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HOSPITAL DIGITAL

Contato

• Claudio Giulliano Alves da Costa

[email protected]

• Site: www.folks.la

O que é um Hospital Digital?

Hospital Digital

Um hospital com ampla e intensautilização da tecnologia da informação na operação, assistência e gestão.

PaperlessFilmless

Hospital Digital

Tecnologias

PEP Avançado

Apoio à decisão clínica

Analytics

Segurança da informação

Alta disponibilidade

Processos

Circuito fechado da administração de medicamentos

Documentação clínica

Protocolos clínicos gerenciáveis

Gestão de TI

Benefícios

Segurança do Paciente

Qualidade Assistencial

Eficiência Operacional

Desempenho financeiro

QUAL O CAMINHO PARA O HOSPITAL DIGITAL?Modelos de Maturidade

Em busca do hospital digital

Hospital Papel

Hospital PEP

HIMSS Stage 6

Hospital Paperless

HIMSS Stage 7

Hospital Digital

Concepção:

Requisitos mínimos para PAPERLESS

Software em conformidade com os requisitos da SBIS

Os prontuários assinados com certificados digitais padrão ICP-Brasil

Segundo resolução CFM 1821/2007:

O caminho para o hospital paperless

Digitalização

Digitalização dos documentos que não podem, ainda, ser assinados

Processos

Automação de processos e mais documentos eletrônicos

Certificação Digital

Certificação dos documentos que já são eletrônicos

Concepção:


Hospital Papel

Hospital PEP

HIMSS Stage 6

Hospital Paperless

HIMSS Stage 7

Hospital Digital

Concepção:

Enabling better health through information technology.

•

Healthcare Information and Management Systems Society (HIMSS)

HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology (IT).

HIMSS leads efforts to optimize health engagements and care outcomes using information technology.

HIMSS Annual Conference, Corp Membership, Thought Leadership, etc.

Marketing Arm, Healthcare IT News, Local Forums, Content Creation & Syndication, etc.

LOGIC™, CapSite, Maturity Models, Insight & Research, Essentials Briefs, etc.

Healthcare’s Most Comprehensive Market Intelligence Resources & Advisory Solutions

Health IT Market Intelligence

Health IT Insight & Research

Healthcare Organization

Benchmarking

Uniquely Positioned to

Deliver Actionable Intelligence

HealthcareDeliveryOrganizations

Health ITSolutions

HIMSS Analytics Toolkit

Health IT

Actionable

Insights

We drive the health IT market in the direction it needs to go

Improved

Patient Care

and Health IT

InsightsAnalytics Maturity Adoption Model

Continuity of Care Maturity Model

Digital Imaging Adoption Model

Outpatient EMR Adoption Model

EMR Adoption Model

O que é a certificação da HIMSS?

• A acreditação HIMSS é reconhecida mundialmente como uma ferramenta de transformação digital na área de Saúde, com foco na segurança do paciente e qualidade assistencial, através do uso da tecnologia da informação.

EMRAM Criteria Update – Effective 1 January 2018

Principais Desafios dos Estágios 6 e 7

… circuito fechado da administração de medicamentos

… sistemas de apoio à decisão clínica

… integração com monitores

… disaster recovery

Prescrição de medicamentosSistemas de apoio à decisão clínica no POC

Validação da prescrição e dispensação com unitarização (ex.:ADM)

Dispensadores automáticosopcional

Identificação segura da enfermeira, paciente e medicação na beira-leito

Administração dos medicamentos

eMARRegistro completoadministração dos medicamentos (checagem no sistema)

Farmácia e Enfermagem

Prescrição Eletrônica

Reconciliação da medicaçãoMedicamentos na admissão e alta

Circuito Fechado da Administração de Medicamentos

Fonte:

Alertas na Prescrição

• Duplicidade

• Alergias

• Dose fora do padrão (mega dose…)

• Dose acumulada acima do limite

• Interação medicamentosa

• Interação medicamento – resultado exame laboratorial

• Interação medicamento com dieta

• Situação clínica do paciente (diagnóstico…)

Tecnologias para Beira Leito

• Equipamentos:– Desktop fixo

– Carrinho

– PDA

– Smartphones

– Tablets

• Tecnologias– Código de Barras comum

– Código de Barras bi-dimensional (QR Code)

– RFID

Equipamentos para Checagem Beira-leito

Smartphones

Tablets

Código de Barras e RFID

Código de Barras

Alto

Médio

Baixo

Nível 3: sistema baseado em regras com alertas disparados

de acordo com as anotações no prontuário

Nível 2: alertas durante a prescrição com um sistema

baseado em regras

Nível 1: checagem de erros durante a prescrição

Sistema, Usuário eRequisitos de Gestão

Nível

Sistemas de Apoio à Decisão Clínica

Fonte:

Tipos de CDS

Passivo

Acesso e valorização da informação relevante do paciente

Ativo

Acesso ao conhecimento clínico e evidência, com diretrizes e protocolos

Interativo

Apoio à decisão durante a entrada do pedido e documentação. Monitoramento decisão

Fonte:

Exemplos de CDS

• Protocolos Gerenciáveis

– TEV

– IAM

– AVC

– Sepsis

– Dor Torácica

• Escalas e Índices

– MEWS

– ICC

Desafios do Estágio 7

• Hospital paperless (certificação digital)

• Circuito Fechado da Administração de Medicamentos

– Todos os setores

– Hemoderivados

– Nutrição parenteral

• Apoio à decisão clínica

• Disaster Recovery

• Analytics

• Integração com monitores na UTI

Desafios Adicionais para o estágio 7

Estágio 7

Planejamento

Orçamento Engajamento

Processos

PROCESSO DE AVALIAÇÃO DA HIMSSRumo ao estágio 7

Processo de avaliação evalidação da HIMSS

Questionário da HIMSS

Gap Analysis da FOLKS

Score oficial da HIMSS

Treinamento

Avaliação

Novas tecnologias

Ajuste de processos

Gestão de projetos

Acompanhamento mensal

Transformação Validation Call

Questionário estágio 6/7

Pré-auditoria da FOLKS

Auditoria da HIMSS

Certificação

Short Gap Analysis ReportHIMSS Europe

Office Leipzig | Schwägrichenstr. 9 | 04107 Leipzig | Germany

Phone: +49 341 33395 300 | Web: www.himss.eu

EMRAM GAP Overview forNameHospital Unimed Vitória

NameParentParent Name Unimed Vitória523918

Date of creation 05.02.2015

ModifierCreated by Isabel Simao (Quality Assurance, HIMSS Europe)

respondentRespondent: CIO / Head of IT Alex Rodrigues

InterviewerLastNameHIMSS Europe contact Isabel Simao (Quality Assurance, HIMSS Europe)

ModifierQuality Assurance Isabel Simao (Quality Assurance, HIMSS Europe)

EMRAMScoreYour EMRAM Score: 2.4700 not validated

EMRAM scores for your comparison Mean Count

emram_Europe* 2.8 1,057

emram_500minus_Hospitals <= 500 beds 2.6 821

emram_pnp_Private for Profit 2.3 171

emram_genmed_General Medical hospitals 2.9 929

Understanding the level of electronic medical record (EMR) capabilities in hospitals is a challenge in the European

healthcare IT market today. HIMSS Europe has developed a European EMR Adoption Model based on the

acknowledged model created by HIMSS Analytics and established across the U.S. and Canada. The model

identifies the levels of electronic medical record (EMR) capabilities ranging from limited ancillary department

systems through a paperless EMR environment.

* Countries included are (descending order by N): Italy, Germany, Spain, Turkey, Netherlands, United Kingdom, Austria,

Denmark, Portugal, France, Switzerland, Poland, Norway, Finland, Slovenia, Belgium, Ireland

* Comparison data is based on HIMSS Europe Hospital Database 09/2014

EMR Adoption Model structure ensures objectivity:

• All ap plication capabilities within each st age must be

operational before that stage can be achieved.

• All lower st ages must have been ac hi eved be f o re the

next higher level can be mastered.

• A hospital ca n ac

h

i eve Stages 6 if it has met al l of the

application requirements for Stages 1-5, and if it is able to

demonstrate to have a closed loop medication process as

well as using clinical decision support triggered by clinical

documentation in at least one single patient care service

(e.g. single nursing floor, intensive care service).

In addition to these rules extra points (figures after the

comma) are given for the implementation of applications in

stages higher than the one fully achieved by the healthcare

organization. Thus other implementation paths than those

prescribed by the stages can be taken into consideration

for correlation with quality and financial research.

0 1 2 3 4 5 6 7

Mean EMRAM Score

In case of specific questions regarding the EMRAM or your Gap Analysis please do not hesitate to contact us at

[email protected].

