The HEGP Case Study - SBIS

Implementing Shared EHRsThe healthcare context• The healthcare context– The evolution of practice– The expectations– The reality in France• The HEGP case study• Conclusion

Health care practiceBirthPractice evolutionDeathEpisodes of careSituation• Life long support (predictive, preventive, curative, palliative medicine)• Multiplicity of parameters (biological signals, images, etc.)• Multiplicity of highly specialized health actorsNeeds• Life long and shared patient records• Cooperative management by health professionals• Increased role of the patient

The healthcare contextSharing Health Records“the expectations”Practitioner2 recordsPatient personal1 recordsTrusted Hosting4 Services3 Hospitalrecords

The healthcare contextSharing Health Records“the reality in France”Practitioner2 recordsPatient personal1 recordsTrusted Hosting4 Services3 Hospitalrecords

The functional dimensionVertical applicationsPROs• The market exists• The pressure of professional lobbiesCONs• Duplication of functions• Heterogeneity of interfaces (end-user training)• Data redundancy• Integrity conflicts• Integration complexity (n*(n-1)/2 interfaces)

The information system contextFrench legislation• A strong security act– Loi “Informatique, Sécurité et Libertés” : January 6, 1978Mandatory declarationNational coordinating body (CNIL)– European council Directive : October 26, 1995• Direct access by the patient to their health record– March 4, 2002 law on patient access rightsHealth Professional Records, Hospital RecordsTrusted hosting centers– Various bills concerning the content of the Personal/PatientHealth Records and the Agreement process for hosting centers(2003-2005)

Implementing SharedElectronic Health RecordsThe HEGP case study• The health care context• The HEGP case study– The strategic objectives– The HEGP shared health record : a short visit– Report transmission to patients and their GPs– Transmission to hosting centers– Results and discussion• Conclusion

HEGP BackgroundA large restructuring effortHôpital Laennec Hôpital Boucicaut Hôpital Broussais

HEGP BackgroundA large restructuring effortBBL HEGP %1999 2003Beds 1,222 825 - 460 - 32%Personnel 3,619 2,792 - 827 - 22%

HEGP BackgroundArchitecture 9 floors 120 000 m² working area 40 000 m² glass walls« Main Street »

HEGPStrategic Goals• Improved Quality of Care Shared Electronic Health Record (EHR) High Quality Guest Services• Improved Openness80% single rooms and 15%rooms with family facilities Better Patient Participation Community Health Care Network Integration• Improved Accountability Decentralization of decision centers

HEGP BackgroundMain figures (2005)NoNumber of active beds 825Number of nurses 1,100Number of physicians (FTE) 400Total number of physicians 800Mean number of inpatient admissions/month 4,300One day hospital care (% of admissions) 31%Number outpatients visits/month 20,000Nb. Visits at the emergency department/day 130Nb. PC 2,300Nb. wireless portables computers 130Nb. simultaneous users (pic time) 1,200

The strategic objectivesFunctionalTo achieve a process-oriented,component-based, enterprise-wideHIS ?Target systemEnterprisewide coveringOrganizationalProcessorientedComponentbasedTechnical

The HEGP Case Study• The health care context• The HEGP case study– The strategic objectivesThe functional dimensionThe technical dimensionThe organizational dimension– The HEGP shared patient record : a short visit– Report transmission to patients and their GPs– Transmission to hosting centers– Results and discussion• Conclusion

The technical dimensionThe issueTechnical ArchitectureMain-frame Client/server N-TierBDepartmental systems(1985-2000)AComponent-basedsystems (2000- …)Centralized systems(1970-1985)CVertical (structure-oriented)ApplicationsHorizontal (process-oriented)

The technical dimensionThe selection of componentsAZVUB, Brussels, 2000COMPOENT FRAMEWORKAdministrativeINFORMATION BUSWorkflowComponentADTAuthorizationComponentGENERIC COMPONENTSMedicalCarePatientComponentNursingHealthcareRecordMedicalSupportActivityComponentAncillaryServicesResourceComponentHEALTHCARE-RELATED COMMON COMPONENTSAPPLICATIONOBJECTSKnowledgeComponentCity J Jane Smith 561224-1234 # 15931212 Diagnosis : Fracture of femur 4pHFamily history : Both parents diedfrom myocardial infarctionPatient history : Fell on slipperypavement in Brussels yesterday ...PERSISTENT LAYERStatus : Examination of right leg shows ...32Medical RecordAlphanumeric data1ImagesBio signals (ECG)DocumentsR. Van de Velde. Framework for a clinical information system. Int J med Inf 2000; 57: 57-72.

