HEALTH CARE AUTOMATION AT ASIAN INSTITUTE OF GASTROENTEROLOGY Pradeep R MS, M.Ch., D Nageshwar Reddy MD, DM, Dsc, FAMS, FRCP.
About AIG Tertiary care single specialty referral center for Gastrointestinal (GI) diseases Offers GI services to national and international patients Trains specialists in the field of Gastroenterology Exclusive research wing - research in various areas of GI Telemedicine project to cover GI healthcare to rural areas
Magnitude of problem • Increasing health care costs, patient demands, need for improving health care standards is a must • Possible only by IT and Automating processes • Integrating the various technologies – Major problem • Health care personnel acceptance ? • Fear • Refusal to learn and change
EMR P Investigations Reports Pharmacy Laboratory A Case sheet Endoscopy Discharge C Summaries Us, CT . X-ray, S ERCP, Capsule, Colonoscopy. Manometry, Magnification HIS Endoscopy, Operation Patient Theater, Pathology appointment Inventory Clinical case Entry (OP and Purchase IP) Financial Indenting Billing Insurance Telemedicine Research Rural Health Projects Project
PROPOSED SOLUTION A SCHEMATIC OVERVIEW Asian institute of Gastroenterology OF 21 st CENTURY HEALTH SOLUTION * Pharmacy * Materials Management * Kitchen/Diet * Linen/Laundry * Appointment Scheduling * CSSD * Out Patient Registration * Finance * Out Patient Billing * Doctor Honorarium * Casualty Registration * MIS * Casualty Billing * Equipment Maintenance * Indoor Patient Regn * Indoor Patient Billing * A D T * Wards Management * OT Management * MIS HOSPITAL ADMINISTRATION / ACCOUNTING MODULES INTERFACE TO Health and Management Hospital Information Information PATIENT ADMINISTRATION MODULES Systems Network Business intelligence CLINICAL MODULES Health and Hospital Information Network EMR LIS IMAGING Backbone * General Medicine • Gastroscopy • C Arm • Magnification • Medical * Internal Medicine * Biochemistry * 2D / Stress Echo • Colonoscopy • Cath Lab * Dermatology * Haematology * ECG Endoscopy Gastroenterology * Gynaecology * Microbiology * CathLab • EUS • ESWL • Elastography * Paediatrics • Surgical * Clinical Pathology * Endoscope * Obstetrics * Immunoassay • Capsule * C-Arm • US • OT * Histopathology * OT Imaging * Urology Gastroenterology • Enteroscopy • CT • Scanner * Serology * Central Station * ENT Health and * other specialties • ERCP • ECG • Pathology Hospital Information Network Output Templates: Document Spreadsheet XML • Endoscopy Reports * Consultation Summary • CT Reports * Surgeon Notes * ECG Waveforms * Anaesthetist Notes • US Reports * Pathology * Cath Lab Reports * Discharge Summary Reports * Cath Lab Loops • ERCP Reports * Referral letters * Endoscopy films * Certificates • Capsule Endoscopy Reports
OUT PATIENT
OP Workflow Patient FRONT OFFICE BACK OFFICE Portal Reception / Regn / Billing Corporate Billing / Insurance / Doctors Honorarium Relative Patient Service Departments CENTRAL DISPATCH CONSULTING EMERGENCY Diagnostic Imaging Pathology Lab Day Care procedures Consulting Ambulance Reports Dispatch Other services ADMISSIONS PHARMACY ADT
OP Workflow Patient FRONT OFFICE BACK OFFICE Portal Reception / Regn / Billing Corporate Billing / Insurance / Doctors Honorarium Relative Patient Service Departments Service Departments Service Departments CONSULTING CENTRAL DISPATCH EMERGENCY Diagnostic Imaging Diagnostic Imaging Diagnostic Imaging Pathology Lab Pathology Lab Pathology Lab Day Care procedures Day Care procedures Day Care procedures Consulting Ambulance Reports Dispatch Other services Other services Other services ADMISSIONS PHARMACY ADT
IN PATIENT
IP Workflow REGISTRATION Service Departments Relative Patient Indoor Registration Diagnostic Imaging WARDS / ICU / NICU Pathology Lab ADMISSION OPERATION THEATRE Nursing Station Intensive Care Admission, Transfers IP MIS IP MIS BACK OFFICE IP BILLING PHARMACY Corporate Billing / Insurance / Indoor Billing Doctors Honorarium
LABORATORY INFORMATION SYSTEM
