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Hospital Information Systems“Hospital” as a big complicated healthcare organisation

Danny SolomonSenior Architect, iSOFT danny.solomon@isoftplc.com www.isoftplc.com

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Objectives

Understand information requirements of hospitals and other health-care organisations

Understand issues and challenges in the life-cycle of health-care information-systems

Understand some of the history – and some future directions

Introduce iSOFT

interrupt

challenge

disp

ute

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Agenda

What is a health-care information system? What’s it for?

Issues in their creation and deployment – why is it hard?

Where they have come from – where they are going

iSOFT

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What is a health-care information system? What’s it for?

Requirements

Context

How it all relates to CfH

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Requirements of a health-care information system

Information-systems to run health-care organisations (HCOs)?

OR

Information-systems to manage the records of patients cared for in those organisations? BOTH

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What is an HCO?

StHA

PCTsGPs

Acute

Mental Health

Community

Sites

.

.

.

.

.

.

LondonNational

. . .

Identity

Clinical informationDirectory and desktop

InfrastructurePopulation record Records AnalysisHRIOut-of hours accessReference dataTerminologySecurity

Service user indexClinical governanceBooking and schedulingKnowledge mgtDigital ImagingPrescribingOrders and resultsDiagnosis and carePathology

Any community service for tactical reasonsEg. PAS, Mental Health, TertiaryNon-federated data

Guys &

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Anatomy of a hospital

Multiple facilities (sites)

Wards

Clinics

Diagnostic services

• Radiology, Pathology, etc

Pharmacy

Treatment

• Theatres, Modalities

Medical Records

Coding

Links to other organisations

• Local: Primary care, Community

• National: DoH, CfH, national information systems

Catering

Portering

Physio

Phlebotomy

Management

• HR, Finance, etc

…

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Information-systems to run health-care organisations

What’s going on?

What’s planned?

Where are my patients?

What reports do I need to generate?

Get my money

Am I about to run out of money?

Run my clinics

Run my waiting lists

Run my wards

Run my theatres

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Information systems to manage patient records

Administrative

• Where do they live

• Booked for a clinic?

• On a ward?

• GP

• Next of kin

• …

Clinical

• What’s wrong with them

• What am I planning to do to them?

• Order a test

• See the result

• Refer them on

• Describe them

• …

Division is not

clear cut Information Governance (IG) issues

• Who can see what?

• Is restricting to demographics safe?

• Who can see clinical?

• Is ward location clinical or demographic?

• How much information is shared? To whom?

• What does the patient expect?

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Issues in the creation and deployment of health-care information systems

Why is it hard?

Total cost of ownership (TCO)

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Why is it hard?

Well, is it hard?• Empirical evidence suggests it is• Beacon examples are generally not reproducible• Productising is an issue

Medicine is not a science

Out of the box, computers are good at numbers, not people

Organisational setting is complex• Different across different markets

Change control and management is always hard

Some specifics…

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Why it is hard

Booking a clinic is like booking a flight?• Slots not constant• Different resources required for different slots/clinics• Recipient has to explicitly accept• Over-booking rules• Patients aren’t predictable …

Clinic booking is the easy bit!

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Why it is hard

Lots of different kinds of users• Clinicians

– Docs– Different grades, specialties, experiences, training, backround

– Nurses– …

– PAMS– …

• Managers• Administrative staff• Patients

– Well– Unwell– Worried well– Vulnerable– Young / old– Expert / non-expert

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Why it is hard

Lots of different kinds of users

Doing different kinds of things• Seeing patients

– Clinics, wards, A&E, telephone

• Planning budgets• Organising resources

– Human, equipment, consumable, locations

In many different settings• Organisational

– Hospital (wards, clinics…), Community, Practice, Lab,

• Specialty– Paed, Geri, Med, Surg, …

Everyone likes to do things their own way

Don’t panic

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Maintaining the balance

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There is commonality we can exploit

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One product, many solutions

Health economy

Care settings

Healthcare services

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Product vs solution

Product = software

Solution = software configured and deployed onto a managed technical architecture

• Many areas to consider: TCO

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Total cost of ownership (TCO)

Forget shelf prices

What will it cost my organisation to procure, contract, implement, run, update and ultimately retire an information system?

What if I do nothing?