The technical dimensionHEGP componentsClientIdentificationdeviceSessionManagerApplicationportalHealthcare componentsPatientcomponent (PC)Actcomponent (AC)Generic componentsContextManager (CM)Referencemanager (RM)DocumentProcessor (DP)CommunicationBus (Com)Health record(HR)Resourcecomponent (RC)SecurityManager (Sec)Workflow engine(WE)Decision SS (DSS)Supervisor (Com)Mediators (Com)Data/informationrepositoriesPatient-relatedidentityclinicalbiologicalimagesdocumentsInstitution-relatedterminologiesstructuresresourcesprotocols

The technical dimensionHEGP 4-tier architectureViews• By specialties (e.g., specialized records)• Profession-oriented (e.g., nursing record)Health BusinessComponents• Health “ERP”LegacyapplicationsIntegration middleware• Enterprise Application Integrationenvironment (EAI)Infrastructure layer(servers, network)• Resource layer

The HEGP Case Study• The health care context• The HEGP case study– The strategic objectivesThe functional dimensionThe technical dimensionThe organizational dimension– The HEGP shared patient record : a short visit– Report transmission to patients and their GPs– Transmission to hosting centers– Results and discussion• Conclusion

The organizational dimensionDeployment strategyPilot unitsFunctional coverageLow HighPartialGlobalEnterprise coverage

The organizational dimensionDeployment strategyEnterprise wide coveragePROs• Voluntary approach (enterprise objective)– Personal investment of the board of directors• Nobody left behind• Patients and physician movements covered– EHR, POE coherence• Maximizes the expected benefitsCONs• High training workload– On site coaching, eLearning tools• Performance/availability risk– Infrastructure maintenance (24/24h, 7/7d), hotline

The organizational dimensionActors points of viewsHealthprofessionals• Functional coverage• Performance (e.g., response time)Hospitaladministrators• Costs, return on investment• Competing advantage• AccountabilityPatientsVendors• Quality and continuity of care• Privacy and security• Enterprise services• Revenue• Market share• Risk

The organizational dimensionActors points of viewsOrder entryOutcome studiesHealthprofessionals2a• Functional coverage• Performance (e.g., response time)Hospitaladministrators• Costs, return on investment• Competing advantage• AccountabilityDecision tools 2bPatientsVendors• Quality and continuity of careElectronic • Privacy and Health securityRecord• Enterprise servicesSecurity 1• Revenue• Market share• Risk

The organizational dimensionFunctionsDependency constraintsComponentsComplexity, costs7 Specialized records6 Orders (drugs)5 Orders (biology, imaging)4 Nurse transmissions3 Laboratory results2 In/outpatient reports1 Patient ID (ADT)AC SchDSS+PM HR Com, CCOW, Sec, RefPM HR Com, CCOW, Sec, Ref0 2 1 3 45Times (years)

The HEGP Case Study• The health care context• The HEGP case study– The strategic objectives– The HEGP shared patient record : a short visit The application portal Electronic Health Record (EHR) Management Provider Order Entry (POE) Management– Report transmission to patients and their GPs– Transmission to hosting centers– Results and discussion• Conclusion

The HEGP clinicalinformation systemThe application portal(THALIS-portal)• Manages the login procedure (single sign on)• Remembers the user preferences• Gives access to authorized functions• Eases the workflow processes through direct access to objectsmanaged by the healthcare components and triggering of theadequate viewers

Application portal (THALIS-portal)Views of thehealth recordHIS FunctionsObjects withinthe healthrecordPatient event list

The HEGP Case Study• The health care context• The HEGP case study– The strategic objectives– The HEGP shared patient record : a short visit The application portal Electronic Health Record (EHR) Management Provider Order Entry (POE) Management– Report transmission to patients and their GPs– Transmission to hosting centers– Results and discussion• Conclusion

Electronic Health Record (EHR) managementDRGsPatient ID and visitsCORBAMedical reportsRadiologyreports andimagesEHRClinical informationPhysician/nursingordersLaboratoryresultsNursing notesFlow sheetsCare plansAppointmentscheduling

