hangzhou health bureau evolution of rhns around the world and in china hangzhou, china august 31,...

Hangzhou Health BureauHangzhou Health Bureau

Hangzhou Health Bureau

Evolution of RHNs Around

the World and in China

Hangzhou, China August 31, 2010

Hangzhou Health BureauHangzhou Health Bureau 2 Dorenfest China Healthcare GroupDorenfest China Healthcare Group2

Presentation Agenda

About The Dorenfest GroupAbout The Dorenfest Group

Evolution of RHNs around the worldEvolution of RHNs around the world

Evolution of RHNs in ChinaEvolution of RHNs in China

EMR evolution and its relationship to RHNs EMR evolution and its relationship to RHNs

Hangzhou Health BureauHangzhou Health Bureau 3 Dorenfest China Healthcare GroupDorenfest China Healthcare Group

The Dorenfest Group

40 years experience in H.I.T.

Offer healthcare improvement services

Focus on improving patient care and operational efficiency through better change management

– Work process improvement

– Management systems improvement

– Improvement in services for patients

– Improvement in quality of patient care


Some Dorenfest Hospital Projects

Abington Memorial Hospital Addison Gilbert Hospital Adventist Health System/Sunbelt Adventist Health System/West Akron General Hospital Albemarle Hospital Baptist Healthcare System Baxter County Regional Hospital Baylor Health Care System Benedictine Health System Boulder Community Hospital Brackenridge Hospital Bristol Bay Regional Health System Burlington Medical Center Caritas Health Services Carondelet Health System Central DuPage Health System Central Washington Hospital Centura Health Charleston Area Medical Center Children’s Health Care Cleveland Home Health Agency Community Memorial Hospital Conway Regional Medical Center Cortland Memorial Hospital Cox Medical Centers and Health Services DCH Healthcare Authority Delnor Community Hospital Dreyer Medical Clinic Duluth Clinic East Alabama Medical Center Edward Health Services Corporation Flagler Hospital Florida Hospital Freeman Health Services Freeport Memorial Hospital Glenoaks Medical Center

The Good Samaritan Hospital Grady Health System Greenwich Health Authority Hamot Medical Center Hazleton-St. Joseph Medical Center Hinsdale Hospital Holy Redeemer Hospital and Medical Center Horizon Health Care Group Howard Young Medical Center Humility of Mary Health Care Illinois Medical Billing Service Integris Health System Jackson County Memorial Hospital Johnston Memorial Hospital Kennebec Health System Lakeland Regional Health System Little Sisters of the Poor Health Services Los Angeles County Department of Health Services Marion General Hospital Medical Center of Southern Indiana Memorial Health Alliance of Burlington Memorial Health Services – Long Beach Memorial Hospital – Belleville Memorial Health System – South Bend Mid-Maine Medical Center Michigan HealthLink Miller-Dwan Health System Mount Clemens General Hospital Muskogee Regional Medical Center Nebraska Methodist Health System Presbyterian Health Care Services Progressive Health System Providence Medical Center Pungo District Hospital Rapides Regional Medical Center Ravenswood Hospital

Resurrection Health Care Corporation River District Hospital Riverside County Health Services Agency Robert Wood Johnson University Hospital Rush North Shore Medical Center Salinas Valley Memorial Hospital San Antonio Community Hospital Scripps Clinic Shadyside Hospital Sharp HealthCare Sisters of Charity of Nazareth Healthcare System South Jersey Hospital System Southeastern Ohio Regional Medical Center Southern Illinois Health Corporation St. Agnes Hospital St. Clare’s Hospital St. Elizabeth Hospital St. Francis Medical Center St. Joseph Health System – Orange, CA St. Joseph Hospital – Cheektowaga, NY St. Joseph’s Hospital – Marshfield, WI St. Joseph’s Medical Center – Brainerd, MN St. Luke’s Hospital – Duluth St. Mary’s Hospital – Amsterdam, NY St. Mary’s Hospital – West Palm Beach St. Mary’s Medical Center – Duluth St. Vincent Infirmary Medical Center Stillwater Medical Center SwedishAmerican Health System Texoma Medical Center Tulane University Hospital and Clinic University of Tennessee Bowld Hospital Valley Hospital Washington County Health System William Beaumont Hospital Corporation Willis-Knighton Medical Center Yuma Regional Medical Center