A useful way of examining areas that make this whole process hard

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Typical TCO model

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Past, present and Future

Health-care information systems: where they have come from & where they are going

History

Drivers

Direction of travel

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Where health-care information systems have been

Organisation often based on physical artefacts• Eg Hospitals• Lots of local autonomy• Need to maintain links with labs• Maintain own coding departments• Maintain own IT infrastructure

Information systems• Local procurement• PAS critical• Clinicals less so

–Lots of local activity at a departmental level – nightmare to manage

• Order-comms typically an early requirement/win• EPR / Prescribing not common in secondary care

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Drivers

Health-care organisation is changing• Everywhere, quite frequently• From the centre

– Reporting requirements– Spine compliance– PBR

• Locally– (some) clinicians demanding better tools– Access to knowledge & best practice, decision support, lose the paper

Procurement model is changing• Local Regional National• Do once and share

– Procurement, configuration

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Drivers

Health-care organisation is changing

Procurement model is changing

Deployment model is changing• Critical data under a GP’s desk?• Critical data in a hospital server-room?• DR-capable data-centre

Information-sharing becoming critical• Support the patient journey• Empower the patient

– Where that’s a good thing

• Avoid unnecessary errors

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Direction of travel

Step 1 – Analyse landscapeQualify legacy systemsPlan the transition

User experience:Mix of modern and legacyOrganisation-focused: little information passed around the community

Step 2 – Install products Legacy replacement commencedService adapters for core services deployedService hubs introducedArchitecture being delivered

User experience:Modern applications becoming pervasiveInformation becoming accessible across the communityLegacy decreasing

Step 3 – Join UpMore uniform landscapeMore information accessCommon services and accessible data Supports shared and coherent care across the community

User experience:Modern applications across the communityInformation accessible across the community

Healthcare community

Integrated healthcare community

GP legacy

Hospital legacy

iSOFT customer

Citizen

SH

SHSA

SHSA

SA

SA

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iSOFT

Mission

Market leadership

Business strategy

Global healthcare and social reform

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Our mission

To be the global leader in the healthcare software applications market.

iSOFT is working with patients, clinicians, other healthcare professionals, administrators and governments to help transform the delivery of healthcare.

We focus on satisfying the needs of all individual stakeholders, whoever they are, and however they participate in the supply chain of healthcare provision. Our solutions not only meet the current need, they also describe the future of healthcare.

Our inspiration and motivation is to improve the life experience of citizens worldwide

iSOFT: inspired by life.

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Leading the healthcare software applications market

Customers

• 1,700 hospitals

• 6,000 family doctors

• 18 countries in five continents

Employees

• 2,700 healthcare IT specialists

• 1,000 technology and development professionals

• Two dedicated offshore development and solution design centres in India

Scale of business

Fourth largest software and computer services business on the LSE

Market capitalisation of over £900m (US$1,600 million)

Stock market listing in July 2000

• Revenues grown from £17m to £262m

• Profits increased by over 2,000%

Financials

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Our business strategy

Delivergrowth in existing markets

Develop and grow existing market shares for LORENZO

Configure LORENZO

to meet local market requirements

Provide world class references for international expansion

Develop andexecute new market entry strategies

Conduct detailed market analysis and qualification

Establish strong foundation based on significant early wins

Build on initial success through effective promotion of LORENZO

Expand partnershiparrangements

Work with third party technology and service partners on large scale projects and new market entry

Develop existing partnership arrangements

Identify opportunities for new partnerships and collaborations

Target rapidmarketleadership

Establish leading competitive position

Win majority of open market procurements

Accelerate market share through targeted acquisitions

Offer strategic ‘universal’ application set

Continue to invest in development capability and capacity

Promote LORENZO as our new generation software solution

Maintainsoftwareapplicationleadership

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The needGlobal healthcare and social reform

Healthcare is undergoing rapid, unprecedented change

Forward referencing solutions required by citizens, clinicians, policy makers

Work to implement the necessary systems will take place over the next 10 years

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Summary

Successful well managed healthcare applications business

Consistent and focused business strategy

Large and growing international market opportunity

Leader in the supply of advanced application solutions

Strong positive differentiation from small number of credible competitors

Well positioned in respect of future growth opportunity in both existing and new international markets

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Re-cap Objectives

Understand information requirements of hospitals and other health-care organisations

Understand issues and challenges in the life-cycle of health-care information-systems

Understand some of the history – and some future directions

Introduce iSOFT