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 ...

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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

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Imag

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rchi

ve

Perf

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dure

Step

Man

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Imag

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idpl

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Middleware

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XDS middlewareXDS middleware

OF

Acq

uisi

tion

Mod

alit

y

Imag

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ve

Per

form

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Step

Man

ager

Imag

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idpl

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AD

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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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