Continuous Innovation In Health Care: Implications Of The Geisinger Experience

“To achieve the diverse health care goals of the United States, health care value must increase. The capacity to create value through innovation is facilitated by an integrated delivery system focused on creating value, measuring innovation returns, and receiving market rewards. This paper describes the Geisinger Health System’s innovation strategy for care model redesign. Geisinger’s clinical leadership, dedicated innovation team, electronic health information systems, and financial incentive alignment each contribute to its innovation record. Although Geisinger’s characteristics raise serious questions about broad applicability to nonintegrated health care organizations, its experience can provide useful insights for health system reform.
Geisinger Health System in Pennsylvania reduced hospital admissions by 20 percent and saved 7 percent in total medical costs by providing a patient-centered medical home (PCMH) model of care—including around-the-clock access to primary and specialty care, and physician and patient access to electronic health records (EHRs)—according to first-year results from pilot-test sites. The findings, released in the September/October issue of Health Affairs, provide the first evidence that the PCMH model can improve quality of care and reduce health care costs. The article also describes Geisinger Health System’s efforts to redesign its care delivery infrastructure and to create incentives aligned to enhanced health care value. ”
Abstract
Ronald A. Paulus, Karen Davis and Glenn D. Steele, Health Affairs, 27, no. 5 (2008): 1235-1245
doi: 10.1377/hlthaff.27.5.1235

‘Orion-Clinic’, el paso decisivo hacia una región sin papeles

“El Hospital Universitario Doctor Peset y el Centro de Especialidades de Monteolivete, ambos en Valencia, son los centros escogidos por la Consejería de Sanidad de la región para la implantación inicial del programa Orion-Clinic, una aplicación informática que permitirá a los centros valencianos completar la historia clínica electrónica (HCE) con el historial hospitalario del paciente y el acceso a los resultados de todas las pruebas clínicas y exploratorias que se le hayan realizado, una vez que el sistema de información de atención primaria, Abucasis II, está prácticamente generalizado.”
Article (Spanish)
Enrique Mezquita, Diario Medico, 28 July 2008

Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries

“The adoption of health information systems is seen world wide as one method to mitigate the widening health care demand and supply gap. The purpose of this review was to identify the current state of knowledge about health information systems adoption in primary care. The goal was to understand factors and influencers affecting implementation outcomes from previous health information systems implementations experiences. A comprehensive systematic literature review of peer reviewed and grey literature was undertaken to identify the current state of knowledge regarding the implementation of health information systems. A total of 6 databases, 27 journal websites, 20 websites from grey sources, 9 websites from medical colleges and professional associations as well as 22 government/commission websites were searched. The searches returned almost 3700 article titles. Eighty-six articles met our inclusion and exclusion criteria.
Articles show that systems’ graphical user interface design quality, feature functionality, project management, procurement and users’ previous experience affect implementation outcomes. Implementers had concerns about factors such as privacy, patient safety, provider/patient relations, staff anxiety, time factors, quality of care, finances, efficiency, and liability. The review showed that implementers can insulate the project from such concerns by establishing strong leadership, using project management techniques, establishing standards and training their staff to ensure such risks do not compromise implementation success. The review revealed the concept of socio-technical factors, or “fit” factors, that complicate health information systems deployment. The socio-technical perspective considers how the technical features of a health information system interact with the social features of a health care work environment.
The review showed that quality of care, patient safety and provider/patient relations were not, positively or negatively, affected by systems implementation. The fact that no articles were found reviewing the benefits or drawbacks of health information systems accruing to patients should be concern to adopters, payers and jurisdictions. No studies were found that compared how provider–patient interactions in interviews are effected when providers used electronic health information systems as opposed to the paper equivalent. Very little information was available about privacy and liability.”
Abstract
D.A. Ludwick and John Doucette, International Journal of Medical Informatics, In Press, Corrected Proof, Available online 21 July 2008, doi:10.1016/j.ijmedinf.2008.06.005

A development framework for semantically interoperable health information systems

“Background
Semantic interoperability is a basic challenge to be met for new generations of distributed, communicating and co-operating health information systems (HIS) enabling shared care and e-Health. Analysis, design, implementation and maintenance of such systems and intrinsic architectures have to follow a unified development methodology.
Methods
The Generic Component Model (GCM) is used as a framework for modeling any system to evaluate and harmonize state of the art architecture development approaches and standards for health information systems as well as to derive a coherent architecture development framework for sustainable, semantically interoperable HIS and their components. The proposed methodology is based on the Rational Unified Process (RUP), taking advantage of its flexibility to be configured for integrating other architectural approaches such as Service-Oriented Architecture (SOA), Model-Driven Architecture (MDA), ISO 10746, and HL7 Development Framework (HDF).
Results
Existing architectural approaches have been analyzed, compared and finally harmonized towards an architecture development framework for advanced health information systems.
Conclusion
Starting with the requirements for semantic interoperability derived from paradigm changes for health information systems, and supported in formal software process engineering methods, an appropriate development framework for semantically interoperable HIS has been provided. The usability of the framework has been exemplified in a public health scenario.”
Abstract
Diego M. Lopez and Bernd G.M.E. Blobel, International Journal of Medical Informatics, In Press, Corrected Proof, Available online 14 July 2008, doi:10.1016/j.ijmedinf.2008.05.009

