DATABASE MANAGEMENTDATABASE MANAGEMENTSYSTEM FORSYSTEM FOREPIDEMIOLOGICAL EVIDENCEEPIDEMIOLOGICAL EVIDENCEON RISK FACTORS:ON RISK FACTORS: DIABETESDIABETESFOOT PROBLEMSFOOT PROBLEMSS. Pruna1, Andreea Pruna1, Mihaela Ionescu2, and M. Grigorescu2.1. Romanian Society for Clinical Engineering and Medical Computing,Telemedicine Centre,2. Diabetes Ambulatory Centre, Bucharest. I.L. Caragiale Str. 12, Sect. 2,70208, Bucharest, ROMANIA, e-mail: firstname.lastname@example.org
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro2BS TeleDiabRomanian Society forClinical Engineering andMedical TelemedicineCentre, BucharestA WHOCollaborating CentreSimion Pruna, PhDPresident of RSCEMCDirector Telemedicine Centre
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro3BS TeleDiabBSTD HistoryBSTD HistoryBSTD began in 1996 :EPI_INFO 1996 (Diabcare)BSTD 1998 (Diabcare - GEHR)SincroDiab 2000 (EHCR-GEHR)It is not, and should not be presented as hardfactual evidence about the performance ofindividual services; it is not a set of leaguetables that should be used to identify good andbad practice.
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro4BS TeleDiabEHCREHCR 1990-20021990-2002 No standard format or methods of data interchangehas emerged Very few doctors are using the electronic medicalrecord despite its technically feasibility Abstinence of doctors, lack of keyboarding skills,unfriendly software, lack of familiarity andtraining, and lack of financial and other incentivesto produce superior medical record
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro5BS TeleDiab““Managing the Epidemic!”Managing the Epidemic!” Managing the Epidemic from countries andregions is a simple goal, but difficult to fulfill– Collection and aggregation of country (or region)wide diabetes data into a single repository,– Unified epidemic data collection and aggregationto examine performance in unique and innovativeways,How can this be achieved?– Integration and aggregation tools are available to assistin the automation of this process
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro6BS TeleDiabNew TechnologyNew Technology To increase the efficiency, speed and accuracy ofdiabetes care results– Billing reports that once took weeks to turnaround arenow taking days, laboratory results that once took daysto turnaround are taking hours, and pharmacy ordersthat once took hours to turnaround are now takingminutes– Real-time data collection for diabetes monitoringand disease management
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro7BS TeleDiabNew IT - new concernsNew IT - new concernsOne of the major concerns when using newtechnology is the issue of data security andconfidentiality, especially when datacontains a person’s medical historyNew IT do not come without costs!
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro8BS TeleDiabWhat Options are Available toWhat Options are Available toMedical Units?Medical Units? Upgrade the legacy systems in order to complywith each of the European Directive of DataProtection and regulations Implement a new hospital system that providescompliance and advanced data visualizationAs managers, what will you say?
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro9BS TeleDiabQuestions?Questions?What are the pros and cons of convertingyour legacy system?What about pros and cons of simplyreplacing your system?
