Transcript Template_SPMS - HIMSS Asia Pac

Keynote Session
“Patient-centric health informatics, from
concepts to practice:
the story of PPP – Portuguese Patient Portal”
18-07-2015
Shared Services Ministry of Health
Serviços Partilhados do Ministério da Saúde, SPMS, EPE
www.spms.pt
Henrique Martins, MD PhD
CEO of SPMS EPE
[email protected]
[email protected]
© 2014 SPMS| Serviços Partilhados do Ministério da Saúde, EPE | Direitos reservados
Wellcome!
“Patient at the heard of all we do? In IT?
In healthcare informatics? Really???
“Health Informatics: A scientific field that draws upon the information sciences &
related technology to enhance the use of the knowledge base of the health sciences
to improve health care, biomedical & clinical research, education, management, &
policy.” Don E Detmer CEO AMIA
With this you can find domain with:
Patient Record-keeping
Clinical Decision-support
System Infrastructure
Patient informatics????
This keynote will explore the following questions:
i)
why is conventional healthcare informatics not (yet) looking at patients first?
ii) how is patient-centric health informatics different from previous health
informatics?
iii) why do we have to worry about this, and do it fast?
iv) what added value is there for organizations in a really patient-centric
approach to health informatics?
v) are there examples?
Portugal
Population : 10,5 Millions (2004)
Area: 91,900 km2
PIB per capita : 19,730 (PPP international $)
 65,6% of the population lives in urban areas
 870 years of History
FUNDAMENTALs
•
•
•
•
•
•
•
18-07-2015
Eletronic Patient records (EPRs),
Patient Portal,
Patient-programed informatics,
Patient vocabularies,
Patient Registries made by Patients,
Patient Summary (EU Directive on Cross Border Care)
Implementing patient-centric ehealth projects.
SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.pt
8
Computer-based
PATIENT record –
Clinic & Hospital
Records
Computer-based
POPULATION
Record Community Records
Data Banks
Repositories
First-class
Health
Care
Computer-based
PERSONAL
Record –
Consumer & ehealth records
Healthcare enhanced by three interlocked computer-based health records (C3PRs). http://www.ncvhs.gov
18-07-2015
SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.pt
9
PDS PHR - Stakeholder Map
Doctor’s
Assoc.
Individual Stakeholders
Pharmacists
Assoc.
Nurses
Assoc.
CEO
Organization
Board
CIO – Chief
Information
Officer
Administrative
Staff
Radiotherapist
Medicine
Pharmaceutical
Companies
Central Admin.
of Health
System
Autonomous
Regions
Regional
Admin.
Azores
Lisbon and
Tagus
Valley
Technician
Private
Hospital
Surgeon
Psychologist
Health
Practitioners
Internist
Sponsors
Health Plans
Public
Health
Drug Institute
Family
Blood
Institute
Investigation
Labs (Clinical
Trials)
Health General
Management
Central
Hospital
Differentiated
Care
Primary
care
Emergency
Care (INEM)
Continuity Care
(Mission Units)
Health
National
Institute
Shared Services
Of Ministry of
Health
Health
Research
Military
Hospital
National
Health
System
Private
Institutions of
Social Security
Religious
Hospitals
National
School of
Public Health
Other
Schools
Doctor’s
Individual
Office
Private
Practice
Other
Healthcare
Providers
Pharmacy
Public
Insurance
Insurance
Companies
Social
Security
Alentejo
Radiology
Exams
Citizen
Centre
North
Doctor
Teaching
Institution
Labs
Specialist
Physiotherapist
Algarve
Madeira
Medical Material
Suppliers
Other Providers
GP
Nurse
Audiologist
Central
Administration
Other Services
Suppliers
Hardware
Suppliers
University
Pharmacist
Dietist
Health Line
24/7
Pharmacy
Associations
Dentists
Assoc.
