Paperless Hospitals Dr Dev Taneja 3rd June2012

Paperless HospitalsHOSPI ARCH, MUMBAI

3rd June 2012

Dr Dev TanejaM.S.(Gen.Surgery),MBA – Healthcare Mgt. ( NUS Business School, Singapore)

Director

TachRoyal Healthcare Consultancy Services, Mumbai

Who are we?

We are a Startup team of senior professionals from the healthcare industry who have a sound understanding of the operational & business challenges and other stakeholders issues related to the healthcare delivery

We seek opportunities to make meaningful interventions to improve the business competitiveness in healthcare delivery segment; thereby improving returns for the promoters & other stakeholders

TachRoyal Healthcare Consultancy Services

Performance Improvement

• Performance – Clinical, Operations & Finance

• Utilisation Reviews & Trend Analysis

• Human Capital Review

• BPR / Change Mgt.

IT in Health

• HIS

• ERP

• Business Intelligence / Health Analytics

Quality & Service Excellence

• NABH / NABL

• JCI

• Service Excellence Culture

Strategic Business Consulting

• Planning & Positioning

• Marketing Strategy

• Balanced Score Card

Healthcare & Hospital Planning

• Formation Reports

• Commissioning

• Roll Out

Leadership & Human Capital Development

• HR Strategy & OD

• Leadership & Management Development

• Training & HC Development

Our Service Offerings


Healthcare IT

Strategic Information Systems

Administrative Information Systems

Clinical Information Systems

Electronic Networking Systems – RFID, Mobile, Telemedicine, Telemetry, Insurance etc.


Transaction Data

ADT

LIS / RIS

PHARMACY

BILLING

STORES

Non Transaction Data

CLINICAL CARE

CLINCAL QUALITY

PATIENT SATISFACTION

MARKETING

SUPPORT SERVICES

HRMS

ASSETS

PROJECTS

Aggregate Data

FINANCIAL MGT.

RESOURCE UTILIZATION

SERVICE LINE EFFICIENCY

CLINICAL QUALITY

RISK MGT.

TRENDS

FORECASTING

Data is captured; both electronically and manually

An Enterprise Level Integration of Processes, KRAs. KPIs for MIS is Required

Why do we need Paperless Hospitals?

HCOs are looking for the killer applications that will slash costs, improve outcomes & send patient home more satisfied. The focus of IT investment is shifting from financial systems to clinical systems.

Digital transformation of healthcare meets three important criteria for market competition – it is better, faster and cheaper


Coordination of Clinical Care Improved Customer Care

Cost Containment,

Productivity Improvement,

Monitoring & Control

Technological Advancements

Push from Govt. & Payers

Profit, Growth

&

Competitive Advantage

Drivers of Paperless Hospital


Coordination of Clinical CareIOM Report, 1999 – To Err is Human: Building a safer healthcare system

Medication Errors

1. Ordering by physicians – 56%

2. Admin. of medication by nursing staff – 34 %

3. Transcription of medication orders by secretarial staff – 6%

4. Dispensation of medication by the pharmacy dept. – 4%

5. Practice variations – Cost of care in the last 6 mths. of life were found to vary tremendously

Clinical Process Improvement

1. Science of Error Reduction –CQI

2. EMR - virtual data warehouse3. Design around patients – Dis.

mgt. programs – patient centered

4. Reduction in Medication Errors5. Research Organisation – RIID

(Research, Investigate, Innovate & Disseminate)

6. Chronic illness Focus – CDM7. Link to Financial Performance

– Report cards


EMR / EHR

It is a database & decision support system

It addresses one of the greatest inefficiencies of healthcare – the immobility of healthcare records

It is built around Clinical Protocols

CPOE – Clinical Physician Office Entry

Clinical Information Systems & Clinical Decision Support Systems


Veteran Affairs Medication Error Reduction

Error Reduction Strategy Percent Improvement

(VA - developed Wireless POC medication administration system)

1. Wrong time incidents 91.6

2. Wrong patient incidents 91.3

3. Wrong medication incidents 73.8

4. Omitted doses 69.6

5. Wrong dose incidents 56.6

Source: IHC (2000)


IT in Care Process

Health Care Team Patients/Consumers

Case Manager

Patient Centered

Information(EHR)

Health plans that seek to better coordinate patient

care – particularly for chronic care patients – should

make sure all health care stakeholders have the same

information when devising treatment strategies.

