Transcript 1999 CHIM EXHIBITOR MARKETPLACE

Hangzhou Health Bureau
Hangzhou, China
August 31, 2010
Evolution of RHNs Around
the World and in China
Hangzhou Health Bureau
Presentation Agenda
 About The Dorenfest Group
 Evolution of RHNs around the world
 Evolution of RHNs in China
 EMR evolution and its relationship to RHNs
Hangzhou Health Bureau
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Dorenfest China Healthcare Group
The Dorenfest Group
 40 years experience in H.I.T.
 Offer healthcare improvement services
 Focus on improving patient care and operational efficiency
through better change management
– Work process improvement
– Management systems improvement
– Improvement in services for patients
– Improvement in quality of patient care
Hangzhou Health Bureau
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Dorenfest China Healthcare Group
Some Dorenfest Hospital Projects
Abington Memorial Hospital
Addison Gilbert Hospital
Adventist Health System/Sunbelt
Adventist Health System/West
Akron General Hospital
Albemarle Hospital
Baptist Healthcare System
Baxter County Regional Hospital
Baylor Health Care System
Benedictine Health System
Boulder Community Hospital
Brackenridge Hospital
Bristol Bay Regional Health System
Burlington Medical Center
Caritas Health Services
Carondelet Health System
Central DuPage Health System
Central Washington Hospital
Centura Health
Charleston Area Medical Center
Children’s Health Care
Cleveland Home Health Agency
Community Memorial Hospital
Conway Regional Medical Center
Cortland Memorial Hospital
Cox Medical Centers and Health Services
DCH Healthcare Authority
Delnor Community Hospital
Dreyer Medical Clinic
Duluth Clinic
East Alabama Medical Center
Edward Health Services Corporation
Flagler Hospital
Florida Hospital
Freeman Health Services
Freeport Memorial Hospital
Glenoaks Medical Center
Hangzhou Health Bureau
The Good Samaritan Hospital
Grady Health System
Greenwich Health Authority
Hamot Medical Center
Hazleton-St. Joseph Medical Center
Hinsdale Hospital
Holy Redeemer Hospital and Medical Center
Horizon Health Care Group
Howard Young Medical Center
Humility of Mary Health Care
Illinois Medical Billing Service
Integris Health System
Jackson County Memorial Hospital
Johnston Memorial Hospital
Kennebec Health System
Lakeland Regional Health System
Little Sisters of the Poor Health Services
Los Angeles County Department of
Health Services
Marion General Hospital
Medical Center of Southern Indiana
Memorial Health Alliance of Burlington
Memorial Health Services – Long Beach
Memorial Hospital – Belleville
Memorial Health System – South Bend
Mid-Maine Medical Center
Michigan HealthLink
Miller-Dwan Health System
Mount Clemens General Hospital
Muskogee Regional Medical Center
Nebraska Methodist Health System
Presbyterian Health Care Services
Progressive Health System
Providence Medical Center
Pungo District Hospital
Rapides Regional Medical Center
Ravenswood Hospital
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Resurrection Health Care Corporation
River District Hospital
Riverside County Health Services Agency
Robert Wood Johnson University Hospital
Rush North Shore Medical Center
Salinas Valley Memorial Hospital
San Antonio Community Hospital
Scripps Clinic
Shadyside Hospital
Sharp HealthCare
Sisters of Charity of Nazareth Healthcare
System
South Jersey Hospital System
Southeastern Ohio Regional Medical Center
Southern Illinois Health Corporation
St. Agnes Hospital
St. Clare’s Hospital
St. Elizabeth Hospital
St. Francis Medical Center
St. Joseph Health System – Orange, CA
St. Joseph Hospital – Cheektowaga, NY
St. Joseph’s Hospital – Marshfield, WI
St. Joseph’s Medical Center – Brainerd, MN
St. Luke’s Hospital – Duluth
St. Mary’s Hospital – Amsterdam, NY
St. Mary’s Hospital – West Palm Beach
St. Mary’s Medical Center – Duluth
St. Vincent Infirmary Medical Center
Stillwater Medical Center
SwedishAmerican Health System
Texoma Medical Center
Tulane University Hospital and Clinic
University of Tennessee Bowld Hospital
Valley Hospital
Washington County Health System
William Beaumont Hospital Corporation
Willis-Knighton Medical Center
Yuma Regional Medical Center
Dorenfest China Healthcare Group
Dorenfest’s Investigation of China Healthcare in
2005-2006
1.
Visited 17 cities in China
2.
Met 100’s of healthcare industry leaders in China
3.
Visited over 100 hospitals to review hospital operations and define
opportunities for improvement
4.
Met provincial and city health bureau leaders in cities visited
5.
Met with many companies selling products and services to the healthcare
industry in China
6.
Evaluated a group of hospital ownership and management opportunities and
assessed viability of the Dorenfest “model hospital” in China
7.
Developed a strategy for bringing Dorenfest’s skill and experience to China
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Dorenfest China Healthcare Group
China Healthcare Leaders Want To “Leapfrog”
the World
1.
Chinese hospitals and health bureaus are making considerable investment in
hospital improvement and information technology use
2.
To do this, Chinese health leaders are working diligently to acquire the skills
needed to make progress more rapidly by doing the following:
 Learning quickly from the global experience
 Doing more of what the rest of the world did right and less of what the
rest of the world did wrong to avoid the mistakes that other countries
have made
 Overcoming resistance to change
 Learning how to manage change
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Dorenfest China Healthcare Group
Examples of Dorenfest Projects in China