EHR ManagementClinical questionnairesCORBA

EHR managementNursing questionnairesCORBA

EHR managementVital Signs Entry

EHR managementNursing care notes & plans

EHR managementMedical report production

Provider Order Entry (POE) : BiologyWorkflowAncillary DepartmentsPatient PortalTHALIS-PortalPortal®Passport to Lab ResultsLaboratoryISNetLabLabrequestLabresultsEPR - Care PlanningDxC@reŒICU EPRCareVue®ExamresultsExamrequestPathology ISAPIXCare Unit

Provider Order Entry (POE): BiologyPhysician ordersCORBA

Provider Order Entry (POE): biologyLaboratory orders :sampling supportCORBA

Provider Order Entry (POE): biologyAlertsCORBA

Provider Order Entry (POE): biologySample PlanningCORBA

Provider Order Entry (POE)Label printing

Provider Order Entry (POE)Sample transportationHidden in false ceilingsdifferent models ofsuitcases, simples orupholstered, transport…… mail or paper documents aswell as biological samples to thelaboratories

Provider Order Entry (POE)Sample arrival

Sample analysisLab specimens are handledby robots and automatons

Provider Order Entry (POE)Result flagsColored flags : newlab results, x-raycompleted

Provider Order Entry (POE)Result displayCORBAThick client interfaceWeb interface

Provider Order Entry : ImagingWorkflowPatient Portal THALIS-portal®Ancillary DepartmentsCare UnitPassport toradiologyreportWorklistRadiology ISRADOSModalitiesRadiologyrequestImagesPACSIMPAXEPR - Care PlanningOrderDxC@reRequest forappointment AppointmentAppointment &SchedulingŒOne-CallImage DistributionWeb1000RadiologyReportIHE

Provider Order Entry : ImagingImage OrderingCORBA

Provider Order Entry : ImagingWork lists

Provider Order Entry : ImagingAppointment schedulingCORBA

Provider Order Entry : ImagingPlanned appointmentsCORBA

Provider Order Entry : ImagingReport productionVoice dictation and recognition

Provider Order Entry : ImagingImage viewersCORBA

Provider Order Entry : Drug orders

Provider Order Entry : Drug ordersKnowledge coupling

Provider Order Entry : Drug ordersPharmaceutical validation

The HEGP Case Study• The health care context• The HEGP case study– The strategic objectives– The HEGP shared health record : a short visit– Report transmission to patients and their GPs– Transmission to hosting centers– Results and discussion• Conclusion

Sharing Patient RecordsSecured transmissionto patients and GPsPractitioner2 recordsPatient personal1 recordsTrusted HostingServices (DMP)SecuredtransmissionSecuredtransmission3 HospitalrecordsShared healthrecord

Patient report transmissionAlert messageH E G PHÔPIT AL EURO PÉEN GEORGES POM PIDOU

Patient report transmissionConnection to “La Poste”serverH E G PHÔPIT AL EURO PÉEN GEORGES POM PIDOU

Patient report transmissionReport transferH E G PHÔPIT AL EURO PÉEN GEORGES POM PIDOU

The HEGP Case Study• The health care context• The HEGP case study– The strategic objectives– The HEGP shared health record : a short visit– Report transmission to patients and their GPs– Transmission to hosting centers– Results and discussion• Conclusion

Sharing Patient RecordsHosting servicesPractitioner2 recordsPatient personal1 recordsTrusted HostingServices (PHR)3 Hospitalrecords

