Optimization of Healthcare Operations: the e-Health Added Value

Optimization of Healthcare Operations: the eHealth Added Value Najeeb Al-shorbaji, Director Knowledge Management and Sharing WHO/HQ Geneva, Switzerland Najeeb Al-shorbaji, Director Knowledge Management and Sharing WHO/HQ Geneva, Switzerland

Optimization of Healthcare Operations: the e-Health Added Value Agenda 1)Quality aspects of healthcare; 2)Patient safety; 3)Access to health knowledge and evidence; 4)Electronic health record: content and functions; 5)Patient education and customer health information; 6)Proactive healthcare: messaging, alerts, notifications, etc. 7)An overview of the work of WHO in ehealth. 1)Quality aspects of healthcare; 2)Patient safety; 3)Access to health knowledge and evidence; 4)Electronic health record: content and functions; 5)Patient education and customer health information; 6)Proactive healthcare: messaging, alerts, notifications, etc. 7)An overview of the work of WHO in ehealth.

From data to knowledge Healthcare knowledge Healthcare information Healthcare data

Optimization of Healthcare Operations: the e-Health Added Value What is quality? Quality is the conformity between actual care and pre-set criteria (Standards) Why quality is needed/required? –Value –Safety –Efficiency –Effectiveness –Acceptability –Accessibility –Interpersonal relations Quality is the conformity between actual care and pre-set criteria (Standards) Why quality is needed/required? –Value –Safety –Efficiency –Effectiveness –Acceptability –Accessibility –Interpersonal relations

Optimization of Healthcare Operations: the e-Health Added Value Access to online information products Clinicians have many clinical questions –5 questions per inpatient encounter * –5 questions per outpatient half-day ** Many of these questions go unanswered ** –45%of the answers are not even pursued –Of 55% pursued, still unable to answer 28% of them Access to an online retrieval system improved clinicians’ answers to clinical questions by 21% *** Continuous education and long-life learning Keep abreast of new developments, drug interaction, etc. Clinicians have many clinical questions –5 questions per inpatient encounter * –5 questions per outpatient half-day ** Many of these questions go unanswered ** –45%of the answers are not even pursued –Of 55% pursued, still unable to answer 28% of them Access to an online retrieval system improved clinicians’ answers to clinical questions by 21% *** Continuous education and long-life learning Keep abreast of new developments, drug interaction, etc.

Optimization of Healthcare Operations: the e-Health Added Value Online information products and services Evidence-based guidelines Evidence-based databases Full-text journals Textbooks MEDLINE, PubMed, IMEMR Drug Reference Information Guidelines Standard Operating Procedures. Evidence-based guidelines Evidence-based databases Full-text journals Textbooks MEDLINE, PubMed, IMEMR Drug Reference Information Guidelines Standard Operating Procedures.

Optimization of Healthcare Operations: the e-Health Added Value Electronic Health Record Legible (people die as a result of bad handwriting) Accessible form anywhere in the hospital and possible over the internet Prerequisite for many types of clinical decision making Easy to identify patients whenever a medication or device is recalled Easy to produce reports for quality organizations Supports graphing of laboratory tests over time. Legible (people die as a result of bad handwriting) Accessible form anywhere in the hospital and possible over the internet Prerequisite for many types of clinical decision making Easy to identify patients whenever a medication or device is recalled Easy to produce reports for quality organizations Supports graphing of laboratory tests over time.

