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Productivity tools in healthcare IT systems (HIS & LIMS), their relation with patient care and developing objectivity in clinical management
DR CHIRANTAN BOSE MDVICE PRESIDENT – CLINICAL AFFAIRS
MEDGENOME LABS, BANGALORENARAYANA HEALTH CITY
The Concept
The present scenario
The Challenges
The Solution
The Concept framework
Data entry into
EMR/LIMSMatrices /
objective evidence of given clinical
scenarios
Meta-Analysis
Change to management /
preventive measures
Clinical process flow
Modification in patient management
Predicting care management outcomes
Financial oversight and planning
The present scenario
Researchers at the University of California at Davis studied how an EMR implementation at six primary care offices affiliated with the same academic medical center affected physician productivity levels. They found that after an initial dip in productivity during the training period -- which is normal -- internists were able to increase productivity above pre-EMR rates
Experts stress that implementation is an ongoing process. Because health care takes place in a continually changing environment, the processes used by physicians to navigate that environment must adapt.
CLINICAL SCENARIOS - SHIFTING FROM SUBJECTIVITY TO OBJECTIVITY
• EHR use by office-based physicians rose from 18% in 2001 to 48% in 2009, and finally to 78% in 2013. (Source: CDC) • Roughly 60% of physicians say they are satisfied with their EHR system.
(Source: Deloitte)• Use of EHR is associated with significantly higher quality of care for breast
cancer screening, Chlamydia screening, colorectal screening, and diabetes testing for hemoglobin. (Source: Journal of General Internal Medicine)• 67% of physicians report EMRs save them time through e-prescribing, and
that EMRs improve care coordination due to interoperability. (Source: Deloitte)
Proportion of electronic medical record (EMR) use and proportion of solo practitioners by specialty type. Proportion of solo practitioners by specialty was determined by the number of physicians who reported being in solo practice to the National Ambulatory Medical Care Survey.
J Am Med Inform Assoc. 2013 Jun; 20(e1): e33–e38.
Cumulative frequencies of electronic medical record (EMR) use among 14 different medical specialties from 2003 to 2010. Percentages represent unadjusted frequencies and represent both part and full EMR use combined. p<0.0001 for the difference between 2003 and 2010 frequencies in all specialties listed. The oncology stratum was not sampled in 2003.
Proportion of electronic medical record (EMR) use by practice ownership.
The Challenges
• 37% of physicians see EHR as their number one challenge; tied with financial issues as their primary concerns. (Source: Hello Health)• 30% of doctors think EHR implantation would hurt practice finances due to higher
costs and overhead or productivity decreases. (Source: Hello Health)• 51% of physicians who say financial issues are their primary concern felt
implementing an EHR would help. (Source: Hello Health) • 54% of physicians are not happy with their EHRs’ interactivity. (Source: Fierce EMR) [Note : The survey also found that the brands used by the largest percentage of respondents are EPIC (22 percent), Allscripts (10 percent) and Cerner (9 percent). However, the top ranked ones were Amazing Charts, Practice Fusion, VA-CPRS, Medent and e-MDs.]
Summarising the challenges• A single patient – multiple doctors – multiple hospitals/clinics –
multiple labs – multiple medication• Information in different formats – harmonisation issue !• Longitudinal tracking is difficult• Different patients – similar clinical factors – similar scenarios and
outcomes – difficult to be clubbed a trend
The Solution
Longitudinal data becomes simple to interpret• Mr A has been suffering from Chronic perennial bronchitis which has been associated with
fluctuant eosinophil counts of 10 – 20% and IgE levels of 150 – 300 since 2003. Drainage procedures were performed on frontal sinusitis. There have been peaks of deterioration during winter months. Preventive measures instituted, Vit D measurement and prophylaxis.
Dec-01 Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03 Apr-03 May-030
50
100
150
200
250
300
350
400
Selected parameters
Eosinophil IgE Vit D
Each medical centre is different and has different workflows• Understanding of the given organisational pattern:• How they work / What’s their modus operandi ?• What are they looking to achieve (eg reduced hosp stay; cost effective care;
work as a referring centre)• What do the leaders wish to monitor?• How much time do they invest in each workstation ?• What are their pain points ?• Where is paper used ?• Where do communication gaps exist (eg lab and supply chain; ER and lab;
registration desk and report dispatch desk)
Some examples of a favourable framework of a healthcare IT system :• User can customise the interface on a need based fashion (eg
dropdown selection of symptoms or progression notes)• User can select parameters of MIS (eg time of patient registration Vs
volume of lab tests ordered vs clinical consultation duration)
55
1023
48
No of OP reg
8 am - 11 am 11 am - 2 pm2 pm - 5 pm 5 pm - 8 pm
42
35
23
20
No of lab orders
8 am - 11 am 11 am - 2 pm2 pm - 5 pm 5 pm - 8 pm
14
1625
8
per clinician per consul-tation duration (min)
8 am - 11 am 11 am - 2 pm2 pm - 5 pm 5 pm - 8 pm
• Singular user logins – swipe card / biometric• Ease of patient data retrieval through variable search options• Categorisation on equipment eg within lab – interface of all data (eg
patient/sample records, scatter plots, photomicrographs, quality control, references, reflex work-ups
IBM Health’s data combined with Truven’s patient records will create an enormous big-data collection representing 300 million patient lives
IBM said that, post-acquisition, it will have one of the world’s largest and most diverse collections of health data within IBM Watson Health. Watson Health currently delivers these cloud-based services:• Analysis of data;• Interpretation of complex questions; and• Evidence-based answers to doctors, research, insurers, and others.
“Truven contributes vital payment information on patients. And payment records include detailed coding on disease types, diagnosis, drugs prescribed, and clues to outcomes if, say, a patient does not respond to one treatment and is given another. It’s a very key cog to give us one of the most complete data sets on patients and healthcare in the world.” said John Kelly, PhD IBM’s Senior Vice President of Cognitive Solutions and IBM Research in a New York Times article
Major Lab related – Operational challenges• Monitoring Return on Investments• Inventory Management –
• on-board inventory, productive consumption, QA consumption, wastage, repeats• Off-board instrument side ; off-board central inventory
• Laboratory personnel behavioural aspects :• Possessiveness towards assets• Non-resilience towards new practice adherence• Continued compliance issues
• Deficit of tools to provide clinical trends pertaining to individual patients or trends pertaining to disease segments or trends pertaining to interpretational results• Deficit of tools to visualise multi-lab location productivity
How much/ where/ commercials/ trend
Metrics of Productivity & EfficiencyHeirarchial interest
Measuring tools / Indicators
Activity Involved
Corporate management
Return on Investment / Gross turnovers
Investment / Capital / Networking
Lab / Dept Management
P&L; Overall performance indicators eg TAT
Resource management ; Scientific /clinical oversight
Technical workforce (Supervisory staff)
QA data, Instrument data, Specimen data, patient records
Analytical workflow management
Bench staff Generation of data Specimen management
Incr
easin
g fo
cus o
n Pr
oduc
tivity
Increasing focus on Efficiency
Solutions• Create user interface templates by importing word doc forms• Import test related or patient information from excel/pdf/jpeg etc• Realtime access to SOPs• Unified technology platforms (eg Specimen mgt systems/LIMS + inventory mgt
system + interfaces + billing + document control system + mobility system)• Integration between clinical / lab sub specialities• Customization of rules by end user (eg shoot an email of sub-adequate
specimen qty to client) without vendor involvement• Enable mobile accessibility • Customisable BI tools
Thanks
Questions