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Adopting Health IT: What, Why, and How?

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Theera-Ampornpunt N. Adopting Health IT: What, Why, and How? Presented at: How to Implement World Standard Hospital IT?; 2010 Nov 3; Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, …

Theera-Ampornpunt N. Adopting Health IT: What, Why, and How? Presented at: How to Implement World Standard Hospital IT?; 2010 Nov 3; Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. Invited speaker, in Thai.

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  • 1. Adopting Health IT: What, Why & How? Nawanan Theera‐Ampornpunt, MD, MS (Health Informatics) PhD Candidate (Health Informatics), University of Minnesota Faculty of Medicine Ramathibodi Hospital, Mahidol University Faculty of Medicine Ramathibodi Hospital, Mahidol University Except copied from elsewhere SlideShare.net/Nawanan
  • 2. Health IT: What’s in a Word? Health Goal Information f Value- Add dd Technology Means
  • 3. Adopting Health IT p g THE “WHAT” WHAT
  • 4. Information is Everywhere
  • 5. Various Forms of Health IT Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records Picture Archiving and g (EHRs) Communication System (PACS)
  • 6. Still Many Other Forms of Health IT Health Information Exchange (HIE) m-Health Biosurveillance Personal Health Records ( (PHRs) ) Telemedicine & Information Retrieval Telehealth Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
  • 7. Health Informatics & Health IT Shortliffe, 2002
  • 8. Adopting Health IT p g THE “WHY” WHY
  • 9. Common “Goals” for Adopting HIT “Go paperless” Go paperless “Computerize” Computerize “Get a HIS” “Digital Hospital” Digital Hospital “Have EMR ” “H EMRs” “Modernize” “Share data” Share data
  • 10. Some Misconceptions about HIT If Current C t New, M d N Modern, Environment Electronic Environment Then Always Bad Good
  • 11. Some Quotes • “Don’t implement technology just for Don t technology’s sake.” • “D ’t make use of excellent t h l “Don’t k f ll t technology. Make excellent use of technology.” (Tangwongsan, Supachai (Tangwongsan Supachai. Personal communication 2005 ) communication, 2005.) • “Health care IT is not a panacea for all that ails medicine ” (H h 2004) medicine. (Hersh, • “We worry, however, that [electronic records] are b i t t d as a panacea f nearly all being touted for l ll the ills of modern medicine.” (Hartzband Groopman, 2008) (H t b d & G
  • 12. Common Denominator • H lth I f Health Information Technology ti T h l • Electronic Health Records • Health Information Exchange • e-Health
  • 13. The Key Is Information Knowledge K l d Information (Data + Meaning) Data
  • 14. Various Ways to Measure Success • DeLone & McLean (1992)
  • 15. 4 Ways IT Can Help Health Care Modified from Strategic Theera-Ampornpunt, 2009 • Business Intelligence • CDSS • Data Mining/ • HIE Utilization • CPOE • MIS • PACS • Research Informatics • EHRs • E-learning Administrative Clinical Enterprise Resource • ADT Planning • HIS • Finance • LIS • Materials • RIS • HR Position may vary based on local context Operational
  • 16. Clinical Care • Information rich but fragmented Information-rich, • Large knowledge body, limited memory • Complex clinical decisions • Busy providers, limited time • Poor handwriting • One small mistake can lead to morbidity & mortality
  • 17. Fundamental Theorem of Informatics Friedman, 2009
  • 18. Clinical Improvements • Literature suggests improvement through – Guideline adherence (Shiffman et al, 1999;Chaudhry et al, 2006) – Better documentation (Shiffman et al, 1999) – Practitioner decision making or process of care (Balas et al, 1996;Kaushal et al, 2003;Garg et al, 2005) – Medication safety (Kaushal et al, 2003;Chaudhry et al, 2006;van Rosse et al, 2009) al al al – Patient surveillance & monitoring (Chaudhry et al, 2006) – P ti t education/reminder (Balas et al, 1996) Patient d ti / i d
  • 19. Clinical Decision Making Model PATIENT Perception CLINICIAN Attention Long Term Memory External Memory Working Memory M Knowledge Data Knowledge Data Inference From a teaching slide by Don Connelly, 2006 DECISION
  • 20. Operational Improvements • Workflow Optimization – Business Process Reengineering (BPR) –OOperations Research & M ti R h Management t • Parallel Access to Information Results • Ti Time savingi • Cost saving • Productivity • Predictability • Flexibility (Organizational slack)
  • 21. Summary Points: The Why • Health IT doesn t fix everything doesn’t • 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
  • 22. Adopting Health IT p g THE “HOW” HOW
  • 23. Considerations • Build or Buy • Vendor Management g • Adoption Concepts & Strategies
  • 24. Build or Buy Build/Homegrown Buy/Outsource • Full control of software • Less control of & data d t software & data ft d t • Requires local expertise • Requires vendor • Expertise competence retention/knowledge g • Vendor relationship p management is vital management is vital • Maybe cost effective if cost-effective • Maybe cost effective cost-effective high degree of local if economies of scale customizations or long- long term projection
  • 25. Build or Buy • No universal right or wrong answer • Depends on local contexts – Strategic p g positioning g – 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 g – Sustainability
