Improving Care efficiency through IT

Transcripción

1 Improving Care efficiency through IT Nyborg, 6-7 October 2015 Antonio Clemente (PhD) Corporate Development Manager

2 INDEX 1. Introducing Denia s Health Department 2. IT strategy foundations 3. Sample: Improving CHF efficiency through it 4. Conclusions

4 Denia s GEOGRAPHICAL Health Department SCOPE (I)

5 Denia s GEOGRAPHICAL Health Department SCOPE (I)

6 Department OPERATIONAL of Health. SCOPEDénia. RED ASISTENCIAL MARINA SALUD 1 Hospital 4 Integrated Health Centers (Specialized care) 32 Primary Care Centers (Managed in 11 Basic areas)

7 Department BEFORE AND of Health. AFTER 2008 Dénia. WHAT? HOW? BEFORE 2008 (OLD HOSPITAL) 136 beds 5 Operating Theaters Medical staff: 180 Nursing staff: 220 (over 1100 employees in the department) 100 % managed by regional government. 100 % of employees are civil servants AFTER JANUARY 2009 (MARINA SALUD S.A.) 206 beds 14 Operating theaters+ 4 ambulatory surgeries Medical staff: 200 Nursing staff: 360 (More than 1200 employees in all department) PPP granted for 15 yrs Invoicing system based on per capita and compensation Civil servants (28%) and labour employees (72) Direct supervision viaavs commissioner Health Department s integrated Management

9 Example: Overview IT structure for CERNER MILLENNIUM support (VIII) Clinical Transformation 1. Information System & applications Strategy Simplifed Information systems map

10 Department 1. Information of Health. System Dénia. & applications Strategy

11 Department 1. Information of Health. System Dénia. & applications Strategy

12 Example: Overview IT structure for CERNER MILLENNIUM support (VIII) Clinical Transformation 1. Information System & applications Strategy Simplifed Information systems map 2. Hospital Information System Full support for HealthCare processes EMR & Data driven (HIMSS Level 6 and 7)

13 Denia s 2. Hospital Health Information Department System (VII) scope CERNER MILLENNIUM s implantation scope FIRST LEVEL CARE SERVICES BY SCOPE AMBULATORY HEALTHCARE EMERGENCY HOSPITALIZATION SURGERY AMBULATORY CONSULTATION HOSPITAL EMERGENCIES MEDICAL URGENT SURGERY Exception! (Primary Care Ambulatory Consultation) DIAGNOSTIC PROCEDURES AND TREATMENTS PRYMARY CARE EMERGENCIES SURGICAL MAJOR HOSPITALIZATION SURGERY MEDICAL DAY UNIT HOME CARE EMERGENCIES INTENSIVE CARE MAJOR AMBULATORY SURGERY SURGICAL DAY CENTER HOME CARE MINOR AMBULATORY SURGERY OUTPATIENT PHARMACY OBSTETRICS SECOND LEVEL CARE SERVICES (SUPPORT SERVICES - ALL SCOPES) INPATIENT PHARMACY STERILIZATION CERNER MILLENNIUM IMAGING AND RADIOLOGY BIOLOGICAL DIAGNOSIS CLINICAL DOCUMENTATION ADMISSION PREVENTIVE MEDICINE REHABILITATION 100% paperless BLOOD BANK PRE-ADMISSION ARRANGEMENTS & APPOINTMENTS SOCIAL WORK

14 Example: Overview IT structure for CERNER MILLENNIUM support (VIII) Clinical Transformation 1. Information System & applications Strategy Simplifed Information systems map 2. Hospital Information System scope Full support for HealthCare processes (Collaboration, Guidance, Continuity of care) EMR & Data driven (HIMSS Level 6 and 7) 3. Service improvement organization Incident Management (Call center): Robustness Change Management (Clinical Transformation Office): Flexibility

15 Example: 3. Continuity IT structure of service for & service CERNER improvement MILLENNIUM support (III) Basics DIRECCIÓN DE SISTEMAS Y TECNOLOGÍAS DE LA INFORMACIÓN COMMUNICATION SOLUTION GO LIVE Level 2 USERS High Management Committee; Clinicar Record Committee CHANGE REQUEST O T C - O T G CHANGE REQUEST Middle Management Level 1 PCP / PCU ÁREA DE DESARROLLO ÁREA DE INFRAESTRUCTURA TÉCNICA CHANGE REQUEST FLOW End Users INCIDENT QUERY C A U ÁREA DE SOPORTE INCIDENT QUERY ÁREA DE TELECOMUNICACIONES COMMUNICATION SOLUTION GO LIVE THIRD PARTY ESCALATION Level 3 Technology Providers

