International Leaders of
the EHR journey
ASSIST and NHS NorthWest
October 9, 2007
16-Jul-12
Denis Protti - University of Victoria & City University London
1
Evidence of progress from
around the world
We are making an impact
16-Jul-12
Denis Protti - University of Victoria & City University London
2
Denmark
12-Jul-16
Denis Protti - University of Victoria & City University London
3
Denmark
Virtually all Danish GPs (and as of 2007, almost all
specialists as well) send and receive clinical
electronic messages.
Sixty standardized messages (up from 32 in 2002)
have been implemented in 100 computer systems in
4,000 organizations.
Over 90% of the country’s clinical communications in
the primary sector are exchanged over Denmark’s
national network.
12-Jul-16
Denis Protti - University of Victoria & City University London
4
Denmark
In 2005, a national health portal provided information
about the Danish National Health Service to its
citizens and patients.
Waiting list information
Online scheduling of GP appointments
Access to online medication profile
Renewal of prescriptions
Email contact with GPs
Quality declarations
12-Jul-16
Denis Protti - University of Victoria & City University London
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New Zealand
12-Jul-16
Denis Protti - University of Victoria & City University London
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AGPAL ACCREDITED
2,200 New Zealand sites
1,200 Australian sites
1-800 support across Australasia
12-Jul-16
Denis Protti - University of Victoria & City University London
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KIWI SCORECARD
85% use of GP clinical systems (in
consultation)
90% use clinical messaging
95% receive electronic pathology reports
95% can receive electronic discharge
summaries and send referrals
60% of hospitals (and growing) send
electronic discharge summaries
12-Jul-16
Denis Protti - University of Victoria & City University London
8
Hong Kong
12-Jul-16
Denis Protti - University of Victoria & City University London
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Hospital Authority Services
43 Hospitals
46 Specialist clinics
74 General clinics
8M Patient Records
Annually:
1M Admissions
2M A&E visits
11M Outpatient visits
52,000 Staff
4,500 Doctors
20,000 Nurses
Clinical Systems
•
•
•
•
Comprehensive
functionality developed
in-house since early 90’s
High utilization by
clinicians
Mission critical systems
Increasing strategic
importance
Source: Dr. NT Cheung
Electronic Patient Record (ePR)
•
Web-based lifelong longitudinal record of all healthcare
transactions for all Hong Kong citizens
•
Patient privacy protected with access controls and full
audit logs
•
Available at all 162 facilities in the HA
•
Many data formats (textual, numerical and digital images)
•
Now extending to external providers
Impressive statistics
•
•
•
•
•
•
•
•
7.6 million patients
57 million episodes of care
540 million laboratory results
34 million radiology results
230 million drug items
1 million image studies
Sub-second response time
7x24 >99.99% uptime
USA
12-Jul-16
Denis Protti - University of Victoria & City University London
14
US – Veteran’s Administration
Every VA Medical Center has
Electronic Health Records and
Computerized Provider Order Entry!
12-Jul-16
Denis Protti - University of Victoria & City University London
15
Veterans Health Administration
• Department of Veterans Affairs (VA)
– Provides benefits and services to our nation’s veterans and selected
family members
• Veterans Health Administration (VHA)
– The branch of VA that provides healthcare benefits to some 5 million
veterans and their families
• Locations & Affiliations
– ~ 1,400 Sites-of-Care
Including 154 medical centers, ~ 875 clinics,
207 counseling centers, plus long-term care, domiciliaries,
home-care programs
– Affiliations with 107 Academic Health Systems
Additional 25,000 affiliated physicians
Additional 35,000 residents & fellows (in 14,000 slots)
