EHR = Care Continum

Hospital ServicesNot just a medical emergency

– part of the care continum

Tromso, Norway, eHealth ‘05

Ursula O’Sullivan

eMail:- osullivanu@mailp.hse.ie

Web:- www.shb.ie

If you don’t know where you are going…. any road will get you there? Even though there are a lot of possibilities it’s still important to set a direction.

ICTs are providing direction and opportunities so we need to introduce new technologies with business / service models in a way that maximises potential.

EHR = Care Continum

eGovernment + eHealtheGovernment• Access to Services and

Information• Citizens and their right

to information• Backend re-organising

systems and services to provide better access

eHealth• Using technology to

improve Healthcare delivery e.g. Telemedicine, Lab Results to GPs, Out-reach Clinics, Appointment Booking

• Electronic Patient Record

Despite the seeming chaos…..

Core Transaction Systems

Enterprise Systems

Consumer Health Systems

eLearning Systems

Decision Support Systems

Clinical Systems

Environmental Health Systems

Electronic Medical Records

Clinical Data Repositories

Data Integration

Internet/Extranet/Intranet

Computer-Telephony Integration

Electronic Commerce

Integrated Medical Devices

Workflow Technologies

Imaging

Telemedical Technologies

Workforce Enabling Technologies

Research Systems

Expert Logic

GP Systems

Wireless

Customer Relationship Management Systems

Networks/Connectivity

eProcurement

Laboratory Systems

Foundation Technologies

• Networks/Connectivity/CDRs/

• Data Integration

• Internet/Intranet/Extranet

• Integrated Medical Devices

• Imaging

• Interactive Computer Telephony Integration

……There is structure in Healthcare

Advanced Technologies

Consumer/Patient Health Systems

Electronic Commerce Relationship Management

Systems Workflow Technologies Research Systems Expert Logic Wireless

Today’s Health Architecture

Value Creation

Sample Capabilities

Public Use

Functions and Features of Clinical, Managed Care and Administrative Applications

Core Data Systems(Patient Care, Clinical,

Administration, Finance)

Uniform Access to Core

Systems

Web

Site

Branding and Identity - TRUST

Patient / Citizen Education

Information Publishing and Communication

Universal Access

Intranet

Work flow Technologies

Self-Serve HR, Administration

Browser Access to Databases (research, knowledge, medical, administrative)

EstablishCommunications

Infrastructure& Productivity

Enhancers

Extranet

Secure Remote Communications

and Access

Patient Registration, appointment requests

“Push” Customised Content to Patients / Diagnostic Groups

Direct order entry and results

GP to Health Board interaction

External Access to speciifics

New healthcare technologies are redefining healthcare and society

New healthcare technologies are redefining healthcare and society

Informatics IndustrialInternet

Wireless

Genomics & Proteomics

New pharmaceuticals

Digital imaging

Minimally invasive surgery

Nanotechnology

Medical devices

• Greatest advances in the history of medicine are happening now through an explosion in new technology

• Societies have the opportunity to eliminate disease, extend life, improve health and wellness

• And to make healthcare more accessible, affordable and satisfying for all participants

• Greatest advances in the history of medicine are happening now through an explosion in new technology

• Societies have the opportunity to eliminate disease, extend life, improve health and wellness

• And to make healthcare more accessible, affordable and satisfying for all participants

eHealth FoundationeHealth Foundation

Secure E-Health Network Infrastructure

Core HealthcareApplications

LongitudinalPatient Data

Surveillance &Analysis

Self-ServicePortals

• Appropriate

• Accessible

• Affordable

• Effective

• Efficient

• Satisfying

20th Century 21st Century

• Internet technologies have broadened access to data and information in a way that shatters previous models

– Cost control

– Information access

– Clinicians, Healthcare Professionals

– Patients, Citizens

1. We need to understand that large advances are coming within 3-5 years, and current investments may require replacement / upgrading

2. Develop strong healthcare professionals education programme today to prepare for the tools that will be available in the near- and mid-term

