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The virtual Hospital Information System of the future

Prof. dr. B. Sijnave
CIO UZ Gent
September 20, 2012



          © 2012 Universitair Ziekenhuis Gent
The classical HIS today




                                       Strategic level



                                        Tactical level



                                      Operational level
© 2012 Universitair Ziekenhuis Gent                       2
The HIS of the future

                                             V  irtual
                                     I ‐dimensional
                                      mult
                                sha R ed
                                cus T omer centered
                                sec  U re
                                     A vailable
                     supporting qua  L ity of care
© 2012 Universitair Ziekenhuis Gent                      3
The virtual HIS or the HIS in the cloud

V
I
R
T
U
A
L
    © 2012 Universitair Ziekenhuis Gent         4
HIS

      The virtual HIS or the HIS in the cloud – MIS part
           Main driver for MIS in the cloud is cost
V          reduction (small set‐up cost, small 
           maintenance cost, …) 
I
           Type of data that is concurrential would only embrace private cloud
R          solutions

T          Example: different TCOs for different ERP 
U          deployment options

A
L
    © 2012 Universitair Ziekenhuis Gent                                          5
HIS

      The virtual HIS or the HIS in the cloud – EHR part

V                                               EHR
                                          EPR
I
R
T       Main driver for EPR in the cloud would most probably be… 
        cost reduction (small set‐up cost, small maintenance cost, …) 
U       Type of data that is confidential would force strictly secured
A       and highly available private cloud solutions
        but this most definitely has a cost, reducing the 
L       effect of the main driver…
    © 2012 Universitair Ziekenhuis Gent                                  6
The multi‐dimensional HIS (1)

      Internal multi‐dimensionality
V
I
R
T
U
A
                                          doctors                       nurses   
L                                                 pharmacists
    © 2012 Universitair Ziekenhuis Gent   paramedics                      …       7
The multi‐dimensional HIS (2)

      External multi-dimensionality
V
I
R
T
U
A
L
    © 2012 Universitair Ziekenhuis Gent   8
The shared HIS: a bare necessity

V
I
R
T
U
A
L
    © 2012 Universitair Ziekenhuis Gent   9
The shared HIS: possible approaches
      The discussion between
V
I
                                                    &
R
T
U     doesn’t have a single truth, but should have a complementarity, or

A                                         instead of 
L
    © 2012 Universitair Ziekenhuis Gent                                    10
Shared Patient record in practice: Netherlands


V                                         Opt Out

I                                         Costly
                                          No ther. relation check
                                          No cxclusions
R
T
U
A
L                                          Smaller, Opt‐IN
    © 2012 Universitair Ziekenhuis Gent                         11
Shared Patient record in practice: NHS


V                                               2009

I
R                                               feb 2010

T
U                                                apr 2010

A
L                                               Dec 2011 
                                                (est: 2014)12
    © 2012 Universitair Ziekenhuis Gent
The shared HIS in Belgium
      What it is today…
V
I
R                                         …

                                          governmental initiatives
T
U
                                   …
A
            hubs of hospitals and GPs
L                                             networks of hospitals
    © 2012 Universitair Ziekenhuis Gent                               13
The shared HIS in Belgium
      What it could become tomorrow…
V
I
R                                         …

                                          governmental initiatives
T
U
                                   …
A
            hubs of hospitals and GPs
L                                             networks of hospitals
    © 2012 Universitair Ziekenhuis Gent                               14
The customer centered HIS
                   250.000                EPR


V                                         patiënt empowerment


                   200.000

I
R                  150.000




T                  100.000



U                   50.000


A                          0

L
                               1990
                               1991
                               1992
                               1993
                               1994
                               1995
                               1996
                               1997
                               1998
                               1999
                               2000
                               2001
                               2002
                               2003
                               2004
                               2005
                               2006
                               2007
                               2008
                               2009
                               2010
                               2011
                                                                Pubmed citations
    © 2012 Universitair Ziekenhuis Gent                                            15
Patient empowerment: finally accessible?


