Upload
doanlien
View
216
Download
3
Embed Size (px)
Citation preview
ccio.ie | eHealthIreland.ie @marrinan @CCIO_IRL @eHealthIreland #ehealthireland
eHealth in Ireland
Project Oak Launch 5/4/2017
Name
Fergal Marrinan, EHR Programme Manager
Delivering eHealth Ireland | Office of the Chief Information Officer
Background
New entity called ‘eHealth
Ireland’ created as a result of the
‘eHealth Strategy for Ireland’.
The Office of the Chief
Information Officer is the team
responsible for delivering this
strategy, led by:
CIO: Richard Corbridge
CCIO: Yvonne Goff
Delivering eHealth Ireland | Office of the Chief Information Officer
What is eHealth?
eHealth is the means of ensuring
that the right health information
is provided to the right person at
the right place and time in a
secure, electronic, accessible and
meaningful format for the purpose
of optimising the quality and
efficiency of healthcare delivery.
Some eHealth systems are: Electronic Health Records
ePrescribing
Telehealth and Telemedicine
Automated Pricing, Performance,
Billing and Claims Management.
Delivering eHealth Ireland | Office of the Chief Information Officer
Why change?
• Our care is mostly reactive, we wait for the
stroke, heart attack…
• We have an ageing population with multiple
chronic diseases and obesity
• Data we receive are intermittent and
fragmented
• Our existing care models are mainly paper-
based
• Resourcing - Lean Teams -1:236, ratio IT
person to HSE Employee
Delivering eHealth Ireland | Office of the Chief Information Officer
• Clinicians inform both small and large scale implementations
• Creating a well tested model for the national EHR (e.g. Lighthouse
projects)
• Leading to a new paradigm of healthcare delivery
What does this mean?
Delivering eHealth Ireland | Office of the Chief Information Officer
What is the National Electronic Health Record?
The National EHR
comprises:
What does the National EHR do?
• Transforms patient experience
• Delivers greater patient safety and more
effective care
• Drives efficient delivery of health services
• Makes the wider reform programme
possible:
- Underpins integrated care
- Provides the information for
proactive health and wellbeing
initiatives
- Provides the operational systems to
realise CHO’s and Hospital Groups
- Captures accurate information on
activities that show the true cost of
treating a patient
!The National EHR is a fundamental cornerstone for the delivery of high quality,
comprehensive and accurate information in a timely manner for the provision of
patient centred, effective and efficient care
Pharmacy
GP Systems Private Hospitals
Delivering eHealth Ireland | Office of the Chief Information Officer
The National EHR Suite
National
Core
Solutions of
Record
Innovative Solutions
National Extended
Solutions
Key capabilities based on minimum viable
solution for all organisations from a single
vendor
Enhanced capability of core solutions are
extended from the core in first instance
unless there is a strong rationale for an
alternative
Emerging and innovative solutions from
the marketplace introduced in a controlled
manner
The implementation of a National Shared Record can progress
in single implementation but solutions for Hospital Groups and
CHOs must be phased given the scale and complexity
National Children’s
Hospital will have a
focused core based on
paediatric requirements.
!
Delivering eHealth Ireland | Office of the Chief Information Officer
Operational Systems (Core & Extended)
Community Operational Systems Acute Operational Systems
Delivering eHealth Ireland | Office of the Chief Information Officer
Personas and Scenarios
9
Scenario: Cerebrovascular Accident
Actors: Citizen (Tom McCarthy), Emergency Medical Technician, Registrar, Case Manager, Physiotherapist, Nurse, GP (Dr. Martin)
Tom McCarthy was diagnosed with atrial fibrillation about six months ago. He has been very non-compliant with taking his warfarin. Four hours ago he started to develop some weakness in the left side of his body and face. He chose to ignore it but it has progressed and Tom is starting to become concerned. When Tom’s wife, Sheila, came home she fears he is having a stroke and calls an ambulance.
The ambulance is en route to Tom and Sheila’s home in Tramore, 13km from Waterford Regional Hospital. One of the Emergency Medical Technicians (EMT) in the ambulance has accessed the National Summary Care Record and has been able to review information about Tom. He retrieves Tom’s health profile and reviews his summary medical history, current problem list, allergies and medications.
