The potential impact of ICT on
Service Planning for
Health Services
Craig Guscott
Andrew P. Howard
Manager, South East
Metropolitan Service & Capital
Planning, Department of Health
Chief Information Officer,
Department of Health
Presentation Content
Setting the Picture
Advances in Information Communication Technology
Potential ICT Impacts on:
Preventing presentations to the Health System
Delivery of Health services during intervention
Preventing re-admission
Potential Qualitative Benefits of ICT on Service Delivery
Potential Quantitative Impacts of ICT on Service Delivery
Advances in Information Communication Technology
New communication devices are a frequent event
Whilst some in the health field are finding the
transition to new technology difficult……
Others are pushing into the future…
The Ever-Present Need and Future-pressing
Need
Demand on health service provision growths yearly
Innovative and effective mitigation strategies are needed to be
developed to meet this current and projected need
Effective ICT solutions are essential if the system is to respond
to the known factors of increasing:
• Presentations (demand)
• Chronic disease (complexity)
• Transparency & clinical governance
• Community expectations
• Workforce shortages
Possible impact of ICT on meeting bed demand
How can current ICT technology assist the State/Nation
in meeting current and growing health service provision
demand?
When planning for the future, what can the Service
Planner safely assume?
When planning for the future, what should the Service
Planner be advocating for as a strategy to mitigate
demand?
What can be done to reduce the need to build more
beds, reduce recurrent costs all while meeting
demand for health service provision?
Context of Disussion
Looking at four of the main types of presentations to the
health system which can be impacted positively by
current ICT enablers
Ambulatory Care Sensitive Conditions
• Vaccine Preventable ACSC’s
• Acute ACSC’s
• Chronic ACSC’s
Acute Multiday presentations
Potential ICT Impacts on:
Preventing presentations to the
Health System
Can ICT enablers reduce the number of original/first
presentations?
What Preventable illnesses/diseases/injuries can be
prevented by ICT enablers?
Lifestyle Disease
Lifestyle disease: A disease associated with the way a
person or group of people lives.
Lifestyle diseases include:
•
atherosclerosis, heart disease, and stroke;
•
obesity and type 2 diabetes;
•
diseases associated with smoking and alcohol and
drug abuse, such as cirrhosis, cancer, COPD,
Ambulatory Care Sensitive Condition’s
Vaccine Preventable ACSC’s
•
prevention of disease occurence
•
influenza, bacterial pneumonia, tetanus, mumps, rubella, pertussis, polio
•
For these conditions, it is the actual condition that is deemed preventable
rather than the hospitalisation.
Acute ACSC’s
•
avoidable hospitalization for acute disease
•
gastro, kidney infection, perforated ulcer, cellulitis, PID, ENT infections,
dental conditions
•
These conditions may not be preventable in themselves but theoretically
should not result in hospitalisation if adequate and timely primary care is
received.
Main Potential Impact
Education
Public Awareness
Communication
Monitoring
Vaccine Preventable ACSC’s
In Victoria 2009-2010
All MD Separations = 3,026 for 27,532 Bed-days at 9.1 avALOS
Equates to 89 beds occupied 365 days/yr at 85% efficiency
(Interestingly HITH = 88 seps for 1,903 bed-days at 21.63 avALOS)
Possible Impact of ICT enablers if:
1% reduction in MD separations = 1 bed
1% reduction in avLOS = 1 bed
1 day reduction in avLOS = 10 beds
Acute ACSC’s
In Victoria 2009/10
All MD Separations:
32,773 seps for 141,093 bed-days at 4.31 avLOS
Equates to 455 beds occupied 365 days/yr at 85% efficiency
Possible impact of ICT enablers if:
• 1% reduction in separations = 4 beds
• 1% reduction in avLOS = 4 beds
• 1 day reduction in avLOS = 105 beds
Potential ICT Impacts on:
Delivery of Health services during intervention
How can ICT assist in reducing Length of Stay (LOS)
during a Multiday intervention?
Today’s Hospital Vs the Hospital of the Future –
Facility Design
Hospital of Today
Hospital of the Future
Centralised nurses stations
Care provided in ‘physical’ hospital
Queuing and waiting – large waiting areas
•De-centralised nurses stations
•‘Virtual’ hospital in the community
•Improved patient flow – JIT approach –
smaller waiting areas
•JIT stock control – less storage areas
•Acuity adaptable / flexible rooms –
patients stay in same bed
•Quiet hospital – sound absorbing
materials, direct messaging,
•Information booths – interactive, printed
maps
•Staff off-site (e.g. video-conferencing,
mobile technologies, etc.)