V
I                         Shared
                         EPR - PHR

R
                     Shared EPR
T
U                            EPR

A                           EMR

L
    © 2012 Universitair Ziekenhuis Gent          16
The secure HIS

V        • Compiled medical data is very attractive…
            Insurance companies
I           Pharmaceutical industry
R           Employer related (sickness)
            ….
T
U        • Data safety concerns (outside hacking)

A
L
    © 2012 Universitair Ziekenhuis Gent                17
The available and performing HIS

      The more simultaneous users, the more the availability 
V     and the performance of the systems gets challenged
I
R
T
U
A
L
    © 2012 Universitair Ziekenhuis Gent                         18
The quality HIS: data quality = care quality

V
I              medical longitudinal record in a mobile world
R              increased complexity, treatment options and regulations

T              increasing number of participating health actors
               transmural care, data sharing, cooperation
U              prevention and home monitoring

A              cost reduction (if implemented right)
               Data = The ‘Evidence’ for Evidence based medicine
L              ….
    © 2012 Universitair Ziekenhuis Gent                              19
The virtual HIS of the future can only be
                          virtual…




                             Thank you for your attention!
© 2012 Universitair Ziekenhuis Gent                          20

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The virtual Hospital Information System of the future by Bart Sijnave

  • 2. The classical HIS today Strategic level Tactical level Operational level © 2012 Universitair Ziekenhuis Gent 2
  • 3. The HIS of the future V  irtual I ‐dimensional mult sha R ed cus T omer centered sec  U re A vailable supporting qua  L ity of care © 2012 Universitair Ziekenhuis Gent 3
  • 4. The virtual HIS or the HIS in the cloud V I R T U A L © 2012 Universitair Ziekenhuis Gent 4
  • 5. HIS The virtual HIS or the HIS in the cloud – MIS part Main driver for MIS in the cloud is cost V reduction (small set‐up cost, small  maintenance cost, …)  I Type of data that is concurrential would only embrace private cloud R solutions T Example: different TCOs for different ERP  U deployment options A L © 2012 Universitair Ziekenhuis Gent 5
  • 6. HIS The virtual HIS or the HIS in the cloud – EHR part V EHR EPR I R T Main driver for EPR in the cloud would most probably be…  cost reduction (small set‐up cost, small maintenance cost, …)  U Type of data that is confidential would force strictly secured A and highly available private cloud solutions but this most definitely has a cost, reducing the  L effect of the main driver… © 2012 Universitair Ziekenhuis Gent 6
  • 7. The multi‐dimensional HIS (1) Internal multi‐dimensionality V I R T U A doctors                       nurses    L pharmacists © 2012 Universitair Ziekenhuis Gent paramedics … 7
  • 8. The multi‐dimensional HIS (2) External multi-dimensionality V I R T U A L © 2012 Universitair Ziekenhuis Gent 8
  • 9. The shared HIS: a bare necessity V I R T U A L © 2012 Universitair Ziekenhuis Gent 9
  • 10. The shared HIS: possible approaches The discussion between V I & R T U doesn’t have a single truth, but should have a complementarity, or A instead of  L © 2012 Universitair Ziekenhuis Gent 10
  • 11. Shared Patient record in practice: Netherlands V Opt Out I Costly No ther. relation check No cxclusions R T U A L Smaller, Opt‐IN © 2012 Universitair Ziekenhuis Gent 11
  • 12. Shared Patient record in practice: NHS V 2009 I R feb 2010 T U apr 2010 A L Dec 2011  (est: 2014)12 © 2012 Universitair Ziekenhuis Gent
  • 13. The shared HIS in Belgium What it is today… V I R … governmental initiatives T U … A hubs of hospitals and GPs L networks of hospitals © 2012 Universitair Ziekenhuis Gent 13
  • 14. The shared HIS in Belgium What it could become tomorrow… V I R … governmental initiatives T U … A hubs of hospitals and GPs L networks of hospitals © 2012 Universitair Ziekenhuis Gent 14
  • 15. The customer centered HIS 250.000 EPR V patiënt empowerment 200.000 I R 150.000 T 100.000 U 50.000 A 0 L 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Pubmed citations © 2012 Universitair Ziekenhuis Gent 15
  • 16. Patient empowerment: finally accessible? V I Shared EPR - PHR R Shared EPR T U EPR A EMR L © 2012 Universitair Ziekenhuis Gent 16
  • 17. The secure HIS V • Compiled medical data is very attractive… Insurance companies I Pharmaceutical industry R Employer related (sickness) …. T U • Data safety concerns (outside hacking) A L © 2012 Universitair Ziekenhuis Gent 17
  • 18. The available and performing HIS The more simultaneous users, the more the availability  V and the performance of the systems gets challenged I R T U A L © 2012 Universitair Ziekenhuis Gent 18
  • 19. The quality HIS: data quality = care quality V I medical longitudinal record in a mobile world R increased complexity, treatment options and regulations T increasing number of participating health actors transmural care, data sharing, cooperation U prevention and home monitoring A cost reduction (if implemented right) Data = The ‘Evidence’ for Evidence based medicine L …. © 2012 Universitair Ziekenhuis Gent 19
  • 20. The virtual HIS of the future can only be virtual… Thank you for your attention! © 2012 Universitair Ziekenhuis Gent 20