16 Example: 3. Continuity IT structure of service for & service CERNER improvement MILLENNIUM support (III) Basics DIRECCIÓN DE SISTEMAS Y TECNOLOGÍAS DE LA INFORMACIÓN COMMUNICATION SOLUTION GO LIVE 2º Nivel USERS High Management Committee; Clinical Record Committee CHANGE REQUEST C T O CHANGE REQUEST Middle Management CHANGE REQUEST Level 1 C A L L PCP/ PCU APPLICATION DEVELOPMENT AREA End Users INCIDETN QUERY C E N T E R SUPPORT AREA (HELP DESK) INCIDENT QUERY COMMUNICATION SOLUTION GO LIVE THIRD PARTY ESCALATION Level 3 Technology Providers

17 Example: Overview IT structure for CERNER MILLENNIUM support (VIII) Clinical Transformation 1. Information System & applications Strategy Simplifed Information systems map 2. Hospital Information System scope Full support for HealthCare processes (Collaboration, Guidance, Continuity of care) EMR & Data driven (HIMSS Level 6 and 7) 3. Service improvement organization Incident Management (Call center): Robustness Change Management (Clinical Transformation Office): Flexibility 4. Representative users engaged & committed Results based agreement Clinical adoption leadership Transversal vision in change management

18 Example: 4. Representative IT structure users for engaged CERNER & MILLENNIUM commited support (III) Basics CLINICAL TRANSFORMATION OFFICE Managed by CIO Obstetrics and Gynecology representative InternalMedicine representative Pediatrics representative Emergency department s representative Primary Care representative IT manager 1 (Supportarea) IT manager 2 (Development area) Biological diagnosis representative Pharmacy department s representative Nursing coordinator s representative 1 Nursing coordinator s representative 2 Contract agreement signed with IT Department

19 Example: Overview IT structure for CERNER MILLENNIUM support (VIII) Clinical Transformation 1. Information System & applications Strategy Simplifed Information systems map 2. Hospital Information System scope Full support for HealthCare processes (Collaboration, Guidance, Continuity of care) EMR & Data driven (HIMSS Level 6 and 7) 3. Continuity of service & service improvement organization Incident Management (Call center): Robustness Change Management (Clinical Transformation Office): Flexibility 4. Representative users engaged & committed Results based agreement Clinical adoption leadership Transversal vision in change management 5. Measurable process improvement benefits (ROI) Functional unit-based Follow up for improving targets Clinical process-based Follow up for improving targets Information-driven business plan

21 Stratification Scenario

24 Chronic analysis SCP Clasificación por Morbilidad y Riesgo Clínico # Pacientes % Pacientes Pacientes Equivalentes % No Sanos % Acum. Pareto 6 Enfermedad significativa crónica en múltiples sistemas orgánicos ,43% % 55% 5 Enfermedad dominante o crónica moderada única ,66% % 76% 7 Enfermedad dominante crónica en tres o más sistemas orgánicos ,96% % 87% 4 Enfermedad crónica menor en múltiples sistemas orgánicos ,17% % 91% 3 Enfermedad crónica menor única ,06% % 95% 8 Neoplasias dominantes, metastásicas y complicadas 874 0,56% % 97% 2 Historia de enfermedad aguda significativa ,79% % 99% 9 Necesidades sanitarias elevadas 532 0,34% % 100% 1 Estado de salud sano ,02% TOTAL Pacientes DHD

25 Chronic analysis SCP Clasificación por Morbilidad y Riesgo Clínico # Pacientes % Pacientes Pacientes Equivalentes % No Sanos % Acum. Pareto 6 Enfermedad significativa crónica en múltiples sistemas orgánicos ,43% % 55% 5 Enfermedad dominante o crónica moderada única ,66% % 76% 7 Enfermedad dominante crónica en tres o más sistemas orgánicos ,96% % 87% 4 Enfermedad crónica menor en múltiples sistemas orgánicos ,17% % 91% 3 Enfermedad crónica menor única ,06% % 95% Neoplasias dominantes, metastásicas y ,56% % 97% complicadas 2 Historia de enfermedad aguda significativa SCP LEVEL 5,79% % 99% 9 Necesidades sanitarias elevadas 532 0,34% % 100% 1 Estado de salud sano ,02% TOTAL Pacientes DHD PATIENTS ATTENDED IN SPECIALIZED CARE 2013 TOTAL COST 22,0% 6 15,7% TOTAL PATIENTS AVG COST (5, 6) ,84

