“8th National Biennial Conference on Medical Informatics 2012” at Jawaharlal Nehru Auditorium, AIIMS New Delhi on 5th Feb 2012,
The organizing committee consisting of Mr. S.K. Meher (Organizing Secretary), Major (Dr.) Anil Kuthiala (Jt. Organizing Secretary) and Ashu (Assistant to the Organizing Secretariat) worked hard and toiled to make the conference a grand success.
The scientific committee comprising of Dr. S.B Gogia, Prof. Khalid Moidu, Prof Arindam Basu, Dr. S Bhatia, Dr. Thanga Prabhu, Dr. Karanvir Singh, Tina Malaviya, Dr. Kamal Kishore, Dr. Vivek Sahi, Spriha Gogia, Dr. Supten Sarbhadhikari, Dr.Sanjay Bedi, Mr. Sushil Kumar Meher actively reviewed all papers for the various scientific sessions.
The document provides a quick reference guide that summarizes recommendations from NICE on the management of rheumatoid arthritis in adults. It was developed by the National Collaborating Centre for Chronic Conditions and reviewed by healthcare professionals and patients. The guide outlines priorities for referral, use of disease-modifying drugs and biologicals, monitoring disease activity, and the roles of the multidisciplinary team and surgery in management. It is intended to help rheumatologists, GPs, and other staff caring for people with rheumatoid arthritis.
Application of Management Principles in the Management of a Patient - ROJosonReynaldo Joson
This document outlines the application of management principles in managing a patient. It discusses establishing overall goals and strategies when a patient first consults, such as resolving their health issue without harm. It describes formulating a clinical diagnosis through interview and exam. The need for further testing is determined by diagnosis certainty and treatment plans. If needed, the most cost-effective test is selected. Finally, treatment options are considered based on benefit, risk, cost and availability to choose the most cost-effective option. The document provides examples of applying each step of the management process rationally.
This document discusses leveraging technology to advance clinical documentation improvement (CDI) programs. It notes that current CDI programs focus primarily on revenue cycle management and have resulted in physician cynicism. The document advocates for more physician-engaged CDI programs that integrate with quality initiatives and utilize technology like computer-assisted physician documentation (CAPD) to provide real-time guidance to physicians. This could help address challenges under ICD-10 by capturing accurate clinical impressions and ensuring compliant documentation. The document concludes that successful CDI programs require advanced, clinically integrated technologies that fit with physician workflows.
This document discusses patient safety indicators (PSIs) as a way to measure and improve healthcare quality. It defines PSIs as a subset of quality indicators focused on preventable complications during or after hospitalization. The document then provides details on 20 specific PSIs, including definitions, calculation methods, and sample results for Portugal between 2000-2005. It analyzes PSI rates by gender, economic hospital group, administrative hospital group, and year to identify safety trends and differences between hospital types. The goal is to understand PSI prevalence, evaluate hospital safety over time, and identify opportunities to enhance patient safety.
Deterioration of a patient can occur at any time in the patient’s journey and eventually they may need critical care intervention or worse. Hear about NHS Ayrshire & Arran’s rescue system and how their model for improvement was used to design, implement and sustain reliable care processes that facilitated a reduction in mortality rates.
Game of documentation, Winter is coming Surviving ICD10Nick van Terheyden
The document provides an overview of ICD-10 implementation and the impact of clinical documentation on outcomes and reimbursement. It discusses how accurate documentation is important for determining severity of illness and risk adjustment, which drives hospital reimbursement and quality metrics. It emphasizes that physicians need to fully document their clinical decision making to avoid issues like payment denials, penalties, or inaccurate performance assessments that could arise from incomplete records.
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
Mission Health System
The document discusses the methodology for adapting clinical practice guidelines at KNH hospital. It describes adapting existing high-quality guidelines from other contexts rather than developing new ones. The ADAPTE process is used, which involves setting up a working group, appraising relevant guidelines using AGREE II, adapting them based on the local population and context, assessing the adapted guideline, and finalizing the new guideline. The goal is to improve healthcare practices and decisions through implementing systematically adapted evidence-based guidelines.
The document provides a quick reference guide that summarizes recommendations from NICE on the management of rheumatoid arthritis in adults. It was developed by the National Collaborating Centre for Chronic Conditions and reviewed by healthcare professionals and patients. The guide outlines priorities for referral, use of disease-modifying drugs and biologicals, monitoring disease activity, and the roles of the multidisciplinary team and surgery in management. It is intended to help rheumatologists, GPs, and other staff caring for people with rheumatoid arthritis.
Application of Management Principles in the Management of a Patient - ROJosonReynaldo Joson
This document outlines the application of management principles in managing a patient. It discusses establishing overall goals and strategies when a patient first consults, such as resolving their health issue without harm. It describes formulating a clinical diagnosis through interview and exam. The need for further testing is determined by diagnosis certainty and treatment plans. If needed, the most cost-effective test is selected. Finally, treatment options are considered based on benefit, risk, cost and availability to choose the most cost-effective option. The document provides examples of applying each step of the management process rationally.
This document discusses leveraging technology to advance clinical documentation improvement (CDI) programs. It notes that current CDI programs focus primarily on revenue cycle management and have resulted in physician cynicism. The document advocates for more physician-engaged CDI programs that integrate with quality initiatives and utilize technology like computer-assisted physician documentation (CAPD) to provide real-time guidance to physicians. This could help address challenges under ICD-10 by capturing accurate clinical impressions and ensuring compliant documentation. The document concludes that successful CDI programs require advanced, clinically integrated technologies that fit with physician workflows.
This document discusses patient safety indicators (PSIs) as a way to measure and improve healthcare quality. It defines PSIs as a subset of quality indicators focused on preventable complications during or after hospitalization. The document then provides details on 20 specific PSIs, including definitions, calculation methods, and sample results for Portugal between 2000-2005. It analyzes PSI rates by gender, economic hospital group, administrative hospital group, and year to identify safety trends and differences between hospital types. The goal is to understand PSI prevalence, evaluate hospital safety over time, and identify opportunities to enhance patient safety.
Deterioration of a patient can occur at any time in the patient’s journey and eventually they may need critical care intervention or worse. Hear about NHS Ayrshire & Arran’s rescue system and how their model for improvement was used to design, implement and sustain reliable care processes that facilitated a reduction in mortality rates.
Game of documentation, Winter is coming Surviving ICD10Nick van Terheyden
The document provides an overview of ICD-10 implementation and the impact of clinical documentation on outcomes and reimbursement. It discusses how accurate documentation is important for determining severity of illness and risk adjustment, which drives hospital reimbursement and quality metrics. It emphasizes that physicians need to fully document their clinical decision making to avoid issues like payment denials, penalties, or inaccurate performance assessments that could arise from incomplete records.
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
Mission Health System
The document discusses the methodology for adapting clinical practice guidelines at KNH hospital. It describes adapting existing high-quality guidelines from other contexts rather than developing new ones. The ADAPTE process is used, which involves setting up a working group, appraising relevant guidelines using AGREE II, adapting them based on the local population and context, assessing the adapted guideline, and finalizing the new guideline. The goal is to improve healthcare practices and decisions through implementing systematically adapted evidence-based guidelines.
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
The document discusses methods for measuring performance and clinical outcomes in healthcare. It describes the major domains of patient safety measurement as harm, mortality, infections, readmissions, patient satisfaction, and safety culture. It then focuses on defining medical errors and adverse events, and explaining why measurement is important for evaluating current systems and improving outcomes. Different methods of data collection are outlined, including direct observation, cohort studies, record review, and incident reporting systems. The Global Trigger Tool for assessing harm using chart review is also summarized.
Audit and stat for medical professionalsNadir Mehmood
This document discusses clinical audit and statistics. It begins by defining audit and its importance in clinical practice. The document outlines the types of audit and how statistics are used in clinical practice. It discusses the components of a clinical audit and defines key statistical terms like population, sample, and descriptive statistics. The document provides examples to illustrate statistical concepts and calculations like descriptive statistics and the area under the curve of a normal distribution. It emphasizes that the goal of statistics is to summarize data in a way that is understandable for non-statisticians.
Admission Disposition: Inpatient or Outpatient Observationampeterson03
This was a staff presentation for Rio Grande Hospital staff in 2012 regarding the correct admission status for patients, billing, and the impact that RACs auditors have on the hospital
Medical audit is a systematic evaluation of medical care to improve patient outcomes. It involves reviewing medical records against criteria to identify areas for improvement. The key aspects that can be audited include structure, processes, and outcomes of care. Medical audit aims to ensure best possible care, evidence-based practice, and implementation of initiatives. It benefits patients through reduced suffering and ensures safety. Hospitals should establish medical audit committees and collect data to facilitate the audit process. Audits help practitioners identify weaknesses and make corrections to enhance quality of care.
- This document provides guidance for initial assessment of patients suspected of having pandemic influenza by primary care providers in Fraser Health.
- It outlines recommendations for triaging patients based on illness severity and risk factors. High-risk patients and those with severe symptoms or complications may require hospital admission.
- General advice is given on addressing patient concerns, providing information about the illness and treatment, and guidance on when further medical help is needed. Scoring systems like CRB-65 and CURB-65 are presented to help assess severity of influenza-related pneumonia.
This document discusses health analytics and Pera Health. It provides background on how much healthcare data is generated and the need for more data scientists. It then summarizes Pera Health's product called the Rothman Index, which analyzes patient data to generate a acuity score to detect deterioration. The document also discusses a case study on using the Rothman Index to predict ICU readmissions and provides some success stories and challenges of healthcare analytics.
oint Commission International Accreditation Standards for Hospitals, 6th Edition, provides the basis for accreditation of hospitals throughout the world. Joint Commission International (JCI) standards define the performance expectations, structures, and functions that must be in place for a hospital to be accredited by JCI. The standards are divided into two main sections: 1) patient-centered care and 2) health care organization management.
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
An audit examines processes and outcomes in intensive care to identify opportunities for quality improvement. It involves comparing objectives and reality by assessing structure, process, and outcomes. Auditing an ICU's performance is important for patient safety, professional development of staff, and efficient use of resources. Key indicators that should be audited include adherence to evidence-based practices for conditions like sepsis, ventilation protocols to prevent pneumonia, and checklists for procedures like central line insertion. Collecting data on adverse events through confidential reporting allows teams to learn from mistakes and standardize care processes. Implementing care "bundles" that group several evidence-based practices for a given condition can help improve outcomes more than single interventions alone. Regular auditing is essential for ongoing assessment and
This document discusses quality improvement and patient safety in anesthesia. It defines key terms like quality improvement, continuous quality improvement and differentiates it from traditional quality assurance. It outlines frameworks for improvement like the Model for Improvement and discusses tools used for quality improvement like Lean methodology, Six Sigma and PDSA cycles. It discusses important measures for quality improvement like process, outcome and balancing measures. Methods for analyzing and displaying quality improvement data like control charts and dashboards are described. Sources of quality improvement information and the importance of incident reporting are also summarized.
DASH - does arthritis self-management help?epicyclops
This lecture was given by Dr Marta Buszewicz, General Practitioner from North London and Senior Lecturer in Community Based Teaching & Research at UCL, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Rui Maio Portugal - Monday 28 - ICU and Organ Donationincucai_isodp
Close cooperation between intensive care unit (ICU) staff and transplant coordinators (TCs) is key to the organ donation process. The profile of professionals involved in transplant coordination has changed, with more medical professionals from ICU and emergency backgrounds. All steps of the donation process must be managed in the ICU by ICU staff and TCs to increase organ donation and quality. As populations age and diseases increase, intensive care needs are growing, requiring preparation to face these challenges.
