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How to move from organization-centredsystems to transactional implementation            opening doors to     an integrated...
The challenge facing healthcare in                 future2                    CLINIQUES UNIVERSITAIRES SAINT-LUC
People ageing      – > 65 yrs : 16.1% (2000)  27.5 % (2050)      – > 80 yr : 3.6 % (2000)  10 % (2050)    • Increase in de...
Rising costs      – Ever more sophisticated technology      – New curative and preventive treatments    • Rational use of ...
Patient, player in health       – Importance of health factor for the public       – Higher and higher standard of trainin...
Decompartmentalization    • From a compartmentalized healthcare system, centred      on the provider (hospital, GP, parame...
Are we ready ?    This change is under way       Projects on sharing medical information (“flow”, labelling of GP’s,      ...
Experience on the ground    Based on our experience at the Cliniques Universitaires      Saint Luc, of changing from a “pa...
Facts and figures    • University hospital, 960 beds, mostly acute    • 3 briefs : Research, Teaching, Care    • Considera...
Projects     • Between 2002 and 2006, several projects (electronic patient records,       report management, scanning and ...
What have we learned ?11               CLINIQUES UNIVERSITAIRES SAINT-LUC
Infrastructure     • A reliable, robust, integrated and consistent IT       infrastructure        – Consistency of informa...
Working in a different way     • Adapt to a different way of working        – Access to information according to different...
“On-line” risks     • Risks related to the benefits of access to shared       electronic information        – “No one is s...
Drowning     • A flood of information from all quarters        –   Constantly growing number of unprocessed images        ...
Confidentiality     • The new challenge of “everything electronically”        – Paper records can be consulted by many peo...
Institutional mobilization     • Both management and people on the ground must be involved in       this process of change...
Take home words…     •   Personal medical information sharing is one of the answers to the challenge         facing health...
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Partage de l’information - E-Health Congress TMAB - Bruxelles 8-11-2007

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Information sharing, one of the answers to the tomorrow challenge in the healthcare
Based on our experience at the Cliniques Universitaires Saint Luc, of changing from a “paper” medical information system to an “electronic” medical information
system, What have we learned from this process, which began in
2002?

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Partage de l’information - E-Health Congress TMAB - Bruxelles 8-11-2007