Tom is taken to Waterford Regional Hospital. After assessment in the Emergency Department there, Tom undergoes a CT scan which suggests a cerebrovascular accident (CVA, or stroke). The General Medicine Registrar on call that evening, Dr. Cheema, assesses Tom in the ED to admit him to hospital. He gets as much history as possible from Tom and Sheila, but this is limited. He examines Tom then reviews the CT images. Dr. Cheema reviews the ED notes in the hospital EHR and accesses Tom’s records. He is able to view Tom’s health profile and see his current and past medical problem list. He can also see the medications which have been prescribed. Dr. Cheema searches for the 15 most recent lab results to get an idea of Tom’s anticoagulation status. After reviewing this information, Dr. Cheema feels Tom has had a stroke secondary to atrial fibrillation with poor anticoagulation. He creates a record of the admitting history and physical in the hospital EHR.
After several weeks in hospital, Tom has recovered to the point where he can be discharged home. On leaving the hospital, Tom is assessed for home care services. The case manager meets with Tom and reviews his recent health events with him. She accesses his records and is able to see the details of his recent hospitalisation. She reviews the medical, nursing, social worker, pharmacy, respiratory therapy, speech therapy, physiotherapy and occupational therapy notes and/or discharge summaries. The case manager does her own assessment of Tom and, together, they formulate a plan of service. She makes a record of her findings and plan in the care record and arranges for the appropriate services to be delivered at Tom’s home.
The home care services arranged for Tom includes physiotherapy. The physiotherapist assigned to work with Tom accesses his records and searches for his last 5 encounters. She drills down into the recent hospitalisation encounter and reads the discharge summary and physiotherapy notes. From this she has a good impression of the history of Tom’s stroke, his deficits from it, the treatment thus far and the ongoing management plan. The physiotherapist assesses Tom in his home. She performs her evaluation and commences treatment with him. At the end of the session she creates a record of the encounter in her Community EHR system.
Six months later, Tom develops a respiratory infection and is readmitted to Waterford Regional Hospital. He is not physically able to return home so is admitted to a long term care facility. He has been residing in a long term care facility for about one year following his stroke. His lung function has continued to deteriorate as a result of chronic obstructive pulmonary disease and, with it, his overall functional abilities. Tom recently developed another respiratory tract infection. He has become very weak and is having greater and greater difficulty breathing. Tom and his family had previously decided with his GP Dr. Martin, that attempts will not be made to resuscitate him should the situation arise. This wish has been recorded in Tom’s Summary Care Record as a patient directive.
Late one night Tom’s condition deteriorates markedly and he passes away. The nurse who was with Tom when he died makes a record of the event in the facility’s electronic records and notifies Dr. Martin. Dr. Martin comes in and pronounces Tom deceased.
Bio:
Tom is a retired 72 year old who spends the majority of his time at home with his wife Sheila. They have a grown up family who live in other parts of the country. Tom is not a major user of technology and prefers more traditional face-to-face interaction.
Health Status:
Tom is not particularly active and while he is good at having check-ups, whenever he’s prescribed medication for any condition, he’s not good at remembering to take it.
Goals:
He wants clinicians to tell him straight up what the outcome is likely to be so he can plan around it.
Frustrations/Fears:
He would not like to ever become a burden on his wife or his family.
Technology: Broadband Access Smartphone/Tablet
High Low Internet Usage
Low High Tech Comfort
Emotional Rational
Organised Disorganised
Extrovert Introvert
Personality
Tom at a glance Age: 72
Location: Waterford
Family Status: Married
Education: College Graduate
Employment Status: Retired
Delivering eHealth Ireland | Office of the Chief Information Officer
5 Years 10 Years
Cri
tic
al Ta
cti
ca
l
So
luti
on
sIn
no
va
tive
Sp
ec
iali
st
So
luti
on
s
National Solutions
PAS
Replacement
Initial National Shared
Record
Haemophilia
Lighthouse Project
Epilepsy
Lighthouse Project
BiPolar Lighthouse
Project
Portal
(Organisation)
Other Future
Innovation Projects
Order/Comms
Other Future
Innovation Projects
NCH Implementation
eDischarge
Single
Solution Set
Evolving to a single
solution set will require
agility and a governance
approach that supports a
dynamic environment
Other Future
Innovation Projects
National Shared Record Development
MEDLis
MN-CMS
MOCIS
Acute Operational Components – Phased Implementation in HG’s
Community Operational Components – Phased Implementation in CHO’s
NIMIS
National Solutions
ePharmacy
eRefferal
EHR: 10 Year Programme
Delivering eHealth Ireland | Office of the Chief Information Officer
Maternal & Newborn Clinical Management System
Background
Ireland is the first country to adopt
EHR for its maternity hospitals.
This project stemmed from reports
looking into maternity service
provision in Ireland.
Current Status
The project went live in Dec 2016
in Cork and earlier in March in
Tralee – a phased national roll out
follows during 2017.
Led by CCIO, OoCIO, and the MN-
CMS team.
Cerner appointed as the preferred
vendor.
