2004 10-19 rudi vdv
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R. Van de Velde 1
Prof. R. Van de Velde
The promise of Clinical Information SystemsThe promise of Clinical Information SystemsChallenges and perspectives at the beginning of the 21th centuryChallenges and perspectives at the beginning of the 21th century
IBBT19 Oktober 2004
R. Van de Velde 2
IntroductionIntroduction
> Introduction
> Design Principles
> Challenges
> Conclusions: AZ-VUB experience
> Introduction
• Setting the scene
R. Van de Velde 3
Hospital “AZ-VUB”
Beds 700 Staff members 2.700 Admissions 2002 26.000 Emergency patients 2002 54.000 Ambulatory patients 2002 280.000
Hospital “De Bijtjes”
Beds 200 Hospital within 10-miles radius
R. Van de Velde 4
IT-StrategyIT-Strategy
> Introduction
> Design Principles
> Challenges
> Conclusions : AZ-VUB experience
> Design Principles
• Component Software
• Multi-Layered
• Hospital-Wide
R. Van de Velde 5
AZ-VUB: IT - Design Principle #1 Conceptual AZ-VUB: IT - Design Principle #1 Conceptual View View
Multi Layer
Hospital Wide
Component OrientedComponent Oriented
R. Van de Velde 6
AZ-VUB: IT - Design Principle #1AZ-VUB: IT - Design Principle #1
Component Oriented
Activity
Patient Organization
AuthorisationKnowledge
Medical Record
R. Van de Velde 7
AZ-VUB: IT - Design Principle #2 Technical AZ-VUB: IT - Design Principle #2 Technical ViewView
Multi Layer
Component Oriented
Multi Layer
Hospital Wide
R. Van de Velde 8
Bio signals (ECG) Images Web Pages
City J Jane Smith 561224-1234 # 15
931212 Diagnosis : Fracture of femur 4pH
Family history : Both parents diedfrom myocardial infarction
Patient history : Fell on slipperypavement in Brussels yesterday ...
Status : Examination of right leg shows ...
3
2
1Medical Record
Alphanumeric data
TheThe Layered IT-Architecture at AZ VUB Layered IT-Architecture at AZ VUB
Patient
Componentry
Act Resource Medical Knowledge Authorization
Patient support EnterpriseMedical Care E-Health
Security Transactions Messaging Naming servicesSecurity Transactions Messaging Naming services J2
EE FR
AM
EW
OR
KJ2
EE FR
AM
EW
OR
K
R. Van de Velde 9
AZ-VUB IT - Design Principle #3 User AZ-VUB IT - Design Principle #3 User PerspectivePerspective
Multi Layer
Component Oriented
Hospital WideHospital Wide
R. Van de Velde 10
Outside the Organization
The Web Expands Composite ViewsThe Web Expands Composite Views
Internal and External Composite View
Electronic bonding with
internal & external users
Reduction of intermediary
personnel
Role-centric view of
information
ApplicationB
ApplicationC
ApplicationA
Function-oriented
Web
R. Van de Velde 11
Ongoing projectsOngoing projects
> Introduction
> Design Principles
> Challenges
• Terminology Server
• Clinical Decision Support Systems (CDSS)
• Workflow Project
• The Storage Gap
• Mobility versus Wireless
> Conclusions : AZ-VUB experience
> Challenges
• Terminology Server
R. Van de Velde 12
Revealing assumptions is an essential component of effective communication.information models are an effective means of documenting our assumptions
about data
Yes, I doplay
football.
Do youplay
football?
Reveal AssumptionsReveal Assumptions
R. Van de Velde 13
> Main Entry: in·ter·op·er·a·bil·i·tyFunction: nounDate: 1977: ability of a system (as a weapons system) to use the parts or equipment of another system
Source: Merriam-Webster web site
> interoperability : ability of two or more systems or components to exchange information and to use the information that has been exchanged.
Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990]
Semanticinteroperability
Syntacticalinteroperability
The Importance of InteroperabilityThe Importance of Interoperability
R. Van de Velde 14
R. Van de Velde 15
TerminologyTerminology
HPI: History of present illness Exam: Physical exam
Diag: Other tests Rx : Medications
PMH: Past medical history Labs: Clinical Lab
Dx: Diagnoses Tx: other therapy
HPI PMH Exam Labs Diag Dx Rx Tx
ICD$ + ++ ++
ICT$ +
DRG +
SNOMED +++ +++ +++ ++ ++ +++ ++ ++
Nursing +++ +++
LOINC +++ +
NDC ++
RxNorm +++
ATC +++
UMLS ++ ++ ++ ++ ++ ++ ++ ++
R. Van de Velde 16
Ongoing projectsOngoing projects
> Introduction
> Design Principles
> Challenges
• Terminology Server
• Clinical Decision Support Systems
(CDSS)
• Workflow Project
• The Storage Gap
• Mobility versus Wireless
> Conclusions : AZ-VUB experience
> Challenges
• Clinical Decision Support Systems (CDSS)
R. Van de Velde 17
Five Generations of EMRsFive Generations of EMRsF
un
ctio
nal
ity
Availability of Products
19931993
1. Collector
2. Result Server
3. Assistant
4. Collaegue
5. Mentor
19981998 2008200820032003 20122012
R. Van de Velde 18
A Continuum Knowledge Application and DiscoveryA Continuum Knowledge Application and Discovery
Monitoring patient data with passive decision support
Interceptingincorrect clinicaldecisions
Making the right decisions the easiest decisions
Rapid Self-Improving Health System
Paper-based InformationAnd Knowledge
Paper-based InformationAnd Knowledge
OnlineAccess To Data and Knowledge
OnlineAccess To Data and Knowledge
Safety NetSafety Net AnticipationAnticipation UnderstandingPerformance
UnderstandingPerformance
Surveillance Interactive Proactive Learning
R. Van de Velde 19
> Alerts and reminders : drug-drug
> Protocols : sequence of tasks
> Administrative : ES Billing
IOM report“To Err is Human”
Clinical DSS : Application areasClinical DSS : Application areas
R. Van de Velde 20
DSS – Protocols : Radiotherapy PlanningDSS – Protocols : Radiotherapy Planning
R. Van de Velde 21
Ongoing projectsOngoing projects
> Introduction
> Design Principles
> Challenges
• Terminology Server
• Clinical Decision Support Systems
(CDSS)
• Workflow Project
• The Storage Gap
• Mobility versus Wireless
> Conclusions : AZ-VUB experience
> Challenges
• Workflow Project
R. Van de Velde 22 Procedures Medication
Outcome & Results
EX
PE
RT
SY
ST
EM
TA
RIF
HO
SP
ITA
L M
AN
AG
EM
EN
T
(33.
000)
Workflow in HC: AZ VUB – Monthly Flow & FiguresWorkflow in HC: AZ VUB – Monthly Flow & Figures
Patient
Nursing
Medical Care
Scheduling
Req
uis
itio
ns
Patient (1.200.000)
Req
uis
itio
ns
(150
.000
)
Outcome & Results (70.000)
Scheduling (70.000)
R. Van de Velde 23
TerminologyTerminology
HPI: History of present illness Exam: Physical exam
Diag: Other tests Rx : Medications
PMH: Past medical history Labs: Clinical Lab
Dx: Diagnoses Tx: other therapy
HPI PMH Exam Labs Diag Dx Rx Tx
ICD$ + ++ ++
ICT$ +
DRG +
SNOMED +++ +++ +++ ++ ++ +++ ++ ++
Nursing +++ +++
LOINC +++ +
NDC ++
RxNorm +++
ATC +++
UMLS ++ ++ ++ ++ ++ ++ ++ ++
R. Van de Velde 24
Ongoing projectsOngoing projects
> Introduction
> Design Principles
> Challenges
• Terminology Server
• Clinical Decision Support Systems
(CDSS)
• Workflow Project
• The Storage Gap
• Mobility versus Wireless
> Conclusions : AZ-VUB experience
> Challenges
• Clinical Decision Support Systems (CDSS)
R. Van de Velde 25
Five Generations of EMRsFive Generations of EMRsF
un
ctio
nal
ity
Availability of Products
19931993
1. Collector
2. Result Server
3. Assistant
4. Collaegue
5. Mentor
19981998 2008200820032003 20122012
R. Van de Velde 26
A Continuum Knowledge Application and DiscoveryA Continuum Knowledge Application and Discovery
Monitoring patient data with passive decision support
Interceptingincorrect clinicaldecisions
Making the right decisions the easiest decisions
Rapid Self-Improving Health System
Paper-based InformationAnd Knowledge
Paper-based InformationAnd Knowledge
OnlineAccess To Data and Knowledge
OnlineAccess To Data and Knowledge
Safety NetSafety Net AnticipationAnticipation UnderstandingPerformance
UnderstandingPerformance
Surveillance Interactive Proactive Learning
R. Van de Velde 27
> Alerts and reminders : drug-drug
> Protocols : sequence of tasks
> Administrative : ES Billing
IOM report“To Err is Human”
Clinical DSS : Application areasClinical DSS : Application areas
R. Van de Velde 28
DSS – Protocols : Radiotherapy PlanningDSS – Protocols : Radiotherapy Planning
R. Van de Velde 29
Ongoing projectsOngoing projects
> Introduction
> Design Principles
> Challenges
• Terminology Server
• Clinical Decision Support Systems
(CDSS)
• Workflow Project
• The Storage Gap
• Mobility versus Wireless
> Conclusions : AZ-VUB experience
> Challenges
• Workflow Project
R. Van de Velde 30 Procedures Medication
Outcome & Results
EX
PE
RT
SY
ST
EM
TA
RIF
HO
SP
ITA
L M
AN
AG
EM
EN
T
(33.
000)
Workflow in HC: AZ VUB – Monthly Flow & FiguresWorkflow in HC: AZ VUB – Monthly Flow & Figures
Patient
Nursing
Medical Care
Scheduling
Req
uis
itio
ns
Patient (1.200.000)
Req
uis
itio
ns
(150
.000
)
Outcome & Results (70.000)
Scheduling (70.000)