1. Healthcare needs information systems ! ICTExpo 2005 Do more with less William Grimson 14 th April 2005

2. Context

4. efficiency cost containment cost effectiveness demand Team-care homecare patient charter eHealth evidence-based medicine shared care computerisation patient empowerment clinical audit genetic medicine accreditation

5. 6 Levels of EPR (UK – NHS)

7. Knowledge

8. The 21st-Century Health Care Systems Quality as a system feature. Goals: safety, effectiveness, patient-centeredness, timeliness, efficiency, quality and equity. Three guiding strategies: patient-centered, knowledge-based, and careflow-based systems.

9. Knowledge Management The goal of KM is to improve organizational performance by enabling individuals to capture, share, and apply their collective knowledge to make optimal decisions ….. in real time, that is to take actions that will affect the outcomes.

10. CDR Future: Knowledge Driven Care by Cerner (AMIA, 2002) Timeliness of Delivery Depth of Knowledge Reactiv e Interactive Proactive Safety Alerts Structured Care Textbook & Journals Post-hoc CDR Alerts Ad hoc CPOE with ADE alerts Ad hoc CPOE With SOC Alerts Decision-driven Flow Just In Time Push Reference Texts Standard of Care Alerts (SOC) CPOE using Evidence-based Order Sets CPOE from within Linked Pathways / Protocols EMR KDC Computerized Physician Order Entry (CPOE)

11. Even the Best Become Outdated...

12. Knowledge refinement Patient Records Knowledge Bases Decision Tools Knowledge Refinement outcomes Evidence based medicine

13. Do we want to build, pay for, and maintain Information systems without having Informatics Standards?

14. efficiency cost containment cost effectiveness demand Team-care homecare patient charter eHealth evidence-based medicine shared care computerisation patient empowerment clinical audit genetic medicine accreditation

15. Two things about the future … What happens time Technological change & advances present predictions Regarding change and technological advances … we tend to over- estimate them in the short-term & under-estimate them in the longer- term

16. Life cycle costs Full life cycle costs need to be considered as well as all the risks over that period For cost containment it is essential that alternatives are considered … i.e. looking well into the future to assess impacts and hence inform current decision-making

17. Design 0.1 Build 1 Maintain 5 Operating cost/staff 100 Where are the real costs over the life-cycle ? Don’t skimp on things at this stage !!!

18. we need a vision, we need to plan, we need to have a rational approach …and we need Standards?

19. Addressing the Issues Information role of the Health Information and Quality Authority (HIQA) Information access and governance Information standards Information deficits and developments The Electronic Healthcare Record ICT Information and service planning

20. Information Standards (HIQA) National Health Information Standards Framework (Action 19) –Data standards –Technical standards –Quality standards Indicator standards (Action 20) Quality assurance of information to public (Action 21)

21. The Electronic Healthcare Record (HIQA) EHRs will be implemented on a phased basis (Action 15) –Defined and adopted through inclusive process –Implementation sites with supporting ICT infrastructure –National roll-out in line with multi-annual ICT action plan

22. ICT (HIQA) Multi-annual ICT action plan (Action 22) –Build on work of HeBe plan –Develop in cooperation with HSE and DoHC –Ensure standard approach and VFM –Support national solutions (eg SAPS,PPARS) –Enable fast and secure communications infrastructure through VPN –Support and enable eHealth applications and development of Electronic Healthcare Records (EHRs) –Address digital divide

23. The Pace of Progress It is important to note that many of the critical actions in the Strategy will be achievable through relatively modest new investment. Examples include improved use of existing information and introduction of governance framework…..Other initiatives are more heavily dependent upon investment decisions and the overall pace of new developments in the wider health system…These include investment in major ICT solutions… However, it is clear that ongoing consultation and partnership with all stakeholders will be of central importance to the implementation process throughout. (NHIS, Chapter 16, Implementation Phases)

24. Standards authorities

25. National Standards Authority of Ireland (NSAI)- HISC To contribute to the development of European or International standards for patient and hospital information systems, specifically through participation in the work of CEN TC 251, ISO TC 215, and HL7; and to advise NSAI in regard to the need for National standards in this area.

26. National Standards Authority of Ireland (NSAI)- HISC More specifically the role of HISC is to: 1. Increase awareness of the role and purpose of Health Informatics Standards in the overall delivery of healthcare in Ireland. 2. To provide a mechanism by which Ireland is represented at appropriate Standards organisations and activities. 3. To act as a conduit to bring back information and assess the impact of future requirements and regulations on the Irish situation.

27. Technology Viewpoint ISO/OMG Interface Definition Language (IDL) ISO/OMG Unified Modeling Language (UML) Computational Viewpoint Enterprise Viewpoint Results Retrieval RegistrationScheduling Order Communications StandardsConformance Engineering Viewpoint CORBADCOM DCEJavaBeans C++ Java COBOL SmallTalk Unix Win32 MVS PIDSCOAS TQS RADCIAS Information Viewpoint HL7DICOM NCPDPX12 ISO TC215 CEN TC251 Snomed Lonic ICD CPT DRG Reference Model for Open Distributed Processing (RM-ODP) © Copyright 1999 Tom Culpepper, and Tim Brinson Purpose, scope, policies. Business rules and content to be supported by the system. Encapsulation of capability, separation of functionality, and interface definition. Distributed interactions & mechanisms between the components. Description of the implementation of the system.

28. Evolution of EPR Standards

29. … evolution

30. Electrical/Information/Mechanical...