Beyond Medical Informatics

(Application period has been extended.)

The IT Department of The Medical City, in coordination with the HR Training Department, will be starting a Health IT for IT Professionals (HIT4IT) Training Program.

Overview:

This is a 14-week introductory course to the Basic Healthcare IT Concepts and Applications for IT graduates and professionals.

Objectives:

• To provide all participants of the course with the necessary knowledge, skills and experience in the fundamentals of Healthcare IT;
• To provide all participants opportunity to apply knowledge and skills in clinical systems analysis and software development and design;
• To prepare the trainees on how to work professionally in a corporate environment; and,
• To align the trainees to the corporate mission and vision of the hospital.

Target Participants or Trainees:

• IT professionals (programmers, systems analysts)
• (Optional) Graduate of any IT-related course
• (Recommended) Experience with JavaScript, PHP, Java, MySQL and MongoDB

Methodology:

• Lectures;
• One-on-one coaching and mentoring sessions;
• On-the-Job-Training; and,
• Practicum Work (Special Projects).

Major Topics:

• Introduction (TMC and IT);
• Concepts in Healthcare Informatics;
• Computer Applications in Healthcare and Nursing;
• Principles of Healthcare Interoperability and Integration;
• Effective Software Development and IT Project Management; and,
• Systems Analysis, Design and Implementation for Clinical Applications.

Practicum Work:

Participants will be working with the TMC-IT Special Projects team. Special projects may include:

• Electronic Medical Record (Clinical Documentation);
• Clinical Data Repository;
• HL7 Integration;
• Telemedicine;
• Electronic Medication Administration Record with Barcode;
• e-KARDEX Planning and Design;
• Hospital Information System Planning and Design; and,
• Outpatient Clinic Management System.

Other Details:

• Training is free. There is NO fee.
• Only 3-4 participants will be accepted.
• Expect programming tasks. Bring your own laptop.
• Target start date is on April 3, 2013. All three slots should be filled up.
• Participants will be interviewed for fit into program and interest in Health IT.
• Program Duration is a minimum of 336 hours (8 hours per day, 3 days a week, 14 weeks)
• Certificate of Attendance shall be given to the trainees who have satisfied all the requirements in the Practicum.

Procedures:

Interested and qualified participants should submit the necessary documents to the TMC Training and OD (TOD) Department and pass the initial interview:

• Letter of Interest specifying the participant’s intention to be part of the Health IT for IT Training Program,
• Updated copy of their resume with 1×1 or 2×2 size picture,
• (Optional) College Diploma or Training Certificate/s.

Shortlisted applicants will be forwarded to the IT Department for their final interview. If the participant passed the final interview, the IT Department shall forward its recommendation to the TOD Department for creation of a Memorandum of Agreement (MOA) between TMC and the participant to cover the training program.

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Interested applicants may also send their application requirements to mbmuin(at)medicalcity.com.ph. I can forward the application to HR for initial screening before final interview with me and IT Department.

Questions, comments and suggestions are welcome.

Source:

Telehealth To Grow Six-Fold By 2017 – Healthcare – Mobile & Wireless.

Quick notes:

• Cited research predicts telehealth to impact 1.8M patients worldwide by 2017.
• Telehealth is narrowly defined as remote patient monitoring in the article.
• Biggest driver is the need to lower healthcare cost.

Lessons/Takeaways:

• Telehealth is a growing field–and is here to stay.
• Hospitals and clinics should start looking into this service to extend their reach.
• Doctors should explore potential of this service to improve outcomes.

Source:

BMC Medical Informatics and Decision Making | Abstract | Does Googling for preconception care result in information consistent with international guidelines? A comparison of information found by Italian women of childbearing age and health professionals.

Quick notes:

• Researchers googled for preconception/pre-natal information,
• They compared search results against international guidelines.
• Result: Not all information available on the Net match medically-approved guidelines.

Lessons learned and take-aways:

• Information across the Web does not yet reflect medical guidelines.
• Patients and health consumers should be advised against believing everything they read on the Net.
• Health providers should take more effort to disseminate correct information in their websites.
• Doctors should be prepared with correct information as some patients may come in with Googled notes that might not exactly be medically sound.

It’s the start of the year and we are in the middle of MANY planning sessions for our different Health IT projects. They include:

• EMR module for our Outpatient Clinics
• EMR module for our Wellness Center
• HL7 integration of Laboratory Information System
• HL7 integration of Radiology Information System
• Legacy data migration of existing systems into our Clinical Data Repository (CDR)
• API integration of legacy systems
• EMR module for Telemedicine setup in satellite clinics

This article made me write down reminders so we can avoid our previous mistakes in project planning. Let me share them with you.

• NEVER ever assume 100% allocation for your staff. Many IT staff work on multiple projects at a time. Don’t assign task timelines that require 1 person or team to be 100% focused. That almost always never happens.
• Don’t forget to include testing and bug-fixing into the plan. This is crucial when you do system integrations (HL7, XML) or data migrations. Testing and bug-fixing, from experience, eats up TOO much time in the project–but you can’t go live without doing them.
• ALWAYS work with VENDOR timelines. Sometimes we assume that vendors can give 100% allocation of their resources. They have other projects and clients. Be realistic.
• ALWAYS work with USER timelines. Availability of project stakeholders, team leaders and user groups vary–especially in a hospital environment. Make sure you don’t draft project plans and timelines without being realistic about their other obligations to patients, staff and hospital.
• If the ultimate goal or outcome is unclear, plan in iterations. Adopt the Agile Methodology–even if it isn’t software. We’ve used iterations (1st round, 2nd round, 3rd round, etc.) in the design of our work spaces, floor plans, furniture.
• If you lack the appropriate manpower for the project, put recruitment in the plan. This is fairly obvious.–but I’ve seen plans drawn up without people to do the specific tasks defined.
• Draft project overview statements and success criteria early on. Don’t wait until everyone is confused before you do the exercise of gaining “clarity of purpose”.
• Pencil in weekly (or regular) review meetings into the plan. Better to have these planned out early on so people can put them in their calendars.
• Don’t forget HARDWARE! Sometimes, project teams can be too focused on software development that they forget they need to make that system run on servers. Make sure to give ample time for ordering and delivery of needed hardware.
• Don’t let inexperienced people (or management) dictate timelines. Although some management deadlines are “doable but EXTREMELY challenging to execute”, some demands are plain impossible to meet. Challenge yourself and your team with timelines but never promise the impossible. It provides unnecessary mental anguish.

