University Hospitals Leuven Health Sciences Campus · • Social security based compulsory health...
Transcript of University Hospitals Leuven Health Sciences Campus · • Social security based compulsory health...
September 16, 2015
University Hospitals LeuvenHealth Sciences Campus
Overview University Hospitals Leuven (UZ Leuven)
• Organisation of hospital care in Belgium
• Organisational Structure
• Strategy- Strategic Options- Care Programs- Quality Improvement Projects- Hospital Informations System (HIS)- Networking
Belgium
Flemish Region : 6 mio inhabitants12.211 km2
Dutch speaking
Belgium : 10.5 mio inhabitants30.528 km2 (~ Maryland)
Federated union of Flemish, Brussels and Walloon Region
Brussels Leuven
Flemish Region : 6 mio inhabitants12.211 km2
Dutch speaking
Belgium : 10.5 mio inhabitants30.528 km2 (~ Maryland)
Federated union of Flemish, Brussels and Walloon Region
• Social security based compulsory health insurance system• Extensive coverage – increasing amount out-of-pocket• Broad accessibility to care : abundant offer• No gatekeeping / echelons : freedom of choice for the patient• Fee-for-service payment, based on extensive tariff list
=> high patient satisfactionno waiting listspercieved good quality
=> low unit cost, high throughput volume
Organisation of health care in Belgium
• Federal competence : curative care- health insurance system (Bismarck model)- legal framework on health care providers (including hospitals)
defines minimally required (mainly structural) quality standards for hospitals
• Regional competence : preventive care- creation of a comprehensive social health system (Beveridge model)- cofunding for infrastructure of hospitals- audit of federal quality standards
no compulsatory accredition - international accredition on voluntary basisno culture of public reporting of outcome data
Legislation on health care in Belgium
Overview University Hospitals Leuven (UZ Leuven)
• Organisation of hospital care in Belgium
• Organisational Structure
• Strategy- Strategic Options- Care Programs- Quality Improvement Projects- Hospital Informations System (HIS)- Networking
Governance structure UZ Leuven
RvB KUL : Leuven University Board of Directors
BsC UZL : Univ Hosp Board of DirectorsChairman : Guy Mannaerts, MD, PhDCEO : Marc Decramer, MD, PhD
DC UZL : Executive CommitteeCEO Marc Decramer, MD, PhD Deputy Vice-Chancelor Wim Robberecht, MD, PhD
KUL LRD
UZ Leuven as Academic Medical Center
(top referral)patient care
(graduate) teaching
basic and clinical research
Driver of quality of care
Creator of jobs for highly qualified professionals
Provider of health care professionals
Provider of scientifically based input in organisation of health care
Education UZL : under graduate students
Total number of students
Yearly degrees % last yr. students in Flanders
Medicine 1939 184 51Biomed sciences 524 72 60Dentistry 230 37 59Pharmacy 579 85 41Master in nursing 56 39 29Physical education 600 130 51Physiotherapy 485 71 50
Logo / Audiology 250 32 39Total 4663 650 45
Number of beds by site
Campus Number of Beds Avg daily Census
Gasthuisberg 1479 1131
Pellenberg 268 162
St Pieter 56 23
1803 1316
Hospital staffFTE People
Medical staff- staff members- residents (in house officers)
1 172 507 665
1 480806674
Other staff-patient care-support
6 4704 3942 176
7 558 5 0002 558
Total staff UZL 7 642 9038
Key figures UZ Leuven
Out patients 684.199
Day care 100.005
Admissions 56.658
ER visits 53.816
Surgical procedures 53.544
Complexity weighed hospital admissions
admissions Belgium
admissions UZL
market share UZL
A pathology 1.317.981 44.401 3.37 %
B pathology 310.603 16.847 5.42 %
C pathology 16.554 1.811 10.94 %
Total 1.645.138 63.059 3.83 %
Patient care - Last resort care
• Internal medicine– vasculitis, medical ICU (acute on chronic liver failure, weaning
problems, ECMO,…),…• Endocrinology
– difficult to treat diabetes (including sc pumps, pancreas TX), male sub fertility,…
• Dermatology – therapy resistant ulcera / psoriasis, melanoma,..
• Oncology– stem cell Tx, complicated radiotherapy treatment,…
• Clinical genetics– genetic counseling, diagnosis of onco-hematological diseases,..
