Sign Indiana Banking Medical History Computer

Industry sign banking indiana medical history computer

hello everyone so yes so desiring to talk about electronic health record systems and our research is based in Kenya so I'm going to focus on Kenya but before I get into what we're doing I thought I'd give just a bit of an overview of what electronic health records are and if there's any jargon I use just stop me and I can explain it I'm quite a geek they kind of get carried away with jargon but so any HR is basically these are normal health records stored in little paper files and they've moved out in many hospitals across the world into electronic systems and some of them you can access them on iPads and things like that so when I started as a doctor I started in the year 2000 and it was the height of the dot-com boom so everyone was raving about technology in the internet and how think was going to change and then when I turned up in the wards I think my primary job actually was just to carry around these paper records which for some patients you had like a pile about this high which would totally couldn't search them you can quickly review them can tabulate any of the information so i was quite keen to see if we could progress things and new things electronically so any HR system generally so you have the actual records themselves which are pretty much the same is the paper records so their notes taken by doctors and nurses health care professionals which is stored in a computer database but they also generally now linked to lots of other systems so if you don't have an x-ray in a hospital quite often it will be a digital x-ray nouns that have been kept on a film and that will be stored in an electronic system and the patients will be managed in a pas patient administration system and this will also be linked to things like pharmacy systems so they'll keep track of what drugs are in the pharmacy you've been prescribed what and laboratory systems so if you have a blood test that will be stored electronically and simply to the electronic health record and also we're now starting to see things like clinical decision support systems and these are systems that plug into the electronic health record that help doctors and healthcare professionals make decisions so they might say something like let's look at the medication that the pharmacies were providing to the patient and see if there's a conflict between two medications that mean that they patients shouldn't be on both at the same time so since 2000 when I started you can see that over the last 10 or 15 years electronic health record use has really taken off around the world and it's quite interesting that the health IT industry probably might be one of the only industries that's really benefited from the global financial crisis so lots of industries have all been collapsing and people being made redundant but the health IT industry has been growing and growing and one of the reasons for this was actually directly caused by the global financial crisis because the US government in response to the gushing stock market one of those normal responses and economics is to just put billions and billions of dollars back into the economy and one of the areas they decided to spend money on was health IT so they wanted to get all hospitals and clinics and doctors electronic using this money say quite luckily for the health IT industry they're given the US government spent 25 billion on EHR adoption that was just many given to hospitals and doctors to buy health IT systems so over the past kind of five or six years that money's been flowing into the system we're seeing lots and lots of new system sorts of companies getting paid big and also during this time the UK government you might have seen this in there in the newspapers it's been quite widely discussed but there was a program called the national program for IT and that was the idea behind that was if you get ill in barnsley and you get a new come from Birmingham the doctoring Barnes you can look at your information on the NHS computer system and treat you however the system the national program for IT systems cost about 10 billion pounds and is recently been scrapped in favor of a new way of doing things which is to devolve the money directly to hospitals rather than having one eyval national system so that's been a bit of a kind of mixed picture with the u.s. putting in a lot of money in the UK having big problems with implementing their best their program with work however and lots of other countries have done pretty well and lots of countries now have pretty much a hundred percent adoption of EHR systems in least in primary care that their hospitals as well are getting expect level so why do we need eh I was a lot of a good thing if you talk to lots of people in the health care profession they'll say they're terrible things there's lots of surveys of doctors and nurses who say it's just made my life a misery working with the EHR I can't do anything that I used to do it's slow more difficult well I I'd like to take a quote from messineo Greg he's been talking about this idea at clean clear water transform healthcare in the 19th century but in this century clean clear knowledge will transform healthcare so it's going to be bigger than any new medication any new way of doing things use of knowledge that high quality and clear can help us improve healthcare so how do they do that well despite what a lot of people say about slowing down work there is a potential might not be fully realized at the moment there's potential for data to be more quickly retrieved out of electronic systems and paper-based systems there might be more accurate everyone knows that doctor's handwriting is terrible but the reality is that if it nurse is giving a drug and they've only got doctors handwriting to see what the day says they might get the wrong dose and eh ours with digital information have a potential to reduce those kind