NHS computer system is in chaos, warn MPs

“The NHS’s new IT system is in a state of chaos, an influential group of MPs will warn tomorrow. The Public Accounts Committee will use a key hearing to question leading figures in the NHS as they attempt to quantify the problems confronting Connecting for Health, the project to electronically link every GP’s surgery and hospital in England and provide online records for up to 50 million patients.”
Article
Jamie Doward, The Observer, 15 June 2008

The deployment of integrated care services for chronic patients (NEXES project)

“Abstract: The societal adaptations required for reducing the burden of chronic disorders and ageing have been recently framed by the WHO initiative on Innovative Care for Chronic Conditions. With this scenario in place, a successful deployment of innovative integrated care services to support healthier and independent living for chronic patients and elderly has emerged as an urgent unmet need. The NEXES project aims at undertaking the deployment of four integrated care programs addressing various aspects of chronic disorders selected because of promising outcomes generated by previous small-scale randomized controlled trials:

• Wellness-rehabilitation: Early diagnosis, promotion of healthy life-styles and patient self-management. Physical activity and cognitive aspects being main components
• Enhanced Care Support of unplanned hospitalizations
• Home hospitalization of patients with exacerbations
• Support: Transient remote support to diagnosis and/or treatment

The project focuses on the main factors modulating the success of an integrated care approach in delivering the services, namely: a) the co-morbidity challenge; b) articulation of healthcare and community services; c) organizational and educational issues; d) modularity, scalability and interoperability of the ICT platform, and, e) identification of business models ensuring service sustainability. Accordingly, the validation strategy prioritises the discovery of evidence supporting the extensive use of the services, applicable at the level of policy decision makers.
Technologically, the Linkcare platform (Linkcare eTEN 517435) sets the reference architecture. Modularity, flexibility and scalability are based on Service Oriented Architectures (SOA) using the IBM UML 2.0 Profile for Software Services. Briefly, the platform consist of a web-based application addressed to management of chronic patients and elderly, facilitating organizational interoperability following a distributed model. The following services are available at the moment: a) Health portal, b) Call centre service, c) Professional mobile access, d) Patient wireless monitoring service, e) Collaborative work service, f) Security modules, and g) Interoperability module with hospital information systems and shared electronic patient records. In the future, it will incorporate knowledge management applications and it is foreseen its evolution towards an IMS platform.”

Bárbara Vallespín, David Fonollosa, Albert Alonso, Josep Roca
Hospital Clinic de Barcelona. Villarroel, 170, 08036 Barcelona, Spain

To be presented at the ICMCC Event

ICMCC Event Preview 5

On the Wednesday, Prof. Bernd Blobel, in cooperation with the Working Groups “Electronic Health Records” and “Security, Safety and Ethics” of the European Federation for Medical Informatics, organizes the session Personal Health Paradigm Challenging Citizens and Patients.

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Two-stage evaluation of the impact of a nursing information system in Taiwan

Purpose
This study evaluated the post-implementation impact of a nursing information system and identified issues related to the technology adoption process. Given the high level of investment necessary to implement information systems, evaluation has become vital to ensure successful adoption and use. Improved understanding of implementation difficulties/barriers and factors leading to them can serve as a platform for the development of strategies and education programs for users.
Method
The study design was a two-stage data comparison analysis of a nursing information system focusing on computerized nursing care plan use. Data were collected from nurses by questionnaire during the first month (December 2004) and 1 year after system installation (December 2005).
Results
While nurses gave the information technology a higher evaluation score at the second stage than at the early stage, the overall ratings were slightly negative at both stages. Age and pressure to use the system were critical factors at both stages, whereas computer skills and perceived time using the system were vital at the beginning stage of implementation. Issues of concern at both stages were system functionality, efficiency, usability, and user support.
Conclusion
Implementation of an information system requires consideration of issues involving hardware and software, staff training, organizational policy, and workflow changes.
Abstract
Ting-Ting Lee, Mary Etta Mills, Barker Bausell and Ming-Hui Lu, International Journal of Medical Informatics, In Press, Corrected Proof, Available online 5 May 2008

Standards work to gather speed as it builds on previous achievements

“The head of the panel charged with setting technology standards to ensure interoperability among healthcare information technology systems across the country said the process of defining and creating those standards is about to accelerate.”
Article
Bernie Monegain, Healthcare IT News, 2 April 2008

NHS CfH joins open source health collaboration

“Open Health Tools has announced a collaborative effort between national health agencies, major healthcare providers, international standards organizations and companies from Australia, Canada, the UK and the US to develop common healthcare IT products and services.”
Article
e-Health Europe, 18 April 2008

