Tekes Finnwell China Seminar

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Tekes Finnwell ChinaSeminar

• Results of the Shanghai-Pudong Project

Dec 16th 2008, Helsinki, Tekes Jiechen Jiang HIS
RD Unit University of Kuopio, Finland
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Shanghai partners results

• Current Situation of Pudong
• Regional Information Sharing Project
• Core Datasets Study
• Digital Health Center Study

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• Current State
• Pudong Health Information Development
• REPORT 1

Huang Xuan, Xi Weinong etc, Kingstar Winning
and Lanhen company
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Survey on the community health center

• 26 community health information systems
• Structure, staff, investment, network
  configuration, hardware configuration, software
  configuration, security devices and future plan
  etc.
• Conclusion all have basic HIS, but with great
  difference in different communities

Source From Xiewei
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• Structure and staff
• Every center has set up information department
  with one or two staffs
• Mainly providing basic maintenance
• Without structure standard
• Has staff trained, but poor quality
• Investment
• In recent 5 years, 0.5 million RMB at lowest
  level, 0.8 million RMB at medium level, 1 million
  RMB at highest
• Mostly,average cost is about 0.1 million RMB one
  year
• Lack of system strategic plan in health
  information construction
• Without detail content and cause in annual budget
  

Source From Xiewei
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• System function module
• Basic functions (common modules in clinic
  registration, billing system (invoice), admission
  discharge management, pharmacy management,
  hospital manager inquery system, nurse
  workstation system )
• Half hospitals equipped e-family health archives
  system
• 30 hospitals equipped doctor work stations
• 25 hospitals equipped LIS RIS etc
• Few hospitals have EPR system, diagnosis and
  treatment monitor system
• Application status
• All basic function are running completely
• Others (including E-health archives system) are
  running partly

Source From Xiewei
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• Hardware, network
• Average 1 to 2 servers at each hospital
• LAN, 1 to 2 Switches
• Connected to Pudong Health information network
• Without storage facilities and special back-up
  devices
• 1.5 to 3 persons equipped 1 Personal Computer
• Investigation of hospital managers expectation
• According to target priority
• 1?doctor work station
• 2?medical technology related information system
• 3?foundation part of HIS
• 4?EHR
• 5?systems integration (inner-hospital data
  share)
• 6?linkage between health archives and public
  health information system

Source From Xiewei
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Survey on Hospital

• Structure and staff
• Every center has information department with 4 to
  7 employees
• Mainly with responsibility for the most basic
  administration, other jobs relied on subcontract
• Normal training for staff, with credible quality
• Without public health information system
• Investment
• Total cost up to 5-10 million RMB
• Mostly, average cost is about 0.4 million RMB one
  year
• Lack of entire system plan in hospital
  information construction
• Without detail content and cause in annual budget
  

Source From Xiewei
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• System function module
• Basic functions (common modules in clinic
  registration, billing system, admission
  discharge management, pharmacy management,
  hospital manager inquery system, nurse work
  station system )
• Most of hospitals equipped doctor work-station
• Most of hospitals equipped LIS etc. systems.
• Many hospitals have EPR, diagnosis and treatment
  monitor system
• All integrations among different systems complete
  based on shared database, but without standard
  interface
• Hardware, network
• Average 4 to 8 servers, most of hospitals
  equipped with Small Computer System
• LAN, a lot of Switches, with normal programming
• Connected to Pudong health information network
• With disk storage facilities and without special
  back-up devices
• One person equipped one Personal Computer

Source From Xiewei
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Current problems

• 1.Lack of health information standards and
  guidelines
• 2.Lack of human resource, IT technicians and
  Research team
• 3.The hospital information systems of health
  organizations are at different levels
• 4.Lack of investment, over 80 health care
  center has no annul budget for information system
  development and maintenance (hardware and
  software)
• 5.The degree of integration within hospitals is
  low.