HIMSS Europe



EMRAM GAP Overview forNameHospital Unimed Vitória

NameParentParent Name Unimed Vitória523918

Date of creation 05.02.2015

ModifierCreated by Isabel Simao (Quality Assurance, HIMSS Europe)

respondentRespondent: CIO / Head of IT Alex Rodrigues

InterviewerLastNameHIMSS Europe contact Isabel Simao (Quality Assurance, HIMSS Europe)

ModifierQuality Assurance Isabel Simao (Quality Assurance, HIMSS Europe)

EMRAMScoreYour EMRAM Score: 2.4700 not validated

EMRAM scores for your comparison Mean Count

emram_Europe* 2.8 1,057

emram_500minus_Hospitals <= 500 beds 2.6 821

emram_pnp_Private for Profit 2.3 171

emram_genmed_General Medical hospitals 2.9 929

Understanding the level of electronic medical record (EMR) capabilities in hospitals is a challenge in the European

healthcare IT market today. HIMSS Europe has developed a European EMR Adoption Model based on the

acknowledged model created by HIMSS Analytics and established across the U.S. and Canada. The model

identifies the levels of electronic medical record (EMR) capabilities ranging from limited ancillary department

systems through a paperless EMR environment.

* Countries included are (descending order by N): Italy, Germany, Spain, Turkey, Netherlands, United Kingdom, Austria,

Denmark, Portugal, France, Switzerland, Poland, Norway, Finland, Slovenia, Belgium, Ireland

* Comparison data is based on HIMSS Europe Hospital Database 09/2014

EMR Adoption Model structure ensures objectivity:

• All ap plication capabilities within each st age must be

operational before that stage can be achieved.

• All lower st ages must have been ac hi eved be f o re the

next higher level can be mastered.

• A hospital ca n ac

h

i eve Stages 6 if it has met al l of the

application requirements for Stages 1-5, and if it is able to

demonstrate to have a closed loop medication process as

well as using clinical decision support triggered by clinical

documentation in at least one single patient care service

(e.g. single nursing floor, intensive care service).

In addition to these rules extra points (figures after the

comma) are given for the implementation of applications in

stages higher than the one fully achieved by the healthcare

organization. Thus other implementation paths than those

prescribed by the stages can be taken into consideration

for correlation with quality and financial research.

0 1 2 3 4 5 6 7

Mean EMRAM Score


[email protected].

HIMSS Europe



ApplicationsIntegra-

tion with EMR

EMREMR / Hospital Information System (Suite) Live MV SISTEMAS -

523918_PASPatient Administration System Live - hospital-wide MV SISTEMAS Yes

523918_ERPEnterprise Resource Planning Live - hospital-wide MV SISTEMAS Yes

523918_BIBusiness Intelligence Not Automated Not Reported Bonus

523918_CDWClinical Data Warehousing Not Automated Not Reported Bonus

523918_QMQuality Management Live - hospital-wide SOFTEXPERT No Bonus

523918_ICUIntensive Care Management System Not Automated Not Reported

523918_RISRadiology Information System Live - hospital-wide MV SISTEMAS Yes Stage 1

523918_CISCardiology Information System Not Automated Not Reported

523918_OISOncology Management Software Live - departmental MV SISTEMAS Yes

523918_LISLaboratory Information System Live - hospital-wide MV SISTEMAS Yes Stage 1

523918_PHAPharmacy Management System Live - hospital-wide MV SISTEMAS Yes Stage 1

523918_EMARElectronic Medication Administration Record Not Automated Not Reported Stage 3

523918_EPRClinical Data Repository Live - hospital-wide MV SISTEMAS Yes Stage 2

523918_NDSNursing Documentation Live - hospital-wide MV SISTEMAS Yes Stage 6

523918_PDSPhysician Documentation Live - hospital-wide MV SISTEMAS Yes Stage 6

523918_CDMSChronic Disease Management System Not Automated Not Reported

523918_DSRDictation with Speech Recognition Live - departmental NUANCE Yes Bonus

523918_ImgImage Management System Live - hospital-wide MV SISTEMAS Yes Stage 5

523918_OEElectronic Order Entry Live - hospital-wide MV SISTEMAS Yes Stage 3

Software usage and IT supported processes

Physician Documentation

76-100%

26-50%

Electronic Ordering

Yes

51-75%

Yes

76-100%

Clinical D

e

c ision S

u

pport (for…)

Yes

Yes

Yes

Image Management System (IMS)

Yes

Yes

76-99%

1-25%

Closed Loop Medication

No

Automated Dispensing of medication is available No Bonus

No

No

No

No

No

What % of medical images in all other departments are managed by your IMS?

Closed-loop medication administration at the point of care

Which of the following is auto-identified during bedside medication administration?

Patient

Nurse

Electronic Medication Administration Record (EMAR) available at point of care / bedside?

Medication

2nd line of validation for critical medication prescriptions which is documented

Is your solution integrated with your Electronic Medical Record (EMR)?

Does your image management solution support Non-DICOM standards?

Stage 6

Stage 6

What % of medical images in Radiology are managed by your IMS?

Stage 6

Stage 6

Stage 6

Stage 5

Stage 5

Stage 5

Clinical Documentation (Physician / Nursing Documentation)

Medication Orders

Non-Medication Orders

What percent of physicians use the Physician Documentation system?