C pathology: APR-DRG labels
• Organ Tx :– Heart / lung / liver / kidney / pancreas – Stem cell / bone marrow Tx
• Major interventions and/or congenital abnormalities in (low birth weight) neonates
• Severe burns• Cardiac vascular surgery in patients with important
co-morbidity• Neurosurgical procedures in patients with important
co-morbidity • HIV related infections
Overview University Hospitals Leuven (UZ Leuven)
• Organisation of hospital care in Belgium
• Organisational Structure
• Strategy- Strategic Options- Care Programs- Quality Improvement Projects- Hospital Informations System (HIS)- Networking
Increase multipathology
Ageing increase chronic diseases and multipathology
Challenge: interaction between disciplines (Barnett et al., 2012)
Societal context
Added Value = Quality/Cost
Mission UZ LeuvenLeading European Academic Health Services System
Strategy UZ Leuven• Integrated approach hospital / university
Translational Research• Added value creation
Innovative care / Quality improvementEmbedded in the local and regional community
• NetworkingPlanning with gp’s, regional hospitals, elderly care units
• Recruitment and retention of human capitalTop Employer Award
• Organisational efficiency• International context• Stimulate clinical research
Added value creation as strategic option
• Continuous improvement of quality and expertise availablewithin UZL :
Compliance with international standards on hospital widequality and patient safety=> re-accreditation by the Joint Commission International (JCI)
Definition of disease specific standards of quality of care=> designing care programs within UZL
Value Creation
a. Value creation through innovaton inprevention, diagnosis, treatment, rehabilitation and care organisation
b. Strong patient centeredness and focus on equity
R&D expenses in Europe
summit zh & gz fin - 19 feb 2014 24
Land R&D uitgaven (%BNP)Griekenland 0.69
Polen 0.90
Italië 1.27
Spanje 1.30
Noorwegen 1.65
Ierland 1.72
België 2.24
Vlaanderen 2.42
Duitsland 2.92
Finland 3.55
EU 28 1.97
Academic mission and budget UZ
0
5
10
15
20
25
30
35
4,6 %
Antares rapport, 2014
Germany CanadaQuébec
Denmark Spain France Netherlands Sweden Switserland Belgium
20 %
6 % 6 %9 % 9 %
34 %
9 %
20 %
(%)
Incomplete estimateComplete estimate
0
5
10
15
2007-2008 2013-2014
Strategischeprojecten
Impulsbudget medische diensten
Investing in innovationIn
vest
erin
g (m
io€)
a. Innovation
i. Organisational culture (organicstructures, bottom up, entrepreneurial, small units)
ii. Medical departments and CP conceptiii. Pathology-specific outcome indicators,
public reporting, bench markingiv. Valorisation
Care Program centered organisational structure
Med. dienst Med. dienst Med. dienst
ZP Comité
Operationele aansturing
Medisch inhoudelijke aansturingDC
Optimale kwaliteit van zorg en patiëntveiligheid
AC
ZP ZP ZP ZP ZP ZP ZP ZP ZP ZP ZP ZP
Broad spectrum of spin-offs
Creating Leverage
Euro
Investeringen in spin-offs 2005 - 2012
0
200
400
600
800
1000
1200
2009 2010 2011 2012 2013
Non-commercialCU, MN art.21Commercial
Clinical studies
Overview University Hospitals Leuven (UZ Leuven)
• Organisation of hospital care in Belgium
• Organisational Structure
• Quality Management- Strategic options- Care Programs- Quality Improvement Projects- Hospital Information System (HIS)- Networking
Example Education
Overview University Hospitals Leuven (UZ Leuven)
• Organisation of hospital care in Belgium
• Organisational Structure
• Quality Management- Strategic Options - Care Programs- Quality Improvement Projects- Hospital Information System (HIS)- Networking
aim :delivery of high
quality care
public accountability
measurements
PDCA cycle
improvement
“CQI” process
- internal follow up- external benchmarking
Quality Management : overall aim
Department specific ISO and other accreditations
• JACIE accreditation : hematology department• NETCORD accreditation: hematology department• EAE accreditation echocardiology lab• BFHI - Baby friendly hospital (UNICEF – WHO)• ISO-Certificate:
– Medical laboratory– Center for molecular diagnostics– Laboratory for clinical genetics– Pathology– Fertility center– Nuclear medicine– Pharmacy– Central sterilisation unit– Center for forensic medicine
• ISAE accreditation: IT department
Overview University Hospitals Leuven (UZ Leuven)
• Organisation of hospital care in Belgium
• Organisational Structure
• Strategy- Strategic Options - Care Programs- Quality Improvement Projects- Hospital Information System (HIS)- Networking
Goals of the Clinical WS
● Access point for the clinician to the HIS● Replaces the paper communication for
Order Entry en Results Reporting● Integration of medical and administrative
data● Source of data for management info
Bart Van den Bosch
Overall approach to clinical system
Clinical workstation
APO
Radiology
Appointment schedulingOrder Entry
Problem list / journalMedical contactsResults reporting
Medical messaging systemRegistration Physical param.
