Transcript Optimization of Healthcare Operations: the eHealth Added

Optimization of Healthcare Operations: the e-Health Added Value
Optimization of Healthcare
Operations: the eHealth
Added Value
Najeeb Al-shorbaji, Director
Knowledge Management and Sharing
WHO/HQ
Geneva, Switzerland
Agenda
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Quality aspects of healthcare;
Patient safety;
Access to health knowledge and evidence;
Electronic health record: content and
functions;
5) Patient education and customer health
information;
6) Proactive healthcare: messaging, alerts,
notifications, etc.
7) An overview of the work of WHO in ehealth.
Optimization of Healthcare Operations: the e-Health Added Value
From data to knowledge
Healthcare knowledge
Healthcare information
Healthcare data
What is quality?
• Quality is the conformity between actual care and
pre-set criteria (Standards)
• Why quality is needed/required?
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Value
Safety
Efficiency
Effectiveness
Acceptability
Accessibility
Interpersonal relations
Optimization of Healthcare Operations: the e-Health Added Value
Access to online information products
• Clinicians have many clinical questions
– 5 questions per inpatient encounter *
– 5 questions per outpatient half-day **
• Many of these questions go unanswered **
– 45%of the answers are not even pursued
– Of 55% pursued, still unable to answer 28% of them
• Access to an online retrieval system improved
clinicians’ answers to clinical questions by 21% ***
• Continuous education and long-life learning
• Keep abreast of new developments, drug interaction,
etc.
Optimization of Healthcare Operations: the e-Health Added Value
Online information products and services
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Evidence-based guidelines
Evidence-based databases
Full-text journals
Textbooks
MEDLINE, PubMed, IMEMR
Drug Reference Information
Guidelines
Standard Operating Procedures.
Optimization of Healthcare Operations: the e-Health Added Value
Electronic Health Record
• Legible (people die as a result of bad handwriting)
• Accessible form anywhere in the hospital and
possible over the internet
• Prerequisite for many types of clinical decision
making
• Easy to identify patients whenever a medication or
device is recalled
• Easy to produce reports for quality organizations
• Supports graphing of laboratory tests over time.
Optimization of Healthcare Operations: the e-Health Added Value
Preventive Care Reminder
Electronic systems have the ability to store triggers that
are automatically activated as soon as a condition is
met. The condition can be time, vital sign, etc
Examples
• Influenza vaccine
– Computer-based reminders increased guideline compliance by
78%*
• Diabetes care
– Electronic reminders increased the odds of recommended care by
30%**
• Coronary Artery Disease care
– Electronic reminders increased the odds of recommended care by
25%**
Optimization of Healthcare Operations: the e-Health Added Value
Provision of InfoButtons and contextual
references
Information Buttons, known as InfoButtons
store text that can be retrieved by pressing
the relevant button. A wealth of knowledge
specific and tailored is a click away. A button
may be:
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Problems List
Medications List
Laboratory Results
Language Versions
Geographic References
List of Experts/Consultants
Check lists and Standard Operating Procedures.
Optimization of Healthcare Operations: the e-Health Added Value
Computerized Physician Order Entry
(CPOE)
Computerized physician/provider order entry is
defined as the computer system that allows
direct entry of medical orders by the person
with the licensure and privileges to do so.
CPOE is effective as it is:
• Eligible: no handwritten instructions
• Enables real time decision support
• Reduces medical errors *
• Improves compliance with quality measures **
• Positive return of investment ***
Optimization of Healthcare Operations: the e-Health Added Value
Order sets
A grouping of patient orders for a specific
diagnosis or condition. It promotes
standardized care processes. Order sets DO:
• Contain the instructions that physicians provide
concerning the care of a given patient
• Standardize care
• Optimize care
• Facilitate evidence-based care
Order sets INCLUDE:
• Emergency department orders
• Admission orders
• Surgical orders
Optimization of Healthcare Operations: the e-Health Added Value
Evidence-based order sets
• THEY must be considered with an entire life cycle in
mind: from initial creation, to updating, to archiving.
This life cycle is made up of numerous components,
including:
– Defining authorship privileges (write, review, edit) for different
members of the quality improvement team
– Coordinating review and approval cycles for new or updated
clinical order sets
– Controlling the release of evidence-based order sets to ensure
that current, approved versions are in use
– Updating evidence-based order sets to reflect changes in local
practice, performance measures, or the peer-reviewed literature
– Preserving a library and archive of institution-wide evidencebased order sets*
Optimization of Healthcare Operations: the e-Health Added Value
Dosing and Allergy Checks
(as part of CPOE)
• Dosing. One size does not fit all. In many
instances, the recommended drug dosage is
appropriate for the majority of the average
population. However, for some drugs, the
prescribed dose may need to be
individualized for patients suffering from
other diseases that require other medications,
advanced age, body weight, gender, etc. *
• Examples:
– Pediatrics (based on patient's weight)
– Renal failure (based on patient’s renal function)
Optimization of Healthcare Operations: the e-Health Added Value
Dosing and Allergy Checks
(as part of CPOE)
• Allergy. A drug allergy happens when a
patient has a harmful reaction to a medicine
that has been used. A computerized system
can alert to:
– Prior adverse reactions to the drug being prescribed
– Prior adverse reactions to a different drug, but one with
cross-sensitivity to the drug being prescribed.
Optimization of Healthcare Operations: the e-Health Added Value
Interaction Checks
(as part of CPOE)
The pharmacological result, either desirable or
undesirable, of drugs interacting with
themselves or with other drugs, with
endogenous chemical agents, with
components of the diet, or with chemicals
used in or resulting from diagnostic tests.*
Computer-based systems storing results of
research are used to signal and alert when
two or more drugs are presibed and possible
interaction occurs.
Optimization of Healthcare Operations: the e-Health Added Value
Interaction Checks
(as part of CPOE)
The interaction check maybe:
• Drug-drug interaction checks
– Drug A may increase effect of Drug B
OR
– Drug A may decrease effect of Drug B
• Drug-lab interaction checks
– Drug A may be contraindicated if lab result X is
too high or too low
– Dosage of Drug A may need to be changed
based on Lab result X
Optimization of Healthcare Operations: the e-Health Added Value
Work of WHO in ehealth
• World Health Assembly Resolution on eHealth
(WHA58.28);
• Global Observatory for eHealth;
• eHealth Standardization Coordination Group;
• eHealth Intelligence Report;
• eHealth for Health Care Delivery;
• Health Academy (eLearning for Health);
• Partnership and collaboration with other UN agencies;
• Conferences, seminars and training sessions;
• Direct assistance to member states.
Optimization of Healthcare Operations: the e-Health Added Value
The way forward
• Develop national policy and strategic directions for:
– Access to health information;
– Information and communication technologies;
– eHealth.
• Secure political commitment;
• Recognize cultural and multilingualism challenges;
• Establish legal framework;
Optimization of Healthcare Operations: the e-Health Added Value
• Address the human resources development issues:
capacity building in healthcare informatics;
• Build public private partnerships;
• Adopt and apply international standards and
ensure interoperability of systems;
• Build ICT infrastructure in healthcare institutions;
• Run pilot projects, show results, evaluate;
• Learn from other's mistakes;
• Involve all stakeholders when prior, while and after
implementation.
Optimization of Healthcare Operations: the e-Health Added Value
Thank you
Discussion