Success rates in specialist training and certification programs should be nearly 100%. This can be achieved by a structured and supervised specialist training program. In such programs, the need for end-of-five year examination is questionable. These slides are basis of a lecture that illustrates the specialist training and certification program in internal medicine in Sweden
The document discusses using data and analytics to drive improvements in healthcare. It outlines the components of a data-driven organization, including an enterprise data warehouse, metrics, predictive models, protocols, and governance. It also discusses how analytics can help healthcare providers transition to value-based payments by measuring quality, reducing variation, and eliminating waste. Specific examples are provided on how one healthcare system used data to reduce variation in spine care, lower bleeding complications after PCI procedures, identify drug cost opportunities in knee replacements, and lower supply costs for lumbar fusion procedures.
Patient safety involves avoiding preventable harm caused by errors in healthcare. There are different types of medical errors from errors to adverse events. A sentinel event is an unexpected occurrence that causes death or serious injury. Near misses refer to errors that could have caused harm but did not. A culture of safety depends on values, attitudes, behaviors and other factors that promote commitment to safety. Proper identification of patients, effective communication, safe practices for high-risk medications, and protocols for surgery are important for quality care and patient safety.
This study aimed to determine the incidence and types of medical errors in ICU patients. The results found that 20% of patients experienced an adverse event, with 45% deemed preventable. A total of 223 serious medical errors occurred, with medications contributing to 78% of errors. The majority of errors were due to slips or lapses in care. The study suggests system-based changes like computerized order entry and barcoding could help reduce medical errors.
Risk Management Training Slides.
Slides prepared based on "The Healthcare Quality Handbook" by Janet A Brown. Very useful health care quality reference for CPHQ exam preparation. For more slides, contact ckmujeeb@hotmail.com
This document discusses clinical audit, which seeks to improve patient care through systematic review of care against criteria and implementing changes where needed. It defines audit and outlines the audit cycle of selecting a topic, identifying standards, collecting data on performance, implementing changes if needed, and monitoring further to ensure improvement. The document provides examples of what can be audited, such as structure, processes of care, or outcomes. It emphasizes that audit criteria should be evidence-based and measurable. The goal of audit is to continuously improve quality of care.
“8th National Biennial Conference on Medical Informatics 2012” Ashu Ash
This document discusses using eLearning to reduce costs and improve adoption of electronic medical record (EMR) systems during implementation in hospitals. Traditional classroom training for thousands of staff was very expensive and time consuming. The approach taken was to develop an enterprise training portal with online courses tailored for different roles. This allowed asynchronous learning over several weeks. Classroom time was reduced to introduce the portal. Costs were cut by 75% and training was completed in two months, achieving a critical mass of adoption, compared to over 10 months for traditional training. eLearning improved the scalability and affordability of training for successful EMR implementation.
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
The document discusses methods for measuring performance and clinical outcomes in healthcare. It describes the major domains of patient safety measurement as harm, mortality, infections, readmissions, patient satisfaction, and safety culture. It then focuses on defining medical errors and adverse events, and explaining why measurement is important for evaluating current systems and improving outcomes. Different methods of data collection are outlined, including direct observation, cohort studies, record review, and incident reporting systems. The Global Trigger Tool for assessing harm using chart review is also summarized.
Audit and stat for medical professionalsNadir Mehmood
This document discusses clinical audit and statistics. It begins by defining audit and its importance in clinical practice. The document outlines the types of audit and how statistics are used in clinical practice. It discusses the components of a clinical audit and defines key statistical terms like population, sample, and descriptive statistics. The document provides examples to illustrate statistical concepts and calculations like descriptive statistics and the area under the curve of a normal distribution. It emphasizes that the goal of statistics is to summarize data in a way that is understandable for non-statisticians.
Admission Disposition: Inpatient or Outpatient Observationampeterson03
This was a staff presentation for Rio Grande Hospital staff in 2012 regarding the correct admission status for patients, billing, and the impact that RACs auditors have on the hospital
Medical audit is a systematic evaluation of medical care to improve patient outcomes. It involves reviewing medical records against criteria to identify areas for improvement. The key aspects that can be audited include structure, processes, and outcomes of care. Medical audit aims to ensure best possible care, evidence-based practice, and implementation of initiatives. It benefits patients through reduced suffering and ensures safety. Hospitals should establish medical audit committees and collect data to facilitate the audit process. Audits help practitioners identify weaknesses and make corrections to enhance quality of care.
- This document provides guidance for initial assessment of patients suspected of having pandemic influenza by primary care providers in Fraser Health.
- It outlines recommendations for triaging patients based on illness severity and risk factors. High-risk patients and those with severe symptoms or complications may require hospital admission.
- General advice is given on addressing patient concerns, providing information about the illness and treatment, and guidance on when further medical help is needed. Scoring systems like CRB-65 and CURB-65 are presented to help assess severity of influenza-related pneumonia.
This document discusses health analytics and Pera Health. It provides background on how much healthcare data is generated and the need for more data scientists. It then summarizes Pera Health's product called the Rothman Index, which analyzes patient data to generate a acuity score to detect deterioration. The document also discusses a case study on using the Rothman Index to predict ICU readmissions and provides some success stories and challenges of healthcare analytics.
oint Commission International Accreditation Standards for Hospitals, 6th Edition, provides the basis for accreditation of hospitals throughout the world. Joint Commission International (JCI) standards define the performance expectations, structures, and functions that must be in place for a hospital to be accredited by JCI. The standards are divided into two main sections: 1) patient-centered care and 2) health care organization management.
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
An audit examines processes and outcomes in intensive care to identify opportunities for quality improvement. It involves comparing objectives and reality by assessing structure, process, and outcomes. Auditing an ICU's performance is important for patient safety, professional development of staff, and efficient use of resources. Key indicators that should be audited include adherence to evidence-based practices for conditions like sepsis, ventilation protocols to prevent pneumonia, and checklists for procedures like central line insertion. Collecting data on adverse events through confidential reporting allows teams to learn from mistakes and standardize care processes. Implementing care "bundles" that group several evidence-based practices for a given condition can help improve outcomes more than single interventions alone. Regular auditing is essential for ongoing assessment and
This document discusses quality improvement and patient safety in anesthesia. It defines key terms like quality improvement, continuous quality improvement and differentiates it from traditional quality assurance. It outlines frameworks for improvement like the Model for Improvement and discusses tools used for quality improvement like Lean methodology, Six Sigma and PDSA cycles. It discusses important measures for quality improvement like process, outcome and balancing measures. Methods for analyzing and displaying quality improvement data like control charts and dashboards are described. Sources of quality improvement information and the importance of incident reporting are also summarized.
DASH - does arthritis self-management help?epicyclops
This lecture was given by Dr Marta Buszewicz, General Practitioner from North London and Senior Lecturer in Community Based Teaching & Research at UCL, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Rui Maio Portugal - Monday 28 - ICU and Organ Donationincucai_isodp
Close cooperation between intensive care unit (ICU) staff and transplant coordinators (TCs) is key to the organ donation process. The profile of professionals involved in transplant coordination has changed, with more medical professionals from ICU and emergency backgrounds. All steps of the donation process must be managed in the ICU by ICU staff and TCs to increase organ donation and quality. As populations age and diseases increase, intensive care needs are growing, requiring preparation to face these challenges.
Success rates in specialist training and certification programs should be nearly 100%. This can be achieved by a structured and supervised specialist training program. In such programs, the need for end-of-five year examination is questionable. These slides are basis of a lecture that illustrates the specialist training and certification program in internal medicine in Sweden
The document discusses using data and analytics to drive improvements in healthcare. It outlines the components of a data-driven organization, including an enterprise data warehouse, metrics, predictive models, protocols, and governance. It also discusses how analytics can help healthcare providers transition to value-based payments by measuring quality, reducing variation, and eliminating waste. Specific examples are provided on how one healthcare system used data to reduce variation in spine care, lower bleeding complications after PCI procedures, identify drug cost opportunities in knee replacements, and lower supply costs for lumbar fusion procedures.
Patient safety involves avoiding preventable harm caused by errors in healthcare. There are different types of medical errors from errors to adverse events. A sentinel event is an unexpected occurrence that causes death or serious injury. Near misses refer to errors that could have caused harm but did not. A culture of safety depends on values, attitudes, behaviors and other factors that promote commitment to safety. Proper identification of patients, effective communication, safe practices for high-risk medications, and protocols for surgery are important for quality care and patient safety.
This study aimed to determine the incidence and types of medical errors in ICU patients. The results found that 20% of patients experienced an adverse event, with 45% deemed preventable. A total of 223 serious medical errors occurred, with medications contributing to 78% of errors. The majority of errors were due to slips or lapses in care. The study suggests system-based changes like computerized order entry and barcoding could help reduce medical errors.
Risk Management Training Slides.
Slides prepared based on "The Healthcare Quality Handbook" by Janet A Brown. Very useful health care quality reference for CPHQ exam preparation. For more slides, contact ckmujeeb@hotmail.com
This document discusses clinical audit, which seeks to improve patient care through systematic review of care against criteria and implementing changes where needed. It defines audit and outlines the audit cycle of selecting a topic, identifying standards, collecting data on performance, implementing changes if needed, and monitoring further to ensure improvement. The document provides examples of what can be audited, such as structure, processes of care, or outcomes. It emphasizes that audit criteria should be evidence-based and measurable. The goal of audit is to continuously improve quality of care.
“8th National Biennial Conference on Medical Informatics 2012” Ashu Ash
This document discusses using eLearning to reduce costs and improve adoption of electronic medical record (EMR) systems during implementation in hospitals. Traditional classroom training for thousands of staff was very expensive and time consuming. The approach taken was to develop an enterprise training portal with online courses tailored for different roles. This allowed asynchronous learning over several weeks. Classroom time was reduced to introduce the portal. Costs were cut by 75% and training was completed in two months, achieving a critical mass of adoption, compared to over 10 months for traditional training. eLearning improved the scalability and affordability of training for successful EMR implementation.
This document proposes the implementation of an electronic health record (EHR) system at a university. It discusses the benefits of health information systems, including improved quality, safety, efficiency and cost reduction. It also covers important considerations for EHR implementation such as privacy, security, component selection, management roles, and evaluating effectiveness. The proposal recommends selecting system components, developing an implementation plan, training staff, and continuously evaluating the system's performance.
The document discusses nursing informatics, which is defined as the combination of computer science, information science, and nursing science used to manage and process nursing data, information, and knowledge. It provides an overview of the historical development of nursing informatics and the roles of nurse informaticists. Key points covered include the use of electronic health records, telehealth, and computerized documentation systems in healthcare. The importance of technical, utility, and leadership competencies for nursing informatics is also highlighted.
Successful EHR Implementation - Strategy & TipsJames Muir
Implementing an EHR is a complex project that requires extensive planning and involvement from all stakeholders. Key steps include defining goals and metrics, analyzing workflows, selecting an appropriate vendor, and providing comprehensive training for end users. A successful implementation follows best practices such as establishing executive support, implementing in increments, thoroughly testing the system, and providing ongoing support and feedback after going live. Shadowing providers during training and post go-live periods is critical to ensure adoption and maximize benefits of the new EHR system.
This document discusses Community Health Connections' implementation of an electronic health record system. It provides an overview of the organization and outlines their plan to implement OpenVista EHR software across three clinics by February 2011. It describes the anticipated benefits of EHR including reduced errors, improved workflows and access to patient information. The implementation plan includes teams for project management, hardware, software and stakeholders. It also covers training, data migration, technical infrastructure including servers and network upgrades, meeting meaningful use requirements and realizing financial benefits and savings.
“Documentation not supportive of the RUG-IV classification billed…” is cited as the reason for multiple post-payment medical record review denials. Accurate and concise documentation to support the RUG-IV classification billed is a critical element in gaining accurate reimbursement, and supporting that reimbursement level during a medical review. This presentation covers the technical and clinical requirements for Medicare coverage, and requirements of skilled nursing documentation. The presentation identifies areas of the MDS 3.0 that are vulnerable to error and critical to accurate RUG-IV classification and identify strategies for better supporting these areas in medical record documentation. The correlation between the MDS 3.0 assessment and publicly reported information for the Quality Measures and 5 Star Quality Reporting are discussed.