of errors and also fall sorts of other things also they could be more accessible so you can have access to your EHR on a tablet computer or on the hospital and desktops or at home and because the information is digital you can see it anywhere and also these clinical decision support tools that I talked about will take over more and more the decision-making that takes place in healthcare so you as you'll as you're making decisions you're not just blindly making decisions you're using data and using information that comes from the HR and finally the secondary use of clinical data which is kind of why we're interested in it at the moment tomorrow interested in Kenya so these EHR systems are being put in for the people and hospitals to work with but as all this data is generated researchers can then get access to that data and look at it and use it for the new research or for gathering information on how healthcare is managed in the country or in a hospital but the problem is the EHR data are not clean and not clear at the moment that is a mess really there's lots of different types of systems they don't talk to each other instead of nicely categorizing things like diagnose you or your past medical history in Nice tabular data that would be very easy to search what often it's just typed in and so you don't have to use natural language processing tools kind of sophisticated ways of analyzing the text to try and pull out the kind of data points from it which is just a which is just messy and kind of not necessary really and then the other problem which is pertinent to Kenya is that the HR is a really expensive so here just before they distributed all this money in the u.s. they didn't exercise to evaluate how much money that need to distribute and this came up with a five-year figure of 48 thousand dollars for the HR and that's a cost per dr so it's not per hospital or / clinic is per individual doctor so you can kind of see why in the UK its cost ten billion pounds and in the US that's spending 25 billion pounds but what does this mean for Kenya because Kenya doesn't have ten billion and pounds spend on i.t but they have been implementing EHR systems so over the last ten years probably there's been a growth and systems in Kenya as well and mostly systems have come from grant funded projects and they did a review of which systems are being used and who's funding them in 2009 I think we've you started in 2007 actually they published their report in 2009 but this was a review with a CDC funded EMR systems systems that are used when the National AIDS of SDI control program which is one out of the Kenyan Ministry of Health and the HMIS assessment report hls was a new unit but they set up inside the Ministry of Health for health management information systems so the Kenyan government is kind of seeing that there's a need for a HR systems and that they are being used by these large grant funded projects particularly around HIV in antiretroviral therapy distribution so in their survey they identify 33 systems that were in use and then they started to develop an eHealth strategy and if you look around developing countries there's not many health strategies in fact if you looked at developed countries there's not many health strategies so quite often a health is part of the normal health strategy of the country with a bit on IT but Kenya developed same IE health strategy it's an initiative that was supported by the World Bank and they had two programs of Health and Africa initiative in the Kenya investment client program that contributed to putting together a workshop when they brought together basically everyone in the country they defined it was interested in health and had some knowledge about it and came up with some principles for how they were going to take me health forward which developed into their national strategy and the idea was to support collaboration of partnerships for shared information and services so their hospitals can talk to government and talk to clinics and harmonizing and coordinating what was becoming a more disparate situation in terms of lots of different systems all been developed in different ways with different standards and Amanda bout the same time as they were doing that wh 0 is also developing a tool kit and the idea behind the tool kit is to look at what's happened around the world in developed countries and to give some guidance to developing countries and how they formulate their their strategy for their country so say things like develop a national bee health vision with consultation with everybody who's interested and then develop an action plan work with the stakeholders integrate the different elements together and determine what resources you need at the government level at the county level to get it implemented and then to monitor and evaluate as you're rolling things out so don't just design everything and just let it go but continuously monitor and look at the situation how it's going so after they had been a strategy they developed a new document which was for guidelines for EHR adoption now this takes some of the knowledge that's been developed around the world in terms of how you integrate systems together and how you plan for the future so they advise things like adopting international standards for data connectivity so because of this problem of lots of different systems around the world people have discovered that if you can say how you should share data with each other in a standard way so that you always share data in the same way and allows the system's talk to each other much more efficiently so they've detail all the standards that they should be applied in the different areas of electronic health records with electronic pharmacy systems and the electronic lab systems and then they did a review in 2011 of how the systems that were currently in place were adopting those standards and those guidelines for how they should roll them out and they reviewed 28 sites