TRSSEPTEUILERESVILLEEECOLEROSAYARNOUVILLE-LES-MANTESE-TEMPLEVILLETTEORGERUSNDE-SUR-VESGREBEHOUSTBOINVILLE-EN-MANTOISSAINT-HILARIONEMANCEVILLIERS-LE-MAHIEU AUTOUILLETGARANCIERESJUMEAUVILLELA QUEUE-LES-YVELINESGALLUISAUTEUILBOISSY-SANS-AVOIRMAULESAULX-MARCHAISLES MESNULSMAREIL-LE-GUYONBEYNESMONTFORT-L'AMAURY BAZOCHES-SUR-GUYONNESAINT-REMY-L'HONOREAUFFARGISLA VERRIERESAINT-LEGER-EN-YVELINESLEVIS-SAINT-NOMLES BREVIAIRESTaux de recrutement de LES tous ESSARTS-LE-ROI lesHERMERAYOSMOYHARGEVILLESAINT-MARTIN-DES-CHAMPSRAIZEUXMILLEMONTFLEXANVILLEGAMBAISEUILGOUSSONVILLEGOUPILLIERESGROSROUVREPOIGNY-LA-FORETGAZERANTHOIRYANDELUAULNAY-SUR-MAULDREMARCQMEREORCEMONTVICQLE PERRAY-EN-YVELINESRAMBOUILLETMAREIL-SUR-MAULDREMONTAINVILLEHERBEVILLELES CLAYES-SOUS-BOISCERNAY-LA-VILLERENNEMOULINBONNELLESSAINT-CYR-L'ECOLEBAILLYROCQUENCOURTORPHINSAINT-ARNOULT-EN-YVELINESPopulation : 2,7 millionshLE VAL-SAINT-GERMAINSAINT-CYR-SOUS-DOURDANPONTHEVRARDSurface : 1130 km 2SAINTE-MESMEPRUNAY-EN-YVELINESDOURDANSERMAISEABLISSAINT-MARTIN-DE-BRETHENCOURTROINVILLEBOINVILLE-LE-GAILLARDCRESPIERESSAINT-GERMAIN-DE-LA-GRANGEVILLIERS-SAINT-FREDERICNEAUPHLE-LE-VIEUXNEAUPHLE-LE-CHATEAULE TREMBLAY-SUR-MAULDREVIEILLE-EGLISE-EN-YVELINESSONCHAMPLES ALLUETS-LE-ROITHIVERVAL-GRIGNONJOUARS-PONTCHARTRAINMAUREPASCOIGNIERESCLAIREFONTAINE-EN-YVELINESDAVRONPLAISIRORGEVALELANCOURTLA CELLE-LES-BORDESFEUCHEROLLESCHAVENAYLE MESNIL-SAINT-DENISétablissements dans leur zone : 50%CH de RambouilletBULLIONTRAPPESDAMPIERRE-EN-YVELINESSENLISSESAINT-FORGETROCHEFORT-EN-YVELINESAIGREMONTCHAMBOURCYFOURQUEUXSAINT-NOM-LA-BRETECHEVILLEPREUXSAINT-LAMBERTLONGVILLIERSFONTENAY-LE-FLEURYBOIS-D'ARCYCHOISELPOISSYMONTIGNY-LE-BRETONNEUXVOISINS-LE-BRETONNEUXCHEVREUSEPECQUEUSEL'ETANG-LA-VILLENOISY-LE-ROIHop privé Ouest Parisien TrappesCORBREUSELES GRANGES-LE-ROBUCSAINT-AUBINVAUCRESSONMARNES-LA-COQUETTEGARCHESSAINT-CLOUDCHAVILLEVIROFLAYSAINT-REMY-LES-CHEVREUSEGIF-SUR-YVETTEBURES-SUR-YVETTEANGERVILLIERSLIMOURSFORGES-LES-BAINSLE MESNIL-LE-ROILE PECQLE VESINETCHATOUMAREIL-MARLYLE PORT-MARLYCROISSY-SUR-SEINEMAGNY-LES-HAMEAUXCHATEAUFORTMILON-LA-CHAPELLEBOULLAY-LES-TROUXMARLY-LE-ROIGUYANCOURTLES MOLIERESCMC EuropeLOUVECIENNESTOUSSUS-LE-NOBLEMONTESSONBOUGIVALLA CELLE-SAINT-CLOUDLE CHESNAYCH André MignotVERSAILLESLES LOGES-EN-JOSASVILLIERS-LE-BACLEGOMETZ-LA-VILLEVAUGRIGNEUSEGOMETZ-LE-CHATELJOUY-EN-JOSASJANVRYBRIIS-SOUS-FORGESCOURSON-MONTELOUPSAINT-MAURICE-MONTCOURONNESAINT-CHERONVILLECONINBREUILLETBREUX-JOUYSOUZY-LA-BRICHEHOUILLESCARRIERES-SUR-SEINESACLAYFONTENAY-LES-BRIISRUEIL-MALMAISONSAINT-YONSEVRESVAUHALLANLES ULISCHAUFFOUR-LES-ETRECHYMAUCHAMPSBEZONSVELIZY-VILLACOUBLAYLA GARENNE-COLOMBESIGNYPALAISEAUVILLEJUSTEGLYCHAMARANDECOLOMBESISSY-LES-MOULINEAUX VANVESCC Marie BIEVRES LannelongueORSAYSAINT-JEAN-DE-BEAUREGARDNANTERREFED 92VILLE-D'AVRAYMARCOUSSISBOISSY-SOUS-SAINT-YONSAINT-SULPICE-DE-FAVIERESSURESNESCMC