Sessatildeo

Prelector

Responsaacutevel

Organizaccedilatildeo Direcccedilatildeo Cliacutenica Internato Meacutedico

09 jul

Processo Cliacutenico Electroacutenico Presente Futuro ndash aqui e laacute fora

Dr Carlos Sousa

--

Ref Bibliograacutefica

COCIR - eHealth toolkit healthcare transformation towards seamless integrades care

HIMSS US - EMRAM Stage 7 - Case Studies

HIMSS Europe - EMRAM Stage 6 amp 7 Club

Revista eSaude N4 (httpissuucomesaudemagazinedocsesaude04)

Anfiteatro

08h30 ndash 09h30

DGTI ndash Direcccedilatildeo da Gestatildeo das Tecnologias e da Informaccedilatildeo

09-07-2015 Carlos Sousa DGTI

Sessatildeo CliacutenicaProcesso Cliacutenico eletroacutenicoldquoPresente futuro ndash aqui eacute laacute forardquo

09-07-2015 3

DGTIDiagrama orgacircnico

09-07-2015 4

DGTIDiagrama orgacircnico

Carlos Sousa

Ana Nunes

ITproject

Daniella Azevedo

Diogo Ermida

ITsystemFilipe Teixeira

Ruben Botelho

Rui Paulo

ITservice

Alexandra Castela

Beatriz Franccedila

Carla Fonseca

Paula Freitas

Paulo Claudino

Valdemar Lopes

Ines Nunes

Renato Morgado

Helder Costa

Gonccedilalo Dinis

Tiago Vardasca

Joatildeo Veiga Inecircs Valente

09-07-2015 5

Como registar e consultar toda a informaccedilatildeo cliacutenica

de forma centralizada

Que aacutereas devo enfocar para os

custos optimizar

Equipa Multidisciplinar de Projecto HFF - Siemens (2010)

GeacuteneseldquoOs idiotasrdquo

09-07-2015 6

Promover o acto cliacutenico de forma colaborativa transversal e multidisciplinar

Encorajar e agilizar o recurso agraves boas-praacuteticas

Conduzir a actividade para resultados previsiacuteveis

Contribuir como ldquoenablerrdquo para a satisfaccedilatildeo do doente e do profissional

Facilitar o processo para decisotildees mais informadas e seguras

Principio da Unicidade (natildeo-duplicaccedilatildeo de informaccedilatildeo normalizaccedilatildeo e tronco comum)

Seguranccedila Confidencialidade e Rastreabilidade

Utilidade (a forma de registo natildeo coloca em causa as esferas cliacutenica epidemioloacutegica pedagoacutegica cientiacutefica e de gestatildeo)

Oferecer funcionalidades para apoiar o ensinoinvestigaccedilatildeo

Desmaterializaccedilatildeo de protocolos em papel (Clinical Pathways)

GeacuteneseOs nossos princiacutepios orientadores - Visatildeo

09-07-2015 7

Soarianreg

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo geracional do PCE

Adaptaccedilatildeo por Carlos Sousa - 2015

To facilitate evaluations and to help ensuresimilar comparisons of vendor offerings Gartnerin 1998 first set forth a five-stage modeldescribing how computer-based patient record(CPR) systems will evolve transforming from verysimple systems that provide results reportinginto very complex fully integrated systems (seeFigure)

The Five Generations of CPR Systems

09-07-2015 8

Sistema de Gestatildeo Administraccedilatildeo e Evoluccedilatildeo

Interoperabilidade

Repositoacuterio de Dados Centralizado

Documentaccedilatildeo e

Captaccedilatildeo de Dados

Vocabulaacuterio Meacutedico Controlado

Visualizadores

Dashboards

Prescriccedilatildeo

Electroacutenica Gestatildeo

da Requisiccedilatildeo

Gestatildeo de

Conhecimento

CliacutenicoWorkflow

Cliacutenico

Suporte agrave Decisatildeo

Cliacutenica

Adaptaccedilatildeo por Carlos Sousa - 2015

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo Conceptual PCE adotado

A CPR system is composed of 10 integrated corecapabilities clinical system managementinteroperability clinical data repository (CDR)controlled medical vocabulary (CMV) andvocabulary server (VOSER) clinical workflowclinical decision support clinical documentationand data capture clinical display (includingclinician dashboards) clinical order management(including computer-based physician order entryand e-prescribing) and knowledge management(see Figure) Of course the CPR must also be ableto adequately meet the needs of a variety of carevenues as well as a wide array of clinician types

09-07-2015 9

Aacutereas de Cuidados

Internamento

Consulta Externa

Urgecircncia

Bloco e Cirurgia Amb

MCDTS

Especialidades

Hospitais de Dia

Grupos de Prestadores Utilizadores

Meacutedicos

Enfermeiros

Teacutecnicos de Sauacutede

Assistentes Sociais

Farmacecircuticos

Administrativos

Desenho de Processos

Avaliaccedilotildees

Opccedilotildees de Prescriccedilatildeo e Requisiccedilatildeo

Processo Cliacutenico Resumo Cliacutenico

Quadros de Tarefas Listas de Trabalho

Censos Quadro de Urgecircncia

Plano de Cuidados outros registos

RelatoacuteriosImpressatildeo

GeacuteneseOs nossos princiacutepios orientadores - Execuccedilatildeo

09-07-2015 10

Dezembro

- UICD Urg Geral

- Internamentos

Fevereiro

- Pediatria

Abril

- Gastroenterologia

- Nefrologia

- Obstetriacutecia

- Cirurgias

- Ortopedia

- ORLOFT

- Urologia

- Psiquiatria

- Ginecologia

Janeiro

- Medicinas

-Todas as aacutereas de Ambulatoacuterio de Urgecircncia

Marccedilo

- UICD Urg Pediaacutetrica

Abril

- Neurologia

Julho

- Urg GinecObst e Bloco de Partos

Marccedilo

- Bloco Operatoacuterio

- Cirurgia Ambulatoacuteria

Janeiro

- Consulta Externa

Abril

- Anestesiologia

Dezembro

- Plano de Cuidados

2010

2011

2012

2013

2014

Programa de Informatizaccedilatildeo CliacutenicaRoadmap histoacuterico (timeline)

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 3

DGTIDiagrama orgacircnico

09-07-2015 4

DGTIDiagrama orgacircnico

Carlos Sousa

Ana Nunes

ITproject

Daniella Azevedo

Diogo Ermida

ITsystemFilipe Teixeira

Ruben Botelho

Rui Paulo

ITservice

Alexandra Castela

Beatriz Franccedila

Carla Fonseca

Paula Freitas

Paulo Claudino

Valdemar Lopes

Ines Nunes

Renato Morgado

Helder Costa

Gonccedilalo Dinis

Tiago Vardasca

Joatildeo Veiga Inecircs Valente

09-07-2015 5

Como registar e consultar toda a informaccedilatildeo cliacutenica

de forma centralizada

Que aacutereas devo enfocar para os

custos optimizar

Equipa Multidisciplinar de Projecto HFF - Siemens (2010)

GeacuteneseldquoOs idiotasrdquo

09-07-2015 6

Promover o acto cliacutenico de forma colaborativa transversal e multidisciplinar