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Comments

• Currently aiming to share the patient data based
  on shared EHR, and build shared health
  information platform.
• 1.More investment on health information
  development, especially on healthcare center
• 2.More training and education to develop human
  resources capacity, organized by Pudong
  Government
• 3 To develop the health information standards

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• Development and Implementation of Regional
  Information System at Pudong
• REPORT 4

Jiang Yimin and Fan Qiyong etc , Kingstar
Winning and Lanhen company
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Project Objectives

• A.331 Health information sharing platform
• 1. To establish Pudong Regional Data Center
• 2. To establish data exchange system of Regional
  Data Center
• 3. To establish data security system of Regional
  Data Center
• 4. To build the two-way referral system
  (Maternity Healthcare)
•  5. To build booking system of patient visitings
• 6. To build Chronic Disease Management system
• B. Public Health Web service 
• 1.To check the citizen health status
• 2.To check the laboratory test results and SMS
• 3.To analysis the health data in the region or
  community

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EHR System

• 1. Community health information systems
  highlight the EHR as core system, including the
  health of citizens, prevention of immunization,
  medical records, public health records, and
  family planning
• 2. EHR covers the whole life health related
  data from birth, growth, to death, for general
  health status assessment, scientific research,
  and medical education
• 3. The health status of the residents in the
  community can be continuously tracked and
  monitored through EHR, for early detection and
  diagnosis of chronic diseases.

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Project Targets

• 1.Government Power
• Government strong supporting are needed to expand
  the
• good results achieved from the project to whole
  shanghai,
• even China national wide
• 2. Cost reduction
• 3. Good use of resources
• 4. 100 Coverage
• 5. Improvement the efficacy of health services
• 6. Guidelines and Standards
• Complete the guidelines
• Set up related standards
• Make workflow for the referral service

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Pudong pilot case setting
Study before, after, future regional info
sharing
22 Jan 2008
Korpela
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Pudong MCH
GongLi Hosp
Pudong CDC
East Hosp
LuJiaZhui CHC
WeiFang CHC
Pudong SD Bureau
TangQiao CHC
ZhangJiang Data Center
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Current situation of Pilots

• 1. Health information network construction has
  connected with all health organizations in Pudong
• a) Health Information Network with 10M fiber
  optic cable to link the various health
  organizations
• b) Zhangjiang regional data center, the data
  exchange platform, Web Service
• 2. Referral service between health center and
  hospital has not been effectively resolved
• 3. Health Information System does not meet the
  full coverage in the whole region

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Current situation of Pilots

• 4. All the pilot hospitals and health centers
  have information systems.
• a) Both East hosp and GongLi Hosp have very
  comprehensive HIS, doctor workstation system,
  LIS, RIS and clinical information systems
  Maternal and Child Health Hospital is now
  currently using the HIS developed by Bsoft, now
  it is bidding for the new system.
• b) 3 pilot healthcare center (Weifang,
  Lujiazui, Tangqiao) all have HIS, doctor
  workstation and EHR system etc
• c) Community Healthcare IS has the EHR as core
  system, with 15x, and now added 2 more systems
  as 17x, with hypertension and diabetes disease
  management system
• d) The utility rate of EHR Data is very low,
  clinical data and Public health data can not be
  integrated well
• e) There are too many HIS venders

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Principles of System Design

• 1.EHR as core, integrated with other clinical
  data, medical and laboratory data
• 2.Study the core dataset of EHR based on the
  national standards
• 3.Keep the original systems at maximum, and do
  modifications accordingly on the existed systems.
• 4.Ensure the network security and data security

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System Design and Development

• Needs analysisTo collect information by
  questionnaires via email, post mail, phone call
  an group discussion
• 1.Current systems, and the functions and
  utilities
• 2.Information sharing within and between health
  organizations
• 3.The coverage of health records
• 4. Current problems
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• System designShared data based on EHR(1nxy)
  and the 3 ways for data inquire and read
• Architecture design based on B/S
• System implementation Weifang, TangQiao and
  LuJiazui has completed the system testing, Gongli
  and East hospital are being tested

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System Design

• 1.Shared dataMain record of the EHR as index,
  related to clinical data, sub record of EHR and
  maternity health record etc
• 2.Three different methods for inquire and read
  shared data
• a)Common data inquire systemfor such health
  organization who has no doctor work station or
  can not have interface
• b)Common date inquire through interfaceOffering
  standard web service interface, there has small
  modification for HIS venders
• c)Information gathering/download shared data via
  interface

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Status Before implementation

• 1.The utilization rate of Pudong health
  information network is not high the main
  applications are for CDC
• 2.Hospital Management Information System is not
  completed EHR and PACS have not been fully
  applied yet
• 3.The data in community health information
  systems are not accurate, completed and shared
• 4.Information isolation information systems
  between health organizations are not integrated,
  even within hospital
• 5.Two-way referral services are paper based,
  there is no any feedback information from higher
  level hospital
• 6. At present, all health organizations do not
  completely meet the function norms and
  standardization of HIS.

