paper less hospital
TRANSCRIPT
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The Workings of a Paperless Hospital
SELAYANG HOSPITALDR. ABDOLLAH SALLEH
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Paperless Hospital - Concept
Computerized hospital information system- paperless & filmless
Central ObjectivesProvide integrated care delivery system
Sharing of information
Automation of work processes
Greater efficiency
Storage and use of data
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THIS: Information System
Three Major System
Clinical: All clinical processes
Management information System
Administration
Finance
Office automation
Communications
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System versionsDuplicates of the integrated system made
available for various functions
Build and Test Version Production Version
Train Version (a duplicate of theproduction version with test patients
and scenarios) Parallel Paper records / transactions
for first three months.
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FunctionsComputerisation of various functions
Appointments and scheduling
Registration, admit / discharge / transfer
Documentation of clinical data
Clerking
Monitoring and charting Documenting diagnosis
Documenting outcome
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Functions (contd) Ordering tasks and tests
Ordering drugs and supplies
Entering results of procedures andtests
Viewing results
Referral and communications
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Benefits of a Computerised
Information System
Sharing of data and information
Automation of transactions or
work processes
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Appointments and schedulingUse of a common
scheduling book
Can be viewed by all
Ability for care
providers to schedule
appointments where
ever and whenever
Clients may call in or
present themselves
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Registration Each patient given a
unique identifier
Demographic andbilling data used for
all other functions
during same and
subsequent visit
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On-line admission / discharge / transfer
Inpatient admissions 150/day
Outpatient visits 1000/day
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Clinical documentation
Clinical data recorded using electronic
forms
Clinical problems / diagnosis entered
into a problem list
Allergies entered into allergy list
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Recording and Retrieving Information
Entering orders
Computerized PatientRecord
(5GB/month)
180,000 records:250Gigabytes
Concurrent Users9
00 to 1000 /hour
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Structured Data Entry
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The Electronic Medical Record
A record of all data generated during
care of patient Data captured or collected
Data generated on performing clinical
tasks
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On line transactions: Order
management(Provider order entry)
Order from a standard list
(tests, drugs, provisions)
Items has cost / charge
and other factors
attached
Allow additional
information to beattached
Decision support
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The Ward Round ±Retrieving information via Wireless
Transmission
22 wireless notebook
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Completing orders and tasks
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Receiving specimens System integration
/ interface
Use of Bar Codetechnology for
recognition and
communications
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Communications by sharing of data:
Receiving orders in the lab
Automated charging based on tasks
150 barcode readers
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Laboratory tests
Computer to
computer
communications
Machine-system
interface
Automated QualityControl
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Taking images
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Capture of Digital Images
Cassettes
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Storage of Digital Images
Image Server
Juke-Boxes
X-ray Images - 3990 Gb
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Viewing Images ± high definition
monitors
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Reviewing X-rays in Emergency
Department
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Dispensing drugs
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Dispensing drugs
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Dentist¶s procedure room
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On-line admission/ discharge and billing
Inpatient admissions 150/day
Outpatient visits 1000/day
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Data Analysis&
Interpretatio
n
Data Management
Data Storage
Data Retrieval
and Display
Data Entryor Capture
DataDistribution
DataTransfer
Data
Generation
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INFORMATION SYSTEMELEMENTS
Data Entry / CollectionFormat Data Display / View
Database Tables
SummaryReportsStatistical Analysis
Links to other systems
QUERY Archive
SQL
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Data Entry Hardware- using keyboard and mouse
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Ubiquitous PC Workstations
1200 PCs
1 PC / clinic room
5-6
PCs per ward
2 PCs per OR
I PC per lab desk
I PC per office worker
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Client
Application Server Database Server
Client Client
LAN
Client
3 TIER INFORMATION SYSTEM ARCHITECTURE
DATA
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Data Distribution: Servers
80 servers«(hardware / software)
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Business continuity
System availability
Help desk
Preventive strategies Alternative system
Redundancy
Back up Upkeep and prevention of data loss
Integrity of EMR
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THIS: Networking Security
Security
Access and authentication
Privileges
Culture re: confidentiality of information
Proxy server ± internet, Firewall with
Intrusion detection system No floppy/CD at workstation
Antivirus
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Support - 24 hour help desk
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Utilization
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Users Satisfaction
Survey on ER Doctors (December 2001)
90% prefer working with THIS
Satisfaction rate: 64% to 85%
70% found that EMR is excellent or very good in
terms of use
70% rated the process of ordering investigation
through THIS excellent or very good
60% rated the process of viewing results through
THIS excellent or very good
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User Satisfaction Survey 2003
1%
27%
53%
12%
7%
0%
10%
20%
30%
40%
50%
60%
Respondent
Unknown
Doctor
Nurse
Allied_staff
Clerk
Online Survey among staff (n=144)
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User Satisfaction
94% prefer working with THIS
94% experienced THIS improve workefficiency
80% satisfied with THIS
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User Satisfaction
60% rated viewing patient information
through THIS excellent or very good
80% rated system data integrity very
good or average.
80% rated system data security very
good or average
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Benefit Study
The business case of THIS in Selayang
Hospital was mainly to improve the quality of
healthcare services and the hospitalsystem«
A comparative study with typical
government hospital - to look for any
qualitative and quantitative benefits of THIS The study is still on-going
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Cost Benefit
Study still in progress - comparison with
Klang Hospital (documentation process/time
motion study) Some of the Early findings
40% time reduction for admitting patient
to the ward
10% time reduction during patient stay
70% time reduction for discharge process
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Cost Benefit
70% time reduction in time for viewing x-ray
following portable x-ray request
10% reduction in staffing for registration
processes
50% gain in efficiency in scheduling patient
80% reduction of time in viewing patientrecord
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Benefit Study
From the observation during the study,some qualitative benefits found wasthat Selayang has:
Easy availability of data and data sharingamong providers improves patient safetyin management of illness
Better patient record management and
security Improve workflow through reengineering
work processes
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What have been successful in
Selayang Hospital?
Prior process re-engineering minimizes hitches
Change Management Process Led toorganisation wide acceptance
Automation in Laboratory and Imaging ProcessesEliminate of redundancy & Improved accuracyand work efficiency
Filmless operation achieved - all internal images
are digitised Integration and interfacing of systems (a qualified
success)
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What were
less successful?
Achieved Paper-less but not paperless
Has to fulfil Regulation / medico legal paper
System performance - speed
Critical factor for acceptance
Underestimate the huge clinical data
Standardization - Need for a lean database
Views are queries of the database!
Training of personnel
Shortage of staff dedicated as trainers
Rely on on the job training
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Value
Knowledge transfer in medicalinformatics
Patient safety Vital information at point of care
A nursery bed for future IT
development Knowledge Management with
technology
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Critical Success Factors
Top management commitment
Commitment of + acceptance by Physician and
other users
Business process reengineering
Thorough System testing and simulation
Adequate number of Professional IT staff for
system administration ( System integrity andsecurity, business continuity) and
troubleshooting.
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Current Development
Fully automated Pharmacy Information
System with Decision Support System
Improve Reporting and Data analysis
Enhance the Clinical Documentation
Module (Decision support.)
Enhance mobile computing function
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The Future...
Selayang Hospital has a long way to go«
Previously : Concerned about the technology
and whether it can be done It is not the technology that matters«
It is how we use the technology to improve
decisions, behavior and effectiveness,
efficiency, outcomes and ultimately patientsatisfaction
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THANK YOU