the impact of ehealth on healthcare professionals and organisations: health information management...
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The impact of eHealth on Healthcare Professionals and Organisations: Health Information Management Systems in Modern Health Care. Shemer J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)TRANSCRIPT
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Health Information
Management Systems in
Modern Health CareProf. Joshua Shemer
ICTAHC – The Israeli Center for Technology Assessment in Health Care
Barcelona, March 2010
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The Israeli Health System –
National Insurance Law
• National Health Insurance Law based on principles of justice, equity & solidarity
• Each citizen has the right receive a standardized basket of health services
• Ministry of Health responsible for health services to be supplied by the 4 Health Care Organizations
• 4 non-profit HMOs – Clalit, Maccabi, Meuhedet, Leumit
• Payment - capitation basis
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Maccabi Healthcare Services
• Maccabi is the 2nd largest health fund in Israel
• 1.8 million members
• Over 3,500 physicians
• Over 3,000 clinics
• 152 branches
• Functions within the framework &
constraints of the National Health
Insurance Law
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Maccabi’s Vision
• Achieve Total Health for its members
• Provide integrative and personally-tailored health
care for each member
• Promotes excellence in the quality of medical
care, knowledge and service
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Diagnostics Drugs
Purchasing
Policy
21%
Physicians
Payment
Guidelines
24%
Oversight
Admin.
Increased
efficiency
NIS 879M NIS1,579MNIS 1,141M NIS 409M NIS 430MNIS 435M
Budgetary Efficiency Processes - (“Piston” System)
9% 9%
Purchasing
Guidelines
Other
medical
7%
Increased
efficiency
Hospitals
Agreements
30%
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Health Information Technology (HIT)
• H.I.T. is a TOOL not a goal
• The goal = OUTCOME
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H.M.I.S. Targets (Organizational Level)
Health Management Information Services
• Decision processes based on qualitative
information & knowledge
• Continuity of medical data
• Continuity of care - integration
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H.M.I.S. Targets (Organizational Level)
• Improvement & increasing efficiency of health
care processes
• Increasing clinical safety & quality
• Better documentation
• Better customer services
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Rationale & Feasibility of H.I.T. in
Maccabi
• Equal access to medical records throughout the country
• On-line diagnosis
• Reliable diagnosis due to digital tools
• Improved quality control & assurance
• Archiving capabilities
• Sharing information among physicians for treatment & consultation
• Lower cost
• Customer Relationship Management
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Telemedicine in Maccabi Today
• E-Laboratory
• E-Prescription
• Tele-Diagnosis
• Tele-Ophthalmology
• Tele-Consultation
• Remote Monitoring of Chronic Patients
• Medical Support by Call Center
• Patient Online Web Site
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Maccabi’s Integrated Information System
INFRASTRUCTURE
Clinic
Extr
anet
Internet
Intra
net
Members Members Members Members
Medical
Control
Admin
Control
Payment
Control
Reimburse-ment
Control
Doc. Clinic
Doc. Clinic
Pharmacy
Specialist
Consultant
Paramedic
Diagnostic
Center
Firewall
Backup
Computer
Main Computer
IDC
Mgmt. of
Insured
People
IDC
Mgmt. of
the Fund
IDC
Mgmt. of
Service
Providers
Drug
consumptio
n control
Labs
control
Tele
radiology
Web
Services
CMRERP
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Imaging
Visits &
Hospitalization
Medications
Lab
Results
Treatments
Demographic
parameters
Medical
HistoryFamily
History
Maccabi Central Medical RecordComputerized Data Available for Patient Tracking & Followup
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Health Value Added (HVA)
HVA links between:
clinical indicators & budget
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Organizational
Processes
(Bureaucracy)
Perceived
Quality
Member
Satisfaction
Quality of
Clinical
Care
Meeting
Budgetary
Objectives
Management Through Setting Strategic Objectives
& Measuring Performance - Health Value Added
(HVA)
Managing the
Organization in
order to
achieve Total
Health
Physician
Satisfaction
Employee
Satisfaction
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• Overall satisfaction with health plan
• Growth in the number of new members
• Number of members that switch to a
competing plan
• Satisfaction with healthcare services
• Satisfaction with administrative services
Perceived Quality (Member Satisfaction)
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Expenditures in accordance with Budget:
Expenditures on Hospital Services
Expenditures on Physician Services
Expenditures on Medications
Overall expenditures
Fiscal Responsibility
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• Measurement at all levels of the
organization:
National
Regional
Local Branch
Physician
• Constructive Competition at each level
HVA Principles
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Quality
indicators
Diabetes
Members’
satisfactionFinancial
indicators
HVA – The Tool
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HVA – The Results
Mammography 2002-2009
Mammography
51.9 51.3 52.7
63.167.7 65.3 68.4 71
0
10
20
30
40
50
60
70
80
2002 2003 2004 2005 2006 2007 2008 2009
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Pneumovax Vaccine among 65+
2002-2009
Pneumovax
35.5
44.451.1
59.362.6 65.5
68.973.2
0
10
20
30
40
50
60
70
80
2002 2003 2004 2005 2006 2007 2008 2009
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To sum up:
Health Value Added (HVA)
Promoting “total health” through
quality-based strategic management
utilizing integrated performance
measurements
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Cardiac Heart Failure Program
Model of Chronic Health Care
Management
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Information System Flowchart
Information
Systems
Maccabi
Healthcare
RF
Patient’s homeMaccabi
M4A
CI Call
Center
Family
doctorRegional
CI
Center
Information
System
M4A
Technical
support
center
Patient
Blood *
pressure
* Pulse
Weight*
HUB
IPV
PN
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In Conclusion
• I.T. is a major tool to measure clinical outcomes and control budget
• It needs strong infrastructure to broadly utilize data online
• Provides continuity on database & information integration
• Implementation of telemedicine is required both today & in the future e.g. Chronic Congestive Heart Failure Program
• HVA model controls, assesses and measures medical performance within a balanced budget
• I.T. is a strong management tool
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THANK YOU