Supplies stockpiled – lots of storage req’d
Specific purpose rooms – patients moved
as condition changes
Noisy hospital – nurse call, pagers,
phones, alarms, overhead announcements
Wayfinding - fixed signage, confusing, outof-date information
Staff in situ
Today’s Hospital Vs the Hospital of the Future
Hospital of Today
Hospital of the Future
Paper-based medical records
Manual or non-integrated ICT systems for:
• Patient registration
• Patients bookings
• Discharge forms
• Referral forms
• Paper prescriptions
• Clinical decision support
• Alert (allergy) management
• Equipment control
• Ward stock control
• Menu ordering
Electronic Medical Record
ICT enabled systems for:
• On-line patient registration and
bookings
• Electronic discharge summaries
• e-ordering - pathology, imaging, etc.
• ePrescribing
• Electronic Clinical Decision Support
• Allergy alerts
• RFID tracking for equipment & stock
control
• Electronic menu ordering from
patient bedside monitor
All Acute Multiday Presentations
In Victoria 2009-10
All separations = 867,041 for 3,888,676 bed-days at 4.48
avLOS
Equates to 12,534 beds occupied 365 days/yr at 85%
efficiency
Possible impact of ICT enablers if:
• Reduce avLOS by 1% = 139 beds
• Reduce avLOS by 1 day = 2,808 beds
Potential ICT Impacts on:
Preventing re-admission
Can ICT assist in preventing patients from requiring
additional multiday stays in our acute hospitals?
Potential ICT Impacts on:
Preventing re-admission
Chronic ACSCs
Chronic conditions are usually not self-limiting and can
lead to extensive use of medical services.
This category includes avoidable hospitalisation for
selected chronic disease, for example, diabetes,
asthma, angina, hypertension, congestive heart failure,
chronic obstructive pulmonary disease (COPD).
In this case, although these conditions may be
preventable through behaviour modification and
lifestyle change, they can also be managed
effectively through primary care in order to prevent
deterioration and hospitalisation.
Chronic Disease Management
Patient Portals for
• ICT can help prevent hospital admissions through improved
monitoring of the patient
Study found 83% decrease in admission rate for CHF patients1
86% lower readmission costs (US$5,850 vs US$44,479)1
Fewer CHF related emergency department visits2
• Tele-health and Home health – home monitoring & ability to
link distant patient & provider
Example: Kaiser Permanente Home Health Program
Study of 212 patients (102 on telehealth)
Av. cost of care – US$1,948 intervention vs US$2,674 control with
difference attributed to hospitalisation costs
Improved patient satisfaction in intervention group3
1 Roglieri et al, 1997
2 Jerant et al, 2001
3 Johnston et al, 2000
Chronic Heart failure Assessment by
Telephone (CHAT)
Issue
•
Multi-disciplinary and community-based care provides substantial benefit to
patients with chronic heart failure (CHF)
•
However, models may not be ideally suited to the care of the rural and remote
CHF patient where there are issues of access to these services
•
Telephone support of the CHF patient may help overcome problems of access
Study Aims
•
To determine whether automated telephone support will improve quality of life
and reduce death & hospital admissions for rural and remote CHF patients
•
To test this system of care as an exemplar of a novel chronic disease
management strategy in areas remote from access to multi-disciplinary care
•
To determine the cost effectiveness of this intervention
Chronic Heart failure Assessment by
Telephone (CHAT)
Key Findings
Automated telephone support to the rural & remote CHF patient
resulted in:
• No change in the Packer clinical composite score
• Significant reduction in risk of:
• All-cause death & hospitalisation
• All-cause hospitalisation
• Non-significant reduction in risk of:
• HF hospitalisation
• No difference in all-cause mortality
Still to be determined is the impact of telephone support to these patients on
ACE inhibitor use & dose, cost-efficacy and plasma NT-pro BNP levels
Significant beneficial impacts were observed on some (but not all) relevant
clinical outcome parameters
Chronic ACSC’s
In Victoria 2009-2010
All MD Separations = 83,580 for 663,052 Bed-days at 7.93
avALOS
Equates to 2,137 beds occupied 365 days/yr at 85% efficiency
Possible Impact of ICT enablers if:
1% reduction in MD separations = 22 beds
Reduce avLOS by 1% = 22 beds
1 day reduction in avLOS = 270 beds
Potential Qualitative Benefits of ICT on Service
Delivery
Benefits of ICT
To the Patient
To the Health System
•Improved quality of care
•Improved access to reliable health
information when & where it is needed
•More patient focused integrated care
•Improved cost effectiveness
•Improved patient safety
•Improved access to healthcare
•Improved continuity of care
•Close the gap between rural and
remote healthcare providers & patients
•Lives saved through better decision
support, increased access to
information & reduced adverse events.
