showcasing e-health innovation in public...
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SHOWCASING E-HEALTH INNOVATION IN PUBLIC SECTOR
Building A Healthcare Information and Management System in the Eastern CapeA Collaborative Endeavor Towards an Affordable Digital Solution to Improve Hospital Service Delivery
CONTENTA.Background
B. Development & Implementation of HMS2
C. Project Impact – Stakeholder Experience
D.Future Development Plans
PART ABACKGROUND
What is HMS2?
How did it come about?
An E-Health software solution
developed by SA for South African Hospitals
An Electronic Medical Record (EMR) system
that aims to assist hospitals to be more Effective and Efficient in
providing quality care to patients and communities
HMS² is developed as an open platform E-Health technology
using the SA Normative Standards Framework (HNSF)
for improved systems interoperability
Forms part of an E-Health digital eco-system within public healthcare in
South Africa
Top Management
• CEO
• Clinical Governance
• Facilities
• HR & Admin
Clinical
• Doctors
• Nurses
• Clinical Support
• Pharmacists
Administration
• Patient Admin
• Case Management
• Revenue Management
TOP DOWN MEETS BOTTOM UPSYSTEMS DEVELOPMENT
ORGANISATIONAL CONTEXTMAIN DRIVERS BEHIND HMS2 DEVELOPMENT
SUB-OTIMAL EXPERIENCE OF
CARE
PUBLIC CONFIDENCE
LOW
POOR PATIENT OUTCOMES
DEMOTIVATED & DISGRUNTLED
HCW
APPROACHLEADERSHIP ACTIVATION
Energising people toward our vision
•A highly skilled and motivated workforce:•Continues to work together as a
team to •Delivers on agreed performance
targets and •Rewarded for their achievements
OPERATIONS PERFORMANCE MANAGEMENT
•Appropriate Strategy→mandate•Maintaining and building on systems:•Measure our performance •Responsive
Safe, Effective And Reliable Patient Care
Patients Satisfied With The QOC
Improve Public Health; Meet Demand
Culture Of Teamwork
Employees Are Valued
Key Structures & Systems
Changes- Critical & Visible
LEA
DER
SHIP
FRERE TURNAROUND STRATEGY 2013-2015
PATIENT-
CENTRED
CARE
EFFICIENCY OF CARE
STAKEHOLDER PERSPECTIVE MAIN DRIVERS BEHIND HMS2 DEVELOPMENT
Collective Health Worker Experience
PATIENT & COMMUNITY
NURSE
DOCTOR
PHARMACIST
CLINICAL SUPPORT
PATIENT ADMIN
CASE MANAGER
ICT TEAM
• Longitudinal view of each patient cumbersome
• Coordinating and ensuring continuous care between clinical care teams difficult
• Paper-based data systems = increased administrative burden (especially nurses, doctors, pharmacists & clerks)
• Exacerbated when Patient records went missing
Waiting TimesPatient Folders
1. Political restitution 1994 single entry point for all patients
2. Policy Changes:– Record Archived (maternity 21years)
Inadequate OPD admissions Unit and Medical record storage capability
Delays Locating Files; Missing Folders;
Long waiting Times for Patients
Turnaround Project #4:
DOCUMENT MANAGEMENT & MEDICAL RECORDS UNIT
REGISTRY PRE-INTERVENTION
IMPACT
ORGANISATIONAL
• Medico-legal risk
• Performance management:• Burden of disease• Service delivery alignment with
demand • Measurement & Trends (morbidity;
mortality; severity; experience; efficiency)
• Case Management & Cost of Care• Unable to bill patients accurately• Loss of Revenue
• Reputational damage
DISSATISFIED PATIENTS & STAFF
• Outcomes: Continuity & Coordination of clinical care between providers challenging
• Experience: long waiting times
• Frustration because work not rewarding
Consensus that ICT
Key Enabler to Realise the Strategy of Affordable Patient-centred
Quality HealthCare
PART BDevelopment and
Implementation
THE FRERE ICT MATURITY MODELReactive, Ad hoc, Problem-Driven
”Avoiding Downtime”
Reactive, Stable IT,
Request Driven, Change Management and Planning
“Keeping it Running”
Proactive, Accountable, Increased Monitoring, Change Management & SLA’s,
Improvement, Predictability
“Quality Driven”
Proactive, Optomised Cost and Quality, Agile, Continues Improvement
“Taking the Lead”
OUR ICT MODEL
US IN 2013
US IN 2018
BASICSTANDARDISED
DYNAMICRATIONALISED
BUILDING BLOCKS REQUIREDCritical to E-HEALTH systems implementation and sustainability is:
• Stable ICT infrastructure (networks, computer equipment and peripheral devices)
• Data Centers (servers and storage)
• Good ICT support (infrastructure and systems and monitoring)
• Clinical Kiosk
• eCAR (Electronic Capital Asset Requests)
• Performance management development system (PMDS) document management
• Electronic dashboard module
Release 1.0 (2013)
• Hospital intranet
• Patient master patient index with Delta 9 integration
• Inpatient / ward bed management
Release 1.1 (2014/2015)
• Radiology order/entry
• Electronic script request
• Electronic clinical discharges with ICD10 integration
• Live performance dashboards
Release 1.2 (2016)
• Wheelchair Management Module
• OPD Booking Module (Pre bookings, Clinical encounter management, NIDS 2017 registers)
• Allied health professionals referrels/encounter management
• Patient eDOC (Essential Scanning e.g. ID Doc, Referral letters, lab results etc.)
