HOW TO MEASURE OUTCOME IN HEALTHCARE, AND HOW HEALTH ICT

HOW TO MEASURE OUTCOME IN HEALTHCARE, AND HOW HEALTH ICT CONTRIBUTES

PRINCIPAL ADVANTAGES OF AN EPR

Pr. Philippe KOLH, MD, PhDCIO CHU of Liège

SPEECH OUTLINE

1. Introduction2. EPR project in CHU of Liège3. Investments4. Principal advantages of the EPR5. Conclusions

1. INTRODUCTION

INTRODUCTION

INTRODUCTION

University Hospital of Liège:• Academic hospital• 895 beds• Based on 7 sites, 3 of which are hospitalizations

INTRODUCTION

• May 2003: First Institutional Strategic Plan :– Implementation based on 22 institutional projects, – 4 key work areas:

• Performance of clinical activities• Patient care• Organizational aspects (procedures, competences and motivation)• Financial aspects

Impact on IT: Implementing:

- Institutional software applications- Efficient IT infrastructure- Information mobility for quality of care

EPR is one of the keyinstitutional projects

INTRODUCTION

• September 2014: Second Institutional Strategic Plan :– Implementation based on 32 institutional projects

• Patient‐centered• Efficiency and operational performance• Enhanced supply• Deepened academic dimensions• Involvement of hospital workers

New IT projects and finalizationof ongoing projects, including EPR project

2. THE 6 PARTS OF EPR PROJECT

Implementation planified in 6 parts:– Part 1: Results server (clinical biology, medical imaging, nuclear medicine

and pathology) deployment completed– Part 2: Medical record deployment completed– Part 3 : Resources management with

• Part 3a: management of multi‐sites patient appointments deployment completed• Part 3b: management of beds in real time deployment completed

– Part 4: Drug order and administration deployment in progress (424 beds covered)

– Part 5:Order of clinical biology and medico‐technical examinations– Part 6: Care management

• Part 6 a: nursing record deployment in progress (754 beds, 16 chairs covered)• Part 6 b: paramedical record deployment completed• Part 6 c : meal management deployment planned

THE 6 PARTS OF EPR PROJECT

In parallel of EPR, and in order to support implementation, establishment of:

1. « Paperless » work mode :1. in collaboration with medical archives : scanning documents still produced in paper form)2. Integration of medical devices to EPR

2. « Wireless » in care units

2004 2005 2006 2007 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 20171 – resultsserver sept. oct.2 – medicalrecord jan. march3a – patient appointments oct. june3b – bedsmanagement déc. march

4 ‐ Drugs feb. july5 – clinicalbiology and medico‐technicalexaminationsorders nov. July Dec.6a – nursingrecord april feb.6b –paramedicalrecord sept. june6c –mealmanagement June Feb.

PLANIFICATION

• EPR completeness of coverage and specialized functions (ophtalmology, prescriptions, oncology …)

• Flow optimization (eg. Emergency)• Care paths and clinical routes (holistically and multi‐stakeholders)

• Tools to support medical decision• Linguistic research tools• Integration with billing• Making appointements by Internet• Bring your own device in the hospital• Telecollaborations or data exchange with external care providers

• Telemedecine• Collaborations with other hospitals

EVOLUTIONS OR BEYOND EPR PROJECT

3. INVESTMENTS

Financial commitment to the project

EPR Budget 2012: 5% of investment planEPR Budget 2013: 4% of investment planEPR Budget 2014: 4% of investment planBudget consumed between 2004 and 2013: 10.313.952,03 €

0 €

500.000 €

1.000.000 €

1.500.000 €

2.000.000 €

2.500.000 €

Budget consumed

consommé

Poly. (consommé)

97,7 % of total budget

4. PRINCIPAL ADVANTAGESOF EPR

PRINCIPAL ADVANTAGES OF THE EPR

1. Integration and transmission of information in patient records are facilitated by:

• Integration of the information: – Patient records can be accessed quickly (large number of workstations =

numerous access points)– Protocol help tools: protocol models, voice recognition, state progress and

follow‐up tools for the secretaries ...• Transmission of the information between internal players – multi‐

site context:– Single, horizontal patient record (used by all medical disciplines)– Accessible from outside by the institution’s physicians (Citrix portal)– Possible request for an opinion to a colleague without moving – Patient appointments facilitated