Associations
Nutritionist
Social
Assistant
Infarmed
Health
Regulatory
Entity
Operational /
Service / Clinical
Manager (UGI)
Software
Suppliers
Health
Centre
Regional
Hospital
Level 1
Hospital
Group of Health
Centre
Family Health
Unit
Integrated Care
(Local Health Units)
Mercies
Most Important Stakeholders
Group of Stakeholders
Sub-group of Stakeholders
Individual / Organizational
Citizen
Citizen
• Citizen is probably the most important stakeholder.
The health system should be Citizen centered.
• Citizens care about their well-being
• They want to be informed and participate actively in
their health management
• Citizens are worried about confidentiality assurance.
They want to have control over their information
access consents (ex. information leaks to insurance
companies or even their employers).
• Direct family’s well-being is a concern
– Children and parents
Daily activities performed by citizens
(Value Constellation Experience)
Citizen
Healthy Citizen
Activities related to
EHR
Daily activities performed by citizens
(Value Constellation Experience)
Citizen
Citizen with Chronic Disease or Active Problems
Activities related to
EHR
Artifacts used by citizens
PCs
Medicine
Citizen
Periphera
l PC
equipme
nt
(printer)
Clinical
instrume
nts
(thermo
meter,
scale)
Exams
Paper
Mobile
phone
Tablet
PCs and
PDAs
Software
(PHRs)
Sport
shoes
Bicycle
Service Design Workshop Results
January, 3rd 2012
Conclusions about benefits and
functionalities
•
The following tables illustrate the most important benefits and functionalities
potentially provided by the PDS service for each group of stakeholder:
Doctor
Alerts and Allergies
Chronologic View of Health Episodes
Exams
Antecedents (Ex. Oncologic)
Vaccines
Audit System
Auth Mechanism
Chronic Medication
Discharge Note
Active Diagnosis
•
Nurse
Diagnosis / Results
Nurse Notes (Discharge and Consultation)
Actions / Interventions
Surveillance and Monitoring Data
Alerts and Allergies
Informal Caregiver
Exams
Prescription Info.
Intensity of Care and Dependence Levels
Chronologic View of Health Episodes
Support Ministry of Health PDS implementation
prioritization
Citizen
Info. Access Management
Chronic Medication
Alerts
SMS and E-mail Alerts (Scheduling)
Schedule Consultation, Exams and Vaccines
Forms and Declarations
Emergency Episodes and Contacts
Administrative Services
Audit System
Auth. Mechanism
Collaboration Platform
Speak with Healthcare Professional
Exams
Therapeutic Information
Allergies
Physical and Functional handicaps, Protheses and Implants
Conclusions about Service Experience and Architectures
•
As expected, different stakeholders perform different daily activities, require
different information and desire different experience factors.
•
Security, privacy and confidentiality subjects were mentioned frequently by
citizens and the preliminary results had to be reinforced in these matters
•
Healthcare practitioners reinforced that, whenever possible, they should continue
using currently legacy systems to minimize the need for replicating operations in
other software.
A unique aplication
professionals…
for
all
NEW????
Hospitals
Primary Care Centers
Hospitals with SClínico
+ de 60.000 Doctors/Nurses
+ de 50 institutions
Hospitals – Triage
Normalização de Registos… CSP e Hospitalar
Diagnósticos/problemas
• ICD 9 – CM; ICD 10 – CM (International Classification of Diseases)
• SNOMED (Systematized Nomenclature of Medicine)
• ICPC-2 (International Classification of Primary Care)
• CIPS (Classificação Internacional de Problemas de Saúde)
• ICNP/CIPE (International Classification for Nursing Practice)
Intervenções/ procedimentos
• ICD-9CM (1,2&3); ICD-10 CPS; Cod OM
• SNOMED (Systematized Nomenclature of Medicine)
• ICNP/CIPE (International Classification for Nursing Practice)
Reacções adversas/alergias
• CPARA – Catálogo Português de Alergias e Reações Adversas
PDS – Plataforma de Dados de Saúde
PHR - Portuguese Health Record
And the Patient Portal
PDS/PHR
Portuguese Health Record
The Portuguese Health Record (PHR) constitutes the
national health record data sharing facility.