Encorajar e agilizar o recurso agraves boas-praacuteticas

Conduzir a actividade para resultados previsiacuteveis

Contribuir como ldquoenablerrdquo para a satisfaccedilatildeo do doente e do profissional

Facilitar o processo para decisotildees mais informadas e seguras

Principio da Unicidade (natildeo-duplicaccedilatildeo de informaccedilatildeo normalizaccedilatildeo e tronco comum)

Seguranccedila Confidencialidade e Rastreabilidade

Utilidade (a forma de registo natildeo coloca em causa as esferas cliacutenica epidemioloacutegica pedagoacutegica cientiacutefica e de gestatildeo)

Oferecer funcionalidades para apoiar o ensinoinvestigaccedilatildeo

Desmaterializaccedilatildeo de protocolos em papel (Clinical Pathways)

GeacuteneseOs nossos princiacutepios orientadores - Visatildeo

09-07-2015 7

Soarianreg

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo geracional do PCE

Adaptaccedilatildeo por Carlos Sousa - 2015

To facilitate evaluations and to help ensuresimilar comparisons of vendor offerings Gartnerin 1998 first set forth a five-stage modeldescribing how computer-based patient record(CPR) systems will evolve transforming from verysimple systems that provide results reportinginto very complex fully integrated systems (seeFigure)

The Five Generations of CPR Systems

09-07-2015 8

Sistema de Gestatildeo Administraccedilatildeo e Evoluccedilatildeo

Interoperabilidade

Repositoacuterio de Dados Centralizado

Documentaccedilatildeo e

Captaccedilatildeo de Dados

Vocabulaacuterio Meacutedico Controlado

Visualizadores

Dashboards

Prescriccedilatildeo

Electroacutenica Gestatildeo

da Requisiccedilatildeo

Gestatildeo de

Conhecimento

CliacutenicoWorkflow

Cliacutenico

Suporte agrave Decisatildeo

Cliacutenica

Adaptaccedilatildeo por Carlos Sousa - 2015

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo Conceptual PCE adotado

A CPR system is composed of 10 integrated corecapabilities clinical system managementinteroperability clinical data repository (CDR)controlled medical vocabulary (CMV) andvocabulary server (VOSER) clinical workflowclinical decision support clinical documentationand data capture clinical display (includingclinician dashboards) clinical order management(including computer-based physician order entryand e-prescribing) and knowledge management(see Figure) Of course the CPR must also be ableto adequately meet the needs of a variety of carevenues as well as a wide array of clinician types

09-07-2015 9

Aacutereas de Cuidados

Internamento

Consulta Externa

Urgecircncia

Bloco e Cirurgia Amb

MCDTS

Especialidades

Hospitais de Dia

Grupos de Prestadores Utilizadores

Meacutedicos

Enfermeiros

Teacutecnicos de Sauacutede

Assistentes Sociais

Farmacecircuticos

Administrativos

Desenho de Processos

Avaliaccedilotildees

Opccedilotildees de Prescriccedilatildeo e Requisiccedilatildeo

Processo Cliacutenico Resumo Cliacutenico

Quadros de Tarefas Listas de Trabalho

Censos Quadro de Urgecircncia

Plano de Cuidados outros registos

RelatoacuteriosImpressatildeo

GeacuteneseOs nossos princiacutepios orientadores - Execuccedilatildeo

09-07-2015 10

Dezembro

- UICD Urg Geral

- Internamentos

Fevereiro

- Pediatria

Abril

- Gastroenterologia

- Nefrologia

- Obstetriacutecia

- Cirurgias

- Ortopedia

- ORLOFT

- Urologia

- Psiquiatria

- Ginecologia

Janeiro

- Medicinas

-Todas as aacutereas de Ambulatoacuterio de Urgecircncia

Marccedilo

- UICD Urg Pediaacutetrica

Abril

- Neurologia

Julho

- Urg GinecObst e Bloco de Partos

Marccedilo

- Bloco Operatoacuterio

- Cirurgia Ambulatoacuteria

Janeiro

- Consulta Externa

Abril

- Anestesiologia

Dezembro

- Plano de Cuidados

2010

2011

2012

2013

2014

Programa de Informatizaccedilatildeo CliacutenicaRoadmap histoacuterico (timeline)

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 4

DGTIDiagrama orgacircnico

Carlos Sousa

Ana Nunes

ITproject

Daniella Azevedo

Diogo Ermida

ITsystemFilipe Teixeira

Ruben Botelho

Rui Paulo

ITservice

Alexandra Castela

Beatriz Franccedila

Carla Fonseca

Paula Freitas

Paulo Claudino

Valdemar Lopes

Ines Nunes

Renato Morgado

Helder Costa

Gonccedilalo Dinis

Tiago Vardasca

Joatildeo Veiga Inecircs Valente

09-07-2015 5

Como registar e consultar toda a informaccedilatildeo cliacutenica

de forma centralizada

Que aacutereas devo enfocar para os

custos optimizar

Equipa Multidisciplinar de Projecto HFF - Siemens (2010)

GeacuteneseldquoOs idiotasrdquo

09-07-2015 6

Promover o acto cliacutenico de forma colaborativa transversal e multidisciplinar

Encorajar e agilizar o recurso agraves boas-praacuteticas

Conduzir a actividade para resultados previsiacuteveis

Contribuir como ldquoenablerrdquo para a satisfaccedilatildeo do doente e do profissional

Facilitar o processo para decisotildees mais informadas e seguras

Principio da Unicidade (natildeo-duplicaccedilatildeo de informaccedilatildeo normalizaccedilatildeo e tronco comum)

Seguranccedila Confidencialidade e Rastreabilidade

Utilidade (a forma de registo natildeo coloca em causa as esferas cliacutenica epidemioloacutegica pedagoacutegica cientiacutefica e de gestatildeo)

Oferecer funcionalidades para apoiar o ensinoinvestigaccedilatildeo

Desmaterializaccedilatildeo de protocolos em papel (Clinical Pathways)

GeacuteneseOs nossos princiacutepios orientadores - Visatildeo

09-07-2015 7

Soarianreg

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo geracional do PCE

Adaptaccedilatildeo por Carlos Sousa - 2015

To facilitate evaluations and to help ensuresimilar comparisons of vendor offerings Gartnerin 1998 first set forth a five-stage modeldescribing how computer-based patient record(CPR) systems will evolve transforming from verysimple systems that provide results reportinginto very complex fully integrated systems (seeFigure)

The Five Generations of CPR Systems

09-07-2015 8

Sistema de Gestatildeo Administraccedilatildeo e Evoluccedilatildeo

Interoperabilidade

Repositoacuterio de Dados Centralizado

Documentaccedilatildeo e

Captaccedilatildeo de Dados

Vocabulaacuterio Meacutedico Controlado

Visualizadores

Dashboards

Prescriccedilatildeo

Electroacutenica Gestatildeo

da Requisiccedilatildeo

Gestatildeo de

Conhecimento

CliacutenicoWorkflow

Cliacutenico

Suporte agrave Decisatildeo

Cliacutenica

Adaptaccedilatildeo por Carlos Sousa - 2015

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo Conceptual PCE adotado

A CPR system is composed of 10 integrated corecapabilities clinical system managementinteroperability clinical data repository (CDR)controlled medical vocabulary (CMV) andvocabulary server (VOSER) clinical workflowclinical decision support clinical documentationand data capture clinical display (includingclinician dashboards) clinical order management(including computer-based physician order entryand e-prescribing) and knowledge management(see Figure) Of course the CPR must also be ableto adequately meet the needs of a variety of carevenues as well as a wide array of clinician types

