Hospital Information Systems Hospital as a big complicated healthcare organisation

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Hospital Information SystemsHospital as a big
complicated healthcare organisation

• Danny Solomon
• Senior Architect, iSOFT
• danny.solomon_at_isoftplc.com
• www.isoftplc.com

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Objectives

• Understand information requirements of hospitals
  and other health-care organisations
• Understand issues and challenges in the
  life-cycle of health-care information-systems
• Understand some of the history and some future
  directions
• Introduce iSOFT

challenge
dispute
interrupt
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Agenda

• What is a health-care information system? Whats
  it for?
• Issues in their creation and deployment why is
  it hard?
• Where they have come from where they are going
• iSOFT

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What is a health-care information system? Whats
it for?

• Requirements
• Context
• How it all relates to CfH

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Requirements of a health-care information system

• Information-systems to run health-care
  organisations (HCOs)?
• OR
• Information-systems to manage the records of
  patients cared for in those organisations?

BOTH
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What is an HCO?
Guys
citizen
Identity
Clinical information
. . . . . .
London
National
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Anatomy of a hospital

• Multiple facilities (sites)
• Wards
• Clinics
• Diagnostic services
• Radiology, Pathology, etc
• Pharmacy
• Treatment
• Theatres, Modalities
• Medical Records
• Coding

• Links to other organisations
• Local Primary care, Community
• National DoH, CfH, national information systems
• Catering
• Portering
• Physio
• Phlebotomy
• Management
• HR, Finance, etc

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Information-systems to run health-care
organisations

• Whats going on?
• Whats planned?
• Where are my patients?
• What reports do I need to generate?
• Get my money
• Am I about to run out of money?
• Run my clinics
• Run my waiting lists
• Run my wards
• Run my theatres

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Information systems to manage patient records

• Administrative
• Where do they live
• Booked for a clinic?
• On a ward?
• GP
• Next of kin

• Clinical
• Whats wrong with them
• What am I planning to do to them?
• Order a test
• See the result
• Refer them on
• Describe them

Division is not clear cut

• Information Governance (IG) issues
• Who can see what?
• Is restricting to demographics safe?
• Who can see clinical?
• Is ward location clinical or demographic?
• How much information is shared? To whom?
• What does the patient expect?

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Issues in the creation and deployment of
health-care information systems
Why is it hard? Total cost of ownership (TCO)
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Why is it hard?

• Well, is it hard?
• Empirical evidence suggests it is
• Beacon examples are generally not reproducible
• Productising is an issue
• Medicine is not a science
• Out of the box, computers are good at numbers,
  not people
• Organisational setting is complex
• Different across different markets
• Change control and management is always hard
• Some specifics

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Why it is hard

• Booking a clinic is like booking a flight?
• Slots not constant
• Different resources required for different
  slots/clinics
• Recipient has to explicitly accept
• Over-booking rules
• Patients arent predictable
• Clinic booking is the easy bit!

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Why it is hard

• Lots of different kinds of users
• Clinicians
• Docs
• Different grades, specialties, experiences,
  training, backround
• Nurses
• PAMS
• Managers
• Administrative staff
• Patients
• Well
• Unwell
• Worried well
• Vulnerable
• Young / old
• Expert / non-expert

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Why it is hard

• Lots of different kinds of users
• Doing different kinds of things
• Seeing patients
• Clinics, wards, AE, telephone
• Planning budgets
• Organising resources
• Human, equipment, consumable, locations
• In many different settings
• Organisational
• Hospital (wards, clinics), Community, Practice,
  Lab,
• Specialty
• Paed, Geri, Med, Surg,
• Everyone likes to do things their own way

Dont panic
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Maintaining the balance
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There is commonality we can exploit
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One product, many solutions
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Product vs solution

• Product software
• Solution software configured and deployed onto
  a managed technical architecture
• Many areas to consider TCO

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Total cost of ownership (TCO)

• Forget shelf prices
• What will it cost my organisation to procure,
  contract, implement, run, update and ultimately
  retire an information system?
• What if I do nothing?
• A useful way of examining areas that make this
  whole process hard

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Typical TCO model
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Past, present and Future

• Health-care information systems where they have
  come from where they are going
• History
• Drivers
• Direction of travel

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Where health-care information systems have been

• Organisation often based on physical artefacts
• Eg Hospitals
• Lots of local autonomy
• Need to maintain links with labs
• Maintain own coding departments
• Maintain own IT infrastructure
• Information systems
• Local procurement
• PAS critical
• Clinicals less so
• Lots of local activity at a departmental level
  nightmare to manage
• Order-comms typically an early requirement/win
• EPR / Prescribing not common in secondary care

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Drivers

• Health-care organisation is changing
• Everywhere, quite frequently
• From the centre
• Reporting requirements
• Spine compliance
• PBR
• Locally
• (some) clinicians demanding better tools
• Access to knowledge best practice, decision
  support, lose the paper
• Procurement model is changing
• Local ? Regional ? National
• Do once and share
• Procurement, configuration

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Drivers

• Health-care organisation is changing
• Procurement model is changing
• Deployment model is changing
• Critical data under a GPs desk?
• Critical data in a hospital server-room?
• DR-capable data-centre
• Information-sharing becoming critical
• Support the patient journey
• Empower the patient
• Where thats a good thing
• Avoid unnecessary errors

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Direction of travel
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iSOFT

• Mission
• Market leadership
• Business strategy
• Global healthcare and social reform

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Our mission

• To be the global leader in the healthcare
  software applications market.
• iSOFT is working with patients, clinicians, other
  healthcare professionals, administrators and
  governments to help transform the delivery of
  healthcare.
• We focus on satisfying the needs of all
  individual stakeholders, whoever they are, and
  however they participate in the supply chain of
  healthcare provision. Our solutions not only meet
  the current need, they also describe the future
  of healthcare.
• Our inspiration and motivation is to improve the
  life experience of citizens worldwide

iSOFT inspired by life.
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Leading the healthcare software applications
market
Financials
Scale of business

• Customers
• 1,700 hospitals
• 6,000 family doctors
• 18 countries in five continents
• Employees
• 2,700 healthcare IT specialists
• 1,000 technology and development professionals
• Two dedicated offshore development and solution
  design centres in India

• Fourth largest software and computer services
  business on the LSE
• Market capitalisation of over 900m (US1,600
  million)
• Stock market listing in July 2000
• Revenues grown from 17m to 262m
• Profits increased by over 2,000

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Our business strategy
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The needGlobal healthcare and social reform

• Healthcare is undergoing rapid, unprecedented
  change
• Forward referencing solutions required by
  citizens, clinicians, policy makers
• Work to implement the necessary systems will take
  place over the next 10 years

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Summary

• Successful well managed healthcare applications
  business
• Consistent and focused business strategy
• Large and growing international market
  opportunity
• Leader in the supply of advanced application
  solutions
• Strong positive differentiation from small number
  of credible competitors
• Well positioned in respect of future growth
  opportunity in both existing and new
  international markets

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Re-cap Objectives

• Understand information requirements of hospitals
  and other health-care organisations
• Understand issues and challenges in the
  life-cycle of health-care information-systems
• Understand some of the history and some future
  directions
• Introduce iSOFT