Some health bureau clients for RHN and digital hospital planning
–
Shenzhen
–
Chongqing
Some hospital clients
–
Peking University Third Hospital
–
Shanghai Changning Maternity & Infant Health Institute
–
Rizhao City People’s Hospital
Help clients from other locations bring their skills to mainland China
–
Hong Kong Hospital Authority
–
Microsoft
–
Philips
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Dorenfest China Healthcare Group
Hangzhou Health Bureau
Evolution of RHNs Around the World
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Dorenfest China Healthcare Group
History of HIT Leading to the Beginning of RHNs in
the U.S.
1.
The U.S. began automating manual work processes in the late 1960s

Financial systems was the area of emphasis until the later 1970s, when
limited clinical systems began to be implemented

Clinical systems, after first emerging on a very limited basis, began to
proliferate in many clinical departments in the 1980s
2.
By the late 1980s, there was lots of automated patient clinical data available on
hospital and physician office computer systems with one person’s health data
stored in many different automated systems at many different locations
3.
This situation resulted in much duplication of data, as well as duplications of
testing and treatments given to patients
4.
This situation motivated the development of the idea of sharing data among the
different healthcare facilities to make healthcare more efficient, and to produce a
single electronic patient healthcare record.
5.
This situation began the movement towards RHNs that started in the early 1990s
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Dorenfest China Healthcare Group
RHNs Began in the U.S. in the Early 1990s as
Community Health Information Networks (CHINs)
Hospital B
Nursing Home
Doctor’s Office
Patient Data
Outpatient Clinic
Outpatient Clinic
Government
Reimbursement
Insurance Payor
Doctor’s Office
Doctor’s Office
Hospital A
Home Health Agency
Blood Bank
Outpatient Clinic
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Dorenfest China Healthcare Group
The First Generation of RHNs in the U.S. Did Not
Succeed
1.
Community health information networks (CHINs) began in 1990 as the first
generation of RHNs in the U.S.
2.
CHINs were formed with a broad vision of sharing information among health
organizations within a city or state, but failed for the following reasons:
 They lacked clear objectives
 Potential participants and stakeholders were not attracted to CHINs
because they could not see their value
 While much money was invested by many CHIN projects, the net result
was that none of them worked because the value to participants and
stakeholders was not apparent to them
3.
Integrated delivery ownership models emerged in 1993 as the hospital’s
answer to the Clinton healthcare reform proposal
4.
By the middle 1990s, integrated delivery systems emerged in every city in the
U.S., and the CHIN concept disappeared by 1996
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Dorenfest China Healthcare Group
The Second Generation of RHNs, Referred to as
RHIOs, Emerged in the Decade of the 2000s


