Information sharing, one of the answers to the tomorrow challenge in the healthcare Based on our experience at the Cliniques Universitaires Saint Luc, of changing from a “paper” medical information system to an “electronic” medical information system, What have we learned from this process, which began in 2002?

1. How to move from organization-centred
systems to transactional implementation
opening doors to
an integrated care approach?
Information sharing, one of the answers to
the challenge facing healthcare in future
Dr B. Debande
CLINIQUES UNIVERSITAIRES SAINT-LUC

2. The challenge facing healthcare in
future
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3. People ageing
– > 65 yrs : 16.1% (2000) 27.5 % (2050)
– > 80 yr : 3.6 % (2000) 10 % (2050)
• Increase in demand for long-term care
• Healthcare journeys : care process inside and
outside hospital – rest homes - …)
Coordination of many players around shared
patient information
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4. Rising costs
– Ever more sophisticated technology
– New curative and preventive treatments
• Rational use of technologies and information
produced
• Treatment according to cost/effectiveness ratio
-> Availability of complete, exhaustive medical
information must mean that resources are
used in the most efficient way
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5. Patient, player in health
– Importance of health factor for the public
– Higher and higher standard of training and
information
• Attitude of informed consumer in an increasingly
international “market”
• Search for quality in products and service: proximity or
habit are not the only criteria on which choice is based
Consolidation and portability of personal medical
information
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6. Decompartmentalization
• From a compartmentalized healthcare system, centred
on the provider (hospital, GP, paramedics, domiciliary
care etc), we have to move towards a healthcare system
which is part of a network, coordinated and centred on
the patient
• Healthcare providers must fit in with this new
coordinated approach, organised around shared patient
information
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7. Are we ready ?
This change is under way
Projects on sharing medical information (“flow”, labelling of GP’s,
nurse’s, physio’s records, etc.)
Data communication associations have tried to organise this
sharing of information
Hospital managements are investing in tools for managing medical
information
But on the ground,
Are those involved ready to use and produce usable medical
information in electronic form ?
Are they willing to take up the challenge, on a daily basis, of sharing
information ?
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8. Experience on the ground
Based on our experience at the Cliniques Universitaires
Saint Luc, of changing from a “paper” medical
information system to an “electronic” medical information
system,
What have we learned from this process, which began in
2002?
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9. Facts and figures
• University hospital, 960 beds, mostly acute
• 3 briefs : Research, Teaching, Care
• Considerable turn-over inherent in teaching
• Culture of paper records grouped by speciality, that can
be shared and managed centrally
• Interprofessional work is something we value, even
though it is a goal which still needs to be achieved.
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10. Projects
• Between 2002 and 2006, several projects (electronic patient records,
report management, scanning and indexing tools, PACS) launched
simultaneously with a view to changing to paperless/filmless
• Philosophy behind introduction :
– Identify the objective clearly from the outset (paperless – filmless)
– Set up by making gradual adjustments
– Take time to make the change
– Communicate to departments (medical – nursing staff – admin)
• To date, no more films are produced and there are almost no paper
records circulating in the hospital any more
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11. What have we learned ?
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12. Infrastructure
• A reliable, robust, integrated and consistent IT
infrastructure
– Consistency of information within a broad set of interconnected
systems
– Dematerialization of information calls for 24/7 availability
• Any interruption to service makes professionals lose faith
• Don’t underestimate clinicians’ (sometimes irrational) fear about
losing information
Don’t underestimate how difficult it is to build up and
keep ”up-to-date” IT teams in today’s competitive
environment
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13. Working in a different way
• Adapt to a different way of working
– Access to information according to different criteria (time,
speciality, type of report etc.)
– Flexibility of paper is lost
• leafing through quickly, highlighting/annotating, colours
• document comparison
• notification function of paper mail
– Rigorous encoding requirements
The drawbacks are always seen before the advantages.
Communication, mutual adjustment and sometimes, quite
simply, time help professionals adapt to change
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14. “On-line” risks
• Risks related to the benefits of access to shared
electronic information
– “No one is supposed not to have access to information”
• Simultaneous access, irrespective of location and “willingness”
• Possibility of “remote” access from home, abroad
• “On-line” transmission of information
– Risk that summary information is not sent (clinical information, subject of
request)
– Risk of losing verbal interaction between professionals when results give cause
for concern
Once the benefits of information in electronic form have
been acknowledged,
one must be vigilant about the risk of essential direct
communication between professionals disappearing
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15. Drowning
• A flood of information from all quarters
– Constantly growing number of unprocessed images
– More and more information
– Difficult to quickly sort out important information from the rest
– Less and less time to sort, select, display
– Danger of losing the “man-to-man” information channel
As soon as records are shared on a large scale, the future
will clearly be in selecting relevant information, in
structuring and in summaries….
But who is going to take the time to do this ?
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16. Confidentiality
• The new challenge of “everything electronically”
– Paper records can be consulted by many people, without much control, when the
patient is in hospital
– Electronic records are permanently available everywhere for those who are
authorised to access them
– Should one take the risk of having a poorer standard of care through lack of
information or risk allowing too many different professions access to medical
data
– Should there be strict rules, in the knowledge that, on the ground, users will
exchange their codes or should one get used to practices and bank on total,
perfect traceability of access to information
The management of access is a problem which deserves to be
considered by all the professions on an almost permanent basis.
This difficulty, within a hospital, is a portent of still greater
problems to come once people are working across disciplines
outside hospitals !
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17. Institutional mobilization
• Both management and people on the ground must be involved in
this process of change
– Management must give the project their unfailing support but also
understand that change takes time
– People on the ground will have to change their ways, the way they
approach information : resistance is planned at department level,
mobilization for change too…
– Project managers must agree to revise their ambitions, give up the
technocratic approach and take the adjustments on board
An institutional project, backed by management and set up
in close collaboration with medical services, giving them
time to grasp the change
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18. Take home words…
• Personal medical information sharing is one of the answers to the challenge
facing healthcare in the future
• In order to really share electronic medical information amongst all care
givers, hospitals must be paperless and filmless
• Becoming paperless and filmless is not only a matter of software
deployment, it is especially a matter of changing the way care providers
work. It is therefore a matter of change management
• Change management needs time, compromises and communication. It
takes time to change working habits, implement new ways to access
information and define who has access to what.
• In hospitals, the medical service is the place where change must be
managed
• Paperless and filmless hospital projects must be institutional projects,
sponsored and followed by the hospital management
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