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
◦ 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

Nursing Clinical
CPOE documentation
Reporting Other
system

FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL

HIS Models: integrated systems
◦ Unified database
◦ Single database, not necessarily single vendor = Clinical Data Repository
◦ Minimizes/eliminates need for interfaces
◦ Becoming more popular in inpatient environments
◦ Standard in outpatient/private practice environments
◦ Advantages
◦ 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

Nursing Clinical
CPOE documentation
Reporting Other
system

FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL

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
◦ 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
◦ Work contracts
◦ Work schedules
◦ Skills
◦ Leave
◦ Training & education
◦ Salary & payments

Interoperability issues
◦ 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 Disability Adjusted Life Years
DALYx = YLLx + YLDx
Reasons for encounter & diagnostics
◦ International classifications: ICD-10, ICPC-2, DSM-4, SNOMED Where:
◦ Many local classifications (not standardized) • DALYx = DALY for clinical condition x
◦ Need for coding aid (insufficiently skilled health workers) • YLLx = Years of Life Lost due to premature
◦ Clinical thesaurus (3BT), keyword & clinical concept based) death caused by clinical condition x
◦ Multi-classification coding (code mapping) • YLDx = Years Lived with Disability caused
◦ Complementary information by clinical condition x
◦ Certainty
◦ Seriousness / gravity (Burden of disease – WHO)
• = [Incidence x] x [Average disability
◦ Problem list management 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
◦ 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
◦ 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
◦ 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
◦ 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, frank.Verbeke@vub.ac.be

http://sourceforge.net/projects/open-clinic/

FRANK VERBEKE, BISI, VRIJE UNIVERSITEIT BRUSSEL