jan de sitter - it & health care delivery
TRANSCRIPT
1
Can IT systems help to manage the
quality of
health care delivery?
25 november 2010
Jan De SitterCIO at GZA
2
Introduction• GZA: « Gasthuis Zusters Antwerpen »
• 3 sites 1033 beds• Sint-Augustinus Wilrijk
• Sint-Vincentius Antwerpen
• Sint-Jozef Mortsel
• Tradition of IT-support for care processes• Since 1990 : « Patient care systems » (PCS)
• Order communication
• Nursing records (activities planning and result reporting)
• Medication• Since 1996 : Medical records (C2M) Patientrecord
• Resultserver
• Reportgenerator
• Support of Paramedic activity
• Structured elements in the EPR
• Since 2000 : Clinical pathways
• Built on PCS technology
• Introduction of online decision support
• Second generation of systems in development and/or implementationphase
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The care process
Quality definition from the Institute of Medicine
‘the degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and
are consistent with current professional knowledge’
Quality care should be
• Result driven
• Based on well defined processes
• Measurable (indicators)
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Drivers for quality care
• Multidisciplinarity, multiprofessionalism• Need to share information
• Fast and accurate communications
Shared patient record,
Convergence of medical record, nursing record…
• Intensity of care• Growing number of actors
• Shorter delivery times
Need for efficient planning systems (order communications)
• Process management• Evidence based Care and Medicine
• General procedures should be instantiated for the individual patient
Care Pathways (incl indicators)
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Drivers for quality care (2)
• Continuum of care• Need to share information with actors outside the hospital
• Need to share processes
Role for eHealth ?
Sharing GMD between actors
Building shared records around disease management ?
• Patient safety• Key element in quality of care
Introducing closed loops in EPD (e.g. medication administration, hemovigilance…)
Structured content in EPD (e.g. structured protocols)
Decision support (e.g. interactions, realtime checks)
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HIMMS EMR adoption modelUS EMR Adoption ModelSM
Stage Cumulative Capabilities2010
Q1
2010
Q2
Stage 7Complete EMR; CCD transactions to share data; Data warehousing; Data
continuity with ED, ambulatory, OP0.7% 0.8%
Stage 6Physician documentation (structured templates), full CDSS (variance &
compliance), full R-PACS1.8% 2.6%
Stage 5 Closed loop medication administration 5.0% 3.2%
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 7.7% 9.7%
Stage 3Nursing/clinical documentation (flow sheets), CDSS (error checking),
PACS available outside Radiology50.0% 50.2%
Stage 2CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging;
HIE capable16.5% 15.5%
Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.9% 6.8%
Stage 0 All Three Ancillaries Not Installed 11.4% 11.2%
Data from HIMSS AnalyticsTM Database © 2010 N = 5,223 N = 5,217
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Generic Care process
• Assessment : systematic collection of information
• Diagnosis: analysis of information and decision
• Planning: time – task: => organisation of the processaround the patient
• EBM-N
• Patient characteristics
• Documentation
• Evaluation
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Planning
• Activities of professionals:• Nurses
• Physicians
• Pharmacy
• Paramedics
• Integrate• Activities of diagnostic and therapeutic services : radiology ,
lab..
• Nursing care activities
• Medication
• Support• Development of individual careplan starting from the generic
plan
• Based on evidence based guidelines
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Document
• Activities• Performed , changed, or not performed?
• Why not?
• Results • Document different parameters
• Documentation is coded• Makes “Rule based decision support” possible
• Facilitates Analysis and evaluation
Care portal : integrates patients
and tasks
Medical Record
Medication
Nursing
Nursing : charting
Orders
Care Pathways
Care Pathways
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Added value from ICT
• Steering from information and processes• Between services (intra-extramural)
• Between professionals (intra-extramural )
• Delivery of structured instruments(intra-extramural)
• To organise and evaluate care delivery
• Operationalize standards and procedures• EB care through algoritms ( decision trees)
• Structured set of acts and instruments
• Measurement systems
• Feed-back• Development of indicators
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Performance indicators:
POBC
Proportion staging pre- or post surgery
1e sem 2002-2009
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2002 2003 2004 2005 2006 2007 2008 2009
Year
% In
ve
sti
ga
tio
ns
Pre-op
post op
Pain score
1e sem '09 (169 ptn)-'08 (145) -'07 (166 ptn )
-'04 (122ptn)
0
2
4
6
8
10
0 1 2 3 4 5 6 7 8 9 10 11 12 13
day post op (day 0 = surgery)
Pa
in v
alu
e
2009
2008
2007
2004
LOS Kp POBC 2002-2009
0,0
1,0
2,0
3,0
4,0
5,0
6,0
7,0
8,0
9,0
2002 2003 2004 2005 2006 2007 2008 2009
Year
Gem
LO
S
Gem. verb
Clinical indicator Financial indicator
Procesindicator
Questions ?