ICT engaged telemedicine: SNUBH experiences

HEE HWANG, MDDepartment of Pediatric Neurology

Center for Medical Informatics, SNUBH

ICT TECHNOLOGY & QUALITY OF CARE

HEE HWANG, MD, CIO

Seoul National University Bundang Hospital

740 physicians / 1,300 nurses

1,400 beds/ 38 operating rooms

6,500 outpatient visits / day

Over 80,000 radiologic exam /

month

2

515 Physicians & 780 Nurses

910 beds, 23 operating rooms

4,000 outpatient visits / day

Over 70,000 radiology exam /

month

2010 2017

IT Adoption Status

3

SNUBH IT Evolution Path

World Best IT

Leading

hospital

2003

2015

2014

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Extension to 909 beds

Telehealth pilot project

Health information exchange (HIE) system

Real-time asset tracking system

Closed loop medication administration

Design of next generation HIS system

Next generation PACS system

Developing next generation HIS

DR system

Desktop virtualization

Mobile EMR

Dashboard

Next generation HIS

Patient Guide & Bedside Concierge

First HIS implementation in KSA

RTLS asset tracking system

2016

2017First HIS implementation in USA

Full digital general hospital (609 beds)

USA, SureScripts Certification

BESTCare2.0C(Chinese Ver.) Launch

Awards

4

2010 2011 2012 2013

First Hospital Chosen

as “Best Practice of

IT Convergence”

by NIPA* (National IT Industry Promotion Agency)

First Hospital to Win

National Presidential

Prize for IT Innovation

Winner of HIMSS-Elsevier

Digital Healthcare

Award

2014

Outstanding ICT

Achievement

• Winner of ReddotDesign Award

• Winner of iF Design Award

• SAP Innovation Award

First HIMSS Stage 7

outside North America

SAP HANAInnovation award

Big Data part “Social Hero”

Harvard Business Review

SAP SAPPHIRE NOW IT Innovation Award

Social HeroTrailblazer Big Data

Global Expansion

-7-

With the excellent capabilities and world class solution, BESTCare 2.0, Consortium

expanded its business to M.E. and Asia, preparing to jump into Global HIS company.

Asia

Middle East

1

North

America

3

Entering KSA (’14)

– MNG-HA1) hospitals

Entering UAE (’14)

Planning to enter other M.E. countries by JV2) (’16)

M.E.Asia North

America

1 2

3

Planning to enter U.S.

– ONC HIT3) certified

– Achieved global brand recognition

Entering USA (’17)

– Aurora Behavioral Healthcare(14)

Planning to enter China (’17)

– Developing BESTCare2.0C

– Tapping to Enter

Note : 1) Ministry of National Guard, Health Affairs 2) Joint Venture 3) Certified Health IT Product List by The Office of the National Coordinator for Health Information Technology

Europe

4

Europe

4 Planning to enter EU (’17)

– Tapping to Enter

– UK & Ireland

2

KAH5) + IAAFH6)

Connected PHCs

Go-Live

(Project period : 2.5

months)

Successful Implementation History in KSA

8

Note: 1) King Abdullah Specialized Children’s Hospital 2) King Abdulaziz Medical City in Riyadh 3) King Abdulaziz Medical City in Jeddah 4) Prince Mohammed Bin Abdulaziz5)King Abdulaziz Hospital 6) Imam Abdulrahman Al Faisal Hospital

KAMC-R2) +

Connected PHCs Go-

Live

(Project period : 10

months)

KAMC-J3) +

Connected PHCs

Go-Live

(Project period : 5

months)

KASCH1) +

Connected PHCs Go-

Live

(Project period : 8

months)

2015 Apr. 2016 Jan. 2016 May.

Total beds : 566 beds

Go-live of fully functional HIS

& Smart Hospital features

without system roll-back

Total beds : 1,215 beds

Successful data

migration & change

management from

existing system

Total beds : 707

beds

Shorten project period

through deployment of

single version

2016 DEC

※ KASCH & KAMC-R achieved HIMSS Stage 6 within 8 months after BESTCare go-live

PMBAH4) +

Connected PHCs

Go-Live

(Project period : 2.5

months)

