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Health IT for Executives
1) The document discusses a presentation on health IT for executives given at the Royal Thai Navy Medical Department's fiscal year 2016 budget training course for medical administration. 2) The presentation was given by Dr. Nawanan Theera-Ampornpunt, who has medical and health informatics degrees from Ramathibodi Hospital and the University of Minnesota. 3) The presentation covers why health IT is needed in healthcare, examples of health IT tools and their uses, and how to manage IT in healthcare organizations by balancing people, processes and technology.
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Health IT for Executives
- 1. Health IT forExecutives บรรยายในหลักสูตรฝึกอบรมการบริหารงานสายแพทย์ทหาร ประจาปีงบประมาณ 2559 ของกรมแพทย์ทหารเรือ July 27, 2016 Nawanan Theera-Ampornpunt, M.D., Ph.D. www.SlideShare.net/Nawanan
- 2. 2 2003 M.D. (1st-ClassHonors) Ramathibodi 2009 M.S. (Health Informatics) University of Minnesota 2011 Ph.D. (Health Informatics) University of Minnesota Currently Faculty of Medicine Ramathibodi Hospital • Instructor, Department of Community Medicine Contacts nawanan.the@mahidol.ac.th SlideShare.net/Nawanan www.tc.umn.edu/~theer002 Facebook.com/InformaticsRound Introduction
- 3. 3 Outline Morning Health ITfor Executives Afternoon IT Management in Healthcare Organizations
- 4. 4 Outline Why: Health &Health Information What: Health IT (e.g. in Hospitals) How: Hospital IT Management
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- 6. 6 Let’s take alook at these pictures...
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- 9. 9ER - ImageSource: nj.com Healthcare (on TV)
- 10. 10 (At an undisclosednearby hospital) Healthcare (Reality)
- 11. 11 • Life-or-Death • Difficultto automate human decisions – Nature of business – Many & varied stakeholders – Evolving standards of care • Fragmented, poorly-coordinated systems • Large, ever-growing & changing body of knowledge • High volume, low resources, little time Why Healthcare Isn’t Like Any Others
- 12. 12 Input Process Output Transfer Banking Value-Add -Security - Convenience - Customer Service Location A Location B But...Are We That Different?
- 13. 13 Input Process Output Assembling Manufacturing Raw Materials Finished Goods Value-Add -Innovation - Design - QC But...Are We That Different?
- 14. 14 Input Process Output PatientCare Health care Sick Patient Well Patient Value-Add - Technology & medications - Clinical knowledge & skills - Quality of care; process improvement - Information But...Are We That Different?
- 15. 15 • Large variations& contextual dependence Input Process Output Patient Presentation Decision- Making Biological Responses Recognizing Variations in Health Care
- 16. 16 “To Computerize” “To Gopaperless” “Digital Hospital” “To Have EMRs” Why Adopting Health IT?
- 17. 17 • “Don’t implementtechnology just for technology’s sake.” • “Don’t make use of excellent technology. Make excellent use of technology.” (Tangwongsan, Supachai. Personal communication, 2005.) • “Health care IT is not a panacea for all that ails medicine.” (Hersh, 2004) Some Quotes
- 18. 18 Management Point #1: StopYour “Drooling Reflex”!!