09-07-2015 9

Aacutereas de Cuidados

Internamento

Consulta Externa

Urgecircncia

Bloco e Cirurgia Amb

MCDTS

Especialidades

Hospitais de Dia

Grupos de Prestadores Utilizadores

Meacutedicos

Enfermeiros

Teacutecnicos de Sauacutede

Assistentes Sociais

Farmacecircuticos

Administrativos

Desenho de Processos

Avaliaccedilotildees

Opccedilotildees de Prescriccedilatildeo e Requisiccedilatildeo

Processo Cliacutenico Resumo Cliacutenico

Quadros de Tarefas Listas de Trabalho

Censos Quadro de Urgecircncia

Plano de Cuidados outros registos

RelatoacuteriosImpressatildeo

GeacuteneseOs nossos princiacutepios orientadores - Execuccedilatildeo

09-07-2015 10

Dezembro

- UICD Urg Geral

- Internamentos

Fevereiro

- Pediatria

Abril

- Gastroenterologia

- Nefrologia

- Obstetriacutecia

- Cirurgias

- Ortopedia

- ORLOFT

- Urologia

- Psiquiatria

- Ginecologia

Janeiro

- Medicinas

-Todas as aacutereas de Ambulatoacuterio de Urgecircncia

Marccedilo

- UICD Urg Pediaacutetrica

Abril

- Neurologia

Julho

- Urg GinecObst e Bloco de Partos

Marccedilo

- Bloco Operatoacuterio

- Cirurgia Ambulatoacuteria

Janeiro

- Consulta Externa

Abril

- Anestesiologia

Dezembro

- Plano de Cuidados

2010

2011

2012

2013

2014

Programa de Informatizaccedilatildeo CliacutenicaRoadmap histoacuterico (timeline)

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 5

Como registar e consultar toda a informaccedilatildeo cliacutenica

de forma centralizada

Que aacutereas devo enfocar para os

custos optimizar

Equipa Multidisciplinar de Projecto HFF - Siemens (2010)

GeacuteneseldquoOs idiotasrdquo

09-07-2015 6

Promover o acto cliacutenico de forma colaborativa transversal e multidisciplinar

Encorajar e agilizar o recurso agraves boas-praacuteticas

Conduzir a actividade para resultados previsiacuteveis

Contribuir como ldquoenablerrdquo para a satisfaccedilatildeo do doente e do profissional

Facilitar o processo para decisotildees mais informadas e seguras

Principio da Unicidade (natildeo-duplicaccedilatildeo de informaccedilatildeo normalizaccedilatildeo e tronco comum)

Seguranccedila Confidencialidade e Rastreabilidade

Utilidade (a forma de registo natildeo coloca em causa as esferas cliacutenica epidemioloacutegica pedagoacutegica cientiacutefica e de gestatildeo)

Oferecer funcionalidades para apoiar o ensinoinvestigaccedilatildeo

Desmaterializaccedilatildeo de protocolos em papel (Clinical Pathways)

GeacuteneseOs nossos princiacutepios orientadores - Visatildeo

09-07-2015 7

Soarianreg

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo geracional do PCE

Adaptaccedilatildeo por Carlos Sousa - 2015

To facilitate evaluations and to help ensuresimilar comparisons of vendor offerings Gartnerin 1998 first set forth a five-stage modeldescribing how computer-based patient record(CPR) systems will evolve transforming from verysimple systems that provide results reportinginto very complex fully integrated systems (seeFigure)

The Five Generations of CPR Systems

09-07-2015 8

Sistema de Gestatildeo Administraccedilatildeo e Evoluccedilatildeo

Interoperabilidade

Repositoacuterio de Dados Centralizado

Documentaccedilatildeo e

Captaccedilatildeo de Dados

Vocabulaacuterio Meacutedico Controlado

Visualizadores

Dashboards

Prescriccedilatildeo

Electroacutenica Gestatildeo

da Requisiccedilatildeo

Gestatildeo de

Conhecimento

CliacutenicoWorkflow

Cliacutenico

Suporte agrave Decisatildeo

Cliacutenica

Adaptaccedilatildeo por Carlos Sousa - 2015

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo Conceptual PCE adotado

A CPR system is composed of 10 integrated corecapabilities clinical system managementinteroperability clinical data repository (CDR)controlled medical vocabulary (CMV) andvocabulary server (VOSER) clinical workflowclinical decision support clinical documentationand data capture clinical display (includingclinician dashboards) clinical order management(including computer-based physician order entryand e-prescribing) and knowledge management(see Figure) Of course the CPR must also be ableto adequately meet the needs of a variety of carevenues as well as a wide array of clinician types

09-07-2015 9

Aacutereas de Cuidados

Internamento

Consulta Externa

Urgecircncia

Bloco e Cirurgia Amb

MCDTS

Especialidades

Hospitais de Dia

Grupos de Prestadores Utilizadores

Meacutedicos

Enfermeiros

Teacutecnicos de Sauacutede

Assistentes Sociais

Farmacecircuticos

Administrativos

Desenho de Processos

Avaliaccedilotildees

Opccedilotildees de Prescriccedilatildeo e Requisiccedilatildeo

Processo Cliacutenico Resumo Cliacutenico

Quadros de Tarefas Listas de Trabalho

Censos Quadro de Urgecircncia

Plano de Cuidados outros registos

RelatoacuteriosImpressatildeo

GeacuteneseOs nossos princiacutepios orientadores - Execuccedilatildeo

09-07-2015 10

Dezembro

- UICD Urg Geral

- Internamentos

Fevereiro

- Pediatria

Abril

- Gastroenterologia

- Nefrologia

- Obstetriacutecia

- Cirurgias

- Ortopedia

- ORLOFT

- Urologia

- Psiquiatria

- Ginecologia

Janeiro

- Medicinas

-Todas as aacutereas de Ambulatoacuterio de Urgecircncia

Marccedilo

- UICD Urg Pediaacutetrica

Abril

- Neurologia

Julho

- Urg GinecObst e Bloco de Partos

Marccedilo

- Bloco Operatoacuterio

- Cirurgia Ambulatoacuteria

Janeiro

- Consulta Externa

Abril

- Anestesiologia

Dezembro

- Plano de Cuidados

2010

2011

2012

2013

2014

Programa de Informatizaccedilatildeo CliacutenicaRoadmap histoacuterico (timeline)

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 6

Promover o acto cliacutenico de forma colaborativa transversal e multidisciplinar

Encorajar e agilizar o recurso agraves boas-praacuteticas

Conduzir a actividade para resultados previsiacuteveis

Contribuir como ldquoenablerrdquo para a satisfaccedilatildeo do doente e do profissional

Facilitar o processo para decisotildees mais informadas e seguras

Principio da Unicidade (natildeo-duplicaccedilatildeo de informaccedilatildeo normalizaccedilatildeo e tronco comum)

