Health Informatics for Allied Health

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1 Health Informatics for Allied Health Newly Appointed Senior AH Staff Program Core Part II 12 Jun 2014 Content Health Informatics in AH Use of Health Informatics Useful websites and information Working structures & 14/15 Work Plan

2 Health Informatics for AH Development Radiology Information System (RIS) Laboratory Information System (LIS) Future 2010 xxxx 2009 Service request GCR(since 2006) Workload capture OPAS OP (since 2000) ANPN IP(since 2011) AH Forms Assessment & Discharge Forms (since 2011)

3 Out Patient Appointment System (OPAS) for Allied Health v4.0 Implementation (AH OPD) since Year 2000 Facilitate appointment booking Capture of Patient condition and Intervention 5 Generic Clinical Request System (GCRS) for Allied Health since Year 2002 (Pilot) 2006 (Full rollout) Ten Disciplines involved: System Workflow: Physiotherapy Occupational Therapy (General & Psychiatric) Speech Therapy Dietetics Medical Social Work (General & Psychiatric) Prosthetic & Orthotic Clinical Psychology Spiritual Care Podiatry Community & Patient Resource Centre (CPRC) 6

4 Allied Health Documentation in CMS since Year 2010 Type of Documentation Assessment Form Progress Note Discharge Summary Name of the form Dietetics Assessment Form Occupational Therapy Work Rehabilitation Assessment Form Physiotherapy Progress Note Occupational Therapy Progress Note Speech Therapy Progress Note Dietetics Progress Note Prosthetic & Orthotic Progress Note Medical Social Services Progress Note Clinical Psychology Progress Note Physiotherapy Discharge Summary Occupational Discharge Summary Medical Social Services Discharge Summary Speech Therapy Discharge Summary 7 Shared in epr 8

5 Development Milestone Year Year Year Year Year Year 09/10 10/11 11/12 12/13 13/14 14/15 Progress Notes Develop Discharge Summary Develop Assessment Form Develop Progress Notes > Summary Progress Notes Diet OCC PHY P&O SPTH MSS CP POD Discharge Summary OCC PHY MSS SPTH CP P&O Assessment Form Diet OCC (Work) SPTH (VFSS) PHY (MS) Information Required Source Remarks Case Mix / Diagnostic Code Timely referral Timely assessment / intervention Intensity of intervention CMS Link with AH forms IPAS vs GCR GCR vs SRE / AHPN AHPN; OPAS Process / Outcomes AH Assessment / Progress / Discharge Upload to data warehouse Analysis via CDARS

6 CP Discharge Summary DIET Assessment Form

7 MSS Discharge Summary OT Discharge Summary

8 PT Discharge Summary P&O Discharge Summary

9 ST Discharge Summary Information System for DR (RIS)

10 Information System for MLT (LIS) Pathology Department Laboratory Information System CMS Administrative functions Registration of requests Uploading of lab results from analysers Test result data capture Workload reports Clinical Functions Lab result reporting Lab result enquiry LIS for different Lab specialties BBLIS MBS APS CPS HMS Use of Health Informatics

11 Application Information System Use GCRS Service requirement Resources prioritization Standardization of services OPAS Demand management Resources prioritization AH Record Communication e Patient Record /e Health Record Profile / Process / Outcome evaluation Support evidence based practice AH forms LIS /RIS Test / examination profile Demand data Workload data Quality data Data Analysis of UCH Diet Assessment Form Condition Description Problem Distribution Number Percentage Acute Myeloblastic Leukaemia/ Acute Lymphoblastic Leukaemia % Acute Renal Failure % Alzheimer's Disease % Anaemia % Angina % Anorexia Nervosa % Arthritis % Atrial Fibrillation % Behavior Problems % Biliary Disease/ Gallstone % Burns and Scald Injury % Cancer of (Others) % Cancer of Bladder % Cancer of Breast %

12 Data Analysis of KH OT In patient Discharge Summary 2012 CVA Brain Injuries Hip # COPD SMI N Age (mean) LOS (mean) OT days (mean) Independent ratio 14.3% 23.1% 10% 48.5% 98.42% Return Home ratio 55.35% 59.5% 68.45% 84.4% 87.5% FIM gain/ot day Mean diff. Mean diff. Mean diff. MMSE gain 1.55** 1.29** 2.45** BI100 gain 10.96** 15.72** 18.25** FIM gain 10.56** 15.63** 10.63** ** p< Outcome Data of TMH PT Discharge Summary NGRCS Improvement in NGRCS from 2011 to N=223 P<0.001 N=203 N= Pre NGRCS Post NGRCS Year Year Year Significant improvement in NPRS in all 3 years Gradual improvement NPRS Improvement in NPRS from 2011 to 2013 P< Pre NPRS Post NPRS Year Significant improvement in NGRCS in all 3 years Improvement maintained Year Apr 2014 Year N=128 N=1233 N=988