- 19. 19 Management Point #2: Focuson Information & Process Improvement, Not Technology
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- 21. 21 To treat &to care for their patients to their best abilities Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen) What Clinicians Want? given limited time & resources
- 22. 22 • Safe • Timely •Effective • Patient-Centered • Efficient • Equitable Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. 337 p. High Quality Care
- 23. 23 Information is Everywherein Healthcare
- 24. 24 “Information” in Medicine ShortliffeEH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
- 25. 25 25 WHO (2009) Components ofHealth Systems
- 26. 26 26 WHO (2009) WHO HealthSystem Framework
- 27. 27 • Safe – Drugallergies – Medication Reconciliation • Timely – Complete information at point of care • Effective – Better clinical decision-making Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/ Achieving Quality Care with Information & ICT
- 28. 28 • Efficient – Fastercare – Time & cost savings – Reducing unnecessary tests • Equitable – Access to providers & knowledge • Patient-Centered – Empowerment & better self-care Achieving Quality Care with Information & ICT
- 29. 29 (IOM, 2001)(IOM, 2000)(IOM, 2011) Landmark IOM Reports
- 30. 30 • To Erris Human (IOM, 2000) reported that: – 44,000 to 98,000 people die in U.S. hospitals each year as a result of preventable medical mistakes – Mistakes cost U.S. hospitals $17 billion to $29 billion yearly – Individual errors are not the main problem – Faulty systems, processes, and other conditions lead to preventable errors Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d Patient Safety
- 31. 31 • Humans arenot perfect and are bound to make errors • Highlight problems in U.S. health care system that systematically contributes to medical errors and poor quality • Recommends reform • Health IT plays a role in improving patient safety IOM Reports Summary
- 32. 32 Image Source: (Left)http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/ (Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg To Err is Human 1: Attention
- 33. 33Image Source: SuthanSrisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital To Err is Human 2: Memory
- 34. 34 • Cognitive Errors- Example: Decoy Pricing The Economist Purchase Options • Economist.com subscription $59 • Print subscription $125 • Print & web subscription $125 Ariely (2008) 16 0 84 The Economist Purchase Options • Economist.com subscription $59 • Print & web subscription $125 68 32 # of People # of People To Err is Human 3: Cognition
- 35. 35 • It alreadyhappens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013) What If This Happens in Healthcare?
- 36. 36 Klein JG. Fivepitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781-3. “Everyone makes mistakes. But our reliance on cognitive processes prone to bias makes treatment errors more likely than we think” Cognitive Biases in Healthcare
- 37. 37 • Medication Errors –DrugAllergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
- 38. 38 Management Point #3: “ToErr is Human”
- 39. 39 External Memory Knowledge Data LongTerm Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Elson, Faughnan & Connelly (1997) Clinical Decision Making & Clinical Decision Support Systems (CDS)
- 40. 40 Example of “Alerts& Reminders” Reducing Errors through “Alerts & Reminders” (A Form of Clinical Decision Support System)
- 41. 41 Why We NeedICT in Healthcare? #1: Because information is everywhere in healthcare
- 42. 42 Why We NeedICT in Healthcare? #2: Because healthcare is error-prone and technology can help
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- 44. 44 Why We NeedICT in Healthcare? #3: Because access to high-quality patient information improves care
- 45. 45 Why We NeedICT in Healthcare? #4: Because healthcare at all levels is fragmented & in need of process improvement
- 46. 46 • Guideline adherence •Better documentation • Practitioner decision making or process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder Documented Values of Health IT
- 47. 47 Management Point #4: LinkIT Values to Quality (Including Safety)
- 48. 48 Outline Why: Health &Health Information What: Health IT in Hospitals How: Hospital IT Management
- 49. 49 Use of informationand communications technology (ICT) in health & healthcare settings Source: The Health Resources and Services Administration, Department of Health and Human Service, USA Slide adapted from: Dr. Boonchai Kijsanayotin Health IT
- 50. 50 Use of informationand communications technology (ICT) for health; Including • Treating patients • Conducting research • Educating the health workforce • Tracking diseases • Monitoring public health. Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe) 2) World Health Assembly, 2005. Resolution WHA58.28 Slide adapted from: Mark Landry, WHO WPRO & Dr. Boonchai Kijsanayotin eHealth
- 51. 51 eHealth HealthIT Slide adapted from: Dr. Boonchai Kijsanayotin eHealth & Health IT
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- 53. 53 Hospital Information System(HIS) Computerized Physician Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS) Various Forms of Health IT
- 54. 54 m-Health Health Information Exchange (HIE) Biosurveillance InformationRetrieval Telemedicine & Telehealth Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc. Personal Health Records (PHRs) Health IT Beyond Hospitals
- 55. 55 Ordering Transcription DispensingAdministration CPOE Automatic Medication Dispensing Electronic Medication Administration Records (e-MAR) Barcoded Medication Administration Barcoded Medication Dispensing Health IT for Medication Safety
- 56. 56 Hospital A HospitalB Clinic C Government Lab Patient at Home Health Information Exchange
- 57. 57 My Life’s Storyand the Journey on My Purpose in Life
- 58. 58WHO & ITU AchievingHealth Information Exchange (HIE)
- 59. 59 • The LargeN Problem N = 2, Interface = 1 # Interfaces = N(N-1)/2 N = 3, Interface = 3 N = 5, Interface = 10 N = 100, Interface = 4,950 Standards: Why?