I’m sure there are more of these reminders. I can’t remember all.

Do you have your share of common HIT project planning mistakes? What were they?

We are currently working on the IT Governance Framework for all IT projects of The Medical City. The projects are not confined to the main TMC hospital (TMC Ortigas) but will also include the other TMC hospitals (Iloilo, Guam) and satellite clinics.

While building our framework with stakeholders, I came up with 5 important characteristics of IT governance.

1. Autonomy: The governing group should be independent of any internal politics. It should be immune from the bias, influence and agenda of specific groups in the organization.
2. Alignment: Free of bias, the group should focus on bridging IT deliverables with business objectives. It should be about what is best for the hospital in the long run.
3. Accountability: The group should hold themselves accountable for their decisions–to the board, to the hospital management and to the staff.
4. Authority: Reporting oversight is not enough. There should be decision-making capabilities built into the system. The group should be empowered to make decisions for the hospital in terms of prioritizing IT projects.
5. Ability to Execute: The group should understand available hospital resources–manpower, technology and budget. This is about being realistic. Decisions cannot be made in a vacuum. They need to be actionable by implementation teams–and these demand resources.

We are still working on the reporting structures and processes towards a complete IT governance framework. As the CIO, I will be making my presentation rounds with the various stakeholder groups in the hospital to get input, feedback and suggestions.

Change is not easy. Change is a lot of work.

But change is coming.

Video observations can be a useful tools in understanding the complexity of the healthcare environment and in the development of EMRs and other Clinical Information Systems.

From BMC Medical Informatics and Decision Making | Full text | Video observation in HIT development: lessons learned on benefits and challenges:

… Overall, video observation can teach us to know and to better understand the users work practice, and therefore, to know better the user requirements and needs for HIT. From a socio-technical perspective this is a precondition for the development of more successful HIT systems in the future.

This is something we can look into when we start implementing in the nursing floors and other clinical units. It would be interesting to see how the staff handle the new data entry process for some of their forms.

I’m inviting everyone to join us in this event.

EMR Discussion Night

When: October 11, Thursday, 6:30pm
Where: Exist Tech Bar (Orient Square Building, Ortigas)
What: EMR presentations, demo and discussions

Speaker lineup:

Dr. Richard Mata (Easy Clinic Software)
Dr. Alex Reyes (Custom-built EMR)
Kit Sumabat (Smart SHINE)

As usual, bring your own baon (unless someone wants to sponsor snacks!).

Please share.

See you all there!

Just saw this news: HL7 to Offer Free License for Standards, Other Properties

Standards development organization Health Level Seven International will make much of its intellectual property available via a free license, an initiative expected to start during the first quarter of 2013.

The free property includes all standards, domain analysis models, profiles, implementation guides and some tools. The intellectual property will not be licensed on the open source market, under which other developers may make enhancements. The freely available property means the content must be licensed for use but the license is free. HL7 will continue to control the content, which will continue to be developed and balloted following the organization’s internal rules and standard development requirements under the American National Standards Institute.

This is definitely good news!

Question: I’m a practicing doctor and I’m thinking of getting an EMR. I sometimes hear about HL7. Is this relevant to me? Is this something I need to know about when choosing or implementing a clinic EMR?

Answer:

To be honest, you don’t need to know–or worry or study–about HL7. HL7 per se is a technical topic best left to the technical and Health IT team.

However, you need to know and appreciate interoperability concepts. The IEEE defines interoperability as:

the ability of two or more systems or components to exchange information and to use the information that has been exchanged.

The key words are exchange and use.

So, when thinking about your practice and choosing an EMR, you will need to ask the following items:

• Do I need to send information to someone or something electronically, e.g. another clinic, a hospital?
• Do I need to get information from some systems, e.g. labs, radiology reports?
• Do I need access to data from other information systems, e.g. scheduling, appointments?
• Do I have other sources of information, e.g. patient database, billing system?
• Do I need to push data into other sources, e.g. research registries?

The more positive answers, the more interoperability becomes essential. And, HL7 as a standard is an integral component of Health IT interoperability.

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If you have a clinic EMR, do you interoperate with other systems outside of  your clinic?

Questions and comments are welcome!

(I recently had a discussion with fellow doctors. They heard about HL7 and had some questions about it.)

Question: Is HL7 a software? How do I install it and where can I buy it?

Answer:

No. HL7 is not a software. HL7 is a set of standards for messaging and interoperability used by clinical/health applications.

You can’t just download and install HL7.

But there is a relationship between software and HL7.

First, disparate software systems is exactly why we need standards like HL7. Different software systems implement data and data models differently. If you want these systems to talk to each other, there needs to be a set of standards that both systems agree on so they can communicate.

Second, you will need software to implement HL7. The most common type is the interface engine or integration engine. This is the system that acts as the go-between among disparate systems. These are also sometimes called middleware.