How Information technology can help in healthcare reform

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How Information technology can help in
healthcare reform

By Magdy Khairallah
Chairman of Information Technology and
communication Chamber Data Management System
DMS CO.
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Management of information System in healthcare
industry
Goals
Improve Quality
Reduce cost
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Traditional mode of practice
Managed Care
Health Reform
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Managed Care
Outcomes managements
Quality
Research
Work Transformation
Health Reform
Cost
Accreditation Requirements
Timely Decision Making
New Technologies
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Why Quality ?

• In 2000, the Institute of Medicine estimated that
  between 44,000 and 98,000 Americans die each year
  from preventable medical errors1.Subsequent
  studies have estimated That the number may be
  twice as high2.
• Medical errors are killing more people per year,
  in the U.S., than breast cancer, AIDS, or motor
  vehicle accidents3.
• The lack of immediate access to patient
  healthcare information is the source of one- ?fth
  of these errors4.

1Kohn, L., J. Corrigan, and M. Donaldson. To Err
Is Human Building a Safer Health System.
Committee of Health Care in America, Institute of
Medicine. 2000. 2HealthGrades. In-Hospital
Deaths from Medical Errors at 195,000 per Year,
Health Grades Study Finds. July 27, 2004.
3Institute of Medicine and Centers for Disease
Control and Prevention. National Center for
Health Statistics Preliminary Data for 1998 and
1999. 2000. 4Health Research Institute Global
Technology Center. Reactive to Adaptive
Transforming Hospitals with Digital Technology,
Price Waterhouse Coopers. 2005.
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• 80 of errors were initiated by
• miscommunication, including missed communication
  between physicians,
• missing information in medical records,
• mishandling of patient requests and messages,
• inaccessible records,
• mislabeled specimens,
• mis?led or missing charts, and
• inadequate reminder systems1.

1 Smith, Peter, et. al. Missing Clinical
Information During Primary Care Visits, The
Journal of the American Medical Association.
February 2005.
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Why Quality ? Patient Safety In American
Hospital July 2004
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Why Quality Medical Errors
38 of patients reported experiencing at least
one specific error related concern, most commonly
misdiagnosis (22 of patients).
Burroughs TE et al. Academic Emergency Medicine
2005. Total national costs of preventable
adverse events estimated at 19bn

Zahn, Miller JAMA 2003/ Healthgardes July 2004.
Between 18 to 28 of patients in UK, USA,
Canada, Australia and New Zealand reported
medication / medical error over the last 2
years.
Medical Medication Errors in
Sicker Adults. Health Affairs. June 2003
Diagnostic error comprise a substantial and
costly fraction of all medical errors and are the
second leading cause for malpractice suits
against US hospitals. Dr Mark
Graber. Academic Medicine Oct 2002
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality
Team work
Focus on patient
Quality principles
Continues improvement
Infrastructure
HW SW and network Laws, regulations
Work Transformation
Applications
Advanced Health information system
Tools ways
Minimize human errors discover unknown
relations interface with equipment, data
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
infrastructure
HW Sw and network
Laws and Regulations
Link Among Hospital Departments and System
Infrastructure
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• HMIS Infrastructure

HMIS
Application Servers
Network Topology OS
Hardware
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality
Applications
Advanced Health information system That
can Assist Alert Operate Monitor Improve
Communication
Work Transformation
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality
Assistance, request information the clinician
perceives to be important in the clinical care
process.
Work Transformation
The inverted knowledge Pyramid
Consultant
Middle Grade Doctor
Junior Doctor GP
Patient
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Management of information System in healthcare
industryForces Demanding Work Transformation
Quality

• Assistance,
• Diagnosis

Work Transformation
Standard related procedure

• Nursing care planes

Case treatment procedure
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Assist Drs by suggested right diagnosis
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Assist Drs by suggested right diagnosis
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Assist by suggest the diagnosis
Assist Drs by suggested right diagnosis
All major specialities
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality
Alerts, must either provide a clinician with
significant, timely information that posses a
real, immediate risk to a patient that
medication errors could be within the top 10
causes of death in the United States. Synopsis
of the Patient Safety Work Group RECOMMENDATIONS
TO THE PATIENT SAFETY FORUM November 16, 2000
Work Transformation
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality

• Alerts,
• Drug to Drug Interaction
• Drug to food interaction
• Drug to allergy
• an order for amoxicillin in a patient with past
  anaphylaxis to penicillin.
• Drug to medication
• prompting the user to order glucose checks
  after ordering insulin) or drug guidelines to
  the physician at the time of drug

