2004 10-19 rudi vdv

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  • Our terms are Interoperability and Innovation. Lets start with some definitions. Interoperability is a relatively new concept, centered on the idea that one system can use parts of another. If you focus on computer interoperability, the IEEE definition includes two concepts. Functional interoperability – the ability to exchange information – and semantic interoperability – the ability to use the information that has been exchanged. As an aside, standards are frequently thought of as focusing primarily on functional interoperability, whereas the critical sine qua non for health care is semantic interoperability - if you don’t know exactly what the information you received means, having received it is useless, or worse, maybe even dangerous!
  • Generations Source: Gartner Research Although there has been continual improvement in products during the the last few years, vendors and end users alike continue to have their own definitions of the EMR, each focused on one or more, but not all, of the core capabilities of a full EMR. Gartner has created metrics for core EMR capabilities that will enable easier comparisons of vendor offerings as well as allowing CDOs to set internal expectations more accurately. Our vision is that EMR offerings will gradually evolve through five generations, transforming from very simple systems that provide reporting of results into very complex, fully integrated systems focused on the tasks directly related to promoting wellness and providing medical care for individuals across the entire healthcare continuum within a single healthcare enterprise. In determining the generations of EMRs, Gartner evaluated each of the eight core capabilities of the EMR and determined the progression of functionality expected. To create the generations, we then divided that functionality into five reasonable incremental steps but also considered the synergism of the set of functions. A given product may have some increased functionality in certain areas, but to be considered an n th generation product it must have all of the capabilities listed for that generation. In addition, each subsequent generation has all of the capabilities of previous generations.
  • Il est possible de définir un protocol par les actes, avec indication des jours et des heures, et des critères d’inclusion et d’exclusion. Ces éléments donnent en effet une représentation taxinomique d’un protocole de traitement.
  • Generations Source: Gartner Research Although there has been continual improvement in products during the the last few years, vendors and end users alike continue to have their own definitions of the EMR, each focused on one or more, but not all, of the core capabilities of a full EMR. Gartner has created metrics for core EMR capabilities that will enable easier comparisons of vendor offerings as well as allowing CDOs to set internal expectations more accurately. Our vision is that EMR offerings will gradually evolve through five generations, transforming from very simple systems that provide reporting of results into very complex, fully integrated systems focused on the tasks directly related to promoting wellness and providing medical care for individuals across the entire healthcare continuum within a single healthcare enterprise. In determining the generations of EMRs, Gartner evaluated each of the eight core capabilities of the EMR and determined the progression of functionality expected. To create the generations, we then divided that functionality into five reasonable incremental steps but also considered the synergism of the set of functions. A given product may have some increased functionality in certain areas, but to be considered an n th generation product it must have all of the capabilities listed for that generation. In addition, each subsequent generation has all of the capabilities of previous generations.
  • Il est possible de définir un protocol par les actes, avec indication des jours et des heures, et des critères d’inclusion et d’exclusion. Ces éléments donnent en effet une représentation taxinomique d’un protocole de traitement.
  • 2004 10-19 rudi vdv

    1. 1. Prof. R. Van de Velde The promise of Clinical Information Systems Challenges and perspectives at the beginning of the 21th century IBBT 19 Oktober 2004