RHIOs were the second generation of RHNs in the U.S.
–
Many different organizations promoted them in the early 2000s
–
By 2004, national policy emerged through the Office of the National
Coordinator for Health Information Technology (ONCHIT)
In the ensuing several years between 2004 and now, almost 100 officially
designated RHIOs emerged
–
Heavy investment required to start up these RHIOs
–
Many were unable to find a sustainable operating model and approached
financial collapse
–
Some long term successes emerged to share limited data
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Dorenfest China Healthcare Group
An Example of the Successful RHIO is the Indiana
Health Information Exchange (IHIE) Project
1.
Started in 2002
2.
Now, any Indiana physician can get access to patient data from many data
sources
3.
The IHIE provides services that its participants and stakeholders in community
healthcare organizations are willing to pay for happily and that benefit them,
including clinical data sharing among many users
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Dorenfest China Healthcare Group
An Example of a Failed RHIO in the U.S. Is the Santa
Barbara Project
1.
The Santa Barbara County Care Data Exchange was once one of the most ambitious
and publicized US health information exchange efforts. Eight years after its inception,
and several months after providing some data, the Santa Barbara Project shut down
operations. Despite its developed HIE infrastructure, participants found no compelling
value proposition in initial HIE services. When external funds were ending, the project
board voted to close down project operations.
2.
Lessons learned:
 The project received a large grant and was viewed as a demonstration project for
RHN forward movement. When the large grant funds were used, the project
participants faced more risk than they were willing to undertake, given the unclear
value proposition for the participants .
 The project lacked leadership and participants were passive while the money was
spent and lacked interest in putting their own funds into the project
 The project lacked momentum and credibility. Delays in the project due to
technical reasons dulled interest among community participants and created
doubts about the project’s credibility
 The vendors providing software to the project overpromised what could be
delivered
 Finally, and most importantly, the project lacked a compelling value proposition
with appropriate benefits to key stakeholders, and therefore the stakeholders did
not support the project
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Dorenfest China Healthcare Group
A Summary of RHN Efforts in the Rest of the World
1.
RHN-type efforts have been taken on by many countries. Some of the leading
successful examples include:
 Hong Kong
 Singapore
 Australia
 Canada
 England
2.
In the next pages, we elaborate on Hong Kong and Canada as examples of
worldwide RHN success stories
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Dorenfest China Healthcare Group
The Hong Kong Hospital Authority Success Story
1.
The Hong Kong Hospital Authority was formed in 1991 when over 40 hospitals in Hong Kong
were combined under a common management authority, allowing central decision making, which
was a key to the success of the Hong Kong Hospital Authority IT efforts over the next 20 years
2.
Hong Kong Hospital Authority manages all public hospitals and government outpatient clinics.
HKHA started its IT program in 1991, including financial, HR, patient administrative and
departmental systems. In 1994, it began developing its Clinical Management System (CMS). HA
adopted a centralized approach in developing its CMS for clinical care, greatly reducing IT cost
per hospital. 94, it began developing its Clinical Management System (CMS). Interoperability
between different hospitals was one of the key aims in developing the CMS system
3.
To date, the HA has spent 200 million USD on the development and implementation of clinical IT
systems
4.
The electronic patient record, (EPR), was first developed in 2000 using a unified information
model. It provides a standardized repository of all clinical data collected throughout the HA and
offers a clinician-friendly view into the comprehensive longitudinal lifelong record of the patient.
Currently 9 million patient records are held in the EPR
5.
The Hong Kong Food and Health Bureau established an EPR sharing project in 2006 to allow
patient records to flow freely between different care settings in both the public and private sectors
throughout Hong Kong. This program will use the core technologies of the Hong Kong Hospital
Authority to help make the sharing with private hospitals a success. The program is well
underway now
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Dorenfest China Healthcare Group
The Canadian Success Story
1.
An independent non-for-profit corporation called Canada Health Infoway was
established in 2001 to lead the national EHR efforts with all federal, provincial
and territorial government as stakeholders
2.
Canada created a national framework to guide the development of an
interoperable EHR across all jurisdictions. Each jurisdiction determines its own
implementation strategy. Canada has national agreement to use a distributed
model approach with health data emanating from different operational
applications within a given jurisdiction
3.
In this model, the pan-Canadian EHR consists of many EHRs resulting in a
