An Introduction of Pudong

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An Introduction of Pudongs Progress in Shanghai
Health Information Development

• Pudong Team
• Aug. 2007

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Contents

• Basic requirements
• Methodology
• Present evolvement
• Investigation research of Pudong health
  information
• Information requirements in Pudong
• core set of electrical health archives
• Next-step tasks
• requirement

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Basic requirements

• Projects name
• Exploring the regional health information sharing
  mechanism
• Basic requirements
• Based on real case Pudong New Area health
  Information System, exploring the regional health
  information sharing model
• Inner-hospital information integration
• Inter-hospital information sharing model

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Methodology

• 5W1H
• Why?
• What?
• Where?
• When?
• Who?
• How?
• Investigating researching
• Theory Model
• Construction Model

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5W1H

• What What do we want to do?
• We underwent two phases in Pudong, first step is
  hospital developed its system independently,
  second step is based on a integrative plan.
• We have established Pudong health information
  network. But what are our next tasks? What is our
  next targets?
• That the relationship between information
  services and health services or people is our
  thoughts.
• People is our focus.
• Information services and patient.
• Information services and health provider system.
• Information services and health services
  efficiency, veracity etc.
• Information services and health management,
  decision-supporting etc.
• Information services and seamless care chains.

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• Establishing region-level data sharing and
  exchange system
• Implementing universal application on personal
  electrical health record and electrical clinical
  workstation
• Implementing interconnect communication between
  them
• Implementing region-level people health
  electrical administration.

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• Projects targets
• Establishing sharing system and model
  (inner-hospital and inter-hospital)
• Investigation of Pudong new area health
  information situation foundation
• Share and exchange data set of community
  electrical health record
• Establishing core data set standard
• Sharing standards and guidelines in regional
  health care, health information
• codes, classifications, vocabularies
• Hardware and network configuration standard
• Basic application software standard (framework,
  function, interface etc)
• Evaluation standard

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• WHY?
• The need of people
• The need of medcare evolution
• The need of medical enterprise development

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• WHEN?
• The regional health information system
  establishment in Pudong new area will be speeded
  by Finland cooperation project.
• Presently, foundation condition has been prepared
  (hardware, network, basic software)
• Local governments support

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• WHERE?
• Pudong New Area, Shanghai

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• WHO?
• Join together, share production
• Government, specialty institution, medcare
  organization, manufacturer, neutral evaluating
  organization

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• HOW?
• Definited targets
• Resoluble targets
• Investigation research, Literature search,
  Discussion
• Theory model
• Information technology
• Experiment Practice
• Evaluation

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Methodology

• What do we share and exchange?
• Inner-hospital
• The community health service center.
• Synthesis hospitalinter-department share and
  exchange
• Inter-hospital
• The community health service center personal
  health archives
• Synthesis hospitalelectrical patient record
• Diagnosis and care chain
• The optimization of clinic service workflow
• Bi-directed transfer of patient

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• How to share and exchange?
• Message based
• Core data set
• Core service set
• Codes, classifications, vocabularies
• Concentrated Data Management
• Data cleansing and data life-cycle management
• Standard, criterion, interface

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• Project progress
• Foundation investigation
• Standard establishment
• core data set
• Application modeling
• Codes, classifications, vocabularies
• Work-flow reconstruction

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Present progress

• Foundation investigation (the community health
  service center)
• 26 community health information systems
• Structure, staff, investment, network
  configuration, hardware configuration, software
  configuration, security devices and future plan
  etc.
• Conclusion all hold basic HIS, but with great
  difference in different communities

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• Structure and staff
• Every center has set up information department
  with one or two staffs
• Mainly provides basic maintenance
• Without structure standard
• Has staff trained, but poor quality

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• Investment
• In recent 5 years, 0.5 million RMB at lowest
  level, 0.8 million RMB at medium level, 1 million
  RMB at highest
• Mostly,average cost is about 0.1 million RMB one
  year
• Absent system strategic plan in health
  information construction
• Without detail content and cause in annual budget
  

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• System function module
• Basic functions (common modules in clinic
  register, charge(invoice), admission leaving
  management, pharmacy management, hospital manager
  query system, nurse workstation system )
• Half hospitals equipped e-family health archives
  system
• 30 hospitals equipped doctor work stations
• 25 hospitals equipped LIS RIS etc
• Few hospitals have EPR system, diagnosis and
  treatment monitor system

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• Application status
• All basic function are running completely
• Others (including E-health archives system) are
  running partly

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• Hardware, network
• Average 1 to 2 servers each hospital
• LAN, 1 to 2 Switches
• Connected to Pudong Health information network
• Without storage facilities and special back-up
  devices
• 1.5 to 3 persons equipped 1 Personal
  Computer(avg)

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• Investigation of hospital managers expectation
• According to target priority
• 1?doctor work station
• 2?medical technology related information system
• 3?foundation part of HIS
• 4?EHR
• 5?systems interconnect (inner-hospital data
  share)
• 6?linkage between health archives and public
  health information system

