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Evi Setianingsih.,S.Kep.,Ns
Outline
. The Road to Digitizing Healthcare
. What is a Smart Hospital?
. Toward a Smart Hospital
3
Health &
Health Information
4
Lets take a look at
these pictures...
5
SmartManufacturing
6
SmartBanking
7
Healthcare (OnTV)
9
WhyHealthcare Isnt (Yet)Smart?
Life-or-Death
Difficult to automate human decisions
Nature of business
Many & varied stakeholders
Evolving standards of care
Fragmented, poorly-coordinated systems
Large, ever-growing & changing body of
knowledge
High volume, low resources, little time
10
But...Are We That Different?
Banking
Transfer
Location A Location B
Value-Add
- Security
- Convenience
- Customer Service
11
But...Are We That Different?
Manufacturing
Value-Add
- Innovation
- Design
- QC
12
But...Are We That Different?
Health care
Value-Add
- Technology & medications
- Clinical knowledge & skilled providers
- Quality of care; process improvement
- Customer service
- Information 13
Standardizing Health care
14
The World of Smart Machines
To go paperless To computerize
the hospital
To Have
To become a
EHRs
Digital Hospital
17
SomeSmartQuotes
Dont implement technology just for
technologys sake.
Dont make use of excellent technology.
Make excellent use of technology.
(Tangwongsan, Supachai. Personal communication, 2005.)
18
Being Smart #1:
Stop Your
Drooling
Reflex!!
19
Being Smart #2:
20
Smart Hospital
Digital Smart Hospital
PaperlessHospital"
23
Outline
The Road to Digitizing Healthcare
. What is a Smart Hospital?
. Toward a Smart Hospital
24
Microsoft Health Future Vision
25
ConnectingPeople toaHealthyFuture
With
Personalized CareKaiserPermanente
Back to
something simple...
27
What CliniciansWant?
To treat & to care
for their patients
to their best
abilities, given
limited time &
resources
28
High Quality Care
Safe
Timely
Effective
Patient-Centered
Efficient
Equitable
29
Informationis Everywhere in Healthcare
30
InformationinMedicine
32
WHO (2009)
WHO Health System Framework
33
WHO (2009)
Being Smart in Healthcare
Safe
Drug allergies
Medication Reconciliation
Timely
Complete information at point of
care
Effective
Better clinical decision-making
Being Smart in Healthcare
Efficient
Faster care
Time & cost savings
Reducing unnecessary tests
Equitable
Access to providers & knowledge
Patient-Centered
Empowerment & better self-care
Landmark Institute of Medicine Reports
36
Patient Safety
To Err is Human (IOM, 2000) reported
that:
44,000 to 98,000 people die in U.S.
hospitals each year as a result of
preventable medical mistakes
Mistakes cost U.S. hospitals $17 billion to
$29 billion yearly
Individual errors are not the main problem
Faulty systems, processes, and other
conditions lead to preventable errors
37
Summary of These Reports
38
To Err is Human1: Attention
# of
The Economist Purchase Options People
41
What If This Happens in Health care?
It already happens....
(Mamede et al., 2010; Croskerry, 2003; Klein,
2005; Croskerry, 2013)
42
Cognitive Biases in Health care
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781
43
Common Errors
Medication Errors
Drug Allergies
Drug Interactions
Ineffective or inappropriate treatment
Redundant orders
Failure to follow clinical practice guidelines
44
Being Smart #3:
To Err is
Human
45
Clinical Decision Making
PATIENT
Perception
CLINICIAN
Attention
Inference
DECISION
Elson, Faughnan & Connelly (1997)46
Reducing Errors through Alerts & Reminders
47
Why We Need ICT in Health care?
48
Why We Need ICT in Health care?
49
Fragmented Healthcare
http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf 50
Why We Need ICT
in Healthcare?
Because
#3: access to
high-quality patient information
should improve care
51
Why We Need ICT in Healthcare?
Guideline adherence
Better documentation
Practitioner decision making or
process of care
Medication safety
Patient surveillance &
monitoring
Patient education/reminder
53
Being Smart #4:
Link IT Values to
Quality (Including Safety)
54
Health IT
Slide adapted from: Mark Landry, WHO WPRO & Dr. Boonchai Kijsanayotin 56
Health IT:Whats in aWord?
Health Goal
Information Value-Add
Technology Tools
58
VariousFormsofHealthIT
Electronic
Health
Records Picture Archiving and
(EHRs) Communication System
(PACS)
59
Health IT Beyond Hospitals
Health Information
Exchange (HIE)
m-Health
Telemedicine &
Telehealth
60
Health IT for Medication Safety
Automatic Electronic
CPOE
Medication Medication
Dispensing Administration
Records
(e-MAR)
Barcoded
Medication Barcoded
Dispensing Medication
Administration
Health In formation Exchange
Government
Hospital B
Hospital A
Clinic C
Lab Patient at Home
My Life-Long Dream...
Achieving Health Information Exchange (HIE)
N = 3, Interface = 3
N = 5, Interface = 10
# Interfaces = N(N-1)/2
Friedman (2009)
Being Smart #6:
Dont Replace
Human Users.
Use ICT to Help Them
Perform Smarter & Better.
76
Unintended Consequences of Health IT
77
Unintended Consequences of Health IT
Workarounds
78
Being Smart #7:
Health IT Also Have
Risks &
Unintended Consequences
79
Balanced Focus of Informatics
Technology
People Process
80
Being Smart #8:
Balance Your Focus
(People, Process, Technology)
81
IT & Organizational Context
The current location
The speed
83
I TasThe Sail
Operational
86
Being Smart #10:
Identify Your
Strategic IT Assets
87
The Sailors
People
Techno-
Process
logy
88
The Special People
http://www.gartner.com/technology/research/methodologies/hype-cycle.js
RogersDiffusion ofInnovations: Adoption Curve
Rogers (2003)
98
Success Factors of Hospital IT Adoption
Communications of project plans & progresses
Workflow considerations
Management support of IT projects
Common visions
Shared commitment
Multidisciplinary user involvement
Project management
Training
Innovativeness
Organizational learning