Printable Medical Billing Forms Templates TeleDiabetes Shared Care TDSC A

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Printable Medical Billing Forms Templates TeleDiabetes Shared Care TDSC A Powered By Docstoc
					   TeleDiabetes Shared Care
                                   (TDSC)
       A clinical management software system
             for the diabetes clinics in the
           Iranian Diabetes Network
Bagher Larijani: Endocrinologist, Head of Endocrinology and Metabolism Research
Center, Professor of Endocrinology, Tehran University of Medical Sciences.
emrc@tums.ac.ir
Eiman Rahimi: MD, MCSE, Administrator of Medical Informatics, Endocrinology
and Metabolism Research Center. e_rahimi@yahoo.com
Mohammad-Reza Amini: MD, Secretary of Endocrinology and Metabolism
Research Center. emrc@tums.ac.ir
Abbas Shojaei: MD, Brainbench Certificated Developer, CEO PegahSoft.
dr_abbas_shojaei@yahoo.com


                                                                             @
                                                                                  2
          Diabetes Mellitus
    The most common metabolic disease
    A chronic disease with high prevalence in
    Iran (3.5 – 5%)
    Rapidly growing prevalence worldwide and
    in Iran
    Disproportionately expensive and a real
    socioeconomic burden ($98b in USA)
    Devastating complications ($54b) including
    blindness, kidney failure, heart failure, foot
    amputations, and ultimately death
@   A threat to individuals’ and public health
                                                     3
    Existing DM Patient Records
    56% no documentation of glycemic
    control, only 15% HbA1c checked
    55% no lipid profile, many undocumented
    or untreated dyslipidemia
    1/3 no eye or foot exam
    Non-specialists see most patients
    69% of visits last less than 15 min
    Inappropriate care → ↓lives, ↑expenditure
@
                                                4
     Iranian Diabetes Network
               (IDN)
    An integrated research network
    Collaboration with all the
    universities of medical sciences
    over Iran
    Pilot phase: standard diabetes
    clinics in 12 major cities of Iran
    More clinics in other cities in future
@
                                             5
          Objectives of IDN
    To ascertain the current state of
    knowledge in the field of diabetes
    mellitus in Iran
    To identify the fields in which no
    research is being carried out
    To manage needed epidemiologic and
    clinical surveys for prevention and
    control of diabetes and its complications
    To facilitate
@     Proper care and management
      Education of diabetic patients            6
                    Endocrinology & Metabolism Research Center




                                 Iranian Diabetes Network

                         • Collaborative Research Projects
                         • Unified Diabetes Care Plans
                         • Educational Courses for
CFFSD                                                                              NGOs
                           Healthcare Workers
                         • Information Interchange and

                             (TDSC)




                       Ministry of Health and Education of Medicine     @

        UMS A            UMS B                              UMS K               UMS L




DC A1       DC A2    DC B1      DC B2                DC K1      DC K2   DC L1       DC L2
           Diabetes Clinics
    Well arranged for standard managed care
    Standard and unified services to the
    diabetic patients according to guidelines
    Collaborative research projects
    Unified nationwide diabetes care plans
    Educational facilities for healthcare
    workers
    Integrated through a web based software
@
    network (TDSC)
                                                8
    Diabetes Team Members
    Endocrinologists (as the head of team)
    General practitioners
    Nurses (for patient education and care)
    Referral Specialists:
      Nutritionists
      Podiatrists (for diabetes foot care)
      Nephrologists
      Obstetricians/Gynecologists
      Cardiologists
@     Surgeons
      …                                       9
    The TeleDiabetes Shared Care
               (TDSC)
     The clinical information system
     implemented over these diabetes
     clinics
     Multidisciplinary and integrated
     team approach to patient care
     Standard & uniform delivery of care
     and research
     Standardized and effective clinical
@    data acquisition, storage, inquiry,
     and interchange                       10
    The TeleDiabetes Shared Care
               (TDSC)
     Feasible and easy to implement
     anywhere
     User-friendly: easy to use and learn
     for the end user
     Internet-based: centralized
     organization and distributed
     management of diabetic patients'
     clinical information
@
                                            11
                  DC
                                DC
                         EMRC
         DC
                                     DC
A Diabetes Clinic (DC)