and found 17 different systems some of them I listed here and they found that in particular see pad system and the IQ care and openmrs were quite good dr. Deering to these standards so there's a bit of a kind of circular thing in the open mrs mic UK have been around for quite a long time and have been funded quite well in terms of these HIV and AIDS programs so they informed some of the strategy but also they are adopting international standards so this is where we came in so we decided that how can we help how can we leave things on but also achieve our objectives which at the end of the day we have a research objective we want to be up-to-date called a time out of these systems for research and try and influence policy and make improvements in the health sector so we wanted to know what systems were out there and what kind of stand is very easy what the data was that was in these systems and could we extract it so we've been conducting an EHR survey so we've been updating survey from 2011 and expanding it you've also been we're looking at building a simulation so the simulation will contain the elements of the health IT system in Kenya and see how they work together and how they share data and then finally we're going to have a process of co.design where we work with clinicians in Kenya to try and come up with new clinical interfaces to try and encourage adoption so the end of the survey was to find out which yet jars are being used in public hospitals so there's lots of pipe hospitals in Kenya but we're really interested in the public hospitals because those are the ones that we currently work with to pull data out and we wanted to know which which systems were being adopted what the plans were for adopting new systems we also wanted to assess the attitudes of the users so the clinicians but also the administrators and we wanted to see how compliant they were standards and guidelines so we could update this review done in 2011 the file name is of the surveys to develop recommendations for secondary use of data so they might have their own objectives but we wanted to make them aware of the possibility for reusing the data as well so we've been using so far with snowballing technique so the idea is there isn't really much knowledge of what systems are out there have there been used so we've just been using personal contacts and following leads and finding our places we can go and visit we've been conducting semi-structured interviews with leaders in the hospital and the IT management and then we've been doing technical reviews of the systems that we have access to so for some of the systems they've given us web access to a server which contains our system so that we can go through it and we can look at the guidelines and the east cases of how the system should be used and see how can black they are we've been putting the technologies and the standards together into a traffic light report and the idea behind this is to see is so you can compare all the different systems and compare different hospitals in a kind of at a glance way so the idea is that if they're very compliant with certain standards they might get a green if they don't do clinical decision support they might get a red for that so in the end you have this kind of color-coded system so you can see at a glance which systems are doing well in which systems are not and you can also play that over time to see how people how it should all be going green and then also be doing a thematic analysis of the interview data so so far we visited a few hospitals in Kenya mostly around the Nairobi region and discovered quite a few different systems some of which had been seen before in the 2011 report and some of the new systems that hadn't been seen before in terms of the new systems so there's one called ziddi and we went out to a hospital in catan do which is a couple of hours out of Nairobi and there's a level three hospital but when you go in you kind of feel it's it's a functioning hospital it's working well but it's fairly resource constrained so patients are sitting in open air waiting rooms as long queues for the doctors and but they all these brand-new Windows 8 computers on their desks with this fancy new system use of touchscreen computers in very modern user interface and they'd actually had six developers working every day in hospital for over a year developing this customized system just for this hospital and a similar system silent ass was in another few hospitals again using very modern technology modern web frameworks young developers spending a lot of time within a lot of hours in creating in bakers to my system just for that hospital and then all say these server systems that have been they've been reviewed before in the 2011 report but also now growing as well so openmrs and IQ care for my key solutions which is part of the futures group so the futures group is a global healthcare consultancy group that's been doing a lot of work with large a project so i'll just as a thereby open amoroso I'll come to that in the moment so our preliminary findings and we haven't completed the survey but there seems to be partial adherence to industry standards so some areas are good and some areas are not so good they all pretty much a good at demographic data that seems to be the primary purpose of most of them just keeping tabs on he's been attending the hospital and when all systems can generate lab reports and prescription orders which seemed quite a positive finding and all systems have got password and role-based security but in terms of things like encryption of backups and real data security we found that some of the systems were a bit lacking the systems can generate a report so aggregated reports of what's going on so how many people have admitted with a certain condition but they're generally not integrated into the government system which is called DHS too and so I'll talk a little bit about the hs2 in a minute as well but they the idea