Dorenfest’s Investigation of China Healthcare in 2005-2006

1.1. Visited 17 cities in ChinaVisited 17 cities in China

2.2. Met 100’s of healthcare industry leaders in ChinaMet 100’s of healthcare industry leaders in China

3.3. Visited over 100 hospitals to review hospital operations and define Visited over 100 hospitals to review hospital operations and define opportunities for improvementopportunities for improvement

4.4. Met provincial and city health bureau leaders in cities visitedMet provincial and city health bureau leaders in cities visited

5.5. Met with many companies selling products and services to the healthcare Met with many companies selling products and services to the healthcare industry in Chinaindustry in China

6.6. Evaluated a group of hospital ownership and management opportunities and Evaluated a group of hospital ownership and management opportunities and assessed viability of the Dorenfest “model hospital” in Chinaassessed viability of the Dorenfest “model hospital” in China

7.7. Developed a strategy for bringing Dorenfest’s skill and experience to ChinaDeveloped a strategy for bringing Dorenfest’s skill and experience to China


China Healthcare Leaders Want To “Leapfrog” the World

1. Chinese hospitals and health bureaus are making considerable investment in Chinese hospitals and health bureaus are making considerable investment in hospital improvement and information technology use hospital improvement and information technology use

2.2. To do this, Chinese health leaders are working diligently to acquire the skills To do this, Chinese health leaders are working diligently to acquire the skills needed to make progress more rapidly by doing the following:needed to make progress more rapidly by doing the following:

Learning quickly from the global experienceLearning quickly from the global experience

Doing more of what the rest of the world did right and less of what the Doing more of what the rest of the world did right and less of what the rest of the world did wrong to avoid the mistakes that other countries rest of the world did wrong to avoid the mistakes that other countries have madehave made

Overcoming resistance to changeOvercoming resistance to change

Learning how to manage changeLearning how to manage change


Examples of Dorenfest Projects in China

Some health bureau clients for RHN and digital hospital planning Some health bureau clients for RHN and digital hospital planning

– ShenzhenShenzhen

– ChongqingChongqing

Some hospital clients Some hospital clients

– Peking University Third HospitalPeking University Third Hospital

– Shanghai Changning Maternity & Infant Health InstituteShanghai Changning Maternity & Infant Health Institute

– Rizhao City People’s Hospital Rizhao City People’s Hospital

Help clients from other locations bring their skills to mainland China Help clients from other locations bring their skills to mainland China

– Hong Kong Hospital AuthorityHong Kong Hospital Authority

– MicrosoftMicrosoft

– PhilipsPhilips



Evolution of RHNs Around the World


History of HIT Leading to the Beginning of RHNs in the U.S.

1.1. The U.S. began automating manual work processes in the late 1960sThe U.S. began automating manual work processes in the late 1960s

Financial systems was the area of emphasis until the later 1970s, when Financial systems was the area of emphasis until the later 1970s, when limited clinical systems began to be implementedlimited clinical systems began to be implemented

Clinical systems, after first emerging on a very limited basis, began to Clinical systems, after first emerging on a very limited basis, began to proliferate in many clinical departments in the 1980sproliferate in many clinical departments in the 1980s

2.2. By the late 1980s, there was lots of automated patient clinical data available on By the late 1980s, there was lots of automated patient clinical data available on hospital and physician office computer systems with one person’s health data hospital and physician office computer systems with one person’s health data stored in many different automated systems at many different locationsstored in many different automated systems at many different locations

3.3. This situation resulted in much duplication of data, as well as duplications of This situation resulted in much duplication of data, as well as duplications of testing and treatments given to patientstesting and treatments given to patients

4.4. This situation motivated the development of the idea of sharing data among the This situation motivated the development of the idea of sharing data among the different healthcare facilities to make healthcare more efficient, and to produce a different healthcare facilities to make healthcare more efficient, and to produce a single electronicsingle electronic patient healthcare record. patient healthcare record.

5.5. This situation began the movement towards RHNs that started in the early 1990sThis situation began the movement towards RHNs that started in the early 1990s


RHNs Began in the U.S. in the Early 1990s as Community RHNs Began in the U.S. in the Early 1990s as Community Health Information Networks (CHINs)Health Information Networks (CHINs)

Hospital A

Doctor’s Office Doctor’s Office

GovernmentReimbursement

Blood Bank

Home Health Agency

Hospital B

Patient DataDoctor’s Office

Insurance Payor

Nursing Home

Outpatient Clinic

Outpatient Clinic

Outpatient Clinic


The First Generation of RHNs in the U.S. Did Not Succeed

1.1. Community health information networks (CHINs) began in 1990 as the first Community health information networks (CHINs) began in 1990 as the first generation of RHNs in the U.S. generation of RHNs in the U.S.

