Hospital Information Systems (August 18, 2015)
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Transcript of Hospital Information Systems (August 18, 2015)
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Hospital Information Systems
(and How To Manage Them)
For “Hospital Management 2015” Program by the Hospital
Administration School, Faculty of Medicine Ramathibodi,
Mahidol University
August 18, 2015
Nawanan Theera-Ampornpunt, M.D., Ph.D.
www.SlideShare.net/Nawanan
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2003 M.D. (1st-Class Honors) Ramathibodi
2009 M.S. (Health Informatics) University of Minnesota
2011 Ph.D. (Health Informatics) University of Minnesota
Currently
Faculty of Medicine Ramathibodi Hospital
• Instructor, Department of Community Medicine
• Deputy Executive Director for Informatics (CIO/CMIO)
Chakri Naruebodindra Medical Institute
Contacts
SlideShare.net/Nawanan
www.tc.umn.edu/~theer002
Introduction
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Outline
Why: Health & Health Information
What: Health IT in Hospitals
How: Hospital IT Management
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Health &
Health Information
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Let’s take a look at
these pictures...
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6Image Source: Guardian.co.uk
Manufacturing
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7Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3
Banking
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8ER - Image Source: nj.com
Healthcare (on TV)
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(At an undisclosed nearby hospital)
Healthcare (Reality)
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• Life-or-Death
• Difficult to automate human decisions
– Nature of business
– Many & varied stakeholders
– Evolving standards of care
• Fragmented, poorly-coordinated systems
• Large, ever-growing & changing body of knowledge
• High volume, low resources, little time
Why Healthcare Isn’t Like Any Others
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Input Process Output
Transfer
Banking
Value-Add- Security
- Convenience
- Customer Service
Location A Location B
But...Are We That Different?
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Input Process Output
Assembling
Manufacturing
Raw
Materials
Finished
Goods
Value-Add- Innovation
- Design
- QC
But...Are We That Different?
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Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value-Add- Technology & medications
- Clinical knowledge & skills
- Quality of care; process improvement
- Information
But...Are We That Different?
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• Large variations & contextual dependence
Input Process Output
Patient
Presentation
Decision-
Making
Biological
Responses
Recognizing Variations in Health Care
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“To Computerize”“To Go paperless”
“Digital Hospital”“To Have
EMRs”
Why Adopting Health IT?
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• “Don’t implement technology just for
technology’s sake.”
• “Don’t make use of excellent technology.
Make excellent use of technology.”(Tangwongsan, Supachai. Personal communication, 2005.)
• “Health care IT is not a panacea for all that
ails medicine.” (Hersh, 2004)
Some Quotes
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Management Point #1:
Stop Your
“Drooling Reflex”!!
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Management Point #2:
Focus on Information &
Process Improvement,
Not Technology
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Back to
something simple...
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To treat & to care for their patients to their best abilities
Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen)
What Clinicians Want?
given limited time & resources
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• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
High Quality Care
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Information is Everywhere in Healthcare
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“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA.
2010 Sep 15;304(11):1227-8.
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24
WHO (2009)
Components of Health Systems
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WHO (2009)
WHO Health System Framework
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• Safe
– Drug allergies
– Medication Reconciliation
• Timely
– Complete information at point of
care
• Effective
– Better clinical decision-making
Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/
Achieving Quality Care with Information & ICT
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• Efficient
– Faster care
– Time & cost savings
– Reducing unnecessary tests
• Equitable
– Access to providers & knowledge
• Patient-Centered
– Empowerment & better self-care
Achieving Quality Care with Information & ICT
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(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark IOM Reports
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• To Err is Human (IOM, 2000) reported
that:
– 44,000 to 98,000 people die in U.S.
