Best Practices of Hospital IT from Ramathibodi Hospital
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Best Practices of Hospital IT from Ramathibodi Hospital

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  • Full Name Full Name Comment goes here.
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  • @kanapon ขอบคุณมากครับ จริงๆ ประสบการณ์ของรามาธิบดีที่เล่าในการบรรยายครั้งนี้ พี่เพียงแต่ทำหน้าที่เล่ามากกว่าครับ ไม่ได้เป็นคนทำให้เกิดคุณประโยชน์ต่อคนไข้เองเท่าไรนักครับ แต่เห็นด้วยว่าระบบสารสนเทศของโรงพยาบาลนั้น หากออกแบบและบริหารจัดการดีๆ ก็จะมีประโยชน์ต่อคนไข้อย่างมาก สิ่งที่รามาธิบดีทำ ก็ยังมีโอกาสพัฒนาอีกเยอะครับ แต่เราก็มีประสบการณ์ 20 กว่าปี เป็นบทเรียนที่ดีสำหรับการก้าวไปข้างหน้าครับ
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  • สุดยอดมากครับ ได้เห็นว่ากว่าจะพัฒนาแต่ละขั้นนี่ใช้เวลาไม่เบาเลย แต่ผมมั่นใจสิ่งที่พี่นรรนทำนั้นมันส่งประโยชน์ถึงคนไข้มหาศาลครับ
    ^^
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  • @pongsakkhowsathit ยินดีครับอาจารย์
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  • เพิ่งเห็น น่าจะเอามาพูดให้ทีมฟังบ้างนะ
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  • ขอบคุณพี่หวาน นวรัตน์ มากๆ ครับ
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Best Practices of Hospital IT from Ramathibodi Hospital Best Practices of Hospital IT from Ramathibodi Hospital Presentation Transcript

  • Best Real Practices of Hospital IT from Ramathibodi Hospital 1 SlideShare.net/Nawanan November 28, 2013
  • A Few Words About Me... 2 2003 Doctor of Medicine (1st-Class Honors) Ramathibodi 2009 M.S. (Health Informatics) University of Minnesota 2011 Ph.D. (Health Informatics) University of Minnesota 2012 Certified HL7 CDA Specialist Currently • Deputy Executive Director for Informatics Chakri Naruebodindra Medical Institute Faculty of Medicine Ramathibodi, Mahidol University Contacts nawanan.the@mahidol.ac.th SlideShare.net/Nawanan www.tc.umn.edu/~theer002 groups.google.com/group/ThaiHealthIT
  • Disclaimers • All views & opinions expressed are those of the presenter alone and do not represent views or positions of the Faculty of Medicine Ramathibodi Hospital or any other affiliated organizations 3
  • Ramathibodi’s Context 4
  • About Ramathibodi 5 • 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
  • 6
  • Ramathibodi’s Organization Chart 7
  • Ramathibodi’s Healthcare Services Item Ramathibodi Hospital QSMC SDMC Strategic Segmentation Super-tertiary care for wide variety of patients (public & private) Excellence center in advanced, complex cases (e.g. transplantation) with integrated wards, ICU, OR, and private care Customer-focused premium services targeting patients with private insurance, corporate security, out-of-pocket & some government officials Inpatient Beds 8 896 Beds 177 Beds
  • 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 9
  • Health Informatics Division 10
  • History of Ramathibodi’s IT Development 11
  • 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) 12
  • Visual FoxPro 13 http://en.wikipedia.org/wiki/Visual_FoxPro
  • Some Limitations of Visual FoxPro • File-based DB, not real DBMS – Performance Issues • Not well designed indexing, concurrency controls & access controls • Indexes sensitive to network disruptions • Single point of failures (no redundancy) – Scalability Issues • Database file size < 2GB • Not service-oriented architecture 14
  • 1st-Generation Development Process • Trials & errors • Individuals or small teams – Teams based on system modules (OPD, IPD, Billing, etc.) • Non-systematic, no documents 15
  • 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) 16
