Corinne Aad Naba’ | Division Manager Healthcare Information Systems “An Integrated Healthcare Technology For Better Care” Corinne Aad Naba’ | Division Manager

Agenda Healthcare Strategy and Analysis Healthcare vision and Strategy Plan Inter operability Platform at the National level Electronic Medical Records at the Hospital level Hello; it s an honor for me representing IT &Beyond to be part of this national forum today , I will be very briefed talking about the HIS As integral part in the future health . Healthcare as industry is where banking was 30 years ago, the challenge was to create a hub to connect many banks with any retailer, so the customer can enter a store , swipe a card and have founds deducted from his account . Now the healthcare providers are in the position of those retailers , I m talking about hospitals and primary heath centers . In today s high tech, we can get info about anything in just few seconds for a click of a mouse but it s not the same in most of the drs offices and medical facilities where antiquated record keeping and billing systems cost facilities precious time and money and can interfere with the quality of the care provided

Healthcare Outcome Index – MENA Region Lebanon sets the standard for Healthcare outcomes in the MENA region, boasting a high healthcare outcome index for a low spend per head, even against global peers Lebanon sets the standards for healthcare outcomes in the MENA region, boasting a high healthcare outcome index for a low spend per head, even againt glob

Strategy & Analysis Compared to global and regional averages, Lebanon is well supplied in hospitals, beds and physicians, while still suffering – although less than the region from global shortage of nurses OECD: Convention on the Organization for Economic Co-operation and Development

Demographic Statistics The Lebanese healthcare market stands at over 4 beds per 1000 capita, yet with different levels of supply across regions and a majority of relatively small size hospitals

Healthcare Sector Policies & Strategies | Challenges in the 21st century Life expectancy raised from 71,6 in 1994 to 79,4 in 2014 in Lebanon Patient Aging population Chronic diseases Empower-ment Involvement Expectation Disruptive? Uberization of healthcare? Hospital/GP Rating? The most frequently observed non communicable diseases are asthma, chronic obstructive pulmonary diseases, diabetes, hypertension and cardiovascular diseases.(source WHO) Millions of websites dedicated to healthcare, IOT, Patient social networks Self-assessment, web booking, apps Quantified self wellbeing Iot : internet of things Urbanization refers to the population shift from rural to urban areas Disruptive changing the traditional way that an industry operates

Unified Working Process but where Is The Patient? General Practitioner Reimbursement Assessment Insurance Primary care center Claim Medical report ? Drug consumption Pharmacy Hospitals Referral Letter Emergency Prescription Discharge letter

How to do it? National Level Platforms Hospital Level integrated EMR

How to do it? Use an inter operability Platform at the National Level

Organizing The Clinical Pathway Medical Assessment Drug Prescription Referral Letter GP Receive prescription and dispense medicine Retail Pharmacy Receive the referral letter Knows about the dispensation Hospital Knows about the actual pathway Third party Payer Using big data enhances public health management MoH Is the new stakeholder of his clinical pathway Patient

Platform Benefits Patient Access an abstract of his medical record regardless of the hospital he went to Added value services (online booking, online payment…) Third party payer Comprehensive vision of the clinical pathway of the patient Better coverage offering Primary care Considered as a stakeholder of the clinical pathway Can easily access the comprehensive patient history Research center Access detailed anonymous information (big data) Ministry of Health Can set up a Public health policy using big data Social Security Better governance of public health facilities

Use EMR at the Hospital Level How to do it? Use EMR at the Hospital Level

EMR Initiative In the 1960s, the development of the problem oriented medical record by Larry Weed introduced the idea of using electronic methods of recording patient information. 1960 2018

EMR Needs In Hospitals Now in 2018 , the EMR is a need in all hospitals regardless of the size and beds number .looking at this chart , we can see the complexity of the workflow between the different stakholders in a medical facility . Given that the medical decisions are based on hundreds and hundreds of inputs , decisions should be accurate and based on a critical thinking, therefore it should be processed in an efficient precise system to be more reliable. In the current workflow system , patient information is fragmented and creates redundant therefore Inefficient efforts . While having an EMR will consolidate information and provide a foundation of unifiying efforts :the added value of having an EMR as The patient record cannot be separated of the care of the patient . It’ s part of the practice .

