Jan de Sitter - IT & health care delivery

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as presented at TMAB eHealth Congress 2010

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Jan de Sitter - IT & health care delivery

  1. 1. Can IT systems help to manage the quality of health care delivery ? 25 november 2010 Jan De Sitter CIO at GZA1
  2. 2. Introduction• GZA: « Gasthuis Zusters Antwerpen » • 3 sites 1033 beds • Sint-Augustinus Wilrijk • Sint-Vincentius Antwerpen • Sint-Jozef Mortsel• Tradition of IT-support for care processes • Since 1990 : « Patient care systems » (PCS) • Order communication • Nursing records (activities planning and result reporting) • Medication • Since 1996 : Medical records (C2M)  Patientrecord • Resultserver • Reportgenerator • Support of Paramedic activity • Structured elements in the EPR • Since 2000 : Clinical pathways • Built on PCS technology • Introduction of online decision support • Second generation of systems in development and/or implementation phase2
  3. 3. The care process Quality definition from the Institute of Medicine ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’ Quality care should be • Result driven • Based on well defined processes • Measurable (indicators)3
  4. 4. Drivers for quality care • Multidisciplinarity, multiprofessionalism • Need to share information • Fast and accurate communications Shared patient record, Convergence of medical record, nursing record… • Intensity of care • Growing number of actors • Shorter delivery times Need for efficient planning systems (order communications) • Process management • Evidence based Care and Medicine • General procedures should be instantiated for the individual patient Care Pathways (incl indicators)4
  5. 5. Drivers for quality care (2) • Continuum of care • Need to share information with actors outside the hospital • Need to share processes Role for eHealth ? Sharing GMD between actors Building shared records around disease management ? • Patient safety • Key element in quality of care Introducing closed loops in EPD (e.g. medication administration, hemovigilance…) Structured content in EPD (e.g. structured protocols) Decision support (e.g. interactions, realtime checks)5
  6. 6. HIMMS EMR adoption modelUS EMR Adoption ModelSM 2010 2010 Stage Cumulative Capabilities Q1 Q2 Complete EMR; CCD transactions to share data; Data warehousing; Data Stage 7 0.7% 0.8% continuity with ED, ambulatory, OP Physician documentation (structured templates), full CDSS (variance & Stage 6 1.8% 2.6% compliance), full R-PACS Stage 5 Closed loop medication administration 5.0% 3.2% Stage 4 CPOE, Clinical Decision Support (clinical protocols) 7.7% 9.7% Nursing/clinical documentation (flow sheets), CDSS (error checking), Stage 3 50.0% 50.2% PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; Stage 2 16.5% 15.5% HIE capable Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.9% 6.8% Stage 0 All Three Ancillaries Not Installed 11.4% 11.2%Data from HIMSS AnalyticsTM Database © 2010 N = 5,223 N = 5,217 6
  7. 7. Generic Care process • Assessment : systematic collection of information • Diagnosis: analysis of information and decision • Planning: time – task: => organisation of the process around the patient • EBM-N • Patient characteristics • Documentation • Evaluation7
  8. 8. Planning• Activities of professionals: • Nurses • Physicians • Pharmacy • Paramedics• Integrate • Activities of diagnostic and therapeutic services : radiology , lab.. • Nursing care activities • Medication• Support • Development of individual careplan starting from the generic plan8 • Based on evidence based guidelines
  9. 9. Document• Activities • Performed , changed, or not performed? • Why not?• Results • Document different parameters• Documentation is coded • Makes “Rule based decision support” possible • Facilitates Analysis and evaluation9
  10. 10. Care portal : integrates patients and tasks
  11. 11. Medical Record
  12. 12. Medication
  13. 13. Nursing
  14. 14. Nursing : charting
  15. 15. Orders
  16. 16. Care Pathways
  17. 17. Care Pathways
  18. 18. Added value from ICT• Steering from information and processes • Between services (intra-extramural) • Between professionals (intra-extramural ) • Delivery of structured instruments(intra-extramural) • To organise and evaluate care delivery• Operationalize standards and procedures • EB care through algoritms ( decision trees) • Structured set of acts and instruments • Measurement systems• Feed-back • Development of indicators18
  19. 19. Performance indicators: Clinical indicator POBC Financial indicator Pain score LOS Kp POBC 2002-2009 1e sem 09 (169 ptn)-08 (145) -07 (166 ptn ) -04 (122ptn) 9,0 8,0 10 7,0 6,0 Gem LOS 8 5,0 Gem. verbPain value 2009 4,0 6 2008 3,0 2007 4 2004 2,0 1,0 2 0,0 2002 2003 2004 2005 2006 2007 2008 2009 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Year day post op (day 0 = surgery) Procesindicator Proportion staging pre- or post surgery 1e sem 2002-2009 100% % Investigations 90% 80% 70% 60% 50% Pre-op 40% post op 30% 20% 10% 0% 2002 2003 2004 2005 2006 2007 2008 2009 Year 19
  20. 20. Questions ?

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