  • 2nd Generation (2001-2005) • Java or .NET? • Open/cost-effective vs. timely development • Technology survival? • Decision: Defer & continue using Visual FoxPro 17 http://thinkunlimited.org/blog/wp-content/uploads/2012/10/Fork_in_the_road_sign.jpg
  • 2nd-Generation Development Process • Small teams – Teams based on system modules (OPD, IPD, Billing, Pharmacy, Lab, etc.) • Realized needs for systematic software development process • Started formal systems analysis & design with some documents 18
  • 3rd Generation (2005-2011) • CIO: Dr. Artit Ungkanont • Continued ongoing projects from 2nd Generation & implemented – ERP, PACS • Implemented commercial LIS • Implemented self-developed webbased “Doctor’s Portal” 19
  • 3rd Generation (2005-2011) • Architectural changes: Used middleware (web services, JBOSS, JCAPS) • Implemented data exchange of lab & ADT data using HL7 v.2 & v.3 messaging • 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) 20
  • 3rd-Generation Development Process • Small teams – Teams based on system modules (OPD, IPD, Billing, Pharmacy, Lab, etc.) • Attempted systematic software development process, with limited success • Balancing quality development with timely software delivery difficult 21
  • 4th Generation (2011-Present) • CIO: Dr. Chusak Okaschareon • Implemented CPOE for outpatients (with gradual roll-out) • Scanned Medical Records for outpatients • RamaEMR (portal & EMR viewer for physicians and nurses in OPD) 22
  • 4th Generation (2011-Present) • Ongoing projects – – – – CMMI & high-quality software testing High-Performance Data Center & IT Services (ISO) Business intelligence Security • Platform: – Web [Mainly Java] (UI) – Web services (Logic) – Oracle & Microsoft SQL Server (Database) • Legacy platform: Visual FoxPro (UI, Logic, DB) 23
  • 4th-Generation Development Process • Project-based development • Roles of “Business Analysts” • From “silo” teams to “pooled” resources – Business Analysis Team – Systems Analysis Team – Development Team – Testing Teams 24
  • Project Management Dilemma Good Fast Project Deliverables Cheap 25
  • The Triple Constraint 26 Marchewka (2006)
  • CMMI 27 Image Source: http://en.wikipedia.org/wiki/Capability_Maturity_Model_Integration
  • Next Step: Chakri Naruebodindra Medical Institute (Bang Phli) 28
  • Overview of Ramathibodi’s Systems 29
  • Architecture Overview OPD IPD Pharmacy Doctors Front Office Finance 30 LIS Data Warehouse Students Back Office Nurses Scientists
  • Patient & Bed Management - Inpatient 31 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • CPOE - Inpatient 32 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • CPOE - Home Medications for Inpatients 33 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • Admission Notes 34 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • Discharge Summary 35 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • Discharge Summary (Diagnoses & Operations) 36 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • Discharge Summary (Cause of Death) 37 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • Lab Orders - Inpatient 38 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • Lab Results - Inpatient 39 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • Outpatient 40 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • RamaEMR - Doctor’s Portal 41 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • RamaEMR - Doctor’s Portal 42 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • RamaEMR - Scanned MR Viewer 43 Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • Kiosk for Insurance Eligibility Verification 44 Photos courtesy of Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.
