Health Information

Management Systems in

Modern Health CareProf. Joshua Shemer

ICTAHC – The Israeli Center for Technology Assessment in Health Care

Barcelona, March 2010

The Israeli Health System –

National Insurance Law

• National Health Insurance Law based on principles of justice, equity & solidarity

• Each citizen has the right receive a standardized basket of health services

• Ministry of Health responsible for health services to be supplied by the 4 Health Care Organizations

• 4 non-profit HMOs – Clalit, Maccabi, Meuhedet, Leumit

• Payment - capitation basis

Maccabi Healthcare Services

• Maccabi is the 2nd largest health fund in Israel

• 1.8 million members

• Over 3,500 physicians

• Over 3,000 clinics

• 152 branches

• Functions within the framework &

constraints of the National Health

Insurance Law

Maccabi’s Vision

• Achieve Total Health for its members

• Provide integrative and personally-tailored health

care for each member

• Promotes excellence in the quality of medical

care, knowledge and service

Diagnostics Drugs

Purchasing

Policy

21%

Physicians

Payment

Guidelines

24%

Oversight

Admin.

Increased

efficiency

NIS 879M NIS1,579MNIS 1,141M NIS 409M NIS 430MNIS 435M

Budgetary Efficiency Processes - (“Piston” System)

9% 9%

Purchasing

Guidelines

Other

medical

7%

Increased

efficiency

Hospitals

Agreements

30%

Health Information Technology (HIT)

• H.I.T. is a TOOL not a goal

• The goal = OUTCOME

H.M.I.S. Targets (Organizational Level)

Health Management Information Services

• Decision processes based on qualitative

information & knowledge

• Continuity of medical data

• Continuity of care - integration

H.M.I.S. Targets (Organizational Level)

• Improvement & increasing efficiency of health

care processes

• Increasing clinical safety & quality

• Better documentation

• Better customer services

Rationale & Feasibility of H.I.T. in

Maccabi

• Equal access to medical records throughout the country

• On-line diagnosis

• Reliable diagnosis due to digital tools

• Improved quality control & assurance

• Archiving capabilities

• Sharing information among physicians for treatment & consultation

• Lower cost

• Customer Relationship Management

Telemedicine in Maccabi Today

• E-Laboratory

• E-Prescription

• Tele-Diagnosis

• Tele-Ophthalmology

• Tele-Consultation

• Remote Monitoring of Chronic Patients

• Medical Support by Call Center

• Patient Online Web Site

Maccabi’s Integrated Information System

INFRASTRUCTURE

Clinic

Extr

anet

Internet

Intra

net

Members Members Members Members

Medical

Control

Admin

Control

Payment

Control

Reimburse-ment

Control

Doc. Clinic

Doc. Clinic

Pharmacy

Specialist

Consultant

Paramedic

Diagnostic

Center

Firewall

Backup

Computer

Main Computer

IDC

Mgmt. of

Insured

People

IDC

Mgmt. of

the Fund

IDC

Mgmt. of

Service

Providers

Drug

consumptio

n control

Labs

control

Tele

radiology

Web

Services

CMRERP

Imaging

Visits &

Hospitalization

Medications

Lab

Results

Treatments

Demographic

parameters

Medical

HistoryFamily

History

Maccabi Central Medical RecordComputerized Data Available for Patient Tracking & Followup

Health Value Added (HVA)

HVA links between:

clinical indicators & budget

Organizational

Processes

(Bureaucracy)

Perceived

Quality

Member

Satisfaction

Quality of

Clinical

Care

Meeting

Budgetary

Objectives

Management Through Setting Strategic Objectives

& Measuring Performance - Health Value Added

(HVA)

Managing the

Organization in

order to

achieve Total

Health

Physician

Satisfaction

Employee

Satisfaction

• Overall satisfaction with health plan

• Growth in the number of new members

• Number of members that switch to a

competing plan

• Satisfaction with healthcare services

• Satisfaction with administrative services

Perceived Quality (Member Satisfaction)

Expenditures in accordance with Budget:

Expenditures on Hospital Services

Expenditures on Physician Services

Expenditures on Medications

Overall expenditures

Fiscal Responsibility

• Measurement at all levels of the

organization:

National

Regional

Local Branch

Physician

• Constructive Competition at each level

HVA Principles

Quality

indicators

Diabetes

Members’

satisfactionFinancial

indicators

HVA – The Tool

HVA – The Results

Mammography 2002-2009

Mammography

51.9 51.3 52.7

63.167.7 65.3 68.4 71

0

10

20

30

40

50

60

70

80

2002 2003 2004 2005 2006 2007 2008 2009

Pneumovax Vaccine among 65+

2002-2009

Pneumovax

35.5

44.451.1

59.362.6 65.5

68.973.2

0

10

20

30

40

50

60

70

80

2002 2003 2004 2005 2006 2007 2008 2009

To sum up:

Health Value Added (HVA)

Promoting “total health” through

quality-based strategic management

utilizing integrated performance

measurements

Cardiac Heart Failure Program

Model of Chronic Health Care

Management

Information System Flowchart

Information

Systems

Maccabi

Healthcare

RF

Patient’s homeMaccabi

M4A

CI Call

Center

Family

doctorRegional

CI

Center

Information

System

M4A

Technical

support

center

Patient

Blood *

pressure

* Pulse

Weight*

HUB

IPV

PN

In Conclusion

• I.T. is a major tool to measure clinical outcomes and control budget

• It needs strong infrastructure to broadly utilize data online

• Provides continuity on database & information integration

• Implementation of telemedicine is required both today & in the future e.g. Chronic Congestive Heart Failure Program

• HVA model controls, assesses and measures medical performance within a balanced budget

• I.T. is a strong management tool

THANK YOU