hospitals each year as a result of
preventable medical mistakes
– Mistakes cost U.S. hospitals $17 billion to
$29 billion yearly
– Individual errors are not the main problem
– Faulty systems, processes, and other
conditions lead to preventable errors
Health IT Workforce Curriculum Version
3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d
Patient Safety
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• Humans are not perfect and are bound to
make errors
• Highlight problems in U.S. health care
system that systematically contributes to
medical errors and poor quality
• Recommends reform
• Health IT plays a role in improving patient
safety
IOM Reports Summary
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31Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/
(Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg
To Err is Human 1: Attention
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32Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: Memory
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• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59
• Print subscription $125
• Print & web subscription $125
Ariely (2008)
16
0
84
The Economist Purchase Options
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• Print & web subscription $125
68
32
# of
People
# of
People
To Err is Human 3: Cognition
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• It already happens....(Mamede et al., 2010; Croskerry, 2003;
Klein, 2005; Croskerry, 2013)
What If This Happens in Healthcare?
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35Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr
2;330(7494):781-3.
“Everyone makes mistakes. But our
reliance on cognitive processes prone to
bias makes treatment errors more likely
than we think”
Cognitive Biases in Healthcare
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• Medication Errors
– Drug Allergies
– Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
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Management Point #3:
“To Err is Human”
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External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
Memory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making &
Clinical Decision Support Systems (CDS)
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Example of “Alerts & Reminders”
Reducing Errors through “Alerts & Reminders”
(A Form of Clinical Decision Support System)
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Why We Need ICT
in Healthcare?
#1: Because information is
everywhere in healthcare
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Why We Need ICT
in Healthcare?
#2: Because healthcare is
error-prone and technology
can help
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42http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
Fragmented Healthcare
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Why We Need ICT
in Healthcare?
#3: Because access to
high-quality patient
information improves care
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Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement
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• Guideline adherence
• Better documentation
• Practitioner decision making
or process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder
Documented Values of Health IT
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Management Point #4:
Link IT Values to
Quality (Including Safety)
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Outline
Why: Health & Health Information
What: Health IT in Hospitals
How: Hospital IT Management
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Use of information and communications
technology (ICT) in health & healthcare
settings
Source: The Health Resources and Services Administration, Department of
Health and Human Service, USA
Slide adapted from: Dr. Boonchai Kijsanayotin
Health IT
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Use of information and communications
technology (ICT) for health; Including• Treating patients
• Conducting research
• Educating the health workforce
• Tracking diseases
• Monitoring public health.
Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe)
2) World Health Assembly, 2005. Resolution WHA58.28
Slide adapted from: Mark Landry, WHO WPRO & Dr. Boonchai Kijsanayotin
eHealth
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eHealth Health IT
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth & Health IT
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Health
Information
Technology
Goal
Value-Add
Tools
Health IT: What’s in a Word?
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Hospital Information System (HIS) Computerized Physician Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)
Various Forms of Health IT
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m-Health
Health Information
Exchange (HIE)
Biosurveillance
Information Retrieval
Telemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
Personal Health Records
(PHRs)
Health IT Beyond Hospitals
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Ordering Transcription Dispensing Administration
CPOEAutomatic
Medication
Dispensing
Electronic
Medication
Administration
Records
(e-MAR)
Barcoded
Medication
Administration
Barcoded
Medication
Dispensing
Health IT for Medication Safety
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Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Health Information Exchange
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56WHO & ITU
Achieving Health Information Exchange (HIE)
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Outline
Why: Health & Health Information
What:Health IT in Hospitals
How: Hospital IT Management
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58Image Source: socialmediab2b.com
IBM’s Watson
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59Image Source: englishmoviez.com
Rise of the Machines?
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• CDS as a replacement or supplement of
clinicians?– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
The “Greek Oracle” Model
The “Fundamental Theorem” Model
Friedman (2009)
Wrong Assumption
Correct Assumption
Clinical Decision Support Systems (CDS)
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Management Point #5:
Don’t Replace
Human Users.
Use ICT to Help Them
Perform Better.
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Some Risks of Clinical Decision Support Systems
• Alert Fatigue
Unintended Consequences of Health IT
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Workarounds
Unintended Consequences of Health IT
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Management Point #6:
Health IT Also Have
Risks &
Unintended Consequences
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Balanced Focus of Informatics
Technology
ProcessPeople
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Management Point #7:
Balance Your Focus (People, Process, Technology)
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67The sailboat image source: Uwe Kils via http://en.wikipedia.org/wiki/Sailing
The destination
The boatThe sailor(s) &
people on
board
The tailwind The headwind
The
direction
The speed
The past
journey
The sea
The sail
The current
location
IT & Organizational Context
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Management Point #8:
Know Your Context &
Align IT with Context
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“The Sail”
Carr (2004) Carr (2003)
IT as “The Sail”
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Strategic
Operational
ClinicalAdministrativeCPOE
ADT
LIS
EHRs
CDSS
HIE
ERP
Business
Intelligence
VMI
PHRs
MPIWord
Processor
Social
Media
PACS
CRM
4 Quadrants of Hospital IT
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Resources/capabilities
Valuable ?
Non-Substitutable?
Rare ?
Inimitable ?
NoCompetitive
Disadvantage
Yes
NoCompetitive
necessity
NoCompetitive
parity
Yes
Yes
No
Preemptive
advantage
Yes
Sustainable
competitive
advantage
From a teaching slide by Nelson F. Granados, 2006 at University of Minnesota Carlson School of Management
IT as a Strategic Advantage
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Management Point #9:
Identify Your
Strategic IT Assets
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People
Techno-logy
Process
“The Sailors"
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74Ash et al. (2003)
The “Special People"
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75Ash et al. (2003)
• Administrative Leadership Level
– CEO• Provides top
level support and vision
• Holds steadfast
• Connects with the staff
• Listens
• Champions
– CIO• Selects champions
• Gains support
• Possesses vision
• Maintains a thick skin
– CMIO• Interprets
• Possesses vision
• Maintains a thick skin
• Influences peers
• Supports the clinical support staff
• Champions
The “Special People"
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76Ash et al. (2003)
• Clinical Leadership Level
– Champions• Necessary
• Hold steadfast
• Influence peers
• Understand other physicians
– Opinion leaders• Provide a balanced
view
• Influence peers
– Curmudgeons• “Skeptic who is
usually quite vocal in his or her disdain of the system”
• Provide feedback
• Furnish leadership
– Clinical advisory committees
• Solve problems
• Connect units
The “Special People"
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77Ash et al. (2003)
• Bridger/Support level
– Trainers & support team• Necessary
• Provide help at the elbow
• Make changes
• Provide training
• Test the systems
– Skills• Possess clinical
backgrounds
• Gain skills on the job
• Show patience, tenacity, and assertiveness
The “Special People"
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Management Point #10:
Manage Your
“Special People” Well
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A True Story of Failure to
Involve Users in Hospital IT
Implementation
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Management Point #11:
Involve Users Early &
Intensively in Your Process
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81Image source: Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle
http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp
Gartner Hype Cycle
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82Rogers (2003)
Rogers’ Diffusion of Innovations:
Adoption Curve
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Management Point #12:
Influence Your People’s
Behaviors through
Managing their
Expectations & Attitudes
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• Communications of project plans & progresses
• Workflow considerations
• Management support of IT projects
• Common visions
• Shared commitment
• Multidisciplinary user involvement
• Project management
• Training
• Innovativeness
• Organizational learning
Theera-Ampornpunt (2009, 2011)
Success Factors of Hospital IT Adoption
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Lorenzi & Riley
(2004)
Leviss (Editor)
(2010)
Resources on Change Management
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• Healthcare is complex
• Health IT can benefit healthcare through
– Information delivery
– Process improvement
– Empowering providers & patients
• The world is moving toward health IT
• Management of hospital IT is crucial to success
– Balance of “People, Process & Technology”
– Know your organization (“context”)
– Strategic mindset
– Project & change management
Summary
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87Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/
Patients Are Counting on Us
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Download Slides
SlideShare.net/Nawanan
Contacts
www.tc.umn.edu/~theer002
Q & A