This data can be shared between citizens, healthcare
professionals and healthcare entities.
While some data can be registered on PHR other is
accessed via webservice technology that links old and new
existing applications.
This project is supported by the Portuguese Ministry of Health and the Comissão de Acompanhamento para a Informatização Clínica
(CAIC), the comission that supports the computerization of clinical records (Dispatch 9725/2013). As well as it is developed by Serviços
Partilhados do Ministério da Saúde, EPE (SPMS).
Computer-based
PATIENT record –
Clinic & Hospital
Records
Computer-based
POPULATION
Record Community Records
Data Banks
Repositories
First-class
Health
Care
Computerbased
PERSONAL
Record –
Consumer &
e-health
records
Healthcare enhanced by three interlocked computer-based health records (C3PRs). http://www.ncvhs.gov
PDS/PHR
Institutional Portal:
Provide statistics from
anonymised clinical data to
central institutions.
Patient Summary
Citizen Portal:
Professional Portal:
Personal Health Record
Authorizations Audit
Provide professionals with
access to patient clinical data
stored in servers and records
from different institutions and
central repositories.
International Portal:
Enable the epSOS/expand pilot to
serve as electronic patient’s
summary review for professionals.
Patient Summary (EU Compatible)
RCU2 - Resumo Clinico Único do Utente
Patient Summary
This is a minimum set of clinical information essential to healthcare professionals,
whenever there is a need for emergency care, or programed care in a healthcare
unit (national or international);
Id do utente, med Familia
Alergias
Diagnósticos Médicos e de
Enfermagem
Procedimentos Médicos
Dispositivos/Implantes *
Medicação Crónica
Vacinas
Demografics; GP id
Alergies
Medical Diagnosis
Medical Procedures
Implantable devices
Chronic medication
Vacines
RCU2 - Patient Summary
It contains general information about the patient and the associated GP, most
important clinical patient data (allergies, medical diagnosis and surgical procedures),
chronic medication and vaccines.
The latter two are uploaded directly to the patient summary while the rest has to be
validated by the patient’s GP.
The national roll-out of patient summary is planned by Regional Health Authority
(RHA) and has already been accomplished on the North RHA.
The process consists in aggregating patient’s information that is spread amongst local
information systems across the country.
RCU2 - Patient Summary
At the moment, there
are 4,771,929
patient summaries.
Document A
CDA
Language A
ICD-10 4-digits codes
Or ICD-9
Pivot
Document
NCP A
Accession to epSOS Terminology Server B
Translation of displayName E to displayName B
Creation of local Document B*
Document B
NCP B
CDA
English
ICD-10 3-digits codes
epSOS Central Reference Terminology Service:
Master Value Set Catalogue: [MVC,]
Subset of International Coding Systems (WHO ICD10, ATC;
SNOMED-CT, EDQM, UCUM, HL7, IHE, ISCO)+
Master Translation/Transcoding Catalogue [MTC]
Local
Terminology
server B
Country
A
Transformation ICD-10 4-digit to 3-digits codes
Accession to epSOS Terminology Server A
Translation of displayName A to displayName E
Creation of pivot Document E*
Local
Terminology
server A
Local document A is coded with ICD-10
4-digit codes and sent to NCP A
CDA
Language B
ICD-10 3-digits codes
Country
B
aims to be a single focal point
concerning the provision of
healthcare services within the NHS.
• Informative Services, which does not need the user to
sign in;
• Electronic Services, available within the “My Health” area.
The sign in requires: NHS number or Citizen’s Card using a
card’s reader. By using the Citizen’s Card, the user is given
a broader access to features.
