Adopting Information Systems in a Hospital: A Case Study & Lessons Learned March 13, 2014 Nawanan Theera‐Ampornpunt, M.D., Ph.D. (Health Informatics) Deputy Executive Director for Informatics (CIO/CMIO) Chakri Naruebodindra Medical Institute Faculty of Medicine Ramathibodi Hospital, Mahidol University SlideShare.net/Nawanan Except copied from elsewhere
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Adopting Information Systems in a Hospital - A Case Study & Lessons Learned
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Adopting Information Systems in a Hospital: A Case Study & Lessons LearnedMarch 13, 2014
Nawanan Theera‐Ampornpunt, M.D., Ph.D. (Health Informatics)Deputy Executive Director for Informatics (CIO/CMIO)Chakri Naruebodindra Medical InstituteFaculty of Medicine Ramathibodi Hospital, Mahidol University
SlideShare.net/Nawanan
Except copied from elsewhere
A Bit About Myself...
2003 M.D. (First-Class Honors) (Ramathibodi)2009 M.S. in Health Informatics (U of MN)2011 Ph.D. in Health Informatics (U of MN)2012 Certified HL7 CDA Specialist
• Deputy Executive Director for Informatics (CIO/CMIO) Chakri Naruebodindra Medical Institute
• Lecturer, Department of Community MedicineFaculty of Medicine Ramathibodi HospitalMahidol University
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. 337 p.
Clinical Care
• Information-rich, but fragmented• Large knowledge body, limited
memory• Complex clinical decisions• Busy providers, limited time• Poor handwriting• One small mistake can lead to
morbidity & mortality
Information is Everywhere in Healthcare
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
Why We Need ICT in Healthcare?
#1: Because information is everywhere in healthcare
• Economist.com subscription $59• Print & web subscription $125
6832
# of People
# of People
Cognitive Biases in Healthcare
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781-3.
“Everyone makes mistakes. But our reliance on cognitive processes prone to bias makes treatment errors more likely
than we think”
• Medication Errors
– Drug Allergies
– Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
Why We Need ICT in Healthcare?
#2: Because healthcare is error-prone and technology
can help
Why We Need ICT in Healthcare?
#3: Because access to high-quality patient
information improves care
Common “Goals” for Adopting HIT
“Computerize”“Go paperless”
“Digital Hospital”
“Modernize”
“Get a HIS”
“Have EMRs”
“Share data”
Some Misconceptions about HIT
Current Environment
Bad
New, Modern, Electronic
Environment
Good
If
ThenAlways
Some Quotes
• “Don’t implement technology just for technology’s sake.”
• “Don’t make use of excellent technology. Make excellent use of technology.”(Tangwongsan, Supachai. Personal communication, 2005.)
• “Health care IT is not a panacea for all that ails medicine.” (Hersh, 2004)
• “We worry, however, that [electronic records] are being touted as a panacea for nearly all the ills of modern medicine.”(Hartzband & Groopman, 2008)
The Key Is Information
Knowledge
Information (Data + Meaning)
Data
Use of information and communications technology (ICT) in health & healthcare
settings
Source: The Health Resources and Services Administration, Department of Health and Human Service, USA
Slide adapted from: Boonchai Kijsanayotin
Health IT
HealthInformation Technology
Goal
Value-Add
Tools
Health IT: What’s in a Word?
• Patient’s Health• Population’s Health• Organization’s Health
(Quality, Efficiency, Reputation & Finance)
“Health” in “Health IT”
Various Ways to Measure Success
• DeLone & McLean (1992)
• Guideline adherence• Better documentation• Practitioner decision making or
process of care• Medication safety• Patient surveillance & monitoring• Patient education/reminder
Values of Health IT
THE “WHAT”Adopting Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic Health
Records (EHRs)
Picture Archiving and Communication System
(PACS)
Various Forms of Health IT
Screenshot Images from Faculty of Medicine Ramathibodi Hospital, Mahidol University
mHealth
Biosurveillance
Telemedicine & Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, HealthVault.com and American Telecare, Inc.
