Presented By. Worldwide Trends in Healthcare IT. The 26th Joint Conference on Medical Informatics Japan 3rd November 2006.

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1 Worldwide Trends in Healthcare IT. The 6th Joint Conference on Medical Informatics Japan 3rd November 006 Integration Presented By Kerry Stratton Healthcare - Managing Director Trained as Medical Scientist Sydney Institute Specialist Cytologist Auckland NZ Started in Healthcare IT 975 Founder Détente D Systems 98 Heyden Spike Public Company 987 Founder Trakhealth Consulting Services Healthcare IT companies

2 Sydney Australia Our Vantage Point Hospitals, Clinics, Laboratories, HMOs, 00,000+ systems, 4,000,000+ users Packaged Applications Custom Applications 00s of application partners Database, Application Development & Integration Most successful healthcare platform

3 HealthCare Over the Last 70 Years Governments have invested in Infrastructure Clinical Equipment throughout each Hospital Department Better Procedures Drug Management / Pharmaceuticals 936 3



6 Healthcare System Needs Worldwide? The Basic System Needs are similar Patient Administration - Register Patient and maintain Demographic Details. Availability of Patient History at Point of Care Create EHR and Single Patient View Coherent Clinical Information Maintain Diagnosis, Allergies, Medicines Management. Laboratory, Radiology & Pharmacy Systems Ordering and Results. Commitment to International Standards i.e. HL7, ICD0, SNOMED Discharge Summary. Improve National Healthcare Statistics AIDS, Bird FLU, SARS 6

7 Healthcare Improvements using IT Mid 980 s Mid 990 s s Basic Patient Administration and Departmental Systems. Recently - vendors have focused on development of total Hospital Information Systems Single integrated system EPR & Single Clinical View Focus on developing a single product and technology. Replacement of Departmental Systems 936 7

8 006 Where Have The Problems Been? The Big Bang approach has not been successful WHY?. Lack of Clear Definition Resulting Scope Creep. Far to long to implement, (Gartner Sept.005 Talks of to 5 years) lack of results & rewards. 3. Very difficult to get agreement from departments. 4. Extent of Change Management trivialized. 5. Champions & Supporters loose Faith. 6. Costs & Budget Blowouts 7. Privacy & Consent with Regard to EHR. 8

9 Current Focus for Most EHR initiatives Aggregate Individual Population Management EHR Continuity of Care EHR Retrospective Disease Surveillance EHR E-health Network EHR Transactional Terminology Electronic Patient Record (EPR) : Computer based patient records within the scope of a single provider organisation i.e. hospital, or Primary Care Electronic Health Record (EHR) : The contents of a (possibly virtual) repository of medical information about a person. Designed to serve a large number of provider organisations and facilitate interoperability of EMR systems to improve the continuity of care given to patients. 9

10 Driving demand for EHR Patient Safety? Reduce Costs? Improve efficiency / throughput? Improve quality of care? Disease Prevention? Patient Choice? Access to Care? Growing Need for Community Health Reduce bed days reduce cost Shift to Community care & allied health services. Better IT systems planned care discharge summary. EHR essential for continuum of care. Patient / Citizen Access 0

11 Patient Safety USA 50% of preventable Adverse Drug Events are due to prescribing errors Up to 98,000 deaths per year from avoidable errors UK Potentially 400,000 avoidable Adverse Events per year Up to 34,000 deaths preventable deaths per year 400 million per year in clinical negligence compensation

12 eprescribing European Survey, 004 Less than % of all European hospitals are using eprescribing System! No known eprescribing systems used in Asia, South Africa and India. > 40% World s s Population What EHR Contains At Minimum! Patient Demographics Diagnosis Medications Allergies Pathology Results Radiology Results

13 Dozens of Countries are trying to build EHRs Canada United States Mexico Denmark Finland Germany UK Lithuania Netherlands Ireland Czech R Switzerland China Korea Spain Croatia Israel Greece Turkey India Japan Taiwan Argentina Brazil South Africa Australia New Zealand EHR Initiatives around the World England Australia Canada U.S. Finland Germany Croatia NHS Connecting for Health HealthConnect Health Infoway Dr. Brailer s s NHIN OpenCDA SCIPHOX Central National Registry Netherlands National IT Initiative for Health 3