Work Transformation
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Forces Demanding Work Transformation
Drug to Drug interaction Drug to food
interaction Drug to allergy Drug to diagnosis
Drug to medication Avoid spilling errors (e.g.,
Celebrex, Celexa, Cerebyx). Maximum dose for
high-risk drugs
LAB
Radiology
Validation
Pharmacy
Network communication
Blood bank
Order Entry
Results Reporting
diet
Review orders results from Medical record
O/R
Results Reporting
Clinical data
Clinical knowledge Data Base
Results Reporting
Financial RECORDS
Contract rules exceptions
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Drug to Drug Interaction
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Order entry screen with Drug to critical data as
allergy
Parastamol
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality
Monitor
Deviation of actual from standards and reasons
Work Transformation
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality
Monitor
Create Standards for health procedures or use DRG
Work Transformation
Compare actual practice against standards
Generate Key performance indicators
Corrective action
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Improve Communication
Improve Internal communication
ADMINSTRATION
HMIS
CRM Online catalog order After
sales Support
Clinical
Web access
Financial
Full Paperless environment
Decision Support
Messaging middle ware
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality
Work Transformation
Cost
Better services less cost more competitive
Standards costing Actual costing
Costing and quality relations
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
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Management of information System in healthcare
industry
Forces Demanding Work Transformation

• Needs to
• Decrease Cost maintain quality
• More quality less complication
• Less complication reduce of stay /diagnosis
• Medical Record Shorten investigation time
• reduce of stay
• Reduce of stay /diagnosis reduce cost of
  health care
• Reduce cost of health care opportunity to
  extend healthcare coverage within the same budget
  
• Opportunity to extend healthcare coverage within
  the same budget reduce need for new hospitals

Quality
Cost
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality

• Needs to
• Decrease Cost maintain quality
• Better Utilization of health Resources (NHRP )
• Establish national health map
• Redistribute resources against demand
• Direct Healthcare investments
• Empower preventive medication
• Improve the efficiency of medical equipments
  through MMT
• Improve HR capabilities (CME, Time and resource
  planning)

Cost
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Management of information System in healthcare
industryForces Demanding Work Transformation

• Decrease Cost maintain quality
• Control medical supply
• Compare Standards Vs. Actual
• Improve tracking capabilities
• Validation and Verification (VV)
• Better budget utilization
• Decrease Cost through new technologies
• Implement film less x rays
• Analysis of Outsource verses owning
• Accurate immediate accounting calculations

Work Transformation
Cost
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Management of information System in healthcare
industry
Accurate immediate accounting calculations

• Online calculation and generation of charges
  based on selected policies and online posting to
  GL
• Contract rules , exception rules
• Approval criteria
• Override

Work Transformation
Cost
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Management of information System in healthcare
industry
Accurate immediate accounting calculations

• Online calculation and generation of charges
  based on selected policies and generate online
  posting to GL
• Contract rules , exception rules
• Approval criteria
• Override
• Rich in functionality
• Support multi financial category
• Automatic calculation of profit and loss
• Support doctor fees
• Support insurance claims
• Support multi sponsor
• Designed especially for hospital environments
• Fully integrated with ACP, ACR, GL

Work Transformation
Cost
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Accurate immediate accounting calculations

• Alert functions
• Alert when patient limit exceed
• Alert when company exceed limit
• Alert when outstanding payment delayed
• Control cash management, claims management
• Flexible to meet the changes in health facility
  work flow, policies
• Facility to track and audit trail
• Rich in analysis indicator
• Reduce manual work
• Automatic calculation of all charges
• Automatic posting to general ledger
• Automatic adjustment Single Key-stroke at update
  financial category will generate internal
  hundreds of actions

Work Transformation
Cost
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Product Profile (Cont.)

• Reduce work required through
• Online posting of any transaction

Contract plans and exceptions
Allocate charges against any service
Cash Management
Create Invoices
Generate Journal entries
Update Vendor/Customer Credit Limit
Update ACR ACP
Cash Bank accounts
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Product Profile (Cont.)