Personal Health Records (PHRs) and Patient Portals
Still Many Other Forms of Health IT
• Master Patient Index (MPI)• Admission-Discharge-Transfer (ADT)• Electronic Health Records (EHRs)• Computerized Physician Order Entry (CPOE)• Clinical Decision Support Systems (CDS)• Picture Archiving and Communication System
• Health IT doesn’t fix everything• Don’t just “turn electronic”• Clearly aim for quality & efficiency of care• Identify problems/risks with current systems• Adopt and use health IT “meaningfully”• Use health IT to
– help clinicians do things better– improve operational workflows– support organizational strategies
Ramathibodi’s Journey
• CIO: Dr. Suchart Soranasataporn• Developed HIS from scratch• Started from MPI, OPD, IPD,
• 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
Build or Buy
• No universal right or wrong answer• Depends on local contexts
– Strategic positioning– Internal IT capability– Existing environments– Level of complexity/customization needed– Market factors: market maturity, vendor choices,
competence, willingness to customize/learn– Pricing arrangements– Purchasing power– Sustainability
The sailboat image source: Uwe Kils via Wikimedia Commons
The destination
The boatThe sailor(s) &
people on board
The tailwind The headwind
The direction
The speed
The past journey
The sea
The sail
The current location
Context
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
Outsourcing Dilemmas
From a teaching slide by Nelson F. Granados, 2006
Doig et al, “Has Outsourcing gone too far,” McKinsey Quarterly, 2001
• “One of the challenges Ford has is that it has outsourced so much of its process, it no longer has the expertise to understand how it all comes together” Marco Iansiti, CIO, 2003
IT Outsourcing: Ramathibodi’s Case
From a teaching slide by Nelson F. Granados, 2006
Does service offer competitive advantage?
Is external deliveryreliable and lower cost?
Keep Internal
Keep Internal
OUTSOURCE!
Yes
No
Yes
No
Core HIS, CPOEStrategic advantages• Agility due to local workflow accommodations• Secondary data utilization (research, QI)• Roadmap to national leader in informatics
Key: Strong & trustworthy partnership with competent partners
“Buy”
Lesson #4Be careful of “Legacy
Systems Trap” or “Vendor Lock-in”
Lesson #5Invest in People
• About 100 IT professionals (1:80)– Health informaticians– Business analysts– Systems analysts– Software developers– Software testers– Project managers– Systems & network administrators– Engineers & technicians– Data analysts– Help desk / user support agents– Supporting staff
• Ratios of IT vs Health from Western countries: 1:50 - 1:60
Ramathibodi IT Workforce
• Importance of “Special People–Business Analysts–Project Managers–Clinician Leaders as Champions– Chief Information Officers– CEO & Other Executives
“Special People”
Lesson #6Pay attention to
“Process”
People
TechnologyProcess
Lesson #7Even large hospitals still
face enormous IT challenges.
Lesson #8Value of Teamwork & Project Management
in IT Projects
Lesson #9We can’t live without IT in
today’s health care. What an exciting time to
be on this journey!
Ramathibodi hospital’s IT builds upon its long history of development and has offered values to the organization, but it still has a long way to go, and there is no “perfect” implementation. Large rooms for improvement.
Summary
THE “HOW”Adopting Health IT
Adoption Considerations
• Organizational adoption ≠ individual use• IT availability vs. IT use• Depth (IT infusion) vs. breadth (IT diffusion)• Components of IT
– Technologies– Functions– Data– Management
People
Techno-logyProcess
Adoption Curve
Source: Rogers (2003)
Key Management Issues
Source: Theera-Ampornpunt (2011)
• Change management Communication Clear, shared vision and user commitment Workflow considerations Adequate and multi-disciplinary user involvement Leadership support Training