Productivity tools in healthcare IT systems (HIS & LIMS), their relation with patient care and developing objectivity in clinical management

DR CHIRANTAN BOSE MDVICE PRESIDENT – CLINICAL AFFAIRS

MEDGENOME LABS, BANGALORENARAYANA HEALTH CITY

The Concept

The present scenario

The Challenges

The Solution

The Concept framework

Data entry into

EMR/LIMSMatrices /

objective evidence of given clinical

scenarios

Meta-Analysis

Change to management /

preventive measures

Clinical process flow

Modification in patient management

Predicting care management outcomes

Financial oversight and planning

The present scenario

Researchers at the University of California at Davis studied how an EMR implementation at six primary care offices affiliated with the same academic medical center affected physician productivity levels. They found that after an initial dip in productivity during the training period -- which is normal -- internists were able to increase productivity above pre-EMR rates

Experts stress that implementation is an ongoing process. Because health care takes place in a continually changing environment, the processes used by physicians to navigate that environment must adapt.

CLINICAL SCENARIOS - SHIFTING FROM SUBJECTIVITY TO OBJECTIVITY

• EHR use by office-based physicians rose from 18% in 2001 to 48% in 2009, and finally to 78% in 2013. (Source: CDC) • Roughly 60% of physicians say they are satisfied with their EHR system.

(Source: Deloitte)• Use of EHR is associated with significantly higher quality of care for breast

cancer screening, Chlamydia screening, colorectal screening, and diabetes testing for hemoglobin. (Source: Journal of General Internal Medicine)• 67% of physicians report EMRs save them time through e-prescribing, and

that EMRs improve care coordination due to interoperability. (Source: Deloitte)

Proportion of electronic medical record (EMR) use and proportion of solo practitioners by specialty type. Proportion of solo practitioners by specialty was determined by the number of physicians who reported being in solo practice to the National Ambulatory Medical Care Survey.

J Am Med Inform Assoc. 2013 Jun; 20(e1): e33–e38.

Cumulative frequencies of electronic medical record (EMR) use among 14 different medical specialties from 2003 to 2010. Percentages represent unadjusted frequencies and represent both part and full EMR use combined. p<0.0001 for the difference between 2003 and 2010 frequencies in all specialties listed. The oncology stratum was not sampled in 2003.

Proportion of electronic medical record (EMR) use by practice ownership.

The Challenges

• 37% of physicians see EHR as their number one challenge; tied with financial issues as their primary concerns. (Source: Hello Health)• 30% of doctors think EHR implantation would hurt practice finances due to higher

costs and overhead or productivity decreases. (Source: Hello Health)• 51% of physicians who say financial issues are their primary concern felt

implementing an EHR would help. (Source: Hello Health) • 54% of physicians are not happy with their EHRs’ interactivity. (Source: Fierce EMR) [Note : The survey also found that the brands used by the largest percentage of respondents are EPIC (22 percent), Allscripts (10 percent) and Cerner (9 percent). However, the top ranked ones were Amazing Charts, Practice Fusion, VA-CPRS, Medent and e-MDs.]

Summarising the challenges• A single patient – multiple doctors – multiple hospitals/clinics –

multiple labs – multiple medication• Information in different formats – harmonisation issue !• Longitudinal tracking is difficult• Different patients – similar clinical factors – similar scenarios and

outcomes – difficult to be clubbed a trend

The Solution

Longitudinal data becomes simple to interpret• Mr A has been suffering from Chronic perennial bronchitis which has been associated with

fluctuant eosinophil counts of 10 – 20% and IgE levels of 150 – 300 since 2003. Drainage procedures were performed on frontal sinusitis. There have been peaks of deterioration during winter months. Preventive measures instituted, Vit D measurement and prophylaxis.

Dec-01 Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03 Apr-03 May-030

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100

150

200

250

300

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400

Selected parameters

Eosinophil IgE Vit D

Each medical centre is different and has different workflows• Understanding of the given organisational pattern:• How they work / What’s their modus operandi ?• What are they looking to achieve (eg reduced hosp stay; cost effective care;

work as a referring centre)• What do the leaders wish to monitor?• How much time do they invest in each workstation ?• What are their pain points ?• Where is paper used ?• Where do communication gaps exist (eg lab and supply chain; ER and lab;

registration desk and report dispatch desk)

Some examples of a favourable framework of a healthcare IT system :• User can customise the interface on a need based fashion (eg

dropdown selection of symptoms or progression notes)• User can select parameters of MIS (eg time of patient registration Vs

volume of lab tests ordered vs clinical consultation duration)

55

1023

48

No of OP reg

8 am - 11 am 11 am - 2 pm2 pm - 5 pm 5 pm - 8 pm

42

35

23

20

No of lab orders

8 am - 11 am 11 am - 2 pm2 pm - 5 pm 5 pm - 8 pm

14

1625

8

per clinician per consul-tation duration (min)

8 am - 11 am 11 am - 2 pm2 pm - 5 pm 5 pm - 8 pm

• Singular user logins – swipe card / biometric• Ease of patient data retrieval through variable search options• Categorisation on equipment eg within lab – interface of all data (eg

patient/sample records, scatter plots, photomicrographs, quality control, references, reflex work-ups

IBM Health’s data combined with Truven’s patient records will create an enormous big-data collection representing 300 million patient lives

IBM said that, post-acquisition, it will have one of the world’s largest and most diverse collections of health data within IBM Watson Health. Watson Health currently delivers these cloud-based services:• Analysis of data;• Interpretation of complex questions; and• Evidence-based answers to doctors, research, insurers, and others.

“Truven contributes vital payment information on patients. And payment records include detailed coding on disease types, diagnosis, drugs prescribed, and clues to outcomes if, say, a patient does not respond to one treatment and is given another. It’s a very key cog to give us one of the most complete data sets on patients and healthcare in the world.” said John Kelly, PhD IBM’s Senior Vice President of Cognitive Solutions and IBM Research in a New York Times article

Major Lab related – Operational challenges• Monitoring Return on Investments• Inventory Management –

• on-board inventory, productive consumption, QA consumption, wastage, repeats• Off-board instrument side ; off-board central inventory

• Laboratory personnel behavioural aspects :• Possessiveness towards assets• Non-resilience towards new practice adherence• Continued compliance issues

• Deficit of tools to provide clinical trends pertaining to individual patients or trends pertaining to disease segments or trends pertaining to interpretational results• Deficit of tools to visualise multi-lab location productivity

How much/ where/ commercials/ trend

Metrics of Productivity & EfficiencyHeirarchial interest

Measuring tools / Indicators

Activity Involved

Corporate management

Return on Investment / Gross turnovers

Investment / Capital / Networking

Lab / Dept Management

P&L; Overall performance indicators eg TAT

Resource management ; Scientific /clinical oversight

Technical workforce (Supervisory staff)

QA data, Instrument data, Specimen data, patient records

Analytical workflow management

Bench staff Generation of data Specimen management

Incr

easin

g fo

cus o

n Pr

oduc

tivity

Increasing focus on Efficiency

Solutions• Create user interface templates by importing word doc forms• Import test related or patient information from excel/pdf/jpeg etc• Realtime access to SOPs• Unified technology platforms (eg Specimen mgt systems/LIMS + inventory mgt

system + interfaces + billing + document control system + mobility system)• Integration between clinical / lab sub specialities• Customization of rules by end user (eg shoot an email of sub-adequate

specimen qty to client) without vendor involvement• Enable mobile accessibility • Customisable BI tools

Thanks

Questions