Optimization of Healthcare Operations: the e-Health Added Value Preventive Care Reminder Electronic systems have the ability to store triggers that are automatically activated as soon as a condition is met. The condition can be time, vital sign, etc Examples Influenza vaccine –Computer-based reminders increased guideline compliance by 78%* Diabetes care –Electronic reminders increased the odds of recommended care by 30%** Coronary Artery Disease care –Electronic reminders increased the odds of recommended care by 25%** Electronic systems have the ability to store triggers that are automatically activated as soon as a condition is met. The condition can be time, vital sign, etc Examples Influenza vaccine –Computer-based reminders increased guideline compliance by 78%* Diabetes care –Electronic reminders increased the odds of recommended care by 30%** Coronary Artery Disease care –Electronic reminders increased the odds of recommended care by 25%**

Optimization of Healthcare Operations: the e-Health Added Value Provision of InfoButtons and contextual references Information Buttons, known as InfoButtons store text that can be retrieved by pressing the relevant button. A wealth of knowledge specific and tailored is a click away. A button may be: Problems List Medications List Laboratory Results Language Versions Geographic References List of Experts/Consultants Check lists and Standard Operating Procedures. Information Buttons, known as InfoButtons store text that can be retrieved by pressing the relevant button. A wealth of knowledge specific and tailored is a click away. A button may be: Problems List Medications List Laboratory Results Language Versions Geographic References List of Experts/Consultants Check lists and Standard Operating Procedures.

Optimization of Healthcare Operations: the e-Health Added Value Computerized Physician Order Entry (CPOE) Computerized physician/provider order entry is defined as the computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so. CPOE is effective as it is: Eligible: no handwritten instructions Enables real time decision support Reduces medical errors * Improves compliance with quality measures ** Positive return of investment *** Computerized physician/provider order entry is defined as the computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so. CPOE is effective as it is: Eligible: no handwritten instructions Enables real time decision support Reduces medical errors * Improves compliance with quality measures ** Positive return of investment ***

Optimization of Healthcare Operations: the e-Health Added Value Order sets A grouping of patient orders for a specific diagnosis or condition. It promotes standardized care processes. Order sets DO: Contain the instructions that physicians provide concerning the care of a given patient Standardize care Optimize care Facilitate evidence-based care Order sets INCLUDE: Emergency department orders Admission orders Surgical orders A grouping of patient orders for a specific diagnosis or condition. It promotes standardized care processes. Order sets DO: Contain the instructions that physicians provide concerning the care of a given patient Standardize care Optimize care Facilitate evidence-based care Order sets INCLUDE: Emergency department orders Admission orders Surgical orders

Optimization of Healthcare Operations: the e-Health Added Value Evidence-based order sets THEY must be considered with an entire life cycle in mind: from initial creation, to updating, to archiving. This life cycle is made up of numerous components, including: –Defining authorship privileges (write, review, edit) for different members of the quality improvement team –Coordinating review and approval cycles for new or updated clinical order sets –Controlling the release of evidence-based order sets to ensure that current, approved versions are in use –Updating evidence-based order sets to reflect changes in local practice, performance measures, or the peer-reviewed literature –Preserving a library and archive of institution-wide evidence- based order sets* THEY must be considered with an entire life cycle in mind: from initial creation, to updating, to archiving. This life cycle is made up of numerous components, including: –Defining authorship privileges (write, review, edit) for different members of the quality improvement team –Coordinating review and approval cycles for new or updated clinical order sets –Controlling the release of evidence-based order sets to ensure that current, approved versions are in use –Updating evidence-based order sets to reflect changes in local practice, performance measures, or the peer-reviewed literature –Preserving a library and archive of institution-wide evidence- based order sets*

Optimization of Healthcare Operations: the e-Health Added Value Dosing and Allergy Checks (as part of CPOE) Dosing. One size does not fit all. In many instances, the recommended drug dosage is appropriate for the majority of the average population. However, for some drugs, the prescribed dose may need to be individualized for patients suffering from other diseases that require other medications, advanced age, body weight, gender, etc. * Examples: –Pediatrics (based on patient's weight) –Renal failure (based on patient’s renal function) Dosing. One size does not fit all. In many instances, the recommended drug dosage is appropriate for the majority of the average population. However, for some drugs, the prescribed dose may need to be individualized for patients suffering from other diseases that require other medications, advanced age, body weight, gender, etc. * Examples: –Pediatrics (based on patient's weight) –Renal failure (based on patient’s renal function)

