The ecosystem of the OpenClinic GA open source hospital

The ecosystem of the OpenClinic GA
open source hospital information
management software
HEALTH FACILITY INFORMATION SYSTEMS AND INTEROPERABILITY
FRANK VERBEKE, VRIJE UNIVERSITEIT BRUSSEL
OpenClinic login
http://ice.minf.be/openclinic
login: vub
password: guest
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
HIS Models: interfaced systems
◦ Best of breed
◦ Natural growth path for EHR functionality
◦ Populating of Clinical Data Repository by HIS components through
◦ Interfaces
◦ Clinical Data Dictionary
◦ Advantages
◦ Progressive system expansion
◦ Select best products available
◦ Disadvantages
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High costs of data integration
Many interfaces to maintain & support
Multiple vendor management
Complex backup policy
System availability harder to manage
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Interfaced systems
Pharmacy
Lab
X-Ray
ADT
MPI
Interfaces
Clinical Data Dictionary
Clinical Data Repository
CPOE
Nursing
system
Clinical
documentation
Reporting
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Other
HIS Models: integrated systems
◦ Unified database
◦ Single database, not necessarily single vendor = Clinical Data Repository
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Minimizes/eliminates need for interfaces
Becoming more popular in inpatient environments
Standard in outpatient/private practice environments
Advantages
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Single vendor
No interfaces required
Complete data integration
Efficient backup management
System availability easier to manage
◦ Disadvantages
◦ Single vendor may not provide best solution for every component
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Integrated systems
Pharmacy
Lab
X-Ray
ADT
MPI
Clinical Data Repository / shared database
CPOE
Nursing
system
Clinical
documentation
Reporting
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Other
HIS modules & interoperability issues
Patient identification
Human resource management
Health insurance management & universal health coverage
Clinical coding
Electronic medical record
Nursing system
Lab information management system
Medical imaging
Pharmacy management
Health reporting
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Patient identification
Unique patient identifiers at different levels: universal, national, subnational, health facility,
departmental
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Universal: biometrics (fingerprints, retina scan)
National: national ID registries, ID cards (machine readable)
Subnational: health facility groups, health programs, ID cards (machine readable)
Health facility: ID cards (machine readable), Health record IDs
Departmental: Health record IDs
Commonly used weak identifiers
◦ Last name, First name, Date of birth, Phone numbers
Privacy risks
Interoperability issues
◦ Shared master patient index at the highest practically achievable level
◦ Multi-criteria patient searches
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Human resource management
Keep track of
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Work contracts
Work schedules
Skills
Leave
Training & education
Salary & payments
Interoperability issues
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Health worker identification: national registration bodies, professional councils.
User ID cards, fingerprint identification (attendance control systems)
Single sign on issues, access rights management (account deactivation!)
Centralization of (public) health sector workforce data (iHRIS, NHIS, GIS)
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Health Insurance Management
Health insurer identification
◦ Health insurer registry
Health insurer coverage plan management
◦ Simple reimbursement plans (percentage, lump sum)
◦ Complex reimbursement plans
◦ Insurer specific reimbursement base (supplements charged to patient)
◦ Different reimbursement rules for in- and out-patients
◦ Limitations of number of reimbursable health services per period of time or episode of care (e.g. ultrasounds / pregnancy)
◦ Complementary health insurance plans (very poor patients, HIV+, public servants…)
Multiple health insurance schemes possible for each patient
Interoperability issues
◦ Health services nomenclature missing or unreliable
◦ Verification of health insurance status of a patient
◦ Electronic transmission of invoiced items from care provider to health insurer
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Clinical coding
Reasons for encounter & diagnostics
◦ International classifications: ICD-10, ICPC-2, DSM-4, SNOMED
◦ Many local classifications (not standardized)
◦ Need for coding aid (insufficiently skilled health workers)
◦ Clinical thesaurus (3BT), keyword & clinical concept based)
◦ Multi-classification coding (code mapping)
◦ Complementary information
◦ Certainty
◦ Seriousness / gravity (Burden of disease – WHO)
◦ Problem list management
Disability Adjusted Life Years
DALYx = YLLx + YLDx
Where:
• DALYx = DALY for clinical condition x
• YLLx = Years of Life Lost due to premature
death caused by clinical condition x
• YLDx = Years Lived with Disability caused
by clinical condition x
• = [Incidence x] x [Average disability
duration x] x [weight x]
DRG reporting
Interoperability issues
