as presented at TMAB eHealth Congress 2010

1. Can IT systems help to manage the
quality of
health care delivery
?
25 november 2010
Jan De Sitter
CIO at GZA
1

2. Introduction
• GZA: « Gasthuis Zusters Antwerpen »
• 3 sites 1033 beds
• Sint-Augustinus Wilrijk
• Sint-Vincentius Antwerpen
• Sint-Jozef Mortsel
• Tradition of IT-support for care processes
• Since 1990 : « Patient care systems » (PCS)
• Order communication
• Nursing records (activities planning and result reporting)
• Medication
• Since 1996 : Medical records (C2M)  Patientrecord
• Resultserver
• Reportgenerator
• Support of Paramedic activity
• Structured elements in the EPR
• Since 2000 : Clinical pathways
• Built on PCS technology
• Introduction of online decision support
• Second generation of systems in development and/or implementation
phase
2

3. The care process
Quality definition from the Institute of Medicine
‘the degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and
are consistent with current professional knowledge’
Quality care should be
• Result driven
• Based on well defined processes
• Measurable (indicators)
3

4. Drivers for quality care
• Multidisciplinarity, multiprofessionalism
• Need to share information
• Fast and accurate communications
Shared patient record,
Convergence of medical record, nursing record…
• Intensity of care
• Growing number of actors
• Shorter delivery times
Need for efficient planning systems (order communications)
• Process management
• Evidence based Care and Medicine
• General procedures should be instantiated for the individual patient
Care Pathways (incl indicators)
4

5. Drivers for quality care (2)
• Continuum of care
• Need to share information with actors outside the hospital
• Need to share processes
Role for eHealth ?
Sharing GMD between actors
Building shared records around disease management ?
• Patient safety
• Key element in quality of care
Introducing closed loops in EPD (e.g. medication administration,
hemovigilance…)
Structured content in EPD (e.g. structured protocols)
Decision support (e.g. interactions, realtime checks)
5

6. HIMMS EMR adoption model
US EMR Adoption ModelSM
2010 2010
Stage Cumulative Capabilities
Q1 Q2
Complete EMR; CCD transactions to share data; Data warehousing; Data
Stage 7 0.7% 0.8%
continuity with ED, ambulatory, OP
Physician documentation (structured templates), full CDSS (variance &
Stage 6 1.8% 2.6%
compliance), full R-PACS
Stage 5 Closed loop medication administration 5.0% 3.2%
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 7.7% 9.7%
Nursing/clinical documentation (flow sheets), CDSS (error checking),
Stage 3 50.0% 50.2%
PACS available outside Radiology
CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging;
Stage 2 16.5% 15.5%
HIE capable
Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.9% 6.8%
Stage 0 All Three Ancillaries Not Installed 11.4% 11.2%
Data from HIMSS AnalyticsTM Database © 2010 N = 5,223 N = 5,217
6

7. Generic Care process
• Assessment : systematic collection of information
• Diagnosis: analysis of information and decision
• Planning: time – task: => organisation of the process
around the patient
• EBM-N
• Patient characteristics
• Documentation
• Evaluation
7

8. Planning
• Activities of professionals:
• Nurses
• Physicians
• Pharmacy
• Paramedics
• Integrate
• Activities of diagnostic and therapeutic services : radiology ,
lab..
• Nursing care activities
• Medication
• Support
• Development of individual careplan starting from the generic
plan
8
• Based on evidence based guidelines

9. Document
• Activities
• Performed , changed, or not performed?
• Why not?
• Results
• Document different parameters
• Documentation is coded
• Makes “Rule based decision support” possible
• Facilitates Analysis and evaluation
9

10. Care portal : integrates patients
and tasks

11. Medical Record

12. Medication

13. Nursing

14. Nursing : charting

15. Orders

16. Care Pathways

17. Care Pathways

18. Added value from ICT
• Steering from information and processes
• Between services (intra-extramural)
• Between professionals (intra-extramural )
• Delivery of structured instruments(intra-extramural)
• To organise and evaluate care delivery
• Operationalize standards and procedures
• EB care through algoritms ( decision trees)
• Structured set of acts and instruments
• Measurement systems
• Feed-back
• Development of indicators
18

19. Performance indicators:
Clinical indicator POBC Financial indicator
Pain score LOS Kp POBC 2002-2009
1e sem '09 (169 ptn)-'08 (145) -'07 (166 ptn )
-'04 (122ptn) 9,0
8,0
10 7,0
6,0
Gem LOS
8
5,0
Gem. verb
Pain value
2009 4,0
6
2008
3,0
2007
4 2004 2,0
1,0
2
0,0
2002 2003 2004 2005 2006 2007 2008 2009
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Year
day post op (day 0 = surgery)
Procesindicator
Proportion staging pre- or post surgery
1e sem 2002-2009
100%
% Investigations
90%
80%
70%
60%
50%
Pre-op
40% post op
30%
20%
10%
0%
2002 2003 2004 2005 2006 2007 2008 2009
Year
19

20. Questions ?