Partage de l’information - E-Health Congress TMAB - Bruxelles 8-11-2007

CLINIQUES UNIVERSITAIRES SAINT-LUC

How to move from organization-centredsystems to transactional implementation

opening doors toan integrated care approach?

Dr B. Debande

Information sharing, one of the answers to

the challenge facing healthcare in future

CLINIQUES UNIVERSITAIRES SAINT-LUC2

The challenge facing healthcare in future


People ageing

– > 65 yrs : 16.1% (2000) � 27.5 % (2050)

– > 80 yr : 3.6 % (2000) � 10 % (2050)

• Increase in demand for long-term care

• Healthcare journeys : care process inside andoutside hospital – rest homes - …)

� Coordination of many players around sharedpatient information


Rising costs

– Ever more sophisticated technology

– New curative and preventive treatments

• Rational use of technologies and information produced

• Treatment according to cost/effectiveness ratio

-> Availability of complete, exhaustive medicalinformation must mean that resources are used in the most efficient way


Patient, player in health

– Importance of health factor for the public

– Higher and higher standard of training and

information

• Attitude of informed consumer in an increasingly international “market”

• Search for quality in products and service: proximity or habit are not the only criteria on which choice is based

� Consolidation and portability of personal medicalinformation


Decompartmentalization

• From a compartmentalized healthcare system, centredon the provider (hospital, GP, paramedics, domiciliary

care etc), we have to move towards a healthcare systemwhich is part of a network, coordinated and centred on

the patient

• Healthcare providers must fit in with this new coordinated approach, organised around shared patient

information


Are we ready ?

This change is under wayProjects on sharing medical information (“flow”, labelling of GP’s,

nurse’s, physio’s records, etc.)Data communication associations have tried to organise this

sharing of informationHospital managements are investing in tools for managing medical

information

But on the ground, Are those involved ready to use and produce usable medical information in electronic form ? Are they willing to take up the challenge, on a daily basis, of sharinginformation ?


Experience on the ground

Based on our experience at the Cliniques Universitaires

Saint Luc, of changing from a “paper” medical information system to an “electronic” medical information

system,

What have we learned from this process, which began in2002?


Facts and figures

• University hospital, 960 beds, mostly acute

• 3 briefs : Research, Teaching, Care

• Considerable turn-over inherent in teaching

• Culture of paper records grouped by speciality, that canbe shared and managed centrally

• Interprofessional work is something we value, eventhough it is a goal which still needs to be achieved.


Projects

• Between 2002 and 2006, several projects (electronic patient records,

report management, scanning and indexing tools, PACS) launchedsimultaneously with a view to changing to paperless/filmless

• Philosophy behind introduction : – Identify the objective clearly from the outset (paperless – filmless)

– Set up by making gradual adjustments

– Take time to make the change

– Communicate to departments (medical – nursing staff – admin)

• To date, no more films are produced and there are almost no paperrecords circulating in the hospital any more


What have we learned ?


Infrastructure

• A reliable, robust, integrated and consistent IT infrastructure

– Consistency of information within a broad set of interconnectedsystems

– Dematerialization of information calls for 24/7 availability

• Any interruption to service makes professionals lose faith

• Don’t underestimate clinicians’ (sometimes irrational) fear about losing information

�� Don’t underestimate how difficult it is to build up and keep ”up-to-date” IT teams in today’s competitiveenvironment


Working in a different way

• Adapt to a different way of working

– Access to information according to different criteria (time, speciality, type of report etc.)

– Flexibility of paper is lost

• leafing through quickly, highlighting/annotating, colours

• document comparison

• notification function of paper mail

– Rigorous encoding requirements

��The drawbacks are always seen before the advantages. Communication, mutual adjustment and sometimes, quitesimply, time help professionals adapt to change


“On-line” risks

• Risks related to the benefits of access to shared electronic information

– “No one is supposed not to have access to information”• Simultaneous access, irrespective of location and “willingness”• Possibility of “remote” access from home, abroad• “On-line” transmission of information

– Risk that summary information is not sent (clinical information, subject of request)

– Risk of losing verbal interaction between professionals when results give cause for concern

� Once the benefits of information in electronic form have been acknowledged, one must be vigilant about the risk of essential direct communication between professionals disappearing


Drowning

• A flood of information from all quarters

– Constantly growing number of unprocessed images

– More and more information

– Difficult to quickly sort out important information from the rest

– Less and less time to sort, select, display

– Danger of losing the “man-to-man” information channel

�� As soon as records are shared on a large scale, the future will clearly be in selecting relevant information, in structuring and in summaries…. But who is going to take the time to do this ?


Confidentiality

• The new challenge of “everything electronically”– Paper records can be consulted by many people, without much control, when the

patient is in hospital

– Electronic records are permanently available everywhere for those who are authorised to access them

– Should one take the risk of having a poorer standard of care through lack of information or risk allowing too many different professions access to medical data

– Should there be strict rules, in the knowledge that, on the ground, users will exchange their codes or should one get used to practices and bank on total, perfect traceability of access to information

� The management of access is a problem which deserves to be considered by all the professions on an almost permanent basis. This difficulty, within a hospital, is a portent of still greater problems to come once people are working across disciplines outside hospitals !


Institutional mobilization

• Both management and people on the ground must be involved in this process of change

– Management must give the project their unfailing support but alsounderstand that change takes time

– People on the ground will have to change their ways, the way theyapproach information : resistance is planned at department level, mobilization for change too…

– Project managers must agree to revise their ambitions, give up thetechnocratic approach and take the adjustments on board

� An institutional project, backed by management and set upin close collaboration with medical services, giving themtime to grasp the change


• Personal medical information sharing is one of the answers to the challenge facing healthcare in the future

• In order to really share electronic medical information amongst all care givers, hospitals must be paperless and filmless

• Becoming paperless and filmless is not only a matter of software deployment, it is especially a matter of changing the way care providers work. It is therefore a matter of change management

• Change management needs time, compromises and communication. It takes time to change working habits, implement new ways to accessinformation and define who has access to what.

• In hospitals, the medical service is the place where change must bemanaged

• Paperless and filmless hospital projects must be institutional projects, sponsored and followed by the hospital management

Take home words…

Health & Medicine

Partage de l’information - E-Health Congress TMAB - Bruxelles 8-11-2007