Seguranccedila Confidencialidade e Rastreabilidade

Utilidade (a forma de registo natildeo coloca em causa as esferas cliacutenica epidemioloacutegica pedagoacutegica cientiacutefica e de gestatildeo)

Oferecer funcionalidades para apoiar o ensinoinvestigaccedilatildeo

Desmaterializaccedilatildeo de protocolos em papel (Clinical Pathways)

GeacuteneseOs nossos princiacutepios orientadores - Visatildeo

09-07-2015 7

Soarianreg

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo geracional do PCE

Adaptaccedilatildeo por Carlos Sousa - 2015

To facilitate evaluations and to help ensuresimilar comparisons of vendor offerings Gartnerin 1998 first set forth a five-stage modeldescribing how computer-based patient record(CPR) systems will evolve transforming from verysimple systems that provide results reportinginto very complex fully integrated systems (seeFigure)

The Five Generations of CPR Systems

09-07-2015 8

Sistema de Gestatildeo Administraccedilatildeo e Evoluccedilatildeo

Interoperabilidade

Repositoacuterio de Dados Centralizado

Documentaccedilatildeo e

Captaccedilatildeo de Dados

Vocabulaacuterio Meacutedico Controlado

Visualizadores

Dashboards

Prescriccedilatildeo

Electroacutenica Gestatildeo

da Requisiccedilatildeo

Gestatildeo de

Conhecimento

CliacutenicoWorkflow

Cliacutenico

Suporte agrave Decisatildeo

Cliacutenica

Adaptaccedilatildeo por Carlos Sousa - 2015

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo Conceptual PCE adotado

A CPR system is composed of 10 integrated corecapabilities clinical system managementinteroperability clinical data repository (CDR)controlled medical vocabulary (CMV) andvocabulary server (VOSER) clinical workflowclinical decision support clinical documentationand data capture clinical display (includingclinician dashboards) clinical order management(including computer-based physician order entryand e-prescribing) and knowledge management(see Figure) Of course the CPR must also be ableto adequately meet the needs of a variety of carevenues as well as a wide array of clinician types

09-07-2015 9

Aacutereas de Cuidados

Internamento

Consulta Externa

Urgecircncia

Bloco e Cirurgia Amb

MCDTS

Especialidades

Hospitais de Dia

Grupos de Prestadores Utilizadores

Meacutedicos

Enfermeiros

Teacutecnicos de Sauacutede

Assistentes Sociais

Farmacecircuticos

Administrativos

Desenho de Processos

Avaliaccedilotildees

Opccedilotildees de Prescriccedilatildeo e Requisiccedilatildeo

Processo Cliacutenico Resumo Cliacutenico

Quadros de Tarefas Listas de Trabalho

Censos Quadro de Urgecircncia

Plano de Cuidados outros registos

RelatoacuteriosImpressatildeo

GeacuteneseOs nossos princiacutepios orientadores - Execuccedilatildeo

09-07-2015 10

Dezembro

- UICD Urg Geral

- Internamentos

Fevereiro

- Pediatria

Abril

- Gastroenterologia

- Nefrologia

- Obstetriacutecia

- Cirurgias

- Ortopedia

- ORLOFT

- Urologia

- Psiquiatria

- Ginecologia

Janeiro

- Medicinas

-Todas as aacutereas de Ambulatoacuterio de Urgecircncia

Marccedilo

- UICD Urg Pediaacutetrica

Abril

- Neurologia

Julho

- Urg GinecObst e Bloco de Partos

Marccedilo

- Bloco Operatoacuterio

- Cirurgia Ambulatoacuteria

Janeiro

- Consulta Externa

Abril

- Anestesiologia

Dezembro

- Plano de Cuidados

2010

2011

2012

2013

2014

Programa de Informatizaccedilatildeo CliacutenicaRoadmap histoacuterico (timeline)

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 7

Soarianreg

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo geracional do PCE

Adaptaccedilatildeo por Carlos Sousa - 2015

To facilitate evaluations and to help ensuresimilar comparisons of vendor offerings Gartnerin 1998 first set forth a five-stage modeldescribing how computer-based patient record(CPR) systems will evolve transforming from verysimple systems that provide results reportinginto very complex fully integrated systems (seeFigure)

The Five Generations of CPR Systems

09-07-2015 8

Sistema de Gestatildeo Administraccedilatildeo e Evoluccedilatildeo

Interoperabilidade

Repositoacuterio de Dados Centralizado

Documentaccedilatildeo e

Captaccedilatildeo de Dados

Vocabulaacuterio Meacutedico Controlado

Visualizadores

Dashboards

Prescriccedilatildeo

Electroacutenica Gestatildeo

da Requisiccedilatildeo

Gestatildeo de

Conhecimento

CliacutenicoWorkflow

Cliacutenico

Suporte agrave Decisatildeo

Cliacutenica

Adaptaccedilatildeo por Carlos Sousa - 2015

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo Conceptual PCE adotado

A CPR system is composed of 10 integrated corecapabilities clinical system managementinteroperability clinical data repository (CDR)controlled medical vocabulary (CMV) andvocabulary server (VOSER) clinical workflowclinical decision support clinical documentationand data capture clinical display (includingclinician dashboards) clinical order management(including computer-based physician order entryand e-prescribing) and knowledge management(see Figure) Of course the CPR must also be ableto adequately meet the needs of a variety of carevenues as well as a wide array of clinician types

09-07-2015 9

Aacutereas de Cuidados

Internamento

Consulta Externa

Urgecircncia

Bloco e Cirurgia Amb

MCDTS

Especialidades

Hospitais de Dia

Grupos de Prestadores Utilizadores

Meacutedicos

Enfermeiros

Teacutecnicos de Sauacutede

Assistentes Sociais

Farmacecircuticos

Administrativos

Desenho de Processos

Avaliaccedilotildees

Opccedilotildees de Prescriccedilatildeo e Requisiccedilatildeo

Processo Cliacutenico Resumo Cliacutenico

Quadros de Tarefas Listas de Trabalho

Censos Quadro de Urgecircncia

Plano de Cuidados outros registos

RelatoacuteriosImpressatildeo

GeacuteneseOs nossos princiacutepios orientadores - Execuccedilatildeo

09-07-2015 10

Dezembro

- UICD Urg Geral

- Internamentos

Fevereiro

- Pediatria

Abril

- Gastroenterologia

- Nefrologia

- Obstetriacutecia

- Cirurgias

- Ortopedia

- ORLOFT

- Urologia

- Psiquiatria

- Ginecologia

Janeiro

- Medicinas

-Todas as aacutereas de Ambulatoacuterio de Urgecircncia

Marccedilo

- UICD Urg Pediaacutetrica

Abril

- Neurologia

Julho

- Urg GinecObst e Bloco de Partos

Marccedilo

- Bloco Operatoacuterio

- Cirurgia Ambulatoacuteria

Janeiro

- Consulta Externa

Abril

- Anestesiologia

Dezembro

- Plano de Cuidados

2010

2011

2012

2013

2014

Programa de Informatizaccedilatildeo CliacutenicaRoadmap histoacuterico (timeline)

