1. EHR = Care Continum Hospital Services Not just a medical emergency – part of the care continum Tromso, Norway, eHealth ‘05 Ursula O’Sullivan eMail:- osullivanu@mailp.hse.ie Web:- www.shb.ie

2. If you don’t know where you are going…. any road will get you there? Even though there are a lot of possibilities it’s still important to set a direction. ICTs are providing direction and opportunities so we need to introduce new technologies with business / service models in a way that maximises potential. EHR = Care Continum

3. eGovernment + eHealth eGovernment Access to Services and Information Citizens and their right to information Backend re-organising systems and services to provide better access eHealth Using technology to improve Healthcare delivery e.g. Telemedicine, Lab Results to GPs, Out- reach Clinics, Appointment Booking Electronic Patient Record

4. Despite the seeming chaos….. Core Transaction Systems Enterprise Systems Consumer Health Systems eLearning Systems Decision Support Systems Clinical Systems Environmental Health Systems Electronic Medical Records Clinical Data Repositories Data Integration Internet/Extranet/Intranet Computer-Telephony Integration Electronic Commerce Integrated Medical Devices Workflow Technologies Imaging Telemedical Technologies Workforce Enabling Technologies Research Systems Expert Logic GP Systems Wireless Customer Relationship Management Systems Networks/Connectivity eProcurement Laboratory Systems

5. Foundation Technologies Networks/Connectivity/CDRs/ Data Integration Internet/Intranet/Extranet Integrated Medical Devices Imaging Interactive Computer Telephony Integration ……There is structure in Healthcare Advanced Technologies  Consumer/Patient Health Systems  Electronic Commerce  Relationship Management Systems  Workflow Technologies  Research Systems  Expert Logic  Wireless

6. Today’s Health Architecture Value Creation Sample Capabilities Public Use Functions and Features of Clinical, Managed Care and Administrative Applications Core Data Systems (Patient Care, Clinical, Administration, Finance) Uniform Access to Core Systems Web Site Branding and Identity - TRUST Patient / Citizen Education Information Publishing and Communication Universal Access Intranet Work flow Technologies Self-Serve HR, Administration Browser Access to Databases (research, knowledge, medical, administrative) Establish Communications Infrastructure & Productivity Enhancers Extranet Secure Remote Communications and Access Patient Registration, appointment requests “Push” Customised Content to Patients / Diagnostic Groups Direct order entry and results GP to Health Board interaction External Access to speciifics

7. New healthcare technologies are redefining healthcare and society New healthcare technologies are redefining healthcare and society Informatics Industrial Internet Wireless Genomics & Proteomics New pharmaceuticals Digital imaging Minimally invasive surgery Nanotechnology Medical devices Greatest advances in the history of medicine are happening now through an explosion in new technology Societies have the opportunity to eliminate disease, extend life, improve health and wellness And to make healthcare more accessible, affordable and satisfying for all participants Greatest advances in the history of medicine are happening now through an explosion in new technology Societies have the opportunity to eliminate disease, extend life, improve health and wellness And to make healthcare more accessible, affordable and satisfying for all participants

8. eHealth Foundation Secure E-Health Network Infrastructure Core Healthcare Applications Longitudinal Patient Data Surveillance & Analysis Self-Service Portals Appropriate Accessible Affordable Effective Efficient Satisfying 20 th Century 21 st Century

9. Internet technologies have broadened access to data and information in a way that shatters previous models –Cost control –Information access –Clinicians, Healthcare Professionals –Patients, Citizens 1.We need to understand that large advances are coming within 3-5 years, and current investments may require replacement / upgrading 2.Develop strong healthcare professionals education programme today to prepare for the tools that will be available in the near- and mid-term EHR = Care Continum

10. A short overview of the SHB experiences addressing the challenges and opportunities of Electronic Health Record Lessons and experiences from regional implementation now applied nationally EHR = Care Continum

