ICT engaged telemedicine: SNUBH experiences
HEE HWANG, MDDepartment of Pediatric Neurology
Center for Medical Informatics, SNUBH
ICT TECHNOLOGY & QUALITY OF CARE
HEE HWANG, MD, CIO
Seoul National University Bundang Hospital
740 physicians / 1,300 nurses
1,400 beds/ 38 operating rooms
6,500 outpatient visits / day
Over 80,000 radiologic exam /
month
2
515 Physicians & 780 Nurses
910 beds, 23 operating rooms
4,000 outpatient visits / day
Over 70,000 radiology exam /
month
2010 2017
IT Adoption Status
3
SNUBH IT Evolution Path
World Best IT
Leading
hospital
2003
2015
2014
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Extension to 909 beds
Telehealth pilot project
Health information exchange (HIE) system
Real-time asset tracking system
Closed loop medication administration
Design of next generation HIS system
Next generation PACS system
Developing next generation HIS
DR system
Desktop virtualization
Mobile EMR
Dashboard
Next generation HIS
Patient Guide & Bedside Concierge
First HIS implementation in KSA
RTLS asset tracking system
2016
2017First HIS implementation in USA
Full digital general hospital (609 beds)
USA, SureScripts Certification
BESTCare2.0C(Chinese Ver.) Launch
Awards
4
2010 2011 2012 2013
First Hospital Chosen
as “Best Practice of
IT Convergence”
by NIPA* (National IT Industry Promotion Agency)
First Hospital to Win
National Presidential
Prize for IT Innovation
Winner of HIMSS-Elsevier
Digital Healthcare
Award
2014
Outstanding ICT
Achievement
• Winner of ReddotDesign Award
• Winner of iF Design Award
• SAP Innovation Award
First HIMSS Stage 7
outside North America
SAP HANAInnovation award
Big Data part “Social Hero”
Harvard Business Review
SAP SAPPHIRE NOW IT Innovation Award
Social HeroTrailblazer Big Data
Global Expansion
-7-
With the excellent capabilities and world class solution, BESTCare 2.0, Consortium
expanded its business to M.E. and Asia, preparing to jump into Global HIS company.
Asia
Middle East
1
North
America
3
Entering KSA (’14)
– MNG-HA1) hospitals
Entering UAE (’14)
Planning to enter other M.E. countries by JV2) (’16)
M.E.Asia North
America
1 2
3
Planning to enter U.S.
– ONC HIT3) certified
– Achieved global brand recognition
Entering USA (’17)
– Aurora Behavioral Healthcare(14)
Planning to enter China (’17)
– Developing BESTCare2.0C
– Tapping to Enter
Note : 1) Ministry of National Guard, Health Affairs 2) Joint Venture 3) Certified Health IT Product List by The Office of the National Coordinator for Health Information Technology
Europe
4
Europe
4 Planning to enter EU (’17)
– Tapping to Enter
– UK & Ireland
2
KAH5) + IAAFH6)
Connected PHCs
Go-Live
(Project period : 2.5
months)
Successful Implementation History in KSA
8
Note: 1) King Abdullah Specialized Children’s Hospital 2) King Abdulaziz Medical City in Riyadh 3) King Abdulaziz Medical City in Jeddah 4) Prince Mohammed Bin Abdulaziz5)King Abdulaziz Hospital 6) Imam Abdulrahman Al Faisal Hospital
KAMC-R2) +
Connected PHCs Go-
Live
(Project period : 10
months)
KAMC-J3) +
Connected PHCs
Go-Live
(Project period : 5
months)
KASCH1) +
Connected PHCs Go-
Live
(Project period : 8
months)