•Improved healthcare planning by
ensuring resources directed to where
most needed
•Enhanced shared care for complex
medical problems & chronic disease
•Encourage innovation to deliver
improvements in health sector
productivity
•Reduced burden on health sector
through better health management (e.g.
reduced duplication of tests, visits,
procedures & capital expenditure)
Hours spent by Medical Staff in Direct Patient
Care
Number of
hours of
direct
patient care
is
decreasing
across all
medical
specialties
Potential Quantitative Impacts of ICT on Service
Delivery
ICT in the Clinical Setting
Clinical Decision Support
More efficient work flow
Fewer adverse events – alert system
Improved patient outcomes
Decreased length of stay
Fewer re-admissions
ICT Benefits
Some of the healthcare delivery improvements documented by
organizations include:
• Using wireless point-of-care solutions has resulted in reductions in
nursing staff administrative workload of up to two hours per nurse,
per shift, allowing for more time in direct patient care.
• At a 550-bed hospital, remote monitoring of ICU patients has led to
a 25 percent decrease in hospital mortality rates for ICU patients, a
17 percent decrease in ICU length of stay, and a savings of $2,150
per patient.
• More than 50 hospitals using automated medication administration
solutions prevented more than 29,000 adverse drug events (ADE)
weekly.
Source: McKesson corporation, 2005
ICT Benefits
Up to 88% reduction in drug errors (Brigham & Womens
Hospital; Montefiore Medical Center; PeaceHealth
Community, )
Reduced staffing need(Indiana Heart Hospital; Tiantan Hospital,
Beijing)
Productivity increases up to 35% (PeaceHealth Community;
Tiantan Hospital, Beijing)
Reduced ALOS by between 0.9 – 2 days
Source: McKesson corporation, 2005
Reference
Ball MJ, Garets DE, Handler TJ, Yearbook
of Medical Informatics of the Intl Med Info
Assn 2003; "Leveraging IT to improve
Patient Safety"
Ball MJ, Garets DE, Handler TJ, Yearbook
of Medical Informatics of the Intl Med Info
Assn 2003; "Leveraging IT to improve
Patient Safety"
Intel Business Centre Case Study 2004;
"End-to-end Intel architecture helps
Germany's K-N improve patient cate and
bottom line"
Intel/McKesson advertisement linked to
Intel.com/healthcare/healthit
Description of
study/finding
Function
al area(s)
Technolo
Patient
gy
journey applicatio
n
Savings/benefit ($US)
Utility
Ohio State U Medical
center implemented
CPOE (OH)
Pharmacy Inpatient
CPOE
Reduced LOS by 2 days;
LOS decreased 2 ds;
pharmacy order TAT reduced 2
pharm cost dec
hours; pharmacy charges down
$910/admit
$910/admission
Wishard Memorial
Hospital implemented
CPOE (IN)
Pharmacy Inpatient
CPOE
Avg. LOS down 0.9 days; avg.
hospital charges down 13%
Klinikum Neumarkt
(Germany) began IT
transformation in 1999
installing point of care
Clinical
technology for viewing of document
Inpatient
digital images and medical ation and
reccords, resulting in LOS viewing
fall from 9 to 7 and avg
DX time from 5 days to 3
by 2004.
point of
LOS 9 to 7; DX time 5 ds to 3;
care
saved time and $ on film, printing,
devices;
med record storage
EMR
Integrated digital hospital
examples demonstrate
wireless point of care
Clinical
solutions in 550 bed
document
remote 25% decrease in ICU mort; 17%
hospital remote monitoring
Inpatient
ation and
monitoring
dec in LOS; save $2150/pt
of ICU pts resulted in 25%
viewing
decrease in ICU mortality
and 17% drop in LOS and
a savings of $2150/pt.
LOS decreased 0.9
ds; avg hospital
charges down 13%
Pt throughput
ICU performance
Conclusion
ICT investment in the health system can facilitate:
• improved patient outcomes
• improved patient & work flow
• enhanced chronic disease management
• reduce the need for additional resources
Reduce the growth in recurrent expense
Reduce the growth of capital expense