Placing high-quality, patient-centered data at the

center of the “circle of care” is where IT systems

(EHR) can be of strong value.


IT Vision

Electronic Health Record

Central Data Repository

First Clinic/HQ

Patients/Consumers

Community HealthWorkerCare

Consultant

Medical Officer Paramedics

Case Manager

InternetInternet

Additional Centers in Future

Quality MetricReports

IT Plan - Web Based Solutions

– Electronic Health Record(EHR)

• Can be accessed anywhere by Health Care Team

• Role specific screens that allows to see/collect information about patient specific to the care provider’s discipline

– Patient Health Record(PHR) portal to facilitate

• Self management

• Open communication with health care team

• Delivery of patient specific education materials in different formats (videos/web pages, etc)


Information Sharing & Exchange

Direct Impact - Customer

Online Appointments Reminders & Alerts Automated Dispensing Machines Digital Signage’s – Token Display, Patient Education materials Patient Portals Wireless Internet Access Video Calling Devices in ICU Telemedicine Health Communities Mobile Health Patient Health Records Online Payment Gateways Smart Cards Patient Entertainment Systems - Movies-on-Demand, Television, Music,

Games

Indirect Impact - Customer

Electronic Health Record

Clinical Decision Support Interoperability

Wrist bands – Barcode / RFID

Feedback collection

Robotic Devices

Surveillance

Real Time Location Tracking


Future Healthcare – Social Media


Business Intelligence / Health Analytics

Readymade Role based Actionable information available

No need to spend time for analysing data

Interactive visualisation of data to support decision making.

Transformation of Data to Information to Knowledge

ERP

Modules cover transactions + support depts.

But +/- Clinical Information Systems

Static MIS Dash boards.

No Analytical capability

HIS

Modules mostly capture Transactional Data Limited applications for all support Depts.


HIS, ERP & BI: Advantages & Limitations

• Broadband Services

• Convergence of ICT services

• Wireless TechnologyInternet Access

• Better Operating systems & Search engines

• Web based systems, Cloud computing

• HTML to XML, Software Applications etc.

Hardware, Middleware &

Software

• HIPPA

• DICOM

• HL 7 , LOINC etc

Health IT Standards

Costs The

The technology to link software, hardware &telecommunications is rapidly becoming available at affordable costs

Technology Advancements


IT Solution + Connectivity


Wi-Fi in Healthcare• IP Phones

• Laptops / Tablet PC

• PDA / IPAD

• Computer-on-Wheels (COWS)

• Real-Time location services

• Wireless Data Transfer– Wristband and pharmaceutical scanners– Wireless glucose meters

• Bedside video conferencing– Remote telemedicine

• Video surveillance

• Medical telemetry/monitoring

• Visitor and patient Wi-Fi access


Technology Considerations in Healthcare


Current Status of Paperless Hospitals

There are perhaps few industries that have to gain more from the internet revolution than medicine…..(but doctors and) hospitals are real laggards when it comes to the internet. What e-health has to be used for is to transform the whole process of delivering care.

Russell Ricci, M.D, (Steinhauer, 2000)


E – Organisation Culture

Ø The ultimate barrier and enabler of the digital transformation are not technical – they are cultural.

Ø A digital divide still exists between the e-users and e-sceptics and healthcare is traditionally slow to adopt new technology.


PAPERLESS Vs PAPER


Semi Automated Systems


Healthcare Executives Straddle the “Digital Divide”

The healthcare system of tomorrow may never be ‘paperless’ but progress is being made despite the legendary reluctance of physicians to accept changes in the way they practice medicine.