should be that they can electronically send data up to the government on how they're doing but currently what they do is they run a report on the computer and then they fill in forms or a print off forms and then send them or even then they get transcribed in the systems at the moment they don't focus on interchanging with other systems so what hospital can't communicate with at the hospital systems aren't set up to do that and none of the systems had a clinical decision support so this idea of intervening when someone's about to make a mistake when they using the system or highlighting an alert that they need to do in terms of what their users thought of the systems there's quite a lot of disparity here again depending on the different systems but some of the things that we got out of the out of the interview so far with some people say it makes the work easier and faster easier to access data importing and some error reduction and improved accuracy which is along the lines of what are talking about before but also include improved monitoring and accountability some people say the systems really user friendly and actually some of these new systems are really nice and much more user friendly than a lot of the systems we use in the UK and elsewhere improve patient confidentiality with is another thing that came up and improved interdepartmental communication so within the hospital themselves they can talk within departments using the electronic health record systems but some people said the systems can be slow blackouts of parfait leah was a real problem so it's not really encountered in the developed world with these EHR systems but when the para guys aren't quite often there's no access to the system there's there's some talk about these kind of workflow business logic and so features basically that they wanted but hadn't been implemented yet and that was causing frustration so some of the quotes some so this is a hospital administrator Hospital collections and increased more than four times over the last three years so it's kind of making a business case for them I wouldn't want to go back to working with the system without without the system we can get our reports that they click of the button before it take days to compile them diagnosis offered by the system sometimes don't match the clinicians impressions and sometimes they can click anything place to them so they can move on to the next item which obviously is creating kind of bad day too many systems processes for fixing systems takes long say a lot of the systems have been provided by one or two man companies and first supplying five or six hospitals in the hospital system has a problem there but the map msar well I'm on the other side of the country for two weeks and I can come to you in two weeks and fix the system which is a big problem and in blackouts you know they haven't provided for what's going to happen during a blackout so everyone just waits until the system comes back and if it doesn't you know nothing continues so that's kind of where we are with our serve at the moment and we we kept we're going to expand it we've just got some new funding to expand it a lot further than what what we can do to get more comprehensive picture and to do more in-depth technical evaluations but I just wanted to talk a bit about openmrs so we have another project which is in working with the Ministry of Health on the wh 0 in one of the counties in Kenya called machakos county when the WHI were funded an implementation of one of the systems which is called openmrs so a pen mls is a big project that's been going going for 10 years or so and it originally came about because some of these us-funded aids groups who were developing their own system for keeping track of what antiretrovirals they were giving out and where the funding was going I decided to come together and pool their resources to create one system that everyone can use so that meant that they created an open source system that was free and also they developed at it in a way that was modular which meant that you could plug in different modules to do different things so open and where someone plan it could be just about tbo HIV and another clinic it might be about something completely different but you can just plug in all these different modules to do different things so the current say to play is that this is now quite a few different types of openmrs system so there's a pronounced version one which is widely used for TB and HIV clinics apron s version 2 which isn't an upgrade of the whole system that designed around moving more out of clinics to cover whole facilities and whole hospitals and there's a hospital called Mirabal a haiti we're partners in health have been working for quite a few years and they basically builds a very modern expensive high quality hospital and the software that they use to run it is the openmrs system so the version 2 is basically a what they've developed in this Mirabella hospital to make it into a into a more modern hospital system in Kenya they've adapted version 12 people to this distribution called Kenya EMR was gone out to six hundred or so clinics in Kenya primarily for HIV in TV care and then there's also been some other developments a barney is a group which has been funded by a group called fort works which is this hawlucha society consultancy group out of the US and they've been linking openmrs with other open source projects open source management system business management systems and open source lab information systems so we're open and West might be good for a clinic it's not very good for a lab system or managing hospitals or billing so they've linked it with these other open source projects to create a whole system and open a gem is is a similar project on as much smaller scale but inside Kenya which we've been looking at as well and then finally there's this new project called Kenya EHRs which uses open and West version one but has developed