hta e cartella clinica - unipd.itgianni/infosan/seminario_saccavini.pdf · 2006-10-19 · hta e...
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14 Giugno, 2006
HTA e cartella clinicaHTA e cartella clinica
Claudio SaccaviniClaudio SaccaviniProject Manager IHE-IProject Manager IHE-I
Università di PadovaUniversità di Padova
HTA e cartella clinicaHTA e cartella clinica
HTA e ICTHTA e ICTPavia 12 Ottobre 2006Pavia 12 Ottobre 2006
Nemocniční informační systémNemocniční informační systém
NIS
Personální, ekonomickéa správní agendy
Řízení Marketing
Účetnictví
Pojišťovna
Komplement- biochemie- hematologie- mikrobiologie- serologie- histologie- patologie- RTG- EKG, EEG, EMG- atd.
Kliniky- interní- chirurgická- lůžkové oddělení- operační sály- atd.
Ambulance- ambulance- praktičtí lékaři
LékárnaStravovací provoz
Skladové hospodářství,zásobování, evidence Doprava
Výzkuma výuka
Správa systému
EHR
Ing. Petr Hanzlíček, Ph.D.Ing. Petr Hanzlíček, Ph.D.
Perchè?Perchè?
La medicina è cambiata ...La medicina è cambiata ...
Perchè?Perchè?
... siamo in piena rivoluzione tecnologica... siamo in piena rivoluzione tecnologica
Ma molto spesso ...Ma molto spesso ...
I modelli organizzativi sono invariati ...I modelli organizzativi sono invariati ...
19/10/06
il periodo paleoHITicoil periodo paleoHITico
il primo periodo dellail primo periodo della HHealth ealth IInformation nformation TTechnologyechnology
applicazioni isolate applicazioni isolate
decisioni tecniche locali - nessuno standarddecisioni tecniche locali - nessuno standard
Diapositiva gentilmente fornita dal prof. Angelo Rossi Mori
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il periodo mesoHITicoil periodo mesoHITico
il periodo intermedioil periodo intermedio
comunicazione comunicazione tra le applicazioni tra le applicazioni
decisionidecisioni localilocali
prima generazione di standard prima generazione di standard
DICOM, EDI, CEN, HL7, …DICOM, EDI, CEN, HL7, …Diapositiva gentilmente fornita dal prof. Angelo Rossi Mori
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il periodo neoHITicoil periodo neoHITico
il periodo recenteil periodo recente
integrazione ad hocintegrazione ad hoc
piattaforme piattaforme di integrazione di integrazione
architetture architetture
di riferimento profili IHE di riferimento profili IHE Diapositiva gentilmente fornita dal prof. Angelo Rossi Mori
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L' Era ModernaL' Era Moderna
integrazione sistemicaintegrazione sistemicain ampie giurisdizioniin ampie giurisdizioni
decisioni politiche decisioni politiche a livello regionalea livello regionale
- reti sanitarie regionali- reti sanitarie regionali- infostruttura- infostruttura
Diapositiva gentilmente fornita dal prof. Angelo Rossi Mori
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Cosa fanno gli USACosa fanno gli USA
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I sette “diritti”I sette “diritti”
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I benefici ... morali!!I benefici ... morali!!
Benefits: Moral, intellectual, and practicalBenefits: Moral, intellectual, and practical
The possible benefits of interoperability in The possible benefits of interoperability in healthcare fall into three categories:healthcare fall into three categories:
The moral benefit. In 2000, the Institute of The moral benefit. In 2000, the Institute of Medicine estimated that Medicine estimated that 44,000 to 98,00044,000 to 98,000Americans are killed by preventable medical Americans are killed by preventable medical errors each year. Since that time, follow-up errors each year. Since that time, follow-up studies have indicated that the number of studies have indicated that the number of preventable deaths is even higher. For example, preventable deaths is even higher. For example, Health Grades, Inc. reported in 2004 that as Health Grades, Inc. reported in 2004 that as many as many as 195,000 Americans were killed in 2000, 195,000 Americans were killed in 2000, 2001, and 2002 by medical mistakes in hospitals 2001, and 2002 by medical mistakes in hospitals nationwide.nationwide.