2.2. CHINs were formed with a CHINs were formed with a broad broad vision of sharing information among health vision of sharing information among health organizations within a city or state, but failed for the following reasons: organizations within a city or state, but failed for the following reasons:

They lacked clear objectives They lacked clear objectives

Potential participants and stakeholders were not attracted to CHINs Potential participants and stakeholders were not attracted to CHINs because they could not see their value because they could not see their value

While much money was invested by many CHIN projects, the net result While much money was invested by many CHIN projects, the net result was that none of them worked because the value to participants and was that none of them worked because the value to participants and stakeholders was not apparent to themstakeholders was not apparent to them

3.3. Integrated delivery Integrated delivery ownership models ownership models emerged in 1993 as the hospital’s emerged in 1993 as the hospital’s answer to the Clinton healthcare reform proposal answer to the Clinton healthcare reform proposal

4.4. By the middle 1990s, integrated delivery systems emerged in every city in the By the middle 1990s, integrated delivery systems emerged in every city in the U.S., and the CHIN concept disappeared by 1996 U.S., and the CHIN concept disappeared by 1996


The Second Generation of RHNs, Referred to as RHIOs, Emerged in the Decade of the 2000s

RHIOs were the second generation of RHNs in the U.S.RHIOs were the second generation of RHNs in the U.S.

– Many different organizations promoted them in the early 2000sMany different organizations promoted them in the early 2000s

– By 2004, national policy emerged By 2004, national policy emerged through through the Office of the National the Office of the National Coordinator for Health Information Technology (ONCHIT) Coordinator for Health Information Technology (ONCHIT)

In the ensuing several years between 2004 andIn the ensuing several years between 2004 and now now, , almost 100almost 100 officially officially designated RHIOs emergeddesignated RHIOs emerged

– Heavy investment required to start up these RHIOsHeavy investment required to start up these RHIOs

– Many were unable to find a sustainable operating model and approached Many were unable to find a sustainable operating model and approached financial collapsefinancial collapse

– Some long term successes emergedSome long term successes emerged to share limited data to share limited data


An Example of the Successful RHIO is the Indiana Health Information Exchange (IHIE) Project

1.1. Started in 2002Started in 2002

2.2. Now, any Indiana physician can get access to patient data from many data Now, any Indiana physician can get access to patient data from many data sourcessources

3.3. The IHIE provides services that its participants and stakeholders in community The IHIE provides services that its participants and stakeholders in community healthcare organizations are willing to pay for happily and that benefit them, healthcare organizations are willing to pay for happily and that benefit them, including clinical data sharing among many usersincluding clinical data sharing among many users


An Example of a Failed RHIO in the U.S. Is the Santa Barbara Project

1.1. The Santa Barbara County Care Data Exchange was once one of the most ambitious The Santa Barbara County Care Data Exchange was once one of the most ambitious and publicized US health information exchange efforts. Eight years after its inception, and publicized US health information exchange efforts. Eight years after its inception, and several months after providing some data, the Santa Barbara Project shut down and several months after providing some data, the Santa Barbara Project shut down operations. Despite its developed HIE infrastructure, participants found no compelling operations. Despite its developed HIE infrastructure, participants found no compelling value proposition in initial HIE services. When external funds were ending, the project value proposition in initial HIE services. When external funds were ending, the project board voted to close down project operations. board voted to close down project operations.

2.2. Lessons learned:Lessons learned: The project received a large grant and was viewed as a demonstration project for The project received a large grant and was viewed as a demonstration project for

RHN forward movement. When the large grant funds were used, the project RHN forward movement. When the large grant funds were used, the project participants faced more risk than they were willing to undertake, given the unclear participants faced more risk than they were willing to undertake, given the unclear value proposition for the participantsvalue proposition for the participants . .

