Beruflich Dokumente
Kultur Dokumente
Central Government
Policy, co-ordination and funding Silo service
support
environments
each
Social Care organisation
Laboratory
Primary Care has its own
Voluntary Org information
STD Clinic
Acute Hospital Private Sector service
Central Government
Policy, co-ordination and funding
Social Care
Accident &
Primary Care Emergency
Voluntary Org
Radiology Integrate legacy
Acute Hospital Private Sector systems using
brokerage
technologies
BROKERAGE TECHNOLOGY
EHR is the consequence of joining together
organisational systems
9Process
Patient and practitioner
9People
9Technology
Source: Booth 2002
Cornwall Electronic Health Record Pilot
CASE STUDY, UK
Aim: Join up patient information and allow remote access 24/7 across range of health service
providers to clinical care system
Topic: Clinical care system
Established: April 2000
Project Budget:
Structure of project
Pan-community EHR demonstrator
Connect all General Practitioners to NHSnet (national-level NHS Virtual Private Network or
intranet)
24 hour emergency care record
Common information architecture
Condition-specific care modules mental health, coronary heart disease, diabetic care
Telemedicine in minor injuries units facilitates nurse-led service and links to remote
Accident & Emergency consultant including tele-radiology
Massive cut in time taken for X-ray process & diagnosis from 2 days to
one hour
Evaluation ongoing see: http://www.nhsia.nhs.uk/erdip/pages/picker/lessons/
To Err is Human: Building a Safer Health System, USA Institute of Medicine (IOM), 2000
IOM research finds there are 44,000 98,000 unnecessary deaths per annum in USA due to medical error. This results in a large
financial burden to healthcare system. The IOM report estimates that medical errors cost the US approximately $US 38 billion per year
with $US 17 billion of those costs associated with preventable errors.
This means there are more people dying from medical error than traffic accidents, breast cancer or AIDS (Richardson 1999)
Value of ICT in health services
strategic resource E-governance value-chain
Aim: communicate relevant information to local change agents in rural, marginalised areas
with limited resources and to enable feedback of community information and care needs
Topic: HIV/AIDS
Established: April 2000, multi-NGO/Kenya MoH
Project Budget: $US 198, 538
Pathfinder Topic: HIV/AIDS
Structure of project
Coordinating hub: collates data and information, translates, repackages and redistributes
(email, internet, print, disks, CDROM, fax, telephone, radio?). Currently developing
Knowledge Management Unit.
Seven field centres (urban/rural; public/NGO; health/education)
supplied with computer, Operating System software, printer, data modem,
WorldSpace wireless satellite, PC adapter card where no telephone connectivity
Three to four trained staff
Solar panels used where no electricity
Source: Driscoll 2001
AfriAfya: Results
Community health benefits
9 Broke the silence on HIV/AIDS
9 Started discussion on high-risk cultural practices
9 Increased condom uptake
9 Increased demand for voluntary counselling and testing services
9 Bigger turnouts at health meetings and action days
Lessons
Partnerships enable synergy and resource sharing
HIV/AIDS focus provided clear framework
Two-way communication essential
Continuous training and support is needed
Community participation leads to greater self-care and self management
data information
This model also works well
with the paradigm of patient &
preventive health care community
Information
action knowledge
Attitude
Behaviour
Joining-up ICT: the health network and hub
Integrating organisations, functions
and projects around the patient, to
create a network with a supporting
Hub
Patient -community level
treatment research & analysis
(e.g. epidemiology disease
patterns) - national policy making
Over time integrate projects,
HUB patients and practitioners into
networks of care
Over time implement shared e-
governance services of common
administrative activities to
avoid duplication and wastage
e.g. purchasing, payroll
National interoperability
policy; infrastructure
development; shared
services; other sectors
Patient-centred healthcare
Prioritise and sequence
9 Africa - HIV/AIDS UK heart disease/cancer
9 Low cost preventive health care
9 Front-line service delivery
Contextualise
Political, cultural, economic, technical environment?
Root and focus e-governance project in specific Getting the
health care programme e.g. disease management
right balance
Localise to e-
9 Patient/community health needs governance
9 Training and education
9 Monitor benefits and adapt if necessary investments
Innovate
9 Join-up services
9 New kinds of professional health carers
9 Technology mix radio, TV, CDROM, Kiosks, internet
Conclusion
Could your organisation benefit from quicker
access and receipt of relevant, better quality health
information?
Ben Crowe
Demos
url: http//:www.demos.co.uk
Email: bencrowe@breathe.com
Telephone: +44 (0)20 7401 5330
Fax: +44 (0)20 7401 5331
Many are joining forces and partnering. But is the data, information and knowledge
useful? Is it being transformed into health-improving ACTION?
Can people in rural communities and target groups e.g. women and children
access this information? Do they need education, training and support?
Is it the right kind of information? Is it changing attitudes and behaviour?
Is there a flow of relevant and clinically useful information going upwards - from
patients and communities - to policy makers and practitioners?
Common Components:
Self-managament & monitoring: patient questionnaires and alerts
New problem solving; medication; treatment decision support via health databases
Remote consultation
Transfer of medical records
Escalation of cases to experts
Potential Benefits:
Effective care increased contact with patient, better information flows: preventive care
impact
Timely care opportunity for earlier intervention and better monitoring: reduces acute care
burden
Quality care reduction of medical errors and lost records
Efficient care reduction of travel costs for both patient and health practitioner; better use of medical
time
Challenges to e-governance in
healthcare
Often difficult to argue the e-governance business case
against competing priorities
Driscoll, Libbie, November 2001, International Development Research Centre, HIV/AIDS and Information
and Communication Technologies, Final Draft Report http://www.idrc.ca/
Forrest, Andrew October 2000, Electronic Record Development and Implementation Programme
Cornwall and Isles of Scilly Health Community Demonstrator Project, Implementing Telemedicine
http://www.nhsia.nhs.uk/erdip/archive/documents/corn/deliverables/corn1-5a.doc
Institute of Medicine (IOM) Committee on Quality of Health Care in America, 2000, To Err is Human:
Building a Safer Health System, Washington DC, National Academy Press
Johnson, Karen & Bond, Laura, March 2001 NHS Executive/Newcastle University, Making Medical
Information Work
Newman, J.A. & Walters, R.M., 2000, FinallyGetting Value from IT Investments and Going Paperless,
HIMSS Proceedings
Protti, Denis & Catz, Mariana, 2002, The EHR and Patient Safety: A Paradigm Shift for Healthcare
Decision-Makers, ElectronicHealthcare Vol.1 No.3 page 35 http://www.longwoods.com/eh/
Richardson, W.C. 1999, Putting Patient Safety First Press Release http://www4.nationalcademies.org
NHS Information Authority, March 2002, Electronic Record Development and Implementation Project
http://www.nhsia.nhs.uk/erdip/pages/news_items/march_2002.pdf