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senza parole ...senza parole ...
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senza parole ...senza parole ...
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La sanità è pericolosa?La sanità è pericolosa?
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Le barriere - Le barriere - Fear of changeFear of change
Doctors’ methods and work habits are key to Doctors’ methods and work habits are key to
their ability to help patients. Doctors their ability to help patients. Doctors
understand implicitly that changing those understand implicitly that changing those
habits can affect the quality of care they habits can affect the quality of care they
deliver; but once a physician has embraced deliver; but once a physician has embraced
technology, he or she can help drive further technology, he or she can help drive further
interoperable efforts to improve healthcare.interoperable efforts to improve healthcare.
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Le barriere - costLe barriere - cost
A question from every healthcare provider is: A question from every healthcare provider is:
Where will the money come from to pay for Where will the money come from to pay for
thisthis? The answer is that some will come in ? The answer is that some will come in
the form of direct savings and some in the the form of direct savings and some in the
form of governmental and private form of governmental and private
incentives.incentives.
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Le barriere - Connecting vendorsLe barriere - Connecting vendors
Vendors—the companies that sell electronic Vendors—the companies that sell electronic health-care systems—often try to protect their health-care systems—often try to protect their market share by making sure their systems will market share by making sure their systems will not interact with anybody else’s system. not interact with anybody else’s system. Vendors have financial incentives to work Vendors have financial incentives to work against each other, not with each other. But with against each other, not with each other. But with the establishment of common standards, and as the establishment of common standards, and as healthcare providers and the public realize that healthcare providers and the public realize that interoperable systems can save lives, pressure interoperable systems can save lives, pressure will grow for vendors to give their clients will grow for vendors to give their clients systems that can connect to one another. systems that can connect to one another.
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Le barriere - Lack of standardsLe barriere - Lack of standards
Besides allowing vendors to create systems that Besides allowing vendors to create systems that don’t “talk” to each other, the lack of standards don’t “talk” to each other, the lack of standards discourages significant investment or effort discourages significant investment or effort toward an interoperable healthcare system. The toward an interoperable healthcare system. The Institute of Electrical and Electronics Engineers Institute of Electrical and Electronics Engineers sets standards for computers and Underwriters sets standards for computers and Underwriters Laboratories ensures that appliances meet Laboratories ensures that appliances meet safety specifications. Without an industry-safety specifications. Without an industry-recognized body for healthcare, the government recognized body for healthcare, the government will need to set those standards, coordinate their will need to set those standards, coordinate their establishment among groups now pursuing establishment among groups now pursuing them, or act as a catalyst for the creation of them, or act as a catalyst for the creation of standards through some other method.standards through some other method.
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The US is far behind other countriesThe US is far behind other countries
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Autocritica!!!!Autocritica!!!!
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Don’t reform! Transform insteadDon’t reform! Transform instead
Healthcare must always be about people, not Healthcare must always be about people, not about a systemabout a system. Even though people . Even though people working in the healthcare system have working in the healthcare system have great concern for patients, there are not great concern for patients, there are not always ways built into the system to always ways built into the system to encourage personalized attention and encourage personalized attention and “second looks” at difficult choices. “second looks” at difficult choices. However, a connected system of health However, a connected system of health information would make that more possible information would make that more possible by creating new and better ways to by creating new and better ways to personalize information and interact with personalize information and interact with medical information. medical information.
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Quanti siamo?Quanti siamo?
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Timeline to an Interoperable Medication Timeline to an Interoperable Medication Record for Every AmericanRecord for Every American
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E noi in Italia ...E noi in Italia ...
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... ne abbiamo almeno due ...... ne abbiamo almeno due ...
