rossimori

Slide1: 

Angelo Rossi Mori, eHealth Unit, CNR-ITB Continuity, Collaboration, Communication Challenges for Healthcare and Opportunities for eHealth Connecting systems or connecting people ?

main principle: 

main principle successful ICT solutions should correspond to perceived needs on Information and Communication of clinicians and citizens, rely on clear healthcare processes, be supported by systemic actions of healthcare managers and by adequate policies

I C ( T ) ?: 

I C ( T ) ? how far I nformation capture and usage, and C ommunication in current clinical settings are suitable for T echnology adoption ? the context for interoperability which interactions are enough mature ? how far are they systematic ?

disciplined vs. fuzzy environments: 

disciplined vs. fuzzy environments disciplined environments diagnostic services (orders and reports), booking, admission, discharge letter, … systematic interactions, stable workflows inter-operability, standard messages fuzzy environments human co-operation, clinical communication clinical pathways, datasets, narrative ! co-operability, document-based approach connecting systems connecting people

rationale: the Ptolemaic approach: 

rationale: the Ptolemaic approach the current approach is innovation-centered the introduction of innovation is driven by the opportunities offered by eHealth solutions (e.g. booking, transfer of prescriptions, …) the health system is able to cope with “organisational micro-traumas”

the Ptolemaic approach: 

the Ptolemaic approach 1. focus on eHealth solutions

the approach is not scalable: 

the approach is not scalable eHealth requires large-scale programmes which are pervasive and accelerated the health system is not able to cope with too large macro-traumas we should go back to look at the the healthcare policies and at the “political readiness” to put programmes in practice

rationale: a Copernican approach: 

rationale: a Copernican approach put the healthcare policies in the center healthcare plans involve structural decisions on the care system, and may bring to innovative organisational models support and enable the new care processes by suitable ICT solutions impact on the decisions by professionals and on the behaviour of citizens

a Copernican approach: 

a Copernican approach 1.focus on health policies

Health: it’s time to drop the “e-” ?: 

Health: it’s time to drop the “e-” ? Ptolemaic approach ehealth solutions strategic opportunities organisational changes Copernican approach health policies health strategies organisational changes & ehealth policies e-

healthcare policies in the center: 

healthcare policies in the center consider how decision makers look for a sustainable evolution: by shifting resources from acute care to chronic care and prevention (elderly, mother and child, oncology, …) by integrating social and health care by encouraging patient empowerment, by promoting clinical governance, etc

four layers of interventions: 

four layers of interventions Ptolemaic approach: L1. enabling infrastructures and services hw, sw, networks, regulations, identification of citizens and professionals authentication, authorization L2. to improve the efficiency of operational workflows booking, prescribing, reporting, portals, ...

four layers of interventions: 

four layers of interventions Copernican approach: L3. to improve the quality of shared care synergy of actors (clinical pathways, clinical data sets) patient empowerment L4. to improve the governance of the healthcare system structural actions to modify the system (indicators) need for a clinical info-structure

L1. basic tools and services to enable upper layers : 

L1. basic tools and services to enable upper layers Various large jurisdictions are envisaging national (federal) and regional programmes, to develop coherent inter-sectoral infrastructures (e.g. by eGovernment actions and generic standard, e.g. HTML, XML) to develop health-specific infrastructures Stakeholders have an increasing attention to define and adopt regulations and standards to make plans for specific educational activities for the public and healthcare professionals

L1. basic tools and services to enable upper layers: 

L1. basic tools and services to enable upper layers build the technological infrastructure; set up the proper regulatory framework, including connectivity, security, privacy; produce or adopt standards and reference documentation to achieve semantic interoperability; set up a certification process on quality and safety of eHealth solutions

L2. to improve efficiency of operational workflows: 

L2. to improve efficiency of operational workflows to improve speed, quality, quantity of procedures performed with a given amount of resources. stereotypical situations (e.g. prescriptions, discharge letters, test reports, …) were the topic for intense activities on interoperability standards in last 15 years largely independent from the actual patients conditions: most of them do not influence appropriateness of procedures and clinical decisions, i.e., the intrinsic nature of healthcare services is not altered

L2. to improve efficiency of operational workflows: 

L2. to improve efficiency of operational workflows provide services to improve the current workflow-oriented services provide a basic electronic assistance to clinicians and managers provide support to Public Health Systems, on epidemiology, management and planning (derived usage of information).