Healthcare Quality & Safety (1/2) The estimated amounts spent on hospitalization during 2015 would reach 95 trillion Lebanese lira*. . *Source: Cooperative of Government Employees Despite many efforts to control the cost of healthcare, the annual rate of increase has almost always exceeded the overall rate of inflation and has often soared into double digits. We will go straight forward to the main goal of a secure healthcare system with high quality standard : Currently in Lebanon , the estimated amounts spent in hospitalization during 2015 would reach 95 trillion Lebanese lira based in the cooperative of government employees and this chart shows us the increase of registered hospitalization requests between 2010 to 2015 …. Despite many efforts to control the cost of healthcare, the annual rate of increase has almost always exceeded the overall rate of inflation and has often soared into double digits. The values of the EMR will be from the population benefits: a RAND study doen in the US has concluded a 80 billion $ per year in savings so to Improve the quality safety and efficiency , we can start by the Preventable medical errors, other slide

Healthcare Quality & Safety (2/2) Medical errors due to : Calculation errors Handwriting Quality health care : Volume of paper: up to 20 different patient registers for each facility Onerous data reporting: nurses spend 4-6 days per month aggregating data Late reporting Inaccurate data Little information flows back to the medical providers : difficult to identify defaulters or high risk patients Medical errors result in the death of residents each year. In Lebanon , data regarding the exact number of reported errors is missing , more than a thousand complaints were reported at the Order of Physicians from 1996 to 2013. Less than a decade ago, nine out of ten doctors in the U.S. updated their patients’ records by hand and stored them in color-coded files. By the end of 2017, approximately 90% of office-based physicians nationwide will be using electronic health records (EHRs). Health records are changing quickly —

EMR & The Patient Journey (1/2) As A comprehensive EMR includes many modules and interfaces with third party systems and medical devices . The EMR system consolidates information and provide a foundation for unifiying efforts between all actors /departements / patients and third party payers so a the end the patient will have consolidated date

EMR & The Patient Journey (2/2): Effect of New Technology on Clinical Outcome To make health service data visible to all health service stakeholders for their prompt attention and action on activities. Create a system that ensures data is standard , accurate and well tracked scientifically and financially Increase workforce accountability Save time and cost through eliminating redundant diagnostic testing Studies predict a gain of as much as 30 % in efficiency from emr use . Mostly through reducing unnecessary tests and prescriptions , paper work and medical mistakes. However, all the above reasons can find a solution, it needs the cooperation of all parties, especially the government in creating health care quality improvement. To encourage interest in and adoption of EMR, and the potential benefits should continue to be disseminated. For example, the patient's EMR capable of storing large amounts of data using only a computer device that can be done. In addition, electronic medical records can provide a warning if the nurse giving the wrong drug or no drug-drug reaction. In this context, the socialization of EMR should be an important part in the campaign of patient safety movement (patient safety).

EMR Challenges Need for national policies & legislation Need for coordination of health care services among the different levels of care limited financial resources seeking funds Resistance to change Despite having a number of benefits for healthcare settings, the successful implementation of health information systems (HIS) continues to be a challenge in many developing countries. Classic reasons why EMR is not growing fast is the absence of a clear legal framework. Often the question arises: how the protection of the hospital in terms of claims to the patient? How validity of electronic documents? If an error occurs in the patient's medical writing of data, whether the electronic device has the facility to continue to record the data previously entered log and do not remove (delete) the incoming data and the type of data to be replaced. - Another issue is the availability of funds. Financial aspects become an important issue because it must prepare the infrastructure (computers, wired and wireless networks, electricity, security systems, consulting, training, etc.). Hospitals usually have a limited budget, especially for information technology.

EMR Perspectives Pursue national support for the promotion of HIS system for better patient care and safety Adopt a unique patient identifier Benefits from the international experience during the last decade to start from a high level; adopt their expertise and adapt it to the local needs Self initiative can not stand alone. EMR expansion should be done continuously and require national-level initiatives. If the government is serious about making the EMR as a key to improving the quality of hospital services, there must be a serious team that formulated the direction of development of EMR in every hospital. Make EMR as part of the need for medical and paramedical and Admistrative team in hospitals is part of the process of diffusion of innovation. In every generation, there will always be early adopters will be a pioneer in adopting the latest developments. He is precisely what will be the role model.

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