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro10BS TeleDiabOpen Source software for diabetesOpen Source software for diabetes
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro11BS TeleDiabBSTD AIMSBSTD AIMS Promote medical informatics in Eastern Europeand New Independent States Software package to store information relating topatients with diabetes Provide framework for monitoring the outcome ofdiabetes care
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro12BS TeleDiabIssues with Implementing aIssues with Implementing aNew System Include:New System Include: What solutions are available?– There are many healthcare systems commercialsolutions available. For NAS and NIS A possible solution include:– BSTD, free of charge at:http://www.telemed.ro/news.htm For the PCD Europe I am suggesting an OpenSource development (which may start from BSTDsources code which is free available)
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro13BS TeleDiabCountrie s re prese nte d in the Good Europe an HealthCountrie s re prese nte d in the Good Europe an HealthRe c ord Pro je ctRe c ord Pro je ctCroix Rouge Francais eS mithKline BeechamUnited KingdomSt Bartholomew’s HospitalMe dica l Colle geThe Royal Hos pitals NHS TrustCity & East London FHS AThe Royal Marsden HospitalUniversity of HullInstituto ClinicaGera l Zona NortePortugalClinica P uerta de Hie rroSpainAssociation des Medecins etMe decins DentistesLuxembourgMicrodata SARLCe ntre de Recherche PublicHenri TudorZe ntralinstitut fur dieKasse narztliche Ve rsorgungGermanyUniversity of AthensGree ceFra nce TelecomFranceC2VKalamazoo S.A.BelgiumHe alth Data Ma nagement PartnersERIMFederation des Association MedecinsGeneralistes de BruxellesInsitut D’Hygiene et d’EpidemiologieGEHR
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro14BS TeleDiabGood European HealthGood European HealthRecordRecordFirst complete data structure for EHCRsAbility to incorporate a wide range of data typesFacility to transmit medical records safely acrosstelecommunications networksIncorporation of mechanisms for translation ofthe information into different languagesSupport for the process of clinical care andmedical education
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro15BS TeleDiabElectronic Health CareElectronic Health CareRecordsRecordsSingle subject of careOwned by particular organisationMedico-legal recordAppropriate access rightsProvision for exchange of informationGlobal distributed recordMirror paper records
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Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro18BS TeleDiabCollection and aggregation ofCollection and aggregation ofdata hospital widedata hospital wideData into a single repository, allowing youto monitor the performance of your entirediabetes care using a network infrastructurePowerful and Flexible Reporting
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Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro22BS TeleDiabQuestion – Cost EstimationQuestion – Cost Estimation As managers, we’reoften asked to estimatecosts What will you say?
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro23BS TeleDiabMake smarter decisionsMake smarter decisionsbased on accurate informationbased on accurate informationBlood Glucose (mg/dl)Missing Data> 150135-150110-13570-110< 70FastingPlasmaGlucose80%60%40%20%0%6711011183998169158269 203898157147389 202550735963N =Duration of Diabetes25-29 years20-24 years15-19 years10-14 years05-9 years0-4 years%ofType2onInsulin100806040200COUNTRY123
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro24BS TeleDiabBSTD has an extensible andBSTD has an extensible andopen architectureopen architectureHighly extensible and open architectureallows to easily integrate new EHCRfunctions:• To create, review, annotate or maintain apatient’s EHCR of any aspect of the patienthealth condition, medication, visit history• Accounting uniform monitoring across bothnetworks or workstation infrastructure
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Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro26BS TeleDiabPharmaceutical reportsPharmaceutical reports
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro27BS TeleDiabIntroducing BSTDIntroducing BSTD The BSTD is a yearly screening tool for earlycomplications and appropriate treatment ifcomplications are detected Managing diabetes in the 21stCentury the qualityis everything– Poor health care delivery result in lost patients and lostrevenue– Ensuring high quality care is expensive– ITC leads to decrease costs and increase quality
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro28BS TeleDiabBSTD comply rules for accessBSTD comply rules for accessto patient recordsto patient records BSTD has resources toeffectively log and monitorevery instance of access to apatient’s records which arerequired for the audit trail Solution:– Control access (limit access)– Use administrative privileges(read vs. write)– Disable high-risk commands(Delete, Modify, etc.)
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro29BS TeleDiabBSTD - SummaryBSTD - Summary Good distribution (RO, UKR) High satisfaction rate Interest from additional countries Data fed back to WHO Unified Performance Data Collection Network Technology Support
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro30BS TeleDiabIT in medicine = hardware,IT in medicine = hardware,software and managementsoftware and management
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro31BS TeleDiabBlack Sea TeleDiab SystemBlack Sea TeleDiab System MEDIFON 2001 boot inLondon was a great successwith substantial audience forour software demo RSCEMC’s success indelivering and implementingBSTD was due two decades ofexperience in the softwaredevelopment combined withthe comprehensive knowledgeof the users requirements
Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro32BS TeleDiabThank youThank you