topic 04 health systems design and basic concepts · corporate solutions 13 vocera, protime,...
TRANSCRIPT
Kevin Robertson, MBA
Topic 04Health Systems Design and Basic Concepts
ACS-2816 Health Information Systems
Winter 2020
Topic 4 Outline
2
HIS in Health Care
Understanding HIS
Factors Developing and Implementing HIS in Health care
Reading: Chapter 6, p189-208
Two Questions
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What role do HIS play in health care?
What approaches can we use to design and implement HIS in health care?
Topic 4 Outline
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HIS in Health Care
Understanding HIS
Factors Developing and Implementing HIS in Health care
HIS within Manitoba – Digital Health
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Manitoba Digital Health provides Information services to the province of Manitoba
Setup to consolidate ICT shared services across the Province
“Provide the right information to the right people at the right place at the right time…”
Organised into Solution Groups
Introduction to Digital Health
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Acute CareLong Term
Care
Cancer Care Manitoba
Coordinationof Care
Business Office
Project Management Office
Architecture & Standards
Corporate Solutions
Application & Integration Solutions
Training Services
PCIS Office
Diagnostic Services
ICT – Information and Communication Technologies
Coordination of Care
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Services delivered to private clinics (EMR’s), hospitals and care homes, also government
Client Registry
eChart
eHealth Hub
Episodic Encounters Information Sharing
DPIN (also Manitoba Health)
Patient Access Reporting Tool
Coordination of Care
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PCIS Office
Primary Care/Community Information Systems EMR Adoption Program
Data Extracts for government
Does not include Clinical Engineering applications for data collection and medical services (MRI, Radiology etc.)
Cancer Care Manitoba
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Provides a complete array of services and applications to support the cancer patient journey and the patient’s family
Relatively new partner joining Shared Health
Laboratory Information System
Nuclear Atomics
In-Sixty Patient Journey – still in development
Mature knowledge base
Visit: CancerCare Manitoba
Diagnostic Service Manitoba
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Provides testing services and image archive and retrieval service
Diagnostic Testing Services
Laboratory Information System (legacy/new)
Diagnostic Imaging (AGFA RIS/PACS)
Digital Mammography
ARIA DSM (billing)
Visit DSM
Acute Care
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Supports Hospitals, Emergency Rooms, Urgent Care Allscripts EHR
ADT Surgery Information Systems Schedulers MedRec (Medicine Reconciliation) Pharmacy (Cerner, Pyxis) Almost anything to do with patient management
Does not include Clinical Engineering applications for data collection and medical services (MRI, Radiology etc.)
Long Term Care
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Supports Personal Care Homes and government agencies
Panorama – immunisations, outbreaks, vaccinations
IPHIS – Public Health Information System
TB Registry
Episodic Encounters Information Sharing
Corporate Solutions
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Vocera, ProTime, Regional Dictation, Staff Time Keeping, Oculys, Promiso (Workforce Planning)
RL6 (Patient safety and risk management)
Application & Integration Solutions (AIS) Custom Development, Integration, Business
Analytics, Web Hosting, Application Management, SharePoint, Key Survey
Example: Organ Donor, ER Wait Times
Computer Training Services Learning Management System
Architecture & Standards
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Security
System Architecture
Enterprise Architecture Standards
Encryption Standards
Password Standards
HL7
Enterprise Information Standard
Business Office
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Helping to manage the secondary value chain
Provides finance management, accounting, contract management services
SAP (developed under BPSP/WHRA)
IMPACT (Contracts DB)
Project Capital & Funding Submissions
Charge Model
Request for Resources (RFR)
Project Management Office
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Responsible for delivering large healthcare projects
Consists of a core group of Project Analysts, Coordinators and Project Managers
Supplements by a large team of contractors provide services that cannot be leveraged internally
E.g. Quality Assurance, Business Analysts and Project Managers
Request For Proposals/Information
Information & Communications Technology
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Hardware Computer Desktop Services PC’s, Printer and other devices Data Centre (Level 4 Security)
Network Wifi Hardwire
Service Desk
Database Administration
Telecoms
Delivery of New Services
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Strategy Driven by Medical Programs & Government
Typically project driven
ConstraintsPriorities ,Time Resources - funding
Long term based on 5 year plan
Has to be adaptive to new situations
Intake process controls allocations
What is a System?
19Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 6.1, p235
Conversion of datainto information
How Can a Computer System Help in Health Care?
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What determines the success of an Information System Hardware? Software? Meeting users’ requirements? Workflow integration?
Variety of users, expectations and knowledge levels Health care professionals Administrators Clerical personnel Patients Operational personnel
How a Computer System Impacts Health Care?
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Health care system
Determines the need for a computer system
Determines the requirements for the system’s operation
Variety of organizational impacts
Who controls the information?
Who is responsible for the accuracy of the data?
Who will finance the system’s operation?
How a Computer System Impacts Health Care?
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Variety of sociological impacts
Workflow impacts
Roles and responsibilities
Ethical and legal, patient confidentiality
Both technical and organizational factors determine the success of a computer system in healthcare
Functions of Computer Systems in Healthcare
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Each health area create special requirements
Computer systems have been applied in a variety of healthcare areas
In general relates to some aspect of information management
Functions of Computer Systems in Healthcare
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Application areas for computer systems Data acquisition and presentation Record keeping and access Communication and integration of information Surveillance Information storage and retrieval Data analysis Decision support Education
Functions of Computer Systems in Healthcare – Data Acquisition
25Figure sources: http://lubbockonline.com/stories/111708/bus_356846319.shtml http://www.upwards.com.tw http://www.huffingtonpost.com/2010/09/29/feds-reopen-probe-into-me_n_743225.html
Current challenges• Data explosion• Data interfaces
Functions of Computer Systems in Healthcare – Record Keeping
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Primary function
Several departments have their own record keeping system (Labs, Radiology, Pharmacy, etc.)
Many vendors involved
Figure sources: http://www.clarionadulted.org/ehealthrecordmgmt.htm http://www.stjoe.on.ca/about/ecare.php
Functions of C. Systems in Healthcare –Communication & Integration
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Team communication & integration essential
HIS / EHR role
Information spread out (inpatient/outpatient info)
Information integration challenges
Figure sources: http://jp.fujitsu.com/group/kyushu/en/business/health.html http://www.asiahealthspace.com
HIS / EHR
HIS / EHR
Functions of Computer Systems in Healthcare – Surveillance
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Timely reaction to data critical
Data overload challenge
E.g. Lab system flagging abnormal test results
E.g. Pharmacy system flagging drug interactions
Public Health
Figure sources: http://www.csc.com http://www.discovermagazine,com
Functions of Computer Systems in Healthcare – Info Storage & Retrieval
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Information sharing
Storage organized and indexed, e.g. registry systems
Variety of users and needs
Figure sources: http://jp.fujitsu.com/group/kyushu/en/business/health.html http://www.asiahealthspace.com
HIS / EHR
HIS / EHR
Functions of Computer Systems in Healthcare – Data Analysis
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Decision makers need help for large amount of data available
Trend analysis
Spot abnormalities
Statistical analysis
Figure sources: http://apprisehealthinsights.com/state-hospital-utilization-comparisons-updated/
Functions of Computer Systems in Healthcare – Decision Support
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Patient care advice
Diagnosis and treatment planning assistance
Figure sources: http://www.informationbuilders.be/images/img_glossary/KPI2.jpg http://4.bp.blogspot.com
HIS / EHR
Functions of Computer Systems in Healthcare – Education
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Information & knowledge complexity, must learn how to learn
Lifelong training
Computer-aided
instruction
Clinical decision
support systems
Figure sources: http://frontpagemag.com/wp-content/uploads/2011/05/edu.jpg
Topic 4 Outline
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HIS in Health Care
Understanding HIS
Factors Developing and Implementing HIS in Health care
Identifying and Analyzing the Need for a Computer System - Issues
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What is the need? Clinical Administrative Research
What is the motivation? Quality of care Cost of care Access to care Information collection
Identifying and Analyzing the Need for a Computer System - Issues
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Lesson learned from previous systems
HIS facilitate healthcare delivery, but there are challenges Poorly organized workflows Information integration Communication / interface to other systems
First, understand the need, then search for techniques to address it, and not vice versa
Identifying and Analyzing the Need for a Computer System - Issues
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Many possible solutions to a broadly defined problem
Dedicate time to the problem definition phase before moving to the solution phase
HIS needs investment of labor, cash and time Fixed budget challenge
How to estimate benefits and ROI Financial benefits Health benefits
Understanding HIS –Where Do We Start? -> High Level View
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Define the problemStatement of the system’s objectivesPriorities, conflicting goals List of candidate functions
Off the shelf, adapt or develop
System design within organization Install, testing, training, evaluating and
maintenance
Understanding HIS – A Case Study
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A major teaching hospital purchased and installed a large computer system that assists physicians with ordering drugs and laboratory tests, the clinical laboratories with reporting laboratory test results, head nurses with creating nursing schedules, and the admissions staff with monitoring hospital occupancy. Personnel access the system using workstations located in each nursing unit. There also are printers associated with each unit so that the computer can generate reports for the patient charts (which continue to be paper-based) and worksheets used by the hospital staff. This information system depends on a large, dedicated computer, which is housed in the hospital complex and is supported by several full-time personnel. It has modules to assist hospital staff with both administrative and clinical duties.