peer-to-peer network of message-based interoperable EHRs deployed across
Canada
4.
The results of Canadian RHN efforts are substantial. Since inception, Infoway
has approved 241 projects in the following targeted program areas: Diagnostic
Imaging System, Drug Information System, Infrastructure, Innovation and
Adoption, EHR, Lab Information System, Public Health Surveillance, Registries
and Telehealth
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Dorenfest China Healthcare Group
What Are the Lessons To Be Learned from Failed
RHN Programs Around the World?
1.
There was a substantial amount of wasted investment in RHN type programs
in the U.S. and some other countries. These programs failed for reasons
described below
2.
They started with broad visions, but had great difficulty creating implementable
plans
3.
The failed programs over-simplified implementation approaches to create
flawed programs
4.
Because of lack of clear objectives, stakeholder commitment could not be
generated, causing lack of user interest in the efforts of these RHN programs
5.
When success was accomplished, it was done through limited, well thought
through first steps and strong stakeholder participation and support
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Dorenfest China Healthcare Group
Summary of Factors Creating Successful RHNs
Around the World
1.
The common ownership factor with centralized decision making has been a
key factor in some of the most successful RHNs around the world, such as
Hong Kong
2.
In successful RHNs without common ownership, a governance and
management structure was created that worked very well to generate
stakeholder commitment and support
3.
Generate political support and strong coordination to involve the various
stakeholders and users of the RHN to come together on the purpose, goals,
and objectives of the RHN
4.
Have clearly stated and shared goals and well-defined business models so that
IT can provide effective support
5.
Find good first steps. Good first steps will let health facility leaders see the
benefits and become willing participants in the RHN
6.
Select partners carefully and wisely
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Dorenfest China Healthcare Group
Hangzhou Health Bureau
Evolution of RHNs in China
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Dorenfest China Healthcare Group
Evolution of RHNs in China
1.
The Ministry of Health (MOH) guidelines for Health I.T. Development called for
regional health networks and digital hospitals to be implemented throughout
China between 2003 and 2010
2.
This provided much momentum for RHNs a few years ago, as many health
bureaus undertook regional health network and digital hospital investment
3.
In the last few years data sharing has begun to emerge in China as some
RHNs share limited data such as test/diagnostic results and some patient
information
4.
Healthcare reform calls for e-health records and RHN development and has
provided substantial additional funding in a variety of ways, so it is expected
that substantial additional progress will be made in the next few years
5.
Much more activity and funding in many cities and provinces with even U.S.
funding for one or two major planning projects, including the Sichuan Provincial
Health Bureau EHR and Regional Health Network Project
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Dorenfest China Healthcare Group
We Studied Seven City RHNs in China to Learn
Progress
1.
Recently, we did an RHN consulting project in which we studied seven regional
health network programs. The seven cities or provinces are listed below
2.
The 7 cities or provinces are listed below:
 Dongguan, Guangdong Province
 Hebei Province
 Foshan, Guangdong Province
 Shanghai
 Shenzhen, Guangdong Province
 Beijing
 Xiamen, Fujian Province
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Dorenfest China Healthcare Group
We Studied Seven City RHNs in China to Learn
Progress (Continued)
3.
We dedicated our efforts in studying these 7 cities to answer the following key
questions:
 What does the RHN do?
 What are the benefits so far?
 How much is the investment so far?
 Which vendor is used?
 What are the success factors and potential challenges?
4.
From this study, we identified some common challenges these RHNs are
facing, as well as some important success factors, which are outlined on the
following pages.
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Dorenfest China Healthcare Group
Our Observations About the 7 City RHN Programs
We Studied
1.
Some common issues we observed are as follows:
 All have a large vision to implement an EHR, but first steps in execution
were often unclear
 All are trying to do too many things at once
 The city or provincial government has made a substantial part of the
initial investment for the RHN and plays an important role in planning and
coordinating RHN efforts
 Technical issues do not seem to be obstacles preventing success in any
of the 7 programs
 All 7 programs are in their early stages of execution, and it is difficult to
forecast how successful they will eventually be. There is much more
work to be completed than the work that has already been done
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Dorenfest China Healthcare Group
Our Observations About the 7 City RHN Programs
We Studied (Continued)
2.
There are key differences in the seven city RHN programs as follows:

The first step in these city programs is different from city to city. Good first steps
can get better stakeholders support. An example is that Dongguan provided a free
Office Automation system and citywide appointment system to attract the hospitals
to involve in the city RHN.

The approaches to building the RHNs in these 7 cities are different. We think the
reasons for the differences include the following:
– The more complex that hospital ownership and medical service resource
distribution are within a city, the more stakeholders are involved and the more
difficult it is to make progress
– If funding requirements are not large and can be provided by a single entity,
such as the city health bureau, or the city government, then the whole
program can be managed with a more centralized approach
– Cities that started their RHN pilot programs earlier have gained some
experience, which has made these cities very aware of the importance of
good planning and a more structured approach

The amount of investment in the 7 cities has varied considerably. The investment
depends on the city size, approach taken to the RHN, and whether or not a good
plan is in place
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Dorenfest China Healthcare Group
The Best Approach to Building Success in an RHN Is
by Building a Strong Foundation
1. Carefully define first steps, make them simple and beneficial, and gain
stakeholder support
2. Limited data sets with high benefit to many stake holders would be
advantageous
3. When first steps prove beneficial, more aggressive second steps can be taken
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Dorenfest China Healthcare Group
Hangzhou Health Bureau
EMR Evolution and Its
Relationship to RHNs
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Dorenfest China Healthcare Group
Opportunities to Improve Healthcare Delivery Have
Been Pursued for Many Years

