Strategic Use of Mobile and Digital Health and Care Solutions Rachelle Kaye, PhD. March 2016
The Israeli Health Care System
National Health Insurance Law of 1995 Universal compulsory statutory health insurance Financed by earmarked and general taxation Coverage for health care services is provided by 4 competing nationwide health plans (HMOs) Every citizen must join a health plan but are free to choose and move from one to another Public and private providers of services including physicians, hospitals, pharmacies and other health care professionals Health Plans must provide a defined public basket of services to all its members
Health ICT in Israel First Ambulatory Electronic Medical Record installed at Maccabi Healthcare Services in 1991. Clalit Health Services followed in 1993. Today, all physicians working with health funds have electronic medical records with electronic referrals, prescribing and comprehensive clinical data exchange Other health professionals also have EMRs (their own or shared) In the two largest Health Funds there is essentially a central computerized medical record containing all interactions of the patient with services paid for by the Health Fund
Health ICT in Israel All hospitals have EMR systems, ATD, ward management and billing system Many are completely paperless A new system “ Eitan ” has been implemented for the exchange of clinical and healthcare data between community clinicians working with the health funds and hospitals.
Focused Information and Operational support for all players Hospitals Researchers Managers and Analysts Patients Nurses, Physicians Healthcare Professionals Clinics
Integrated Care for Prevention and Management of Chronic Disease Access of Clinicians and Patients to all necessary information Defined responsibility for care coordination Decision support – alerts and reminders Timely Access to services “ Seamless ” transition between all points of care Care that is guided by the “ big picture ” – holistic view of patient problems and needs The patient receives the care he needs, when and where he needs it, and up-to-date information on his condition is available in real time to the care providers and the patient
Maccabi ’ s system is fully digitalized -the Cornerstone- Clinical Information System Every transaction with the patient is computerized Shared EMR and Central Medical Record Hospital E-Laboratory Medical Diagnoses Visits E- Prescription Central E- Consultation Pathology Medical Treatment Tests Record Alerts and Reminders Physician Portal Imaging Medicines Tests & Drugs Member Portal (PHR) Lab Results
Problem List and current Drugs Patient Details Prescribing Medication An Alert on drug to drug interaction
Hello, Yael Nor Pharmacy| Information | Appointments | Communication with the Doctor | PHR Travel Drugs Pre Notification Request from Test Results Appointments insurance Approval Authorization Doctor Healthcare Recommendations Leaving the Flu Here you can receive personal reminders on test or treatments recommended outside in accordance with your age, sex, and health status Go to your doctor today 4 personal recommendations are waiting / click here to see them for a flu shot My medical home Recent visits, hospitalizations, test and treatments Recent drugs purchased Recent debits and credits
Maccabi Online - PHR – Access to Medical Information and Online Services
Doctor Portal - Patient EMR Main App enabled doctors to view patients records and respond to immediate issues Launched: December 2011 Platforms:iPhone, Android Patient test results Medication Visits Medical Knowledgebase
Mobile Patients Portal #1 Pregnancy App in the world Find a service Find a doctor Laboratory Results Urgent Care Centers Pharmacy Mobile Pregnancy Branch -Referring doctor Follow up - Date Labs and Clinics Maccabi “ N`atural ” Maccabi “ First look ”
Request Prescription Renewal New Request cance MY DRUGS ok l Member;Israel israel ID 123456789 Dr Ido Jacobs Family Physician Member;Israel israel ID 123456789 Prescription? Choose from your list of drugs Phone : Send request
View of the Request With Response Requests to doctor Member;Israel israel ID 123456789 Response from Dr Gidi Lorben Dear Israel, Attached are the 3 prescriptions you requested. Sincerely, Dr. Gidi Lorben Prescription: Valid 13.5.13-13.6.13 Prescription Valid Prescription – Not Valid My request Renew Request
Telemedicine Services Service from a Distance (cost, time) Need for 24/7 response Tele-Diagnosis Tele-radiology Tele- ECG/Holter monitoring Tele-mammography: mobile unit Tele- ophthalmology Tele-dermatology: skin ulcers Tele-Treatment/ Consultation Video Conference – care giver – patient Video Conference- home care Video Conference- service station Video Conference-Specialist-Primary Care
Telemedicine Services Service from a Distance (cost, time) Need for 24/7 response Call Centers Multidisciplinary Telecenter for Chronically Ill Patients Maccabi Pharm Nurses Call Center - Triage Smoking Cessation Interpreter Services On line services Website Patient health Record Mobile Phone Applications
Acute Care Tele-Health Center A complementary Chronic hospital & Care community based healthcare system Preventi on
Triage: Emergency nurse center; Home doctor Chronic Care Rehabilita Prevention: tion Smoking Cessation; Post-partum health Caregiv er Support
The MOMA Center Innovative platform for chronic care management Multi-disciplinary center Tele-health solutions for chronic conditions Fully coordinated with patients Primary physician Nationwide support network for remote care management Over 7,000 current subscribers 15,000 patients treated to date
Technolo logy gy Computerized Medical Protocol System MOMA Nurse System BI Control Management Panel Video Consultation Medical Transmitting Sensors
Medical Transmitting Sensors Blood glucose Electronic medical box Pulse (wearable)
Electronic medical box
Remote cardiac rehabilitation Pulse (wearable) Based on: • Secondary prevention • Patient empowerment • Individual training plan
Assuta Ashdod Public Hospital – May 2017 “ A Community that has a hospital ” The hospital will be full service hospital with all departments and medical specialties. It will open with 300 beds (planned for 650 in the future ). Centers of excellence: ● Heart Disease ● Oncology ● Pediatrics ● Women ’ s Healthcare ● Ambulatory and Endoscopic (minimally invasive) Procedures
Vision for Integrated Care Assuta Ashdod Hospital “ A Community that has a hospital ” ● Innovative, advanced general public hospital, affiliated to a medical school ● Full integration with the community's medical services, meeting the special needs of the patients and their families, both within the hospital and at home ● Integration with Social Services and other support services in the municipality ● All 4 HMOs in Israel have agreed to participate in this model ● The municipality and the department of social services are committed to this vision
Integrated care solution Rehabilitation Specialist Nurse Hospital Nurse Nurse ICS Social PC Municipality Primary Care Care Specialist Municipality Social care
System for Insuring Seamless Information Exchange Between the Hospital and the Community Patient PHR EHR INTEROPERABILITY System for data exchange Between EMRs Social Services EMR EMR Hospital Community Clinics COMMUNITY Coordinate HOSPITAL Discharge Video Consulting
Technology and Information Exchange Is NOT ENOUGH • We need to break down traditional organizational barriers – between the hospital and the community – between health care and social care • We need to change attitudes of clinicians • We need to build multidisciplinary teams • We need to make the patient and his family fully functioning members of the care team
Thank You
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