,030 Active Patients• 8,300 Employees

Ramathibodi At A Glance

Health Informatics Division

• 1st Generation (~1987-2001)– CIO: Dr. Suchart Soranasataporn– Developed HIS from scratch– Started from MPI, OPD, IPD, Pharmacy,

Billing, etc.– Platform: Visual FoxPro (UI, Logic, Database)

Long History of IT Development

• 2nd Generation (2001-2005)– CIO: Dr. Piyamitr Sritara– Developed CPOE for inpatients medication

orders, lab orders and lab results viewing, discharge summaries, etc.

– Enhanced existing HIS modules and add more modules and departmental systems (e.g. LR, OR)

– Platform: Visual FoxPro (UI, Logic, Database)


• 3rd Generation (2005-2011)– CIO: Dr. Artit Ungkanont– Implemented ERP, PACS, LIS, Doctor Portal– Use of middleware (web services, JBOSS, JCAPS)– Implemented data exchange of lab & ADT data using

HL7 v.2 & v.3 messaging– Informatics academic activities– Enhanced existing HIS & add more functions– SDMC becomes operational (2011)– Platform: Web [Mainly Java] (UI); Web services

(Logic); Oracle & Microsoft SQL Server (Database)– Legacy platform: Visual FoxPro (UI, Logic, Database)


• 4th Generation (2011-Present)– CIO: Dr. Chusak Okaschareon– Implemented CPOE for outpatients (go live soon)– Scanned Medical Records for outpatients– RamaEMR for physicians and nurses in OPD– Software project management changed from functional

teams (silos) to project-based teams– Future projects: CMMI, ISO9001, better software

testing, business intelligence, security– Platform: Web [Mainly Java] (UI); Web services

(Logic); Oracle & Microsoft SQL Server (Database)– Legacy platform: Visual FoxPro (UI, Logic, Database)


Patient & Bed Management - Inpatient

Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

CPOE - Inpatient


CPOE - Home Medications for Inpatients


Admission Notes


Discharge Summary


Discharge Summary (Diagnoses & Operations)


Discharge Summary (Cause of Death)


Lab Orders - Inpatient


Lab Results - Inpatient


Outpatient


RamaEMR - Doctor’s Portal


RamaEMR - Scanned MR Viewer


Build or Buy

Build/Homegrown• Full control of software &

data• Requires local expertise• Expertise

retention/knowledge management is vital

• Maybe cost-effective if high degree of local customizations or long-term projection

Buy/Outsource• Less control of software &

data• Requires vendor

competence• Vendor relationship

management is vital• Maybe cost-effective

if economies of scale or few customizations

Does service offer competitive advantage?

Is external deliveryreliable and lower cost?

Keep Internal

Keep Internal

OUTSOURCE!

Yes

No

Yes

No

From a teaching slide by Nelson F. Granados, 2006

IT Outsourcing Decision Tree

Does service offer competitive advantage?

Is external deliveryreliable and lower cost?

Keep Internal

Keep Internal

OUTSOURCE!

Yes

No

Yes

No

From a teaching slide by Nelson F. Granados, 2006

IT Outsourcing Decision Tree: Ramathibodi’s Case

Core HIS, CPOEStrategic advantages• Agility due to local workflow accommodations• Secondary data utilization (research, QI)• Roadmap to national leader in informatics (internal “lab”)

External delivery unreliable• Non-Core HIS,External delivery higher cost• ERP maintenance/ongoing customization

ERP initial implementation,

PACS, RIS, Departmental

systems

• Quality software– Reflects quality of the team and process– Software testing & lessons learned crucial

• Software development process reform– Project-based; Value of teamwork

• System outages– Common issues of real-life IT operations– Disaster recovery and business continuity

planning

Ramathibodi’s Priorities & Challenges

• Secondary use of data / DW & BI– Important for academic health centers &

university hospitals– Important for cost savings & quality

improvement– Privacy safeguards important

Ramathibodi’s Priorities & Challenges

• “Preemptive advantage” of using Health IT• “Build” approach was economical and makes our systems flexible to changing internal & external requirements

• “Legacy systems trap” (aka. vendor lock-in)• Customization vs. standardization tension• IT as operational tools or quality improvement tools?• Recruiting & retaining high-quality workers a challenge that needs management solutions

Ramathibodi’s Lessons Learned

Site Visit Outline• 1:00 - 1:45 PM Presentation• [15-minute walk to Rama1 Main Building]• 2:00 - 2:15 PM Inpatient Ward (7SW)• [15-minute walk back to SDMC]• 2:30 - 2:50 PM Outpatient Clinic (Ortho)• 2:50 - 3:10 PM Radiology Department• 3:10 - 3:25 PM Pharmacy• 3:25 - 3:40 PM Server Room• 3:40 - 4:30 PM Coffee Break & Conclusion

Questions?

faculty of tropical medicine, mahidol university's site visit at ramathibodi

Health & Medicine