Release 1.3 (2017)
• Orthopaedicsmodule
• Theatre Management Module
• Billing module
Release 1.4 (2018)
ROAD MAP 2013-2018
Corporate Governance✓PMDS
✓HR MIS
✓Automating Performance Dashboards →Cost Management Accounting Capability
• Clinical; Clinical Support; Soft Services
• Engineering; Clinical Engineering
✓eEmployee Satisfaction Survey
Patient-Centredness✓Patient
Satisfaction Survey
FRERE HOSPITAL WEBSITEwww.fh.echealth.gov.za
“Dyantyi said it was an undisputed fact that technologies played a
significant role in our daily lives”
HMS²
HPRS
Patient registered on the HPRS system, during which the
patient demographic data is recorded.
A PRN is allocated to the patient
PATIENT REGISTRATIONHPRS Integrated
PIX/PDQ Profile from HNSF used to obtain patient demographic
detail and PRN
Master Patient Index
(MPI)
HMS²
The module records:patient demographic data, medical aid detail and debtor’s detail etc.
The registration module allocate a visit number for OPD visits and a
admission number for patient admission to a ward
HNSF
Patient Registration Business Process
PatientArrives
At Hospital
Receive / Triage and
direct patient
Clerk Register patient
Reception Area
New patient
HMS²Master Patient Index
Existing patient Retrieve patientrecord
Clerk Update patient info
where required
Record OPD visit / ward admission
HMS²
File updated, labels printed
etc.HPRSMaster Patient Index
HPRS
Demographic, Classification, Medical Aid,
Debtor, document
scanning etc.
HNSFPIX/PDQ
1
Patient collect file
and proceed to
OPD2
Electronic OPD bookings
The electronic bookings sub module enables OPD’s and allied
health the ability to manage patient bookings electronically. The module interfaces with the
inpatient management module to enable electronic admission request to a ward. From the
booking module all future and walk-in bookings can be managed
with ease.
OUT PATIENT MXThe OPD module consist of three submodules namely:
Patient Consultation
The electronic clinical encounter sub module allows clinicians to record the clinical notes during a patient consultation. As part of this sub module the clinician can record clinical notes, ICD10 diagnoses,
treatment plans, investigations etc. From the sub module, a clinician can also prepare and submit electronic scripts to pharmacy and radiology
request to the radiology department. The clinician can also
prepare discharge summary reports, referral letters, perform down
referrals etc.
Electronic OPD Registers
The electronic OPD register is aligned to the national minimum
data set requirements and registers are customised per OPD to enable the OPD to only complete the data elements relevant to their area of
operation. The register sub module works hand in hand with the clinical
encounter module and receives information about the directly into the register, therefore eliminating
the duplication of information.
Out Patient Business Process
Make Booking OPD Booking List Screening
NurseClerk/Nurse Patient Arrives at OPD
Patient Consultation
Doctor Consultation
Radiology / Pharmacy / Allied Health
Ward AdmitFollow-up BookingDown referralsConsultation report
Data ExchangeHL7, Web Services
Pre booking or Walk-in
booked on OPD booking
list
OPD Register updated
Arrival Recorded
eAlliedeScripteRadiology
Encounter Complete
Clerk/NurseArrange ward admissionPatient admitted to wardMake follow-up bookingElectronic OPD register updated etc..
HPRS HMS²
2
3
This module manages the full life cycleof an inpatient ward admission,transfer, discharge, recording of deathand clinical discharge management.
The modules make use of the ICD10(International Classification ofDiseases Version 10) diagnostic codesand the UPFS (Uniform Patient FeesSystem) procedure coding systems.
INPATIENT MX (WARDS)
• Ward admissions• Ward transfers• Ward discharges• Clinical discharge summaries• ICD10 and UPFS integration• Interfacing for electronic scripts• Interfacing for electronic radiology
requests• Recording of investigations• Ward reports• Capturing of clinical notes
Inpatient Management Business Process
Patient arrives at ward Admit the patient Bed ListNursing care
NurseNursing / Ward Clerk Bed/Ward List Updated
HPRS HMS²Data Exchange
HL7, Web Services
Inpatient care
Doctor
Radiology / Pharmacy / Allied Health
TTO Discharge summaryFollow-up Booking
eAlliedeScripteRadiology
Patient Separation
Clerk/NurseTransfer patientDischarge patientMake follow-up bookingElectronic ward register updated etc..
3
eScripts
This module integrates with the outpatient and
inpatient modules and allows for generating an
electronic script, electronic processing to pharmacy and
script acceptance and dispensing by pharmacy.
