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eHealth. Patient First, time for change JAN- ERIC SLOT MB MBA MSc CHCIO
CIO and CMIO at Bernhoven Hospital
UDEN, The Netherlands
Transforming health through IT 2 www.himss.eu
My personal Journey
• Chief Information Officer and Chief Medical Information Officer and member of the Executive Board at Bernhoven Hospital since December 2013.
• CHCIO (Certified CIO) and member of the Board of CHIME since 2015.
• CEO of SNOMED International in Denmark (2010-2013)
• CIO at the Academic Medical Center in Amsterdam (2005-2010)
• HIMSS Governing Council Member (2009-2014)
• Teaching IT Governance at Medical Informatics, University of Amsterdam (since 2007)
30 years experience
in Healthcare IT
Transforming health through IT 3 www.himss.eu
Session Topics
• What is Digital Transformation?
• What does it mean for Healthcare sector?
• User Centric Approach
• User Centric vs Patient Centered Approach
• Bernhoven Dream journey in Digital Transformation
• Next challenges
Transforming health through IT 4 www.himss.eu
Digital Transformation, the 9 elements.
The use of technology to radically improve performance or reach of enterprises
(definition MIT SLOAN, Westerman)
• MIT Sloan approach: look at 100’s of example and look for the elements, traits and patterns in successful environments
• 157 interviews in 50 companies
Transforming health through IT 5 www.himss.eu
Digital Transformation, the 9 elements.
The use of technology to radically improve performance or reach of enterprises
(definition MIT SLOAN, Westerman)
• Transforming Customer Experience
–Customer understanding
–Top-line growth
–Customer touch points
Transforming health through IT 6 www.himss.eu
Digital Transformation, the 9 elements.
The use of technology to radically improve performance or reach of enterprises
(definition MIT SLOAN, Westerman)
• Transforming Operational Processes
–Process digitization
–Worker enablement
–Performance Management
Transforming health through IT 7 www.himss.eu
Digital Transformation, the 9 elements.
The use of technology to radically improve performance or reach of enterprises
(definition MIT SLOAN, Westerman)
• Transforming Business Models
–Digitally Modified Business
–New Digital Business
–Digital Globalization
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DIGITAL TRANSFORMATION What does it mean for the healthcare sector?
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Digital Transformation, the 9 elements in healthcare
• Transforming Customer Experience
–Customer understanding
–Top-line growth
–Customer touch points
• Get patient data before encounter
• Care for the Silver Tsunami • Not just a table
Transforming health through IT 10 www.himss.eu
Digital Transformation, the 9 elements in healthcare
• Transforming Operational Processes
–Process digitization
–Worker enablement
–Performance Management
• Patient as input for record • Redistribute tasks • Use the data for analysis
Transforming health through IT 11 www.himss.eu
Digital Transformation, the 9 elements.
• Transforming Business Models
–Digitally Modified Business
–New Digital Business
–Digital Globalization
• Redesign care delivery • Extend services to the
home • Extend services elsewhere
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DIGITAL TRANSFORMATION User-Patient-Person Centric Approach
• Physicians
• Patients
• Citizens/ persons
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Physicians leading means talking about patients:
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Patient experience
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Patient experience
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Patient First
• Overtreatment
• Failure of care delivery
• Failure of care coordination
Patient experience
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DIGITAL TRANSFORMATION User: Physician vs Patient/ Citizen Centered
• Continuity of Care is Integrated Care
• Some barriers: - Separate information systems or
ones not interoperable
- No single assessment process
- Money doesn’t follow the patient
- Highly risk averse organizations
- Clinical responsibility is not clear
- Unwillingness to transfer care
- Culture: Where is the power?
