THE CHINA MINISTRY OF HEALTH DELEGATION EDUCATIONAL VISIT TO HARVARD

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THE CHINA MINISTRY OF HEALTH DELEGATION EDUCATIONAL VISIT TO HARVARD. Boston, Massachusetts. December 13, 2012. Where Does China Stand on the Global HIT Continuum? How Can China “Leapfrog” in HIT Use?. Presentation Agenda. Page Evolution of Global HIT3 - PowerPoint PPT Presentation

Text of THE CHINA MINISTRY OF HEALTH DELEGATION EDUCATIONAL VISIT TO HARVARD

  • THE CHINA MINISTRY OF HEALTH DELEGATION EDUCATIONAL VISIT TO HARVARDWhere Does China Stand on the Global HIT Continuum?

    How Can China Leapfrog in HIT Use?

    Boston, MassachusettsDecember 13, 2012

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *Presentation AgendaPageEvolution of Global HIT3Current Status and Future Direction of HIT in China11Where Does China Stand on the Global HIT Continuum?21How Can China Leapfrog in HIT Use?23How Does Dorenfest Help?29

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *Opportunities to Improve the Healthcare Delivery Process Have Been Pursued for Many YearsGreat redundancy of informationHigh error potentialLack of timelinessHigh costOrganization complexity

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *The U.S. Hospitals Have Sought an EMR/EHR Since the 1960s through Four Generations of IT SystemsFinance Systems (1960s and 1970s) Limited Clinical Systems (1970s and 1980s) More Advanced Clinical Systems (Late 1980s and 1990s) Electronic Health Records (2000s)

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *But Poorly Implemented Change Created Redundant Work on Top of Original Inefficiency Before IT=1x2x3x4xGrowth in RedundancyTotal Hospital Work Process

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *At the Beginning1.Large vision2.Hardware technology limited and expensiveLarge computers Inefficient software development methodologies 3.Self development was the only software approach and remained the preferred approach for a period of time 4.Packaged software emerged first as a customizable starter set and later became products requiring less customization from user to user 5.As time passed, packaged software products became preferred Less expensiveFaster to implement But many problems in implementation

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *The Late 1970s and 1980s1.Several generations of technology, software vendors, software approaches, and products came and went 2.Software buying and implementation methods improved Users and management became more involved Functional requirements to define needs and compare vendors became more complete and usefulUser site visits, user customer references, and user discussions with counterparts at other hospitals became part of an improved buying approach3.Integration became a large problem as the number of software vendors used by a hospital increased Started out all manual with duplicate entry into multiple systems Moved to hard coding of interfaces between systems Caused a focus on the development of standards for software products of different vendors to communicate with each other

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *The 1990s and 2000s1.Management of the buying and implementation of IT software continued to improve2.A new generation of software systems emerged, with better features and functions built on superior technological platforms3.Integration problems kept growing, causing the movement from hard coded interfaces to standards such as HL7, and interface engines which facilitated the transfer of data in a more efficient way between software systems 4.Clinical data repositories, data analytics tools, and clinical decision support systems emerged 5.The pressure for physicians to enter orders through CPOE grew in the late 1990s and early 2000s. 6.The U.S. 2009 Healthcare Stimulus Program emphasizes the further expansion of EHR use, and today much activity is going on in this area

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *HIT Evolution in the Rest of the WorldCanada started in the late 1970sEurope and Australia began in the early 1980sAsia began in the 1990sCanada, France, Germany, England, and Australia all started later than the U.S., Invested less, and have made more progressHong Kong started even later, invested less, and now is the state of the art in HIT use in the world China HIT is now at an earlier stage of development. China has the goals and desire to leapfrog the rest of the world in HIT use in the next few years

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *China Ministry of Health Delegation at Harvard

    Current Status and Future Direction of HIT in China

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *The Development of HIT in China Chinese hospitals began to computerize in the early 1990s The initial focus of computer efforts was on financial systems In the early 2000s, Chinese hospitals began to implement IT for clinical systemsMany software solutions are now available, with well over 1,000 smaller software companies now operating in the HIT market in ChinaBetween 2005 and 2010, China hospital spending on IT grew from 5 billion RMB in 2005 to 16 billion RMB in 2010, and to 21.5 billion RMB in 2011 This rapid growth in spending will continue at an even more rapid pace over the next several years