Case source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Section 6.2.1, p 243-5
Understanding HIS – A Case Study
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Four major modulesPharmacy system Laboratory systemBed-control systemDiagnosis system
Everything looks good, but…→ After few months, there are mixed reviews regarding effectiveness
Understanding HIS – A Case Study
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The bad Need doctors to enter info instead of nurses No chart access at rounds Bed transfers late info Many options on screen Frustration / variable expectations
The good Improve turnaround lab tests / drugs
Understanding HIS – A Case Study
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Some key points for issues
Failed to account for key aspects in the way health professionals practice medicine
System inflexible - forces users to change patterns (workflow)
Risk to personnel’s persistent negative bias
Understanding HIS – Case Study
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Lessons learnt
Analyze where the system fits into workflow
What solution is purchased and what to adapt / customize
Design for the actual users
Involve users throughout the process
Plan for subsequent changes
Understanding HIS – Users
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Involve users during projectPeople are critical in systemsWe can’t anticipate all scenariosEffective communication Different backgrounds
Flexibility challenge Health delivery vs machine
Role of health information specialists
TIP- Organisation Change Management
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Organizational change management (OCM) is a framework for managing the effect of new business processes, changes in organizational structure or cultural changes within an enterprise. Simply put, OCM addresses the people side of change management.
Reference: http://searchcio.techtarget.com/definition/organizational-change-management-OCM
Topic 4 Outline
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HIS in Health Care
Understanding HIS
Factors Developing and Implementing HIS in Health care
Developing and Implementing Systems in Health Care
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The new information system will
Replace all existing computing capabilities?
Will it provide new capabilities? or
Replace some existing capabilities?
→ Depending on the answer, the tasks to perform
Developing and Implementing Systems in Health – System Acquisition Options
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Vendor systems
Functionality provided might be different from actual needs
Some features might be costly to implement
Smooth interaction among vendor systems
Contracting services vs own systems
Developing and Implementing Systems in Health – System Acquisition Options
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Buying vs building the system
Turnkey solutions Integration challenges
Vendor reputation and contract terms
Custom-designed solutions Why we should go for it?
Do we have the resources?
What about system maintenance costs?
Developing and Implementing Systems in Health – System Acquisition Options
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Technology Transfer
Innovations from research
Are they ready for prime time?
Evaluation for evidence of suitability
Difficult and challenging: technology knowledge transfer
Developing and Implementing Systems in Health – Processes Specifications
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Data is essential in health care
Many inputs (patients, labs, reports, etc.)
Many outputs (systems, clinicians, mgrs, etc.)
Multiple uses (clinical, admin, legal)
Data movements everywhere
One of the most important tasksNeed to understand data flows
Developing and Implementing Systems –Building a New System
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Not very common
Software engineering
Software development lifecycle process
Software maintenance costs
→ There are always alternatives when implementing a system in health care
Developing and Implementing Systems –Solution Delivery Lifecycle
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The ‘Waterfall’ model
Requirements
Design
Implementation
Quality Assurance
Release
Maintenance
Developing and Implementing Systems –Solution Delivery Lifecycle
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Requirements & Analysis
Design – what is implemented? hardware / software, etc.
