HEALTH CARE AUTOMATION AT ASIAN INSTITUTE OF GASTROENTEROLOGY - PowerPoint PPT Presentation

HEALTH CARE AUTOMATION AT ASIAN INSTITUTE OF GASTROENTEROLOGY Pradeep R MS, M.Ch., D Nageshwar Reddy MD, DM, Dsc, FAMS, FRCP.

About AIG  Tertiary care single specialty referral center for Gastrointestinal (GI) diseases  Offers GI services to national and international patients  Trains specialists in the field of Gastroenterology  Exclusive research wing - research in various areas of GI  Telemedicine project to cover GI healthcare to rural areas

Magnitude of problem • Increasing health care costs, patient demands, need for improving health care standards is a must • Possible only by IT and Automating processes • Integrating the various technologies – Major problem • Health care personnel acceptance ? • Fear • Refusal to learn and change

EMR P Investigations Reports Pharmacy Laboratory A Case sheet Endoscopy Discharge C Summaries Us, CT . X-ray, S ERCP, Capsule, Colonoscopy. Manometry, Magnification HIS Endoscopy, Operation Patient Theater, Pathology appointment Inventory Clinical case Entry (OP and Purchase IP) Financial Indenting Billing Insurance Telemedicine Research Rural Health Projects Project

PROPOSED SOLUTION A SCHEMATIC OVERVIEW Asian institute of Gastroenterology OF 21 st CENTURY HEALTH SOLUTION * Pharmacy * Materials Management * Kitchen/Diet * Linen/Laundry * Appointment Scheduling * CSSD * Out Patient Registration * Finance * Out Patient Billing * Doctor Honorarium * Casualty Registration * MIS * Casualty Billing * Equipment Maintenance * Indoor Patient Regn * Indoor Patient Billing * A D T * Wards Management * OT Management * MIS HOSPITAL ADMINISTRATION / ACCOUNTING MODULES INTERFACE TO Health and Management Hospital Information Information PATIENT ADMINISTRATION MODULES Systems Network Business intelligence CLINICAL MODULES Health and Hospital Information Network EMR LIS IMAGING Backbone * General Medicine • Gastroscopy • C Arm • Magnification • Medical * Internal Medicine * Biochemistry * 2D / Stress Echo • Colonoscopy • Cath Lab * Dermatology * Haematology * ECG Endoscopy Gastroenterology * Gynaecology * Microbiology * CathLab • EUS • ESWL • Elastography * Paediatrics • Surgical * Clinical Pathology * Endoscope * Obstetrics * Immunoassay • Capsule * C-Arm • US • OT * Histopathology * OT Imaging * Urology Gastroenterology • Enteroscopy • CT • Scanner * Serology * Central Station * ENT Health and * other specialties • ERCP • ECG • Pathology Hospital Information Network Output Templates: Document Spreadsheet XML • Endoscopy Reports * Consultation Summary • CT Reports * Surgeon Notes * ECG Waveforms * Anaesthetist Notes • US Reports * Pathology * Cath Lab Reports * Discharge Summary Reports * Cath Lab Loops • ERCP Reports * Referral letters * Endoscopy films * Certificates • Capsule Endoscopy Reports

OUT PATIENT

OP Workflow Patient FRONT OFFICE BACK OFFICE Portal Reception / Regn / Billing Corporate Billing / Insurance / Doctors Honorarium Relative Patient Service Departments CENTRAL DISPATCH CONSULTING EMERGENCY Diagnostic Imaging Pathology Lab Day Care procedures Consulting Ambulance Reports Dispatch Other services ADMISSIONS PHARMACY ADT

OP Workflow Patient FRONT OFFICE BACK OFFICE Portal Reception / Regn / Billing Corporate Billing / Insurance / Doctors Honorarium Relative Patient Service Departments Service Departments Service Departments CONSULTING CENTRAL DISPATCH EMERGENCY Diagnostic Imaging Diagnostic Imaging Diagnostic Imaging Pathology Lab Pathology Lab Pathology Lab Day Care procedures Day Care procedures Day Care procedures Consulting Ambulance Reports Dispatch Other services Other services Other services ADMISSIONS PHARMACY ADT

IN PATIENT

IP Workflow REGISTRATION Service Departments Relative Patient Indoor Registration Diagnostic Imaging WARDS / ICU / NICU Pathology Lab ADMISSION OPERATION THEATRE Nursing Station Intensive Care Admission, Transfers IP MIS IP MIS BACK OFFICE IP BILLING PHARMACY Corporate Billing / Insurance / Indoor Billing Doctors Honorarium