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *Factors Contributing to Future Spending Growth in China HITRedundant, expensive, and error-prone hospital work processes led to the initiation and development of HIT in China Fueled by the Ministry of Health (MOH) guidelines for health IT development issued in 2003, calling for all cities in China to implement RHNs and digital hospitals by 2010, hospitals began to purchase clinical systems in a variety of areas In 2009, China Healthcare Reform was passed, and a stimulus spending program of almost one trillion RMB in new spending was initiated to support Healthcare ReformImproved use of IT is one of eight pillars of the new China Healthcare Reform. The 3521 project national vision for HIT was summarized in the twelfth five-year plan for HIT to provide the framework for HIT and RHN development in China from 2011 to 2015. Focuses of HIT development include:Improve hospital IT systems leading to digital hospitalsImplement electronic health records (EMR and EHR)Create the second wave of RHN development to provide data sharing throughout cities, provinces, and at a national levelIT systems to support expanded healthcare insurance

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *Factors Contributing to Future Spending Growth in China HIT (Continued)The vision document for 3521 is comprehensive and extensive, and may be summarized as follows: 3 levels of health information platform nation, province and region (city or county)5 groups of applications public health, healthcare service, health insurance, drug administration, general management2 basic databases resident electronic health record and electronic medical record1 dedicated health infrastructure network2 sets of systems data standards system and network security systemMuch spending is going on right now to implement first steps in the execution of this vision.

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *What Are the Key Factors Impeding Success in Chinese Hospital IT Use? Low investment in the 20-year period 1990 to 2010 caused slow progress in HITWeaknesses in the approach to buying and implementing new IT systems has created unnecessarily redundant work processes, poorly integrated systems, and unhappy users The weaknesses in approach to buying of HIT software products in China followed a similar path to how earlier adopter countries started their HIT efforts. Most of the world has learned from their own bad experiences to find better ways to buy and implement HIT systems

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *What Are the Key Factors Impeding Success in Chinese Hospital IT Use? (Continued)The current foundation of HIT efforts in China, including software and hardware platforms, and integration tools, is in need of improvement to support the accomplishments of Chinas vision for HIT improvementOn many occasions hospital and health bureau leadership, not knowing what they do not know, are continuing to make similar mistakes to the past. By paying much greater attention to what worked and did not work in early adopter countries of the world and using more of what worked and less of what did not work, Chinese hospitals and health bureau leaders will make much greater progress toward their vision and leapfrog goals

    CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDDORENFEST CHINA HEALTHCARE GROUP

    *The Current Computing Environment in a Typical Large Complex Chinese Hospital Today Major Ancillary Systems Note: Chart taken from a couple of real hospital situations with each vendor or product family shown in a different color Sample Current Systems (High Level View) Major FinancialSystemsMajor ClinicOR/Anesthesia(Vendor 5)R.I.S./PACS(Vendor 4)L.I.S.(Vendor 3)Blood Bank(Vendor 3)Bar Code(Vendor 3)Ultrasound(Vendor 6)Stomatology (Vendor 7)Financial(Vendor 2)MD Workstation(Vendor 2)Pharmacy(Vendor 2)L.I.S.(Vendor 3)Core Vendor(Vendor 1)Inpatient EMR(Vendor 8)Medical Records(Vendor 11)Medical Ins(Vendor 9)Medical Ins(Vendor 10)Human Resources(Vendor 12)Performance Assessment System(Vendor 13)Policy Exchange Platform (Vendor 13)Webport System(Vendor 13)Hospital Website (Vendor 13)Office Automation SystemsMajorAdmin SystemsOrder ManagementInpatient Physician WorkstationOutpatient PhysicianWorkstationInpatient PharmacyOutpatient PharmacyInpatient ADT and BillingOutpatient and ER RegistrationOutpatient Pricing and ChargingMaterial SupplySmart CardPatient ConsultationSurveyLab Price SystemInstrument and Equipment ManagementInpatientIn