1. Learn to describe the technical and clinical requirements for Medicare coverage.
2. Understand the goal of supportive skilled nursing documentation.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn to identify sections of the MDS 3.0 assessment that are vulnerable to error and articulate strategies to support these areas in medical record documentation.
5. Learn to identify the correlation between medical record documentation, the MDS 3.0, and publicly reported information for the Quality Measures and 5 Star Quality Rating.
ICN Victoria presents Dr Dashiell Gantner, research fellow at the Monash University in Melbourne. Here he talks about translating ICU research into clinical practice.
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
This document discusses strategies to prevent and manage delirium in critically ill patients. It outlines the ABCDEF bundle which includes assessing, preventing, and managing pain, both spontaneous awakening and breathing trials, minimizing sedation, assessing and preventing delirium, early mobility and exercise, and engaging family members. Screening for delirium using the CAM-ICU tool and implementing non-pharmacological interventions can reduce length of hospital stay, duration of mechanical ventilation, and mortality. Widespread use of protocols and bundles that incorporate these strategies may help address the high cost and poor outcomes associated with delirium.
1. The document discusses using real-world big data (RWBD) from sources like insurance claims, EMRs, registries, and devices to analyze real-world treatment pathways and generate real-world evidence (RWE).
2. A case study analyzes longitudinal treatment pathways of patients with non-malignant multiple myeloma using Hadoop and MapReduce to query and merge data from large tables.
3. Visualizations of individual patient timelines and aggregate pathways show variability in treatments and outcomes that could help identify opportunities to improve care management and adherence to guidelines.
Dr Brent James: quality improvement techniques at the frontlineNuffield Trust
Dr Brent James, Intermountain Institute for Healthcare Delivery Research, presents to the Health Policy Summit 2015 on delivering quality improvement techniques at the frontline.
This document discusses big data in healthcare and physical therapy. It provides an overview of ATI's use of big data through its large patient outcomes registry, which includes over 800 variables and has been accepted into federal registries. ATI leverages data on patient demographics, referrals, outcomes, satisfaction surveys, and costs to enhance care and outcomes. The challenges of evidence-based medicine in an era of big data are also examined, highlighting the need to reconcile evidence-based and precision approaches through standardized sharing of data.
KT research involves studying how to effectively promote the uptake of knowledge into clinical practice. Passive educational activities like conferences are generally ineffective at changing physician behavior, while knowledge translation approaches in the clinical environment using tools like clinical pathways and decision support can impact outcomes. The examples described implemented guidelines for diagnosing pulmonary embolism and increased physician use of electronic resources through a mobile clinical decision support system.
The document discusses chronic care and the chronic care model. It notes that while 55% of people have no chronic conditions, those with chronic conditions account for the majority of health care visits, admissions, days in the hospital, and prescriptions. The chronic care model emphasizes a system-wide approach rather than just physician behavior, and includes elements like self-management support, delivery system design, decision support, clinical information systems, and community resources. Productive interactions between prepared practice teams and informed, activated patients are key. Payment issues around chronic care include how to pay providers for new services and share savings from reduced utilization.
Leveraging Predictive Models to Reduce ReadmissionsHealth Catalyst
Far too often analytics efforts have fallen short of making a tangible impact on outcomes because they haven’t been successfully implemented in real workflows. Predictive models remain at risk of becoming isolated in their use along the continuum of care where their integration may provide benefits larger than the sum of each silo.
To combat this, UnityPoint Health (UPH) focused on integrating analytical models within the same readmission reduction strategy and coaching the care team to facilitate their adoption. Using this approach, one of UPH hospital’s risk-adjusted readmission indexes improved 40 percent over three years, surpassing internal system targets in performance and becoming the top performer in the health system.
Learning Objectives:
- Describe applicable predictive models useful in reducing 30-day readmissions.
- Learn the elements of a successful readmissions reduction strategy in an integrated health system.
- Understand common obstacles faced in the adoption of analytical tools and how to overcome them.
View this webinar to gain knowledge of the analytics tools and methods UPH used, including innovative individualized risk heat-maps generated for each patient, strategies for analytics adoption, and lessons learned along the way.
This document discusses key performance indicators (KPIs) and metrics for measuring performance in healthcare organizations. It defines KPIs as measures of performance or outcomes that use clinical and non-clinical metrics. Metrics are the specific numbers or data points used within KPIs to track progress. The document provides examples of common clinical metrics like readmission rates and non-clinical metrics like wait times. It also discusses the importance of measuring performance to manage healthcare operations effectively and outlines standards and requirements for healthcare organization performance measurement.
Transforming the Office Management of Heart Failure Using the Chronic Disease...MedicineAndHealthUSA
This document describes a project to transform the management of heart failure patients using a chronic disease model in a family medicine residency program. It discusses shortcomings in current chronic disease management and introduces the chronic care model. The project aims to improve guideline adherence, patient education and self-management, care coordination, and use of an electronic registry to track patients and monitor outcomes. Initial lessons learned include challenges with governance approvals and achieving buy-in from part-time providers during a cultural change.
I was asked to discuss recently the latest guidelines with the fellows. Here's my work. I also included some slides on how to apply for support via Phil Charity Sweepstakes Office.
This document summarizes a presentation on optimizing the use of urine drug testing. It contains 4 learning objectives focused on identifying obstacles to appropriate urine drug testing, describing a clinical approach, explaining legal liability, and advocating for policy responses. The presentation consists of 4 speakers and a moderator and covers developing a consensus on urine drug testing, including general guidelines, test selection, use in diagnosis and treatment. It emphasizes individualizing decisions based on patient history and needs, using preliminary tests for quick results and definitive tests for accuracy, and documenting decisions in medical records.
Advanced Methods in Delivery System Research –Planning, Executing, Analyzing, and Reporting Research on Delivery System Improvement Webinar #2: Statistical Process Control
1) The webinar discusses the use of statistical process control (SPC) in healthcare delivery system research and quality improvement. SPC uses control charts to monitor processes and outcomes over time and distinguish normal variation from meaningful changes.
2) An example is provided of how SPC was used to monitor disease symptoms electronically during the 2002 Salt Lake City Olympics to detect bioterrorism attacks. Near real-time SPC of clinic data allowed quick identification of a significant increase in gastrointestinal issues from influenza.
3) SPC can also be applied at the patient, provider, and population levels. An example pilot study used SPC to monitor the effects of a clinical workflow redesign emphasizing the medical assistant's
This document discusses monitoring response variables in clinical studies. It defines response variables as the outcomes used to answer the study's primary and secondary questions. Ideal response variables are well-defined, stable, reproducible, unbiased, and can be ascertained in all participants. Surrogate response variables can be used but require validation as they may not fully capture the effect of an intervention on the true clinical outcome. Data and safety monitoring boards provide independent oversight of clinical studies to ensure participant safety and appropriate study conduct.
The medical director is responsible for developing, implementing, and overseeing a facility's robust quality assessment and performance improvement (QAPI) program. This includes establishing a multidisciplinary team to regularly review data, prioritize issues, and take corrective actions to improve patient outcomes and safety. The QAPI program must measure and address various clinical areas at minimum, and compliance is determined by reviewing outcomes, records, and interviewing staff.
How to Define Effective and Efficient Real World TrialsTodd Berner MD
This document discusses strategies for designing effective and efficient real-world clinical trials. It covers topics such as using real-world evidence to inform clinical trial design, the differences between efficacy and effectiveness, challenges around representativeness in trial populations, and the value of pragmatic clinical trials. It also discusses leveraging electronic health records for condition-specific prompts and clinical decision support to improve performance and quality of care.
How to design effective and efficient real world trials TB Evidence 2014 10.2...Todd Berner MD
This document discusses strategies for designing effective and efficient real-world clinical trials. It covers topics such as using real-world evidence to inform clinical trial design, the differences between efficacy and effectiveness, challenges in defining quality metrics, and strategies for improving performance within healthcare systems. The document provides information on pragmatic clinical trials and how real-world evidence could reduce costs compared to traditional clinical trials.
Similar to “8th National Biennial Conference on Medical Informatics 2012” (20)
HCL Notes and Domino License Cost Reduction in the World of DLAUpanagenda
Webinar Recording: https://www.panagenda.com/webinars/hcl-notes-and-domino-license-cost-reduction-in-the-world-of-dlau/
The introduction of DLAU and the CCB & CCX licensing model caused quite a stir in the HCL community. As a Notes and Domino customer, you may have faced challenges with unexpected user counts and license costs. You probably have questions on how this new licensing approach works and how to benefit from it. Most importantly, you likely have budget constraints and want to save money where possible. Don’t worry, we can help with all of this!
We’ll show you how to fix common misconfigurations that cause higher-than-expected user counts, and how to identify accounts which you can deactivate to save money. There are also frequent patterns that can cause unnecessary cost, like using a person document instead of a mail-in for shared mailboxes. We’ll provide examples and solutions for those as well. And naturally we’ll explain the new licensing model.
Join HCL Ambassador Marc Thomas in this webinar with a special guest appearance from Franz Walder. It will give you the tools and know-how to stay on top of what is going on with Domino licensing. You will be able lower your cost through an optimized configuration and keep it low going forward.
These topics will be covered
- Reducing license cost by finding and fixing misconfigurations and superfluous accounts
- How do CCB and CCX licenses really work?
- Understanding the DLAU tool and how to best utilize it
- Tips for common problem areas, like team mailboxes, functional/test users, etc
- Practical examples and best practices to implement right away
Infrastructure Challenges in Scaling RAG with Custom AI modelsZilliz
Building Retrieval-Augmented Generation (RAG) systems with open-source and custom AI models is a complex task. This talk explores the challenges in productionizing RAG systems, including retrieval performance, response synthesis, and evaluation. We’ll discuss how to leverage open-source models like text embeddings, language models, and custom fine-tuned models to enhance RAG performance. Additionally, we’ll cover how BentoML can help orchestrate and scale these AI components efficiently, ensuring seamless deployment and management of RAG systems in the cloud.
HCL Notes und Domino Lizenzkostenreduzierung in der Welt von DLAUpanagenda
Webinar Recording: https://www.panagenda.com/webinars/hcl-notes-und-domino-lizenzkostenreduzierung-in-der-welt-von-dlau/
DLAU und die Lizenzen nach dem CCB- und CCX-Modell sind für viele in der HCL-Community seit letztem Jahr ein heißes Thema. Als Notes- oder Domino-Kunde haben Sie vielleicht mit unerwartet hohen Benutzerzahlen und Lizenzgebühren zu kämpfen. Sie fragen sich vielleicht, wie diese neue Art der Lizenzierung funktioniert und welchen Nutzen sie Ihnen bringt. Vor allem wollen Sie sicherlich Ihr Budget einhalten und Kosten sparen, wo immer möglich. Das verstehen wir und wir möchten Ihnen dabei helfen!
Wir erklären Ihnen, wie Sie häufige Konfigurationsprobleme lösen können, die dazu führen können, dass mehr Benutzer gezählt werden als nötig, und wie Sie überflüssige oder ungenutzte Konten identifizieren und entfernen können, um Geld zu sparen. Es gibt auch einige Ansätze, die zu unnötigen Ausgaben führen können, z. B. wenn ein Personendokument anstelle eines Mail-Ins für geteilte Mailboxen verwendet wird. Wir zeigen Ihnen solche Fälle und deren Lösungen. Und natürlich erklären wir Ihnen das neue Lizenzmodell.