Optimization of Healthcare Operations: the e-Health Added Value Dosing and Allergy Checks (as part of CPOE) Allergy. A drug allergy happens when a patient has a harmful reaction to a medicine that has been used. A computerized system can alert to: –Prior adverse reactions to the drug being prescribed –Prior adverse reactions to a different drug, but one with cross-sensitivity to the drug being prescribed. Allergy. A drug allergy happens when a patient has a harmful reaction to a medicine that has been used. A computerized system can alert to: –Prior adverse reactions to the drug being prescribed –Prior adverse reactions to a different drug, but one with cross-sensitivity to the drug being prescribed.

Optimization of Healthcare Operations: the e-Health Added Value Interaction Checks (as part of CPOE) The pharmacological result, either desirable or undesirable, of drugs interacting with themselves or with other drugs, with endogenous chemical agents, with components of the diet, or with chemicals used in or resulting from diagnostic tests.* Computer-based systems storing results of research are used to signal and alert when two or more drugs are presibed and possible interaction occurs. The pharmacological result, either desirable or undesirable, of drugs interacting with themselves or with other drugs, with endogenous chemical agents, with components of the diet, or with chemicals used in or resulting from diagnostic tests.* Computer-based systems storing results of research are used to signal and alert when two or more drugs are presibed and possible interaction occurs.

Optimization of Healthcare Operations: the e-Health Added Value Interaction Checks (as part of CPOE) The interaction check maybe: Drug-drug interaction checks –Drug A may increase effect of Drug B OR –Drug A may decrease effect of Drug B Drug-lab interaction checks –Drug A may be contraindicated if lab result X is too high or too low –Dosage of Drug A may need to be changed based on Lab result X The interaction check maybe: Drug-drug interaction checks –Drug A may increase effect of Drug B OR –Drug A may decrease effect of Drug B Drug-lab interaction checks –Drug A may be contraindicated if lab result X is too high or too low –Dosage of Drug A may need to be changed based on Lab result X

Optimization of Healthcare Operations: the e-Health Added Value Work of WHO in ehealth World Health Assembly Resolution on eHealth (WHA58.28); Global Observatory for eHealth; eHealth Standardization Coordination Group; eHealth Intelligence Report; eHealth for Health Care Delivery; Health Academy (eLearning for Health); Partnership and collaboration with other UN agencies; Conferences, seminars and training sessions; Direct assistance to member states. World Health Assembly Resolution on eHealth (WHA58.28); Global Observatory for eHealth; eHealth Standardization Coordination Group; eHealth Intelligence Report; eHealth for Health Care Delivery; Health Academy (eLearning for Health); Partnership and collaboration with other UN agencies; Conferences, seminars and training sessions; Direct assistance to member states.

Optimization of Healthcare Operations: the e-Health Added Value The way forward Develop national policy and strategic directions for: –Access to health information; –Information and communication technologies; –eHealth. Secure political commitment; Recognize cultural and multilingualism challenges; Establish legal framework; Develop national policy and strategic directions for: –Access to health information; –Information and communication technologies; –eHealth. Secure political commitment; Recognize cultural and multilingualism challenges; Establish legal framework;

Optimization of Healthcare Operations: the e-Health Added Value Address the human resources development issues: capacity building in healthcare informatics; Build public private partnerships; Adopt and apply international standards and ensure interoperability of systems; Build ICT infrastructure in healthcare institutions; Run pilot projects, show results, evaluate; Learn from other's mistakes; Involve all stakeholders when prior, while and after implementation. Address the human resources development issues: capacity building in healthcare informatics; Build public private partnerships; Adopt and apply international standards and ensure interoperability of systems; Build ICT infrastructure in healthcare institutions; Run pilot projects, show results, evaluate; Learn from other's mistakes; Involve all stakeholders when prior, while and after implementation.

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