COLLECTION ROOM WARDS / ICU / OT OPD Service Registration Sample Collection Consultation Sample Collection & Barcode Generation Service Barcode Generation Registration Consultant Relative Patient Nurse Patient OPD Nursing Phlebotomist IPD / ICU / OT Station OPD Reception LABORATORY HEM/AB00123456-P (14-Mar) DISPATCH Ajit Srivastav 26Y/M /AB00 WARDS / ICU / OT Sample Verification 101123456 Sample Segregation Worksheet Generation Centralized Printing Sample Distribution Final Report Reporting Printing Centralized Dispatch Lab Tech Batch Reporting View Ward Work Printing Printing Sheet Final Report Nursing Ward View Station Dispatch Desk MICRO-BIOLOGY HISTOPATHOLOGY/CYTO BIOCHEM/HEMAT/ SEROLOGY/OTHERS BIOCHEMISTRY / MICROBIOLOGY DEPT HISTOPATHOLOGY DEPT HEMATOLOGY / SEROLOGY / OTHER DEPTS
ELECTRONIC MEDICAL RECORDS
Holistic EMR Sources of data Clinical aspects of capture data capture
Back IMAGING Pathology Holistic EMR
Rural Health Camp – Telemedicine
Rural Health Camp – Telemedicine
Data Generated - Gastroenterology 2005-2010 Modes Number Clinical Data Out Patients 3,45,960 In Patients 54, 634 Imaging Images Upper GI Endoscopy 1,64,693 4,94,079 Colonoscopy 50,905 1,52,715 ERCP 36,011 1,44,044 5 GB/Day EUS 9347 37,388 US 2,60,280 5,20,560 CT 19,822 Capsule Endoscopy 633 Rural Programme & Telemedicine Patients Treated 1,47,263 Endoscopy 4,640 US 3,244
HIS – Implementation Difficulties & Limitations Software: Integration of Different modules Cost and Maintenance Version upgrade related User Acceptance: Administrators – Good Paramedical – Fair Medical – Bad
Data Acquisition History , Physical etc – Text based Predefined Templates – Data fields Images – DICOM & Non DICOM Lab Data – Integration with HIS
Data Usage - Present Retrieval – Patient Management Analysis : Retrieved by user defined coding and third party program for analysis Research To evaluate pattern of diseases – Geographical, Seasonal Genetic study Hospital infections – Alerts Auditing – Quality care Images PACS – Diagnostic Automation
Data Usage - Present Limitations of Manual analysis: Large Data bases Hidden and Potential relationships of data may not be recognized
Data Usage - Future These tools and techniques bring out the hidden patterns in the data which will help us in making decisions
Data Usage - Future Diagnostic Dilemma Evaluating Treatment Choices
Inflammatory Bowel Disease Data: No of Subjects: >1100 No of Fields / Subject: 78 Data Components: Clinical, Investigations, Genetic, Drugs, Surgery, Follow up. Data Format: Text, Tables, Excel, Images
PATIENT HISTORY
Case scenario – Crohns Disease Diagnosis Problem: Intestinal TB – Common in India Crohns Disease – Incidence increasing in India Differentiation: Difficult Critical – Treatment is different
Case scenario – Crohns Disease Diagnosis Question: In a given number of patients (>4000) – (TB & Crohns): Can we diagnose the disease accurately? Predict the outcome of treatment? Recommend best treatment based on previous treatments?
Chronic Pancreatitis: Prevalence France 26/100000 USA Japan 41.7/100000 27.4/100000 South India 126/100000
Chronic Pancreatitis Data: 5 Years No of Subjects: >5000 No of Fields / Subject: 58 Data Components: Clinical, Investigations, Genetic, Drugs, Endoscopic Procedure, Surgery, Follow up. Data Format: Text, Tables, Excel, Images
Chronic Pancreatitis - Proforma
Data of Chronic Pancreatitis (1 st Aug 2011 to 8 th Dec 2011) N= 313 0.9 3.4 0.8 5.1 3.4 34.8 6.8 44.9
Case scenario – Chronic Pancreatitis Treatment Problem: Chronic Calcific Pancreatitis – Heterogeneous group of disease Different modalities of Treatment - Available Controversy : Which modality in Which Patient ?
Case scenario – Chronic Pancreatitis Treatment Question: Stent ESWL Drainage Resection Success % 50-70 60-80 65-90 87-95
Data Usage - Future Decision Tools Outcomes of Evidence Knowledge Patient Based Bases Records Medicine Knowledge Refinement
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