1

Can IT systems help to manage the

quality of

health care delivery?

25 november 2010

Jan De SitterCIO at GZA

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Introduction• GZA: « Gasthuis Zusters Antwerpen »

• 3 sites 1033 beds• Sint-Augustinus Wilrijk

• Sint-Vincentius Antwerpen

• Sint-Jozef Mortsel

• Tradition of IT-support for care processes• Since 1990 : « Patient care systems » (PCS)

• Order communication

• Nursing records (activities planning and result reporting)

• Medication• Since 1996 : Medical records (C2M) Patientrecord

• Resultserver

• Reportgenerator

• Support of Paramedic activity

• Structured elements in the EPR

• Since 2000 : Clinical pathways

• Built on PCS technology

• Introduction of online decision support

• Second generation of systems in development and/or implementationphase

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The care process

Quality definition from the Institute of Medicine

‘the degree to which health services for individuals and

populations increase the likelihood of desired health outcomes and

are consistent with current professional knowledge’

Quality care should be

• Result driven

• Based on well defined processes

• Measurable (indicators)

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Drivers for quality care

• Multidisciplinarity, multiprofessionalism• Need to share information

• Fast and accurate communications

Shared patient record,

Convergence of medical record, nursing record…

• Intensity of care• Growing number of actors

• Shorter delivery times

Need for efficient planning systems (order communications)

• Process management• Evidence based Care and Medicine

• General procedures should be instantiated for the individual patient

Care Pathways (incl indicators)

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Drivers for quality care (2)

• Continuum of care• Need to share information with actors outside the hospital

• Need to share processes

Role for eHealth ?

Sharing GMD between actors

Building shared records around disease management ?

• Patient safety• Key element in quality of care

Introducing closed loops in EPD (e.g. medication administration, hemovigilance…)

Structured content in EPD (e.g. structured protocols)

Decision support (e.g. interactions, realtime checks)

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HIMMS EMR adoption modelUS EMR Adoption ModelSM

Stage Cumulative Capabilities2010

Q1

2010

Q2

Stage 7Complete EMR; CCD transactions to share data; Data warehousing; Data

continuity with ED, ambulatory, OP0.7% 0.8%

Stage 6Physician documentation (structured templates), full CDSS (variance &

compliance), full R-PACS1.8% 2.6%

Stage 5 Closed loop medication administration 5.0% 3.2%

Stage 4 CPOE, Clinical Decision Support (clinical protocols) 7.7% 9.7%

Stage 3Nursing/clinical documentation (flow sheets), CDSS (error checking),

PACS available outside Radiology50.0% 50.2%

Stage 2CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging;

HIE capable16.5% 15.5%

Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.9% 6.8%

Stage 0 All Three Ancillaries Not Installed 11.4% 11.2%

Data from HIMSS AnalyticsTM Database © 2010 N = 5,223 N = 5,217

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Generic Care process

• Assessment : systematic collection of information

• Diagnosis: analysis of information and decision

• Planning: time – task: => organisation of the processaround the patient

• EBM-N

• Patient characteristics

• Documentation

• Evaluation

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Planning

• Activities of professionals:• Nurses

• Physicians

• Pharmacy

• Paramedics

• Integrate• Activities of diagnostic and therapeutic services : radiology ,

lab..

• Nursing care activities

• Medication

• Support• Development of individual careplan starting from the generic

plan

• Based on evidence based guidelines

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Document

• Activities• Performed , changed, or not performed?

• Why not?

• Results • Document different parameters

• Documentation is coded• Makes “Rule based decision support” possible

• Facilitates Analysis and evaluation

Care portal : integrates patients

and tasks

Medical Record

Medication

Nursing

Nursing : charting

Orders

Care Pathways

Care Pathways

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Added value from ICT

• Steering from information and processes• Between services (intra-extramural)

• Between professionals (intra-extramural )

• Delivery of structured instruments(intra-extramural)

• To organise and evaluate care delivery

• Operationalize standards and procedures• EB care through algoritms ( decision trees)

• Structured set of acts and instruments

• Measurement systems

• Feed-back• Development of indicators

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Performance indicators:

POBC

Proportion staging pre- or post surgery

1e sem 2002-2009

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2002 2003 2004 2005 2006 2007 2008 2009

Year

% In

ve

sti

ga

tio

ns

Pre-op

post op

Pain score

1e sem '09 (169 ptn)-'08 (145) -'07 (166 ptn )

-'04 (122ptn)

0

2

4

6

8

10

0 1 2 3 4 5 6 7 8 9 10 11 12 13

day post op (day 0 = surgery)

Pa

in v

alu

e

2009

2008

2007

2004

LOS Kp POBC 2002-2009

0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

9,0

2002 2003 2004 2005 2006 2007 2008 2009

Year

Gem

LO

S

Gem. verb

Clinical indicator Financial indicator

Procesindicator

Questions ?