keep faith and strive forward - hisa · keep faith and strive forward development on china’s...
TRANSCRIPT
SHEN TAO
Deputy Director
Chinese Hospital Information Management Association
Keep Faith and Strive Forward
Development on China’s Hospital
Information Systems
Chinese Hospital Information Management Association
Established in 1997, and attached to Chinese Hospital Association
The most influential HIT professional association in mainland China
CHIMA
Health Informatics Society of Australia
Established in 1992
Agenda
Background
HIT Construction Features in China
Obstacles and Challenges
China Healthcare Industry Brief
31 provinces and municipality cities 1.368 billion people 974.4 thousand medical institutions
24.7 thousand hospitals
9790 thousand medical staff 2795 thousand licensed doctors
Mainland1754
1998
2435 2812
3166
0
1000
2000
3000
4000
2009 2010 2011 2012 2013
bill
ion
China Total Health Expenditure
With the development of economy, the public have higher demands
for their health and pay more attention to healthcare service quality
Source: China Statistical Yearbook, 2014
Change on way of life leads to the result that chronic
disease become the main economic burden
Continuous growth on urbanization:
54.77% by 2014
Aging problem becomes more
serious: 212 million aged 60 and
above, account for 15.5%
Main Drivers of HIT Development
HIT
Government Policy
Medical Institutions Demand
IT Develop-
ment
Mar. 2009, the government launched medical reform
• Promote HIT construction that focus on hospital management and EMR
• Promote cooperation of urban hospitals and communities via IT
• Positively develop telemedicine that oriented on rural and remote areas
Nov. 2013, the overall framework of HIT construction is issued by the government
Rapid growth on healthcare demands
• Payment model reform (DRGs, zero drug price difference); healthcare service supervision and performance evaluation
• Cost control and fine management; work process optimization, better patient experience
• 4 levels of HIT platform
• 6 applications on public health, family planning, healthcare, medical insurance, drug management and comprehensive management
• 3 data bases for demographic information, EHR, EMR
• 1 private network
• 2 security systems
Rapid development and years accumulation of IT
• 30 years accumulation on healthcare institutions IT construction
• Emerging of new technologies: virtualization, cloud computing, big data, IOT, mobile……
Agenda
Background
HIT Construction Features in China
Obstacles and Challenges
38.8%
23.8%22.6%
21.0%
22.5%20.0%
0%
10%
20%
30%
40%
0
10
20
30
2010 2011 2012 2013 2014 2015(E)
Public Health
Healthcare Institutions
Growth
Source:CCW Research (2015)
68.0%
32.0%
27.8%
72.2%
28.3%
71.7%
29.8%
70.2%
30.7%
69.3%
33.0
12.2
15.1
18.6
22.5
billion
27.5
31.4%
68.6%
Investment Scale Keeps Growing
Hospital IT Investment in Latest 3
Years
19.2%
13.2%
17.0%
14.0%
24.7%
7.7%
0.9%
3.4%
0.0%
22.1%
2.4%
2.7%
7.8%
18.5%
17.0%
14.0%
12.5%
3.0%
0% 10% 20% 30%
Non-response
below 0.5
0.5-1
1-2
2-5
5-10
10-20
20-50
above 50
Tertiary Hospitals(N=335) Non-Tertiary Hospitals(N=235)
Source: Survey on China Hospital IT Status 2014-2015(CHIMA)
million
EMR Adoption
1
2
3
4What see is what get + structured module + free text entry is basically settled.Mainstream products functions become convergence
Advocated by healthcare administration bodies, generally accepted by doctors and the public
Government healthcare service supervision and performance evaluation.Real-time monitor on healthcare quality(urgent lab value, HAI).Important data source for clinical research
Higher CIS adoption rateAttention to system integration technology
Obviously Rising Attention on
Clinical Related Applications
EMR is generally accepted
Writing software become matureData utilization is
regarded gradually
Push forward the whole development of CIS
National Push on EMR Adoption
Experience based,
gradually generalize
43
2
1Feb 2010, 《The Basic Specification of EMR》
Sep 2010, 《EMR Trails Work Plan》
Dec 2010, 《The functional Specification of EMR》
Oct 2011, 《Model of EMR Grading(MEG)》
EMR Adoption Status
38.3%
34.6%
27.1%
21.2%
7.7%
71.1%
0% 20% 40% 60% 80%
No Plans Yet
Plan to Implement
Implemented
2014-2015(N=570) 2009-2010(N=926)
Source: Survey on China Hospital IT Status 2009-2010/2014-2015(CHIMA)
Drive All-round CIS Construction
5.6%
24.4%
0.0%
0.0%
7.9%
18.9%
0.0%
0.0%
3.1%
24.8%
22.6%
9.9%
0.0%
29.9%
31.4%
43.8%
27.1%
45.9%
48.0%
74.6%
8.8%
16.3%
16.8%
19.7%
23.2%
29.3%
32.6%
36.3%
36.8%
44.6%
45.8%
51.6%
52.6%
56.3%
58.1%
67.7%
71.1%
71.1%
74.2%
75.3%
0% 20% 40% 60% 80%
Regional Health Information…
Anesthesia Information System
Telemedicine system
Infection/HAI Surveillance System
Clinical Decision Support System
ECG Information System
Endoscopy Information System
Physical Examination…
Clinical Pathway Management…
PACS
Pathology Information System
ICU Information System
Clinical Knowledge Repository…
Ultrasonography Information…
Radiology Information System(RIS)
Laboratory Information System(LIS)
Electronic Medical Record(EMR)…
Outpatient and Emergency…
Inpatient Doctor Workbench
Inpatient Nurse Workbench
2014-2015(N=570) 2009-2010(N=926)
Source: Survey on China Hospital IT Status 2009-2010/2014-2015(CHIMA)
Model of EMR Grading(MEG)
Inpatient
Physicians
Inpatient
Nurses
Outpatient
Physicians
Ancillary Dept.
