VUB Fac Geneeskunde. Rudi Van de Velde

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1 EMR Challenges & Evolutions VUB Fac Geneeskunde Rudi Van de Velde

2 Agenda Setting the scene We need a medical record Dynamic Hollistic Patient Engagement Intelligent Mobility Towards EMR Implementation 2

3 Two core problems to solve when demand for resources and supply diverge Sustainability Demand Health services Resources available Sustainibility gap Inferential gap Time

4 LEFT Health Status 20% of Population Generates 80% of the Cost Healthy / Low Risk At-Risk High Risk Chronic Disease Early stage Acute Stage Chronic Disease Progression End of Life Care Value Cost 4

5 Dgigital penetration Digital Immigrants Digital is the norm Time 24/04/2014 5

6 ICT associated patient harm ICT related harm Opportunity for harm 24/04/2014 6

7 We need a medical record that is Dynamic Misrepresenting collective, interactive work as a linear, clear-cut and predictable workflow Provider collaboration & productivity under continuous time pressure and in constant interaction Understandable & holistic Interface not suitable for highly interruptive context. Fit the ecology of the workplace Cognitive overload due to overly structured information entry and complete information Value for the money Misrepresenting communication as information transfer. Increasing mismatch between information overload and ability to manage 24/04/2014 7

8 CDSS EMR Workflow Repository R. Van de Velde 8

9 UZBrussel Flow CPOE /day Plan 5.000/day CP EMR QUERIES/DAY ADT Billing 2.000/day /day R. Van de Velde

10 Processen Taken Clinical workflow & CDSS A Mutual Relationship 10 R. Van de Velde *

11 Protocols : Radiotherapy Planniing R. Van de Velde

12 Notify the Appropriate Person Need to know who Reminders for non-life threatening events must not interrupt clinician Escalation procedure Notification modalities Active Passive Notify at network or application logon Print on a face sheet at time of visit 12

13 The Medical Organizer 13 R. Van de Velde

14 CDSS EMR Workflow Repository R. Van de Velde 14 *

15 Barriers to the Introduction of CP Clinical implementation Complexity Data mapping Discrepancy Execution Expressivity Localization Flexibility and adaptibility Goal modeling Crossing Boundaries Model verification semantic interoperability Maintenance Information/ Rule extraction Clinician attitude Exception handling Process modeling Organizational change Organizational modeling Visualization Separation of concerns Tooling Timeline Temporal abstraction User interface & Usability System architecture Guideline translation R. Van de Velde

16 UZBrussel Case : Task Network Model

17 Then the demands of increasingly advanced technology will drive paradigm changes in how we view and manage data 1970 s era single slice CT 17

18 CT during the early 1990s (160 slices) 18

19 2006 cardiac CT (4000 slices) 19

20 Lots of Clincal data going online Lots of Genetic data coming Lots of personal data coming 20

21 Sort by: Relevant Important (Mass)-Personalized Other Points of View AND Simple R. Van de Velde 21

22 A Strange Phenomenon User Satisfaction Consumer Tech Business Hospitals Time R. Van de Velde 22

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25 OUTCOME = EXPECTED R. Van de Velde 25

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27 CDSS EMR Workflow Repository Quality Cost Access R. Van de Velde 27

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29 Interactions : Antibiotics 30

30 Interactions :Pregnancy 31

31 Context Sensitive Input 32 *

32 Order Sets 33

33 Protocols : Radiotherapy Planniing R. Van de Velde

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37 Empowering Knowledge Analytics The secondary use of EMR..just couriers, bringing our records from one doctor to another without understanding what s in them.. *

38 Full text search Text data Motivation There is a significant need to conduct full-text search Very few electronic health records (EMR) Have full-text search functionality (Natarajan et al., IJMI 2010) Improved understanding of end-user search behavior will help design. Clinical Data Ware House Structured data Smart Indexing Unstructured data 39 24/04/201 4

39 IBM Watson brings together a set of transformational technologies to drive optimized outcomes 1 Understands natural language and human speech 2 Generates and evaluates hypothesis for better outcomes 99% 60% 10% 3 Adapts and Learns from user selections and responses built on a massively parallel probabilistic evidence-based architecture optimized for POWER7

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41 Agenda Setting the scene We need a medical record Dynamic Hollistic Patient Engagement Intelligent Mobility Towards EMR Implementation 43

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45 SECURITY Therapeutic Relation

46 Therapeutische Relatie (4/4) Secretar. Nurse A Dr. X TR Patiënt Soc. Verpl. Dr. Y Spec A Dr. Z Spec A Dr. W Spec A Nurse B Duur = 3 maand Nurse C Circles of trust Opname Secretariaat Sociaal verplegenden (nota, brief,e.a..)

