Healthcare needs information systems ! ICTExpo 2005 Do more with less William Grimson 14 th April 2005.

Healthcare needsinformation systems !

ICTExpo 2005

Do more with less

William Grimson 14th April 2005

Context

Frameworks for Change

Reform Programme

Information

Human Resources

FundingAcute Hospital

System

Organisational Reform

Primary Care

ProspectusReport

NHIS

Brennan Report

Hanly Report

HIQA

Action Plan forPeople

Primary CareStrategy

efficiency

cost containmentcost effectiveness

demand

Team-care

homecare

patient charter

eHealth

evidence-based medicine

shared care

computerisation

patient empowerment

clinical audit

genetic medicine

accreditation

6 Levels of EPR (UK – NHS)

Knowledge

The 21st-Century Health Care Systems

• Quality as a system feature.

• Goals: safety, effectiveness, patient-centeredness, timeliness, efficiency, quality and equity.

• Three guiding strategies: patient-centered, knowledge-based, and careflow-based systems.

Knowledge Management

The goal of KM is to improve organizational performance by enabling individuals to capture, share, and apply their collective knowledge to make optimal decisions ….. in real time, that is to take actions that will affect the outcomes.

CDR

Future: Knowledge Driven Care by Cerner (AMIA, 2002)

Timeliness of Delivery

De

pth

of

Kn

ow

led

ge

Reactive

Interactive

Proactive

SafetyAlerts

StructuredCare

Textbook& Journals

Post-hocCDR Alerts

Ad hoc CPOEwith ADE alerts

Ad hoc CPOEWith SOC Alerts

Decision-driven FlowJust In Time Push

ReferenceTexts

Standard ofCare Alerts

(SOC)

CPOE usingEvidence-based Order Sets

CPOE from withinLinked Pathways / Protocols

EMRKDC

Computerized Physician Order Entry (CPOE)

Even the Best Become Outdated...

Knowledge refinement

PatientRecords

KnowledgeBases Decision Tools

Knowledge Refinement

outcomesEvidence based medicine

Do we want to build, pay for, and maintain Information systems

without having Informatics Standards?

efficiency

cost containmentcost effectiveness

demand

Team-care

homecare

patient charter

eHealth

evidence-based medicine

shared care

computerisation

patient empowerment

clinical audit

genetic medicine

accreditation

Two things about the future …

What happens

time

Technological change & advances

present

predictions

Regarding change and technological advances … we tend to over-estimate them in the short-term & under-estimate them in the longer-term

Life cycle costs

• Full life cycle costs need to be considered as well as all the risks over that period

• For cost containment it is essential that alternatives are considered … i.e. looking well into the future to assess impacts and hence inform current decision-making

Design0.1

Build 1

Maintain 5

Operating cost/staff 100

Where are the real costs over the life-cycle ?

Don

’t s

kim

p on

thin

gs a

t th

is

stag

e !!

!

we need a vision, we need to plan, we need to have a rational

approach …and we need Standards?

Addressing the Issues

• Information role of the Health Information and Quality Authority (HIQA)

• Information access and governance• Information standards• Information deficits and developments• The Electronic Healthcare Record• ICT• Information and service planning

Information Standards (HIQA)

• National Health Information Standards Framework (Action 19)– Data standards– Technical standards– Quality standards

• Indicator standards (Action 20)• Quality assurance of information to public

(Action 21)

The Electronic Healthcare Record (HIQA)

• EHRs will be implemented on a phased basis (Action 15)– Defined and adopted through inclusive process– Implementation sites with supporting ICT

infrastructure– National roll-out in line with multi-annual ICT action

plan

ICT (HIQA)

Multi-annual ICT action plan (Action 22)– Build on work of HeBe plan– Develop in cooperation with HSE and DoHC– Ensure standard approach and VFM– Support national solutions (eg SAPS,PPARS)– Enable fast and secure communications infrastructure through

VPN– Support and enable eHealth applications and development of

Electronic Healthcare Records (EHRs)– Address digital divide

The Pace of Progress

It is important to note that many of the critical actions in the Strategy will be achievable through relatively modest new investment. Examples include improved use of existing information and introduction of governance framework…..Other initiatives are more heavily dependent upon investment decisions and the overall pace of new developments in the wider health system…These include investment in major ICT solutions… However, it is clear that ongoing consultation and partnership with all stakeholders will be of central importance to the implementation process throughout. (NHIS, Chapter 16, Implementation Phases)

Standards authorities

National Standards Authority of Ireland (NSAI)- HISC

To contribute to the development of European or International standards for patient and hospital information systems, specifically through participation in the work of CEN TC 251, ISO TC 215, and HL7; and to advise NSAI in regard to the need for National standards in this area.

National Standards Authority of Ireland (NSAI)- HISC

More specifically the role of HISC is to: 1. Increase awareness of the role and purpose of Health Informatics Standards in the overall delivery of healthcare in Ireland. 2. To provide a mechanism by which Ireland is represented at appropriate Standards organisations and activities.3. To act as a conduit to bring back information and assess the impact of future requirements and regulations on the Irish situation.

Technology Viewpoint

ISO/OMG Interface Definition Language (IDL)

ISO/OMG Unified Modeling Language (UML)

Computational Viewpoint

Enterprise Viewpoint

ResultsRetrieval

Registration SchedulingOrder

Communications

Standards Conformance

Engineering Viewpoint CORBA DCOM

DCE JavaBeans

C++

Java

COBOL

SmallTalk

Unix

Win32

MVS

PIDS COASTQS RAD CIAS

Information Viewpoint HL7 DICOM

NCPDP X12

ISO TC215

CEN TC251

Snomed

Lonic

ICD

CPT

DRG

Reference Model for Open Distributed Processing (RM-ODP)

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Purpose, scope, policies.

Business rules and content to be supported by the system.

Encapsulation of capability, separation of functionality, and interface definition.

Distributed interactions & mechanisms between the components.

Description of the implementation of the system.

Evolution of EPR Standards

… evolution

Electrical/Information/Mechanical ...