ACS Systems Improving Delivery of Healthcare in Malta

“Affiliated Computer Services, Inc. announced that it has successfully completed Phase I of the Government of Malta’s Integrated Health Information System (IHIS), program to attain the highest quality patient care for the citizens of Malta.”
Article
eHealthNews.eu, 18 April 2008

Advance health informatics

“Stronger health information systems not only improve everyday medical visits, but they are essential to counter pandemics and biological or chemical attacks.”
Article
US National Academy of Engineering, February 2008

The Aspects of Safety in Future Care Settings

Peter Pharow a, Bernd G.M.E. Blobel a and Mario Savastano b
a eHealth Competence Center, University of Regensburg Medical Center, Germany
b National Research Council of Italy, Naples, Italy

Abstract.

Communication and cooperation processes in the growing healthcare and welfare domain require a well-defined set of security services provided by a standards-based interoperable security infrastructure. Any communication and collaboration procedures require a verifiable purpose. Without such a purpose for communicating with each other, there’s no need to communicate at all. But security is not the only aspect that needs to carefully be investigated. More and more, aspects of safety, privacy, and quality get importance while discussing about future-proof health information systems and health networks – regardless whether local, regional and national ones or even pan-European networks. The patient needs to be moved into the center of each care process. During the course of the current paradigm change from an organization centered via a process-related to a person-centered healthcare and welfare system approach, different new technologies need to be applied in order to meet the new challenges arising from both legal and technical circumstances. International organizations like WHO, UNESCO and the European Parliament increasingly aim at enhancing the safety aspect in future care settings, and so do many projects and studies. Beside typical information and communication devices, extended use of modern IT technology in healthcare and welfare includes large medical devices like, e.g., CT, X-ray and MR but also very tiny devices like sensors worn or implemented in a person’s clothing. Safety gets on top of the nations priority list for several reasons. The paper aims at identifying some of these reasons along with possible solutions on how to increase patient’s awareness, confidence, and acceptance in future care settings.

Primary healthcare information system – development and deployment issues

Ranko Stevanovic a, Vinko Kojundzic b, Galibedin Galijasevic c
a Croatian National Institute of Public Health, Croatia
b Maticnjak Ltd, Croatia
c ABA informatika Ltd, Croatia

Abstract.

Croatian national primary healthcare ICT Implementation strategy is determined by Croatian national health strategy and plan, Croatian ICT development strategy for 21st century, and requirements specifications for the heath information system. National primary healthcare ICT implementation strategy components are accented: purpose of the ICT implementation strategy, information principles, need and ICT enablement in domains of patients, healthcare professionals, policy-makers and managers and public. Based on the determinants, three organizational levels have been established – government, ministerial and project levels. General architecture of Croatian primary healthcare information system and its implementation as well as national ICT environmental accelerations for national primary healthcare ICT environmental accelerators for health ICT implementations are presented.

Personal Health – the Future Care Paradigm

Thomas Norgall, Bernd Blobel and Peter Pharow
Image Processing and Medical Engineering, Fraunhofer Institute for Integrated Circuits IIS, Erlangen;
eHealth Competence Center, University of Regensburg Medical Center, Germany

Abstract

Demographic, economic and social conditions developed countries are faced with require a paradigm change for delivering high quality and efficient health services. In that context healthcare systems have to turn towards individualized of patient’s care, also called personal care. Interoperability requirements for ubiquitous personalized health services reach beyond current concepts of health information integration among professional stakeholders and related Electronic Patient Records (”e-Health”): Future personal health platforms have particularly to maintain semantic interoperability among systems using different modalities and technologies, different knowledge representation and domain experts’ languages as well as different coding schemes and terminologies to include home, personal and mobile systems. The paper introduces the evolving paradigm related to personal health information systems.

Formal Policies for Flexible EHR Security

Bernd Blobel and Peter Pharow
eHealth Competence Center, University of Regensburg Medical Center, Germany

Abstract

State of the Art methodologies for establishing requirements and solutions to securing applications are based on narrative descriptions about the use of available system, sometimes also dedicated to system components. Even nowadays new developments to ruling application security services by the use of predicate logic suffer from being administered manually. Therefore, security and privacy requirements cannot be properly met resulting in restrictions and fears for allowing the use of sensitive data and functions. Because of the sensitivity of personal health information and especially of genetic data with its wider implications beyond the original subject of care, weaknesses in guaranteeing fine-grained security and privacy rules lead to less acceptance or even the avoidance of essential information transfer and use. To overcome the problem, security and privacy have to become properties of the architectural components of the respective health information system. Embedding security into the systems architecture allows for negotiating and enforcing any security and privacy services related to principals, their roles, their relationships, further contextual information as well as other regulations summarized in formally modeled policies. The paper introduces the evolving paradigm of the model-driven architecture, first time also comprehensively deployed for security and privacy services in bio-genetic and health information systems.