- 60. 60 นวนรรน ธีระอัมพรพันธุ์. ตำนำนควำมเชื่อและข้อเท็จจริงเกี่ยวกับมำตรฐำนสำรสนเทศทำงสุขภำพ.ใน: Health Data Standards Expo: From Reimbursement to Clinical Excellence; 2011 Aug 8-9; Bangkok, Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2011 Aug. http://www.slideshare.net/nawanan/myths-and-truths-on-health-information-standards Myths & Truths on Standards
- 61. 61 Myths • We don’tneed standards • Standards are IT people’s jobs • We should exclude vendors from this • We need the same software to share data • We need to always adopt international standards • We need to always use local standards Theera-Ampornpunt (2011) Myths & Truths on Standards
- 62. 62 Management Point #5: Gofor Systems that Use Standards, Not a Unified, Conquer-the-World System
- 63. 63 Outline Why: Health &Health Information What:Health IT in Hospitals How: Hospital IT Management
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- 65. 65Image Source: englishmoviez.com Riseof the Machines?
- 66. 66 • CDSS asa replacement or supplement of clinicians? – The demise of the “Greek Oracle” model (Miller & Masarie, 1990) The “Greek Oracle” Model The “Fundamental Theorem” Model Friedman (2009) Wrong Assumption Correct Assumption Clinical Decision Support Systems
- 67. 67 Management Point #6: Don’tReplace Human Users. Use ICT to Help Them Perform Better.
- 68. 68 Some Risks ofClinical Decision Support Systems • Alert Fatigue Unintended Consequences of Health IT
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- 70. 70 Management Point #7: HealthIT Also Have Risks & Unintended Consequences
- 71. 71 Balanced Focus ofInformatics Technology ProcessPeople
- 72. 72 Management Point #8: BalanceYour Focus (People, Process, Technology)
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- 74. 74The sailboat imagesource: Uwe Kils via http://en.wikipedia.org/wiki/Sailing The destination The boat The sailor(s) & people on board The tailwind The headwind The direction The speed The past journey The sea The sail The current location IT & Organizational Context
- 75. 75 Management Point #9: KnowYour Context & Align IT with Context
- 76. 76 รพ.มหาวิทยาลัย 900 เตียง Visionเป็นโรงพยำบำลชั้นนำของ ภูมิภำคเอเชียที่มีควำมเป็นเลิศใน ด้ำนบริกำร กำรศึกษำ และวิจัย รพ.เอกชน 200 เตียง Vision เป็นโรงพยำบำล High Tech High Touch ชั้นนำของประเทศ Direction & Destination
- 77. 77 “The Sail” Carr (2004)Carr (2003) IT as “The Sail”
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- 79. 79 Resources/ capabilities Valuable ? Non-Substitutable? Rare ? Inimitable? No Competitive Disadvantage Yes No Competitive necessity No Competitive parity Yes Yes No Preemptive advantage Yes Sustainable competitive advantage From a teaching slide by Nelson F. Granados, 2006 at University of Minnesota Carlson School of Management IT as a Strategic Advantage
- 80. 80 รพ.มหาวิทยาลัย 900 เตียง Visionเป็นโรงพยำบำลชั้นนำของ ภูมิภำคเอเชียที่มีควำมเป็นเลิศใน ด้ำนบริกำร กำรศึกษำ และวิจัย Current IT Environment – เป็น รพ.แรกๆ ที่มี HIS ซึ่งพัฒนำเอง และ ต่อยอดจำก MPI, ADT ไปสู่ CPOE (แต่ยัง ขำด advanced CDSS) ระบบ HIS เข้ำกับ workflow ของ รพ. เป็นอย่ำงดี – ปัจจุบัน ระบบ HIS ยังใช้เทคโนโลยี เดียวกับช่วงที่พัฒนำใหม่ๆ (20 ปีก่อน) เป็นหลัก มีกำรนำเทคโนโลยีใหม่ๆ มำใช้ อย่ำงช้ำๆ รพ.เอกชน 200 เตียง Vision เป็นโรงพยำบำล High Tech High Touch ชั้นนำของประเทศ Current IT Environment • มี MPI, ADT, EHRs, CPOE แต่ยังมี CDSS จำกัด • ยังไม่มี Customer Relationship Management (CRM) • ยังไม่มี Personal Health Records (PHRs) IT as “The Sail”
- 81. 81 Management Point #10: IdentifyYour Strategic IT Assets
- 82. 82 Does service offer competitiveadvantage? Is external delivery reliable and lower cost? Keep Internal Keep Internal OUTSOURCE! Yes No Yes No IT Outsourcing Decision Tree