Transforming health through IT 18 www.himss.eu
DIGITAL TRANSFORMATION in the Netherlands: putting the patient really in control
• Healthsuite Labs session 50 players in the Ecosystem
• Results bundled in booklet
• Pledge made at the HIMSS Amsterdam E-health week June ‘16
• Minister of Health provides 105M€ over three years to hospitals to provide a Digitally Transformed Interaction between Patient and the medical Professional (VIPP program)
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HIMSS Patient Engagement Framework
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DIGITAL TRANSFORMATION at Bernhoven Hospital
• Objectives:
- Progressing towards a paperless environment
- Reach the EMRAM Stage 6 for Bernhoven Hospital
- Use Continuity of Care Model to assess starting point and create roadmap for implementation (Governance, Clinical, IT)
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Regional Patient Platform: Personal Health Environment
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2016 2017 2018
Q3 Q4 Q1 Q2 Q3 Q4 Q1 timeboxen
VIPP
system integration
EHR
governance & patient participation
integration xCare - platform
PGO 1.0 & ReumaNet
structured documentation
integration Bernhoven-systems - platform
COPD
timebox
timebox
timebox
timebox
Roadmap Bernhoven
business case
business case
business case
business case
hartfailure
scheduling an appointment
etc business case
questionnaires
business case COPD-integrated care plan
Shared decision making tools
diabetes
samenwerking/kennisdeling
VIPP; patient & information
VIPP; patient & medication
governance
participation patient-general practitioner-hospital
Transforming health through IT 34 www.himss.eu
SCREENSHOTS
patient
34
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Patient first, Bernhoven’s Dream
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Rationale and Droom strategy
Critical success factors & experiences
New organizational model
ICT & Continuity of Care
▪ Own strength as starting point of Dream (rather change ourselves than be changed)
▪ Quailty improvement and volume reduction ▪ Organize along the functions and 4 care models
▪ Create environment that supports these changes ▪ Dream = docter in the lead ▪ 4 initiatives showcases ▪ Challenges
▪ Dream needs another organizational structure (C. Christensen) ▪ 4 Care models have different dynamics and management models
▪ From patients in between our 4 walls to 400,000 citizens in the region
Transforming health through IT 46 www.himss.eu
Bernhoven creates health specific value in 4 ‘’care-models’’
3 2 4
1 Acute zorg: Op de SEH het beste van Bernhoven laten zien Intensiveren van de
samenwerking met HAP Versterken inhoudelijke
expertise op de SEH Inrichten van een
mensgerichte SEH Bijdragen aan regiovisie
hoog-complexe acute zorg
Interventie zorgstraten: Selectief aanbod met boven-regionale allure. Alleen voldoende volume
interventies aanbieden Apart organiseren van
interventies in zorgstraten Samenwerken met de regio
voor laag volume verrichtingen
Personaliseren van zorgproces
Diagnose- en indicatiestelling: Breed aanbod van gepersonaliseerde en gezamenlijke besluitvorming Meer mogelijk maken in en ondersteunen van de 1e lijn Verhogen van de kwaliteit van (monodisciplinaire)
besluitvorming Inzetten op integrale diagnostiek
Chronische zorg: Netwerkzorg binnen en buiten ziekenhuismuren Organiseren van zorg samen met 1e lijn Integraal begeleiden multimorbide ouderen Uitbreiden van netwerk zorg
Transforming health through IT 47 www.himss.eu
The Vicious Circle of Efficiency To Quality as the driver
More procedures And services Less time for patient
Less time for quality
Efficiency drive
Higher cost
Less cost Less overtreatment:
diagnostics, procedures
Quality
More time for patient More time for quality
The Dream strategy is based on the conviction that quality is the recipe for cost reduction.
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Our strategy is supported by growing awareness that more healthcare is not always better
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Dream is from, for and by docters
49
Dream strategy & initiatives
Organisation design
Ownership
Docter in the lead on 3 levels
Dream strategy started with the docters
All initiatives owned by medical docter
Dream transformation carried by 2 Chief Medical Officers
Medical Leaders in charge of 4 Care models
Participation model: specialists employees as well as
owners
Transforming health through IT 50 www.himss.eu
Three major activities for the healthcare professional; and their translation into 4 care models (Clayton Christensen, Harvard)
50
Diagnostics
Acute zorg
Chronic care
Intervention carepaths
Activity
Separating acute and elective patient streams in proces
and organization creates calm, peace of mind
Rational for care model Care model
Advice & Treat (in acute setting)
Treat
Support
Advice In Diagnostics there is time to reflect (do the right thing,
decision making with the patient)
After joint decision making, efficiency and outcome
oriented (doing things right)
Supporting patients takes place in the Continuity of Care,
(Hospital, GP and at home)
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Implementation of organizational model (matrix) for Bernhoven based on the 4 care models
51
Directie
Ondersteunende staf diensten
Medisch ondersteunende diensten
D&I Interventie zorgstraten Chronische zorg
ML BL ML BL
Acute zorg
Acute en intensieve
zorg
Acuut bedden-huis
Poli omgeving
ML BL ML 2 BL
Verlos-kunde/ kind
Opname/ ontslag
OK interventies
Niet-OK interventies
Electief beddenhuis
Chronische zorg poli
Transmurale netwerkzorg
ML BL
Vakgroepen
Vakgroep
Vakgroep
Vakgroep
Vakgroep
Vakgroep
Vakgroep
VGL (per vg)
Diagn. Bedrijf
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Complex IT landscape (lots of legacy)
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Now: start of continuity of care
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HIMSS Analytics by numbers
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DIGITAL TRANSFORMATION Next Challenges
• Reach EMRAM level 6 (October 2017)
• Reach CCMM level 4 (End 2019)
• Outcome measurement (ICHOM)
• Scaling up the HIE (Personal Health Environment) and create an on-going financial structure and governance
• Creating a new business model for Chronic Care model
Transforming health through IT 58 www.himss.eu
Conclusions
Panel discussion
Thank you!
JAN-ERIC SLOT