The project lacked leadership and participants were passive while the money was The project lacked leadership and participants were passive while the money was spent and lacked interest in putting their own funds into the projectspent and lacked interest in putting their own funds into the project

The project lacked momentum and credibility. Delays in the project due to The project lacked momentum and credibility. Delays in the project due to technical reasons dulled interest among community participants and created technical reasons dulled interest among community participants and created doubts about the project’s credibilitydoubts about the project’s credibility

The vendors providing software to the project overpromised what could be The vendors providing software to the project overpromised what could be delivereddelivered

Finally, and most importantly, the project lacked a compelling value proposition Finally, and most importantly, the project lacked a compelling value proposition with appropriate benefits to key stakeholders, and therefore the stakeholders did with appropriate benefits to key stakeholders, and therefore the stakeholders did not support the projectnot support the project


A Summary of RHN Efforts in the Rest of the World

1.1. RHN-type efforts have been taken on by many countries. Some of the leading RHN-type efforts have been taken on by many countries. Some of the leading successfulsuccessful examples include:examples include:

Hong KongHong Kong

SingaporeSingapore

AustraliaAustralia

CanadaCanada

England England

2.2. In the next pages, we In the next pages, we elaborate onelaborate on Hong Kong and Canada as examples of Hong Kong and Canada as examples of worldwide RHN success storiesworldwide RHN success stories


The Hong Kong Hospital Authority Success Story

1.1. The Hong Kong Hospital Authority was formed in 1991 when over 40 hospitals in Hong Kong The Hong Kong Hospital Authority was formed in 1991 when over 40 hospitals in Hong Kong were combined under a common management authority, allowing central decision making, which were combined under a common management authority, allowing central decision making, which was a key to the success of the Hong Kong Hospital Authority IT efforts over the next 20 years was a key to the success of the Hong Kong Hospital Authority IT efforts over the next 20 years

2.2. Hong Kong Hospital Authority manages all public hospitals and government outpatient clinics. Hong Kong Hospital Authority manages all public hospitals and government outpatient clinics. HKHA started its IT program in 1991, including financial, HR, patient administrative and HKHA started its IT program in 1991, including financial, HR, patient administrative and departmental systems. In 1994, it began developing its Clinical Management System (CMS). HA departmental systems. In 1994, it began developing its Clinical Management System (CMS). HA adopted a centralized approach in developing its CMS for clinical care, greatly reducing IT cost adopted a centralized approach in developing its CMS for clinical care, greatly reducing IT cost per hospital. 94, it began developing its Clinical Management System (CMS). Interoperability per hospital. 94, it began developing its Clinical Management System (CMS). Interoperability between different hospitals was one of the key aims in developing the CMS systembetween different hospitals was one of the key aims in developing the CMS system

3.3. To date, the HA has spent 200 million USD on the development and implementation of clinical IT To date, the HA has spent 200 million USD on the development and implementation of clinical IT systemssystems

4.4. The electronic patient record, (EPR), was first developed in 2000 using a unified information The electronic patient record, (EPR), was first developed in 2000 using a unified information model. It provides a standardized repository of all clinical data collected throughout the HA and model. It provides a standardized repository of all clinical data collected throughout the HA and offers a clinician-friendly view into the comprehensive longitudinal lifelong record of the patient. offers a clinician-friendly view into the comprehensive longitudinal lifelong record of the patient. Currently 9 million patient records are held in the EPRCurrently 9 million patient records are held in the EPR

5.5. The Hong Kong Food and Health Bureau established an EPR sharing project in 2006 to allow The Hong Kong Food and Health Bureau established an EPR sharing project in 2006 to allow patient records to flow freely between different care settings in both the public and private patient records to flow freely between different care settings in both the public and private sectors throughout Hong Kong. This program will use the core technologies of the Hong Kong sectors throughout Hong Kong. This program will use the core technologies of the Hong Kong Hospital Authority to help make the sharing with private hospitals a success. The program is well Hospital Authority to help make the sharing with private hospitals a success. The program is well underway nowunderway now


The Canadian Success Story

1.1. An independent non-for-profit corporation called Canada Health Infoway was An independent non-for-profit corporation called Canada Health Infoway was established in 2001 to lead the national EHR efforts with all federal, provincial established in 2001 to lead the national EHR efforts with all federal, provincial and territorial government as stakeholdersand territorial government as stakeholders

2.2. Canada created a national framework to guide the development of an Canada created a national framework to guide the development of an interoperable EHR across all jurisdictions. Each jurisdiction determines its own interoperable EHR across all jurisdictions. Each jurisdiction determines its own implementation strategy. Canada has national agreement to use a distributed implementation strategy. Canada has national agreement to use a distributed model approach with health data emanating from different operational model approach with health data emanating from different operational applications within a given jurisdictionapplications within a given jurisdiction