Medication Prescription
App1 AppN...Laboratories
One function for all departments
All
func
tions
for
one
depa
rtm
ent
Func
tions
Departments
X windows
formTools
motifTools tupleTools{System 9 generator
SybaseBart Van den Bosch
Bart Van den Bosch
Strategic choices● No best of breed approach● Holistic system, no separation between
● inpatient - outpatient● nursing - medical● specialty files
● Much in house development● Generic modules (breadth instead of depth first)
● Re-use of code as much as possible● Pro-actively seeking and migrating to new technology
● Buy ancillary systems only if they can be integrated with the KWS
Bart Van den Bosch
Bart Van den Bosch
2013 20141994
Deviceinterfacing
Othello
2013201220122007 2010 2010 2010 2010 2011
(KWS) mailbox mynexuz(pro)
Appointments
Mail outbox eHealthBox
Request asurgicalprocedure
Request ahospital stay
LUCKBTCNo report necessary
Cancel
1-7-2015
KWS Demo Net
• SM-SM link• Combined
appointments• Kiosk
• Cover Flow
• Feedback tointerns
Org
aniz
atio
nTe
chno
logy
Sigh
tsee
ing
• Templates• Word integration
Ordering ofprocedures
• NEO
Planning
Attendance
Order entry
Productivity tools
Multimedia
Ad hoc
• Framegrabbing-scopy
All tracks subject to static anddynamic access control
Beware of (test)patients
The tracks indicate the flow ofdemonstration and notnecessarily the flow of the data
Worth the trip
Worth a detour
Interesting
Care programs
Final report
Medicationcollector
• Time-out
MZG
2004
• Photo
XDShubs
ONE
WA
Y
ONE
WA
Y
ONE WAY
ONE WAY
ONE WAY
E-nursing
Mirth / nexuz
• Bedsidescanning
1 2 3 4 5 6 7 8 1098 9 107654321
ONE
WA
Y
Overview externalregistrations
Joining date
MKG SNOMED
• ANE file
• nexuz mobile• KWSM-CPV
1011
1995 134 211 415 348 439 844 1066 310 243 660#beds
12
• Medication dispenser
13 2014
287
14
7826
2014
644
15 2014
230
16
ADT(Admission-Discharge-Transfer)
Lab system(internal)
ERP(PeopleSoft & Maximo)
Data Warehouse
HIS of the UZ KULeuven
45
Patient billing(OASIS – XTenso)
Clinical WSLab system (external)
Use of (proprietary) standards
● HL7 (Mirth as broker)● XML ● DICOM: PACS for radiology/cardiology
o Visual light images = jpeg● ASTM 1394-97 (Lab connections)● KMEHR: Belgian standard for interaction w government● XDS: comm. internally on VZN eHealth hub● TIFF (OCR) + JPEG (full color)● PDF
3 applications, 3 types of users, 1 DB
EHR DB
nexuzCWSClinic
al workstation
mynexuz
myUZ
mynexuzpro
LISA
Employees (care providers)
Referring care providers
Patients
ehBox
nexuz health service points
7.596 beds total (25,6% of Flemish hospital beds; and growing)
Overview University Hospitals Leuven (UZ Leuven)
• Organisation of hospital care in Belgium
• Organisational Structure
• Strategy- Strategic Options - Care Programs- Quality Improvement Projects- Hospital Information System (HIS)- Networking
Vlaams Ziekenhuisnetwerk K.U.Leuven
DamiaanOostende
GroeningeKortrijk
GroeningeKortrijk
Sint-LucasBrugge
Sint-JozefTurnhoutSint-JozefTurnhout
ImeldaBonheiden
SalvatorHasselt
Virga JesseHasselt
Virga JesseHasselt
ZOLGenk
UZLeuven
UZLeuven
MariaziekenhuisNoord-Limburg
Sint-TrudoSint-Truiden
AZ ZvBRonse
Sint-FranciskusHeusden Zolder
Sint-BlasiusDendermonde
Sint-ElisabethTurnhout
OLV Aalst
AZ Sint-MaartenDuffel
Locoregional care partners
Flemish Hospital Network KU Leuven
Networking
Multicenter Electronic Patient Record
Heilig HartLeuven
Nationaal MS CentrumMelsbroek
Heilig HartziekenhuisMol
AZ Sint-JozefMalle
Vlaams ZiekenhuisNetwerk
External training VMS
≥ 12m
3-11 m
0 m
46 %
15 %
39 %
63 %
Belgische nationaliteit
Andere nationaliteit
63%
37%
Proportion foreign physicians 2011-2014
Senior ASO VMS
37%26%
74%
20
20
54
6
3
2
NederlandItaliëDuitslandZuid-Afrika
Andere landen
LitouwenCanadaGroot Brit.
22
2 6
Senior ASO
24
2 3
22
2
22
5
22
2 5
NederlandSpanje
Andere landen
Zuid-AfrikaCongoDuitsland
EgypteHongarijeItaliëOostenrijk
VMS
Provenance