Decision Support

At the federally qualified health center and patient-centered medical home, telehealth technology has changed the way primary care physicians deliver care.

Four experts in artificial intelligence technology offer advice to healthcare CIOs on how to best begin implementing an AI system.

The machine learning algorithm can also help with screening for diabetic macular edema, a boon for patients in a country where physicians are in short supply.

The HIMSS Electronic Health Record Association's Opioid Crisis Task Force has created what it calls the "ideal minimum data set" to get physicians the right information to enable safer EPCS.

Dr NT Cheung has been the Chief Medical Informatics Officer (CMIO) of Hong Kong’s Hospital Authority (HA) for the past 26 years. The HA is a statutory body established under the Hospital Authority Ordinance in 1990 and has been responsible for managing Hong Kong's public hospitals’ services since December 1991. As the CMIO, Dr Cheung has been key in driving the IT transformation of the organisation from one which began with a very rudimentary use of IT in the 1990s to one which is able to continuously roll out new initiatives, very quickly and at a high degree of standardisation not just to improve the work processes of clinicians, but ultimately for the benefit of patients under their care. “Looking forward on healthcare - the pressures on healthcare, which all of us share in any advanced economy now, it's the same, which is that people live longer, you have more chronic disease, you have more demands, and healthcare people expect more and your healthcare manpower is not growing at the same pace.  You can't just keep on doing more and more healthcare in the old way, you have to change the way that you are doing it – you have to change your service models, you have to add significant amounts of automation to this very labour-intensive sector of the industry. And so again, that's what health IT is able to deliver. And there are very few other options to be honest. So it's becoming an increasingly important part of getting us into a more sustainable model for the whole healthcare in the future,” Dr Cheung explained. HA’s Clinical Management System (CMS) – 1990s till present Currently in its fourth generation, the CMS at HA started off modestly in the 1990s with convincing the frontline to start using these tools with a very basic digitalisation of hospital wards. By the year 2000, the second phase of development for CMS began when HA linked together the various hospitals, as well as linking the outpatient and inpatient records together. More tools were also built to support the healthcare process with features such as order entry and rudimentary forms of decision support. Phase three of the CMS was about rebuilding the entire platform to a more modern one which allowed for a much greater integration/standardisation across the board. “So from CMS two, we had this integrated electronic record but in terms of functionality and functional modules, they were all pretty much stovepipes and they would then contribute data into the central repository but they were separate stovepipes. So CMS three was trying to build it as a platform using the then newest technology of putting the applications on the server side rather than the client side of approach, and then build that platform using a more modern Java-based platform,” Dr Cheung said. The fourth phase of development of the CMS has a ring to it – with a slogan called the 5Ps approach: Paperless – Dr Cheung shared that the HA has hit an inflection point where in many cases, the paper workflows are now going to be more cumbersome than the digital workflows that they can now design, Protocol-based – introducing clinical intelligence from people, guidelines, websites, books into the CMS Closed looP - in a very complex workflow like a high volume hospital, things get missed out, the loop does not get closed because nobody can keep track of everything all the time. Communication tools at the clinical side will be strengthened to make sure everything is followed up and the loop is closed. Personalised - to allow for a greater degree of personalisation for every single individual user across different hospitals, depending on their particular situation. Patient-centricity - a reminder that the patient is still the centre of the healthcare universe. A unified patient app One of the five portfolios under HA’s IT 5-Year Strategic Portfolio is Enhanced Patient Experience & Outcome, which focuses on new patient-centric service models with disruptive technology. Dr Cheung said that one of the key deliverables that HA is working on now is a unified patient app. HA has been releasing patient apps since 2011 and a portfolio of apps have been built but there are simply too many apps for patients to keep up with. “We are building a single patient app that we call HA GO - it does several things more than the previous collection of apps. So first of all, it's a one stop shop. So you would download the single app from HA, and then you would register as an app user once and all the apps will know who you are. Secondly, it functions as a conduit - it's not just a collection of little apps, it is a framework for allowing your health care which is delivered in the hospital or clinic to extend out to the rest of your life when you're in the community or at home,” he added. The HA GO single patient app is slated to be launched this year with a modular design consisting of ‘mini apps’. For instance, diabetic care would be a mini app and the app will be pushed to the phones of diabetic patients who need it.

It's touted as the first use of network analysis as a method to examine the relationships between common symptoms suffered by a large group of cancer patients undergoing chemotherapy.

A patient-flow system implemented at MidCentral District Health Board (DHB) in New Zealand is helping to streamline patient journeys through Palmerston North Hospital and allowing clinical staff to view important patient information at the bedside. The MIYA patient flow system, from Alcidion, is live in 17 wards and the emergency department at Palmerston North Hospital and one ward at the Horowhenua Health Centre. Alcidion is an Australian-based provider of Clinical Decision Support Systems, including Patient Flow Software, EDIS, Mobile EMR and Outpatient Solutions. MIYA gives real-time updates of bed management and patient flow throughout the hospital and health centre, showing a patient’s progress from the time they arrive to the time they are discharged, as well as an overview of hospital occupancy. Charge nurse Sarah Donnelly says, “The mobile technology is a godsend on ward rounds and has helped improved patient flow in and out of the ward, making discharges more evident and timely. I love it and wouldn’t be without it now”. The system was tested on two wards for three weeks in early November 2018 before being rolled out to all clinical areas later that month. Acute care and hospital operations service manager Carrie Naylor-Williams says the next phase of the implementation involves looking at how to use the data being collected by the system on a day-to-day basis. The hospital also plans to go live with MIYA in theatres before the end of this year. The data can be used to predict future demand, so staff know what to expect on different days and can plan accordingly. It’s also used to forecast operations for surgical patients. “We can see the cohort of patients currently admitted and what their predicted length of stay is and therefore what surgeries we can do. It will give us greater understanding to be able to manage the capacity of the hospital,” says Naylor-Williams. Bed management and capacity planning was previously done on paper and whiteboards and experienced staff getting a “general feel” for how things were looking, she explained. “We want to put be able to put a science to it and not be dependent on someone with experience being able to do it, but anybody can look at the board and see what the day’s like,” says Naylor-Williams. MIYA pulls data from the hospital’s clinical portal, so clinicians can securely view a current patient’s history, including admissions, demographics and results, on mobile devices at the bedside. The software platform has successfully integrated with five clinical information systems at Midcentral DHB, including WebPas, CareStream Radiology, Clinical portal and Pathology to provide clinical staff with detailed patient information displayed on the ward’s journey board. Naylor Williams says this means doctors can discuss results with patients face to face and make immediate decisions while on their ward rounds. They can also quickly view immediate bed availability in suitable wards. A version of this article first appeared on eHealthNews.nz.

Hospitals that reach the pinnacle of the HIMSS Analytics EMR Adoption Model have more satisfied docs, more widespread personalization of EHRs and better teamwork between clinicians, according to a new survey with HIMSS Analytics.

VivaLNK debuted an Internet of Things-enabled wearables sensor platform, TriFin Labs unveiled a patient engagement platform, eMDs launched a revenue cycle management system and Philips introduced an epidemiology system that uses genomics and deep learning.

Could 2019 be the year where distributed ledger technology transcends its early hype and enters into its "plateau of productivity" phase? At least one expert thinks so.