and Service
s
Laboratory
Procedures
Other Ancilla
ry Dept.
Records
Management
EMR Infrastructur
e
Order Entry
Lab Test Requests
View Lab Reports
Exam Requests
View Exam Reports
Inpatient Reports
Clinical Knowledge
Bases
Patient Assessment
and Management
Order Execution
Nurse Documents
Requests and
Appointments
Patient Records
Report Generation
Images
Order Entry
Lab Requests
View Lab Reports
Exam Requests
View Exam Reports
Clinic Visit Notes
Clinical Knowledge
Bases
Sample Processing
Result Records
Report Generation
Treatment Records
Surgery Scheduling,
Registration and Records
Anesthesia
ICU Monitory Data
Blood Preparation
Blood Matching
and Use
Outpatient
Pharmacy
Inpatient Pharmacy
Quality Control
Data Storage
E-authentication and
e-signature
Data Access Control
and Auditing
Backup and Disaster
Recovery
Item
sR
ole
sIt
em
s
2014 MEG Result
0
1
2
3
4
Inpatient
Physicians
Inpatient
Nurses
Outpatient
Physicians
Ancillary
Dept. and
Services
LaboratoryProcedures
Other
Ancillary
Dept.
Records
Manageme
nt
EMR
Infrastruct
ure
Eastern Middle Western
Source: National Institute of Hospital Administration
Grade 0
46.4%
Grade 1
10.4%
Grade 2
21.8%
Grade 3
15.3%
Grade 4
5.6%
Grade 5
0.3%
Grade 6
0.2%
Grades Description
Percentage, 2013
Amount
Percentage, 2014
Amount
7Fully-featured EMR and regional healthcare information sharing
0.04% 1 0% 0
6Close-loop medical data management and advanced CDS
0.16% 3 0.19% 4
5Centralized data management and consolidation of data from different depts.
0.21% 5 0.38% 9
4Hospital-wide information sharing and intermediate CDS
3.89% 94 5.61% 147
3Interdepartmental data exchange and primary clinical decision support(CDS)
13.05% 315 15.25% 400
2 Departmental data exchange 22.33% 539 21.78% 571
1 Departmental data collection 11.1% 268 10.41% 273
0 EMR not available 49.21% 1188 46.38% 1216
2014 MEG Result
2014 MEG Result2.9
22.4
6 2.8
42.2
0 2.6
72.7
91.4
83.1
73.2
91.9
82
.74
2.8
32.5
12.6
32.3
71.6
81.3
92.0
52.1
5 2.5
0
2.1
6 2.5
32.6
72.7
91.7
1 1.9
61.0
71.1
9 1.6
0
1.6
0
2.5
52.3
72.5
3
4.0
0
2.9
92.7
62.0
9
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
病房
医嘱
处理
病房
检验
申请
病房
检验
报告
病房
检查
申请
病房
检查
报告
病房
病例
记录
病房
医疗
知识
库
患者
管理
与评
估
医嘱
执行
护理
记录
处方
书写
门诊
检验
申请
门诊
检验
报告
门诊
检查
申请
门诊
检查
报告
门诊
病历
记录
医疗
知识
库
申请
与预
约
检查
记录
检查
报告
检查
图像
标本
处理
检验
结果
记录
报告
生成
一般
治疗
记录
手术
预约
与登
记
麻醉
信息
监护
数据
血液
准备
配血
与用
血
门诊
药品
准备
与调
剂
病房
药品
配置
病历
治疗
控制
病历
数据
存储
电子
认证
与签
名
病历
数据
访问
控制
系统
灾难
恢复
体系
病房医师 病房护士 门诊医师 检查科室 检验处理 治疗信息处
理
医疗保障 病
历
管
理
电子病历基
础
M-Health Application Continuous
Active
0.0%
0.0%
6.2%
10.9%
7.1%
20.7%
9.5%
14.6%
15.3%
20.2%
27.2%
45.8%
0% 20% 40% 60%
Internet of Things
Cloud Computing
RFID
Tablet PC
PDA
Wireless network
2014-2015(N=570) 2009-2010(N=1028)
Source: Survey on China Hospital IT Status 2009-2010/2014-2015(CHIMA)
Typical M-Health Applications
Outpatient Infusion Management
Mo
bile
Ward
Ro
un
d
Mobile Nursing
Typical M-Health ApplicationsM
ed
ical W
ast
eM
an
ag
em
en
t
APPs:AppointmentQueryGuidancePayment
Eq
uip
men
t Po
siti
on
ing
Data Value Gradually Showed
Co
mp
lian
ce C
heck
of
Med
ical In
sura
nce
Clin
ical P
ath
way
Man
ag
em
en
t
Use
Co
ntro
lo
f An
tibio
tics
Rem
ind
er o
f RD
U
Data Value Gradually Showed
HA
I Mo
nito
r
Lab
Urg
en
tV
alu
eA
lert
DR
Gs E
xpen
seA
nalysis
Clin
ical R
ese
arch
Focus on Improving Medical
Experience
Self-ServiceOne-Card Service ModelWeChat, Smart Phone
Example of Regional HIT
