Improving Health Outcomes through HIT

Category: Education

Presentation Description

Presentation to MOH Brunei Dec 2008


Presentation Transcript

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Improving Health Outcomesthrough Information Technology Prof Dato Dr Jai Mohan Professor of Health Informatics & PaediatricsInternational Medical University Vice-President, Malaysian Health Informatics Association Wednesday 17 December 2008

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Rising Costs Rising Expecta- tions Change drivers “Information Technology is the linchpin for medical care that is high quality, safe, timely, affordable and equitable.” (David Lawrence)

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By increasing adherence to guidelines, enhancing disease surveillance, and decreasing medication errors. Much of the evidence on quality improvement relates to primary and secondary preventive care. The major efficiency benefit has been decreased utilization of care. Health information technology has been shown to improve quality

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Effect on time utilization is mixed. Empirically measured cost data are limited and inconclusive. Most of the high-quality literature regarding multifunctional health information technology systems comes from 4 benchmark research institutions. Little evidence is available on the effect of multifunctional commercially developed systems. A major limitation of the literature is its generalizability. Health information technology has been shown to improve quality

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Comparing EMR Adoption to Care Outcomes at UHC Hospitals, Including Davies Award Winners, Using HIMSS Analytics’ EMR Adoption Model Scores

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All hospitals

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EMRs impact on patient care ? It would be possible to conclude from this survey that EMRs have little or no impact on patient care. That is the suggestion from the 40,000-foot view of all UHC hospitals as a group. But that conclusion would be wrong. Drilling deeper, we see something much more positive.

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All hospitals EMR scores > or = 2 EMR scores > or = 3 EMR scores > or = 4

Stage 3 vs Stage 4 Hospitals : 

Stage 3 vs Stage 4 Hospitals There is a fairly dramatic leap in the impact of hospital EMRs once an institution has achieved Stage 4 status. As we have seen, the outcome quality gap between hospitals at Stage 3 and those at Stage 4 is remarkable. Where Stage 3 hospitals have six slight positive correlations between their EMRs and AHRQ’s quality indicators and just one strong positive, the 22 UHC hospitals that have reached Stage 4 have nine strong positive correlations and 11 slight positives.

Stage 4 Hospitals: Positives : 

Stage 4 Hospitals: Positives What’s more, the strong positives at Stage 4 are in important, difficult areas, including acute stroke, heart failure in-hospital mortality percentages, and gastrointestinal hemorrhage in-hospital mortality percentages. The slight positives at Stage 4 affect such areas as pneumonia, complications from surgical anesthesia and acute myocardial infarction inhospital mortalities. These are very important medical correlations. Stage 4 hospitals are a key segment, and we need to learn more about what these hospitals are doing right.

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Stage 2: Major ancillary clinical systems feed data to a CDR that provides physician access for retrieving and reviewing results. The CDR contains a controlled medical vocabulary and a clinical decision support/rules engine for rudimentary conflict checking. Information from document imaging systems may be linked to the CDR at this stage. Stage 3: Clinical documentation (e.g. vital signs, flow sheets, nursing notes, care plan charting and eMAR) and general order entry are implemented and integrated with the CDR for at least one service in the hospital. The first level of clinical decision support is implemented to conduct error checking with order entry (i.e., drug-drug, drug-food and drug-lab conflict checking normally found in the pharmacy). Some level of medical image access from PACS is available.

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Stage 4: CPOE for use by any clinician is added to the nursing and CDR environment along with the second level of clinical decision support capabilities related to evidence-based medicine protocols. If one patient service area has implemented CPOE and completed the previous stages, then this stage has been achieved. Stage 5: The closed loop medication administration environment is fully implemented in at least one patient care service area. The eMAR and bar coding or other auto- identification technology, such as radio frequency identification (RFID), are implemented and integrated with CPOE and pharmacy to maximize point-of-care patient safety processes for medication administration.

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Stage 6: Full physician documentation and charting (structured templates) is implemented for at least one patient care service area. Level three of clinical decision support provides guidance for all clinician activities related to protocols and outcomes in the form of variance and compliance alerts. A full complement of PACS systems displaces film-based images. Stage 7: This is the ideal. The hospital has a paperless EMR environment. Clinical information can be readily shared via electronic transactions or exchange of electronic records with all entities within a regional health network (i.e., other hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients).

eHealth is Integration : 

20 eHealth is Integration individual population Information Workflow + collaboration Rules and reasoning Clinical Workflow Decision Support eHealth Phase 3 Phase 2 Phase 1 e-Prescribe, CPOE Shared Pathways Shared Information (EHR) + collaboration Drug interactions, monitoring, compliance, alerts, … Personal Health Record (PHR) Population monitoring, epidemiology, Bio surveillance Research from bench to bed, from bed to bench Information Workflow + collaboration Rules and reasoning Clinical Workflow Decision Support e-Prescribe, CPOE Shared Information (EHR) + collaboration Personal Health Record (PHR) Research from bench to bed, from bed to bench Drug interactions, monitoring, compliance, alerts, … Population monitoring, epidemiology, Bio surveillance Shared Pathways Disease Mgmt. Programs Personal Health Plan Electronic Health Record Health Monitoring Health Mgmt. Programs Inter-professional collaboration Translational Medicine

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24-27 Feb 2009 Kuala Lumpur

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Even the best technology will only make matters worse by increasing clinician’s workload. Unless technology presents the right information to the right clinician at the right time and place, it adds no value. Automating existing paper documentation system is not enough

Google groupseHealth-Developing-Nations : 

Google groupseHealth-Developing-Nations

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