 ~90,000 trainees each year in all disciplines
– 1,500 Health Professions Training Affiliations
Nearly half US health professionals (>65% physicians) have
some training in VA
Scope of Use
Scope of use
• Inpatient:
Wards,
care,
specialty
care, Bone
Single patient
record critical
immediately
available
real time, supports
both
continuity
and longitudinal
patient-centric
Marrow
Transplant
Unit,
surgerycare across continuum
• Outpatient: Primary Care, Specialty Care, Allied
health, Community Based Outpatient Clinic
• Emergency room
• Nursing Home
• Home Care
• Home Telemonitoring
10 Year Cumulative % Change in Costs
- VA, Medicare, CPI
50%
• VHA Cost per Patient–
Total Medical Care
Obligations per Total
Unique Patients (inc non
Veterans)
• Average Medicare
Payment per
(www.cms.hhs.gov/resea
rchers/pubs/datacompen
dium)
• Medical Consumer
Price Index-- Bureau of
Labor Statistics
40%
30%
20%
10%
0%
-10%
-20%
VHA Cost Per Patient
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
-
-0.3%
0.8%
-6.2%
-8.6%
-6.5%
-7.3%
-9.1%
-4.6%
0.8%
6.4%
14.9%
14.9%
12.8%
14.9%
25.5%
31.9%
40.4%
44.7%
3.3%
5.9%
9.8%
13.5%
18.4%
23.7%
29.5%
34.7%
39.4%
Avg. Medicare Payment/Enrollee
Medical CPI
-
VHA Cost Per Patient
Avg. Medicare Payment/Enrollee
Medical CPI
Performance Measurement
Setting the U.S. Benchmark for
18 Comparable Indicators
Clinical Indicator
VA 2003
Medicare 03
Best Not VA or Medicare
Advised Tobacco Cessation (VA x3, others x1)
75
62
68 (NCQA 2002)
Beta Blocker after MI
98
93
94 (NCQA 2002)
Breast Cancer Screening
84
75
75 (NCQA 2002)
Cervical Cancer Screening
90
62
81 (NCQA 2002)
Cholesterol Screening (all pts)
91
NA
73 (BRFSS 2001)
Cholesterol Screening (post MI)
94
78
79 (NCQA 2002)
LDL Cholesterol <130 post MI
78
62
61 (NCQA 2002)
Colorectal Cancer Screening
67
NA
49 (BRFSS 2002)
Diabetes Hgb A1c checked past year
94
85
83 (NCQA 2002)
Diabetes Hgb A1c > 9.5 (lower is better)
15
NA
34 (NCQA 2002)
Diabetes LDL Measured
95
88
85 (NCQA 2002)
Diabetes LDL < 130
77
63
55 (NCQA 2002)
Diabetes Eye Exam
75
68
52 (NCQA 2002)
Diabetes Kidney Function
70
57
52 (NCQA 2002)
Hypertension: BP < 140/90
68
57
58 (NCQA 2002)
Influenza Immunization
76
P
68 (BRFSS 2002)
Pneumocooccal Immunization
90
P
63 (BRFSS 2002)
Mental Health F/U 30 D post D/C
77
61
74 (NCQA 2002)
Spain (Andalucia)
12-Jul-16
Denis Protti - University of Victoria & City University London
20
Health Care Information and
Management Integrated System
Andalusian Health Service
Andalusian Public Health System
Primary Care
1,500 health centres
19,000 professionals
Specialized Care
37 hospitals
64,000 professionals
System gateway
General practitioner
Paediatrician
Nurse
Other services: Dentist, Rx...
Outpatient
Admissions
Emergency room services
Diagnostic tests
Diraya´s objective
Integrate the healthcare
information of every citizen
A
SINGLE
HEALTH
RECORD
KEYS
Diraya’s key elements
1 A SINGLE Health record for each citizen
2 Unified access to all services
3 All relevant information structured
4 Developed by the practitioners/users
Diraya. Building blocks
DATA
WAREHOUSE
ELECTRONIC
PRESCRIPTION
CENTRALISED
APPOINTMENT
OPERATORS
MANAGEMENT
HEALTH RECORD
CITIZEN
REGISTER
STRUCTURE
(resources)
Diraya. Implementation in Primary Care
2002
Population coverage
< 25 %
25 - 50 %
50 - 75 %
75 - 90 %
> 90 %
Implementation in Primary Care
With clinical data: 5.2 million (79 %)
2007
Monthly:
• Consultation forms: 1.9 million
• Prescriptions: 5.6 million
Population coverage
< 25 %
25 - 50 %
50 - 75 %
75 - 90 %
> 90 %
521 Health centres
6,700, 000 inhabitants
Diraya. Implementation in Specialized Care
2007
Monthly:
• Emergencies: 76,000 episodes
• Consultations: 4,000 episodes
Diraya. Appointments
Salud
Responde
Primary Care
Specialized Care
Diagnostics tests
902 505 060
Festina Lente
Make haste slowly
Denis.Protti.1@city.ac.uk
dprotti@uvic.ca
16-Jul-12
Denis Protti - University of Victoria & City University London
30