Delivering eHealth Ireland | Office of the Chief Information Officer
MN-CMS
Key Benefits
Improved patient care through
better communication and visibility
Improved standards of recording
information through the adoption
of best practice
Better quality data for clinical
audits and research
Informed business intelligence to
guide management decisions
locally and nationally
Image adapted from: http://healthitsecurity.com/
Delivering eHealth Ireland | Office of the Chief Information Officer
Cloud First Strategy
Aims
Provide and maintain robust, secure,
accessible, high performance Cloud
architecture for healthcare.
Deliver high performance and scalable
IaaS to any application and disaster
recovery programmes.
Provide robust, affordable and scalable
secure platforms for Test and
Development systems.
All future procurements will be
developed as ‘Cloud First’ solutions.
To future-proof Irish healthcare IT solutions and become a world technology
leader in healthcare.
Delivering eHealth Ireland | Office of the Chief Information Officer
ePharmacy Programme
Our approach was to meet
with most of the stakeholders
and software vendors.
This allowed us to listen to
their concerns and ideas
while we reviewed the
documentation.
With this we were able to
determine the best way to
progress ePrescribing across
Ireland in a structured,
standardised, coordinated
and safe way.
Delivering eHealth Ireland | Office of the Chief Information Officer
eHealth Ireland is working to deliver an Electronic Health
Record (EHR)
To understand the benefits of an EHR, three project areas
have been chosen:
Bipolar Disorder
Haemophilia
Epilepsy
We are working with a number of other organisations to
research the implementation of a flexible and reusable EHR.
Through the projects the many positive outcomes and
benefits for patients as well as healthcare professionals
associated with using information technology within health will
be showcased.
Lighthouse Projects
Delivering eHealth Ireland | Office of the Chief Information Officer
Epilepsy Lighthouse
16
• Nationwide eHealth Project
• Participants– 50 adults with intellectual disability and
epilepsy
– 50 children with epileptic encephalopathy
– Unaffected parents
– Healthcare/service Providers
• National Epilepsy Electronic Patient Record (EPR) Enhancements– Genomics Module
– Patient Reported Outcomes Portal
– Data Analytics Visualisation
Delivering eHealth Ireland | Office of the Chief Information Officer
Innovation Centre
What is it?
A culmination of a number of
collaborations and health strands
that have been in place over the
last 2 years.
Why?
To encourage people, academics,
clinicians and other stakeholders
to further research and collaborate
on the development of innovative
projects in health.
Inspire the development of future
projects using the Lighthouse
Projects as templates.
Delivering eHealth Ireland | Office of the Chief Information Officer
HealthTech
Aims
Identify health technology start-ups with a
vision to creating a new future for
healthcare.
What is it?
A pre-accelerator – a partnership initiative
between NDRC and eHealth Ireland.
How does it work?
The programme is an intensive action
learning and mentoring based.
Based on the results of the pre-accelerator,
successful candidates would be eligible to
apply for a place on an NDRC Investment
Programme with the aim of building a
successful start-up.
Delivering eHealth Ireland | Office of the Chief Information Officer
Who are the council and what do they do?
Established to provide clinical governance for the
delivery of eHealth solutions.
It acts primarily as an advisory group with primary
governance oversight provided by the Office of the CIO
and the eHealth Ireland board.
It can include: Any clinician with an interest in improving care and patient safety
through the use of eHealth solutions.
Information Leaders - who promote and deliver eHealth solutions.
Academics who have involvement in education, research and
development in eHealth success.
Supplier CCIOs - partnerships rather than a customer/vendor setup.
Council of Clinical Information Officers
Delivering eHealth Ireland | Office of the Chief Information Officer
• Over 260 members
• Bringing together clinicians to guide the
successful delivery of eHealth
• Clinicians are empowered through the
Special Interest Groups to guide
projects
• Engagement throughout the lifecycle of
both national and local projects
• Events, Social Media, Discussion
Forum, Blogging Site
Council of Clinical Information Officers
Delivering eHealth Ireland | Office of the Chief Information Officer
Collaboration: building relationships, nationally and
internationally with other CCIOs (e.g. Summer School,
Leeds).
Education: promoting Health Informatics training in
undergraduate programmes.
Policy: working with groups to develop policies, for
example supporting the broad adoption of mobile apps in
health.
Clinical Leadership: CCIO members are the Clinical
Leads on the 3 Lighthouse Projects – these focus on
Epilepsy, Haemophilia and Bipolar.
Special Interest Groups: contribute to national policy.
CCIO Developments – 2016/17
Delivering eHealth Ireland | Office of the Chief Information Officer
Do follow up
@marrinan
22