Nehmen Sie an diesem Webinar teil, bei dem HCL-Ambassador Marc Thomas und Gastredner Franz Walder Ihnen diese neue Welt näherbringen. Es vermittelt Ihnen die Tools und das Know-how, um den Überblick zu bewahren. Sie werden in der Lage sein, Ihre Kosten durch eine optimierte Domino-Konfiguration zu reduzieren und auch in Zukunft gering zu halten.
Diese Themen werden behandelt
- Reduzierung der Lizenzkosten durch Auffinden und Beheben von Fehlkonfigurationen und überflüssigen Konten
- Wie funktionieren CCB- und CCX-Lizenzen wirklich?
- Verstehen des DLAU-Tools und wie man es am besten nutzt
- Tipps für häufige Problembereiche, wie z. B. Team-Postfächer, Funktions-/Testbenutzer usw.
- Praxisbeispiele und Best Practices zum sofortigen Umsetzen
Programming Foundation Models with DSPy - Meetup SlidesZilliz
Prompting language models is hard, while programming language models is easy. In this talk, I will discuss the state-of-the-art framework DSPy for programming foundation models with its powerful optimizers and runtime constraint system.
Ivanti’s Patch Tuesday breakdown goes beyond patching your applications and brings you the intelligence and guidance needed to prioritize where to focus your attention first. Catch early analysis on our Ivanti blog, then join industry expert Chris Goettl for the Patch Tuesday Webinar Event. There we’ll do a deep dive into each of the bulletins and give guidance on the risks associated with the newly-identified vulnerabilities.
Let's Integrate MuleSoft RPA, COMPOSER, APM with AWS IDP along with Slackshyamraj55
Discover the seamless integration of RPA (Robotic Process Automation), COMPOSER, and APM with AWS IDP enhanced with Slack notifications. Explore how these technologies converge to streamline workflows, optimize performance, and ensure secure access, all while leveraging the power of AWS IDP and real-time communication via Slack notifications.
Unlock the Future of Search with MongoDB Atlas_ Vector Search Unleashed.pdfMalak Abu Hammad
Discover how MongoDB Atlas and vector search technology can revolutionize your application's search capabilities. This comprehensive presentation covers:
* What is Vector Search?
* Importance and benefits of vector search
* Practical use cases across various industries
* Step-by-step implementation guide
* Live demos with code snippets
* Enhancing LLM capabilities with vector search
* Best practices and optimization strategies
Perfect for developers, AI enthusiasts, and tech leaders. Learn how to leverage MongoDB Atlas to deliver highly relevant, context-aware search results, transforming your data retrieval process. Stay ahead in tech innovation and maximize the potential of your applications.
#MongoDB #VectorSearch #AI #SemanticSearch #TechInnovation #DataScience #LLM #MachineLearning #SearchTechnology
How to Get CNIC Information System with Paksim Ga.pptxdanishmna97
Pakdata Cf is a groundbreaking system designed to streamline and facilitate access to CNIC information. This innovative platform leverages advanced technology to provide users with efficient and secure access to their CNIC details.
Best 20 SEO Techniques To Improve Website Visibility In SERPPixlogix Infotech
Boost your website's visibility with proven SEO techniques! Our latest blog dives into essential strategies to enhance your online presence, increase traffic, and rank higher on search engines. From keyword optimization to quality content creation, learn how to make your site stand out in the crowded digital landscape. Discover actionable tips and expert insights to elevate your SEO game.
Building Production Ready Search Pipelines with Spark and MilvusZilliz
Spark is the widely used ETL tool for processing, indexing and ingesting data to serving stack for search. Milvus is the production-ready open-source vector database. In this talk we will show how to use Spark to process unstructured data to extract vector representations, and push the vectors to Milvus vector database for search serving.
OpenID AuthZEN Interop Read Out - AuthorizationDavid Brossard
During Identiverse 2024 and EIC 2024, members of the OpenID AuthZEN WG got together and demoed their authorization endpoints conforming to the AuthZEN API
TrustArc Webinar - 2024 Global Privacy SurveyTrustArc
How does your privacy program stack up against your peers? What challenges are privacy teams tackling and prioritizing in 2024?
In the fifth annual Global Privacy Benchmarks Survey, we asked over 1,800 global privacy professionals and business executives to share their perspectives on the current state of privacy inside and outside of their organizations. This year’s report focused on emerging areas of importance for privacy and compliance professionals, including considerations and implications of Artificial Intelligence (AI) technologies, building brand trust, and different approaches for achieving higher privacy competence scores.
See how organizational priorities and strategic approaches to data security and privacy are evolving around the globe.
This webinar will review:
- The top 10 privacy insights from the fifth annual Global Privacy Benchmarks Survey
- The top challenges for privacy leaders, practitioners, and organizations in 2024
- Key themes to consider in developing and maintaining your privacy program
Monitoring and Managing Anomaly Detection on OpenShift.pdfTosin Akinosho
Monitoring and Managing Anomaly Detection on OpenShift
Overview
Dive into the world of anomaly detection on edge devices with our comprehensive hands-on tutorial. This SlideShare presentation will guide you through the entire process, from data collection and model training to edge deployment and real-time monitoring. Perfect for those looking to implement robust anomaly detection systems on resource-constrained IoT/edge devices.
Key Topics Covered
1. Introduction to Anomaly Detection
- Understand the fundamentals of anomaly detection and its importance in identifying unusual behavior or failures in systems.
2. Understanding Edge (IoT)
- Learn about edge computing and IoT, and how they enable real-time data processing and decision-making at the source.
3. What is ArgoCD?
- Discover ArgoCD, a declarative, GitOps continuous delivery tool for Kubernetes, and its role in deploying applications on edge devices.
4. Deployment Using ArgoCD for Edge Devices
- Step-by-step guide on deploying anomaly detection models on edge devices using ArgoCD.
5. Introduction to Apache Kafka and S3
- Explore Apache Kafka for real-time data streaming and Amazon S3 for scalable storage solutions.
6. Viewing Kafka Messages in the Data Lake
- Learn how to view and analyze Kafka messages stored in a data lake for better insights.
7. What is Prometheus?
- Get to know Prometheus, an open-source monitoring and alerting toolkit, and its application in monitoring edge devices.
8. Monitoring Application Metrics with Prometheus
- Detailed instructions on setting up Prometheus to monitor the performance and health of your anomaly detection system.
9. What is Camel K?
- Introduction to Camel K, a lightweight integration framework built on Apache Camel, designed for Kubernetes.
10. Configuring Camel K Integrations for Data Pipelines
- Learn how to configure Camel K for seamless data pipeline integrations in your anomaly detection workflow.
11. What is a Jupyter Notebook?
- Overview of Jupyter Notebooks, an open-source web application for creating and sharing documents with live code, equations, visualizations, and narrative text.
12. Jupyter Notebooks with Code Examples
- Hands-on examples and code snippets in Jupyter Notebooks to help you implement and test anomaly detection models.
Your One-Stop Shop for Python Success: Top 10 US Python Development Providersakankshawande
Simplify your search for a reliable Python development partner! This list presents the top 10 trusted US providers offering comprehensive Python development services, ensuring your project's success from conception to completion.
Have you ever been confused by the myriad of choices offered by AWS for hosting a website or an API?
Lambda, Elastic Beanstalk, Lightsail, Amplify, S3 (and more!) can each host websites + APIs. But which one should we choose?
Which one is cheapest? Which one is fastest? Which one will scale to meet our needs?
Join me in this session as we dive into each AWS hosting service to determine which one is best for your scenario and explain why!
Choosing The Best AWS Service For Your Website + API.pptx
“8th National Biennial Conference on Medical Informatics 2012”
1. Objectified Assessment of
Rheumatoid Arthritis (RA) in Real-
Time as an Aid for Treat-to-Target
(T2T) Treatment Strategy
Prof. A. N. Malaviya,
MD, FRCP (Lond.), M-ACR, FAMS, FNASc
Ex- HOD Medicine and Chief of Clinical Immunology & Rheumatology, AIIMS
Consultant Rheumatologist, ISIC Superspeciality Hospital, New Delhi
Dr. S. B. Gogia,
MS (Surgery), Consultant Surgeon,
Past President IAMI
2. Rheumatoid disease
• A systemic multiorgan disease where the
brunt of the disease is on the joints in the
extremities
• It is an autoimmune where the body’s own
defence system attacks the body itself.
• The disease has genetic basis.
• What is (are) the trigger(s) for these genes to
start attacking the body remain to be
discovered (smoking is one of them)
3. Pathogenesis well characterised
Imbalanced production of cytokines with
excess of proinflammatory cytokines the
main one being tumour necrosis factor – α
(TNF-α)
4.
5. Dramatic advances in the treatment of
RA
• Disease modifying drugs (DMARDs)
• Biological response modifiers (Biologics)
• Which drug; at what stage of the disease;
what dose and routes:
– Monotherapy
– Combination therapy
– Strategy for their use
6. RA treatment
From being
“There is not much that can be done, patient
would die”
It has now become a
“Treatable condition where patients can lead a
normal life”
With dramatic advances in drug treatment of this
disease
7. RA can now be compared to
diabetes, hypertension and other
chronic diseases
They can be well controlled
With almost a normal life span with good
quality of life
Don’t worry about ‘cure’ –
Although ~ 20% go in drug-free remission
8. Basic treatment strategy for these
diseases
• Keep the disease under ‘tight control’
– Keep Hb-A1C < 6 (by proper close follow-up and
regular blood testing) in diabetes
– Keep BP <140/90 (will need to be adjusted for
younger people) in patients with hypertension
• This approach of treatment is called ‘treat-to-
target’ (T2T)
• How do we know what is the target in RA? There
are so many domains in the disease, very unlike
diabetes or hypertension!
9. RA has multiple domains
• Pain in the joints
• Swelling in the joints
• Poor ‘general health’ due to disease
• Poor ‘function’ due to joint involvement
• Inflammation in the body
All this needs to be measured
How do we obtain a number that represents
DISEASE ACTIVITY ON THAT DAY?
10. Composite indices
• Disease activity index (44 joints) – DAS44
– With erythrocyte sedimentation rate (ESR)
– With C-reactive protein (CRP)
• Disease activity index (28 joints) – DAS28
– With erythrocyte sedimentation rate (ESR)
– With C-reactive protein (CRP)
• Clinical Disease activity index – CDAI
• Simplified Disease activity index – SDAI
– With erythrocyte sedimentation rate (ESR)
– With C-reactive protein (CRP)
12. RA assessment using CDAI and SDAI
• SDAI = (28TJC) + (28SJC) + MDGA + PtGA + CRP*
– Remission = <3.3
– Low disease activity = >3.3 to <11
– Moderate disease activity = >11 to <26
– High disease activity = >26
• CDAI = (28TJC) + (28SJC) + MDGA + PtGA*
– Remission ≤2.8
– Low disease activity = >2.8 to ≤10
– Moderate disease activity = >10 to ≤22
– High disease activity = >22
13. Assessment of RA
• At each patient visit to the clinic we must know the
status of disease activity to keep it under tight control
i.e.:
• In ‘remission’
Or at least
• In ‘low disease state’
Therefore:
• It becomes mandatory to have DAS28 or CDAI or SDAI
at each visit
To be able to adjust the drugs / drug dosages
To keep the disease under ‘tight control’
14. Remember the formulae?
• DAS28 = 0.56 * sqrt(tender28) + 0.28 *
sqrt(swollen28) + 0.70 * ln(ESR) + 0.014 * GH
• SDAI = (28TJC) + (28SJC) + MDGA + PtGA +
CRP*
• CDAI = (28TJC) + (28SJC) + MDGA + PtGA*
• Can you imagine doing the calculations and
finding out whether the patient is in:
– Remission, low disease state or not?
15. Gadgets are needed
• Pre-programmed calculators
• On-line DAS calculators (now available)
• Why not have an EMR that would help:
– Permanent record of patient’s medical record
including medical history, examination findings,
laboratory test records
– Sequential assessment details
– Make drug prescriptions as well!