  1. 1. How to move from organization-centredsystems to transactional implementation opening doors to an integrated care approach? Information sharing, one of the answers to the challenge facing healthcare in future Dr B. Debande CLINIQUES UNIVERSITAIRES SAINT-LUC
  2. 2. The challenge facing healthcare in future2 CLINIQUES UNIVERSITAIRES SAINT-LUC
  3. 3. People ageing – > 65 yrs : 16.1% (2000) 27.5 % (2050) – > 80 yr : 3.6 % (2000) 10 % (2050) • Increase in demand for long-term care • Healthcare journeys : care process inside and outside hospital – rest homes - …) Coordination of many players around shared patient information3 CLINIQUES UNIVERSITAIRES SAINT-LUC
  4. 4. Rising costs – Ever more sophisticated technology – New curative and preventive treatments • Rational use of technologies and information produced • Treatment according to cost/effectiveness ratio -> Availability of complete, exhaustive medical information must mean that resources are used in the most efficient way4 CLINIQUES UNIVERSITAIRES SAINT-LUC
  5. 5. Patient, player in health – Importance of health factor for the public – Higher and higher standard of training and information • Attitude of informed consumer in an increasingly international “market” • Search for quality in products and service: proximity or habit are not the only criteria on which choice is based Consolidation and portability of personal medical information5 CLINIQUES UNIVERSITAIRES SAINT-LUC
  6. 6. Decompartmentalization • From a compartmentalized healthcare system, centred on the provider (hospital, GP, paramedics, domiciliary care etc), we have to move towards a healthcare system which is part of a network, coordinated and centred on the patient • Healthcare providers must fit in with this new coordinated approach, organised around shared patient information6 CLINIQUES UNIVERSITAIRES SAINT-LUC
  7. 7. Are we ready ? This change is under way Projects on sharing medical information (“flow”, labelling of GP’s, nurse’s, physio’s records, etc.) Data communication associations have tried to organise this sharing of information Hospital managements are investing in tools for managing medical information But on the ground, Are those involved ready to use and produce usable medical information in electronic form ? Are they willing to take up the challenge, on a daily basis, of sharing information ?7 CLINIQUES UNIVERSITAIRES SAINT-LUC
  8. 8. Experience on the ground Based on our experience at the Cliniques Universitaires Saint Luc, of changing from a “paper” medical information system to an “electronic” medical information system, What have we learned from this process, which began in 2002?8 CLINIQUES UNIVERSITAIRES SAINT-LUC
  9. 9. Facts and figures • University hospital, 960 beds, mostly acute • 3 briefs : Research, Teaching, Care • Considerable turn-over inherent in teaching • Culture of paper records grouped by speciality, that can be shared and managed centrally • Interprofessional work is something we value, even though it is a goal which still needs to be achieved.9 CLINIQUES UNIVERSITAIRES SAINT-LUC
  10. 10. Projects • Between 2002 and 2006, several projects (electronic patient records, report management, scanning and indexing tools, PACS) launched simultaneously with a view to changing to paperless/filmless • Philosophy behind introduction : – Identify the objective clearly from the outset (paperless – filmless) – Set up by making gradual adjustments – Take time to make the change – Communicate to departments (medical – nursing staff – admin) • To date, no more films are produced and there are almost no paper records circulating in the hospital any more10 CLINIQUES UNIVERSITAIRES SAINT-LUC
  11. 11. What have we learned ?11 CLINIQUES UNIVERSITAIRES SAINT-LUC
  12. 12. Infrastructure • A reliable, robust, integrated and consistent IT infrastructure – Consistency of information within a broad set of interconnected systems – Dematerialization of information calls for 24/7 availability • Any interruption to service makes professionals lose faith • Don’t underestimate clinicians’ (sometimes irrational) fear about losing information Don’t underestimate how difficult it is to build up and keep ”up-to-date” IT teams in today’s competitive environment12 CLINIQUES UNIVERSITAIRES SAINT-LUC
  13. 13. Working in a different way • Adapt to a different way of working – Access to information according to different criteria (time, speciality, type of report etc.) – Flexibility of paper is lost • leafing through quickly, highlighting/annotating, colours • document comparison • notification function of paper mail – Rigorous encoding requirements The drawbacks are always seen before the advantages. Communication, mutual adjustment and sometimes, quite simply, time help professionals adapt to change13 CLINIQUES UNIVERSITAIRES SAINT-LUC
  14. 14. “On-line” risks • Risks related to the benefits of access to shared electronic information – “No one is supposed not to have access to information” • Simultaneous access, irrespective of location and “willingness” • Possibility of “remote” access from home, abroad • “On-line” transmission of information – Risk that summary information is not sent (clinical information, subject of request) – Risk of losing verbal interaction between professionals when results give cause for concern Once the benefits of information in electronic form have been acknowledged, one must be vigilant about the risk of essential direct communication between professionals disappearing14 CLINIQUES UNIVERSITAIRES SAINT-LUC
  15. 15. Drowning • A flood of information from all quarters – Constantly growing number of unprocessed images – More and more information – Difficult to quickly sort out important information from the rest – Less and less time to sort, select, display – Danger of losing the “man-to-man” information channel As soon as records are shared on a large scale, the future will clearly be in selecting relevant information, in structuring and in summaries…. But who is going to take the time to do this ?15 CLINIQUES UNIVERSITAIRES SAINT-LUC
  16. 16. Confidentiality • The new challenge of “everything electronically” – Paper records can be consulted by many people, without much control, when the patient is in hospital – Electronic records are permanently available everywhere for those who are authorised to access them – Should one take the risk of having a poorer standard of care through lack of information or risk allowing too many different professions access to medical data – Should there be strict rules, in the knowledge that, on the ground, users will exchange their codes or should one get used to practices and bank on total, perfect traceability of access to information The management of access is a problem which deserves to be considered by all the professions on an almost permanent basis. This difficulty, within a hospital, is a portent of still greater problems to come once people are working across disciplines outside hospitals !16 CLINIQUES UNIVERSITAIRES SAINT-LUC
  17. 17. Institutional mobilization • Both management and people on the ground must be involved in this process of change – Management must give the project their unfailing support but also understand that change takes time – People on the ground will have to change their ways, the way they approach information : resistance is planned at department level, mobilization for change too… – Project managers must agree to revise their ambitions, give up the technocratic approach and take the adjustments on board An institutional project, backed by management and set up in close collaboration with medical services, giving them time to grasp the change17 CLINIQUES UNIVERSITAIRES SAINT-LUC
  18. 18. Take home words… • Personal medical information sharing is one of the answers to the challenge facing healthcare in the future • In order to really share electronic medical information amongst all care givers, hospitals must be paperless and filmless • Becoming paperless and filmless is not only a matter of software deployment, it is especially a matter of changing the way care providers work. It is therefore a matter of change management • Change management needs time, compromises and communication. It takes time to change working habits, implement new ways to access information and define who has access to what. • In hospitals, the medical service is the place where change must be managed • Paperless and filmless hospital projects must be institutional projects, sponsored and followed by the hospital management18 CLINIQUES UNIVERSITAIRES SAINT-LUC

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