- 83. 83 Does service offer competitiveadvantage? Is external delivery reliable and lower cost? Keep Internal Keep Internal OUTSOURCE! Yes No Yes No Core HIS, CPOE Strategic advantages • Agility due to local workflow accommodations • Secondary data utilization (research, QI) • Roadmap to national leader in informatics External delivery unreliable • Non-Core HIS External delivery higher cost • ERP maintenance/ongoing customization ERP initial implementation, PACS, RIS, Departmental systems, IT Training IT Outsourcing: Ramathibodi’s Case
- 84. 84 Management Point #11: KnowWhen To and When Not To Outsource
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- 86. 86 รพ.มหาวิทยาลัย 900 เตียง •บุคลำกรมีอำยุเฉลี่ย 42 ปี (range 20-65) • แผนก IT มีทั้งบุคลำกรใหม่และที่เคย พัฒนำระบบ HIS ตั้งแต่แรกเริ่ม • แพทย์มีควำมเป็นตัวของตัวเองสูง, มักทำงำนเอกชนด้วย, มี turn-over rate สูง • พยำบำลและวิชำชีพอื่นมักมองว่ำ แพทย์คืออภิสิทธิ์ชน และมีเรื่อง ถกเถียงกันบ่อยๆ รพ.เอกชน 200 เตียง • บุคลำกรมีอำยุเฉลี่ย 32 ปี (range 20-57) • แผนก IT เข้มแข็ง • แพทย์ไม่ค่อยมี interaction กับ บุคลำกรอื่น, รำยได้เป็นแรงดึงดูดหลัก • ผู้บริหำรได้รับกำรยอมรับจำกบุคลำกร ทุกวิชำชีพว่ำมีวิสัยทัศน์และ บริหำรงำนได้ดี “The Sailors"
- 87. 87Ash et al.(2003) The “Special People"
- 88. 88Ash et al.(2003) • Administrative Leadership Level – CEO • Provides top level support and vision • Holds steadfast • Connects with the staff • Listens • Champions – CIO • Selects champions • Gains support • Possesses vision • Maintains a thick skin – CMIO • Interprets • Possesses vision • Maintains a thick skin • Influences peers • Supports the clinical support staff • Champions The “Special People"
- 89. 89Ash et al.(2003) • Clinical Leadership Level – Champions • Necessary • Hold steadfast • Influence peers • Understand other physicians – Opinion leaders • Provide a balanced view • Influence peers – Curmudgeons • “Skeptic who is usually quite vocal in his or her disdain of the system” • Provide feedback • Furnish leadership – Clinical advisory committees • Solve problems • Connect units The “Special People"
- 90. 90Ash et al.(2003) • Bridger/Support level – Trainers & support team • Necessary • Provide help at the elbow • Make changes • Provide training • Test the systems – Skills • Possess clinical backgrounds • Gain skills on the job • Show patience, tenacity, and assertiveness The “Special People"
- 91. 91 Management Point #12: ManageYour “Special People” Well
- 92. 92 A True Storyof Failure to Involve Users in Hospital IT Implementation
- 93. 93 Management Point #13: InvolveUsers Early & Intensively in Your Process
- 94. 94 Image source: JeremyKemp via http://en.wikipedia.org/wiki/Hype_cycle http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp Gartner Hype Cycle
- 95. 95 Rogers (2003) Rogers’ Diffusionof Innovations: Adoption Curve
- 96. 96 Management Point #14: InfluenceYour People’s Behaviors through Managing their Expectations & Attitudes
- 97. 97 • Communications ofproject plans & progresses • Workflow considerations • Management support of IT projects • Common visions • Shared commitment • Multidisciplinary user involvement • Project management • Training • Innovativeness • Organizational learning Theera-Ampornpunt (2009, 2011) Success Factors of Hospital IT Adoption
- 98. 98 Lorenzi & Riley (2004) Leviss(Editor) (2010) Resources on Change Management
- 99. 99 • Healthcare iscomplex • Health IT can benefit healthcare through – Information delivery – Process improvement – Empowering providers & patients • The world is moving toward health IT • Management of hospital IT is crucial to success – Balance of “People, Process & Technology” – Know your organization (“context”) – Strategic mindset – Project & change management Summary
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