11. Environment 4,700 sq miles 564k population base 18,000 Staff, 6,000 field based 250 Locations Personal Computers – 6,800 Laptop Computers - 1500 Mobile Phones – 2,200 Extensive WAN and Local Area Networks EHR = Care Continum

12. Drivers Internal –Low Morale – No Communications –20 year old Paper Based processes –Need for change External –Consumerism, Patient Centered –Integration –Legislation, Regulations EHR = Care Continum

14. 10 Goals 1.Integration of patient based services 2.New ways of delivering services and information 3.Manage information as an asset 4.Manage creation of knowledge 5.Optomise use of resources 6.Create an effective organisation 7.Achieve an Electronic Health Record [EHR] 8.eEnable Clinical Systems 9.eEnable Administrative Systems 10.Develop an enabling Technology Architecture Health eSHB

15. What do we mean by that? Providing Citizen Access –Listening Days, eGovt Initiatives, Information & Knowledge Management –Medical Protocols, Research, Best Practice Development of Single Patient Record Advanced Communications Telemedicine EHR = Care Continum

16. Building Blocks eGovt eEU eBroker eCitizen eService Defined Enterprise Architecture Support Advanced Communi- cations SHBnet Information & Knowledge Management eLearning Organisation Single Patient Record eSHB New IT Systems – Labs, PACs, Radiology, EHR = Care Continum

17. Practical Examples eProcurement eServices –Births, Death & Marriages –Environmental Health, Bridges Dental Word Based Content Management System Nation-wide VPN [Virtual Private Network] Integrated patient records –Community, Mobile Computing Blended eTraining / eLearning EHR = Care Continum

18. Integrated EHR MOBILE & COMMUNITY PIMs EHR = Care Continum

19. MOBILE & COMMUNITY PIMs Integrated Service Delivery EHR = Care Continum

20. Interactive Hospital School EHR = Care Continum

21. From the chaos….. To....... Core Transaction Systems Enterprise Systems Consumer Health Systems eLearning Systems Decision Support Systems Clinical Systems Environmental Health Systems Electronic Medical Records Clinical Data Repositories Data Integration Internet/Extranet/Intranet Computer-Telephony Integration Electronic Commerce Integrated Medical Devices Workflow Technologies Imaging Telemedical Technologies Workforce Enabling Technologies Research Systems Expert Logic GP Systems Wireless Customer Relationship Management Systems Networks/Connectivity eProcurement Laboratory Systems

22. Applications Blueprint

24. Consolidation of access for the Patient Information Management System (including Lab, PACS and Community PiMS) E-enablement of Health Board Processes (where currently addressed) SHBnet Infrastructure collaboration (Hardware/Software and Communication links) Content Management Application (Intranet and other WEB Form Applications) Change Management (program to foster e-culture throughout the Southern Health Board’s community of users) Migration to Web Services environment Benefits to Date EHR = Care Continum

25. Lessons Learned Check the Power Supply… Involve Users Plan for ‘big picture’ Be Flexible Develop ‘Partnership’ approach EHR = Care Continum

26. Where are we going now? Continue to implement Health eSHB goals but on a national basis New National EHR Contract [iSOFT] New National Health Strategy Recent replacement of 11 Health Boards by one national organisation - HSE Continue to work with eGovt. initatives eServices, Benchmarks, EU Indicators, Govt. VPN, develop new means of delivery e.g. Digital TV, Health Portal, GP Access, etc…. EHR = Care Continum

27. ‘E’ …. is not just about computers and systems. It is about people and processes and most importantly it is about thinking differently…. eSHB….. 2001- 2005 Care Continum

28. Contact Details:- Ursula O’Sullivan eMail:- osullivanu@mailp.hse.ie Web:- www.shb.ie Phone:- 021-4922990 Hospital Services Not just a medical emergency – part of the care continum Tromso, Norway, eHealth ‘05 EHR = Care Continum