Integrated Delivery System... Integrated Delivery System... XXX Health System Health Enterprise Computing Long Term Care and Patient Identification Specialists 6.872/HST.950 Home Health Pharmacy Tertiary Care February 13, 2003 Peter Szolovits Clinics Community (with first half content Hospitals Primary Care Docs from David Margulies) Reference Lab Complexity now Complexity now within... within... Context: Evolution of Clinical Computing... THE HOME • Focus evolved from automating AR process THE EMPLOYER THE GOVERNMENT in hospitals, to LAN-based SI of THE ENROLLEE departmental systems, to enterprise clinical Plan Plan computing, toward region- and system-level Plans Plans process automation PPO PPO Contracts Contracts • Changing healthcare organizational models PSO PSO Carve Carve- -Outs Outs PPO PPO and economic models ---> changing clinical Tertiary Tertiary Clinics MSO MSO Clinics computing priorities and designs Assets Assets PHO PHO Purveyors Purveyors Knowledge Knowledge Affiliations Affiliations IDS IDS 1 1
Phase 2: LAN-based SI -- Automate Data Phase 3: Data-based SI to Create an EMR... Distribution to MDs... Clinician’s System Clinician’s System Expert Expert Physician Physician Order Order Document Document Viewer Viewer Systems Systems Mgmt Mgmt Order Comm Order Comm Nursing Nursing Paradigm 1 Paradigm 1 Paradigm 2 Paradigm 2 Order Order ATDs Comm Comm Pharmacy Pharmacy ATDs Entry Order Comm Order Comm Entry Nursing Nursing ATDs ATDs Laboratory Laboratory Nursing Nursing Data Data Pharmacy Pharmacy Repository Repository ATDs ATDs Laboratory Laboratory Laboratory Laboratory Pharmacy Pharmacy Radiology Radiology “Electronic “Electronic Radiology Radiology Medical Medical Radiology Radiology Record” Record” Surgery Surgery Surgery Surgery Surgery Surgery Interface Engine Interface Engine Int Med Med Int Int Med Int Med Internal Medicine Internal Medicine Patient Acct Patient Acct Pat Pat Material Mgmt Material Mgmt Acct Acct Patient Acct Patient Acct Payroll Payroll Case Case General Ledger Mix Mix General Ledger Case Case Material Mgmt Material Mgmt General Ledger General Ledger Mix Mix Accounts Payable Accounts Payable Payroll Payroll Accounts Payable Accounts Payable Phase 4: Enterprise-level Clinical Process Automation... DATA REPOSITORY Health Health Episode Episode Schedule Schedule Status Status Authorization Authorization Membership Membership Activation Activation Mgt. Mgt. Facilities Facilities Group- Group -Provider Provider Group- Group -Patient Patient Roles & & Groups Groups Roles Relationships Relationships Locations Locations Visit Visit Refer Refer Activation Activation Plan Plan Visits Visits Health Health Design Health Health Mgt. Mgt. Design Mgt. Mgt. Team Team Record Record Self Self Patient Patient- -Provider Provider Facility- Facility -Group Group Care Care Encounters Encounters Assess Assess Affiliations Affiliations Settlement Settlement Patient- -Provider Provider Patient Relations Relations Measure Measure Providers Providers Community Community & Other & Other Patients Patients Care Care Care Care Plan Plan Clinical Events: Clinical Events: Evaluate Evaluate Personnel Personnel Procedures, Results Team Team Procedures, Results & Documents & Documents Account Account Clinical Clinical Orders Orders Styles of Styles of Discharge Discharge Act Act Practice Practice Dismiss Dismiss Clinical Clinical Problems Problems Rad Rad Surgery Surgery Institutional Institutional Clinical Lab Lab Clinical Care Care Careplans Careplans Standards Standards Int. Int. & Protocols & Protocols Pharm Pharm Med Med 2 2