ACCESS IN: https://servicos.min-saude.pt
• Texts that help
introducing health
measurements
• Improve the
graphical view of
these
measurements
• Patient’s Summary
Official launch of the
1st version of Citizen
Portal, focused on
electronic services
May2012 …
May2013
• New image
• Informative
services
• “My Health” area
• Child and Youth
Health eBook
• Medical history
timetable
July2013
• Rare Diseases’
Card
Aug2013
Dec2013
• Inclusion of
prescriptions on
the historical
timetable
• Design
improvement
Jan2014
July 2014
• Anticipated
Directive/Vital Will
Online appointment of consultations for primary care services of the NHS
and online ordering of chronic medication;
Request the remission of user charges regarding NHS services provided;
Integrated Personal Health Record. Manage and share with GP’s: emergency
contacts, Health information, Biometrics Monitoring);
Visualize personal Vital Will;
Visualize NHS data: medical episodes timeline with a view of the
38
prescription detail, electronic version of the Child and Youth Health Bulletin,
NHS number
Citizen’s Card
using a card’s
reader
39
Autorizações dadas pelo utente
Data sharing is managed and controlled by the
citizen through the Patient Portal. There are
three types of authorizations
22-01-2014
24-02-2014
SPMS,EPE
SPMS,EPE
40
Three types of authorizations
:
Autorizações dadas pelo utente
•
Give the healthcare professionals access to the personal data
registered on the Citizen Portal: health related habits, allergies,
medications, diseases and documents.
•
Give the healthcare professionals access to the personal clinical
data existing in other applications from the NHS
•
Give the healthcare professionals from a country participating on
epSOS access to the patient’s summary
22-01-2014
24-02-2014
SPMS,EPE
SPMS,EPE
41
Data regsitered on the Patient Portal that can be shared with
heathcare professionals:
Emergency contacts;
Biometrics Monitoring:
Health information:
43
The Professional Portal allows health data sharing between
healthcare professionals when visualizing an active episode
of the patient on the institution clinical system.
The Professional
Portal has been
visualized by more
than 42.000
professionals,
integrates around
600 databases and
accounts for an
average of 18.000
daily views.
44
Clinical Episodes Timetable
Systems Integrated:
• Prescription
National Database
•
Portuguese
emergency systems
•
National Network
of Long-Term Care
•
Connection to local
services
45
Patient Portal
O utente deverá dar
consentimento para o
acesso a esta área.
Informação disponível:
• Alergias
• Contactos
Emergência
• Medições
• Hábitos
• Doenças
• Documentos
46
2014
47
Personal rare disease card
Doença
ORPHA586 - Fibrose quística
ORPHA739 - Sindrome de Prader-Willi
ORPHA90291 - Esclerodermia sistémica
ORPHA101330 - Porfiria cutânea tardia
ORPHA589 - Miastenia gravis
ORPHA905 - Doença de Wilson
ORPHA666 - Osteogénese imperfeita
ORPHA716 - Fenilcetonúria
ORPHA273 - Distrofia miotónica de Steinert
ORPHA77259 - Doença de Gaucher tipo 1
Total
29
11
11
8
7
7
6
6
5
5
ORPHA85447 - Polineuropatia amiloidótica familiar
ORPHA803 - Esclerose lateral amiotrófica
ORPHA904 - Síndrome de Williams
ORPHA399 - Doença de Huntington
4
3
3
3
328 requested
• 164 Activated
• 88 Printed
48
Personal rare disease card
21-11-2013
SPMS,EPE
49
Personal rare disease card
21-11-2013
SPMS,EPE
50
Personal rare disease card
21-11-2013
SPMS,EPE
51
Digital Registry Instruments for the
National Child and Youth Health Program
Directorate-General of Health (DGS):
Normative Guideline 10/2013 of 31 May 2013 – New (revised) National Child and Youth
Health Program (PNSIJ)
Global review of the registry instruments:
Child and Youth Health Bulletin (“redbook”);
Birth News;
DGS and SPMS developed:
Child and Youth Health eBulletin;
Digital Birth News;
NHS number at birth;
The implementation of
these instruments in the
National Health System
relies on direct guidance
from the DGS through
normative and
informative guidelines.
