Just-in-time Decision Support for Improving and Optimising Professional Practices. Geissbühler A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Optimizing the Use of
Hospital Resources through
Real-world, Real-time
Information Systems
Prof. Antoine Geissbühler, MD
Geneva University Hospitals

2. Geneva University Hospitals
• 2'200 beds
• 3 campuses, 30 smaller sites
• Primary, secondary and
tertiary care
• 50'000 admissions/year
• 800'000 outpatient visits/year
• 10'000 collaborators
• 1‘500 physicians
• 3'500 nurses

3. Meaningful integration in the care
processes

5. Integrating information

6. Considering today's
serum creatinine level,
I recommend that you
adjust the dosage of
intravenous gentamicin
to 80mg every 24 hours
(and check its blood
level in three days)

8. From documentation to coordination

9. Collaborative care: clinical pathways

10. Shorter feedback loops
Resources Processes Results
People Interventions Costs
Equipment Medications LOS
Space Tests Satisfaction
Care Outcome
Evaluation, feedback

11. Shorter feedback loops
Resources Processes Variance Results
People Interventions % of goals Costs
Equipment Medications achieved LOS
Space Tests Satisfaction
Care Often missed Outcome
Goals goals
Evaluation, feedback

12. From orders to workforce adjustment
Order entry
Split orders into
activities
Schedule activities
into acts
Value the workload
for each act
Match with resources
from HR system
Adjust team
workforce if needed

13. From activity to flow modeling

14. Connected to the real world of people
and objects

15. Real-world, real-time information
Challenges:
• Getting the information at its source, once
• Connecting the various information domains
with semantic consistency
• Shorten feedback loops so that the link
between actions and results is more likely
• Errors are photodegradable → transparency