47 Agenda Setting the scene We need a medical record Dynamic Hollistic Patient Engagement Intelligent Mobility Towards EMR Implementation 56

48 Mobility Agressive Momentum Be able to do your work wherever In all locations At the Patient At home On the road Be able to do your at any time Be able to do your work on any device On any computer On your tablet On your smarthphone 57

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50 What to buy? DESKTOP OS Windows Mac OSX Linux BSD MOBILE OS Windows Phone ios Android BlackBerry Different Challenges Customizable Fully manageable Closed More secure Limited management possibilities 59

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52 Kaiser Permanente 61

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54 ehealth-platform In de praktijk De patiënt raadpleegt zijn geneesheer Administratieve voordelen Mogelijkheid om therapeutische relaties en geïnformeerde toestemming te registreren 63

55 ehealth-platform In de praktijk Opzoeken voorgeschiedenis via de SumEHR Online advies en guidelines Medicatieschema Medische voordelen Elektronische voorschriften Raadplegen van laboresultaten Elektronische verwijsbrief 64 64

56 Ziekenhuizen naar Artsen Dossier per instelling Niet-geadresseerd Samenwerking in zorgteam Dossier per patiënt Niet-geadresseerd Ontslagbrieven Resultaten Beelden HUBS VITALINK INTERMED Medicatieschema Sumehr Vaccinaties Gegevens delen Verzenden Voorschriften: geneesmiddelen kinesitherapie verpleging RECIP-E ehbox Brieven Formulieren Medische gegevens Niet-geadresseerd Voorschriften Verwijsbrieven Geadresseerd Eén-op-één communicatie 66

57 APB 2009 RECIP-E

58 Agenda Setting the scene We need a medical record Dynamic Hollistic Patient Engagement Intelligent Mobility Towards EMR Implementation 68

59 EPD is een werkwoord Geen IT project Proces kennis is cruciaal!

60 Gartner 70

61 Difficulties involved with EMR High Physician Online Documentation Difficulty to Achieve Success Pharmacy Laboratory PACS Results Review Computerized Physician Order Entry Clinical Decision Support Low Reliance on Physicians for Execution High R. Van de Velde 71

62 ICT-landschappen verbinden Samenwerkingsvormen: tussen gelijken? Zijn de partijen gelijkwaardig qua omvang, kennisniveau en volwassenheid? ad hoc, tijdelijk of permanent of blijven de partijen autonoom? op alle vlakken of alleen op bepaalde gebieden? Gaat men bepaalde taken uitbesteden? Is er sprake van uniformering van ICT-infrastructuur, van applicaties of zelfs van diensten en bedrijfsprocessen? Ligt de regie bij een van de alle partijen, bij of daarbuiten? R. Van de Velde 72

63 Functionaliteit Implementatie Opties Best of breed Modulair Massa - Personalisatie Monoliet In house Flexibiliteit Integratie Integratie

64 Diensten die uitbesteed kunnen Incident, problem, change & release management Security Management Physical Logical Network security & antivirus-antispam Capacity and performance management Availability Backup and restore services: Redundancy Level (Tier1-2-3) Archiving LT-MT storage Disaster Recovery Services Service Level management (24/7?) Monitoring, operations,...high availability management Response and resolution SLA s Availability SLA s Performance SLA s Disaster Recovery SLA s Governance Financial Contract management Architceture & Innovation board Apr-14

65 The Flip is about to happen We are Half way ICT associated Harm! No platform, form factor or technology will dominate ( Post-PC era) We need. 24/04/

66 Thank You