52
Child and Youth Health eBulletin
Birth News
PHR – Professional Portal
53
Child and Youth Health eBulletin
Registers the same information as the paper Bulletin; namely:
Child/Youth Identification;
Relevant pregnancy data;
Relevant pre-natal data;
Created at birth, as the paper Bulletin;
Available for consultation by the Health Professionals through PHR – Professional
Portal, allowing them to register new information;
Registration
of new information may be done directly in eBulletin or, if the health
Project
in Pilot Fase.
professional uses an information system integrated with the platform, directly on his
The system.
gradual adoption of the eBulletin is coordenated by the Directorate-General of Health,
through normative and informative guidelines.
54
Child and Youth Health eBulletin
55
Child and Youth Health eBulletin
Child and Youth Health eBulletin
Child and Youth Health eBulletin
Child and Youth Health eBulletin
Child and Youth Health eBulletin
Electronic Registry of Vital Will
Citizens
Medical
Professionals
Visualizati on
Visualizati on
Validated Vital Will
RENTEV (Vital Will) Clerk
1st Line
Paper Documentation
Citizens
Vital Will
Registration
RENTEV (Vital Will) Clerk
2nd Line
Vital Will Clinical Validator
61
Vital Will
Official paper model
62
Vital Will
Professional Portal
63
Vital Will
Patient Portal
64
Professional Portal
Private Professionals (Non NHS)
https://servicos.min-saude.pt/profissional/pds/
Access: physicians
Patient with Citizen’s Card (plus card’s reader)
PDS Live
Telemedicine
66
PDS LIVE - Principles
•
Total Mobility
•
Any desktop/mobile
•
Any professional
•
Any patient
•
Multiplataform / Multidevice
•
Multiuser
•
Suplyer indipendence
•
No external maintenance costs
18-07-2015
SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.pt
67
PDS LIVE
Teleconsulta
© 2014 SPMS| Serviços Partilhados do Ministério da Saúde, EPE | Direitos reservados
PDS LIVE
Videoconf
Exchange messages
Sharing Desktop environment
Sharing files
Quadro branco para brainstorming
© 2014 SPMS| Serviços Partilhados do Ministério da Saúde, EPE | Direitos reservados
Telemonitoring
70
Telemonitoring
•
In order to enhance the Portuguese market of medical devices and applications, as
well as PDS itself, a set of APIs will be made available for suppliers of IT solutions,
NHS institutions and patients .
•
This solution is based on RESTful web services provided by PDS.
•
Nowadays it is already possible to send Chronic Obstructive Pulmonary Disease
related data to PDS from telemonitoring devices. That data can be visualized by
the patient and healthcare professional.
25-11-2013
SPMS,EPE
71
Telemonitoring
Chronic Obstructive Pulmonary Disease
ULSAM
CHUC
CHCBEIRA
ULSNA
Grupo de Trabalho de Telemedicina
( GTT )
Administração Central do Sistema de Saúde
( ACSS )
CHA
Serviços Partilhados do Ministério e Saúde
( SPMS ) – caderno de encargos
Administração Regional de Saúde do Norte
( ARS Norte )
Programs financed by the Ministry of health
Pilot - 5 healthcare institutions
Period - 1 year - 2014
Total - 75 patients
15 patient per institution
Statistics
“A minha saúde”
73
Total users registered
900,000
800,000
700,000
600,000
500,000
400,000
300,000
200,000
100,000
0
74
Sessions by district
1-1-2014 a 31-8-2014
Nº registered patients
Facebook
4,7 Million
Facebook users
have between 25
and 34 anos.