FochVERRIERES-LE-BUISSONVILLEBON-SUR-YVETTENOZAYBRUYERES-LE-CHATEL OLLAINVILLEARPAJONTORFOUBOIS-COLOMBESASNIERES-SUR-SEINEFONTENAY-AUX-ROSESCHAMPLANBALLAINVILLIERSVIRY-CHATILLONLA VILLE-DU-BOIS VILLEMOISSON-SUR-ORGEVILLIERS-SUR-ORGEGRIGNYLA NORVILLEGUIBEVILLELARDYCLICHYCOURBEVOIELEVALLOIS-PERRETNEUILLY-SUR-SEINE PARIS 17PUTEAUXBOULOGNE-BILLANCOURTMEUDONLINASCLAMARTMALAKOFF MONTROUGEBOURAY-SUR-JUINECACHANFRESNESWISSOUSEPINAY-SUR-ORGESAINT-MICHEL-SUR-ORGEMAROLLES-EN-HUREPOIXARCUEILPARIS 2PARIS 13GENTILLY IVRY-SUR-SEINEKREMLIN-BICETREVILLEJUIFRUNGISMONTLHERYLONGPONT-SUR-ORGESAINTE-GENEVIEVE-DES-BOISLEUVILLE-SUR-ORGESAINT-GERMAIN-LES-ARPAJONAVRAINVILLEJANVILLE-SUR-JUINEADEMVPARIS 16H.E.G.P.CHATILLONMASSYSAULX-LES-CHARTREUXLE PLESSIS-PATEBRETIGNY-SUR-ORGECHEPTAINVILLEPARIS 15PARIS 8Hôtel-DieuPARIS 7BAGNEUXCHILLY-MAZARINPARIS 9MORSANG-SUR-ORGELEUDEVILLEPARIS 1 PARIS 3PARIS 4PARIS 6PARIS 14PARIS 5BOURG-LA-REINELE PLESSIS-ROBINSONSCEAUXL'HAY-LES-ROSESCHATENAY-MALABRYCHEVILLY-LARUEANTONYHop privé AntonyLONGJUMEAUSAINT-OUENIM MontsourisL'ILE-SAINT-DENIS SAINT-DENISSAINT-VRAINPARIS 18ITTEVILLEAUBERVILLIERSFLEURY-MEROGISVERT-LE-PETITVITRY-SUR-SEINEBOBIGNYPARIS 19PRE-ST-GERVAISROMAINVILLELES LILASPARIS 11PARAY-VIEILLE-POSTEMORANGISPARIS 10Institut CurieSAVIGNY-SUR-ORGEPARIS 20PARIS 12ATHIS-MONSBONDOUFLEVERT-LE-GRANDPANTINBAGNOLETDRANCYVINCENNESSAINT-MANDECHARENTON-LE-PONTTHIAISORLYRIS-ORANGISCOURCOURONNESECHARCONNOISY-LE-SECFONTENAY-SOUS-BOISSAINT-MAURICEJOINVILLE-LE-PONTALFORTVILLECHOISY-LE-ROIABLON-SUR-SEINEVIGNEUX-SUR-SEINEDRAVEILFONTENAY-LE-VICOMTEBALLANCOURT-SUR-ESSONNELISSESMENNECYMONTREUILMAISONS-ALFORTCRETEILCHEVANNESLE PERREUXBRY-SUR-MARNENOGENT-SUR-MARNEVALENTONCROSNEMONTGERONSOISY-SUR-SEINEPAVILLONS-SOUS-BOISCLICHY-SOUS-BOISBONDYROSNY-SOUS-BOISCHAMPIGNY-SUR-MARNE VILLIERS-SUR-MARNEBONNEUIL-SUR-MARNELE RAINCYNEUILLY-PLAISANCE NEUILLY-SUR-MARNEMORSANG-SUR-SEINENAINVILLE-LES-ROCHESORMESSONBOISSY-SAINT-LEGERVILLECRESNESMONTFERMEILNOISEAUMANDRES-LES-ROSESBOUSSY-SAINT-ANTOINEEVRYSAINT-GERMAIN-LES-CORBEIL LIEUSAINTEtb. Privé à but non lucratifCHAMPCUEILETIOLLESYERRESSAINTRY-SUR-SEINEORMOYentre 250 et 400AUVERNAUXVILLEMOMBLELIMEIL-BREVANNESVILLENEUVE-LE-ROIVILLENEUVE-SAINT-GEORGESBRUNOYLIVRY-GARGANSUCY-EN-BRIEEPINAY-SOUS-SENARTQUINCY-SOUS-SENARTTIGERYCORBEIL-ESSONNESSAINT-PIERRE-DU-PERRAYGAGNYCOUBRONGOURNAYVARENNES-JARCYNANDYSAINT-FARGEAU-PONTHIERRYPRINGYCHAMPSNOISY-LE-GRANLE PLESSIS-TRSAINT-MAUR-DES-FOSSESCHENNEVIERES-SUR-MARNEEtb. Public de SantéAP-HPEtb. PSPHEtb. Privé à but lucratifNombre d' habitants au Km²entre 50 et 100VILLABE entre 100 et 150entre 150 et 200entre LE 400 COUDRAY-MONTCEAUX et 700entre 700 et 1 100entre 1 100 et 1 800entre 1 800 et 3 000MAROLLES-EN-BRIEPERIGNYSECOMBS-LA-VILLSAVIGNY-LE-TESEINE-PORTLA QUEUESANTENYMOISBOISSISEBOISSISE-LE-ROISAINT-SAUVEUR-SUR-ECOLE© 2005 ARHIF-CRAMIF tous droits réservésCEVIL