14 Brazilian project of Community Health Brazil Health federal district Government Systems Summary: SES s s project Helath Care Secretary of GDF together with CODEPLAN Compahia de Desenvolvimento do Distrito Federal and TrakHealth; PE Community profile : GO Population: habitants GDP Participation:,8% Questions and Services: PR DF MG SP RJ Admissions:.47 Death:.989 RS Surgery: births: Radiology exams: Pathology Clinical exams: Operational beds: 3.75 NISa 3 NITS NITN NIBz Mód. 3 BRAZLÂNDIA HRB LRC PSU U M Mód. HRC CEILÂNDIA HRC CRT SAMAMBAI A HRSa REGIÕES: NIC Mód. TAGUATINGA HRT Recanto das Emas Mód. PSU GAMA HRG NIG Norte Health federal district government system Centro Norte Centro Sul PSU NIP HBDF ATEND. TERCIÁRIO Mód. Mód. 3 PLANALTINA HOSP. SOBRAD. REG. ATEND. Project Plan: SECUNDÁRIO HRS HRP ATEND. 4 PRIMÁRIO Hosp. NIS Apoio USP 3 6PSU 7 Hospitals; FEPE REGIONALIZAÇÃO HIERARQUIZAÇÃO LACEN Mód. REDE PRÓPRIA CONVENIADOS Brasília Hemocentro 34 Health Clinics; ASA NORTE COMPP HRAN HSVP - Hosp. São Vicente CBMDF Corpo de de Paulo Bombeiros NICr NILN ISM - Instituto de Saúde Mental HFA HFA Hosp. Forças Armadas DISAT - Diretoria de Saúde do CBMDF 3 Diagnostic HUB- Hosp. Univ. de Brasília USP do Trabalhador PSU COMPP - Centro de Orientação Sarah Brasília Reference Médico-Psico-Pedagóica PSU HUB Mód. NIGu Mód. HBDF Centro de Saúde PARANOÁ Laboratories; SERVIÇOS GUARÁ CONTRATADOS LRGu NIBsB HRPa PSU - Posto Saúde Urbano HRGu NILS HEMODIÁLISE (7 estabelec.) - Posto Saúde Rural HSVP U M HEMODINÂMICA (3 estabelec) USP USP Unidade Unidade de de Saúde Saúde 0 Emergencies Prisional Prisional CATARATA ( estabelec.) NIRF DISAT Riacho Mód. RETINOPATIA DIABÉTICA Núcleo NIPr UM - Unidade Mista Units; Fundo Brasília (8 estabelec.) Band. Candan LRC e LRGu Laboratório ASA SUL I e II golân HRAS Ceilândia e do VITRECTOMIA ( estabelec.) PSU dia U M USP Guará PSU ESTUDO CRT - Central de Radiologia de ELETROFISIOLÓGICO Tagguatinga SARAH ( estabelec.) NINB São LACEN ISM NICd Sebas ISDF - Instituto - Laboratório de Saúde Central USP -Exploração Diagnóstica da ISDF de - Instituto Saúde Pública de Saúde do tião do DF do DF Epilepsia ( estabelec.) PSU DF NI Núcleo de Inspeção NI Núcleo de Inspeção () USP 0 () FEPE Santa PSU FEPE Fundação de de USP Ensino PSU NISM Maria Ensino e e Pesquisa Pesquisa em em Ciências Ciências da da Saúde professional Saúde using Sul Leste Oeste EXTENSÃO DA COBERTURA Elab. Gutemberg/SUPLAN /SES 09/004 3 Diagnostic services; Around health just one Electronic Health Record 4

15 Nictiz Functional View Hospital GBZ LSP GBZ General practitioners, pharmacists, dentists, nurses, surgeons, secretaries, administrative employees Functional Example Get x-ray x record from hospital y Hospital y GBZ LSP X-ray record of hospital y is relevant, admission is not GP needs record of patient x GBZ Need record of patient x Nurse Radiologist Admissions GP Dentist Pharmacist 5

16 South Africa Commitment to Improve Healthcare May President of Republic of South Africa Inaugural Speech Spending is to be in two areas Healthcare and Education - National EHR 006 The time for the healing of the wounds has come. The moment to bridge the chasms that divide us has come. The time to build is upon us 6

17 Summary Number one Priority Get started! Commitment To Standards i.e. HL7, ICD0, SNOMED EPR Systems:- Deploy in small steps, quickly Integration Deliver systems that support the continuum of patient care Coherent Clinical information Deliver systems that maintain freedom of choice Avoid scope creep Discharge Summaries Cost Effective Low Risk EHR Systems:- Coherent Clinical Information A Complex Challenge Privacy & Security Thank You 7