3.3. In this model, the pan-Canadian EHR consists of many EHRs resulting in a In this model, the pan-Canadian EHR consists of many EHRs resulting in a peer-to-peer network of message-based interoperable EHRs deployed across peer-to-peer network of message-based interoperable EHRs deployed across CanadaCanada

4.4. The results of Canadian RHN efforts are substantial. Since inception, Infoway The results of Canadian RHN efforts are substantial. Since inception, Infoway has approved 241 projects in the following targeted program areas: Diagnostic has approved 241 projects in the following targeted program areas: Diagnostic Imaging System, Drug Information System, Infrastructure, Innovation and Imaging System, Drug Information System, Infrastructure, Innovation and Adoption, EHR, Lab Information System, Public Health Surveillance, Registries Adoption, EHR, Lab Information System, Public Health Surveillance, Registries and Telehealthand Telehealth


What Are the Lessons To Be Learned from Failed RHN Programs Around the World?

1.1. There was a substantial amount of wasted investment in RHN type programs There was a substantial amount of wasted investment in RHN type programs in the U.S. and some other countries. These programs failed for reasons in the U.S. and some other countries. These programs failed for reasons described belowdescribed below

2.2. They started with broad visions, but had great difficulty creating implementable They started with broad visions, but had great difficulty creating implementable plans plans

3.3. The failed programs over-simplified implementation approaches to create The failed programs over-simplified implementation approaches to create flawed programs flawed programs

4.4. Because of lack of clear objectives, stakeholder commitment could not be Because of lack of clear objectives, stakeholder commitment could not be generated, causing lack of user interest in the efforts of these RHN programs generated, causing lack of user interest in the efforts of these RHN programs

5.5. When success was accomplished, it was done through limited, well thought When success was accomplished, it was done through limited, well thought through first steps and strong stakeholder participation and support through first steps and strong stakeholder participation and support


Summary of Factors Creating Successful RHNs Around the World

1.1. The common ownership factor with centralized decision making has been a key The common ownership factor with centralized decision making has been a key factor in some of the most successful RHNs around the world, such as Hong factor in some of the most successful RHNs around the world, such as Hong Kong Kong

2.2. In successful RHNs without common ownership, a governance and In successful RHNs without common ownership, a governance and management structure was created that worked very well to generate management structure was created that worked very well to generate stakeholder commitment and support stakeholder commitment and support

3.3. Generate political support and strong coordination to involve the various Generate political support and strong coordination to involve the various stakeholders and users of the RHN to come together on the purpose, goals, stakeholders and users of the RHN to come together on the purpose, goals, and objectives of the RHN and objectives of the RHN

4.4. Have clearly stated and shared goals and well-defined business models so that Have clearly stated and shared goals and well-defined business models so that IT can provide effective supportIT can provide effective support

5.5. Find good first steps. Good first steps will let health facility leaders see the Find good first steps. Good first steps will let health facility leaders see the benefits and become willing participants in the RHNbenefits and become willing participants in the RHN

6.6. Select partners carefully and wiselySelect partners carefully and wisely



Evolution of RHNs in ChinaEvolution of RHNs in China


Evolution of RHNs in China

1.1. The Ministry of Health (MOH) guidelines for Health I.T. Development called for The Ministry of Health (MOH) guidelines for Health I.T. Development called for regional health networks and digital hospitals to be implemented throughout regional health networks and digital hospitals to be implemented throughout China between 2003 and 2010China between 2003 and 2010

2.2. This provided much momentum for RHNs a few years ago, as many health This provided much momentum for RHNs a few years ago, as many health bureaus undertook regional health network and digital hospital investmentbureaus undertook regional health network and digital hospital investment

3.3. In the last In the last few few years data sharing years data sharing has has begun to emerge in China as some begun to emerge in China as some RHNs share limited data such as RHNs share limited data such as test/diagnostictest/diagnostic results results and some patient and some patient informationinformation

4.4. Healthcare reform Healthcare reform calls for e-health records calls for e-health records and RHN developmentand RHN development and and has has provided substantial additional funding in a variety of ways, so it is expected provided substantial additional funding in a variety of ways, so it is expected that substantial additional progress will be made in the next few yearsthat substantial additional progress will be made in the next few years

