Faculty of Tropical Medicine, Mahidol University's Site Visit at Ramathibodi

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Faculty of Tropical Medicine, Mahidol University's Site Visit at Ramathibodi

  1. 1. Welcome Biomedical and Health Informatics StudentsFaculty of Tropical Medicine April 1, 2013 © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  2. 2. About Ramathibodi• A medical school in Mahidol University• Established 1965, Operational 1969• Vision: To be an internationally-recognized leading medical institution• Mission: Integrating education, research, and healthcare services for the society’s health• Determination: To be the country’s guiding light on health
  3. 3. Ramathibodi’s Organization Chart
  4. 4. Ramathibodi’s Healthcare Services Item Ramathibodi QSMC SDMC Hospital Strategic Super-tertiary care Excellence center Customer-focusedSegmentation for wide variety of in advanced, premium services patients (public & complex cases targeting patients private) (e.g. with private transplantation) insurance, with integrated corporate security, wards, ICU, OR, out-of-pocket & and private care some government officialsInpatient Beds 896 Beds 177 Beds
  5. 5. Ramathibodi At A Glance• 1073 Total Beds• 68 Wards (Rama1=44; QSMC=7; SDMC=17)• 115 Inpatient admissions/day (+11 newborns)• 5,600 Outpatients/day – Regular (Office Hours) 4,400 patients/day – Special (Non-Office Hours) 1,200 patients/day – Premium (SDMC) 880 patients/day• 1,062,030 Active Patients• 8,300 Employees
  6. 6. Health Informatics Division
  7. 7. Long History of IT Development• 1st Generation (~1987-2001) – CIO: Dr. Suchart Soranasataporn – Developed HIS from scratch – Started from MPI, OPD, IPD, Pharmacy, Billing, etc. – Platform: Visual FoxPro (UI, Logic, Database)
  8. 8. Long History of IT Development• 2nd Generation (2001-2005) – CIO: Dr. Piyamitr Sritara – Developed CPOE for inpatients medication orders, lab orders and lab results viewing, discharge summaries, etc. – Enhanced existing HIS modules and add more modules and departmental systems (e.g. LR, OR) – Platform: Visual FoxPro (UI, Logic, Database)
  9. 9. Long History of IT Development• 3rd Generation (2005-2011) – CIO: Dr. Artit Ungkanont – Implemented ERP, PACS, LIS, Doctor Portal – Use of middleware (web services, JBOSS, JCAPS) – Implemented data exchange of lab & ADT data using HL7 v.2 & v.3 messaging – Informatics academic activities – Enhanced existing HIS & add more functions – SDMC becomes operational (2011) – Platform: Web [Mainly Java] (UI); Web services (Logic); Oracle & Microsoft SQL Server (Database) – Legacy platform: Visual FoxPro (UI, Logic, Database)
  10. 10. Long History of IT Development• 4th Generation (2011-Present) – CIO: Dr. Chusak Okaschareon – Implemented CPOE for outpatients (go live soon) – Scanned Medical Records for outpatients – RamaEMR for physicians and nurses in OPD – Software project management changed from functional teams (silos) to project-based teams – Future projects: CMMI, ISO9001, better software testing, business intelligence, security – Platform: Web [Mainly Java] (UI); Web services (Logic); Oracle & Microsoft SQL Server (Database) – Legacy platform: Visual FoxPro (UI, Logic, Database)
  11. 11. Patient & Bed Management - Inpatient Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  12. 12. CPOE - InpatientScreenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  13. 13. CPOE - Home Medications for Inpatients Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  14. 14. Admission NotesScreenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  15. 15. Discharge SummaryScreenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  16. 16. Discharge Summary (Diagnoses & Operations) Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  17. 17. Discharge Summary (Cause of Death) Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  18. 18. Lab Orders - InpatientScreenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  19. 19. Lab Results - InpatientScreenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  20. 20. OutpatientScreenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  21. 21. RamaEMR - Doctor’s PortalScreenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  22. 22. RamaEMR - Doctor’s PortalScreenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  23. 23. RamaEMR - Scanned MR ViewerScreenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  24. 24. Build or BuyBuild/Homegrown Buy/Outsource• Full control of software & • Less control of software & data data• Requires local expertise • Requires vendor• Expertise competence retention/knowledge • Vendor relationship management is vital management is vital• Maybe cost-effective if • Maybe cost-effective high degree of local if economies of scale or customizations or long- few customizations term projection
  25. 25. IT Outsourcing Decision Tree Keep Internal No Is external delivery No reliable and lower cost? Does service offer Yes OUTSOURCE! competitive advantage? Yes Keep InternalFrom a teaching slide by Nelson F. Granados, 2006
  26. 26. IT Outsourcing Decision External delivery unreliable • Non-Core HIS, Tree: Ramathibodi’s Case External delivery higher cost • ERP maintenance/ongoing customization Keep Internal No Is external delivery No reliable and lower cost? Does service offer Yes OUTSOURCE! competitive advantage? ERP initial Keep Internal implementation, Yes PACS, RIS, Core HIS, CPOE Departmental Strategic advantages systems • Agility due to local workflow accommodations • Secondary data utilization (research, QI) • Roadmap to national leader in informatics (internal “lab”)From a teaching slide by Nelson F. Granados, 2006
  27. 27. Ramathibodi’s Priorities & Challenges• Quality software – Reflects quality of the team and process – Software testing & lessons learned crucial• Software development process reform – Project-based; Value of teamwork• System outages – Common issues of real-life IT operations – Disaster recovery and business continuity planning
  28. 28. Ramathibodi’s Priorities & Challenges• Secondary use of data / DW & BI – Important for academic health centers & university hospitals – Important for cost savings & quality improvement – Privacy safeguards important
  29. 29. Ramathibodi’s Lessons Learned• “Preemptive advantage” of using Health IT• “Build” approach was economical and makes our systems flexible to changing internal & external requirements• “Legacy systems trap” (aka. vendor lock-in)• Customization vs. standardization tension• IT as operational tools or quality improvement tools?• Recruiting & retaining high-quality workers a challenge that needs management solutions
  30. 30. Site Visit Outline• 1:00 - 1:45 PM Presentation• [15-minute walk to Rama1 Main Building]• 2:00 - 2:15 PM Inpatient Ward (7SW)• [15-minute walk back to SDMC]• 2:30 - 2:50 PM Outpatient Clinic (Ortho)• 2:50 - 3:10 PM Radiology Department• 3:10 - 3:25 PM Pharmacy• 3:25 - 3:40 PM Server Room• 3:40 - 4:30 PM Coffee Break & Conclusion
  31. 31. Questions?

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