Different Imperatives, Most Installations... Different IT Strategies Check Register Schedule History Admit Computer- -Based Patient Record Based Patient Record Care Team Support Computer Care Team Support Refer Medical Medical World- World -Wide Wide Critiqueing Critiqueing Record Record Follow- Assess Up Community Community- -Wide Wide Scheduling Scheduling Account Multiple Facilities Multiple Facilities Common Clinical Ordering Common Clinical Ordering Dismiss Evaluate Care Care Plan Mayo Dischrg Team Team Genesys Electronic Chart Viewer Electronic Chart Viewer Clinical Data Clinical Data SOM Repository Repository Act EMMC Clinical Data Repository Clinical Data Repository Based... Based... HMW MPI/ADT Synchronization MPI/ADT Synchronization Clinicians’ Clinicians’ …... Lab Rad Surgery Worksystem Worksystem Independent Departmental Systems Independent Departmental Systems Samaritan Int Pharm Med Evolutionary Stages Beyond the Enterprise: CHINs Valid needs, No Buyer... Stages Stages Characteristics Characteristics Examples Examples Departmental Departmental Access Directly Via Program Access Directly Via Program PathNet Laboratory PathNet Laboratory Network Applications Network Applications Core Services Core Services Network Applications Core Services Information System Information System Utility System System • E • E- -Mail Mail • E • E- -Mail Mail • E-Mail • E-Mail Providers • highly structured Database Application Database Application Database Systems Database Systems Database Application Database Systems • powerful Workstation Access Via Network Workstation Access Via Network HL7 Query Tools • • Membership Membership • • Membership Server Membership Server Virtual Virtual HL7 Query Tools • Membership • Membership Server � distribution data distribution data Database Database • • Eligibility Eligibility • • Health Plan Server Health Plan Server � disparate databases and user interface disparate databases and user interface • Eligibility • Health Plan Server • • Health Record Access Health Record Access • • Health Record Index Health Record Index • Health Record Access • Health Record Index Community Community Copy Data into Central Depository Copy Data into Central Depository ORACLE ORACLE • • Outcomes Measurement Outcomes Measurement • • Outcomes Management Outcomes Management • Outcomes Measurement • Outcomes Management Integrated Integrated � relationships possible relationships possible Physicians Database � common user interface common user interface Transaction Applications Transaction Applications Transaction Systems Transaction Systems Database Transaction Applications Transaction Systems Health Health � multimedia multimedia • • Scheduling/Referrals Scheduling/Referrals • Scheduling Services • Scheduling Services • Scheduling/Referrals • Scheduling Services Control Access and Encode Control Access and Encode • • Electronic Signature Electronic Signature • • Report Management Report Management Open Clinical Open Clinical • Electronic Signature • Report Management Computer- Computer -Based Based � nomenclature support nomenclature support Information Information Foundation Data Foundation Data • • Claims Processing • Claims Processing Claims Processing • • Claims Consolidation • Claims Consolidation Claims Consolidation Patient Record Patient Record � security and audit control security and audit control Repository Repository � data succession data succession Clinical Systems Clinical Systems • Utilization Review • Utilization Review Clinical Systems • Utilization Review � date authenticity date authenticity Services Services • • Case Management Case Management Business Systems Business Systems • Case Management Clinics, HMOs Business Systems Care Process Care Process Diagnoses, Care Plans and Orders Diagnoses, Care Plans and Orders ProNet ProNet Orders Orders • • AHP Business Systems • AHP Business Systems AHP Business Systems • Client Billing • • Client Billing Client Billing � context for results context for results Intrarelation Intrarelation CareNet CareNet Plans Plans � expectations possible expectations possible • Financial Accounting • Financial Accounting MRNet Operations MRNet Operations • Financial Accounting � requirements for records requirements for records Operations Data Pro- Pro -Active Active Operations Data Open Management Open Management � care management care management Repository Management Management Foundation Data Foundation Data External � fiscal management fiscal management Repository Repository � EIS EIS Organizations Hospitals Concurrent Concurrent Normative Data and Rules Normative Data and Rules Discern Rules Discern Rules Event Event � extrapolations extrapolations APACHE APACHE Critiquing Critiquing � management by protocol management by protocol MEDIQUAL MEDIQUAL 3 3
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