That is the question Dr. Gogia asked us
(rheumatologists) when he saw us struggling for
the use of ‘T2T’ approach for our RA patients
16. Development of rheumatology-specific
EMR
• Two of us worked closely
• Understanding each other’s way of working
• Work-flow of a rheumatology clinic was
understood by Dr. Gogia
• ‘Objectified assessment methodology’ as
discussed including all the composite indices for
the assessment of disease activity and their
formulae, cut-off points etc.
• Final EMR (~ 2 ½ years in development) ready for
use
23. Summary
• Rheumatology-EMR has the following
advantages:
– Quick and objectified assessment for guiding
treatment
– Clearly stated disease status
– Neat prescription with detailed instructions
– Appointment, tests before the next visit
– Many other benefits: more patients in the same
time period, data-mining easy for research
25. Significance Of An Appropriate
Change Management Strategy In
Successful Implementation Of A
Health Management Information
System
Dr. Aman Rana (IIHMR, Delhi)
&
Dr. Anandhi Ramachandran (IIHMR, Delhi)
26. HEALTH CARE INFORMATION SYSTEM
• Corporate Social Responsibility
• Benefits: for management- Workforce: an asset
- track of health status
-underlying occupational hazard
-success of any health intervention
-medi-claims easy
Employees:
-sense of security
-all information at one place
-reduced medical negligence
27. STUDY BACKGROUND:
• Location
A notable public organization,
EMPLOYEE HEALTH MANAGEMENT
SYSTEMS (EHMS) : Unsuccessful for past 2
years
28. OBJECTIVES
• To understand the Knowledge and Attitude of
the Employees towards EHMS
• To ascertain the reasons for failure of EHMS
adoption in the organization
• To put forth an operational framework for
successful adoption of EHMS
• To evaluate the success of the interventions
implemented
• To provide a suitable recommendations for
future continuous adoption of EHMS
29. METHODOLOGY
• STUDY TYPE: Quantitative
• SAMPLE SIZE: 353 employees
• SAMPLING: Convenience Sampling
• DATA UTILIZED: Primary and Secondary data
• TOOLS USED: Questionnaires, Focus Group
Discussions and Personal Interviews
30. PRE INTERVENTION STATUS:
• Out of the 353 employees:
• 5 = somewhat correct awareness of EHMS ( All
Admin.)
• 12= filled up self declarations
• No one had filled up the detailed periodic health
record.
• 85 = had some where heard of EHMS but had no clear
idea of what it is.
• 251 = people had never heard of EHMS.
• In house doctors (2 in number) found the system too
technical to understand and time consuming to work
on.
31.
32. BARRIER TO ADOPTION
• Technical Barriers
• User Perception of EHMS
• Resisting Change
33. USE OF IT TO INITIATE CHANGE
MANAGEMENT
People
Process Technology
34. 8 Steps to Transform an Organization
(‘Harvard business review on change’ by John P.Kotter)
1. Establishing a sense of Urgency
2. Forming a powerful guiding coalition
3. Creating a vision
4. Communicating the vision
5. Empowering others to act on the vision
6. Planning for and creating short-term wins
7. Consolidating improvements and producing
still more change
8. Institutionalizing new approaches
37. POST INTERVENTION STATUS
• AWARENESS REGARDING EHMS:
all 353 employees.
• SELF- DECLARATIONS FORMS STATUS:
226
• PERIODIC HEALTH EXAMINATION STATUS:
26
• DOCTORS’ CONSULTATION
Motivated and trained. Patient Consultation and Drugs
dispensing through the system.
38.
39. CADRE WISE RESPONSE TO THE
INTERVENTION PROGRAMME
• Management staff:
▫ Out of 172 people, 107 filled up declaration forms.
• Non Management staff/ Clerical Staff:
▫ 90 out of 124 gave in their self declarations.
• Labor staff:
▫ 29 out of 57 filled up their self declarations
40. ASSESSMENT OF THE CHANGE
MANAGEMENT PROCESS
• 100% awareness raised
• 64% of the staff entered self declaration forms
• Which contained preliminary health data.
• 7% people filled PHR forms which included detailed
information about person’s health data and past medical
history.
• Implies in spite of awareness, the workforce still needs to
accept and be a part of EHMS endeavor. So, the people
still need to know more about PHR. Awareness needs to
be accompanied with some visual fringe benefits.
• Privacy and confidentiality issues
41. RECOMMENDATIONS PROPOSED FOR
FUTURE ACTION
• A Change Management Champion.
• Administration should embrace the change in
the process, communicate vision and promote
health seeking behavior in the staff.
• Doctors: not just acceptors but also propagator.
• Doctors, Administrator and staff should sharea
good rapport.
• Periodic review: every six months
• Teams: Seniors and Juniors equal mix.
42. POINTS TO BE REMEBERED
• Change management is not an event but a process which needs a
focused vision and a visionary.
• The employees should be involved in the process from the initial
level.
• It is the responsibility of top management to assure that the
workforce stays motivated throughout.
• The leaders, who will propagate the change should be the ones who
are trusted by all and share excellent rapport with everyone.
• The more aware people are, the easier is the acceptance.
• The Employees’ expectations from the product should be kept
realistic throughout.
• It is as essential to retain the change as it is to bring the change.
43. REFERENCES
• McCarthy,M., and Eastman, D., Change Management Strategies for an Effective EMR
Implementation. Ohio: HIMSS; 2010. Available from: www.himss.org/content/files/Change
Management.pdf. Accessed 2011.
• Strebel, P., „Why Do Employees Resist Change?‟ Harvard Business Review May–June 1996
• Cohen D. The Heart of Change Field Guide: Tools and Tactics for Leading Change in Your
Organization. Boston, MA: Harvard Business School Press; 2005.
• .Bridges W. Managing Transitions: Making the Most of Change. 2nd ed. Cambridge, MA: Perseus
Publishing; 2003.
• Campbell, Robert James. Change Management in Health Care. Health Care Manager. 27(1):23-
39, January/March 2008.
• Abraham J, Feldman R, Carlin C,Understanding Employee Awareness of Health Care Quality
Information: How Can Employers Benefit? Health Services Research 39:6, Part I (December
2004)
• Heeks R. (2006) Health information systems: failure, success and improvisation. Int J Med
Inform. Feb; 75(2), 125-37.
• Al-Mashari, M., and Zairi, M. (1999) BPR implementation process: An analysis of key success and
failure factors. Bus. Process Manag. J. 5(1), 87–112
• Beynon-Davies, P., and Lloyd-Williams,M. (1999) When health informationsystems fail. Top.
Health Inf. Manage 20(1), 66–79.
• Chang, R., Process Reengineering in Action: A Practical Guide to Achieving Breakthrough Results.
Jossey-Bass Pfeiffer, San Francisco, 1999.
44.
45. Hardeep Singh, MD MPH Invited Panelists:
Houston VA Health Services Research Max Health Care EHR Team
Center of Excellence (Divye Chhabra, Nikhil Mishra, Neena
Pahuja, Shubnum Singh)
Dean F. Sittig, PhD And
The University of Texas Health Science Kanav Kahol, PhD,
Center School of Biomedical Informatics Public Health Foundation of India
46. Momentum for large scale health reform to
improve delivery and patient outcomes
Transformation must leverage use of
technology
Technology use must be accompanied by a
strategic approach accounting for the context
of the environment where implemented.
47. A Hospital system implements an EHR but a
year later has to switch to another one
U.K. Scrapping National Health IT Network
“…(after) nine years and £11.4 billion
($18.7 billion), the British government is
about to scrap its attempt to build a
massive, nationwide health IT network
for the 52 million residents of England,
a London news report says…”
48. Efficiency - 10% reduction
Inconsistent Clinical Decision Support
outcomes
We expect quality & safety to improve, but…
22 types of computerized provider order entry
(CPOE) errors
Unexpected downtimes
900 patients mistakenly given Viagra instead of
Zyban due to an error in the dispensing
pharmacy’s medication mapping table
49. National electronic health record (EHR)-
based intervention in VA
Required all pathology results (normal or
abnormal) to be transmitted to ordering providers
via mandatory automated notifications
We analyzed 2 hospitals…results were a bit
surprising…
Laxmisan et al Under Review
51. Design, development, implementation, use,
and evaluation of health information
technology is complex and prone to failure
Need a method of understanding the
relationships to get it “right”
Sittig & Singh JAMA 2009
52. Discuss a multi-faceted “socio-
technical” approach to safe and
effective health IT implementation
and use
Discuss how these socio-technical
concepts could apply to health IT
projects currently underway in India
53. Dean F. Sittig, PhD - Model Dimensions
Hardeep Singh, MD MPH – U.S. Case Studies
Discussion of model application in India:
Private health system (Max Health Care IT Team
and Leadership)
Public health system (Kanav Kahol, PhD, Public
Health Foundation of India)
54.
55. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
56. Must be capable of supporting ALL
required clinical activities.
EHR should be able to:
Calculate a medication dose
Transmit the order to the appropriate
department
Notify the nurse of a
placed order
57. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
58. Standard medical vocabularies to
encode clinical findings
Clinical knowledge to create specialty-
specific features and functions
Must be evidence-based, carefully
constructed, monitored, complete, and
error free
59.
60. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
61. Allows clinicians to quickly grasp a complex system
safely and efficiently
Displays all the relevant patient data so clinicians can
rapidly perceive problems, formulate responses, and
document actions.
Physical aspects of the interface (e.g., keyboard,
mouse, or touch screen) may also contribute to error
in input or selection of information.
? Common user interface
standards
62. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
63. Trained and knowledgeable personnel are
essential
System developers
Trainers, implementers, and maintenance staff
Users
Close interaction among informatics experts,
clinical application coordinators, and end
users is essential
65. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
66. Disruptions in workflow or information
transfer are fertile grounds for inefficiencies
Careful workflow analysis that accounts for
health IT use could lead to identification of
potential breakdown points
Errors may result from interventions that are
not delivered at the best point in the
workflow
67. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
68. Work environment
Culture of innovation, exploration, and
continual improvement are key
Organizations should:
Actively facilitate reporting of errors or barriers to
care resulting from health IT use,
carefully review their existing policies and
procedures before implementation.
69. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
70. Regulations may act as barriers or facilitators for safe
EHR use
Patient privacy
Policies must address safety and effectiveness of
health information exchange across organizational
boundaries
State and federal governments should create an
environment compatible with widespread use and
interoperability
71. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
72. Organizations must continually
evaluate usability & performance of
systems after implementation to:
Reliably measure benefits
Assess potential e-iatrogenic effects
73. Acknowledgments:
VA, NIH, AHRQ, ONC
Eight Rights of Safe Electronic Health Record Use
JAMA. 2009;302(10):1111-1113
Safe electronic health record use requires a comprehensive
monitoring and evaluation framework
JAMA. 2010 Feb 3;303(5):450-1
A new sociotechnical model for studying health information
technology in complex adaptive healthcare systems.
Qual Saf Health Care. 2010 Oct;19 Suppl 3:i68-74.
74. Hardeep Singh, MD, MPH
Chief Health Policy Quality Program,
Houston Veterans Affairs Health Services Research &
Development Center of Excellence
Michael E. DeBakey VA Medical Center & BCM
Director, Houston VA Patient Safety Center of Inquiry
75. Research and evaluation case studies in:
Communication of diagnostic test results
CPOE prescriptions
Electronic Referrals
How can the model guide us towards a
high performing “EHR enabled work-
system”
76. Safety issues related to communication
and coordination breakdowns prevalent
What affect will technology have on
communication and coordination of test
results and referrals?