LABORATORY INFORMATION SYSTEM

COLLECTION ROOM WARDS / ICU / OT OPD Service Registration Sample Collection Consultation Sample Collection & Barcode Generation Service Barcode Generation Registration Consultant Relative Patient Nurse Patient OPD Nursing Phlebotomist IPD / ICU / OT Station OPD Reception LABORATORY HEM/AB00123456-P (14-Mar) DISPATCH Ajit Srivastav 26Y/M /AB00 WARDS / ICU / OT Sample Verification 101123456 Sample Segregation Worksheet Generation Centralized Printing Sample Distribution Final Report Reporting Printing Centralized Dispatch Lab Tech Batch Reporting View Ward Work Printing Printing Sheet Final Report Nursing Ward View Station Dispatch Desk MICRO-BIOLOGY HISTOPATHOLOGY/CYTO BIOCHEM/HEMAT/ SEROLOGY/OTHERS BIOCHEMISTRY / MICROBIOLOGY DEPT HISTOPATHOLOGY DEPT HEMATOLOGY / SEROLOGY / OTHER DEPTS

ELECTRONIC MEDICAL RECORDS

Holistic EMR Sources of data Clinical aspects of capture data capture

Back IMAGING Pathology Holistic EMR

Rural Health Camp – Telemedicine

Rural Health Camp – Telemedicine

Data Generated - Gastroenterology 2005-2010 Modes Number Clinical Data Out Patients 3,45,960 In Patients 54, 634 Imaging Images Upper GI Endoscopy 1,64,693 4,94,079 Colonoscopy 50,905 1,52,715 ERCP 36,011 1,44,044 5 GB/Day EUS 9347 37,388 US 2,60,280 5,20,560 CT 19,822 Capsule Endoscopy 633 Rural Programme & Telemedicine Patients Treated 1,47,263 Endoscopy 4,640 US 3,244

HIS – Implementation Difficulties & Limitations Software:  Integration of Different modules  Cost and Maintenance  Version upgrade related User Acceptance:  Administrators – Good  Paramedical – Fair  Medical – Bad

Data Acquisition  History , Physical etc – Text based  Predefined Templates – Data fields  Images – DICOM & Non DICOM  Lab Data – Integration with HIS

Data Usage - Present  Retrieval – Patient Management  Analysis :  Retrieved by user defined coding and third party program for analysis  Research  To evaluate pattern of diseases – Geographical, Seasonal  Genetic study  Hospital infections – Alerts  Auditing – Quality care  Images PACS – Diagnostic Automation

Data Usage - Present Limitations of Manual analysis:  Large Data bases  Hidden and Potential relationships of data may not be recognized

Data Usage - Future These tools and techniques bring out the hidden patterns in the data which will help us in making decisions

Data Usage - Future Diagnostic Dilemma Evaluating Treatment Choices

Inflammatory Bowel Disease Data: No of Subjects: >1100 No of Fields / Subject: 78 Data Components: Clinical, Investigations, Genetic, Drugs, Surgery, Follow up. Data Format: Text, Tables, Excel, Images

PATIENT HISTORY

Case scenario – Crohns Disease Diagnosis Problem: Intestinal TB – Common in India Crohns Disease – Incidence increasing in India Differentiation: Difficult Critical – Treatment is different

Case scenario – Crohns Disease Diagnosis Question: In a given number of patients (>4000) – (TB & Crohns):  Can we diagnose the disease accurately?  Predict the outcome of treatment?  Recommend best treatment based on previous treatments?

Chronic Pancreatitis: Prevalence France 26/100000 USA Japan 41.7/100000 27.4/100000 South India 126/100000

Chronic Pancreatitis Data: 5 Years No of Subjects: >5000 No of Fields / Subject: 58 Data Components: Clinical, Investigations, Genetic, Drugs, Endoscopic Procedure, Surgery, Follow up. Data Format: Text, Tables, Excel, Images

Chronic Pancreatitis - Proforma

Data of Chronic Pancreatitis (1 st Aug 2011 to 8 th Dec 2011) N= 313 0.9 3.4 0.8 5.1 3.4 34.8 6.8 44.9

Case scenario – Chronic Pancreatitis Treatment Problem: Chronic Calcific Pancreatitis – Heterogeneous group of disease Different modalities of Treatment - Available Controversy : Which modality in Which Patient ?

Case scenario – Chronic Pancreatitis Treatment Question: Stent ESWL Drainage Resection Success % 50-70 60-80 65-90 87-95

Data Usage - Future Decision Tools Outcomes of Evidence Knowledge Patient Based Bases Records Medicine Knowledge Refinement