Trusted hosting servicesProject ManagementPatient/Citizen supportToolsFrontdeskContract managementAccess PortalDocumentmanagementCall CenterVocal serverPHR storagePatient/Professional IDmanagementInternet accessData Warehouse

Trusted hosting servicesPHR Project (DMP)1) Testing phase (Q4 2005 – Q1 2006) Regional coverage• Patient-host contracts• Educational kits (citizen/health professionals)• PHR server configuration Patient private zone Professional zone Access right management• Technical and organizational assessment2) Deployment phase (Q2 2006 – Q4 2006) Regional coverage• Interoperability issues• Economic model consolidation3) Generalization phase (2007 - ) National coverage – 6 operators

The HEGP Case Study• The health care context• The HEGP case study– The strategic objectives– The HEGP shared patient record : a short visit– Report transmission to patients and their GPs– Transmission to hosting centers– Results and discussion• Conclusion

ResultsImproved productivityInpatient admissions BBL HEGP1999 2001 2003Beds 1,222 650 825 - 32%Staff 3,619 2,792 2,828 - 22%Patient admissions 48,441 43,368 51,195 + 5%

ResultsUse of the clinical information system (Q3 2005)Nb. using/Nb. concernedhealth units %Admission, discharge, transfer 100%Electronic health recordIn/outpatient reports 100%Access to lab. data & images 100%Care plans 100%Nurse notes & transmissions (inpatients) 100%Physician notes (inpatients) 50%Provider order entryLaboratory, Rx order entry, Nursing, Education 100%Drug orders 25%SchedulingAppointments 100%

ResultsUse of the provider order entry functionsQ1 2002 Q1 2003 Q1 2004 Q1 2005Laboratory orders- Direct entry by physicians 65% 73% 79% 93%Imaging orders- Direct entry by physicians 55% 66% 68% 71%Drug orders*-Direct entry by physicians 100% 100% 100%* 30% of beds

Patient requests for record transmissionHEGPYear 2001 2003 2005* 2005/2001Number of requests 92 285 850* + 820%Number of admissions 47,502 51,195 52,000* + 9%Percentage 0,2% 0,6% 1,6%* x 8,5*Estimate from 2005 Q1-Q3 figuresSource : Jean Wils, House of Patients, HEGP

Implementing Shared EHRsConclusion• The healthcare context• The HEGP case study• Conclusion

Jules Verne (1828-1905)From the Earth to the Moon (1865)Twenty Thousand Leagues Under the Sea (1873)

ConclusionBenefitsImproved productivity• Reduction of the length of stay (from 6.6 to 5.6 days) at year 3Quality of care• Immediately and ubiquitously accessible EHR• Common provider entry through protocols (>1,500 in January 2005)Continuity of care• Direct communication with patients and their GPs through securedemails (2003)• Deployment of a trusted PHR server (Q4 2005 - )

ConclusionLimitsHuman resistance to change

The The future“The future will not just happen if one wishes hardenough.It requires decision —now.It imposes risk —now.It requires action —now.It requires allocation of resources and, above all, ofhuman resources —now...”and patient (citizen) willingness[Peter Drucker, 1993]