Singh & Graber JAMA 2010
79. Communication more than information
transfer
Response and appropriate follow-up action
Providers may not acknowledge all alerts
they receive; some lost to follow-up
Timely follow-up should occur if they
acknowledge an alert
Singh et al JAMIA 2007
80. Evaluation of timely follow-up actions on abnormal
test result notifications communicated through the
View Alert system
1,163 outpatient abnormal labs & 1,196 abnormal
imaging results
7% labs lacked timely follow-up despite
acknowledgment
8% imaging lacked timely follow-up despite
acknowledgment
Singh et al AJM 2010 and Archives of IM 2009
81.
82. “One of the issues is just the
sheer volume of alerts, and
there’s a number of alerts that
in all honesty [you] really don’t
have any business seeing.”
83. Barriers & solutions span multiple dimensions:
Software (functionality for saving, tracking, and retrieving
alerts)
Content (e.g. what alert types are absolutely necessary)
Usability/ UI (improving existing functionality to improve
signal to noise ratio)
Workflow (e.g., surrogate alerts when providers out of
office)
Providers (e.g. knowledge)
Organizational (e.g. training, policies for follow-up)
Singh et al Under review
84.
85.
86. Of 532 scripts reported to have
inconsistent communication
20% errors had potential for severe
harm, if they reached the patient
Issues: training, complex orders
Singh et al Arch Int Med 2009
87. Transmission and tracking of referrals
finally possible!
Of 61,931 referrals, 36% discontinued and
0.8% unresolved at 30 days
Unexplained lack of follow-up actions by
subspecialists in 6.3% of all referrals
Unexplained lack of follow-up by PCPs in
7.4% of discontinued referrals
Singh et al JGIM 2010
88. Marked differences in PCPs' and subspecialists'
communication views (e.g. content)
Lack of an institutional referral policy,
Lack of standardization in referral procedures,
Ambiguity in roles and responsibilities, and
Inadequate resources to adapt and respond to
referral requests effectively
Very few technology barriers
Hysong et al Impl Science 2011
89.
90.
91. Information Technology
Measuring and Tracking the Progress of Implementing a
Comprehensive Electronic Health Record: A Mixed-
Methods Approach
February 5, 2012
92. Authors
Sandeep Budhiraja MD1
Nikhil Mishra1
Divye Chhabra MD1
Dean F. Sittig, PhD2
Hardeep Singh, MD, MPH3
Neena Pahuja PhD1
1Max Health Care Institute Ltd., New Delhi
2Professor,School of Biomedical Informatics, University of Texas Health Sciences
Center, Houston, Texas, USA
3Chief,Health Quality and Policy Program, Houston Veterans Affairs Health
Services Research and Development Center of Excellence and Baylor College
of Medicine, Houston, Texas, USA
94. Some Published Statistics: IT
supporting Healthcare
Ref: http://www.bbc.co.uk/news/health-15340102
• Death rates gone down by 17% among emergency patients
(16,000 deaths preventable)
• Higher accountability of staff
• Lower cases of missed medicine
• Medication allergy alerts supports safer healthcare
• Reduction of medication errors to ½.
• Checks on infection control
95. Hospital Group Level Systems Integration
Evolutionary need for Health Information Exchange
•Network of 8 hospitals in NCR
•Expanded by 4 new, spreading to
rest of north India. Altogether ~1900 beds
•EHR implementations complete in 4 hospitals
Hospital Data
Group level
integration Centre
Sheer Health
Volume of
Patient care
information ‘cloud’
51
97. eCare - Key Terms
• CPRS - Computerized Patient Record System
• EHR - Electronic Health Record
• HIS - Hospital Information System
• CPOE- Computerized Physician Order Entry
• BCMA - Bar Coded Medication Administration
• COWs – Computer On Wheels
98. The eCare vision
• To have a patient centric clinical record
• Embracing change to standardize care processes across the
organization
• To improve electronic access and availability of patient clinical
information
• To capture multi-
disciplinary patient
information
• The implementation of a
minimum data set
ensuring foolproof
documentation
99. Rationale EHR Implementation
• Complete IT Outsourcing
• WorldVistA integrated to Max-HIS
• Rationale
– Potential reduction of medical errors
– Improved medication management
– Rapid access to vital and accurate information
– Reduced duplication of services and cost
– Access to a more comprehensive picture of health for promoting
advances in the diagnosis and treatment of illnesses
– Improved and informed decision making
– Providing continuity of care to patients
55
100. Preparation for EHR Implementation
• External Consultants
• Process mapping of as-is workflows
• Data Cleaning
• Design Future-State Workflows (Map “as-is” to system
functionality)
• Approach
– Prepare patient demographics integration
– Prepare for Lab, Radiology & Pharmacy
– BCMA (e-MAR + closed loop medicine administration)
– CPOE
56
101. Preparation for EHR Implementation
• Training, Training & more Training
• Change Management is the key
• Big-Bang approach for IT- systems
– Phased approach “Slow change” for humans
• Super-Users and Change Managers
• 23rd July 2011 6 months
57
102. Study Methodology
• Mixed method for measuring and tracking progress of EHR
implementation
First
– quantitative approach
– six “automated” metrics
– extracted from Mumps database (Backbone)
Senior Consultants
Second Junior Consultants
Floor Mentors
– interviewed four groups of representative users Nursing Supervisor
– Content analysis of interviews identify major themes
Third
– fact-finding questionnaires
A total of 5 months of Data
58
103. Barcode Medical Administration
COW*– Nurse
Login Barcoded Patient
Identifying the nurse Wrist Band
Identifying the
patient
Barcoded Label
on Drug-
Identifying the Drug
Right Patient, Right Drug, Right Time
* COW- Computer on wheels 59
104. Results I-
Quantitative Approach – 6 automated Metrics
Implementation Metric % Use
1) Use of Progress Notes 76%
2) Use of CPOE for medications, procedures, lab and 100%
imaging tests
3) Documentation of 2 daily inpatient progress notes 65%
(morning and evening) by a consultant on all
inpatients
4) Use of Problem lists involving selection from ICD-9 15%
coded problems
5) Documentation of Input and Output logs by nurses 82% in IPD, Critical care on
parallel paper process
6) Use of BCMA by nurses Real Time MAR 41%,
however including after the
fact goes upto 78%
EHR-Structure 60
105. Results II-
Interviews with representative groups
Qualitative Analysis
Younger Doctors -more comfortable
Senior Consultants -hesitant with new technology
-had low degree of adoption.
Typing issues - Only 28% were comfortable
EHR system “complexity” - main concern of participants
(mainly senior consultants)
Perceived reduction of efficiency- due to time required in day to day
However most users- post 2-3 days of hands-on EHR use
-perceived its benefits
-reported high degree of comfort in its use.
-Divide between resistors and early adopters
61
106. Results II contd-
Interviews with representative groups
Differences between doctors and nurses also emerged
– 100% nurses had to use the system from day one
– Also had attended all training sessions
– Doctors were hard pressed for time for training as well as day to day use
– Ongoing Support
Facilitators of the process
• Leadership role (Top Management)
• Clinical Transformation & Change Management
• User friendly clinical templates
• Easy accessibility of all Max enrolled patients’ records
– Any Max facility
– Any Patient
• Light System (client application) - quick response time & stability
– also be credited with aiding its acceptance.
62
107. Results III-
Fact-finding Questionnaires
• “Did You Know” type features of system identified
– 12 in number, All Specific to doctors, 5 of these generic to nurses
– Nurses faired 5/5
– Doctors varied from 5-8
• Additionally 18 specific fact finding questions ranging from
– Rate your own usage, comfort level, perceived improvements
perceived benefits, suggestions for improvement
63
108. Results III contd-
Fact-finding Questionnaires
Five level scale used (Very Low Low Medium High Very High)
Question Group Majority Others
Comfort level in using system 65% Low to Medium 13-18% on both extremes
Viewing of existing notes/progress
notes
83% Medium to High rest Very High
scattered result 50% low to
Usage of templates on CPRS very few High
Medium
Usage of Orders
(lab/radio/drug/procedures)
83% High to Very High _
Frequency of entering findings of
consult
52% Medium to high 30% Low
Viewing of reports on CPRS software Majority high to Very High _
Surprisingly High to Very
Comfort level of typing
High
Ease of use of CPRS software 78% Medium to High Rest Low, none very high
Rate the overall improvement in time
taken for activities
80% Medium to High 10% low
Rate the overall improvement in the
efficiency for activities
90% Medium to High _
In your deptt. How would you rate the
Scattered results ranging
benefit of using systems over the 64 _
existing process from low to very high
109. Challenges Identified
• CPOE- Filling time for STAT medication orders,
only 90% compliance
Identified as an area for improvement
• An increase in the overall time in the discharge
process when the EHR was only used partially
- both paper + electronic records
- expected to be transitional phase
65
110. Discussion
• Early experience Largest implementation of its kind
– 4 facilities, comprehensive EHR, large health care system
• Several lessons learned by measuring and tracking
– Patience and aggressive Change Management is key
– Focus and Support from Leadership
– People don’t like to put in data, but once its there they really value it
– Benefits are perceived only by the ones who use more and vice-
versa
– Early adopters benefit more than laggards
– Laggards resist most
– Aggressive Supporting required at least till ratio tips in favor of adopter
66
112. Further Benefits
• Chronic Care Management using clinical reminders
– Clinical reminders
– automated reminders
– for the clinicians based on rules (diagnosis/ lab result/ drug allergy etc)
• Diabetic care
– Reminders setup for
– Periodic Glycosylated Hemoglobin (HbA1c)
– Diabetic Foot Exam (Skin and Neurological)
– Diabetic Eye Exam
– Data of these reminders when due is periodically passed to
Endocrinology team who in turn suggest the same to patients
– Services with Ophthalmology, Podiatry and Lab services is coordinated
through Endocrinology
68
115. Change Management Is Key
• It is not an IT project…..its an operations project
• Leadership support
• Support support support…..evolve…support
• Train train ….retrain….evolve….support
• Help on call- 24 hour support …..Human aspects
• Workshops
• As is workflows/future state
• Ease everyone in.
71
116. Change Management After Go-Live
• Healthcare- Standardized but flexible
• Operations cannot slow down to support change
• Shaken users prone to errors
• Real time support
• Leadership support
72
117. Results III contd-
Fact-finding Questionnaires
Five level scale used (Very Low Low Medium High Very High)
Question Group Majority Others
Comfort level in using system 65% Low to Medium 13-18% on both extremes
Viewing of existing notes/progress notes 83% Medium to High rest Very High
Usage of templates on CPRS scattered result 50% low to Medium very few High
Usage of Orders (lab/radio/drug/procedures) 83% High to Very High _
Frequency of entering findings of consult 52% Medium to high 30% Low
Viewing of reports on CPRS software Majority high to Very High _
Comfort level of typing Surprisingly High to Very High
Rate the availability of the COW(computer on Scattered results ranging from low to
wheels) in a ward
_
very high
Ease of use of CPRS software 78% Medium to High Rest Low, none very high
Rate the overall improvement in time taken for
activities
80% Medium to High 10% low
Rate the overall improvement in the efficiency for
activities
90% Medium to High _
In your deptt. How would you rate the benefit of Scattered results ranging from low to
using systems over the existing process
_
very high
73
118. Kanav Kahol
Division of Affordable Health Technologies
Public Health Foundation of India
kanav.kahol@phfi.org
120. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
121. Mhealth Solutions.
Portable with long or
extended battery life.
Enable non-physicians
to deliver care with
supervision and
monitoring
Example: Swasthya
Slate
122. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
123. Indigenized and local
language support.
Allow co-
development by
central agencies and
local players through
computer supported
collaborative
platforms.
Need support for
empowerment of
patients and the
healthcare workers.
124. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
125. Use of semiotics and
images is helpful
Simplified
questionnaires and
sets.
Affordance of the
user interface is key.