                                 DC

                          DC
          TDSC Software
    Customize an existing system or
    develop a new one from scratch?
     Expert developing team
     Time delays → standstill
       Study and analyses
       Developing
       Testing
       Fine Tuning
@
                                      13
          Which Software?
    Domestic and International
    softwares e.g. Diabeta 3, NovoNet,
    DEMS, …
    Desires:
      Standard
      Comprehensive
      Satisfy all or most of our needs
@     Affordable
                                         14
           Hakim Software
    Developed by PegahSoft Group (a team
    of physicians and engineers)
    A general clinic software tailored to
    special needs in Iran
    Already met most of our needs
    Great flexibility to put up with our special
    customizations
    Piloted in Mashhad, and soon in Dr.
@   Shariati, and Imam Khomeini’s Hospitals
                                                   15
               Justification
    Telemedicine → costs > normal care
    Compare that cost to the cost of:
      Renal failure, and going on dialysis
      Having a stroke
      Going blind

    We hope to prevent blindness, strokes,
    and heart attacks.
    We hope it's obvious that telemedicine is
@   better in the long run.
                                                16
    Estimates and Optimism
    Coverage of about 300,000 patients
    in 18 months
    Active participation of primary care
    physicians, diabetes-expert nurses
    & other health care professionals
    Financial and administrative
    support of MOH, Takfab, other
    domestic & int’l NGOs assure
    continuation of the project
@
    Benefit for diabetic patients          17
TDSC Software Features

     ‘Hakim–Diabetes’




                         18
        Technical Features
    Internet based
    SQL 2000 client/server architecture
    VB coded, will be upgraded into
    .NET framework
    Simple telecommunication: the
    system can operate from a dial-up
    to VSAT
@
                                          19
       TDSC Telemedicine
    Improved sharing of high quality
    information between diabetes care
    team members, and between
    diabetes care clinics in different
    locations
      Teleconsultation
      Teleradiology
      Tele-education
@
                                         20
           TDSC as a CIS
    Quick and easy retrieval & analysis
    of online electronic record
    information about patients or
    groups of patients by privileged
    clinics and providers
    Timely access to both patient data
    and valid and applicable evidence
      Diabetes Guidelines
@
      Clinical Decision Support
                                          21
           TDSC as a CIS
    Prospectively planned and scripted
    visits
    Monitoring one-to-one and group
    education of patients
    Close online follow up of patients
    Close administrative monitoring of
    providers’ clinical competency
@   Monitoring of treatment goals
                                         22
           TDSC as a CIS
    Effective aggregation and timely
    display of data used by team
    members
    Performance reports of providers
    Performance reports of patients and
    their adherence to the goals


@
                                          23
           TDSC as a CIS
    Appropriate preventive care
    Active participation of patient in
    disease management




@
                                         24
    Some Kinds of TDSC Data
    Outpatient and inpatient clinical data
    Referral specialists suggestions
    Educational milestones
    Nutritional regimens
    Pharmacy or Prescription
    Laboratory or ancillary testing results
    Billing and Insurance
    Administrative
@   ...
                                              25
     Flexible and Extensible
    Adaptable with our users
    specifications
    Customizable EPR and workflow
    according to specific settings or
    culture of each clinic
    Easy to add new drugs, tests, pick
    up lists, prescription templates,
    report templates, letter templates…
@
                                          26
    Staged Input of Records
    The pre-evaluation stage by a trained
    assistant interviewing the patient to
      enter or review demographic information
      Flag recent events (e.g. out-of-system
      ophthalmology visit, death of family member)
      Complete a screening ROS and medication

