Case study Health North Norway. Bjørn Nilsen Helse Nord RHF

Transcription

1 Case study Health North Norway Bjørn Nilsen Helse Nord RHF

2 Major aspects of the reform From January 1 st 2002 an organisational reform of the specialised health care came into practice: hospital ownership was transferred from our 19 counties to the central government organised as health enterprises % owned by the state The major structure is four regional health enterprises, and in total 23 local health enterprises Every health enterprise is a separate legal body

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4 Key figures 2011 Revenue 13,6 bill NOK employees Investments 2011: 1.4 billion 45% of the area of Norway, incl Svalbard 9,5 % of the population Transport expenses ca 1.9 billion/year Surplus 2011: 373 million

5 ICT strategic management in Northern Norway Regional Health Authority With the establishment of the regional health authority in 2002 was decision-making authority regarding ICT in the region assigned to CEO. Northern Norway Regional Health IT-manager Health North Norway had the strategically responsibility to secure realizing vision of information sharing. Investment Funds on ICT was centralized to IT-Manager, Health North Norway and subjected to a common regional priorities. System Procurements conducted regional iso. locally as before. Standardization and consolidation is the leading principles where deviation seldom is permitted. - However, strong involvement and participation of Health Thrusts in the various procurement processes. - Guided by or with strong participation from the various Clinical areas.

6 Framework agreements vs. purchase agreements Northern Health has with one exception used purchase agreements in the procurement of new systems: - Allows for a longer duration of the agreements - A greater degree of strategic partnerships with suppliers - Facilitate a greater degree of standardization - Expect better commercial terms - For the procurement of clinical systems purchase was used for the whole region. - Site-agreements - The agreements shall not have production limitations that hinder the utilization of the systems in clinical practice. - Important framework conditions for the use of the principles of service orientation (SOA).

7 referral and discharge summary ordering of hours for treatment Treatment Plans Clinical results questions and answers related to the treatment Ordering of hours for treathment Clinical results Treatment plans Cost data Quality data Ordering of hours for treatment Service information counseling Clinical results Telemedisine A vision for information sharing Patient Arzt Primary Healthcare (e.g. GP s) Content portal Content portal Hospital Trust Common clinical and administrative core systems Service Centre

8 Administrative Information Support Common administrative systems implemented within the following areas: - financial system (to be integrated with clinical systems?) - procurement system - Quality and Procedure system (to be integrated with clinical systems) - Intranet / Internet - Human resource system (to be integrated with clinical systems or AD) - invoice scanning - work planning system (to be integrated with clinical systems) - Management Information System (Data Warehouse) (to be integrated with the clinical system process monitoring) Standardization of processes, procedures, practices, etc. of the joint implementation of the various systems, but has areas for improvement.

9 Consolidated systems as the basis for good corporate governance. The realization of our vision for information sharing shown previously, will facilitate a more cost effective and easier access to enterprise data that can form the basis for: Clinical databases Regional quality records Analysis of patient groups flow through the health trust and the region Access to databases of anonymous statistics and management information based on user-defined access Improved data capture Comparison of cost information from multiple clinical systems to illustrate the costs associated with a patient's path through the processing chain. Better research and quality. SAS Institute has been selected as a strategic tool for data warehouse.

10 Electronic interaction in the treatment chain All GP practices in Northern Norway interact electronically with hospitals in Northern Health Region. Electronic referrals, discharge summaries, laboratory results, X-ray response, etc. Implementation of telemedicine services E-alert Plastic referral Ear Nose Throat Cardiac Piloting / testing Electronic requisition of laboratory services Several projects with the use of videoconferencing in the treatment chain. Electronic booking of appointments from primary care physicians in the treatment chain ("One Stop") University Hospital of North Norway is the "locomotive" for the development of most of these services. The solutions are rolled out quickly to other Trusts on the basis of the standardized system portfolio and infrastructure. Electronic messaging Start date End Date Lab / test results to GP and between hospitals Discharge summaries and radiology information to GPs (Upgrade 2006/2012) Referral from GP X-ray requisition from GPs Application Receipts (receipt from the recipient that a message is received). Feedback Letter / list letters from hospitals to GPs Connecting of the last GPs in the region to the Health Network Discharge summaries and clinical notes between hospitals in the region Improved Lab Requisitions from GPs Sharing of X-rays results/image between hospitals Under introduction Upgrade 2008 Referral from hospital to Hospital