Great redundancy of information

High error potential

Lack of timeliness

High cost

Organization complexity
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Dorenfest China Healthcare Group
U.S. Hospitals Have Sought an EMR Since the 1960s
Through Four Generations of I.T. Systems
1.
Finance Systems (1960s and 1970s)
2.
Limited Clinical Systems (1970s and 1980s)
3.
More Advanced Clinical Systems (Late 1980s and 1990s)
4.
Electronic Health Records (2000s)
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Dorenfest China Healthcare Group
Current Status of EMR Adoption in U.S. Hospitals
 EMR adoption in U.S.
hospitals is still limited
 According to 7-stage EMR
adoption model of HIMSS
Analytics:
– Stage 4 Is considered the
minimum level an EMR is
used effectively
– By the end of the second
quarter of 2010, 83.7% of
hospitals are still under
stage 4. Only 16.3% are
in stage 4 or higher
 US hospitals still have a long
way to go in adopting EMR
Hangzhou Health Bureau
Data from HIMSS AnalyticsTM Database © 2010
(formerly The Dorenfest Integrated Healthcare Delivery System DatabaseTM)
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Dorenfest China Healthcare Group
The Stepping Stones to Paperless
Community Based
EHR
EMR
Hybrid
Record
Traditional
HIS collects
information
Digital documents,
Paper based
common views,
files and workflow
multiple access points,
with some computers
HIS and departmental
systems
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Codified data
in EMR integrated
with other clinical
systems
Data sharing across the
continuum of care,
payers, patient, etc.
Dorenfest China Healthcare Group
Overview of EMR Status in China
1.
EMR is critical to the long-term success of citywide data sharing in RHNs
2.
Today, many Chinese hospitals have an EMR operational or in implementation
3.
While some of these EMRs are working well, many of these EMRs are causing
more problems and work for clinicians in the hospitals. Some reasons for this
include:
 Data entry by physicians through CPOE has added time to their workday
without providing offsetting benefits
 Methods of entering information into the EMR is often through straight
typing with very little facilitation through assisters to make EMR entry
easier
 In many EMR systems, it is difficult to find what is wanted, as compared
to finding it in the manual record
 In many EMR systems in use today, erroneous data finds its way into the
EMR, because of poor integration of a variety of software systems in use
by the hospital
4.
These problems have emerged because many EMRs were purchased without
adequate clinician involvement and were implemented with poor clinician
training
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Dorenfest China Healthcare Group
Some Suggestions for Creating Successful EMRs in
Chinese Hospitals
1.
Make a very careful evaluation of the EMR software products available. Take
a careful look at how other hospitals use them in order to build up a solid
foundation for the buying decision
2.
Involve a large enough group of clinicians at various stages of the software
evaluation so that they understand the differences between products and can
contribute their wisdom to the buying decision
3.
Use the clinicians who were selected to be involved in the buying process as
super users during the implementation and as trainers of the other clinicians
4.
Do not oversimplify your evaluation. Be sure and look carefully at how the
EMRs are working at user sites to be able to understand what you need to do
to be successful in implementing an EMR
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Dorenfest China Healthcare Group
Planning Hospital EMR and RHN Together by Using a
Hospital Clinical Data Repository Can Be Beneficial
1.
RHNs in China are or will be sharing patients’ clinical data extracted from different
organizations. The types of data shared or to be shared include, but are not limited to,
lab test results, diagnostic imaging test results, and even the images themselves
2.
These types of data are usually stored in different components’ clinical information
systems. To be able to easily share this data, there is a need to have a consolidated
database within each hospital. This type of database is called a Clinical Data Repository
3.
The Clinical Data Repository can be used in the hospital to extract and store data from
the EMR for hospital medical decision-making purposes
4.
The Clinical Data Repository structure and data model can be made to have some
common characteristics for all of the hospital EMRs so that the data sharing among
hospitals is made easier
5.
The citywide RHN data model can then be structured to draw data from the Clinical Data
Repositories in each hospital
6.
By giving this careful thought as the EMR strategies for the hospitals are further
developed, the citywide RHN foundation will be stronger
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Dorenfest China Healthcare Group
THANK YOU.
FOR MORE INFORMATION CONTACT:
SHELDON I. DORENFEST OR XIAO LIU
THE DORENFEST GROUP
NBC TOWER, SUITE 2725
455 N. CITYFRONT PLAZA DRIVE
CHICAGO, IL 60611-5555
UNITED STATES OF AMERICA
PHONE: 312-464-3000
FAX: 312-467-0541
THE DORENFEST CHINA
HEALTHCARE GROUP
HUAIHAI EAST ROAD NO. 45
HUAIHAI PLAZA
SUITE 908
SHANGHAI, CHINA
PHONE: 021-51001821
WEB SITE ADDRESS: www.Dorenfest.com
E-MAIL ADDRESS: [email protected]
SHELDON’S E-MAIL ADDRESS: [email protected]
XIAO’S E-MAIL ADDRESS : [email protected]
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Dorenfest China Healthcare Group