    Provider’s encounter
      Focused examination

@     Patient education
      Dietitian visit                                27
              Data Entry
    Easy and rapid
    Data input using pick lists and
    radial buttons minimizing
    keyboarding during the encounter
    Tree structure of signs, symptoms,
    physical findings, lab, & other data
    Data entry into tree or free forms of
@   the fields
                                            28
@
    29
      Flexible User Interface
    Customizable templates of specific data
    fields for special visits or parts of an
    encounter with the emphasis on shared
    care (modules for every member of the
    multidisciplinary team either in tree form
    or free form)
      Eye or feet complications and exams
      Diabetes medication or education
      Lab results
@     Action Plan
                                                 30
      Flexible User Interface
    As few screens as appropriate
    during the encounter
    Interactive or offline data entry
    Allow prospective structured data
    entry



@
                                        31
              Standards
    Dataset based on NDOQRIN
    (Australia), DEMS (Mayo Clinic),
    Belgium, and NHS (UK)
    ICD 10 support of diagnoses and
    medications term coding
    Messaging protocols: HL7 v. 3.0
    CDA compatible (Clinical
    Documentation Architecture)
@   Imaging processes: DICOM 3.0
    support                            32
             www.tdsc.ir
    A secure website
    Links to and administrative control
    over all the collaborating diabetes
    clinics over IDN as well as the
    central database
    Dynamic customized EPR generated
    for the patient or privileged
    providers
@
                                          33
             www.tdsc.ir
    Statistical reports available to
    public and privileged users
    Tutorial contents and online help
    material for privileged users
    Public and professional educational
    material
    Expert consultation system (future)
@
                                          34
    Decision Support System
    Personalized guideline suggestions for
    patients
    Collect provider’s notes in a structured
    format for analysis
    Integrates lab and other data in the same
    record for real-time access to current and
    historical data
    Integrates graphical display to help
    feedback performance information, trend
    curves, and goals to the provider and
@   patient
                                                 35
    Decision Support System
    Remind providers of routine
    preventive care
    Issues that needs special attention
    are flagged (e.g. “Foot At Risk” is
    flagged if an abnormal vascular or
    neurological examination of the foot
    is documented)
    Link to patient education material
@   and medication information
                                           36
    Decision Support System
    Link to prescription information and
    monitor for medication
    contraindications or interactions or
    clerical errors (e.g. metformin use in
    a patient with deteriorating kidney
    function)
    Expert system in consultation (step-
    by-step intelligent consultation) in
@   the next version
                                             37
    Decision Support System
    Suggest future arrangements
     Schedule next visit
     Lab tests needed before the visit
     Immunizations schedule
     Medication renewal and monitoring
     The diabetes educator reminder to
     contact the patient if a goal should be
     reviewed or accomplished before the
@
     next visit
                                               38
    Decision Support System
    Who attend the clinic or not
    Who are missing a key evaluation
      Ophthalmology evaluation
      Influenza vaccine
      HbA1c check
      Medication adjustment
    Who are doing well and who need intense
    support

@   Personalized follow-up by phone, postal,
    email
                                               39
    Blood Glucose Control




@
                            40
    Blood Pressure Control




@
                             41
    Management of Dyslipidemia




@
                                 42
    Kidney Assessment




@
                        43
    Eye Examination




@
                      44
    Combination Therapy




@
                          45
    Oral Medicines




@
                     46
    Therapeutic Regimens




@
                           47
          Image Handling
    Portrait, lesions, any diagnostic
    images
    DICOM 3.0 compatible image
    processing (OSIRIS)
    Symbolic and schematic diagram of
    different organs, limbs, and nervous
    system

@   Annotations and highlights on parts
    of the picture                         48
@
    49
@
    50
            Prescriptions
    Definable prescriptions, diagnostic
    requests, verifications, and
    certifications per specific diagnoses
    Categorized list of diagnostic and
    therapeutic interventions to select
    Prescriptions or certifications
    definable drug lists with proper
    drug preparations and instructions
    for a prescription
@
    Save a prescription for later use       51
          Correspondence
    Automatically generated letters,
    printed at the end of a consultation,
    ensures fast and efficient
    communication of patient’s
    information.
    Grammar casts (ordinary sentences
    with dynamic parameters of the pt.)
    Fully editable (formatting, inserting
@   logo, mottos, health ads, …)
                                            52
          Correspondence
    Customized summarization of data
    for different purposes (interns,
    referring physicians, residents,
    specialists, the patient herself, …)
    Translatable to different languages