• The effect of Updating the financial category

Contract plans and exceptions
New F.C
Allocate charges against any service
New F.C
Cash Management
New F.C
Create Invoices
Reverse
New F.C
New F.C
Generate Journal entries
Update Vendor/Customer Credit Limit
New F.C
New F.C
Update ACR ACP
Cash Bank accounts
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Managed Care
Changes in the health care delivery system,
particularly the emergence of "managed care," are
breaking down the organizational barriers that
have stood between providers, insurers, medical
researchers, and public health officials . Costs
of technology have decreased, while pressures to
contain health care costs have grown .
Information technologies are helping to achieve
this transformation in the way health care is
delivered . Innovations such as computer-based
patient records, hospital information systems,
computer-based decision support systems,
community health information networks,
telemedicine, and now internet-based virtual
medical records are impacting the cost, quality,
and accessibility of health
Work Transformation
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Quality
Managed Care

• Changes in the health care delivery system will
  help in calculating cost of bed which needs
• Accurate patient account to distribute
• Patient part,
• Doctor part,
• Insurance part,
• Hospital part
• Decrease in cost of technology
• Innovation
• CPR
• HIS
• EMR
• VMR

Work Transformation
Managed Care
Cost of technology
Cost
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Supporting International Standards
USE International Standards as CPT4
ICD10
CPT4, ICD10
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Eliminate user intervention by implementing
Inelegant LAB Interface engine
(2) Test Query
(3) Test Requests
(4) Results
(1) Samples
HMIS Sheet
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Integration With Hospital Equipments
EKG
Interface
Patient ID
X-ray equipments
Interface
Lab Equipments
Laparoscopy
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Graphical Indicator to represent the management
indicators
Graphical Indicator to represent Management
indicators
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Management of information System in healthcare
industry
Forces Demanding Work Transformation

• QIDW quality in daily work
• Define vital processes
• Define quality measures for each process
• Define quality indicators
• Information system to collect daily information
  And indicators
• Analysis of the gaps between standards and actual
  
• PDCA
• -Plan -DO -Check - ACT
• Patient Education, other issues

Quality
Managed Care
Work Transformation
Accreditation Requirements
Cost
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Accreditation Requirements
New policy
Encourage private investment in health Phase out
MOH hands on ownership, operational, and
delivery of health care services
Authoritative oversight, and regulatory capacity
Health care finance reform policy (Cooperative
insurance)
Together with
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Accreditation Requirements
New policy
Phase out MOH hands on ownership, operational,
and delivery of health care services

• A phase approach
• Separate operational from regulatory body within
  MOH.
• Establishing Management infra-structure for
  public and private sector and develop health
  standards.
• Outsource facility management.
• Implement Information system to provide all KPI.
• Assessment and accreditation.

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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Accreditation Requirements IT and as tool
An internet solution To help health facility For
accreditation
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THE ACCREDITATION PROCESS
IMPROVEMENTS
N
APPLICATION FOR ACCREDITATION
PEER REVIEW
ACCREDITED
SATISFIED?
SATISFIED?
Y
Y
SURVEYOR ASSESSMENT
SELF ASSESSMENT
PREPARED?
N
IMPROVEMENTS
N
RECOMMENDATIONS IMPLEMENTATION
SATISFIED?
Y
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Accreditation Process Block Diagram
PHASE I
PHASE II
PHASE III
Accreditation Process
Organize Project
Conduct Hospital Diagnostics
Maintain Total Quality System
Conduct formal Accreditation Audit
Design and Update Cost, Quality and Management
Systems System
Implement Total Quality Systems
Prepare accreditation audits
Project management
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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Patient
6
7
5
Clinical Findings
Advise Actions
1
Advice
Result
Clinical Finding
Doctor
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2
Clinical Finding
4
Clinical data systems Lab system ,EPR
3
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Management of information System in healthcare
industry
Forces Demanding Work Transformation

• Results of implementing DSS
• Correct diagnosis on 40 of Drs diagnosis list
  pre-DSS
• In 12 of cases ,DSS caused doctors to add
  correct diagnosis
• In 6 DSS caused Dr to drop it
• Clinical decision support systems Prof Jeremy
  Wyatt
• National institute of clinical Excellence, London

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Management of information System in healthcare
industry
Forces Demanding Work Transformation
Decision Support

• Needs for Information to draw the health map
• A comparison between available resources and its
  status
• the distribution of health beneficiary
  population geographically
• Needs to decide which services preferred to be
  outsourced
• Needs to improve national material purchase and
  Its stander as FDA
• National key performance Indicators
• Comparative analysis
• What If analysis
• Data Minning

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Management of information Decision-making
levels within an Organization
Managed care
What Goals are to be achieved
Strategic Decision Making
Developed of CPR
Tactical Decision Making
How Goals are to be achieved

• Order Entry
• Results Reporting
• Clinical Data
• Network
• communication

operational Decision Making
How goals are implemented
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More details
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Workload BY Clinic Type
Workload BY Doctor
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Concurrent review to all hospital sensitive
relations in single interface