The transformation process of building electronically integrated systems that manage patients with “seamless” care has already gained traction across the globe.


Source: http://www.hhnmag.com/hhnmag/gateFold/PDF/07_2011/HHN07-2011gatefold.pdf

Modules NA Basic Intermediate Advanced

OPD

Outpatient & Emergency Inquiry System

OPD & Emergency Queue Mgt Sys

OPD & Emergency Billing & Charging Sys

OPD & Emergency Pharmacy Mgt. Sys

OPD & Emergency Physician Workstationt Sys

OPD & Emergency Nurse Workstationt Sys

IPD

IPD Registration / ADT Mgt Sys

IP Expense Mgt Sys

IP Bed Mgt Sys

IP Prescription Mgt Sys

IP Pharmacy Mgt Sys

IP Physician Workstationt Mgt Sys

IP Nurse Workstationt Mgt Sys

Clinical Examination Sub Sys

Pharmacy

Medication Inventory Mgt Sys

Medication Preparation Mgt Sys

Electronic Standard Prescription

Laboratory IS

Pathology IS

Radiology IS

PACS System

Indian HIS Vendors – Most Common Module Offerings

Modules NA Basic Intermediate Advanced

Electronic Medical History Records

Financial Mgt & Economic Acc MS

Costing Software

Client Relationship MS (CRM)

Hospital Resource Planning System (ERP)

HR Mgt Sub System

Logistic Mgt Sub Sys

Office Automation (OA)

Comprehensive Search & Analysis Sys

Clinical Decision Making support Sys

Medical Mgt & Quality Control Sys

Clinical Data Warehouse

Remote Medical Service Sys

Patients Enquiry Terminal

Knowledge Mgt Platform / BI

Patient online Service Platform

Medical Ins & Community HC interphase

Patient Card (Intra Hospital)

Patient Card (Inter Hospital)

Medical History Records & Statistics

Indian HIS Vendors – Most Common Module Offerings

TOP MNC HIS Vendors Clinical IS Financial IS

1 Meditech

2 Mckesson

3 Siemens

4 Cerner Corp.

5 Eclipsys Corp

6 Epic Systems

7 3M HIS

8 Dairyland HC Solutions

9 SCC Computer

10 Per-Se Technologies

11 Mediware IS

12 SoftMed Systems, Inc.

13 QuadraMed

14 MiSys

15 Lawson Software N ****

16 People Soft ****

17 SAP ****

18 SSA Global ****

19 SSI Group* N ****

Source: ClinicalSystemsHospitalMarket_HIMMS, DORENFEST (IHDS+Database) Institute 2006

Clinical Information Systems Comparision - Indian Vs MNC Vendors

Modules Basic Intermediate Advanced Not Available

1 Abstracting

2 Chart Deficiency

3 Chart Tracking Locator

4 Clinical Data Repository

5 Clinical Decision Support

6 Enterprise EMR

7 Enterprise Master Patient Index

8 Laboratory Information Systems

9 Pharmacy Management Information Systems

10 Point of Care

11 Radiology Information Systems

12 Surgery

Financial Information Systems Comparision - Indian Vs MNC Vendors

Financial Information Systems Basic Intermediate Advanced Not Available

1 Accounts Payable

2 Benefit Administration

3 Case Mix Management

4 Cost Accounting

5 Electronic Claims

6 Executive Information Systems

7 General Ledger

8 Materials Management

9 Patient Billing

10 Pay Roll

11 Registration / ADT

Lets interact

Thank You

Contact Info:

Dr Dev TanejaDirector,


701, Viceroy Park

Plot No. 53, Sector 44A

Seawoods Darave, Nerul(W)

Navi Mumbai. 400706

Mobile: 09987708685

E-mail: [email protected]

Paperless Hospitals Dr Dev Taneja 3rd June2012

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