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 8

Sistema de Gestatildeo Administraccedilatildeo e Evoluccedilatildeo

Interoperabilidade

Repositoacuterio de Dados Centralizado

Documentaccedilatildeo e

Captaccedilatildeo de Dados

Vocabulaacuterio Meacutedico Controlado

Visualizadores

Dashboards

Prescriccedilatildeo

Electroacutenica Gestatildeo

da Requisiccedilatildeo

Gestatildeo de

Conhecimento

CliacutenicoWorkflow

Cliacutenico

Suporte agrave Decisatildeo

Cliacutenica

Adaptaccedilatildeo por Carlos Sousa - 2015

GeacuteneseOs nossos princiacutepios orientadores ndash Modelo Conceptual PCE adotado

A CPR system is composed of 10 integrated corecapabilities clinical system managementinteroperability clinical data repository (CDR)controlled medical vocabulary (CMV) andvocabulary server (VOSER) clinical workflowclinical decision support clinical documentationand data capture clinical display (includingclinician dashboards) clinical order management(including computer-based physician order entryand e-prescribing) and knowledge management(see Figure) Of course the CPR must also be ableto adequately meet the needs of a variety of carevenues as well as a wide array of clinician types

09-07-2015 9

Aacutereas de Cuidados

Internamento

Consulta Externa

Urgecircncia

Bloco e Cirurgia Amb

MCDTS

Especialidades

Hospitais de Dia

Grupos de Prestadores Utilizadores

Meacutedicos

Enfermeiros

Teacutecnicos de Sauacutede

Assistentes Sociais

Farmacecircuticos

Administrativos

Desenho de Processos

Avaliaccedilotildees

Opccedilotildees de Prescriccedilatildeo e Requisiccedilatildeo

Processo Cliacutenico Resumo Cliacutenico

Quadros de Tarefas Listas de Trabalho

Censos Quadro de Urgecircncia

Plano de Cuidados outros registos

RelatoacuteriosImpressatildeo

GeacuteneseOs nossos princiacutepios orientadores - Execuccedilatildeo

09-07-2015 10

Dezembro

- UICD Urg Geral

- Internamentos

Fevereiro

- Pediatria

Abril

- Gastroenterologia

- Nefrologia

- Obstetriacutecia

- Cirurgias

- Ortopedia

- ORLOFT

- Urologia

- Psiquiatria

- Ginecologia

Janeiro

- Medicinas

-Todas as aacutereas de Ambulatoacuterio de Urgecircncia

Marccedilo

- UICD Urg Pediaacutetrica

Abril

- Neurologia

Julho

- Urg GinecObst e Bloco de Partos

Marccedilo

- Bloco Operatoacuterio

- Cirurgia Ambulatoacuteria

Janeiro

- Consulta Externa

Abril

- Anestesiologia

Dezembro

- Plano de Cuidados

2010

2011

2012

2013

2014

Programa de Informatizaccedilatildeo CliacutenicaRoadmap histoacuterico (timeline)

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 9

Aacutereas de Cuidados

Internamento

Consulta Externa

Urgecircncia

Bloco e Cirurgia Amb

MCDTS

Especialidades

Hospitais de Dia

Grupos de Prestadores Utilizadores

Meacutedicos

Enfermeiros

Teacutecnicos de Sauacutede

Assistentes Sociais

Farmacecircuticos

Administrativos

Desenho de Processos

Avaliaccedilotildees

Opccedilotildees de Prescriccedilatildeo e Requisiccedilatildeo

Processo Cliacutenico Resumo Cliacutenico

Quadros de Tarefas Listas de Trabalho

Censos Quadro de Urgecircncia

Plano de Cuidados outros registos

RelatoacuteriosImpressatildeo

GeacuteneseOs nossos princiacutepios orientadores - Execuccedilatildeo

09-07-2015 10

Dezembro

- UICD Urg Geral

- Internamentos

Fevereiro

- Pediatria

Abril

- Gastroenterologia

- Nefrologia

- Obstetriacutecia

- Cirurgias

- Ortopedia

- ORLOFT

- Urologia

- Psiquiatria

- Ginecologia

Janeiro

- Medicinas

-Todas as aacutereas de Ambulatoacuterio de Urgecircncia

Marccedilo

- UICD Urg Pediaacutetrica

Abril

- Neurologia

Julho

- Urg GinecObst e Bloco de Partos

Marccedilo

- Bloco Operatoacuterio

- Cirurgia Ambulatoacuteria

Janeiro

- Consulta Externa

Abril

- Anestesiologia

Dezembro

- Plano de Cuidados

2010

2011

2012

2013

2014

Programa de Informatizaccedilatildeo CliacutenicaRoadmap histoacuterico (timeline)

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 10

Dezembro

- UICD Urg Geral

- Internamentos

Fevereiro

- Pediatria

Abril

- Gastroenterologia

- Nefrologia

- Obstetriacutecia

- Cirurgias

- Ortopedia

- ORLOFT

- Urologia

- Psiquiatria

- Ginecologia

Janeiro

- Medicinas

-Todas as aacutereas de Ambulatoacuterio de Urgecircncia

Marccedilo

- UICD Urg Pediaacutetrica

Abril

- Neurologia

Julho

- Urg GinecObst e Bloco de Partos

Marccedilo

- Bloco Operatoacuterio

- Cirurgia Ambulatoacuteria

Janeiro

- Consulta Externa

Abril

- Anestesiologia

Dezembro

- Plano de Cuidados

2010

2011

2012

2013

2014

Programa de Informatizaccedilatildeo CliacutenicaRoadmap histoacuterico (timeline)

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 11

Programa de Informatizaccedilatildeo Cliacutenica ndash ldquodia-a-diardquoEquipa multidisciplinar envolvimento parametrizaccedilatildeo especifica formaccedilatildeo

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 12

Sistema de InformaccedilatildeoPlataforma de Interoperabilidade e Universo de Aplicaccedilotildees

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 13

Programa de Informatizaccedilatildeo CliacutenicaPROJECTOS - Niacutevel de progresso

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

BI Clinico HFF Em carteira

BPOC - Administraccedilatildeo Terapeutica InternamentoA aguardar implementaccedilatildeo do modelo Ekanban e decisatildeo

relativa agrave informatizaccedilatildeo global da Farmaacutecia Implica ainda

DoseWatch Imagiologia ago-13 Projecto com arranque em Setembro

easyvista DGTI jan-14Licenccedilas adquiridas Necess recursos DGTI para PMO do

projecto e implementaccedilatildeo com serviccedilos Easyvista (por

EKanban Farmaacutecia jan-13 Projecto retomado no Logistica

Farmaacutecia - Informatizaccedilatildeo Global HFF jan-15Em avaliaccedilatildeo as condiccedilotildees para adopccedilatildeo de um SI

completo para os Serviccedilos Farmaceuticos

GA - Chamada de Doentes Urgecircncia Suspenso (a substituir pelo UNO)