    2. 2. Introduction <ul><li>Introduction </li></ul><ul><ul><li>Setting the scene </li></ul></ul><ul><li>Introduction </li></ul><ul><li>Design Principles </li></ul><ul><li>Challenges </li></ul><ul><li>Conclusions: AZ-VUB experience </li></ul>
    3. 3. Hospital “AZ-VUB” Beds 700 Staff members 2.700 Admissions 2002 26.000 Emergency patients 2002 54.000 Ambulatory patients 2002 280.000 Hospital “De Bijtjes” Beds 200 Hospital within 10-miles radius
    4. 4. IT-Strategy <ul><li>Design Principles </li></ul><ul><ul><li>Component Software </li></ul></ul><ul><ul><li>Multi-Layered </li></ul></ul><ul><ul><li>Hospital-Wide </li></ul></ul><ul><li>Introduction </li></ul><ul><li>Design Principles </li></ul><ul><li>Challenges </li></ul><ul><li>Conclusions : AZ-VUB experience </li></ul>
    5. 5. AZ-VUB: IT - Design Principle #1 Conceptual View Multi Layer Hospital Wide Component Oriented Component Oriented
    6. 6. AZ-VUB: IT - Design Principle #1 Component Oriented Activity Patient Organization Authorisation Knowledge Medical Record
    7. 7. AZ-VUB: IT - Design Principle #2 Technical View Multi Layer Component Oriented Multi Layer Hospital Wide
    8. 8. The Layered IT-Architecture at AZ VUB Patient support Enterprise Medical Care E-Health Security Transactions Messaging Naming services J2EE FRAMEWORK Bio signals (ECG) Images Web Pages Alphanumeric data Patient Componentry Act Resource Medical Knowledge Authorization
    9. 9. AZ-VUB IT - Design Principle #3 User Perspective Multi Layer Component Oriented Hospital Wide Hospital Wide
    10. 10. The Web Expands Composite Views <ul><li>Internal and External </li></ul><ul><li>Composite View </li></ul><ul><li>Electronic bonding with internal & external users </li></ul><ul><li>Reduction of intermediary personnel </li></ul><ul><li>Role-centric view of information </li></ul>Outside the Organization Application B Application C Application A Function- oriented Web
    11. 11. Ongoing projects <ul><li>Challenges </li></ul><ul><ul><li>Terminology Server </li></ul></ul><ul><li>Introduction </li></ul><ul><li>Design Principles </li></ul><ul><li>Challenges </li></ul><ul><ul><li>Terminology Server </li></ul></ul><ul><ul><li>Clinical Decision Support Systems (CDSS) </li></ul></ul><ul><ul><li>Workflow Project </li></ul></ul><ul><ul><li>The Storage Gap </li></ul></ul><ul><ul><li>Mobility versus Wireless </li></ul></ul><ul><li>Conclusions : AZ-VUB experience </li></ul>
    12. 12. Reveal Assumptions Revealing assumptions is an essential component of effective communication. information models are an effective means of documenting our assumptions about data Yes, I do play football. Do you play football?
    13. 13. <ul><li>Main Entry: in·ter·op·er·a·bil·i·ty Function: noun Date: 1977 : ability of a system (as a weapons system) to use the parts or equipment of another system Source: Merriam-Webster web site </li></ul><ul><li>interoperability : ability of two or more systems or components to exchange information and to use the information that has been exchanged. Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990] </li></ul>The Importance of Interoperability Semantic interoperability Syntactical interoperability
    14. 15. Terminology HPI: History of present illness Exam: Physical exam Diag: Other tests Rx : Medications PMH: Past medical history Labs: Clinical Lab Dx: Diagnoses Tx: other therapy HPI PMH Exam Labs Diag Dx Rx Tx ICD$ + ++ ++ ICT$ + DRG + SNOMED +++ +++ +++ ++ ++ +++ ++ ++ Nursing +++ +++ LOINC +++ + NDC ++ RxNorm +++ ATC +++ UMLS ++ ++ ++ ++ ++ ++ ++ ++
    15. 16. Ongoing projects <ul><li>Challenges </li></ul><ul><ul><li>Clinical Decision Support Systems (CDSS) </li></ul></ul><ul><li>Introduction </li></ul><ul><li>Design Principles </li></ul><ul><li>Challenges </li></ul><ul><ul><li>Terminology Server </li></ul></ul><ul><ul><li>Clinical Decision Support Systems (CDSS) </li></ul></ul><ul><ul><li>Workflow Project </li></ul></ul><ul><ul><li>The Storage Gap </li></ul></ul><ul><ul><li>Mobility versus Wireless </li></ul></ul><ul><li>Conclusions : AZ-VUB experience </li></ul>
    16. 17. Five Generations of EMRs Functionality Availability of Products 1993 1998 2008 2003 2012 1. Collector 2. Result Server 3. Assistant 4. Collaegue 5. Mentor