126. MyPortal State and District Portals
MyHealth Epidemiology
MyAppointments Early Warning Systems
MyMessages Messaging Center
MyTreatments Certification Portal
Learning Portal
Community Health Portal
eHealth/mHealth
Portals
Physician and Hospital Portal
National Portal
Patient Alerts
Certification Standards and Results
Scheduling Manager
Health Promotion
Message Center
National Security Portal
Information Reporting
Financial Management Portal
127. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
128. Technology illiteracy
is rapidly reducing.
People born in 1994
will be 22 in 2016.
Creation of suitable
cadres already a part
of the UHC Report.
Usable technology is
the key
Gap skills training will
have to be
undertaken.
129. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
130. Public Health Decision
Support System
Use algorithms from
supply chain and
related fields to help
with optimal resource
usage and allocation.
West Bengal and
Drishti.
131. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
132. Promote use
of HealthIT
Use grants
and universal
payer
mechanism
to ensure
compliance.
133. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
134. Use single payer as a leverage for adoption along
with grants.
Clearly define telemedicine (Use telemedicine law
draft)
Define privacy and security laws.
Ensure the right to connectivity.
135. Hardware and
Monitoring
Software
Workflow and
Content
Communication
Issue Under Study
State and
User
Federal
Interface
Rules
Organizational
Personnel
Characteristics
JAMA. 2009;302(10):1111-1113
136. Monitoring Financial and Clinical measures is the
key.
EHR enables a method of authentication and
verification.
Case in Point: Mother Child Tracking System and
Immunization Records.
Use cloud.
Caveat: Make reporting easy.
Caveat: Reporting is not the only or the most
important feature of ICT.
137.
138. Personal Eternal Health
Passbook
By
Dr. G. D. Mogli, Ph.D., MBA., FHRIM (UK), FAHIMA (USA)
Chief Executive Officer & MD
Dr. Mogli Healthcare Management Consultancy
www.drmogliit.com gdmogli@yahoo.com
Formerly served as
WHO Consultant and Sr. Consultant /Adviser to the Ministries of Health
India, Afghanistan, Iran, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, UAE &
Sr. Consultant eHealth Management
HEARTCOM INC. (USA)
139. Evolution of medical records
EHR/PH
R????
Comprehe Computer
• card nsive Unit
Writing on records based
Outpatient medical records
walls s records Comprehensive
unit records
Outpatient cards
140. Personal Eternal Health Passbook
The “Personal Eternal Health Passbook (PEHP) containing the ID, is a lifelong
electronic, universally available document, initiated at the time of birth, containing,
mother’s delivery information including congenital anomaly, immunizations given.
This will contain entire information such as episodic, hospitalization, self medications
and other habits including significant events. This is maintained by parents/guardian
and contains immunizations, growth charts, significant events and health status. The
PEHP information is contributed by health care providers and self and maintained in
a secure and private environment, with the individual determining rights of access”.
Definition by---
Dr G. D Mogli
141. PEHP
PEHP kept by individual, EHR by Hospital
PEHP is owned by individual and contain every detail.
PEHP information is managed by (care providers and himself).
Right of access of record is owned by PEHP owner.
142. What EHR cannot have? But
What PEHP can have?
Awareness among patients through media.
Internet forums and blogs for medical information.
Persons suffering from minor ailments, doesn’t visit, hospitals,
Applies self medication, self care/treatment.
Extensive information leads to Self-medication too.
This kind of information is not recorded in a EHR which could
prove to be detrimental for patient care.
143. Non Allopathic treatment
Many types of medicine are coming to light and being practiced.
Ex: Unani, Acupuncture, homeopathy, ayurvedic, yogic healing etc..
EHR is based on allopathic only.
other medications / therapies underwent by the patient is not recorded.
144. Types of PEHP
Paper based.
PC-based.
Web based. (maintained on private line-accessed by username and password)
Hybrid (desktop/Web-based.)
A mix of both PC’s and Online PEHP.
PEHP. Connecting through USB port to the computers.
146. What should the PEHP contain
Patient Identification Data.
Health Summary. Hospitalization.
Child Development. Obstetrics & Gynecology.
Immunizations. Surgeries/Therapy.
Chronic Disease (old age).
Self care/treatments.
Allergies and Drug
Medications. sensitivities.
Investigations.
147. Patient ID format
3 parts
Part I contains: Personal data.
Part II contains: allergies, blood group, significant health
problems.
Part III contains: other habits such as food, alcoholic,
smoking, any addiction, environmental, exercise, etc.
148. Patient Care Summary
For recording chronological data.
Should record details of visits to OP,IP,ER etc..
Self care or other treatments.
150. Immunizations
Mainly for children and also can be used for adults.
Indicates due dates for other immunizations e.g. 1st dose, 2nd
dose etc..
151. Self-care for medication / treatment
A unique feature of PEHP.
Available only with the PEHP and not found in the
allopathic healthcare organizations.
155. Obstetrics & Gynecology
For women patients from child bearing age onwards.
Periodic Mammography check information is also recorded.
156. Therapy
Different types of therapies such as physical, occupational,
speech, optometric refractions, radio therapy etc. are recorded.
157. Implementing PEHP
People Born prior to implementation
New born records –to be maintained by the care taker
Carry a pen-drive, external hard drives or any other
portable devices on move.
Patient with conditions (heart diseases, diabetes, hypertension) should
carry Alert devices for Emergency.
158. Conclusion…..
EHR at health institution level and PEHP at personal level
to gain complete 360 degree information.
For providing continuity of care to patient, at right time,
at right place and at right cost.
PEHP prevents duplication of investigations,
medications, delay in care, check on risk and cost.
159. Continue………………
Standardizing of PEHP information for continuity of care.
PEHP allows practitioners from different settings and
disciplines to share information.
Allows the patient to carry this information with him or her
upon referral, transfer, or discharge.
160. Normal condition
Update
PEHP Physician
treatment
Disease
state
Self
medication Non allopathic
therapy
161.
162. Effects of PEHP on the Patients
Advantages Disadvantages
Information on the go. Cumbersome for
Ensure Information is maintaining.
accurate and complete. Access to the Computers.
Self medication is updated. Illiteracy.
Different physicians opinion
recorded. Costs him extra.
Careful Security concerns.
Handy in Emergency. Accessing the web in
Quick treatment remote places.
prevents duplication
163. Effects of PEHP for the Physicians
Advantages Disadvantages
Complete Information. Distrust on Information
Quick treatment. viability.
Opinions of other physicians. Doesn’t like to expose his
opinion.
Disease pattern is easy to
understand. Fear of medico-legal issues.
Duplication of records.
Increased workload.
164. Medical record
MR history parallels the history of medicine.
Contains medical information of an individual from
“Womb to Tomb”.
“A clear, concise and accurate history of the patient's life and
illness, written from the health point of view, and is a complete
compilation of scientific data derived from many sources,
coordinated and integrated into an orderly document for
further multifarious uses”.
--Dr G.D Mogli
165. Necessity
Contains patient demographic information, history,
physical examination, progress notes, investigations,
consultations opinions, diagnosis, treatment including
medical, surgical, therapies.
Necessary for various reasons.
Insurance sector
Medico legal cases
&
analysis Also for effective
Patients forget but Records remember"
166. Advantages of EHR
Manual records Electronic records
Inaccessibility, parts of Decentralized,
the records are simultaneous access all
geographically widely the time.
distributed.
Active it can trigger
Passive: unable to certain actions according
trigger certain actions to the data
“Manual” linkage “Increased” linkage
with external health care
Time consuming to providers
explore for clinical or
financial studies Excellent basis to
conduct clinical and
financial studies
168. Problems with EHR
Interoperability
Vendors develop readymade software’s
/ In-house tailor made
to suit only certain
health institutions.
Survey indicates old
people want to follow the
manual records.
These are problems which can be solved by developing
of standards.
169. EHR (Electronic health record)
Refers to an individual patient's longitudinal
medical record in digital format.
Easy to maintain.
Usually accessed on a computer,
often over a network.
Instantly accessible to all authorized from
different stations.
High end gadgets are available for
making the recording easy.
170. Precautions In selecting a PEHP provider
Ensure Security of the records.
Maintain Confidentiality of records.
Ensure Privacy.
Technologically stable and advanced.
Should be Interoperable.
Cost.
Provide long term support.
171. A Wireless Sensor Network based Fall
Detection and Activity Monitoring System
for the Elderly
By
Prof. Subrat Kar, Sanat Sarangi and Akshat Bisht
Bharti School of Telecommunication Technology and
Management, IIT Delhi, India
NCMI 2012, AIIMS
172. Motivation
Prevalent technologies-
Smart Insole, Smart Cane and Smart Headset monitor underfoot
pressure, improper usage behaviour and EEG signals
respectively.
Armbands, waistbands and ankle-bands have been developed
that measure skin temperature, energy spent (calories) and
activity.
Our concern is to not just to create a smart device but a smart space
using a number of such devices – a sensor network.
A sensor network helps communicate events of interest over large
geographic distances without using a legacy network.
173. Sensor Networks
Sensor Nodes:
Low-cost
Resource-constrained
Autonomous
Form a resilient Mesh
Network, hence the
term- Sensor Network
Fault Tolerant
174. Gaitsense
(Gait Assessment System)
Consists of
A sensor network formed by gait nodes and relay nodes.
A multi-tier control and notification system (consisting of a gateway, user application and
DBMS) that talks to Internet and cellular networks.
Gateway acts as an interface between the sensor network and the GUI-based user
application and logs all communication in the DBMS.
User Application provides multi-dimensional visualization capabilities for sensor
events through charts, tables and maps.
User Application runs custom algorithms that take specific actions based on user
requirements and sends appropriate notifications.
175. Gait Node
Consists of a sensor node and an accelerometer.
The Sensor node has a extremely low-power micro-controller and on-board
radio transmission capabilities.
The accelerometer can sense acceleration on upto three axes. Acceleration is
used to recognize gait characteristics.
Gait Node can be conveniently worn at the waist or ankle to detect the state of
the subject- standing, sleeping, walking, running, fallen.
Status of gait node 1 as seen in user application
Gait Node
176. Deployment Scenario
A Geriatric care unit as shown, can
be a possible application scenario
for GaitSense.
The objective is to monitor
residents wearing gait nodes and
auto-notify events such as postural
changes, activity changes or
number of steps taken.
Fixed relay nodes installed at
strategic positions and the gait
nodes form a sensor network that
reliably streams events to the
gateway and user application in the
administrative section.
Services like email, twitter or sms
are used to send notifications.
178. Conclusion
A fall detection and activity monitoring system for the elderly is
proposed and its integration with the public communication
infrastructure is discussed to enable its widespread adoption.
By notifying events like a fall, the system promises to help
reduce human casualties by allowing effective rescue and
remedial operation-planning.
The systematic automated recording of all behavioural aspects
could also provide valuable information to doctors for analysing
medical conditions.
The work done in this paper is supported by DST project titled
“Development of a wireless sensor network based gait
assessment system for fall prediction in elderly patients” vide
sanction ref- SSD/NI/020/2007-TIE dt. 31 Jan, 2008.
179. Thank You
Contact:
Prof. Subrat Kar
Professor, Electrical Engineering & Bharti School of
Telecom, IIT Delhi, Hauz Khas, New Delhi – 110016
Ph: (011) 26591088
Email: subrat@ee.iitd.ac.in
180. MediCall: Hospital Resource System
Based on VistA implemented at
JPNATC, AIIMS
Easily Accessible, Affordable &
Advance Healthcare Solution
GTI Infotel
http://www.gtiinfotel.com
Corporate HQ: A-51 SECTOR 8, NOIDA, UP; Tel: +91-120-427-3656; Fax: 433-7855
181. Table of Contents
Affordable, Accessible & Advance Healthcare for Hospital &
Patients
VistA Implementation & Integration with HIS
Integrated HRS Implementation at JPNATC, AIIMS:
– Block Diagram
– Back ground & Service provided at JPNATC, AIIMS
Integrated HRS: Components
– Hospital Information System:
Registration, ADT, OPD, Stores, Inventory, Display, Equipment management & Utilization, Waiting
times, In-patient Bed status
– CRM:
Patient data, Appointments, Complaints, Information, IPD Data & SMS/Email, Integration with PACS
& other HIS.