HER HFF jul-14Infra-Estrututra jaacute instalada Falta agendar todas as tarefas

para integraccedilatildeo com Soarian formaccedilatildeo ect

INTERNET HFF HFF Em carteira

INTRANET HFF HFF Em carteira

PATOLOGIC Anatomia abr-11A aguardar reuniatildeo HFF-Fornecedor para avaliar uma

proposta para fazer evolir a soluccedilatildeo a todo o Serviccedilo

RIS - Especialidades HFF out-12Exames de Otorrino e de Oftalmologia digitalizados via RIS

desde 161214 Exames adiconais em execuccedilatildeo

RIS - Imagiologia HFFProcesso de maturidade e evoluccedilatildeo contiacutenua

Ultimo upgrade realizado no mecircs passado

Scheduling HFF mai-14 Fase I LIVE Fase II em planeamento

SIVIDA Infecciologia out-12

Por definir qual o repositoacuterio cliacutenico para a

EspecialidadeDependente de Prescriccedilatildeo Electroacutenica para

centralizar a prescriccedilatildeo e o registo de dispensa em amb

Soarian - Oncologia Oncologiaa adopccedilatildeo em pleno estaacute dependente da possibilidade de

avaliaccedilatildeo clinica preacutevia (consulta sem presenccedila do doente)

Soarian - SINAS HFF A aguardar decisatildeo estrateacutegica

Soarian - SOcupacional DGRH

SONHOv2 HFF jul-13 A aguardar feedback da SPMS

UNO - Balcatildeo Uacutenico HFF set-14 Em fase de execuccedilatildeo

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 14

NOME STATUS ImpactoKick-Off

DateEXECUCcedilAtildeO REPORT

DGTI - Reorg DGTI jan-14Recrutar 2 FTE + Procedimentos BASE escritos e aprovados

+ Regulamento organico

GH - Upgrade HW HFF jul-14 Suspenso

HOSIX - Interface WebGDH HFF ago-14 Em processo de analise Pelo Gab CodificaccedilatildeoDGTI

OutSystem - Reg Dispositivo M Bloco Operatoacuterio jan-14

Em fase de testes com soluccedilatildeo de recurso Limitaccedilotildees pela

falta de utilizaccedilatildeo do SI pelos profissionais Plano B em

estudo

PACS - Consolidaccedilatildeo Non-DICOM HFF nov-14

Em produccedilatildeo os 4 ECOCARDIOGRAFOS da Cardiologia (a

enviar as imagens para o PACS Falta upgrade Soarian para

garantir a prescriccedilatildeo do ato integraccedilatildeo com a Worklist e

visibilidade do resultado no Soarian

Em curso UCIENP bem como os Arco-C do Bloco

PAI HFF abr-14Plano de Alfabetizaccedilatildeo Informaacutetica a aguardar feedback do

CF

PCFI HFF fev-13

Suspenso A aguardar meios teacutecnicos (Storage) e upgrade

do Soarian Soacute depois o mecanismo de replicaccedilatildeo pode ser

activado

PDS - NA HFF A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PDS - NNascimento Obsteacutetricia A aguardar activaccedilatildeo do protocolo HFF-SPMS para esta aacuterea

PortalAmbulatorio + PEM-HFF HFF abr-14

Em produccedilatildeo desde 12 de Janeiro na Infecto

Na prox semana arranca a Nefro Em Fev os demais

serviccedilos de acordo com a DP CONSIS em desenvolvimento

RIS - MEDWEB Imagiologia nov-14Iniciado projecto de integraccedilatildeo HL7 MedWeblt-gtRISSoarian

Limitaccedilatildeo de meios para executar face ao pipeline

SAP - Upgrade HFF Upgrade concluido a 17062015

SAP EAPS DF jan-15 Em execuccedilatildeo (na dependencia do upgrade SAP)

Soarian - Consulta HFF mar-13Enfoque na Cardiologia Neurologia Anestesiologia e

Oftalmologia

Soarian - HELICS Bloco OperatoacuterioFase I Concluiacuteda e em produccedilatildeo A aguardar prioridade para

a Fase II

Soarian - Internamento Internamento abr-13Falta integrar todos os registos da Cardiologia (Avaliaccedilatildeo

Inicial Diaacuterios Nota Alta) e UCIs

Soarian - PoC (Plano de Cuidados) HFF jan-13Em produccedilatildeo desde desde 171214 LIVE na NEUROLOGIA

Processo de formaccedilatildeo para outras areas em curso

Soarian - SINAS HFF jun-14Limitaccedilotildees graves ao nivel dos registos cliacutenicos Soarian natildeo

adaptado aos requisitos que o SINAS exiger e inexistencia

Soarian - UCI UCIs jan-14A aguardar plano de acccedilatildeo para adopccedilatildeo Soarian em funccedilatildeo

da decisatildeo estrateacutegica jaacute tomada

Soarian - Upgrade v34 HFF Em execuccedilatildeo

Programa de Informatizaccedilatildeo CliacutenicaINICIATIVAS - Niacutevel de progresso

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 15

Programa de Informatizaccedilatildeo CliacutenicaProjecto de Informatizaccedilatildeo da Imagem Meacutedica

bull Diagrama da arquitetura da soluccedilatildeo implantada

bull Integraccedilatildeo de Electromedicina

bull Imagem DICOM

bull Imagem NON-DICOM

bull Integraccedilatildeo de Relatoacuterios

bull Worklists e Agendamento

Urologia

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 16

Plano de Cuidados de Enfermagem em produccedilatildeo

Quedas

Ulceras Pressatildeo

Focos de atenccedilatildeo

ldquoAgora registo aquilo (intervenccedilotildees) que antes fazia mas natildeo

escreviahelliprdquo (Enf PV)

Programa de Informatizaccedilatildeo CliacutenicaIniciativa para o Plano de Cuidados ndash Qualidade amp Seguranccedila do Doente

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 17

Programa de Informatizaccedilatildeo CliacutenicaPercursos Cliacutenicos (Protocolos NOC Procedimentos Pathways)

NOTIFICACcedilOtildeES

CVC JUGSUBC TORACOCENTESE CVC FEMURAL PARACENTESE PUNCcedilAtildeO LOMBAR IV Med vs Oral

ONR ndash Ordem para Natildeo Reanimar

Via Verde SEPSIS

Check-Duplicate (per time per guideline) Custo Uacuteltimo Resultado

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 18

A informaccedilatildeo que estaacute disponiacutevel na PDS eacuteRelatoacuterios Imagiologia Gastrenterologia Ginecologia e CardiologiaAnaacutelises de Patologia CliacutenicaDiagnoacutesticosTriagem de ManchesterAlergiasReceitas de medicamentos para as farmaacutecias comunitaacuterias

Em desenvolvimento em parceria com a SPMSECGsNota de Alta Meacutedica e de Enfermagem (Incluindo as UCIrsquos)Registo para o exterior(Consulta Internamento Urgecircncia) Registo de Alta da Urgecircncia (Uacuteltimo registo de urgecircncia + diagnoacutesticos + meacutedico alta + destino da alta)Protocolo Ciruacutergico Noticia de NascimentoImagem Meacutedica (Imagiologia)

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Plataforma de Dados da Sauacutede

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 19

Programa de Informatizaccedilatildeo CliacutenicaRCU2 ndash Resumo Clinico Uacutenico do Paciente