    17. 18. A Continuum Knowledge Application and Discovery <ul><li>Monitoring patient data with passive decision support </li></ul><ul><li>Intercepting incorrect clinical decisions </li></ul><ul><li>Making the right decisions the easiest decisions </li></ul><ul><li>Rapid Self-Improving Health System </li></ul>Paper-based Information And Knowledge Online Access To Data and Knowledge Safety Net Anticipation Understanding Performance <ul><li>Surveillance </li></ul><ul><li>Interactive </li></ul><ul><li>Proactive </li></ul><ul><li>Learning </li></ul>
    18. 19. <ul><li>Alerts and reminders : drug-drug </li></ul><ul><li>Protocols : sequence of tasks </li></ul><ul><li>Administrative : ES Billing </li></ul>Clinical DSS : Application areas IOM report “To Err is Human”
    19. 20. DSS – Protocols : Radiotherapy Planning
    20. 21. Ongoing projects <ul><li>Challenges </li></ul><ul><ul><li>Workflow Project </li></ul></ul><ul><li>Introduction </li></ul><ul><li>Design Principles </li></ul><ul><li>Challenges </li></ul><ul><ul><li>Terminology Server </li></ul></ul><ul><ul><li>Clinical Decision Support Systems (CDSS) </li></ul></ul><ul><ul><li>Workflow Project </li></ul></ul><ul><ul><li>The Storage Gap </li></ul></ul><ul><ul><li>Mobility versus Wireless </li></ul></ul><ul><li>Conclusions : AZ-VUB experience </li></ul>
    21. 22. Workflow in HC: AZ VUB – Monthly Flow & Figures HOSPITAL MANAGEMENT (33.000) Patient (1.200.000) Requisitions (150.000) Outcome & Results (70.000) Scheduling (70.000) Procedures Medication Outcome & Results EXPERT SYSTEM TARIF Patient Nursing Medical Care Scheduling Requisitions
    22. 23. Terminology HPI: History of present illness Exam: Physical exam Diag: Other tests Rx : Medications PMH: Past medical history Labs: Clinical Lab Dx: Diagnoses Tx: other therapy HPI PMH Exam Labs Diag Dx Rx Tx ICD$ + ++ ++ ICT$ + DRG + SNOMED +++ +++ +++ ++ ++ +++ ++ ++ Nursing +++ +++ LOINC +++ + NDC ++ RxNorm +++ ATC +++ UMLS ++ ++ ++ ++ ++ ++ ++ ++
    23. 24. Ongoing projects <ul><li>Challenges </li></ul><ul><ul><li>Clinical Decision Support Systems (CDSS) </li></ul></ul><ul><li>Introduction </li></ul><ul><li>Design Principles </li></ul><ul><li>Challenges </li></ul><ul><ul><li>Terminology Server </li></ul></ul><ul><ul><li>Clinical Decision Support Systems (CDSS) </li></ul></ul><ul><ul><li>Workflow Project </li></ul></ul><ul><ul><li>The Storage Gap </li></ul></ul><ul><ul><li>Mobility versus Wireless </li></ul></ul><ul><li>Conclusions : AZ-VUB experience </li></ul>
    24. 25. Five Generations of EMRs Functionality Availability of Products 1993 1998 2008 2003 2012 1. Collector 2. Result Server 3. Assistant 4. Collaegue 5. Mentor
    25. 26. A Continuum Knowledge Application and Discovery <ul><li>Monitoring patient data with passive decision support </li></ul><ul><li>Intercepting incorrect clinical decisions </li></ul><ul><li>Making the right decisions the easiest decisions </li></ul><ul><li>Rapid Self-Improving Health System </li></ul>Paper-based Information And Knowledge Online Access To Data and Knowledge Safety Net Anticipation Understanding Performance <ul><li>Surveillance </li></ul><ul><li>Interactive </li></ul><ul><li>Proactive </li></ul><ul><li>Learning </li></ul>
    26. 27. <ul><li>Alerts and reminders : drug-drug </li></ul><ul><li>Protocols : sequence of tasks </li></ul><ul><li>Administrative : ES Billing </li></ul>Clinical DSS : Application areas IOM report “To Err is Human”
    27. 28. DSS – Protocols : Radiotherapy Planning
    28. 29. Ongoing projects <ul><li>Challenges </li></ul><ul><ul><li>Workflow Project </li></ul></ul><ul><li>Introduction </li></ul><ul><li>Design Principles </li></ul><ul><li>Challenges </li></ul><ul><ul><li>Terminology Server </li></ul></ul><ul><ul><li>Clinical Decision Support Systems (CDSS) </li></ul></ul><ul><ul><li>Workflow Project </li></ul></ul><ul><ul><li>The Storage Gap </li></ul></ul><ul><ul><li>Mobility versus Wireless </li></ul></ul><ul><li>Conclusions : AZ-VUB experience </li></ul>
    29. 30. Workflow in HC: AZ VUB – Monthly Flow & Figures HOSPITAL MANAGEMENT (33.000) Patient (1.200.000) Requisitions (150.000) Outcome & Results (70.000) Scheduling (70.000) Procedures Medication Outcome & Results EXPERT SYSTEM TARIF Patient Nursing Medical Care Scheduling Requisitions

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