11 One common Internal ICT department and Standardization of infrastructure In Local (in 4 Thrusts) ICT departments was consolidated in to 1. Difficult to get consensus between the ICT departments on ICT standards. Difficult to realize the vision with 11 different IT departments. Continual discussions surrounding the target image Standardization of infrastructure. In 2007 the region started a project regarding standardization of infrastructure ( with a total cost of 105 mill. kroner Necessary for realization of centralized clinical system (Vision of information sharing) Regional infrastructure is described in form of specification of technical requirements in the offer phase to the vendors providers is contractually committed to realizing centrally hosting of the clinical systems on the infrastructure the region now have established

12 Clinical information support - Status 2009 Equally PACS systems (10 of 11 hospitals use AGFA PACS) Equally HER systems (started 1987, DIPS at University Hospital in 2004) Common blood bank system Equally microbiology system Equally pathology system Equally birth registration system Common public patient transportation system Equally system related to clinical chemistry (DIPS) Etc.. contains the region's offerings in e-learning to employees of hospitals, GPs, local authorities...

13 The Public Procurement Act requires that the current contracts is opened up to competition on a regular basis - next step in the realization of the vision of information sharing

14 Procurement of clinical systems for the Northern Norway Regional Health. In 2009 it was decided to carry out a major procurement process for the main clinical systems. The Procurement included: ELECTRONIC PATIENT RECORDS AND PATIENT ADMINISTRATION (EHR) WHICH INCLUDES THE FOLLOWING SUBJECT AREAS: - SOMATIC - ADULT PSYCHIATRY - OPERATION PLANNING - CHILD AND ADOLESCENT PSYCHIATRY - SUBSTANCE ABUSE - RADIOLOGY INFORMATION SYSTEM INCLUDED PACS (PICTURE ARCHIVING AND COMMUNICATION SYSTEM) - Laboratory Information System in the areas of: Medical Biochemistry Immunology Clinical Pharmacology - Electronic requisition of laboratory services (ERL) including - electronic requisition for other disciplines (optional) - Pathology

15 Clinical Pathways Traditionally, clinical systems for the most part been regarded as documentation systems, but with a limited degree of process support. There was a desire to acquire systems that in a much greater degree supported the clinical processes that existed at the hospital. There was also an underlying assumption that the standardization of clinical practice, to a greater degree facilitates an increase in quality.

16 Strategic objectives for the procurement of clinical systems evaluation of ERP principles vs. Best of Breed Purpose: Acquisition of standardized system solution for the relevant system areas of the Northern Health. This will contribute to more consistent patient care, ease of use, and efficient system management and operation in the health region. Objectives: Solutions that support the business needs of patient flow, workflow and information flow internally at the hospitals and between hospitals Solutions that support integration between systems Solutions that provide good decision support Solutions with high usability Solutions with high stability, scalability, availability, safety and low response times

17 Steering Group Appointed by CEO, Mr. Lars Vorland (Project owner) Members Mr. Paul Martin Strand (Leader) Nothern Norway Health Auth. Mr. Eivind Solheim, CEO (Nordland Hospital Trust) Mr. Tor Ingebrigsten CEO (University Hospital of Nothern Norway Trust) Mr. Jan Erik Furunes CEO (Helgeland Hospital Trust) Mrs. Eva Pedersen CEO (Finnmark Hospital Trust) Mr. Ole J. Hauge Director (internal ICT Nothern Norway Health Auth.) Mrs. Irene Skiri Nothern Norway Health Auth.