  • Lessons Learned 45
  • Lesson #1 “Preemptive Advantage” of Using Health IT 46
  • IT as a Strategic Advantage Sustainable competitive Yes advantage Yes Yes Yes Non-Substitutable? Valuable ? No Resources/ capabilities 47 Rare ? No Inimitable ? No Preemptive advantage No Competitive necessity Competitive parity Competitive Disadvantage From a teaching slide by Nelson F. Granados, 2006 at University of Minnesota Carlson School of Management
  • 4 Quadrants of Hospital IT Strategic Business Intelligence HIE PHRs CRM Social Media CDSS CPOE Administrative Clinical VMI EHRs PACS LIS ERP ADT Word Processor 48 MPI Operational Nawanan Theera-Ampornpunt
  • Lesson #2 Customization vs. Standardization: Always a Balancing Act 49
  • Customization: A Tailor-Made Shirt 50 http://www.soloprosuccess.com/tailor-made-business-blueprint/
  • Customization & Standardization Customization Standardization 51
  • Lesson #3 Build or Buy?: A Context-Dependent, but Serious Decision 52
  • Build or Buy Build/Homegrown • Full control of software & data • Requires local expertise • Expertise retention/knowledge management is vital • Maybe cost-effective if high degree of local customizations or longterm projection 53 Buy/Outsource • Less control of software & data • Requires vendor competence • Vendor relationship management is vital • Maybe cost-effective if economies of scale or few customizations
  • IT Outsourcing Decision Tree No No Is external delivery reliable and lower cost? Yes Does service offer competitive advantage? Yes 54 Keep Internal OUTSOURCE! Keep Internal From a University of Minnesota teaching slide by Nelson F. Granados, 2006
  • IT Outsourcing Decision Tree: Ramathibodi’s Case External delivery unreliable • Non-Core HIS, External delivery higher cost • ERP maintenance/ongoing customization No No Is external delivery reliable and lower cost? Yes Does service offer competitive advantage? Yes Keep Internal Keep Internal Core HIS, CPOE OUTSOURCE! ERP initial implementation, PACS, RIS, Departmental systems Strategic advantages • Agility due to local workflow accommodations • Secondary data utilization (research, QI) • Roadmap to national leader in informatics (internal “lab”) 55 From a teaching slide by Nelson F. Granados, 2006
  • IT Decision as “Marriage” 56 Image Source: http://charminarpearls.com/pearls/
  • Divorces 57 Image Source: http://3plusinternational.com/2013/04/divorce-marital-home/ http://www.violetblues.com/breaking-up/financial-cost-of-getting-divorce-3-816.html/attachment/divorcemoney-fight-2
  • Context The current location The tailwind The past journey The headwind The direction The destination The speed 58 The sailor(s) & people on board The sail The boat The sea The sailboat image source: Uwe Kils via Wikimedia Commons
  • “Build” Key: Successful recruitment, sustainable retention, effective IT management & patience 59
  • “Buy” Key: Strong & trustworthy partnership with competent partners 60
  • Lesson #4 Be careful of “Legacy Systems Trap” or “Vendor Lock-in” 61
  • Lesson #5.1 Invest in People 62
  • Ramathibodi IT Workforce • About 100 IT professionals (1:80) – – – – – – – – – – – 63 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 • First (and still the only) medical school in Thailand with M.D., Ph.D. formally trained in Health Informatics • Return on investment (ROI) still to be proven :) 64
  • Building Workforce: Example • HL7 Certified Specialists Kevin Asavanant HL7 V3 RIM (2009) 65 Supachai Parchariyanon HL7 CDA (2010) Nawanan Theera-Ampornpunt HL7 CDA (2012) Sireerat Srisiriratanakul HL7 V3 RIM (2013) 65
  • Lesson #5.2 Identify & Utilize “Special People” 66
  • Special People • Bridgers – Informaticians – Business analysts • Clinical leaders • Natural leaders • Front-line workers 67
  • Lesson #6 Pay attention to “Process” (e.g. software development process) 68
  • 69 Image Source: Paragon Innovations, Inc. (2005)
  • People Process 70 Technology
  • Lesson #7 Data are golden 71
  • Data & Business Intelligence 72 Image Source: http://www.zawya.com/story/ZAWYA20121016035553/
  • Secondary Use of Data & Business Intelligence (BI) • Important for academic health centers & university hospitals • Important for cost savings & quality improvement • Privacy safeguards important 73
  • Lesson #8.1 Even large hospitals still face enormous IT challenges. 74
  • Lesson #8.2 Real-world hospital IT management is messy, difficult, tiring & discouraging. Live with it... 75
  • Lesson #9 Value of Teamwork & Project Management in IT Projects 76
  • Teams & Outcomes • Restructuring IT teams very helpful in effective & efficient software development • Quality of software reflects quality of the team and process 77
  • Lesson #10 We can’t live without IT in today’s health care. What an exciting time to be in the field! 78
  • Summary 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. 79
  • Ramathibodi Healthcare CIO 80 80 http://med.mahidol.ac.th/has/
  • Ramathibodi Healthcare CIO, 4th Class 81 81
  • Best Real Practices of Hospital IT from Ramathibodi Hospital SlideShare.net/Nawanan 82
  • Questions? 83