2015 Apr. 2016 Jan. 2016 May.
Total beds : 566 beds
Go-live of fully functional HIS
& Smart Hospital features
without system roll-back
Total beds : 1,215 beds
Successful data
migration & change
management from
existing system
Total beds : 707
beds
Shorten project period
through deployment of
single version
2016 DEC
※ KASCH & KAMC-R achieved HIMSS Stage 6 within 8 months after BESTCare go-live
PMBAH4) +
Connected PHCs
Go-Live
(Project period : 2.5
months)
2016 Aug.
Total beds : 320
beds
Shorten project period
through deployment of
single version
Total beds : 585
beds
Shorten project period
through deployment of
single version
Paradigm Shift of Medicine
PREVIOUS PARADIGM NEW PARADIGM
Descriptive medicine
Empirical diagnosis
Grouped by Organ Site
Uniform treatment
Retrospectively diagnose
Acute care Early detection and intervention
Prospectively evaluate relative disease risk
Individualized treatment
Subgrouped by molecular/biological classification
Mechanism-based diagnosis/treatment
Understanding of disease mechanisms
ICBM-based Healthcare
IoT Cloud Big Data Mobile
Lifestyle + Environment + Phenotype + Genotype Mobile Services
11
Core “4C” Agents in EMR for Healthcare Transformation
4C
CLMA(Closed Loop
Medication
Administration)
CDSS(Clinical Decision
Support System)
CP(Clinical
Pathway)
CI(Clinical
Indicator)
Patient Safety
Standardized Practice
Quality Control
11
12
Medication Administration
(Right patient, Right medication, Right dose, Right route, Right time)
Crosscheck patient ID and medication barcode
Print RFID wristband RFID wristbands given to all inpatients
1 2
4
Scan RFID tag to staff ID card and patient’s RFID tag to wristband
3
Mismatch
Save
(Right patient, Right medication, Right dose, Right route) (Right time : Plan ±1 hour)
Wrong patient ID!
Wrong Time! Check time of administration.
Time of administration
SNUBH’s CDW history
2004
CDW 1.0 OPEN
2005 2012 2013
Clinical Indicator OPEN
Request Analysis
CDW 2.0 OPEN
*NEW ADDITION
Insurance Indicator &
Infection Indicator
255 Indicators
320 Indicators
2015
Currently
463 Indicators
14
Clinical Data Warehouse (CDW)
Data Warehouse
PatientInfo.
MedicalRecords
Nursing records
OrderInfo.
FinancialInfo.
TestInfo
OperationDB
ETL
Updated
Daily
ODS
Managers
WorkingUsers
Users
CI CP
Test Tpl
Order …
ExtractionTransfor-mationLoad
CDW
OLAPSever
CDWWeb Server
OLAP Server +Web Server
In-Memory Platform
DX
OP Test
Rx
CC
TplPT
NU
Memory
ETL
In-Memory Big data Solution
22
86 115
183
261
337
376
416 436
503
556
6
46 73
113
181
253 288
325 345
410
463
0
100
200
300
400
500
600
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
No.
Year
Number of Clinical IndicatorsTotal number of CI
Total number of computerized CI
15
Clinical Indicator Development/Monitoring
547 electronically
managed indicators. (As of 31.12.2016 )
16
Optimal Prescription of Preventive Antibiotics by CI Application
0%
10%
20%
30%
40%
50%
60%
70%
80%
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
2007 2008 2009 2010 2011 2012 2013 2014 2015
Avoid antibiotics to rate (%)
3rd Cephalosporin administratio rate (%)
Aminoglycoside administratio rate (%)
Combination of antibiotics rate (%)
Administration rate of non-recommended antibiotics: target (10%)
Appropriateness at SNUBH improved via CP, after-cause analysis,
and course-correction with the medical department
Credited to its CI application, SNUBH provides consistent quality of healthcare, such as improving
preventative antibiotics administration rates beyond target level
17
What is Population Health Management?
…a transformational approach to healthcare delivery that shifts the
focus
from caring for patients who self-select for care based on their
own assessment of their condition
to
taking transcendent responsibility for the health status of a
cohort or population of patients.
Source: HIMSS 2017
18