Barcode tube label

ASSOCIATION

=

SAFETY

Patient wristband

with barcode

Eg. Cross‐matching in sample management Security improved

Blood products administration

IT solution for data scanning at the bedside with mobile device (cross matching blood bag/patient identity)

Security improved


2. Integration and transmission of information in patient records are facilitated by:

• Transmission of the information outside : – Protocols sent to the GP via secure messaging– Possibility of integration into an information exchange system (eg. Réseau

Santé Wallon, www.RSW.be )– Telecollaborations (exemple : remotely, several people, on the same

data/image)

2. Quality of the patient record and performance• RHM (minimum hospital summary) entered = RCM

(min. clinical summary), DI‐RHM (nursing record‐min. hospital summary), ADT data, staff data, administrative data ... a high level of coherence required between all these data

• Advantages for DI‐RHM: structure in episodes of care, created on the basis of bed management; Electronic Nursing Record and automatic extractions …


2. Quality of the patient record and performance


Finalisation of deploymentMedical record (March 2007)

Number of « justified beds »

Justifiedbeds

A single, global, easy‐to‐access patient record, is likely contributing to the hospital’s performance: justified activity

2. Quality of the patient record and performance


A single, global, easy‐to‐access medical record is likely contributing to the hospital’s performance: decrease in average length of hospital stays

Finalisation of deploymentMedical record (March 2007)

Average hospital stays observed, over all locationsAverage hospital stays observed, over all University hospital locations

Average length of hospital stays

3. Information management

Transition from a word processing system to a structured data entry system:

horizontal search for information in the patient’s record

use of the data


Eg. Hospital statistics Mother ‐ Child

3. Information management


4.Structuring ‐ harmonisation of departmental procedures

• Multi‐site harmonisation• Use of standard protocols (models of multiple choice surgery protocols, list of treatments, shared order forms)

• Systematisation of data entry• Use dependent on training


5. Global view on patient care• Patient’s “history”: clinics, hospitalizations, technical interventions, surgery protocols, medication, nursing, …

• Possibility of isolating some information (medical history, allergies, etc.)• Electronic patient record organised in a precise way, common to each department Filing of events in the records of all hospitalised patients checked every day.

• Visibility of the list of exam requests and those performed• View of scheduled appointments (past and future)


Assigning an appointment

transmission to medical file software

Eg. Medical Imaging order and appointments management visible in EPR

Appointmentsvisibility in the medical file

PRE = Prescrit (prescribed)

ATT = Attendu

(expected)

Eg. Medical Imaging order and appointments management visible in EPR

6. Adhering to the code of ethics: access traceabilityActions: User identification system by a login and personal password access logging Elaboration of an “Ethics and Data Security” convention whose signature is

needed for access to the EPR For external access: signature of convention + use of the Belgian eID (strong

authentication)Possibility, at any moment, to ask the medical management for the list of

people who have consulted a patient recordCreation of an access control unit to avoid any misuseAwareness‐raising/reminders during training sessions


5. CONCLUSION

• 4 % CHU investment effort on EPR project• A projet of around 10,5 million €• Financial ROI not easy to assess • But qualitative benefits for security and access to information

CONCLUSION

Organisational training

Patients

Internal process

Funding

Secure single record, accessible to everyone in real time throughout the institution

Patient record, order: Reduction in waiting times and copying out information, contribution to the coordination and continuity of care, structured and coordinated collective approach (quality approach), improvement in organisation

Saves time (tel., moving around, etc.) and prevents redundancy, reduction in length of stays,…

Use dependent on proper training

EMR

CONCLUSION

EPR project has a direct action on 4 key areas:

THANK YOU FOR YOUR ATTENTION!

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HOW TO MEASURE OUTCOME IN HEALTHCARE, AND HOW HEALTH ICT