Disponibiliza um conjunto de informaccedilatildeo miacutenima essencial aos profissionais de sauacutede sempre que existe necessidade de um atendimento urgente ou programado numa entidade de sauacutede nacional ou estrangeira com traduccedilatildeo automaacutetica para a liacutengua materna do profissional de sauacutede

Dados de identificaccedilatildeo do utente da unidade de sauacutede e meacutedico de famiacutelia (RNU)

Contactos de emergecircncia (PUtente) Alergias CPARA (PUtente) Alergias Sistemas locais CPARA (SAM Hospitais CSP) Diagnoacutesticos Meacutedicos (ICD 9 CM ndash desde 2000) Diagnoacutesticos Meacutedicos (ICPC2 ndash desde inicio dos registos) Procedimentos Meacutedicos (ICD 9 CM ndash desde 2011 FocosDiag Enfermagem (CIPE) (CSP) FocosDiag Enfermagem abertos (CIPE) (Hospitais) DispositivosImplantes Medicaccedilatildeo Croacutenica (constante no CSPrimaacuteriosPEM)

Carregamento progressivo Ediccedilatildeo MFG Enfermeiro CSauacutedeUSF

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 20

0

200

400

600

800

1000

1200

1400

1600

1800

out nov dez jan fev mar abr mai jun jul ago set out nov dez jan fev mar abr mai jun jul ago set out nov dez jan

2012 2013 2014 2015

Total de Acessos - Mecircs

Programa de Informatizaccedilatildeo CliacutenicaPDS ndash Acessos dos Profissionais do HFF

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 21

Programa de Informatizaccedilatildeo CliacutenicaIndicadores de monitorizaccedilatildeo - Adopccedilatildeo e Maturidade

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 22

Programa de Informatizaccedilatildeo CliacutenicaLearned Lessons

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 23

100 90 80 70 60 50 40 30 20 10

Curv

a d

e R

OG

ER

ndashS

orian

iza

ccedilatilde

o

Cirurgia 3B

Cirurgia 3CMFR

Cirurgia PediatricaCirurgia Maxilo-F Gastro Pediatria Imagiologia

Cirurgia Plaacutetica

Ginecologia Pneumologia

Urologia

Oftalmologia

Cardiologia

Infecciologia

Neurologia

Obstetriacutecia A

Psiquiatria

Oncologia

Dezembro 2013 Pelo menos 1 nota de alta gravada no serviccedilo de alta

Para o caacutelculo entraram as avaliaccedilotildees Preacute-Operatoacuteria (internamento + UCA) Checklist de Seguranccedila Ciruacutergica Protocolo Operatoacuterio

Registo Enf Circulante Registo Enf Anestesia Recobro (UCPA + UCA) e Nota de Alta (internamento + UCA)

000

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Internamento Consulta Bloco Operatoacuterio Urgecircncia

Programa de Informatizaccedilatildeo CliacutenicaIacutendice Global de ldquoSoarianizaccedilatildeordquo

JUNHO 2015

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 24

Upgrade Infra-estrutura de Sistemas

Upgrade Rede (Core Switchs Wireless)

Upgrade Soarian

Upgrade RIS

Upgrade Parque IT (Expansatildeo Substituiccedilatildeo Normalizaccedilatildeo HW e SW)

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Teacutecnicos - 2015

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 25

RIS - Imagem meacutedica 100 eletroacutenica + Consolidaccedilatildeo DICOM e Non-DICOM no PACS + Integraccedilatildeo Equipamentos

UNO - Balcatildeo Uacutenico de Atendimento (Kiosks CRM ContactCenter)

Informatizaccedilatildeo dos Serviccedilos de Anatomia Patologica

Evoluccedilatildeo na Informatizaccedilatildeo dos Serviccedilos Farmacecircuticos

Implementaccedilatildeo do moacutedulo nacional de Prescriccedilatildeo Eletroacutenica de Medicamentos (PEM)

Programa de Interoperabilidade - Roadmap2015

Objectivos CIC 2015

Implementar o PCE nas UCIs

Uniformizar o circuito dos MCDTs integrado no PCE

Uniformizar o circuito do medicamento no HFF

Criar circuito automatizado de referenciaccedilatildeo de utentes para RNCCI

Promover o potencial do suporte clinico eletroacutenico para a melhoria da Excelecircncia Clinica (ex SINAS)

Integrar os sistemas cliacutenicos e administrativos internos com Plataforma externa (PDS)

Expansatildeo do Moacutedulo de Agendamento Transversal (Soarian Scheduling) ndash Fase II

Programa de Informatizaccedilatildeo CliacutenicaObjetivos Funcionais - 2015

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 26

Defender o HFF - Evidenciar a Excelecircncia da Praacutetica CliacutenicaPDS amp Escrutiacutenio Internacional - Futuro

0

200

400

600

800

1000

1200

1400

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 27

bull HIMSS - Healthcare Information and Management Systems Society

bull EMRAM - European EMR Adoption Model

bull EMR - Electronic Health Record

Modelo adaptado ao mercado Europeu desde 2004

Constituiacutedo por 8 niacuteveis maturidade

Descreve o niacutevel de maturidade das instituiccedilotildees de sauacutede no objetivo ldquopaperless Hospitalrdquo

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 28

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 29

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash Intermountain Case Study

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 30

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS (Mundial)

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 31

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 32

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 33

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS

Source HIMSS Analytics Europe - HAE (CountryComparison Report 2012)Note the EMRAM algorithm differs across differentregions to reflect HIT implementation of that particularregion This includes Austria (19) Belgium (2) Denmark (4)Finland (3) France (32) Ireland (5) Norway (8)Sweden (2) Switzerland (3) United Kingdom (25)

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 34

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

El Hospital Marina Salud de Deacutenia elprimer centro del mundo fuera deEstados Unidos en conseguir el HIMSSDavies Awards14112014

University of Iowa Hospital and Clinics Selectedas 2014 HIMSS Enterprise Davies AwardRecipient (HIMSS - Healthcare Information andManagement Systems Society)

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 35

a capacidade para demonstrar que se consegue reduzir as reaccedilotildees adversas e infeccedilotildees nosocomiais

a instituiccedilatildeo de formas de desmaterializar mais segura e efectivamente muacuteltiplos percursos cliacutenicos

a reduccedilatildeo em diversos MCDTs do respectivo ldquotempo-de-ciclordquo (duraccedilatildeo entre prescriccedilatildeo agendamento execuccedilatildeo relatoacuterio)

o aumento do impacto positivo no reconhecimento financeiro da actividade incluindo reduccedilatildeo na demora-meacutedia nas readmissotildees ou no inicio precoce na administraccedilatildeo da terapecircutica antibioacutetica por exemplo etchellip

os ganhos operacionais cliacutenicos ou sociais dependem muito de instituiccedilatildeo de para instituiccedilatildeo

Poreacutem eacute possiacutevel comparar 2 organizaccedilotildees de sauacutede com culturas distintas modelos e politicas de sauacutede antagoacutenicas atraveacutes do instrumento Electronic Medical Record Adoption Model (EMRAM) do HIMSS Dimensotildees mais relevantes

Clinical Value

ROI

Clinical Decision

Accountable Care

Patient Safety

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studyrsquos

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 36

Evidenciar a Excelecircncia da Praacutetica CliacutenicaHIMSS Davies Award ndash University of Iowa vs Marina del Salud Case Studys