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... con la prospettiva di averne 22... con la prospettiva di averne 22
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Quando il saggio indica la luna, Quando il saggio indica la luna, lo stolto guarda il ditolo stolto guarda il dito
Dal caos ... Dal caos ...
Trento 2002
... all'ordine ... ... all'ordine ...
Padova 2004
... al nuovo caos... al nuovo caos
Medmatic@ 2006
Cartella ClinicaCartella Clinica
Diversi nomi (EHR, EPR, CDR, etc.) per Diversi nomi (EHR, EPR, CDR, etc.) per diversi concetti (Cartella di ricovero, cartella diversi concetti (Cartella di ricovero, cartella di reparto, fascicolo personale, cartella di reparto, fascicolo personale, cartella diabetologica, etc.) e sopratutto diversi diabetologica, etc.) e sopratutto diversi strumenti tecnologici.strumenti tecnologici.
Approcci diversi:Approcci diversi:
Data RepositoryData Repository
Document RepositoryDocument Repository
Repository Repository
Aspettative (molte)Aspettative (molte)
Soluzioni (poche)Soluzioni (poche)
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IHE: disaccoppiare ...IHE: disaccoppiare ...
OF
AcquisitionModality
Image Archive
Performed ProcedureStep Manager
Image Didplay
RISPACS
Diagnostiche
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... per governare... per governare
OF
AcquisitionModality
Image Archive
Performed ProcedureStep Manager
Image Didplay
OF
Acq
uisi
tion
Mod
ality
Imag
e A
rchi
ve
Perf
orm
ed P
roce
dure
Step
Man
ager
Imag
e D
idpl
ay
Middleware
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XDS middlewareXDS middleware
OF
Acq
uisi
tion
Mod
alit
y
Imag
e A
rchi
ve
Per
form
ed P
roce
dure
Step
Man
ager
Imag
e D
idpl
ayMiddleware XDS
AD
T
CU
P
XD
S R
egis
try
XD
S R
egis
try
XD
S R
egis
try
XD
S C
onsu
mer
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““Strumento di reparto”Strumento di reparto”
Funzionalità:Funzionalità:
gestione ADTgestione ADT
Order Entry (prestazioni)Order Entry (prestazioni)
Order Entry (farmacia, magazzini, diete, sale Order Entry (farmacia, magazzini, diete, sale operatorie, etc.)operatorie, etc.)
gestione workflow repartogestione workflow reparto
visualizzazione dati clinicivisualizzazione dati clinici
supporto alle decisionisupporto alle decisioni
......
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La cartella ... dei desideriLa cartella ... dei desideriCourtesy by C. Peter Waegemann
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LO strumentoLO strumento
Unico applicativo?Unico applicativo?
Uguale per tutti i reparti?Uguale per tutti i reparti?
Più applicativi?Più applicativi?
Sincronizzati?Sincronizzati?
WorkplaceWorkplace
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Disaccoppiamo ...Disaccoppiamo ...
XDS Middleware
Supporto alle decisioni
Interfaccia utente (GUI)
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... facendo attenzione!... facendo attenzione!
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ConclusioniConclusioni
Ci si deve attendere un sviluppo per la Ci si deve attendere un sviluppo per la “Cartella Clinica” simile a quello del mondo “Cartella Clinica” simile a quello del mondo radiologicoradiologico
E' molto probabile che progetti di Fascicolo E' molto probabile che progetti di Fascicolo Sanitario saranno realizzati prima di quelli di Sanitario saranno realizzati prima di quelli di Cartella ClinicaCartella Clinica
Il mercato non presenta delle “killer Il mercato non presenta delle “killer applications” ma evolverà rapidamente nei applications” ma evolverà rapidamente nei prossimi tre anniprossimi tre anni
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Perché informatizzare è ...Perché informatizzare è ...
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... non dover mai dire “mi dispiace”... non dover mai dire “mi dispiace”
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