Stage 4

Stage 4

Stage 6

Stage 6

Stage 6

Stage 3

Stage 6

Electronic ordering for nursing and/or physician services

Stage 6

Stage 4

What percent of Physician Documentation generates discrete (computer-readable) data?

Stage

Relevance

Electronic ordering for medication

What % of all inpatient medication orders are processed electronically?

What % of all inpatient non-medication orders are processed electronically?

Stage

RelevanceAvailability Vendor


[email protected].

Gap Analysis On Site


Analytics

BusinessContinuity

CDS

ClinicalDocumentation

CLMA

CPOE

DeviceIntegration

Documentscanning

HealthInformationExchange

ITGovernance

Laboratory

Pharmacy

Radiology

Checked

Pending

Gaps


0

5

10

15

20

25

30Analytics

BusinessContinuity

CDS

ClinicalDocumentation

CLMA

CPOE

DeviceIntegrationDocumentscanning

HealthInformationExchange

ITGovernance

Laboratory

Pharmacy

Radiology

Hospitais Estágio 6 e 7 fora dos EUA

Ásia: 6Europa: 4Oriente Médio: 1América Latina: 4

Europa: 58Ásia: 31Oriente Médio: 16Brasil: 26Argentina: 2Colômbia: 1Chile: 1

Hospital HIMSS Stage 7 no Brasil

RecifeVolta Redonda

Nota: atualizado até 01/Dez/2017

Hospital HIMSS Stage 6 no Brasil

BP FilantrópicoBP Hospital BPBP MiranteCardiopulmonarHospital 9 de JulhoHospital Alemão Oswaldo CruzHospital do Idoso Zilda ArnsHospital Israelita Albert EinsteinHospital Novo MetropolitanoHospital PortuguêsHospital Samaritano de São PauloHospital Santa CatarinaHospital Santa Marta

Nota: atualizado até Dez/2017

Hospital Santa PaulaHospital Santa RosaHospital São Camilo - Unidade PompéiaHospital São Camilo - Unidade SantanaHospital Sírio LibanêsInstituto de Ortopedia de Palmas (Intensicare)Promatre PaulistaSanta Casa da Bahia - Hospital Santa IzabelUnimed Belo Horizonte - Maternidade GrajaúUnimed CaruaruUnimed ChapecóUnimed SorocabaUnimed Sulcapixaba


Hospital Papel

Hospital PEP

HIMSS Stage 6

Hospital Paperless

HIMSS Stage 7

Hospital Digital

Concepção:

POR QUE DEVERÍAMOS NOS TORNAR UM HOSPITAL DIGITAL?

Questão muito frequente

Por que usar um modelo de maturidade?

1. Aprende-se com outras experiências

2. Oferece um roadmap claro

3. Ajuda a comunicar a “visão”

4. Encoraja todos a trabalhar coletivamente

Fonte: John Daniels, VP HIMSS Analytics

1,9%4,8%

10.1% 8,1%4,2%

6,5% 7,9% 9,7%0,4%

1.7%

6,2% 10,0%

6,4%6,4%

12,8%

30,1%

0%

10%

20%

30%

40%

50%

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7

All

ho

spit

als

wit

hin

eac

h E

MR

AM

Sta

ge

3 or less 4 or more

2.3%

6.5%

16.3%18.1%

10.6%

12.9%

20.7%

39.8%


Melhores métricas de performance

38,9

45,5 44,645,9 45,9

42,7

49,0

64,3

30

40

50

60

70


AV

G P

roje

cted

VB

P C

linic

al S

core

Tipping Point

Tipping Point

Clinical Performance Scores



Taxas de Mortalidade


Performance Financeira

Representação dos hospita is classificados com o

"A" pela Leapfrog Hospita l Safety Grade por

estágio de EMRAM

0,0% 5,9%

12,8% 14,3% 20,1% 21,8%

30,8%

62,6%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

100,0%


Ponto crítico

Fonte: HIMSS Analytics

Segurança do Paciente

Impacto da TI na segurança do pacienteHIT Improving Safety and Quality - 1

Meaningful Use Functionalities have Positive Effects on Health Care Quality, Safety and Efficiency

5 Source: ONC Systematic Review of Literature from 2007-2013

Fonte: Enrico Coeira, MacQuarie Univeristy

Apoio à Decisão Clínica

COMO IMPLANTAR UM SISTEMA COM SEGURANÇA

Um alerta!

Safer Guides

Fonte: https://www.healthit.gov/policy-researchers-implementers/health-it-and-safety

Obrigado pela atenção!!!

• Claudio Giulliano Alves da Costa

[email protected]

• Site: www.folks.la