The impact of eHealth on Healthcare Professionals and Organisations: Health Information Management Systems in Modern Health Care. Shemer J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Health Information
Management Systems in
Modern Health Care
Prof. Joshua Shemer
ICTAHC – The Israeli Center for Technology Assessment
in Health Care
Barcelona, March 2010

2. The Israeli Health System –
National Insurance Law
• National Health Insurance Law based on
principles of justice, equity & solidarity
• Each citizen has the right receive a
standardized basket of health services
• Ministry of Health responsible for health
services to be supplied by the 4 Health
Care Organizations
• 4 non-profit HMOs – Clalit, Maccabi,
Meuhedet, Leumit
• Payment - capitation basis

3. Maccabi Healthcare Services
• Maccabi is the 2nd largest health fund in Israel
• 1.8 million members
• Over 3,500 physicians
• Over 3,000 clinics
• 152 branches
• Functions within the framework &
constraints of the National Health
Insurance Law

4. Maccabi’s Vision
• Achieve Total Health for its members
• Provide integrative and personally-tailored health
care for each member
• Promotes excellence in the quality of medical
care, knowledge and service

5. Budgetary Efficiency Processes - (“Piston” System)
NIS 1,141M NIS 409M NIS 879M NIS 435M NIS1,579M NIS 430M
30%
24% 21%
9% 7% 9%
Oversight
Payment
Purchasing
Purchasing Increased Agreements
Guidelines Policy Increased
Guidelines efficiency efficiency
Other Hospitals Admin.
Physicians Diagnostics Drugs medical

6. Health Information Technology (HIT)
• H.I.T. is a TOOL not a goal
• The goal = OUTCOME

7. H.M.I.S. Targets (Organizational Level)
Health Management Information Services
• Decision processes based on qualitative
information & knowledge
• Continuity of medical data
• Continuity of care - integration

8. H.M.I.S. Targets (Organizational Level)
• Improvement & increasing efficiency of health
care processes
• Increasing clinical safety & quality
• Better documentation
• Better customer services

9. Rationale & Feasibility of H.I.T. in
Maccabi
• Equal access to medical records throughout the country
• On-line diagnosis
• Reliable diagnosis due to digital tools
• Improved quality control & assurance
• Archiving capabilities
• Sharing information among physicians for treatment &
consultation
• Lower cost
• Customer Relationship Management

10. Telemedicine in Maccabi Today
• E-Laboratory
• E-Prescription
• Tele-Diagnosis
• Tele-Ophthalmology
• Tele-Consultation
• Remote Monitoring of Chronic Patients
• Medical Support by Call Center
• Patient Online Web Site

11. Maccabi’s Integrated Information System
INFRASTRUCTURE
Doc. Clinic
Members Members Members Members
Doc. Clinic Internet
Medical
Firewall
Control
Extranet
Pharmacy
Main Computer
Clinic
Intranet
Backup
Admin
Specialist Computer
Control
Consultant Payment
CMR
ERP Control
IDC
Paramedic
IDC IDC
Reimburse-ment
Control
Diagnostic Drug Labs Tele Web Mgmt. of Mgmt. of Mgmt. of
Center consumptio control radiology Services Service the Fund Insured
n control Providers People

12. Maccabi Central Medical Record
Computerized Data Available for Patient Tracking & Followup
Medical Family
Demographic History History
parameters
Lab
Visits &
Results
Hospitalization
Imaging Medications
Treatments

13. Health Value Added (HVA)
HVA links between:
clinical indicators & budget

14. Management Through Setting Strategic Objectives
& Measuring Performance - Health Value Added
(HVA)
Perceived Quality of
Quality Clinical
Member Care
Satisfaction
Managing the
Meeting Physician
Organization in
Budgetary Satisfaction
order to
Objectives
achieve Total
Health
Organizational Employee
Processes
Satisfaction
(Bureaucracy)

15. Perceived Quality (Member Satisfaction)
• Overall satisfaction with health plan
• Growth in the number of new members
• Number of members that switch to a
competing plan
• Satisfaction with healthcare services
• Satisfaction with administrative services

16. Fiscal Responsibility
Expenditures in accordance with Budget:
 Expenditures on Hospital Services
 Expenditures on Physician Services
 Expenditures on Medications
 Overall expenditures

17. HVA Principles
• Measurement at all levels of the
organization:
 National
 Regional
 Local Branch
 Physician
• Constructive Competition at each level

18. HVA – The Tool
Quality
indicators
Diabetes
Financial Members’
indicators satisfaction

19. HVA – The Results
Mammography 2002-2009
Mammography
80 71
67.7 65.3 68.4
70 63.1
60 51.9 51.3 52.7
50
40
30
20
10
0
2002 2003 2004 2005 2006 2007 2008 2009

20. Pneumovax Vaccine among 65+
2002-2009
Pneumovax
80 73.2
68.9
70 62.6 65.5
59.3
60 51.1
50 44.4
40 35.5
30
20
10
0
2002 2003 2004 2005 2006 2007 2008 2009

21. To sum up:
Health Value Added (HVA)
Promoting “total health” through
quality-based strategic management
utilizing integrated performance
measurements

22. Cardiac Heart Failure Program
Model of Chronic Health Care
Management

23. Information System Flowchart
Family
doctor Regional
CI HUB
Center
CI Call RF
Center
Patient
Information * Blood
pressure
Systems * Pulse
Maccabi Weight*
Healthcare
IPVPN
Maccabi Patient’s home
Technical
support
Information center
System
M4A M4A

24. In Conclusion
• I.T. is a major tool to measure clinical
outcomes and control budget
• It needs strong infrastructure to broadly utilize
data online
• Provides continuity on database & information
integration
• Implementation of telemedicine is required
both today & in the future e.g. Chronic
Congestive Heart Failure Program
• HVA model controls, assesses and measures
medical performance within a balanced
budget
• I.T. is a strong management tool

25. THANK YOU