L3. to improve quality of shared care: 

L3. to improve quality of shared care rationalisation of the processes of care provision by a problem-oriented perspective: support the daily clinical decisions of multiple healthcare professionals and a more effective behaviour of patients and clinicians with the capture, storage and transmission of specific data items, depending on the particular context within the care plan

L3. to improve quality of shared care: 

L3. to improve quality of shared care advanced services on information and knowledge for clinicians services for the empowerment of health consumers: citizens, patients, their families and caregivers programs supporting the current care processes

L4. to improve governance of healthcare system: 

L4. to improve governance of healthcare system information support to discover bottlenecks to negotiate among stakeholders to decide for systemic actions more effective management of services and refinement of medium- and long- term policies, by the analysis of accurate and timely data, directly taken from the routine care processes of each individual patient increase in quality and appropriateness (better control on resources)

L4. to improve governance of healthcare system: 

L4. to improve governance of healthcare system re-engineering of care processes structural actions on the healthcare system to increase quality and appropriateness of care provision enabling innovative organisational models production and evaluation of eHealth roadmaps support change management processes for eHealth deployment

four layers of interventions: 

ENE four layers of interventions ENABLEMENT GOVERNANCE EFFICIENCY QUALITY

eHealth evolution: driving factors: 

eHealth evolution: driving factors L1 L2 L3 L4

eHealth asks for new drivers: 

eHealth asks for new drivers increasing role for regional / national authorities (ministries of health and innovation) roadmaps, infrastructures and regulations and healthcare professionals infostructure (context-related data sets, …) balance the attention from technological issues (market) to governance and organisation of the healthcare system

from policies to I & C: 

from policies to I & C healthcare targets Interoperability and Cooperability action lines policy objectives Information and Communication issues

1a. from policies to actions: 

1a. from policies to actions to work out the possible consequences of selected policy objectives: from the policy issues to potential specific goals to systemic actions on the healthcare milieu to the involved semantic issues and tools next steps: work out the corresponding actions to promote interoperability

policy issue 1 - safer decisions, quality of care processes: 

policy issue 1 - safer decisions, quality of care processes increase influence on risk management (e.g. medical errors and patient's errors) by timely providing adequate knowledge to assist proper decisions increase the quality of care processes, i.e. declaring and following explicit reference clinical pathways increase the mutual awareness about what other clinicians are knowing, doing or planning on the patient

influence on risk management: 

influence on risk management goal - avoid errors e-prescribing (producing the prescription) database on potential drug interactions, adverse reactions (formulary) assist patient in performing procedures instructions to patients (multi-cultural, multi-channel)

influence on decisions: 

influence on decisions goal - leverage authoritative clinical knowledge for clinicians assure quality of routine care provision reference clinical pathways decision support assisted access to authoritative knowledge

influence on information sharing: 

influence on information sharing goal - effectively manage unexpected contacts (patient mobility) emergency patients, not able to effectively present their history emergency data set, special needs, problems maintained lists (active problems, allergies, ongoing medications) incidental access, without a shared plan (GP and hospital, second opinion) basic patient profile, problem-oriented profile

policy issue 2 – sustainable evolution of healthcare: 

policy issue 2 – sustainable evolution of healthcare the increasing cost of healthcare requires a rationalisation of services provided, without a negative effect on quality of care. continuity of care, patient empowerment accurate governance based on routine clinical data and suitable indicators, to produce benchmarks and to allow self-assessment of healthcare professionals

role of ICT solutions vs. the evolution of healthcare sector: 

role of ICT solutions vs. the evolution of healthcare sector going towards the upper layers, technological factors become less relevant semantic interoperability is more crucial the major goal becomes the governance for a sustainable evolution of the healthcare sector driving forces are shifting from market and ministries of innovation to clinicians and ministries of health

influence on care models: 