5.5. Much more activityMuch more activity and funding and funding in many cities and provinces in many cities and provinces with even U.S. with even U.S. funding forfunding for one or two major one or two major planning planning projects, including the Sichuan Provincial projects, including the Sichuan Provincial Health Bureau EHR and Regional Health Network ProjectHealth Bureau EHR and Regional Health Network Project


We Studied Seven City RHNs in China to Learn Progress

1.1. Recently, we did an RHN consulting project in which we studied seven regional Recently, we did an RHN consulting project in which we studied seven regional health network programs. The seven cities or provinces are listed belowhealth network programs. The seven cities or provinces are listed below

2.2. The 7 cities or provinces are listed below:The 7 cities or provinces are listed below:

Dongguan, Guangdong ProvinceDongguan, Guangdong Province

Hebei ProvinceHebei Province

Foshan, Guangdong ProvinceFoshan, Guangdong Province

ShanghaiShanghai

Shenzhen, Guangdong ProvinceShenzhen, Guangdong Province

BeijingBeijing

Xiamen, Fujian ProvinceXiamen, Fujian Province


We Studied Seven City RHNs in China to Learn Progress (Continued)

3.3. We dedicated our efforts in studying these 7 cities to answer the following key We dedicated our efforts in studying these 7 cities to answer the following key questions:questions:

What does the RHN do?What does the RHN do?

What are the benefits so far?What are the benefits so far?

How much is the investment so far?How much is the investment so far?

Which vendor is used?Which vendor is used?

What are the success factors and potential challenges?What are the success factors and potential challenges?

4.4. From this study, we identified some common challenges these RHNs are From this study, we identified some common challenges these RHNs are facing, as well as some important success factors, which are outlined on the facing, as well as some important success factors, which are outlined on the following pages. following pages.


Our Observations About the 7 City RHN Programs We Studied

1.1. Some common issues we observed are as follows:Some common issues we observed are as follows:

All have a large vision to implement an EHR, but first steps in execution All have a large vision to implement an EHR, but first steps in execution were often unclearwere often unclear

All are trying to do too many things at onceAll are trying to do too many things at once

The city or provincial government has made a substantial part of the initial The city or provincial government has made a substantial part of the initial investment for the RHN and plays an important role in planning and investment for the RHN and plays an important role in planning and coordinating RHN effortscoordinating RHN efforts

Technical issues do not seem to be obstacles preventing success in any Technical issues do not seem to be obstacles preventing success in any of the 7 programsof the 7 programs

All 7 programs are in their early stages of execution, and it is difficult to All 7 programs are in their early stages of execution, and it is difficult to forecast how successful they will eventually be. There is much more forecast how successful they will eventually be. There is much more work to be completed than the work that has already been donework to be completed than the work that has already been done


Our Observations About the 7 City RHN Programs We Studied (Continued)

2.2. There are key differences in the seven city RHN programs as follows:There are key differences in the seven city RHN programs as follows:

The first step in these city programs is different from city to city. Good first steps The first step in these city programs is different from city to city. Good first steps can get better stakeholders support. An example is that Dongguan provided a free can get better stakeholders support. An example is that Dongguan provided a free Office Automation system and citywide appointment system to attract the hospitals Office Automation system and citywide appointment system to attract the hospitals to involve in the city RHN. to involve in the city RHN.

The approaches to building the RHNs in these 7 cities are different. We think the The approaches to building the RHNs in these 7 cities are different. We think the reasons for the differences include the following:reasons for the differences include the following:

– The more complex that hospital ownership and medical service resource The more complex that hospital ownership and medical service resource distribution are within a city, the more stakeholders are involved and the more distribution are within a city, the more stakeholders are involved and the more difficult it is to make progressdifficult it is to make progress

– If funding requirements are not large and can be provided by a single entity, If funding requirements are not large and can be provided by a single entity, such as the city health bureau, or the city government, then the whole such as the city health bureau, or the city government, then the whole program can be managed with a more centralized approachprogram can be managed with a more centralized approach

– Cities that started their RHN pilot programs earlier have gained some Cities that started their RHN pilot programs earlier have gained some experience, which has made these cities very aware of the importance of experience, which has made these cities very aware of the importance of good planning and a more structured approachgood planning and a more structured approach

The amount of investment in the 7 cities has varied considerably. The investment The amount of investment in the 7 cities has varied considerably. The investment depends on the city size, approach taken to the RHN, and whether or not a good depends on the city size, approach taken to the RHN, and whether or not a good plan is in placeplan is in place