18 Project Deliverables: Mandate Acquisition Strategy Communication strategy and action plan for communication Qualification Basis tender, including specifications and contract set for the purchase and maintenance of the procured solution as well as for possible subsequent procurement of services / development agreements Plan for competition and negotiation Evaluation Report with recommendations to the steering committee on the choice of solution (s) Acquisition Protocol Contract with the supplier (s) of system The overall implementation plan or consolidation plan of the selected solution (s) Plan for implementation of the agreement within the Northern Health

19 Design of requirements Between 80 and 100 people from the hospitals where involved in the formulation of requirements for the various system areas First, the requirements where formulated within the various system areas. Then the participants from the various system areas work together to define how their discipline should interact with other disciplines in order to establish the best overall processes. Functional and technical requirements were then updated in the respective specifications so that the process could be realized across the system areas

20 Requirements phase of clinical systems - how to ensure good integration and rec. of services.? LAB Funksjonelle krav Tekniske krav EPJ/PAS Funksjonelle krav Tekniske krav Patologi Funksjonelle krav RIS Funksjonelle krav PACS Funksjonelle krav Tekniske krav Tekniske krav Tekniske krav

21 Service-oriented architecture and flexibility in the presentation layer Purpose: supplier industry will adapt to the principles surrounding service-based architecture. Objectives: Better and more flexible clinical work space but as part of system portfolio. Integration of multiple levels (integration palette) Structured data Commitment to integration with existing national services Clear integration commitments for selected suppliers.

22 Legal framework Norwegian law: Legal frameworks up to 2011 not allowed to accumulate data for multiple legal units when stored in a common databases, data must be logical separated no collection of data by a person in a legal entity from another entity access to data between legal units shall be conducted by means of electronic messaging realization of the vision for information sharing at this point would involve a breach of Norwegian law from 2012 Norwegian law is changed so that clinicians now can obtain information directly from other health enterprise databases Still: Data must bee logical separated when stored in common databases.

23 Standardization and harmonization (Common Health Organization in the North) The project team and steering committee recommends a greater degree of uniformity in the region, including: Agreement on the processing line / production processes Agreement on standardized course templates Agreeing on common codes and layouts Common journal Structure Agreeing on common recording practice / procedure Best possible centralized operating environment Common performance indicators (KPIs) and reporting Decision-controlled access Regional government groups Providers assume a high degree of decision-making ability of the Customer

24 Overview of providers/suppliers EPJ/PAS LAB ERL Patologi RIS PACS DIPS DIPS DIPS Tieto Sectra Sectra Systematic Profdoc - Whitelake Software Point RisCo Agfa - Whitelake Software Point - Siemens Healthcare DIPS Siemens Healthcare

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26 Customer's resource commitment estimated by suppliers not included description of common Clinical Pathway År 1 År 2 År 3 År 4 1.kvartal 2.kva3.kvartal 4.kvartal 1.kvartal 2.kvartal 3.kvartal 4.kvartal 1.kvartal 2.kvartal 3.kvartal 4.kvartal 1.kvartal 2.kvartal 3.kvartal 4.kvartal Planl. EPJ/PAS BUP/RUS Forprosjekt EPJ/PAS Nye produkter EPJ/PAS HF 1 (UNN) HF 2 HF 3 HF 4 SFO Planlegging RHF Planl. LAB Planl. Patologi Planl. RIS og PACS Forprosjekt LAB Forprosjekt Patologi Forprosjekt RIS og PACS HF1 (UNN) HF 2 HF 3 HF 4 ERL HF1 HF2 HF3 HF4 HF 1 HF 2 HF 1 (UNN) HF2-4 EPJPAS LAB ERL Patologi SFO RIS/PACS Year 1: 8,2 FTE Year 2: 48,3 Year 3: 57,9 Year 4: 24,3

27 Investment plan was used to verify the necessary investments for the realization of the vision for information sharing in the region. In reporting to the Board, it was noted that the amount of XXX million kroner was incomplete. The following is added (2012) Test Environment payment for participation by clinicians in the development fase payment to the Internal IT in the project (customer /supplier model is the basis of agreed pricing model) After quality assurance in 2011/12 is the level of investment in the project increased to XXX million kroner Total estimated ICT investment in the period is 860 million kroner (118 mill Euro).

28 Thank You for Your attention.