1. ENABLING EFFICIENT HEALTHCARE Something old – something new Tomas Nordheim Alme Chief Medical Officer

2. ENABLING EFFICIENT HEALTHCARE A huge investment  DIPS ASA puts about 150 mill Euro in the development of DIPS Arena between 2012 and 2016  OpenEHR is a central part of the strategy

3. ENABLING EFFICIENT HEALTHCARE Goal – Develop the world’s best EHR  High functionality  Open  Flexible

4. ENABLING EFFICIENT HEALTHCARE How do you move  15 Hospital Trusts  + 75 000 users to a new, standardized, service oriented, OpenEHR-based platform?

5. ENABLING EFFICIENT HEALTHCARE …or put differently…

6. ENABLING EFFICIENT HEALTHCARE A gigantic change of mindset  Customers love the idea of two level modelling  Harder to sell in-house  OpenEHR is complex  Huge first step  Capacity building takes time and constant effort

7. ENABLING EFFICIENT HEALTHCARE The Norwegian advantage  3 of 4 Regional Health Trusts use DIPS Classic EHR  Planning migration to DIPS Arena  Structured patient records and CDS is the goal  Where to start?

8. ENABLING EFFICIENT HEALTHCARE «The interregional structured patient record project»  From April to June 2014  Clinicians and health informatics staff from the three regions  DIPS is host, but vendor neutral delivery  Project deliverables to be sent to National ICT (national CKM) – An interregional admission note – Generic and a starting point for specialization

9. ENABLING EFFICIENT HEALTHCARE The interregional admission note (draft)  Step 1: Separate persistent information from event information – 1 document => 5-7 documents Previous diseases (problem list) Heredity Social status Use of substances (alchohol/tobacco/other) Medication (separate module) Critical information (separate module) The admission note  Step 2: Structure of the different documents

10. ENABLING EFFICIENT HEALTHCARE How did we work?  The starting point is the generic template for admission notes used by all hospitals today  2 page document – Background incl social – Presenting problem – Natural functions – Substance use – Clinical examination – Assessment – Plans

11. ENABLING EFFICIENT HEALTHCARE How did we work?  Three workshops  Material sent out in advance  About 25 delegates, about 10 active clinicians  Group and plenary discussions

12. ENABLING EFFICIENT HEALTHCARE

13. National vs international  Preliminary assessment: – About 40 archetypes involved – Probably need for 5-10 new archetypes – Change request 10-15  A national admission note template based on common international archetypes is within reach

14. ENABLING EFFICIENT HEALTHCARE What else?

15. ENABLING EFFICIENT HEALTHCARE Three ongoing projects  Involuntary psyciatric commitment  Surgery planning  ER-tool

16. ENABLING EFFICIENT HEALTHCARE Psyciatric commitment  New national standard a few years back  Will be made statutory  Current module in DIPS Classic does not fulfill the requirements  Focus on process and correct paperwork/workflow  A pilot for what we can achieve with archetypes  Plan to pilot with University of Northern Norway in 2014

17. ENABLING EFFICIENT HEALTHCARE Surgery planning  DIPS Classic contains an advanced surgery planning module  Need more process support in early planning state  A pilot for what we can achieve with archetypes  Plan to pilot at University of Northern Norway in 2015

18. ENABLING EFFICIENT HEALTHCARE Emergency room  Based on existing, non-archetype module  Patient list/ER-wall application  Built in archetype support  Any archetype (last registered) can be configured as a column in the list  Enters production on October 20th at Oslo University Hospital

19. ENABLING EFFICIENT HEALTHCARE

21. What have we learned so far?  OpenEHR is powerful and complex  Issues not related to new platform (backward compatiblity)  Form quality is an issue – need to improve form design  Underestimated the need for business logic around the structured documents – Business rules/error prevention – Applies to process oriented functionality (instr/actions)

22. ENABLING EFFICIENT HEALTHCARE What’s ahead?  Strong customer support for an open, structured, process supporting EHR  The job at hand is huge!  Need a stronger and more focused collaboration within the OpenEHR community – Industry cooperation – Academic activity – Archetypes, tooling, promotion – GDL

23. ENABLING EFFICIENT HEALTHCARE Thank you for your attention!