EHR = Care Continum

A short overview of the SHB experiences addressing the

challenges and opportunities of Electronic Health Record

Lessons and experiences from regional implementation now

applied nationally

EHR = Care Continum

Environment

• 4,700 sq miles

• 564k population base

• 18,000 Staff, 6,000 field based

• 250 Locations

• Personal Computers – 6,800 Laptop Computers - 1500

• Mobile Phones – 2,200

• Extensive WAN and Local Area Networks

EHR = Care Continum

Drivers• Internal

– Low Morale – No Communications– 20 year old Paper Based processes– Need for change

• External– Consumerism, Patient Centered– Integration– Legislation, Regulations

EHR = Care Continum

EHR = Care Continum

10 Goals1. Integration of patient based services

2. New ways of delivering services and information

3. Manage information as an asset

4. Manage creation of knowledge

5. Optomise use of resources

6. Create an effective organisation

7. Achieve an Electronic Health Record [EHR]

8. eEnable Clinical Systems

9. eEnable Administrative Systems

10. Develop an enabling Technology Architecture

Health eSHB

What do we mean by that?

• Providing Citizen Access– Listening Days, eGovt Initiatives,

• Information & Knowledge Management– Medical Protocols, Research, Best Practice

• Development of Single Patient Record

• Advanced Communications

• Telemedicine

EHR = Care Continum

Building Blocks

eGovt

eEU

eBroke

r

eCitizen

eService

Defined Enterprise

Architecture Support

Advanced Communi-

cations SHBnet

Information & Knowledge Management

eLearning

Organisation

Single Patient Record

eSHB

New IT Systems –

Labs, PACs, Radiology,

EHR = Care Continum

Practical Examples

• eProcurement

• eServices– Births, Death & Marriages

– Environmental Health, Bridges Dental

• Word Based Content Management System

• Nation-wide VPN [Virtual Private Network]

• Integrated patient records– Community, Mobile Computing

• Blended eTraining / eLearning

EHR = Care Continum

Integrated EHR

MOBILE & COMMUNITY PIMs

EHR = Care Continum

MOBILE & COMMUNITY PIMs

Integrated Service Delivery

EHR = Care Continum

Interactive Hospital School

EHR = Care Continum

From the chaos….. To.......

Core Transaction Systems

Enterprise Systems

Consumer Health Systems

eLearning Systems

Decision Support Systems

Clinical Systems

Environmental Health Systems

Electronic Medical Records

Clinical Data Repositories

Data Integration

Internet/Extranet/Intranet

Computer-Telephony Integration

Electronic Commerce

Integrated Medical Devices

Workflow Technologies

Imaging

Telemedical Technologies

Workforce Enabling Technologies

Research Systems

Expert Logic

GP Systems

Wireless

Customer Relationship Management Systems

Networks/Connectivity

eProcurement

Laboratory Systems

Applications Blueprint

• Consolidation of access for the Patient Information Management System (including Lab, PACS and Community PiMS)

• E-enablement of Health Board Processes (where currently addressed)

• SHBnet Infrastructure collaboration (Hardware/Software and Communication links)

• Content Management Application (Intranet and other WEB Form Applications)

• Change Management (program to foster e-culture throughout the Southern Health Board’s community of users)

• Migration to Web Services environment

Benefits to Date

EHR = Care Continum

Lessons Learned

• Check the Power Supply…

• Involve Users

• Plan for ‘big picture’

• Be Flexible

• Develop ‘Partnership’ approach

EHR = Care Continum

Where are we going now?• Continue to implement Health eSHB

goals but on a national basis

• New National EHR Contract [iSOFT]

• New National Health Strategy• Recent replacement of 11 Health Boards by one

national organisation - HSE

• Continue to work with eGovt. initatives

• eServices, Benchmarks, EU Indicators, Govt. VPN, develop new means of delivery e.g. Digital TV, Health Portal, GP Access, etc….

EHR = Care Continum

‘E’ …. is not just about computers and systems.

It is about people and processes and most importantly it is about thinking differently….

eSHB….. 2001- 2005

Care Continum

Contact Details:- Ursula O’Sullivan

eMail:- osullivanu@mailp.hse.ie

Web:- www.shb.ie

Phone:- 021-4922990

Hospital ServicesNot just a medical emergency

– part of the care continum

Tromso, Norway, eHealth ‘05

EHR = Care Continum