influence on care models goal – support new care models: disease management, long term care support to chronic conditions, frail elderly control of remote devices (home care), support to care managers patient's folder, problem-oriented profile, context-specific data sets

influence on care fragmentation: 

influence on care fragmentation goal - face fragmentation of care provision planned shared care, with multiple professionals (continuity of care) shared clinical pathways, cooperative shared plans, context-specific data sets sharing any type of electronic clinical document (according to any format) referral letter to pass care mandates between professionals avoid duplicated tests repository of test results

influence on patient behaviour: 

influence on patient behaviour goal - patient empowerment adequate impact on lifestyle and on compliance to therapy recalls, alerts, reminders clinical knowledge for patients (multi-channel) Patient Health Record (PHR) clinical pathways and health balance patient self-assessment, appropriate requests for healthcare facilities / services simple flow-charts to guide patient's access to appropriate facilities

influence on governance: 

influence on governance goal – improve governance and quality timely information on healthcare processes and outcomes datawarehouse, with indicators of process and outcome registries for management and epidemiology

policy issue 3 improve access to services: 

policy issue 3 improve access to services simplification of the paperwork rationalisation of organisational and administrative processes increase of efficiency of operational workflows (e.g. prescriptions, booking, reports, …). effective portals, with practical information and authoritative clinical knowledge

influence on efficiency: 

influence on efficiency goal – increase efficiency, avoid burden operational workflows e.g. booking, reminders, prescriptions, reports continuity over time, maintain history across episodes immunisations, derived lists (e.g. tests, events, treatments, prescriptions) simplify administrative processes registration data (e.g. insurance, preferred GP, exemptions from payments), enrolment in programs (e.g. home care, dialysis, …)

influence on appropriate access: 

influence on appropriate access goal – select the most appropriate point-of-service (improve patient choice) make information about services more accessible citizen's portal (multi-cultural, multi-channel), (e.g. yellow pages about available healthcare services and facilities) patient self-assessment, appropriate requests for healthcare facilities / services simple flow-charts to guide patient's access to appropriate facilities

influence on availability : 

influence on availability goal – extend availability of healthcare services primary care centre, on-call physician, out-of-hours, patients shared among a group of GPs extended patient profile, sharing the local EPRs

an example: the Clusters in the eHealth ERA project: 

an example: the Clusters in the eHealth ERA project Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 41

bottom up vs. top down approach: 

Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 42 policy situation solution data cluster 1: variants of patient summary several solutions several policies bottom up vs. top down approach

the case of patient summaries: 

the case of patient summaries Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 43

variants of patient summary: 

variants of patient summary Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 44

policies and solutions: 

Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 45 policy predetermined modalities situation solution emergency data set plus list of events, medications, test results, allergies … support (chronic) care models unexpected contact mobility of citizens suggested follow-up adopt common care plan ad hoc referral data finalize care plan synchronize with the others ad hoc referral letter transfer of mandate with dormant conditions with active care processes current problems +ongoing plan life cycles of procedures latest acts+ suggested plan cope with ongoing plan read (once) past history variants of patient summary policies and solutions

Continuity, Collaboration, Communication - 3C : 

Continuity, Collaboration, Communication - 3C International Conference Challenges for Healthcare and Opportunities for eHealth Facilitating the Collaboration through Communication among Health Professionals in support for the Continuity of care: A Copernican Approach for Healthcare National Research Council

structural actions to facilitate the involvement of stakeholders: 

structural actions to facilitate the involvement of stakeholders Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 47

a web-based toolkit -1: 

a web-based toolkit -1 Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 48

a web-based toolkit -2: 

a web-based toolkit -2 Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 49

a web-based toolkit -3: 

a web-based toolkit -3 Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 50

a community of mediators - 1: 

a community of mediators - 1 Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 51

a community of mediators - 2: 

a community of mediators - 2 Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 52

a community of mediators - 3: 

a community of mediators - 3 Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 53

a community of mediators - 4: 

a community of mediators - 4 Berlin, 19 April 2007 Angelo Rossi Mori, eHealth Unit, ITB-CNR, Rome 54

thanks !: 

thanks ! contact: Angelo Rossi Mori rossimori@itb.cnr.it google: "RIDE project" > public deliverables