@
                                           53
     Financial Management
    Calculates the expenses by
      Type of insurance & provider’s share
      Type of contracts with providers
      Discounts
    Printable financial reports for
    providers and insurance services
    Printable bills for patients
@
                                             54
             Scheduling
    Scheduling different services in the
    clinic for each patient by the
    secretary
    Definable calendar of services and
    their working timetable
    Calendar of duties for each provider


@
                                           55
         Extensive Search
    Simple or complex searches by
      Patients’ demographics
      Date range
      Signs and symptoms
      Diagnostic tests and their results
      And every parameter in a record
    Showing the results in various chart
@   types (bar, pie, line, area, …)
                                           56
      Security and Auditing
    Secure transactions and maintenance of
    clinical data
    Secure sessions by defining user access
    levels, permissions, and privileges
    (integrates into the Active Directory)
    Comprehensive audits: monitoring user
    transactions, modifications, and data
    manipulations
    Fault tolerance: secure backup policies or
    redundant measures (offline and offsite
@   media, or replicas over the network)
                                                 57
     Messaging and Alerting
    Flexible messaging between the
    team members (secretary,
    colleagues, the provider herself)
    Alerts, notes, memos, and reminders
    Definable
      Time to live
      Time to show (beginning, during, or
      end of a visit, or event triggered)
@     Frequency to show
                                            58
    Scalability and Maintenance
    Scalability – from one PC on its
    own, to a system supporting many
    concurrent users
    Maintenance – a low level of
    maintenance required to keep the
    system running, at both a user- and
    IT-level

@
                                          59
         Help and Support
    Step-by-step tutorials and help
    within the application and the
    Website
    Comprehensive support – a friendly
    help for all aspects from organizing,
    training and talking through user
    rights, to IT server maintenance and
    support.
@   24/7 customer service
                                            60
      TDSC Tele-homecare
    For rural and inner-city patients (in
    future)
    Patients will receive comprehensive
    information through their
    computers on how to manage their
    disease
    Patients will check their BS, BP, and
    other factors → data entered into
@   the website for analysis
                                            61
      TDSC Tele-homecare
    Data in abnormal range →
    automatic alert sent to a doctor or
    nurse as soon as it happens to
    make adjustments
    limitless chances for rural patients
    to receive treatment e.g. in every
    climatic situation
    They can get `visits' as often as
@   necessary
                                           62
       Joslin Tele-homecare
    Joslin Center for Diabetes, New York City
    $28m federal grant over four years
    1500 rural and inner city diabetic patients:
      750 with free PCs, internet access, and health
      monitoring equipment
        a blood sugar monitoring device
        an automatic blood pressure cuff
        a camera hooked up to the PC

      750 with only the usual care from their doctors
@
                                                        63
    Equipments in Each Clinic
    A Microsoft Windows 2004 server
    A PC or laptop computer with
    Microsoft Windows XP for every
    physician during interactive clinical
    visits (estimated number for each
    clinic is 7 diabetes-expert
    physicians)

@
                                            64
    Equipments in Each Clinic
    A central UPS to supply the network
    devices
    A licentiate diabetes-clinic
    application client software installed
    on each client computer
    A dial-up link (or higher bandwidth
    Internet link if available) shared over
    the clinic LAN, connecting each
@   client software to the Internet
                                              65
      Equipments at EMRC
    A central powerful Microsoft
    Windows database server for
    management of all the clinical data
    The administrative version of the
    TDSC software installed for
    administrative purposes and remote
    assistance
    The Internet address www.tdsc.ir
@   assigned to the host in TUMS
                                          66
Thank You




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