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• Foundation investigation in second-level
  synthesis hospital (Polyclinic)
• Structure and staff
• Every center has information department with 4 to
  7 employees
• Mainly with responsibility for the most basic
  administration, other jobs relied on exterior
  contract
• Normal training for staff, with credible quality
• Without public health information system

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• Investment
• Total cost up to 5-10 million RMB
• Mostly, average cost is about 0.4 million RMB one
  year
• Absent entire system plan in hospital information
  construction
• Without detail content and cause in annual budget
  

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• System function module
• Basic functions (common modules in clinic
  register, charge, admission leaving management,
  pharmacy management, hospital manager query
  system, nurse work station system )
• Most of hospitals equipped doctor work-station
• Most of hospitals equipped LIS etc. systems.
• Many hospitals have EPR, diagnosis and treatment
  monitor system
• All interconnect among different systems complete
  based on share database, but without standard
  interface

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• Hardware, network
• Average 4 to 8 servers, most of hospitals
  equipped with Small Computer System
• LAN, a lot of Switches, with normal programming
• Connected to Pudong health information network
• With disk storage facilities and without special
  back-up devices
• One person equipped one Personal Computer

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Kernel set of electrical health archives

• Core data set
• Electrical health record
• Doctor work-station (electrical case history)
• Codes, classifications, vocabularies

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• Electrical health record
• The combined electrical record set of personal
  and family health
• Records the correlative procedures and factors of
  humans health
• Implements the administration and monitor of
  whole people and complete procedure
• Provides services for daily work, administration,
  making decision

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• 15xY pattern
• 33 hospital pilot units

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• The composite of Chinese electrical health record
• Personal health archives
• Basic status
• Important events
• Main health problems
• Disease administration
• Family health archives
• Basic information
• Family members
• Social and economic status
• Health status
• Family characteristic

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• The reduced set of electrical health record
• Personal health archives
• Basic status (including part of health problem,
  optimal reduction)
• Important events (optimal reduction)
• Main health problems (integration of public
  health system, optimal reduction)
• Disease administration (based on core public
  health system)
• Family health archives
• Optimal reduction

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• The coordination and coalition of electrical
  health archives with other systems
• With doctor work-station
• Event reports (involving disease history
  home-page)
• Disease reports
• Diagnosis and treatment daily log
• With public sanitation system
• Health administration
• Disease administration
• Health evaluation

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• The application of electrical health record
• Data authentication
• Data cleansing
• Data query
• Interface

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• The risk of electrical health record
• Authority
• Reality
• Credibility
• Timely
• Integrality
• Feasibility
• Privacy

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Core set of Personal health record

• Discussion about personal health record
• (see attached pages)

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• Synthesis hospital share data set
• As one of the first phases targets, we are going
  to collect following four kinds of data from
  hospitals, which is not involved image operations
• Patients diagnosis and treatment record
• Patients basic information
• Lab test reports
• Inpatient Case history during staying at hospital

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• Patients diagnosis and treatment record includes
  following four data tables
• Diagnosis and treatment record table
• Detailed doctor's advice table
• Detailed charge table
• Charge record table

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• Patients basic information table
• Medical card number
• Identity card number
• Identity card type
• Sex
• Name
• Marriage status
• Birth date
• Birth place

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• Lab test reports

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• Inpatient

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Next-step tasks

• Definition of core data set
• Researches on data share model
• Standardization of Codes, classifications,
  vocabularies
• Data exchange guidance and standard
• Construction standard of community health service
  centers information system
• Data share pattern in second-level synthesis
  hospital
• Reconstruction of work-flow
• Data query mode
• integration specification methods

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Needed help

• Hope following helps from Finland collaborator
• Contents and forms of inter-hospital shared
  information
• Application pattern of hospital EPR
• Interconnect and integration platform in hospital
  
• Finland localization experience on HL7,
  especially CDA-R2
• vocabularies, category method and standard
• Interconnect standard between hospitals
  (transmission, format)
• Data security standard
• Privacy administration criterion
• Electrical health record in Finland

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• Thanks!

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• Personal health archives
• Focus on persons health
• Span whole life-cycle
• Cover different factors associated with health
• Implement dynamic information collection from
  multi-channel
• Satisfy need from many ways
• Provide personal health data for information
  integration
• Mainly includes four parts basic information,
  important events, primary health problem and
  disease administration
• Family health archives
• All kinds of family members valuable health
  records from family or society activities
• Reflect familys primary health characteristic
• Collect every members personal health archives
• Mainly includes five parts basic information,
  family members data, social and economic status,
  health status and familys characteristic

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• Community health archives
• Reflect communitys primary health characteristic
• Formed by every familys health archives
• The important part of community construction
• The real record of community work
• Mainly include eight parts physical geography,
  habitation, economic status, traffic and
  communication, population quantity, population
  structure, health status, sanitation resource and
  its exploitation

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• Personal health archives plus familys
  characteristic forms family health archives.
  Moreover, family health archives plus community
  characteristic forms community health archives
• Personal health archives is our emphasis in this
  project