The Best Approach to Building Success in an RHN Is by Building a Strong Foundation

1.1. Carefully define first steps, make them simple and beneficial, and gain Carefully define first steps, make them simple and beneficial, and gain stakeholder supportstakeholder support

2.2. Limited data sets with high benefit to many stake holders would be Limited data sets with high benefit to many stake holders would be advantageousadvantageous

3.3. When first steps prove beneficial, more aggressive second steps can be takenWhen first steps prove beneficial, more aggressive second steps can be taken



EMR Evolution and Its EMR Evolution and Its Relationship to RHNsRelationship to RHNs


Opportunities to Improve Healthcare Delivery Have Been Pursued for Many Years

Great redundancy of informationGreat redundancy of information

High error potentialHigh error potential

Lack of timelinessLack of timeliness

High costHigh cost

Organization complexityOrganization complexity


U.S. Hospitals Have Sought an EMR Since the 1960s Through Four Generations of I.T. Systems

1.1. Finance Systems (1960s and 1970s) Finance Systems (1960s and 1970s)

2.2. Limited Clinical Systems (1970s and 1980s) Limited Clinical Systems (1970s and 1980s)

3.3. More Advanced Clinical Systems (Late 1980s and 1990s) More Advanced Clinical Systems (Late 1980s and 1990s)

4.4. Electronic Health Records (2000s)Electronic Health Records (2000s)


Current Status of EMR Adoption in U.S. HospitalsCurrent Status of EMR Adoption in U.S. Hospitals

EMR adoption in U.S. EMR adoption in U.S. hospitals is still limitedhospitals is still limited

According to 7-stage EMR According to 7-stage EMR adoption model ofadoption model of HIMSS HIMSS Analytics:Analytics:

– Stage 4 Is considered the Stage 4 Is considered the minimum level an EMR is minimum level an EMR is used effectivelyused effectively

– By the end of the second By the end of the second quarter of 2010quarter of 2010, 83.7% of , 83.7% of hospitals are still under hospitals are still under stage 4. Only 16.3% are stage 4. Only 16.3% are in stage 4 or higherin stage 4 or higher

US hospitals still have a long US hospitals still have a long way to go in adopting EMRway to go in adopting EMRData from HIMSS AnalyticsTM Database © 2010

(formerly The Dorenfest Integrated Healthcare Delivery System DatabaseTM)


The Stepping Stones to Paperless

Paper basedfiles and workflow

with some computers

Digital documents,common views,

multiple access points,HIS and departmental

systems

Codified datain EMR integratedwith other clinical

systems

Data sharing across thecontinuum of care, payers, patient, etc.

TraditionalHIS collectsinformation

HybridRecord

EMR

Community BasedEHR


Overview of EMR Status in China

1.1. EMR is critical to the long-term success of citywide data sharing in RHNsEMR is critical to the long-term success of citywide data sharing in RHNs

2.2. Today, many Chinese hospitals have an EMR operational or in implementationToday, many Chinese hospitals have an EMR operational or in implementation

3.3. While some of these EMRs are working well, many of these EMRs are causing While some of these EMRs are working well, many of these EMRs are causing more problems and work for clinicians in the hospitals. Some reasons for this more problems and work for clinicians in the hospitals. Some reasons for this include:include:

Data entry by physicians through CPOE has added time to their workday Data entry by physicians through CPOE has added time to their workday without providing offsetting benefitswithout providing offsetting benefits

Methods of entering information into the EMR is often through straight typing Methods of entering information into the EMR is often through straight typing with very little facilitation through assisters to make EMR entry easierwith very little facilitation through assisters to make EMR entry easier

In many EMR systems, it is difficult to find what is wanted, as compared to In many EMR systems, it is difficult to find what is wanted, as compared to finding it in the manual recordfinding it in the manual record

In many EMR systems in use today, erroneous data finds its way into the In many EMR systems in use today, erroneous data finds its way into the EMR, because of poor integration of a variety of software systems in use by EMR, because of poor integration of a variety of software systems in use by the hospitalthe hospital

4.4. These problems have emerged because many EMRs were purchased without These problems have emerged because many EMRs were purchased without adequate clinician involvement and were implemented with poor clinician trainingadequate clinician involvement and were implemented with poor clinician training


Some Suggestions for Creating Successful EMRs in Some Suggestions for Creating Successful EMRs in Chinese HospitalsChinese Hospitals

