1. International Leaders of the EHR journey
ASSIST and NHS NorthWest
October 9, 2007
From what perspective I come from – it’s a tool
16-Feb-19
Denis Protti - University of Victoria & City University London

2. Evidence of progress from around the world
We are making an impact
16-Feb-19
Denis Protti - University of Victoria & City University London

3. Denis Protti - University of Victoria & City University London
Denmark
16-Feb-19
Denis Protti - University of Victoria & City University London

4. Denis Protti - University of Victoria & City University London
Denmark
Virtually all Danish GPs (and as of 2007, almost all specialists as well) send and receive clinical electronic messages.
Sixty standardized messages (up from 32 in 2002) have been implemented in 100 computer systems in 4,000 organizations.
Over 90% of the country’s clinical communications in the primary sector are exchanged over Denmark’s national network.
including 16 physician office systems, 9 hospital systems,12 laboratory systems and 4 pharmacy systems.
16-Feb-19
Denis Protti - University of Victoria & City University London

5. Denis Protti - University of Victoria & City University London
Denmark
In 2005, a national health portal provided information about the Danish National Health Service to its citizens and patients.
Waiting list information
Online scheduling of GP appointments
Access to online medication profile
Renewal of prescriptions
contact with GPs
Quality declarations
It is also beginning to serve as a unified hub for electronic communication between patients and the Health Service.
16-Feb-19
Denis Protti - University of Victoria & City University London

6. Denis Protti - University of Victoria & City University London
New Zealand
16-Feb-19
Denis Protti - University of Victoria & City University London

7. Denis Protti - University of Victoria & City University London
AGPAL ACCREDITED
2,200 New Zealand sites
1,200 Australian sites
1-800 support across Australasia
16-Feb-19
Denis Protti - University of Victoria & City University London

8. Denis Protti - University of Victoria & City University London
KIWI SCORECARD
85% use of GP clinical systems (in consultation)
90% use clinical messaging
95% receive electronic pathology reports
95% can receive electronic discharge summaries and send referrals
60% of hospitals (and growing) send electronic discharge summaries
16-Feb-19
Denis Protti - University of Victoria & City University London

9. Denis Protti - University of Victoria & City University London
Hong Kong
16-Feb-19
Denis Protti - University of Victoria & City University London

10. Hospital Authority Services
43 Hospitals
46 Specialist clinics
74 General clinics
8M Patient Records
Annually:
1M Admissions
2M A&E visits
11M Outpatient visits
52,000 Staff
4,500 Doctors
20,000 Nurses

11. Clinical Systems
Comprehensive functionality developed in-house since early 90’s
High utilization by clinicians
Mission critical systems
Increasing strategic importance
Source: Dr. NT Cheung
The Hospital Authority adopted a centralized approach in developing its IT system for clinical care, the clinical management system (CMS). This has reduced IT cost per hospital. High mobility of both patients and doctors are characteristics in Hong Kong. Therefore, inter-operability between different hospitals is one of the forefront initiative in developing the clinical management system. A familiar user interface is important in enhancing the efficiency in a busy clinic setting. The Hospital Authority CMS has very high user acceptance and is in use in everyday care delivery.

12. Electronic Patient Record (ePR)
Web-based lifelong longitudinal record of all healthcare transactions for all Hong Kong citizens
Patient privacy protected with access controls and full audit logs
Available at all 162 facilities in the HA
Many data formats (textual, numerical and digital images)
Now extending to external providers

13. Impressive statistics
7.6 million patients
57 million episodes of care
540 million laboratory results
34 million radiology results
230 million drug items
1 million image studies
Sub-second response time
7x24 >99.99% uptime

14. Denis Protti - University of Victoria & City University London
USA
16-Feb-19
Denis Protti - University of Victoria & City University London

15. US – Veteran’s Administration
Every VA Medical Center has Electronic Health Records and Computerized Provider Order Entry!
16-Feb-19
Denis Protti - University of Victoria & City University London

16. Veterans Health Administration
Department of Veterans Affairs (VA)
Provides benefits and services to our nation’s veterans and selected family members
Veterans Health Administration (VHA)
The branch of VA that provides healthcare benefits to some 5 million veterans and their families
Locations & Affiliations
~ 1,400 Sites-of-Care
Including 154 medical centers, ~ 875 clinics, counseling centers, plus long-term care, domiciliaries, home-care programs
Affiliations with 107 Academic Health Systems
Additional 25,000 affiliated physicians
Additional 35,000 residents & fellows (in 14,000 slots)
~90,000 trainees each year in all disciplines
1,500 Health Professions Training Affiliations
Nearly half US health professionals (>65% physicians) have some training in VA