  • 26. Outsourcing Decision Tree Keep Internal No Is external delivery No reliable and lower cost? Does service offer Yes OUTSOURCE! competitive advantage? titi d t ? Yes Keep Internal From a teaching slide by Nelson F. Granados, 2006
  • 27. Outsourcing Dilemmas Doig et al, “Has Outsourcing gone too far,” McKinsey Quarterly, 2001 • “One of the challenges Ford has is that it has outsourced so One much of its process, it no longer has the expertise to understand how it all comes together” Marco Iansiti, CIO, 2003 From a teaching slide by Nelson F. Granados, 2006
  • 28. IT Outsourcing: Ramathibodi’s Case External delivery unreliable • Non-Core HIS HIS, External delivery higher cost • ERP, IT Support? No Keep Internal Is external delivery No reliable and lower cost? Does service offer Yes OUTSOURCE! competitive advantage? PACS, RIS, PACS RIS Departmental Yes Keep Internal systems, Core HIS, C O C S CPOE IT Training Strategic advantages • Agility due to local workflow accommodations •SSecondary d t utilization ( d data tili ti (research, QI) h • Roadmap to national leader in informatics From a teaching slide by Nelson F. Granados, 2006
  • 29. If Decision = Build Challenges g • Recruitment & retention • Keeping up with new technologies & requirements – The “legacy systems” trap • Justifying “slow” implementation
  • 30. If Decision = Build Suggestions • Recruitment & retention • Knowledge management: Tacit -> Explicit > • Have long-term vision/strategies • Aim for system evolution – New requirements – New technologies/best practices – Refactoring • Prioritize • Reevaluate build/buy decision every 5 years
  • 31. If Decision = Buy Challenges g • Vendor selection • Justifying long-term costs • Managing risks • The “vendor lock-in” problem p
  • 32. If Decision = Buy Suggestions • Take time & effort in knowing your potential vendors • Be flexible in requirements, project delivery • Look at vendor as partner, not contractor – Be careful of “us-versus-them” mentality y • Understand “learning curves” • Be less bureaucratic more collaborative bureaucratic, • Be specific in SLAs, MAs, IP, data ownership • Choose technologies wisely, with rooms for later migration if possible • Knowledge transfer • Always have a Plan B (Alternative vendors, internal workforce)
  • 33. Gartner’s Sourcing Life Cycle Strategic g Tactical Sourcing Strategy Evaluation and Selection g Alignment g Identification g Organization assessment g Criteria development g Core competencies g Organization fit g Market scan g Selection process g Make-or-buy decisions g Partnership g Risk analysis opportunities Sourcing Contract Management Development g Relationship g Governance model g Performance g Metrics assessment g Payment models g Goals: reach business objectives, efficiency, g Terms and conditions q quality, innovation y, g Provision g Transition for changes From a teaching slide by Nelson F. Granados, 2006
  • 34. Levels of Adoption Individual Department within organization Organization
  • 35. Adoption Considerations • Organizational adoption ≠ individual use • IT availability vs. IT use • Depth (IT infusion) vs. breadth (IT diffusion) • Components of IT – Technologies People – Functions – Data Techno- Process – Management logy
  • 36. Adoption Curve Source: Rogers (2003)
  • 37. Key Management Issues • Change management Communication Clear, shared vision and user commitment C Workflow considerations Adequate and multi-disciplinary user involvement Leadership support p pp Training • Project management • Organizational learning • Innovativeness Source: Theera-Ampornpunt (unpublished)
  • 38. Summary • Know what to adopt – Gap analysis • Know why adopt – Individual & organizational impacts (clinical/administrative, strategic/operational) • Know how to adopt – L Local contexts di t t how; “K l t t dictate h “Know your organization” i ti ” – Balance technology focus with people & process focus – Manage risks – Manage change – Balance immediate needs with long term journey long-term – Evaluate!!
  • 39. References • DeLone WH, McLean ER. Information systems success: the quest for the dependent variable. Inform Syst Res. 1992 Mar;3(1):60-95. • Friedman CP. A "fundamental theorem" of biomedical informatics. J Am Med Inform Assoc. 2009 Apr;16(2):169-70. • Hartzband P Groopman J Off the record avoiding the pitfalls of going electronic N Engl J P, J. record--avoiding electronic. Med. 2008 Apr 17;358(16):1656-1658. • Hersh W. Health care information technology: progress and barriers. JAMA. 2004 Nov 10:292(18):2273-4. • Shortliffe EH. Sh tliff EH JBI status report. Journal of Biomedical Informatics. 2002 O t 35(5 6) 279 t t t J l f Bi di l I f ti Oct;35(5-6):279- 80. • Theera-Ampornpunt N. Measurement of health information technology adoption: a review of the literature and instrument development [master’s Plan B project] (unpublished). Minneapolis (MN): University of Minnesota; 2009. 165 p. • Theera-Ampornpunt N. Medical informatics: a look from USA to Thailand. Presented at: Ramathibodi's Fourth Decade: Best Innovation to Daily Practice; 2009 Feb 10-13; Nonthaburi, Thailand. Panel discussion via videoconference, in Thai. , , http://www.slideshare.net/nawanan/medical-informatics-a-look-from-usa-to-thailand- 1009781