a whole load of new modules to cover Lisa these areas that aren't currently covered by the HIV clinic systems so they've got something like 10 or 12 new modules around billing patient management in patient care the laboratory systems and that's the system that we've been working with the Ministry of Health as they roll it out in machakos county so some of the groups involved in april mrs there's AI tech which is from the university of washington and the university of california in san francisco and they've been supporting is eight Kenya EMR distribution so version one going out to lots of small clinics across Kenya Ministry of Health have been funded in funding over the last few years big rollout of that system with the support of PEPFAR am path which is out of the University of Indiana and one of the cofounders of openmrs and they're based in elder lassen in Kenya and they're using it for their programs and their us funded programs as well and then hisp india wh 0 so this is the project that I was just talking about with using this API my eyes and hospitals building new modules so his India software group that work mainly with the DHS to software which I talked back in a minute but have been rolling out a pmos in hospitals in India and there's lots of these small private hospitals in India where they all want an EHR system so they develop these plug-in modules to make a penumbra suitable for Indian hospitals and that's the system that's being out adapted to be rolled out in Kenya so in terms of what we want to do next the idea is that currently there's quite a few different options available to the government is international best practice there's adoption of standards and then there's choice of systems as well and it's a bit difficult to evaluate things as before you've implemented them and even as you're implementing them things take priority over evaluation so we thought it might be a good idea to try and put the different systems that are being proposed together in a in silico simulation so it won't would get Amazon Cloud Servers and have them represent things like hospitals and clinics and government departments and then install the open-source software that's going to run on them open unless has a sample database of five thousand or so patients putting that into this into the clinics and seeing if you can leave a patient say from a clinic into a hospital or send data from a hospital to the government into their DHS queue system so all these listed here they're open source projects that together could potentially cover the different elements of a health IT system in a developing country Saudi access to this is a system out of the University of Oslo that's widely used for gathering data on statistics on health statistics so the way it's used in Kenya is they have a server government controls and hospitals can log on to the server through a web form and entering data or upload a spreadsheet of data and the idea is that they'll gather all the data and can be submitted to whi all the government can use it for planning but because the data is currently manually entered so it might be that there's a Clark and hospital goes through the records tabulates things and then puts it into the data there's lots of opportunities for the data to not be very good so one of the big pushes behind the adoption of standards-based EHR systems you save it with the doctors put in the data as they need it for their work and then the data is extracted automatically out into DHS to the other element of the simulation is to promote interoperability systems and the people behind openmrs have got a new system for helping with that called open hie an apron hie is an open source system designed to help pull the data together from different systems so it's likely that you're not going to get one system and eventually you're going to get lots of systems but if they can adhere to certain standards you can pull them pull the data out together and then finally we want to adopt this places of k design so quite often with clinical IT systems they're designed by company purchased by management in a hospital and put in and then the doctors and nurses expected to use it and quite often what happens is the doctors and nurses don't use it and that's something we've seen quite a lot in Kenya is seen around the world so we want to promote a process of care desiring because with the opening a PMI system it's a modular system you can potentially develop a module that you've developed with users to be the interface to the database so what we're proposing to do is to develop a new module which is around pediatric in patient care so Mike English he leads i agree is a pediatrician based in kenya has a good network of pediatricians who are all involved in gathering data and we want to work with them through workshops and a process of continuous situation to try and prove how they enter data into the system make it easy friendly so that when you do put it into hospitals the clinicians will want to use it and the data will be accurate and representative of what the doctors are doing well or not so that's all I wanted to talk about today really but in some way I think the answer the question of what's going on in Kenya in terms of EHRs there seems to be fairly rapid adoption of eh Charles in Kenya pretty much similar to how there's been adopting of the hrs around the world and what we don't want to do have a situation to mimic what's happened in other countries where you end up with lots of systems that don't talk to each other and we can't exchange data so we kind of feel that we can get involved with the process add a bit of insight into what's been going on around the world and how things could happen in might enable countries to adopt a sensible strategy in terms of sharing data and we want to see how that's going and evaluate it and report back to the world as well on what Kenya's doing is as a leader in this area I think so thank you very much