Implementation
Testing – requirements met?, user acceptance
Release – Go-live
Maintenance – people changes, costs, etc.
Developing and Implementing Systems –Solution Delivery – Requirements
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Functional What is it we want the system to do? What is in-scope and what is out-of-scope? Business flows
Non-Functional Performance (access time, report time) Backups & Recovery Standards Security
Developing and Implementing Systems –Solution Delivery – Design
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High level system design (context diagram)
Technical Design Infrastructure Architecture
Software Solution Design Database design Application architecture Integration & API Roadmap
Developing and Implementing Systems –Solution Delivery - Implementation
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Buy vs Build
Integration
Build Software
Configuration
Screens (GUI)
Reports (often left to end of project)
Data Conversion
Developing and Implementing Systems –Solution Delivery - Quality Assurance
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Validation & Verification
Does the system do what it is supposed to do?
Performance testing
Test Plan – how is testing to be done, criteria?
Test Scripts
Test Data
User Acceptance Testing
Developing and Implementing Systems –Maintenance
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Often called “Operations”
Application & User Support
Software Maintenance
Patches and Updates Application Operating System Infrastructure Refresh/Growth
Problems – Transferring a Project to Op’s (T2P)
Developing and Implementing Systems –Building a New System – SW Lifecycle
59Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 6.5, p 256
The ‘Spiral’ model
Developing and Implementing Systems –Building a New System – SW Lifecycle
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Spiral Model Risks Limited initial prototype, how much we do on
first iteration? Several cycles and limited functionality Scalability challenges
→ Experience needed to make correct assessments
→ If system entails risks to health services then there is high likelihood to be rejected
Developing and Implementing Systems in Health – System Acquisition Options
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Transition From Project to Operations
Knowledge often grown and created in a project
Project Team are generally not operational Difficult to do two jobs
Backfilling skilled/knowledgeable staff
Developing and Implementing Systems –Hospital Information Systems
62Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 6.4, p 254
Developing and Implementing Systems –Incorporating Remote Services
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Health care systems do not operate in isolation internally or externally
Need to communicate to outside
Interfaces / standards
Specific business arrangements Public access
Vendor / service providers contractual
Specific group of users
Developing and Implementing Systems in Health – Integration & Interoperability
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Integration – Connecting data from separate systems seamlessly
Interface – mechanism to transfer data from one source to another Transport Layer Based on standards (HL7) Point-to-Point Publish subscribe Automate vs Manual
Interoperability Ability to make external applications and services look like
part of the main application Minimise “hopping” between applications Data/information appears to be part of the same application
Developing and Implementing Systems –Designing for Effectiveness – Factors
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Quality and style of user interfaceFor the user, system’s interface is the systemConsistency / CleanData entry
ConvenienceAccessible wherever and whenever neededMobility Logging
Developing and Implementing Systems –Designing for Effectiveness – Factors
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Speed and response
Capacity for demand
Timely & readily access
Reliability
Minimum risks to data loss
Redundancy
Workarounds
Developing and Implementing Systems –Designing for Effectiveness – Factors
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SecurityAuthorized personnel easy accessBiometricsRole, group & location accessData privacy
IntegrationMultiple systems Sharing data / standards
Developing and Implementing Systems –Planning for Change
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System implementation takes time
How to minimize risks?
Users demo
Incremental installation
Prototypes
How to increase user acceptance?
Training for different users
User support
Health Systems Design Wrap-up
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Variety of Health Information Systems
Turnkey systems
Web-based services
Customized solutions
Vendor dilemma
Commit to a major vendor
Deal with a variety of vendor solutions and customized in-house subsystems
Health Systems Design Wrap-up
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Maintenance strategy
HIS is a political and technical processDifferent groups with conflicting priorities,
goals and values
HIS alter workflows & rolesHow to minimize disruption to organizational
infrastructure?
Strategy to identify and deal with political forces
Two Questions (Recap)
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What role do HIS play in health care?
What approaches can we use to design and implement HIS in health care?