(estudo Bareme
Internet)
836.003
PORTUGAL
11-9-2014
Only 1/3 of
portuguese families
have internet and use
it in their home
1-1-2014 a 31-8-2014
Average of 2100
sessons/day
High value of 1 off
visits every day
Geografic dispersion
1-1-2014 a 31-8-2014
Azores
Portalegre District
Guarda District
Evora District
Vila Real District
Sessions
Coimbra District
Faro District
Braga
Aveiro District
Lisbon
0
40000
80000
120000
160000
200000
Acesses per hour of the day
1-1-2014 a 31-8-2014
45000
40000
35000
30000
25000
desktop
20000
mobile
tablet
15000
10000
5000
0
00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Days since the last visit
1-1-2014 a 31-8-2014
365+
121-364
61-120
31-60
15-30
8-14
7
6
5
4
3
2
1
0
Every 2
weeks to 1x
every 3
months
Pageviews
Sessions
No mesmo dia
0
500000
1000000
1500000
2000000
Emergency contacts registered
6000
5000
4000
3000
2000
1000
0
Age
Female
Male
Habits recorded
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
Age
Female
Male
Disease recorded
1400
1200
1000
800
600
400
200
0
Age
Female
Male
Medication recorded
3500
3000
2500
2000
1500
1000
500
0
Age
Female
Male
Recorded as having Alergies
1000
900
800
700
600
500
400
300
200
100
0
1-5
6-10
11-15
16-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
Age
Female
Male
61-65
66-70
71-75
76-80
81-85
86-90
91-95 101-105
Uploaded documents
350
300
250
200
150
100
50
0
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
Age
Female
Male
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Registration of lab and physiological variables
3500
3000
2500
2000
1500
1000
500
0
1-10
11-20
21-30
31-40
41-50
51-60
61-70
Altura
Colesterol
Glicemia
INR
SaturacaoO2
TADiastolica
TASistolica
Triglicerido
71-80
Peso
81-90
91-100
Portuguese
NEW SYSTEM 2nd Wave
Eletronic Prescription and dispensing
PEM@med
Integration with patients health records
PEM@med – Process
… a new application
PEM@med – Prescription
 Implements the recent Portuguese law introducing prescription by International
Common Denomination
 verify patient identification, and benefits (National Patient Registry)
 Integrated with the patient's clinical records:
 alerts for interaction with allergies and adverse reactions registered on patient
summary
 access to chronical medication managed by his physician registered on patient
summary
 access to historic of prescriptions
 access to drugs dispensed at the pharmacy and date
 Access to clinical prescribing regulation and recommendations in which that medication
plays a role
 Access to drug information (national drug database ), characteristics resume, leaflet,
prices, …
PEM@med – Prescription
… a new application
 Integrated with clinical applications:
 Context data is send to PEM app ( Patient data / Prescriptions local / other)
 Prescritions made in PEM app are integrated in the Local Patient Health Record :
information is send “on the fly” to the local database and integrated in the clinical
registry
 Implementation of some clinical recommendations
 prescribing health care respiratory
Ongoing…
 Drug interactions with drugs
PEM@med – for professional
Patient Summary
• Allergies and adverse
reactions
• Chronical medication
Update chronical
medication
Prescription
Update Health Patient
Record
Alert to Clinical
recomendations
Prescription
alerts
Drug
Information
Local System: Health Patient Record
Historical
Prescriptions
(with dispense information)
PEM@med - Dispense
… e-dispensing … eletronic envoicing
o Patient authorization
o Citizen Card and “acess code” to acess the prescrition by pharmacy
o Option code to sell a drug more expensive then the 5th cheapest … Prescription guide
Access code
o Dispensing (online conference)
o Verifies the accuracy of medication (CNPEM)
o Verifies the cost of drug and the reimbursement to the state
Benefits to pharmacy
 guarantee of the authenticity and correctness of the prescription

guarantee of reimbursement from the state
 reduce discards by the National Health System reimbursement office
option code
PEM@med – for patient
 Information about the cost of drugs – the maximum price he has to
pay at pharmacy
 medical history through a readily available Web Patient Portal
 request for chronically medicine throw Web Patient Portal
 more safety in prescription process and dispensing process
 Control the access to his historical prescription by Web Patient Portal
PEM@med – for patient
Treatment Guide
PEM@med – EU Patient Summary
Patient Summary
• Allergies and adverse
reactions
• Chronical medication
Update chronical
medication
Prescription
Update Health Patient
Record
Alert to Clinical
recomendations
Prescription
alerts
Drug
Information
Local System: Health Patient Record
Historical
Prescriptions
(with dispense information)
A solução está na partilha!
Obrigado