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 37

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Studyrsquos

OVERVIEW

Mayo Clinic is the first and largest integrated not-for-profit medical group practice in the world

55000 employees which includes 3700 physicians and scientists and a health support staff of 49100

Mayorsquos campuses are located in Minnesota Florida Arizona and over 70 communities across the northern Midwest region

Mayo Clinic collectively serves over 1 million patients annually spanning across all 50 states and 150 countries globally

Stage 7 Award Validated hospitals in 2011 2

CHALLENGEThe key to the successful system deployment depended on three essential factors

1) communication with busy clinicians of how imminent changes will impact workflow

2) clinician access to resources available on a ldquowhen neededrdquo basis and

3) garnering the support of leadership to allocate clinician training time

Scheduling training time for clinicians

Avoiding impacting provider efficiency

Implementing effective tools for medication reconciliation

Installing bedside workstations in smaller rooms

Dealing with competing desires of adding sophistication vs completing rollout

Completion of order sets (400+) and protocols (48) in CPOE

Learning curve for staff to ramp to the new system

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 38

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

CLINICAL OUTCOMES 45-minute patient wait for a medication reduced to 3 minutes after CPOE implementation A combination of order sets and decision support raised the level of VTE prophylaxis compliance within 48 hours of medical

admission from 90 to 984 Complex patient itineraries can be created in moments and appointments scheduled closer together reducing overall visit

times Nursing reminder work-list alerts improved overall patient care Pharmacy alerts in order entry reduced wrong dose errors in pediatrics Patients state that they feel safer with Barcode Medication Administration in place

FINANCIAL ROI $7 million annual savings from computer-based microbial monitoring $40 million from automation of basic EMR functions $15 million annually from documentation for IHI reporting of invasive line placements 85 day reduction in institutional daysrsquo revenue outstanding from automated chart checking and reminder if needed to

complete anesthesia documentation $18 million savings the first year due to backend speech recognition 162 hours of manual screening were saved with implementation of the Sudden Cardiac Arrests Alerts Rule

ldquoThe Stage 7 achievement was reached due to the hard work of employees

from the clinical practice Information Technology and Systems and

Procedures Mayo will continue to advance all of its hospitals to this level to

ensure meaningful use of technology for improved patient carerdquo

John H Noseworthy MD

President and CEO

Mayo Clinic

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 39

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Mayo Clinic Case Study

Lessons Learned

Effective training is key to successful implementations

Understand the processes you are trying to automate-donrsquot replicate from paper (eg printing simply to provide paper notifications of a new order)

Different education models are needed to fit different learning styles and work patterns such as videos classes on-the-spot individual training taking a lsquoclassroomrsquo to staff meetings

Allow time for staff to educate themselves and become proficient with the new system

Allow time for refresher training and lsquotips and tricksrsquo in convenient locations at convenient times to help staff get the most out of the automation

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 40

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

CHALLENGEIn 2002 the organizations chairman and CEO asked clinical operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management inpatient and patient portal options The strategic planning outlined to Home as the hub Integration and leveraging Secure and seamless transitions and Customization Integrate outpatientinpatient medical record with appointments registration and billing Serve as a complete health care business system and Enable care coordination between the physicianrsquos office hospital and ancillary services (radiology laboratory pharmacy)

OVERVIEW

Staff of 159000 and more than 14000 physicians serving 86 million members

Operates 36 hospitals with 34 in California one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia

As a large integrated care delivery system Kaiser Permanente serves members with a full spectrum of needs from sick care to well care Reimbursement for care includes commercial health plans individual health plans Medicare Medicaid and charity care

Stage 7 AwardRecognized hospitals in 2009 12 Recognized hospitals in 2010 12 Recognized hospitals in 2011 11

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 41

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

RECOGNIZING THE ROI OF EMR IMPLEMENTATION

One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect Another region saved more than $120000 in dictation costs in just one year post-implementation

Saved costs for printed forms almost immediately after implementing the EMR with a $14 million decrease in one region on printing expenses of annual outpatient forms alone

Vacated more than 22000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $04 and $33 million in 2001 Kaiser Permanente is now building new hospitals without medical record storage areas Saved $200000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space

Provide patients with test results within two days instead of a week or longer

Reduced the rate of medication errors by 57 one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration

Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect illustrating the reduction in duplicate tests

ldquoWith the worldrsquos most widely used personal health record Kaiser Permanentersquos experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team They also want the site to allow them to view key components of their medical records conduct clinical transactions online In addition the site provides them with information so that they can make knowledgeable decisions about their healthrdquoAnna-Lisa Silvestre | Vice President of Online Services | Kaiser Permanente

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 42

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEMRAM Stage 7 ndash Kaiser Permanent Case Studyrsquos

Lessons Learned

The right people at the tableIts imperative that clinicians play a significant role in the planning design and implementation of an EHR system They use the system day in and day out so they need to be involved in the decision-making process If not you end up with just a fancier version of the paper record In our case hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members

Training is integral to successA large portion of our costs were attributable to training and workflow re-design We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented We have continued with the training and exchanges of best practices and believe that it must be an ongoing process

Donrsquot underestimate the desire to do the right thingIt would be unrealistic to say that every doctor switched over to electronic records without any issue The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years Some were more resistant to change than others which can be expected in a project of this size At the end of the day though our clinicians understood that what we were doing was in the best interest of the patient

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 43

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 44

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HIMSS Europe

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 45

HFF(presente)

2016

2017

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash OBJECTIVO HFF FUTURO

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 46

- Processo cliacutenico eletroacutenico implementado em quase todos os serviccedilos

- LIS RIS e PHIS implementados- Informaccedilatildeo cliacutenica centrada no

utente- Prescriccedilatildeo meacutedica associada agrave

documentaccedilatildeo de enfermagem- PACS implementado

Onde estamos Para onde queremos ir

- Soarian Upgrade- Administraccedilatildeo de terapecircutica

como circuito fechado- Alarmiacutesticas de interaccedilotildees

medicamentosas e aleacutergicas- Implementaccedilatildeo de protocolos

cliacutenicos- Business intelligence data

warehouses- Recolha de indicadores

(PrePost) ndash Business Case

Have Need

Gap

Evidenciar a Excelecircncia da Praacutetica CliacutenicaEscrutiacutenio e Reconhecimento Internacional ndash HFF Gap Roadmap

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 47

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 48

IntegradorRIS DonorNow

EmailCoordenaccedilatildeo Hospitalar de

doaccedilatildeo

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 49

17066 reports analyzed (Octrsquo13-Octrsquo14)

1148 classified as catastrophic

110 confirmed and followed by the Donation Coordination

0 catastrophic reports that were not detected (no false negatives)

7 cases lead to organ collection

gt Organ collections nearly doubled and surpassed the expected value for a Hospital without Neurosurgery

96

CE-CT classified as false

CT-CE classified as true

CT-CE confirmed as catastrophic

Confirmed Classified true

+

DonorNOWApp ndash sinalizaccedilatildeo automaacutetica de possiacutevel dadores

09-07-2015 50

PatientNOWApp ndash mobile para acesso de consulta ao Soarianreg

Video