◦ Code mapping onto national clinical databases (DHIS2, Global Health Barometer, NHIS & GIS)
◦ Linguistic issues (lack of translation, different clinical concepts in different languages)
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Electronic Medical Record
Many different clinical documentation needs for different specialties
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Specific content for the health care sub-domain (HIV, Diabetes, Stomatology, Gynecology…)
Different medical schools & health professional individualism
Level and objectives of the health facility
Workload
Qualifications of care providers
Diagnostic capabilities
Standardization of clinical content
◦ Lots of free text, minimal use of international standards in routine clinical documentation
Interoperability issues
◦ Electronic transfer of clinical information between health facilities
◦ Combining the general medical record with vertical health program records
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Nursing system
Interaction with physicians’ order entry modules
◦ Drug prescriptions
◦ Care prescriptions
◦ Diagnostic prescriptions (lab, medical imaging)
Nursing health record
◦ Biometrics & vital signs
◦ In-patient follow-up records
◦ Limited access to diagnostic & pharmaceutical prescribing
Integration with billing modules
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Lab information management system
Identification of lab analyses
◦ Internal laboratory codes, exceptional use of internationally standardized LOINC codes
◦ Reference values management
◦ Result editor management
Lab order entry
◦ Lab order profiles & lab prescription normalization, integration with billing
◦ Hospital wide, departmental or user specific lab order forms
◦ SMS & email notification of results availability
Lab results data entry
◦ Specialized editors (numerical, option lists, microbiology)
◦ Traceability
Interoperability issues
◦ Automatic lab analyzers (sample identification, results transmission)
◦ Lab results messaging systems (SMS gateway, SMTP gateway)
◦ Microbiology reporting (WHONET)
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Medical Imaging
Identification in radiology & other imaging procedures
◦ Internal procedure codes, exceptional use of CPT codes
◦ Study, series, instance, modality, operator identification…
Computerized Order Entry
◦ Order identification &tracking
◦ Radiology workflow management -> efficiency
Modality connectivity
◦ HL7, DICOM
◦ Integration of (DICOM) images in electronic health record (DCM4CHE & WEASIS)
Regional PACS solutions
◦ ImageHub, AfriPACS
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Medical Imaging not part of a
holistic patient approach today
in low resource settings
• Film & development products
costs
• Supply chain problems
Digital imaging offers major
opportunities:
• Cost reduction
• Computerized Radiology
• Digital Radiology
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Pharmacy management
Pharmaceutical products management
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Packaging
Dose, dispensing schema
Billing
International ATC codes
Pharmaceutical stock management
◦ Multiple stocks
◦ Batch management
◦ Traceability (pharmacovigilance)
Order management
Reporting
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
Health reporting
Many health data from different information sources
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Health facility context (level, management, covered population…)
Financial activity (income, expenses, capital, investments, immovable)
Health insurance & universal health coverage (e.g. free health care programs)
Clinical activity (out-patient, in-patient, RFE, diagnostics, target health programs)
Operating theatre activity
Pharmacy (stock information, pharmaceutical in/out transactions)
Lab activity (analyses performed, analysis results distributions)
Medical imaging
Human resources information (HRH category numbers, recruitments, discharges)
Interoperability issues
◦ Lack of international/regional standardization of data elements & health indicators
◦ DHIS2, iHRIS, NHIS, Health insurances
◦ Different coding systems used for the same data, different aggregation criteria (age classes, gender…)
◦ Lack of international aggregate data reporting protocol (SDMX-HD abandoned, DXF2?)
◦ DHIS-2 middleware API, IMIA-HELINA CHEDAR initiative, WHO/Unicef initiatives
◦ Many different legacy national & health program reporting instruments to support
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
The Global Health Barometer project
International datawarehouse for health related information
◦ Monitoring & evaluation
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Financial data
Morbidity
Mortality
Human resources
◦ Operational support
◦ Nearly real time bed occupancy information
◦ Server performance
◦ ID card production
Integration with other datawarehouse projects based on DHIS-2
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL
IMIA Global Health Informatics &
Interoperability WG
Bring together experiences & identify solutions for the global health sector
Share Open Source modules and components
Standardize information and methods in healthcare
Frank Verbeke, [email protected]
http://sourceforge.net/projects/open-clinic/
FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL