- 1. Implementability and Sustainability in Health Information
Technology (HIT) SolutionsBlent KunaBSc & MSc CEng. METU Vice
President, Tepe International & corTTex Member of the Board,
TURKMIA Chairman, HL7 Turkey [email protected]
2. Agenda: Company ProfilesCurrent Status in Healthcare &
HITWhat is Needed for a Successful HIT ImplementationWhat is Needed
for a Sustainable HIT Success?Some Good Examples 2008 Tepe
International 3. Among top holdings in Turkey Leading e-Health
company in Europe $3+ Billion annual turnover$ 250+ Million annual
turnover 62 Companies Serving 300,000 physicians, dentists, 22,000
Employees.specialists40+ companies and 1,700 employees, 2008 Tepe
International 4. Leading Health Information Technologies (HIT)
Company In Turkey Operations in 6 countries $32 M Turnover 205
Employees 2008 Tepe International 5. corTTex Enterprise Enterprise
EPR Information System corTTex HISIntegrated Hospital Management
System corTTex RADMulti Media Radiology Information System corTTex
LABMulti Media Laboratory Information System corTTex
PHARMPharmacology Information System corTTex MEDDat Enterprise
Medical Data Dictionary corTTex CISCardiology Information System
corTTex MedRas Resource Planning, Cost Accounting corTTex ProMis
Distributed Asynchronus MIS corTTex RTIS Radiotherapy Information
System corTTex NMIS Nuclear Medicine Information System corTTex
DRGManager DRG Management System corTTex ECPElectronic Claims
Processing System MEDSIMOptimization and Simulation TERMANSemantic
Terminology Manager UBB National DATA Bank for Pharma, Med. Dev
NORAL Fraud Detection System 2008 Tepe International 6. Tepes
Involvement in National Healthcare Reform Improving current Fee For
Service Payment System Development of National On-line Provision
and e-Invoicing Systems Development of National DRGs, ICD-10 TRM to
enable Prospective Payment System Development of National Health
Supply Chain Management System Development of National Data Banks,
Registries Drugs, Devices, Materials/Consumables Hospitals,
Physcians, Pharmacies, Citizens... Development of Simulation Tools
Development of Fraud Detection Systems 2008 Tepe International 7.
is the only IT solution provider in KSA who can commit, deliver and
sustain an end-to-end solution including Services, Hardware,
Software and Technology Full End-to-End CapabilitiesProfessional
Integration Outsourcing ServicesServicesServicesPlan and design the
solutionBuild the solution using state- Run, manage and grow
thebased on industry bestof-art technology including solution using
the highestpractices and thoroughbusiness applications,operational
standardsleadership know-how hardware, software, operatingsystems,
and network Saudi Business Machines Ltd.Product OfferingIntegrated
Technology Professional Services Systems & Software
ServicesBusiness Consulting Services 2008 Tepe International 8.
LEAST TRUSTED: 1. Car sales men2. Real estate agents3. Computer
sales men4. The internet Martin Lindstrom, born 1970, founded his
own advertising agency at the age of 12. Needless to say, Lindstrom
has a highly unusual background. According to the Chartered
Institute of Marketing, the rapid rise of his career has made him
one of today's most respected branding gurus in the world. He sits
on several boards globally, and his clients include Disney, Mars,
Pepsi, American Express, Mercedes-Benz, Reuters, McDonald's,
Kellogg's, Yellow Pages 2008 Tepe International and Microsoft. 9.
Current Status in Healthcare & HIT 2003 IBM Corporation 10.
2008 Tepe International 11. Current Healthcare Environment 2008
Tepe International 12. How about the costs?US Total Spending on
Healthcare in 1980: 25 Billion USDUS Total Spending on Healthcare
in 2005 : 1,600 Billion USD *Relative Increase: 5,000+ %* 31% Cost
($500 Billion) caused by paperwork SOURCE: Journal of Healthcare
Information Management Vol, 19, No 4, Page:17 2008 Tepe
International 13. Is it only about $$$ ? 2003 IBM Corporation 14.
Please solve the paradox: 2008 Tepe International 15. HIT Status:
Something is wrong! X 2008 Tepe International 16. An analogy from
the authorities: This is healthcare This is your healthcare IT
provider in healthcare 2008 Tepe International 17. LDELTA ADT
RHEMOCARE Physician Billing (Daily) S M H A A SAMPLE MIS v5.01 CIS
v3.09.01 / 49 ORSOSLEE /HP /CCH v5.2aHP LAB 1 48CCHS A HOSPITAL
LEE/ HP /CCHGS9HGLEE /HP /CCHm Sv rInstrumentsCH R X C/4 Svrb Ter
Order)DX-PR489 TUMOR REG (Mthly) F A FROM USA rm4 8 /4 P La M RX
n-TS T e CHGSTS HADT y) LEE / HPTNo UL SUL ail FES D / RE LEE LAB(D
P(on HH INVISION v24- Lee & HPOBF FTPD/RADT; OROR InstrumentsR
CLAIMS T; FTP PayorsSSI G (CICSINVA - L0A9) ADS (Daily)QOB F L/H/C
HL7 FIX FIX1PMRX FL GENERIC TIFFIX RD/DT; O RX INDIGENT Reimb.
TLEE/HP/CCH (Mthly) PMA SOFTMED TIFFIX O FIX/ ARESULTS Lee Lab Term
SvrDawningHL7 PATIENT ACCOUNTINGH CCH LAB S RX TIF ASIP HL7ADT; ORD
/ RESULTS LabTerm SvrCCHDIAB TRMT DX-PRGENIE TIFE ADT; Lab Results
Instruments AHL7 HL7CCI# 2 GEACLEE /HP(Mthly) M OAM / PMSAN
M-RXM-RXCLINICOMP (on Mainframe)MAXSYS SOFTMED RTIF HL7M-RXLEE /
HPVOF & Misc LEE / HP / CCHLEE / HPDX-PR CI ARAD RTIFL ADT ;
ORD;(on Mainframe) (Daily) TieN HL7LAB RTIFI HL7 CHGS PROCAR PYXIS
LEE / HP /) MEDICAID ily FHL7/FIX CCHRX1000DaLEE / CCH 7M D
HerringRHEMOCARE RTIFN DE E )(Herring Collections HL7M
CCHNCNTHPuest)CCH A CLINIVISION RTIF MK sTA (92 OLLLEE/ HP Chg AHL7
MIT 7M) MAI & (Wkly) M BCF (Lee/HP TANKFILE)PYXISk)MIS (By
Req/w/93 ADT ; CHGSM: YRE: FIXRE 93 & aily v 1x aint;HL7PROCAR
1000 CCH FILE VOLHDX (T/RTIF) ; EAD (T/RTIF) 2/ (D RecPA GEACSTHP(9
C: MLEE / HP / CCHREV Rw/ MBLUE E PLECH M v21.4.2-3Q/R AR CROSS
PA(Daily) EC M PYXISEM (on Mainframe) IC ECC:VANED CLEE / HPO FVMS
6.2 ADT ; CHGS1000 VOL AB EDI /M AN )OGL REHT 7M
(Daily:REVEADLEEFTP IT &R A HL7PROCARLMHS M Recv 3x/wk) (Mthly)
GLv23.1CUTE RE 2/93 TrendstarMFAXNET Contract HDXA (9TrendstarLEE
/HP/ (CICSEADA-OMAINFRAME: CCHAMGMT Eligibility RS1/ OBF CCH
LEE/HPCDM T CCH E0A9)FIX OBF FTP REFORMAT REMITS (92/93 & 7M)
(Mthly) AB FTP Files HERRINGF(Monthly) LEE / /R OCCH Pat Detail
CADT / RT ORDERS ; CHG CLINIVISION v3.3H FAXHL7 EC (Wkly) CC:
RecipientsLEE / HP HP CCHWX Q HBSI Pat DetailFIX/HL7 ADT; COR LAB
RESULTS LEE/HP FAXNETHBSI(Mthly) WXINVISION v24 - CCHPYXIS ADT;
PYXIS ORDSMS PHARMACYHL7v1.3.43 LEE/HP CDM RX CHGS: PYXIS HL7;
ORSOS 48/49v23.0Lee/HP/CCH M A(CICSINVA - N0A9)FIX /HL7FAX(Mthly)
FLEE / HP / CCHCCH Day-End- All RX CHGS- 48/49 RecipientsPMFIXOBF
DecnetHPSTATE RPT STGENERIC TIFFIXSMS RADIOLOGY AHCA ADT with ORDER
w/SOFTMED TIF HL7HL7v24PATIENT ACCOUNTING LEECC:Outside (Qtrly) CRX
TIF ASIHL7COR- RESULTS; OSU- CHGS; AOOLEE / HP / CCH Transcription
GENIE TIF HL7Lee/Hp Physician BillingHL7 ADT / ORDERSSMS OPENLab
Perse OAM / PMSCOR- RESULTS; OSU- CHGS/AOO ; TranscriptionPath
Demos & Chrgsv25.6CC: Perse CCHRad DemosC SOFTMED RTIF HL7FIX/
LABINSTR ADT; ORD/ RESULTSLEE / HP / CCHServ Org (TSO) `RAD RTIF
HL7HL7 (Daily&Monthly)LAB RTIF HL7/FIX Prod 3M
ENCODERLee/HpCC:17 PersePhysician BillingHEMOCARE
RTIFHL7HL7ADTChartLincSOFTMED Perse Rad- R SMS BCF (CCH
TANKFILE)FIX DX-PROC; TRANSCRIPv6.0 LEE/ HP /CCHDICTAPHONE CCH
Chrgs M S RADHL7 2008 Tepe InternationalHDX
(TIF/RTIF)LEE/HP/CCH(Trans. Rpts) F (Daily) 1 EAD (TIF/RTIF) 18.
This is the right analogy: This is Healthcare Environment This is
Healthcare ITProvider 2008 Tepe International 19. What is needed
for a successful HITimplementation? 2008 Tepe International 20.
Some Facts:When projects fail, its rarely technical.Jim Johnson,
The Standish Group Average cost overrun: 189% Projects re-started:
94% Time overrun: 222% Functionality delivered on average:
61%Standish Group 2008 Tepe International 21. Success factors for
HIT Implementation CEOs View:1. Strong organizational vision and
strategy 2. Talented and committed leadership 3. Partnership
between the clinical, administrativeand IT staffs 4. Thoughtful
redesign of clinical processes 5. Excellent implementation skills,
especially in PMand support 6. Good-to-excellent IT Glasser J.
Success factors for clinical System implementation. Hospital and
Health, June 13, 2005 2008 Tepe International 22. Ten Steps for
Successful HIT Implementation 1. All hands on deckPhysicians View:
2. Pay physician champions 3. Analyze your workflow 4. Build
adequate order sets 5. Recognize politics 6. Set a deadline and
mean it 7. Train, train, train 8. Exploit physician resistance 9.
Sell the benefits Baldwin G. Bringing order to CPOE.10. Crack the
whip Health Leaders, October 2005 2008 Tepe International 23. Six
Deadly Mistakes to Avoid in HIT ImplementationCIOs View:When
projects fail, its 1. Raising expactations too high rarely
technical.Jim Johnson, The Standish Group 2. Provide skimpy
training 3. Doing the big bang implementation 4. Leaving the
physicians to their own devices 5. Disregarding dissidents 6.
Giving the physicians a choiceBaldwin G. Six Deadly Mistakes.Health
Leaders, January 2005 2008 Tepe International 24. What is needed
for a sustainable success? 2008 Tepe International 25. Quick Wins
in HIT = Traps = Illusions 2008 Tepe International 26. A good
example: ... let us integrate ...Some phrases you hear
frequently:... no problem, we can integrate it ... ... it is not an
issue for us, we have the interface for that ...... we are XYZ
compliant ... ... we have already integrated it before, this case
seems quite similar ... 2008 Tepe International 27. Classical
Approach: Discrete (case by case) IntegrationHospital nHospital
1Hospital ... Hospital 2 Hospital 4Hospital 3Integration effort
amount = (n2 n) / 2 n: sites, systems or devices to be integrated
2008 Tepe International 28. Ultimate Approach: Creating an
Interoperable EnvironmentHospital n Hospital 1Hospital ...Hospital
2 Hospital 4 Hospital 3Connectivity effort amount = n n: sites,
systems or devices to be connected 2008 Tepe International 29.
Dicrete Integration vsInteroperable Environment#
sites/systems/devicesn n=2 n=10 n=100Classical Approach (case by
case Integration)(n2-n)/21 45 4,950Interoperable Environment n2 10
100 2008 Tepe International 30. Still insisting ??? 2008 Tepe
International 31. L DELTA ADT R HEMOCARE Physician Billing (Daily)
S M H AA SAMPLE MIS v5.01CIS v3.09.01 / 49ORSOS LEE /HP /CCH
v5.2aHP LAB 148CCHS AHOSPITAL LEE/ HP /CCH GS9HG LEE /HP /CCHm Sv r
Instruments CH R XC/4 Svr b TerOrder)DX-PR 489 TUMOR REG (Mthly) F
AFROM USrm4 8 /4P La MRX n-TS T e CHG S TS H ADTy) LEE / HPT No UL
SULail F ES D / RELEE LAB (D P (on HH INVISION v24- Lee & HP
OBF FTPD/RADT ; OR ORInstrumentsR CLAIMST; FTP PayorsSSI G
(CICSINVA - L0A9)ADS (Daily)Q OB F L/H/CHL7 FIX FIX1PMRX FL GENERIC
TIF FIX RD/ DT; O RX INDIGENT Reimb. TLEE/HP/CCH (Mthly) PMA
SOFTMED TIF FIXO FIX/ ARESULTS Lee Lab Term Svr Dawning HL7 PATIENT
ACCOUNTINGHCCH LAB S RX TIFASIP HL7ADT; ORD / RESULTSLabTerm Svr
CCHDIAB TRMT DX-PRGENIE TIF E ADT; Lab Results Instruments A HL7
HL7CCI# 2 GEACLEE /HP(Mthly) M OAM / PMSA N M-RX M-RX CLINICOMP (on
Mainframe)MAXSYS SOFTMED RTIFHL7M-RXLEE / HPVOF & Misc LEE / HP
/ CCHLEE / HPDX-PR CI ARAD RTIF L ADT ; ORD;(on Mainframe) (Daily)
TieNHL7LAB RTIF I HL7 CHGS PROCAR PYXIS LEE / HP / )MEDICAIDily F
HL7/FIX CCH RX1000 Da LEE / CCH7M D HerringRHEMOCARE RTIF
NDEE)(Herring CollectionsHL7M CCHNC NT HP uest)CCH A CLINIVISION
RTIF M Ks TA(92 OLLLEE/ HPChg A HL7M IT 7M)MAI& (Wkly) M BCF
(Lee/HP TANKFILE)PYXIS k) MIS (By Req /w /93 ADT ; CHGS M:YRE:
FIXRE 93 & aily v 1xaint; HL7 PROCAR1000CCHFILE VOL HDX
(T/RTIF) ; EAD (T/RTIF) 2/ (D Rec PA GEACST HP(9C: MLEE / HP /
CCHREV Rw/ M BLUEEPL ECHM v21.4.2-3 Q/RAR CROSSPA(Daily) EC M PYXIS
EM (on Mainframe)IC E CC:VAN ED CLEE / HP O FVMS 6.2 ADT ; CHGS1000
VOLAB EDI /M AN )OGL REH T 7M (Daily:REVEADLEEFTPIT &RA HL7
PROCARLMHSMRecv 3x/wk) (Mthly) GL v23.1 CUTERE 2/93
TrendstarMFAXNET Contract HDXA(9TrendstarLEE
/HP/(CICSEADA-OMAINFRAME: CCHA MGMT EligibilityRS1/ OBF CCH
LEE/HPCDM TCCH E0A9)FIX OBF FTP REFORMAT REMITS (92/93 & 7M)
(Mthly) A BFTP Files HERRINGF (Monthly) LEE //R OCCH Pat Detail C
ADT / RT ORDERS ; CHG CLINIVISION v3.3 H FAX HL7EC (Wkly)CC:
RecipientsLEE / HPHP CCHWXQ HBSI Pat Detail FIX/HL7 ADT; COR LAB
RESULTS LEE/HPFAXNETHBSI(Mthly) WXINVISION v24 - CCH PYXIS ADT;
PYXIS ORDSMS PHARMACY HL7 v1.3.43 LEE/HP CDMRX CHGS: PYXIS HL7;
ORSOS 48/49v23.0 Lee/HP/CCH M A(CICSINVA - N0A9) FIX /HL7FAX(Mthly)
F LEE / HP / CCHCCH 48/49 Recipients OBF Decnet Day-End- All RX
CHGS-PM FIXHPSTATE RPT ST GENERIC TIF FIXSMS RADIOLOGY AHCAADT with
ORDER w/ SOFTMED TIFHL7 HL7 v24PATIENT ACCOUNTING LEE CC:Outside
(Qtrly) C RX TIFASI HL7COR- RESULTS; OSU- CHGS; AOO LEE / HP / CCH
Transcription Physician BillingGENIE TIFHL7 ADT / ORDERSLee/Hp
HL7SMS OPENLab PerseOAM / PMS COR- RESULTS; OSU- CHGS/AOO
;TranscriptionPath Demos & Chrgsv25.6 CC: Perse CCHRad DemosC
SOFTMED RTIF HL7 FIX/LAB INSTR ADT; ORD/ RESULTS LEE / HP / CCH
Serv Org (TSO)`RAD RTIFHL7 HL7 (Daily&Monthly) LAB
RTIFHL7/FIXProd 3M ENCODERLee/HpCC:31 PersePhysician Billing
HEMOCARE RTIF HL7 HL7 ADTChartLinc SOFTMED Perse Rad- R SMSBCF (CCH
TANKFILE) FIX DX-PROC; TRANSCRIPv6.0LEE/ HP /CCHDICTAPHONE CCH
Chrgs M S RAD HL7 2008 Tepe International HDX (TIF/RTIF)LEE/HP/CCH
(Trans. Rpts) F (Daily) 1EAD (TIF/RTIF) 32. See the BIG PICTURE
BIHIS MIS/DSSECPTelemedicineCISe-prescriptione- HealthReference
Terminologies Reference Information Model Electronic Medical
RecordsMedical Informatics Standards Interoperability Framework
2008 Tepe International 33. Healthcare - HIT Ecosystem 2008 Tepe
International 34. Focus on Business Processes & Workflow If a
system does not fit into a medical professionals workflow, or it
slows them down significantly, it does notmatter how
technologically advancedthe system is the system will simply not be
used! ... Business logic is probably the single most important
asset of a healthcare IT system... 2008 Tepe International 35.
Process - Workflow Hierarchy VIRTUAL HEALTHCARE ENVIRONMENT
WORKFLOW WITHIN AND BETWEEN HEALTHCARE MACROFLOWS ENVIRONMENT/S
BETWEEN COUNTRIES WORKFLOW WITHIN AND BETWEEN HEALTHCARE
ENVIRONMENT/S IN A COUNTRY WORKFLOW WITHIN AND BETWEEN HOSPITAL
INFORMATION SYSTEM/SWORKFLOW WITHIN AND BETWEEN
DEPARTMENTAL/CLINICAL SYSTEM/SWORKFLOW WITHIN ANDBETWEEN
APPLICATION/S MICROFLOWS 2008 Tepe International 36. Back to the
paradox: 2008 Tepe International 37. Manage the ChangeBenefits
depend on the organization's propensity to changeThere are 4 ways
to realize the value from an IT investment 1. Purchase an
integrated system withrich functionality 10% 2. Ensure the software
allows fors of value esflexibility of designocPrPeople Te ch 3.
Implement best practice noloprocesses and workflows90% gy 4.
Persuade people to changeof valueHealthlink 2008 Tepe International
38. Be Determined !A Computer in the Exam Room? 38That it will ever
come into general use, notwithstanding its value, is extremely
doubtful because its beneficial application requires much time and
gives a good bit of trouble, both to the patient and to the
practitioner because its hue and character are foreign and opposed
to all our habits and associations. from The London Times in 1834
Commenting on ...the stethoscope 2008 Tepe International 39. Get
top executives supportREASONS WHEN HIT INITIATIVES FAIL TO%
responding "most prevalent"to each underlying reason forPRODUCE
DESIRED VALUEnot generating value from ITLack of process and IT
alignment; inadequate process change51 Lack of executive ownership
and accountability49Lack of understanding of expected business
benefits41 Communication breakdown or failure28 Bad business
objectives 24Lack of outcomes measurements24Lack of strong or
adequate project governance23 Failure to align business vision /
goals with IT22Lack of understanding of what users really needed20
Volatile situation: organization's needs changed18 Poor project
management 17 Costs exceeded benefits 16Nothing significantly
improved 14 Users did not want the IT solution12Poor performance by
vendor or consultant9 A problem of timing: the opportunity was
lost5Technical failure of software or hardware 0 2008 Tepe
InternationalAdapted from CHIME CIO Survey: IT Value 40. Find Your
Right = trusted, knowledgeable, experienced Partner BECAUSE HIT
PROJECT IS NOT: Purchasing of Good HW and Good SW On the contrary,
it is an Continuing Project which can only be accomplished:When the
Healthcare Enterprise is Ready to Work for the Project ratherthan
expecting from othersWhen both parties collaborate and are
committed for the same goalWhen both parties communicate well and
understand each other HIT Project is a Long Term Partnership of
Healthcare Enterprise and Healthcare IT Solution Provider 2008 Tepe
International 41. ... and if possible: one partner... 2008 Tepe
International 42. Manage the expectationsproject, vendor, product
customer, project teamend-userout of control expectations, requests
... 2008 Tepe International 43. Study & Implement Medical
Informatics DICOM-IIIOpenEHRCEN TC 251 ICD-10 AM ECRI UMDNS CPT-4
ACHI LOINC GMDN SNOMED CTDRG / CASE-MIX UMLS CDA, CCOW MIB 2008
Tepe International 44. Back to the Analogy DICOM-III 2008 Tepe
International 45. Some Good Examples 2008 Tepe International 46. An
Excellent Example: KFMC IHIMSKing Fahad Medical City, Riyadh, KSA
2008 Tepe International 47. An Excellent Example: KFMC IHIMSKFMC
has successfully carried all business processes into an electronic
and paperless domain with the help of multidisciplinary teams.KFMC
decided at the very early stage to implement a workflow based HIS
system designed to assure the overall continuity and consistency of
healthcare services within the healthcare enterprise via providing
an intelligent process, information and control flow predefined by
the authorities and standards. The system assures that the computer
users perform all the activities from patient registration to
patient discharge. Eng. Khalid Al-Salama, CIO, KFMC 2008 Tepe
International 48. Some Figures from KFMC IHIMS: # of workflows: 211
# of patients: 191,176# of workflow steps: 671# of actions:
4,234,493# of screens : 1,192# of sub-actions: 11,733,854# of
fields in screens : 19,517 # of stock actions: 296,185# of lists :
696# of reports : 775# of logic scripts : 1,844# of roles: 720# of
rights in roles : 3,809 2008 Tepe International 49. Number of Users
2007 vs. 2006 2008 Tepe International 50. An Excellent Example:
SMART Project King Khalid Eye Specialist Hospital, Riyadh, KSA 2008
Tepe International 51. An Excellent Example: KFMC IHIMS ... the
advances in IT have led to the creation of opportunities to
represent and process different, richer forms of information that
enhance our intellectual abilities. Our IT Department drives
innovation which is a key to the institutionss evolution and
success in fulfilling its mission and vision... Fahad Abdulaziz
Al-Eid, CIO, KKESH 2008 Tepe International 52. 2008 Tepe
International 53. 2008 Tepe International 54. 2008 Tepe
International 55. Blent KunaBSc & MSc CEng. METU Vice
President, Tepe International & corTTex Member of the Board,
TURKMIA Chairman, HL7 Turkey [email protected] 2008 Tepe
International