Construction
HIT private network in Fujian province:5 levels province, city, county, township and
village
86 healthcare administration bodies
1356 public healthcare institutions
10 military hospitals
37 private healthcare institutions
16000 village clinics in the future
Shanghai
•Blood Collecting and Supplying organizations
•Communities
•Comprehensive Hospitals
•New Village Cooperation Healthcare Institutions
•First-Aid Centers
•MCH Organizations
•CDC
Push Forward Residents Health
Card Regional trials in 29 provinces
Agenda
Background
HIT Construction Features in China
Obstacles and Challenges
Obstacles of HIT Development in
China
3.7%
3.3%
17.2%
20.4%
25.3%
25.6%
26.7%
38.4%
41.1%
41.8%
51.1%
67.9%
0% 20% 40% 60% 80%
Others
Unsuccessful Implementation of IT Plan
Lack of Legal or Policy Support
Lack of Clinical Leadership
Difficulty Achieving End-User Acceptance
Lack of Top Management Support
Lack of Strategic IT Plan
Lack of Medical Data Standards
Difficulty Proving ROI
Vendors Inability to Deliver Product
Lack of Staffing Resources
Lack of Adequate Financial Support
Source: Survey on China Hospital IT Status 2014-2015(CHIMA)
Rapid-growth but Insufficient
Investment
5.6%
9.4%
17.1%
0%
5%
10%
15%
20%
Total Health Expenditure as % of GDP
Imbalance of Regional Development
Different regions and hospitals present different HIT development levelEconomy
Leadership
Talents
0
1
2
3
4
Inpatient
Physicians
Inpatient
Nurses
Outpatient
Physicians
Ancillary
Dept. and
Services
LaboratoryProcedures
Other
Ancillary
Dept.
Records
Manageme
nt
EMR
Infrastruct
ure
Non-Tertiary
Hospitals
Tertiary
Hospitals
0
1
2
3
4
Inpatient
Physicians
Inpatient
Nurses
Outpatien
t
Physicians
Ancillary
Dept. and
Services
Laborator
y
Procedure
s
Other
Ancillary
Dept.
Records
Managem
ent
EMR
Infrastruct
ure
Eastern Middle Western
Lack of IT Talents
Critical shortage of multi-disciplinary talents in healthcare institutionsAverage IT FTEs in Chinese hospital is 9 (tertiary
12, below tertiary 5)──Survey on China Hospital IT Status 2014-2015(CHIMA)
Average IT FTEs in American hospital is 39──25th Annual HIMSS Leadership Survey
Difficulty in breaking through system dilemma in short termUnsatisfactory in education system
Long training cycle, Insufficient pay in return, Lots of temptation from outside……
Vendors Incapability to Meet Users
Needs
Lack of clear understanding on the complexity and difficulty of HIT industry needs for products development
Lack of professional talents
Low market concentration2622 hospitals attended MEG, 2014320 EMR vendors
Total users number of top 10 vendors is 796, account for 30.4%
Top 1 vendor’s user number 149, account for 5.7%
Source: National Institute of Hospital Administration
Top 10 Vendors, Number of Users,
2014
149
132
97
7670 66 64
5648
38
2.09
2.54
2.27 2.39 2.50 2.39 2.28
2.66 2.81
2.42
0.00
1.00
2.00
3.00
4.00
0
40
80
120
160
C62 C1 C17 C11 C15 C6 C19 C10 C13 C16
Ave
rag
e G
rad
e
Nu
mb
er
of
Use
rs
EMR Vendor Code
Low Degree of Standardization
5.6%
18.6%
3.8%
5.4%
21.8%
28.5%
38.3%
72.7%
3.3%
11.4%
5.4%
6.1%
37.7%
37.7%
52.5%
78.3%
0% 20% 40% 60% 80%
Non-response
Others
LOINC
SNOMED
HL7
ICD9
DICOM3
ICD10
2014-2015(N=570) 2009-2010(N=1028)
Source: Survey on China Hospital IT Status 2009-2010/2014-2015(CHIMA)
Conclusion
Developing Is an Unyielding Principle
Whoever seeks shall findQui cherche trouve
May this conference be a complete success!