26 Chronic analysis COST OF PATIENTS ATTENDED IN SPECIALIZED CARE WITH ICC DIAGNOSIS SCP Clasificación por Morbilidad y Riesgo Clínico # Pacientes % Pacientes Pacientes Equivalentes % No Sanos SCP LEVEL TOTAL COST # PATIENTS % AVG COST % Acum. Pareto 6 Enfermedad significativa crónica en múltiples sistemas orgánicos ,43% % 55% 5 Enfermedad dominante 1 o crónica moderada 7.136,63 única ,66% 2,0% ,16 21% 76% 7 Enfermedad dominante crónica en tres o más ,14 sistemas orgánicos ,96% 1,5% ,71 11% 87% 4 Enfermedad crónica menor en múltiples sistemas orgánicos ,17% ,0% 4% - 91% 3 Enfermedad crónica menor única ,06% % 95% 8 Neoplasias dominantes, 4 metastásicas y 1.371,25 complicadas ,56% 0,5% ,25 3% 97% 2 Historia de enfermedad aguda significativa ,79% % 99% 9 Necesidades sanitarias 5 elevadas , ,34% 12,3% ,58 1% 100% 1 Estado de salud sano ,02% TOTAL Pacientes DHD , ,7% 5.352, , ,7% , ,83 4 2,0% , ,16 6 2,9% , , ,5% 8.162,68 TOTAL , ,60

27 Chronic analysis SCP Clasificación por Morbilidad y Riesgo Clínico # Pacientes % Pacientes Pacientes Equivalentes % No Sanos % Acum. Pareto 6 Enfermedad significativa crónica en múltiples sistemas orgánicostotal COST ,43% % 55% 5 Enfermedad dominante o crónica moderada ,66% % 76% única 5 22,0% COST OF PATIENTS ATTENDED IN SPECIALIZED CARE WITH ICC DIAGNOSIS 7 Enfermedad dominante crónica en tres o más sistemas 6 orgánicos 15,7% SCP LEVEL TOTAL COST # PATIENTS 0,96% % 11% AVG COST87% Enfermedad crónica menor en múltiples 4TOTAL PATIENTS sistemas orgánicos 7.136, ,17% ,0% 4% 1.784,16 91% 3 Enfermedad crónica menor única ,06% % 95% AVG COST (5, 6) 1.132, ,14 3 1,5% 3.044,71 Neoplasias dominantes, metastásicas y ,56% % 97% complicadas ,0% - 2 Historia de enfermedad aguda significativa ,79% % 99% 9 Necesidades sanitarias elevadas , ,34% ,5% 1% 1.371,25 100% 1 Estado de salud sano ,02% TOTAL Pacientes DHD , ,3% 5.354,58 SCP LEVEL PATIENTS ATTENDED IN SPECIALIZED CARE , ,7% 5.352, , ,7% , ,83 4 2,0% , ,16 6 2,9% , , ,5% 8.162, CHF chronic patients= 2% total cost TOTAL , ,60

28 CHF program Process Map

29 Medical prescription

30 Program inclusion

31 Program inclusion

32 Patient follow up

33 Clinical protocols & treatments

34 Adapted Care plans

42 RESULTS

43 CHF program incidence in SC activity Data collected from 146 Patients included in CHF program INDICADOR VARIACIÓN urgencias % % urgencias ingresadas ICC 57% 39% -31,2% % urgencias ingresadas MS 15,9% 15,5% -2,7% Tiempo de permanencia ICC 16:32:24 13:49:47-16,4% Tiempo de permanencia MS 6:06:24 5:49:46-4,5%

44 CHF program incidence in SC activity Data collected from 146 Patients included in CHF program INDICADOR VARIACIÓN ALTAS % ESTANCIAS ,0% ESTANCIA MEDIA 6,20 6,45 4,1% INDICADOR VARIACIÓN CONSULTAS EXTERNAS % PRUEBAS DIAGNOSTICAS % RADIOLOGÍA %

45 CHF program incidence in SC activity

47 Conclusions (our experience) Cerner implentation 2010 Clinical Transformation Office HIMSS ( ) Process improvement From 2009 Users not confident Users as drivers of the system Process improvement Not a goal A consequence Same company, same tool, same people, different organization, different culture,, different results Mesure as a way to improve Triple perspective (patient, profesional an also organization)

48 Conclusions (our experience) HIMSS level 7 award ceremony in Copenhagen 2012

49 Thank you!