1. 1. Health Information Systems (HIS) at Landspitali University Hospital Hannes r Bjarnason, hannesb@landspitali.is, Landsptali University Hospital
2. 2. 2/3 Population 320.000 Reykjavik metro 200.000 Akureyri 2nd largest town 18.000 ------------------------------------------------------ Landsptali University Hospital, Reykjavik FSA Hospital, Akureyri 6 Regional hospitals 10 Health Care Centers with beds 80 Primary health care clinics 42 Nursing Homes Numerous private run organizations Some Facts on the Healthcare System in Iceland
3. 3. About Landspitali 70 employees IT equipment 3600 workstations 200 network servers 3300 IP phones Medical equipment 9000 listed Worth 10 billion ISK Software system Over 100 system Clinical system Financical system Office system IT & Clinical Engineering at LSH Only university hospital in Iceland Largest organization in Iceland 4600 employees 17 locations in Reykjavik and vicinity 40 medial specialities & many sub specialities Medical speciality trained abroad Mostly in Sweden, Norway, USA, UK, The Netherlands
4. 4. EHR Systems in Iceland Main EHR system is Saga First launched in 1997 Local development Used in all government run institutions More systems in use Main hospitals (specialized systems) Specialist clinics (smaller solutions)
5. 5. FSA LSH HH HVE HVA HSS HSU FS Regional EHR Databases Currently working on linking the EHR systems, giving providers access to patient records in other EHR databases
6. 6. Electronic Health Records at LSH Current Strategy
7. 7. Current EHR access in Iceland Landspitali serving other health care units Use of LSH Laboratory system Use of LSH Radiology system Access to clinical system via Ljorinn LSH Clinical Portal accessible to health care units Etc.
8. 8. Buy and implement a standard EHR system to support most of its clinical activity EHR for LSH Strategy & next steps Landspitalis EHR strategy : Preperation work already started : Financing has to be clarified Working on intermediate strategy EHR at Landspitali 2018
9. 9. 1. Integrated EHR based on what we already have + Most health units in Iceland use Saga as their main EHR system + Investment cost not too high Cant compete with the big system in the long run 2. New comprehensive EHR system + Proven solutions already in use at many hospitals or regions + New functionality, like clinical decision support Complicated & very costly project - High risk EHR for Iceland Where to go ? Future strategy for EHR on a National scale
10. 10. LSH implements new comprehensive EHR system supporting all clinical activity. How to reach that goal: Observations: Expected total cost for LSH is 6-8 billion ISK (65m $), and timeframe 4-7 years. Financing of the project must be assured before going further. EHR system choosen must be able to fit as a national system. Coordination needed between the EHR project and new hospital project. Reality: New EHR will at first be in use after 7-10 years Define a strategy to 2020, based on current best of breed approach 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Design/Build new hospital Buy/Implement new EHR The EHR shall serve the patients need in an efficient way with patient safety as key focus. Landspitalis goal:
11. 11. Saga Core Clinical system (ca 30 system) Other clinical system (ca. 50 system) Heilsugtt LSH Clinical staff EHR at other Health care units Ljrinn Vera Clinical staff outside LSH Patients and reletives LSH Electronic Health Records Strategy 2016-2020 Data warehouseOrri Finance & HR system
12. 12. KEY FINDINGS Landsptali shows a mixture of (highly) mature to less mature areas in terms of IT infrastructure, IT usage and IT governance. The highest potential for future efficiency and process improvements around the EMR lies with Clinical Documentation, Decision Support and Medication Safety. CDR Nursing Documentation Electronic Ordering / CPOE Medical Imaging Physician Documentation Medication ManagementIntensive Care Unit Emergency Department Health Information Exchange Monitoring and (operational and predictive) Analytics Governance / Clinical Transformation Through IT Business Continuity High Maturity Low Maturity
13. 13. New System for Intensive Care Tender was advertised in March Opening of bids on 20. April Selection of tenderer 26. May Standstill period ended TODAY Winner is CIS by Daintel Signature of contract this summer Preparation for implementation this fall Start using the system in 2017
14. 14. RIS Svr/beinir PACS Rntgen Flexlab Bl/Kema Glims Skla,veiru.. Sympathy Meinafri Prosang Blbanki Shire Erfafri ROS Svr/beinir Cyberlab Svr Papprs svr Papprs svr Papprs svr Status in 2010 Doctor use many system to order lab tests and view results. 70% paper based. Status 2016: All lab results and most specialized test results available in Heilsugtt Most Lab request forms part of Heilsugatt (few important missing) Various features to improve patient safety (acknowledge, SMS/email etc) CPOE system with possible Clinical Ordersets Access from other health care units (no paper results sent) Most health care units use the LSH database for their Clinical chemistry tests Real time quality meters Lab requests & Lab results
15. 15. Heilsugtt Lab/Test Order entry
16. 16. Doctors Front page Ward or Speciality Patients Page 1 2 3 Lab and Test results
17. 17. Heilsugtt Projects that will transform Clinical work Dashboards CPOE & Ordersets Timeline Clin. Inbox Collaboration EHR Outside LSH Rule based engine (Clinical Decision Support)
18. 18. Lab units essential part of LSH clinical processes Heilsugatt is the glue Continue working according to the strategy LSH EHR 2020 All lab/test requests Ordersets & Embedded rules (Clinical Decision Support) Improved access for other Health care units to Lab service and EHR at LSH More integration with laboratories outside LSH Patients have access to their test results Lab units at LSH & IT Looking ahead
19. 19. Barcoded Wristbands
20. 20. Allir lmmiar vera lka me strikamerkjum Barcoded Wristbands
21. 21. Heilsugtt - iPad Pro
22. 22. 31 Real-time Gauges
23. 23. Real-time Gauges
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26. 26. Real-time Gauges