2016 Aug.

Total beds : 320

beds

Shorten project period

through deployment of

single version

Total beds : 585

beds

Shorten project period

through deployment of

single version

Paradigm Shift of Medicine

PREVIOUS PARADIGM NEW PARADIGM

Descriptive medicine

Empirical diagnosis

Grouped by Organ Site

Uniform treatment

Retrospectively diagnose

Acute care Early detection and intervention

Prospectively evaluate relative disease risk

Individualized treatment

Subgrouped by molecular/biological classification

Mechanism-based diagnosis/treatment

Understanding of disease mechanisms

ICBM-based Healthcare

IoT Cloud Big Data Mobile

Lifestyle + Environment + Phenotype + Genotype Mobile Services

11

Core “4C” Agents in EMR for Healthcare Transformation

4C

CLMA(Closed Loop

Medication

Administration)

CDSS(Clinical Decision

Support System)

CP(Clinical

Pathway)

CI(Clinical

Indicator)

Patient Safety

Standardized Practice

Quality Control

11

12

Medication Administration

(Right patient, Right medication, Right dose, Right route, Right time)

Crosscheck patient ID and medication barcode

Print RFID wristband RFID wristbands given to all inpatients

1 2

4

Scan RFID tag to staff ID card and patient’s RFID tag to wristband

3

Mismatch

Save

(Right patient, Right medication, Right dose, Right route) (Right time : Plan ±1 hour)

Wrong patient ID!

Wrong Time! Check time of administration.

Time of administration

SNUBH’s CDW history

2004

CDW 1.0 OPEN

2005 2012 2013

Clinical Indicator OPEN

Request Analysis

CDW 2.0 OPEN

*NEW ADDITION

Insurance Indicator &

Infection Indicator

255 Indicators

320 Indicators

2015

Currently

463 Indicators

14

Clinical Data Warehouse (CDW)

Data Warehouse

PatientInfo.

MedicalRecords

Nursing records

OrderInfo.

FinancialInfo.

TestInfo

OperationDB

ETL

Updated

Daily

ODS

Managers

WorkingUsers

Users

CI CP

Test Tpl

Order …

ExtractionTransfor-mationLoad

CDW

OLAPSever

CDWWeb Server

OLAP Server +Web Server

In-Memory Platform

DX

OP Test

Rx

CC

TplPT

NU

Memory

ETL

In-Memory Big data Solution

22

86 115

183

261

337

376

416 436

503

556

6

46 73

113

181

253 288

325 345

410

463

0

100

200

300

400

500

600

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

No.

Year

Number of Clinical IndicatorsTotal number of CI

Total number of computerized CI

15

Clinical Indicator Development/Monitoring

547 electronically

managed indicators. (As of 31.12.2016 )

16

Optimal Prescription of Preventive Antibiotics by CI Application

0%

10%

20%

30%

40%

50%

60%

70%

80%

1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q

2007 2008 2009 2010 2011 2012 2013 2014 2015

Avoid antibiotics to rate (%)

3rd Cephalosporin administratio rate (%)

Aminoglycoside administratio rate (%)

Combination of antibiotics rate (%)

Administration rate of non-recommended antibiotics: target (10%)

Appropriateness at SNUBH improved via CP, after-cause analysis,

and course-correction with the medical department

Credited to its CI application, SNUBH provides consistent quality of healthcare, such as improving

preventative antibiotics administration rates beyond target level

17

What is Population Health Management?

…a transformational approach to healthcare delivery that shifts the

focus

from caring for patients who self-select for care based on their

own assessment of their condition

to

taking transcendent responsibility for the health status of a

cohort or population of patients.

Source: HIMSS 2017

18