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Changes after implementation

• 1.Make good use of Pudong health information
  network 500 doctor work stations of pilot
  hospitals can share the real-time information
  from the regional database via Pudong health
  information health network
• 2.Shared platform construction For all
  physicians, they can inquire and read the patient
  related data, (even without the doctor work
  station), a comprehensive patient data, including
  clinical data, public health data,
  rehabilitation, and laboratory results. The
  shared platform has solved the problem of
  information isolation. In terms of data
  collection, standard data sets, all hospital
  information system venders should meet in the
  standardization of data structure, improving or
  upgrade the existing system
• 3.Two-way referral systems, complete
  replacement of the original paper based referral
  services, and it has the function of printing,
  alarming, real-time transferring and tracking.

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Achievements of the Project

• This research project started from the system
  requirements analysis, system design, system
  implementation. The whole project team
  participated in the joint discussion, research
  programs, and regular meetings.
• 1.EHR(1nxy) shared structure, which
  integrated community health information systems
  and HIS, public health information systems,
  clinical information systems, and other disease
  management system
• 2.Community health information system
  effectively integrated with Hospital information
  systems that improve the quality of health
  service and enhance the disease prevention and
  control
• 3. Two ways referral system between health
  organizations(health center and hospital)
  effectively fulfills the seamless health service
  in the region
• 4.Effective security system solves the patient
  privacy and data safety. (Network, patient data,
  hospital data security)

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• Structured Core Dataset
• Health Record (EHR)
• for information sharing
• REPORT 2

Du Zhaohui and Shen Jiani etc Kingstar Winning
and Lanhen company
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Core Dataset of Health Record in SH

• The Objective is to identify the core dataset of
  EHR in Shanghai
• for information sharing based on National
  Standards, and Finnish
• core dataset as reference.
• Methodology (Delphi)
• Tables designing ? Tables sending (first round)?
  Table
• collecting (feedback) ? Analysis, table
  redesigning and table
• sending (second round) ? Selecting the necessary
  date elements
• Results Finally selecting 453 of 601 data
  elements from 14 Core
• Datasets in Shanghai,which will be applied as
  structured shared
• data in Shanghai in future.

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14 Core datasets in Shanghai

• 1.Personal Basic Information
  
• 2.Medical Care Service (Hospital Data)
  
• 3.Public Health Service(Health factors)
• 4.Public Health Service(Hypertension)
• 5.Public Health Service(Diabetes)
• 6.Public Health Service(Tumour)
• 7.Public Health Service(Mental Problem)
• 8.Public Health Service(Infectious Diseases)
  
• 9.Public Health Service(Immunization and
  Vaccination)
• 10.Public Health Service(Maternity Healthcare)
  
• 11.Public Health Service(Child Healthcare)
• 12.Public Health Service(The Elder care)
• 13.Public Health Service(The Disable care)
• 14.The Death information

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Overview of National Basic data sets

• BDSS of hospital information
• the National Institute of Hospital administration
  of MOH (NIHA)
• the Chinese Hospital Information management
  Association (CHIMA)
• 29 universities and hospitals as well as 16
  companies
• 2006 May
• BDSS of public health care information
• the Center of disease prevention and control
  (CDC)
• China health information institute (public
  health)
• 14 CDC offices of different special areas as well
  as 3 companies
• 2007 Jan
• BDSS of community health care information
• The center of health statistics information of
  MOH (CHSI)
• health care onganizations and 28 companies
• 2006 Nov
• Source From Hellevi

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Basic data sets of the hospital information
Source From Hellevi
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Public health information Shared data
Source From Hellevi
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Basic data set of community health care

• Family Health Record Dataset
• Personal Health Record Dataset
• Physical check-up Dataset
• Clinical Record Dataset
• Home visit Dataset
• Inpatient Care Dataset
• Patient Referral Dataset
• Vaccination Dataset
• Children Immunization Statistics Dataset
• Chronic Disease Related Dataset
• Infectious Disease Related Dataset
• Emergent Public Health Event Dataset
• Maternity Basic Dataset
• Maternity check-up ataset
• Newborn Baby Dataset
• Children Health Examination Dataset
• Rehabilitation Dataset
• Health Promotion Dataset
• Population Health Behavior Dataset

Source From Hellevi
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• Criteria and evaluation
• Digital Health Center
• REPORT 3

Song Huijiang, Xue Lan etc
Kingstar Winning and Lanhen company
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Framework of Digital Health Center
 
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TACK
TAK