17. Scope of Use
Scope of use Single patient record immediately available real time, supports both continuity and longitudinal patient-centric care across continuum
Inpatient: Wards, critical care, specialty care, Bone Marrow Transplant Unit, surgery
Outpatient: Primary Care, Specialty Care, Allied health, Community Based Outpatient Clinic
Emergency room
Nursing Home
Home Care
Home Telemonitoring

18. 10 Year Cumulative % Change in Costs - VA, Medicare, CPI
-20%
-10% 0%
10%
20%
30%
40%
50%
VHA Cost Per Patient
Avg. Medicare Payment/Enrollee
Medical CPI -
-0.3%
0.8%
-6.2%
-8.6%
-6.5%
-7.3%
-9.1%
-4.6%
6.4%
14.9%
12.8%
25.5%
31.9%
40.4%
44.7%
3.3%
5.9%
9.8%
13.5%
18.4%
23.7%
29.5%
34.7%
39.4%
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
VHA Cost per Patient– Total Medical Care Obligations per Total Unique Patients (inc non Veterans)
Average Medicare Payment per (
Medical Consumer Price Index-- Bureau of Labor Statistics

19. Performance Measurement Setting the U. S
Performance Measurement Setting the U.S. Benchmark for 18 Comparable Indicators
Clinical Indicator
VA 2003
Medicare 03
Best Not VA or Medicare
Advised Tobacco Cessation (VA x3, others x1) 75 62
68 (NCQA 2002)
Beta Blocker after MI 98 93
94 (NCQA 2002)
Breast Cancer Screening 84
75 (NCQA 2002)
Cervical Cancer Screening 90
81 (NCQA 2002)
Cholesterol Screening (all pts) 91 NA
73 (BRFSS 2001)
Cholesterol Screening (post MI) 94 78
79 (NCQA 2002)
LDL Cholesterol <130 post MI
61 (NCQA 2002)
Colorectal Cancer Screening 67
49 (BRFSS 2002)
Diabetes Hgb A1c checked past year 85
83 (NCQA 2002)
Diabetes Hgb A1c > 9.5 (lower is better) 15
34 (NCQA 2002)
Diabetes LDL Measured 95 88
85 (NCQA 2002)
Diabetes LDL < 130 77 63
55 (NCQA 2002)
Diabetes Eye Exam 68
52 (NCQA 2002)
Diabetes Kidney Function 70 57
Hypertension: BP < 140/90
58 (NCQA 2002)
Influenza Immunization 76 P
68 (BRFSS 2002)
Pneumocooccal Immunization
63 (BRFSS 2002)
Mental Health F/U 30 D post D/C 61
74 (NCQA 2002)

20. Denis Protti - University of Victoria & City University London
Spain (Andalucia)
16-Feb-19
Denis Protti - University of Victoria & City University London

21. Health Care Information and Management Integrated System
Andalusian Health Service

22. Andalusian Public Health System
Primary Care
Specialized Care
37 hospitals
64,000 professionals
Outpatient
Admissions
Emergency room services
Diagnostic tests
1,500 health centres
19,000 professionals
System gateway
General practitioner
Paediatrician
Nurse
Other services: Dentist, Rx...

23. Diraya´s objective
Integrate the healthcare information of every citizen
A SINGLE
HEALTH
RECORD

24. 1 2 3 4 A SINGLE Health record for each citizen
Diraya’s key elements 1
A SINGLE Health record for each citizen
KEYS 2
Unified access to all services 3
All relevant information structured
Developed by the practitioners/users 4

25. Diraya. Building blocks
DATA WAREHOUSE
ELECTRONIC PRESCRIPTION
CENTRALISED APPOINTMENT
HEALTH RECORD
CITIZEN REGISTER
STRUCTURE
(resources)
OPERATORS MANAGEMENT

26. Diraya. Implementation in Primary Care
2002
< 25 % % % %
> 90 %
Population coverage

27. 2007 Implementation in Primary Care 521 Health centres
With clinical data: 5.2 million (79 %)
Monthly:
Consultation forms: 1.9 million
Prescriptions: 5.6 million
2007
< 25 % % % %
> 90 %
Population coverage
521 Health centres
6,700, 000 inhabitants

28. 2007 Diraya. Implementation in Specialized Care Monthly:
Emergencies: 76,000 episodes
Consultations: 4,000 episodes

29. Diraya. Appointments Primary Care Salud Responde Specialized Care
Primary Care
Specialized Care
Diagnostics tests

30. Make haste slowly Denis.Protti.1@city.ac.uk dprotti@uvic.ca
Festina Lente
Make haste slowly
16-Feb-19
Denis Protti - University of Victoria & City University London