1.1. Make a very careful evaluation of the EMR software products available. Take a Make a very careful evaluation of the EMR software products available. Take a careful look at how other hospitals use them in order to build up a solid careful look at how other hospitals use them in order to build up a solid foundation for the buying decisionfoundation for the buying decision

2.2. Involve a large enough group of clinicians at various stages of the software Involve a large enough group of clinicians at various stages of the software evaluation so that they understand the differences between products and can evaluation so that they understand the differences between products and can contribute their wisdom to the buying decisioncontribute their wisdom to the buying decision

3.3. Use the clinicians who were selected to be involved in the buying process as Use the clinicians who were selected to be involved in the buying process as super users during the implementation and as trainers of the other clinicianssuper users during the implementation and as trainers of the other clinicians

4.4. Do not oversimplify your evaluation. Be sure and look carefully at how the Do not oversimplify your evaluation. Be sure and look carefully at how the EMRs are working at user sites to be able to understand what you need to do EMRs are working at user sites to be able to understand what you need to do to be successful in implementing an EMRto be successful in implementing an EMR


Planning Hospital EMR and RHN Together by Using a Planning Hospital EMR and RHN Together by Using a Hospital Clinical Data Repository Can Be BeneficialHospital Clinical Data Repository Can Be Beneficial

1.1. RHNs in China are or will be sharing patients’ clinical data extracted from different RHNs in China are or will be sharing patients’ clinical data extracted from different organizations. The types of data shared or to be shared include, but are not limited to, organizations. The types of data shared or to be shared include, but are not limited to, lab test results, diagnostic imaging test results, and even the images themselveslab test results, diagnostic imaging test results, and even the images themselves

2.2. These types of data are usually stored in different components’ clinical information These types of data are usually stored in different components’ clinical information systems. To be able to easily share this data, there is a need to have a consolidated systems. To be able to easily share this data, there is a need to have a consolidated database within each hospital. This type of database is called a Clinical Data Repositorydatabase within each hospital. This type of database is called a Clinical Data Repository

3.3. The Clinical Data Repository can be used in the hospital to extract and store data from The Clinical Data Repository can be used in the hospital to extract and store data from the EMR for hospital medical decision-making purposesthe EMR for hospital medical decision-making purposes

4.4. The Clinical Data Repository structure and data model can be made to have some The Clinical Data Repository structure and data model can be made to have some common characteristics for all of the hospital EMRs so that the data sharing among common characteristics for all of the hospital EMRs so that the data sharing among hospitals is made easierhospitals is made easier

5.5. The citywide RHN data model can then be structured to draw data from the Clinical Data The citywide RHN data model can then be structured to draw data from the Clinical Data Repositories in each hospitalRepositories in each hospital

6.6. By giving this careful thought as the EMR strategies for the hospitals are further By giving this careful thought as the EMR strategies for the hospitals are further developed, the citywide RHN foundation will be strongerdeveloped, the citywide RHN foundation will be stronger


THANK YOU.THANK YOU.FOR MORE INFORMATION CONTACT:FOR MORE INFORMATION CONTACT:

SHELDON I. DORENFEST OR XIAO LIUSHELDON I. DORENFEST OR XIAO LIU

THE DORENFEST GROUPTHE DORENFEST GROUP THE DORENFEST CHINATHE DORENFEST CHINANBC TOWER, SUITE 2725NBC TOWER, SUITE 2725 HEALTHCARE GROUPHEALTHCARE GROUP455 N. CITYFRONT PLAZA DRIVE455 N. CITYFRONT PLAZA DRIVE HUAIHAI EAST ROAD NO. 45HUAIHAI EAST ROAD NO. 45CHICAGO, IL 60611-5555CHICAGO, IL 60611-5555 HUAIHAI PLAZAHUAIHAI PLAZAUNITED STATES OF AMERICAUNITED STATES OF AMERICA SUITE 908SUITE 908PHONE: 312-464-3000PHONE: 312-464-3000 SHANGHAI, CHINASHANGHAI, CHINAFAX: 312-467-0541FAX: 312-467-0541 PHONE: 021-51001821PHONE: 021-51001821

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SHELDON’S E-MAIL ADDRESS: SHELDON’S E-MAIL ADDRESS: [email protected]

XIAO’S E-MAIL ADDRESS XIAO’S E-MAIL ADDRESS : : [email protected]

hangzhou health bureau evolution of rhns around the world and in china hangzhou, china august 31,...

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