13 Information Required Source Remarks Case Mix / Diagnostic Code Timely referral Timely assessment / intervention Intensity of intervention CMS Link with AH forms IPAS vs GCR GCR vs SRE / AHPN AHPN; OPAS Process / Outcomes AH Assessment / Progress / Discharge Upload to data warehouse Analysis via CDARS Development Milestone Year Year Year Year Year Year 09/10 10/11 11/12 12/13 13/14 14/15 Progress Notes Develop Discharge Summary Develop Assessment Form Develop Progress Notes > Summary Progress Notes Diet OCC PHY P&O SPTH MSS CP POD Discharge Summary OCC PHY MSS SPTH CP P&O Assessment Form Diet OCC (Work) SPTH (VFSS) PHY (MS)

14 System Support CDARS Ad hoc query Data analysis on clinical form

15 Questions Is the test / care plan prescribed appropriate to specific condition? Does it produce intended outcome? Are standards been met? Are the activities justified? Is the intervention / test costeffective? Does the intervention produce positive / significant impact? Is there any good practice we can learn / apply?. Our Goals 2014 Future Standard & practicing guidelines are incorporated Provide quality & useful data on performance Enable AH profession resources to be used effectively

16 Related Websites & Information on AH Informatics Websites / Information HO Allied Health Grade Department Health Informatics AH IT Plans AH Forms OPAS Patient Condition & Intervention Lists AH GCR Master List Clinical Data Analysis and Reporting System (CDARS) Cross systems data analysis and reporting Executive Information System (EIS) Executive information for performance management and service planning Management Information Portal (MIPo) For reporting KPI HO Health Informatics HO Health Informatics website

17 Working Structure & Work Plan for 14/15 AH Information Technology Committee TOR To identify the IT needs and gaps to assist allied health services in achieving quality and efficient patient care To advise the CMS Steering Group on IT requirement for allied health To facilitate the integration of IT systems being used by various allied health professions To coordinate different allied health IT development to minimize variation To advise and facilitate the implementation of IT in allied health services Composition Chairman: Members: CM(AH), HAHO SM(AH)s, HAHO Representatives of Planning (S&P Division), HAHO Cluster representatives Clinical Stream Coordinator (AH)s AH COC / Subcommittee representatives Other co opted members M(AH) (Secretary) Frequency of Meeting Twice a year

18 Membership List of AH Information Technology Committee HAHO Cluster Representatives Mr Lawrences FUNG (Chairperson) Ms Ivis CHUNG (Co chairperson) Mr Jimmy WU Mr Daniel LO Dr Joanna PANG Mr Dick LAM Mr H L HUI Mr Ricky SIU Ms Louise CHAN (Secretary) Ms. Jeanie NGAN (HKEC) Ms Alice CHIU (HKWC) Mr. David YU (KCC) Ms. Esther POON (KEC) Mr. Lawrence Fung (KWC) Mr. Anthony LAU (NTEC) Mr. Joseph POON CSC(Allied Health)/ KWH DM(PHYS) CM(AH), HAHO SM(AH), HAHO SM(AH), HAHO SHI (CS), HAHO SM(CS)6, HAHO SSM(CS), HAHO SM(CS)9, HAHO M(AH), HAHO Coordinator (CP), HKEC / Sr CP i/c, PYNEH SPT, DKCH SPT, QEH CDM(ST), KEC CSC(AH)), KWC / DM(PHYS), KWH CC(PT), NTEC / DM(PHYSIO), AHNH CC(OT), NTWC as at April 2014 Membership List of AH Information Technology Committee Discipline Representatives Ms. Jeanie NGAN Ms. Sandra LO Mr. T S FUNG Ms. Tina CHAN Mr. Simon WONG Mr. Anthony LAU Mr. K M LAI Mr. Sai Wing SIN Ms. Esther POON Coordinator (CP), HKEC / Sr CP i/c, PYNEH CC(DIET), NTEC PMH/NLTH DM(Radiology) SWO(MSS), TWH DM(OCCUP), TPH CC(PT), NTEC / DM(PHYSIO), AHNH CDM(POD), KEC SPO, PWH CDM(ST), KEC as at April 2014

19 Clinical Documentation Development Milestone Year Year Year Year Year Year 09/10 10/11 11/12 12/13 13/14 14/15 Progress Notes Develop Discharge Summary Develop Assessment Form Develop Progress Notes > Summary Progress Notes Diet OCC PT P&O ST MSS CP POD Progress Note Enhancement (CP, OT, PT, ST) Discharge Summary OCC PT MSS ST CP P&O Assessment Form Diet OCC (Work) ST (VFSS) PT (MS) ST (FEES) 2014/15 AHIT Plan Promulgation of forms roll out : Roll out in April 14 CP COC P&O COC ST COC POD COC Discharge Summary Discharge Summary Assessment Form (VFSS) Progress Note Forms development and enhancement: Target completed by 1Q15 PT COC ST COC CP COC OT COC Assessment Form (Musculoskeletal) Progress Note enhancement Assessment Form (Feeding Instruction) Progress Note enhancement Progress Note enhancement

20 2014/15 AHIT Plan Hardware enhancement: Call for return by 3Q14 CMS workstation Other devices Continue the support for clinical documentation e.g. notebook for input in IP, Community or OP with space constraint Review & Monitoring 1. Monitor the utilization and report to AHITC 2. Review the form design or function, put up improvement proposal via AHIT change request mechanism, if needed 3. Plan for quality and outcome evaluation Thank you