The module also keeps the reporting unit e.g. ward and the doctor updated on the
progress of the script.
ELECTRONIC REQUESTS
eRadiology
This module integrates with the outpatient and inpatient
modules that allows for generating an electronic radiology request by the
doctor, electronic processingto the radiology department
and radiology acceptance and processing of requests. The
module also keeps the reporting unit e.g. ward and the doctor updated on the progress of the radiology
request.
Bed Request
Clinical and administrative users can electronically
request an inpatient bed
Allied Health Worker Request
Doctors can request services from allied health
workers
CLINICAL KIOSK
The clinical kiosk module provides a single point of entry from where clinical teams can access various systems and information relevant to their area of
operation. From the clinical kiosk, clinical teams can for instance access NHLS, PACS,
document repositories, video libraries etc.
OTHER FEATURES
INTRANET
This module provides a variety of features, with intranet web based
content management to, for instance distribute news articles,
documents (text, video and audio) with flexible category management
etc. The intranet module also offers
features such as blogging and bulk email sending.
The intranet modules can assist hospitals to share information,
knowledge management, compliance to the national core
standards and etc.
OTHER…
• User based role management
• Audit trials• Encryption• HL7 engine• Security• Ad hoc reporting
OM & CONSULTANT: OPD PATIENT STATUS
CLINICAL PATIENT VITAL SIGNS
ADMISSION STATUS
PART CProject Impact
Dev PM Implement.
Licensing &
Hosting Fees
Annual Maint
In Op (yrs)
Op Savings to date
Next 5years Op
Solution Upgrades Total Savings
Intranet website 2 000 000 80 000 100 000 10 3 800 000 900 000 1 000 000 5 700 000
Internet website 600 000 80 000 100 000 1 780 000 900 000 100 000 1 780 000
HRMiS 2 000 000 80 000 100 000 3 2 540 000 5 400 000 100 000 8 040 000
HR Accruals 500 000 80 000 100 000 3 1 040 000 900 000 - 1 940 000
Employee verification 500 000 80 000 100 000 4 1 220 000 900 000 100 000 2 220 000
HMS2 500 000 80 000 100 000 3 1 040 000 9 700 000 - 10 740 000
6 100 000 480 000 600 000 24 10 420 000 18 700 000 1 300 000 30 420 000
PART DFUTURE DEVELOPMENT PLANS
Advancing Healthcare…Towards a Unitary SA National Health System
Section 21
DESIGN AND BUILD• Project / System Definition
• User requirement definition
• System requirement and definition
• System analysis and design
• System build / prototype / pilot
SYSTEM ENABLEMENT
• Institutional compliance assessment
• GAP Analysis to address challenges with processes,
people and technology
• System Implementation
OPERATE AND MAINTAIN
• Operational systems support
• Onsite technical support
• Ongoing training and hand holding
Partners Partners
INCLUSIVE E-HEALTH ECOSYSTEM FRAMEWORK FOR SA
MemberRegistry
HMS (Open Platform)
PatientRegistration
Doc MX OPD MXInpatient
MX
TheatreMX
NHLS
RadiologyDigital Radiology
RxSolution/MedsasPharmacy
Medical aidDebtor
Classification
eScripteRadiology
Kiosk
BookingsConsultation
Registers
ADTClinical Discharges
eRegistersEfficiency Reports
DHISHEALTH
TECHNOLOGYOTHER
HPRN
ACADEMIC INSTITUTIONS
NAT
ION
AL
HEA
LTH
INFO
RM
ATIO
N E
XCH
AN
GE
DHIS
3RD PARTY SYSTEMS USED IN FACILITIES
INNOVATION HUB
RESEARCH
REGISTRIES
Partnersh
ips
PR
OV
INC
IAL
HEA
LTH
INFO
RM
ATIO
N E
XCH
AN
GE
HNSF
MOU
SLA
COMPANIESNGO’S
POLICY, SECURITY. AUDIT
CONTRACTS
Patient Demographics
OTHER…
ApplicationsImplementationTraining and Development
INCLUSIVE E-HEALTH GOVERNANCE FRAMEWORK
Product delivery teams (Manage product delivery)
Accept Work packages Execute Work packages Deliver Work Packages
PUBLIC & PRIVATE
National & Provincial HMS Committee
Leadership Strategic direction Corporate advice and decisions Authorizations
ExecutivePolitical
Strategic directionIdentify PrioritiesProvide AdviceAuthorizations
Project prioritiesIssue work packagesProvide advice and guidanceAuthorizations
Work packages deliveryWork package reports
E-Health Strategic planHighlight reportsException reportsIssue reports etc…
Chairperson
Building A Healthcare Information and Management System in the Eastern CapeA Collaborative Endeavor Towards an Affordable Digital Solution to Improve Hospital Service Delivery
Transforming Healthcare Together
Building Our Legacy: Universal Access to Quality Healthcare so that South Africans can Live Long & Healthy Lives