– Website:
Real time data of OPD, IPD, Stats, etc. Hospital Info, Faculty Info
Awards received
182. Affordable, Accessible & Advance Healthcare for all
GTI MediCall Hospital Resource System helps in
providing affordable, accessible & advance
healthcare for Patients as well as Hospitals:
– Developed on the most stable healthcare platform
VistA developed over decades of research.
– Accessible over the internet
– Accessible over telephone
– Availability of Patient Data & Healthcare provider at
lower cost
– Available 24x7 over the internet, telephone (Call
Center) & on-site (at the hospital)
183. Healthcare computing:
Mapping industry needs to technology capabilities
There are several reasons why GTI MediCall HRS is
solution to the health industry’s unique blend of
requirements:
It can lead to easier update and higher quality
patient data—a feature especially important in
health care, where fragmented, redundant, and
inconsistent data is rampant today.
SaaS-based electronic medical record (EMR)
solutions area natural fit for small physician
practices to which most physicians belong
because of their affordability, ease of use, and
small requirement for ongoing technical
support.
184. The exoskeleton nature of the cloud makes it relatively
easy to inter-connect disparate systems from different
health organizations, and provide an elastic infrastructure
that can start inexpensively and quickly scale as adoption
increases.
Thus, it provide an ideal architectural alternative for
Health Information Exchanges (HIEs). There are promising
advances across a broad spectrum of patient-facing and
telemedicine/telehealth applications.
There is also growing attention on providing direct,
continuous engagement between patients and providers
through “in the cloud” relationships that include
advanced continuous home and portable monitoring.
Technopak Healthcare, a consulting firm, expects
spending on health care in India to grow from $40 billion
in 2008 to $323 billion in 2023.
Sources: Gartner, Factiva [from Accenture ‘Cloud Computing in Healthcare’ deck, date Feb 19 2010,
185. On the Cloud or
Physically Co-located Solution?
GTI can provide both On the Cloud as well as
Physically Co-located solution for the Hospital.
The Hospital can choose between the two
solutions or a hybrid of both solutions (as
implemented at AIIMS)
Both Systems provide equivalent & optimum
solution for the Hospital.
186. MEDICALL HOSPITAL RESOURCE SYSTEM :
SOLUTION IMPLEMENTED AT JPNATC, AIIMS
(VISTA INTEGRATION)
IN ANOTHER FIRST BY AIIMS, AN INTEGRATED HRS STARTED OPERATIONS FOR
JPN APEX TRAUMA CENTRE, AIIMS
187. Integration & Implementation of VistA &
Development of HIS on top of the VistA Engine
The company specializes in Implementation of
VistA for Hospitals & integration with HIS & PACS
The current system has been Integrated with:
• VistA at the Hospital
• PACS at the Hospital
188. MediCall Hospital Resource System
Services that include
not only call center
for the patients &
doctors but a total
back office support to
the entire hospital.
We integrate with
your existing database
or develop new
software for you to
offer round-the-clock
services.
189. MediCall Hospital Resource System (HRS)
Communication Call Center
Hospital Resource System:
- Website
- Hospital Info System
- Call Center CRM
Hospital Mobile Support
190. Our Solution features:
End-to-end solution with Software, Hardware & Manpower:
The systems & processes are ready & available to be deployed on-site or on the cloud. Hence, providing the right solution
deployable in 2-3 weeks is now possible.
Completely outsourced and scalable:
This frees up valuable real estate at the Hospital besides potentially decreasing the overheads like electricity, parking and
toilets which an on-site facility would use. Being completely scalable, the call centre can quickly ramp up operations in line
with increased demand and in case of disasters.
Professional operations:
The call centre will provide best-in-class service to clients with quality control at every stage and 100% call recording for
auditing and quality purposes.
Patient services:
With the main thrust on improving the quality of patient care, the call centre will manage all appointments and follow-up of
patients. The call centre will also answer queries on all admitted patients and will provide information on all diagnostic &
therapeutic services available, the procedure and pricing of getting a specific service or test done and the approximate wait-
times. Thus the patients may not need to approach anyone physically for information.
Research:
Research is one of the key mandate of AIIMS and the call centre will facilitate research by ensuring follow-up of patients,
administering surveys and ensuring authenticity of data.
Centralized help desk & support:
The call centre will take over the responsibility of logging & initial troubleshooting software & hardware problems helping in
providing professional 24 X 7 support services
Inventory Management & support:
The call centre will act as the single window for all inventory related issues for the Hospital. The call centre can provide
completely audit trail for any breakdown or even and follow up with the vendor and end user to ensure optimal utilization of
resources.
191. MediCallHRS: Hospital Info System Modules (partial listing)
Registra
tion
Inventor
Roster
y Mgmt
Equipm
ent
Billing
Mgmt &
Maint.
Equipm
ent
OPD
Utilizati
HIS on
Surgery
ADT Patient
Waitlist
Real
Call
Time Pt.
Centre
Mvmnt
& CRM
Nursing In- Display
Quality patient
Imp. Bed
Mgmt Status
192. Solution Overview
1 Hospital Info. Benefits
System (HIS)
A ADT Registration - Admission
- Discharge
- Transfer
- Registration
B OPD Out Patient Department Management
- Takes care of all the Waiting lists, Queue management,
Appointments etc.
C Billing Integrated Billing
D Duty Roster Includes duty roster as well as time schedule, leaves, monitoring, etc.
E Laboratory Investigations & reporting on all the Lab findings & integrating with
other modules
F Radiology Supports DICOM for direct access to equipments.
193. 1 Hospital Info. Benefits
System (HIS)
G Registration - Computerized for future access & control
- Maintain database
H Inventory/Stores - Control pilferage
- Know status of each item
- Know movement of each item
- Know low stock details for ordering
- Paperless system
I Equipment - Monitor AMC of all medical equipment
Management & - Less breakdown
Maintenance - No burden on hospital manpower for maintenance issues
J Utilization of - Equipment wise utilization details
Equipment - Know the utility & cost/use of each equipment
K Surgery Waitlist - Transparent & seamless maintenance
- Patients get information from the call center regarding date
L Real-time Patient - Movement of patient recorded
Movement - Realtime info seen by attendants, hence reducing burden on the
Display staff
- Helps patients to know his movements
194. # Functions Benefit
2 CRM integrated - Appointment system for the Doctors & Patients
with VistA & Call - Queue-less OPD
Center - Appointment information on phone/SMS
- Change of appointment by Patient/Doctor now possible
- Patient Information on phone
- Hospital Information available on phone
- Complaint handling & monitoring
- 24x7 availability to patients, attendants, staff
3 Website - Hospital Information on the internet
- Real time appointment & wait-time info to patients
196. Registration
Parameters captured:
– Name, Address, Phone, Symptom, General
ID/Ref. No., custom reports, Diagnosis, Pupil,
Injury & much more
General Registration
Specialty Registration based on Gen. Reg:
– Ortho/Neurosurgery/Surgery
Output:
– Online Reports, Specialized Reports, Admin,
etc.
Logistics:
– Operation Timings: 24x7
– Manpower Required: Minimum 5 for 24x7
operation
– Hardware: PC with 30mins UPS
– Internet Access: Data Card/Broad band
204. Inventory Management System
Inventory of
– Consumables like medicines, tables, powder,
etc.
– Disposables like syringes, gloves, etc.
– Utilities like bed, etc.
– Equipment
– Complete detail including location of the
Inventory
Output:
– Status, Stock levels at wards/stores/etc.,
Indents, etc.
Logistics:
– Different types of Alarms at various predefined
levels
– Operation Timings: 6 days a week (7 hrs x 6
days)
207. Equipment Management & Maintenance module
Assist to monitor the AMC/Warranty
of all medical equipments
Book complaints
Monitor performance of Contractor
under AMC/Warranty
Identify Repeat faults
Take Preventive maintenance
Replacements of active elements in
time
Mandatory calibration of equipment
208.
209. Equipment Utilization
Equipment wise utilization:
– By day
– By week
– By month
Utilization efficiency of:
– Machine
– Operator
Equipment Applied & removal days
Equipment used on which Patient
Breakdown & likely repair time estimation
210.
211. Surgery Patient Waitlist & OT Management
Patients earmarked for surgery
Type of Surgery
Doctor allocated to carry out the surgery
Waitlist in weeks/months
Weekdays for surgery according to its allocation to
individual Doctor
Patients to be informed accordingly on
– Phone/SMS/Email
Admission to Surgery after waitlist
OT Management
217. Real Time Patient Movement Display System
Patient (under treatment) movement display
system
Helps attendant to know movement of
patient undergoing different tests/stages
Displays on 40” LCD monitor include
– Patient Name
– Department
– Process
Helps patients in moving from one test to
another
Specialty Dept does their own data entry &
the same is displayed
Realtime Bed Availability: for the patient &
Doctor alike
222. In-patient Bed Status
Real time bed status / availability of Beds.
Data can be sorted as per
– Ward
– Doctor
– Date
– Department
Criticality of Patient including complete detail
online
Number days stay & much more
223.
224.
225. Nurse Quality Improvement Mgmt
Captures the Error incident detail done by
the Nurse
Helps in monitor Nursing Quality service
Capture Patient Care lapse
Patient wise details are captured
Nurse wise details are captured
226.
227.
228. 2. CRM: Integrated with real-time info for
the call center
Call Center CRM to be deployed at the call center/Cloud to have
following functions:
Patient Information
Appointments
Staff Information/Rosters
Dashboard for Faculty/Doctor
SMS/Email
Reports
Complaints handling & monitoring
Inventory/Stores
Integration with VistA/PACS & other HIS.
234. Appointment Details
# Patient Existing Appointment
Call Status
TC No. Name Disc. Date Resident Dr. Ward Diagnosis Procedure Date Time Exec Rem
DR. MAMRAJ Connected/
1 195719 Akash FEB 1,2010
GUPTA
TC6-15 BTA WITH SPLENIC LACERATION non operative management Feb 6,2010 10:00am Bhavana Ist Call
confirm
LEFT ICD WITH WATER SEAL DRAIN
LEFT A/E GUILLOTINE AMPUTATION
RTC WITH MULTIPLE RIBS # WITH LEFT UNDER BRACHIAL PLEXUS BLOCK ON
DR. AMAR
Shri Ram HEMOTHORAX WITH GANGRENOUS 19/10/2010 DELAYED PRIMARY Connected/
2 193779 JAN 31,2010 NATH TC6-01
LEFT FEOREARM CLOSURE OF LEFT A/E AMPUTATION
Feb 6,2010 10:10am Bhavana Ist Call
Naresh MUKERJI confirm
STUMP UNDER GA ON 25/1/2010
EXPLORATORY LAPAROTOMY, ILEAL
DR. ANURAG RTA WITH BTA AND ILEAL TRANSECTION EXTERIORIZED AS
3 195089 Pramod JAN 31,2010
GUPTA
TC6-19
TRANSECTION DOUBLE BARREL ILEOSTOMY,
Feb 6,2010 10:20am Bhavana Wr Number Ist Call
PERITONEAL LAVAGE AND CLOSURE
BLUNT TRAUMA ABDOMEN WITH
DR. ANURAG EXP. LAP. & PERITONEAL LAVAGE WITH Connected/
4 192915 Satpal JAN 11,2010
GUPTA
TC6-18 HEMO. & PNEUMOPERITONEUM WITH
DRAINAGE.
Feb 6,2010 10:30am Bhavana IInd Call
LIVER LACERATION confirm
235. Dashboard for the Faculty displaying Faculty’s
Appointments, Patients, Stats, Roster ,etc.