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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
Em busca do hospital digital
Hospital Papel
Hospital PEP
HIMSS Stage 6
Hospital Paperless
HIMSS Stage 7
Hospital Digital
Concepção:
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:
Em busca do hospital digital
Hospital Papel
Hospital PEP
HIMSS Stage 6
Hospital Paperless
HIMSS Stage 7
Hospital Digital
Concepção:
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
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.
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
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
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
customer.service@himssanalytics.eu.
HIMSS 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
customer.service@himssanalytics.eu.
HIMSS Europe
Office Leipzig | Schwägrichenstr. 9 | 04107 Leipzig | Germany
Phone: +49 341 33395 300 | Web: www.himss.eu
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
In case of specific questions regarding the EMRAM or your Gap Analysis please do not hesitate to contact us at
customer.service@himssanalytics.eu.
HIMSS Europe
Office Leipzig | Schwägrichenstr. 9 | 04107 Leipzig | Germany
Phone: +49 341 33395 300 | Web: www.himss.eu
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
In case of specific questions regarding the EMRAM or your Gap Analysis please do not hesitate to contact us at
customer.service@himssanalytics.eu.
Gap Analysis On Site
Analytics
BusinessContinuity
CDS
ClinicalDocumentation
CLMA
CPOE
DeviceIntegration
Documentscanning
HealthInformationExchange
ITGovernance
Laboratory
Pharmacy
Radiology
Checked
Pending
Gaps
Gap Analysis On Site
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 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
Em busca do hospital digital
Hospital Papel
Hospital PEP
HIMSS Stage 6
Hospital Paperless
HIMSS Stage 7
Hospital Digital
Concepção:
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%
Fonte: John Daniels, VP HIMSS Analytics
Melhores métricas de performance
38,9
45,5 44,645,9 45,9
42,7
49,0
64,3
30
40
50
60
70
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
AV
G P
roje
cted
VB
P C
linic
al S
core
Tipping Point
Tipping Point
Clinical Performance Scores
Fonte: John Daniels, VP HIMSS Analytics
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%
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
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
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