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5.3 Historia Clínica Electrónica

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5.3 Historia Clínica Electrónica UNIVERSIDAD DE CHILE FACULTAD DE CIENCIAS FÍSICAS Y MATEMÁTICAS DEPARTAMENTO DE INGENIERÍA INDUSTRIAL “DISEÑO DE UNA ESTRATEGIA PARA INCORPORAR UN SISTEMA DE HISTORIA CLÍNICA ELECTRÓNICA EN UNA CLÍNICA ONCOLÓGICA” MEMORIA PARA OPTAR AL TÍTULO DE INGENIERO CIVIL INDUSTRIAL IGNACIO ANDRÉS ETCHART BRAVO PROFESOR GUÍA: JORGE ARAVENA SALAZAR MIEMBROS DE LA COMISIÓN: DANIEL VARELA LÓPEZ MARIO KUFLIK DERMAN SANTIAGO DE CHILE 2015 RESUMEN DE LA MEMORIA PARA OPTAR AL TÍTULO DE INGENIERO CIVIL INDUSTRIAL POR: IGNACIO ETCHART BRAVO FECHA: 23/01/2015 PROFESOR GUÍA: JORGE ARAVENA “DISEÑO DE UNA ESTRATEGIA PARA INCORPORAR UN SISTEMA DE HISTORIA CLÍNICA ELECTRÓNICA EN UNA CLÍNICA ONCOLÓGICA” Una de las mayores preocupaciones en clínicas y hospitales se relaciona con el uso y gestión de la información. Los Sistemas de Información que se utilizan en el área de la salud no tienen diferencias sustanciales en comparación a los utilizados en otras industrias, sin embargo su implementación es tremendamente compleja. El origen de esta complejidad radica en la cantidad de sistemas específicos que conforman la solución integral, lo crítico de la información contenida en estos sistemas y muy especialmente en la idiosincrasia particular de las personas ligadas al uso de estos sistemas. Por este motivo, resulta indispensable diseñar una estrategia que permita gestionar la incorporación de un Sistema de Historia Clínica Electrónica El crecimiento de las organizaciones junto con la sofisticación de tratamientos y protocolos clínicos ha hecho que la cantidad de datos que se manejan aumente y que la información que se requiere para desarrollar los tratamientos sea mucho más indispensable. El mayor volumen de información pone freno a los flujos de trabajo. La incorporación de un Sistema de Historia Clínica Electrónica representa un proyecto de carácter estratégico que requiere planificación a largo plazo, al menos 10 años. Este trabajo de memoria entrega directrices estratégicos para poder enfrentar la incorporación y empezar desde ya a tomar acciones que aseguren el éxito del proyecto. Si bien el proyecto en un principio es netamente de carácter tecnológico, (instalación e integración de sistemas informáticos y redes), los desafíos más grandes se encuentran al momento de gestionar a las personas y adecuar los procesos. Por esta razón es necesario considerar medidas para gestionar el cambio. Estas medidas más humanizadas debes estar incluidas en todos los planes de proyectos que se desarrollen y con el mismo nivel de detalle que requiere una carta Gantt. Este trabajo define la situación interna actual y analiza diferentes soluciones y proveedores del mercado. Recogiendo la experiencia de las mejores prácticas internacionales, resultados científicos y consolidando las recomendaciones realizadas por organizaciones como la Healthcare Information and Management Systems Society y el Departamento de Gestión Sectorial TIC del Ministerio de Salud fue posible enmarcar el proyecto en un contexto nacional y desarrollar una estrategia que apunta a conseguir un Sistema de Historia Clínica Electrónica orientado a las necesidades del futuro. El trabajo concluye con la definición de una estrategia de TI capaz de alinear el Sistema Historia Clínica Electrónica a los demás desarrollos de TI de la clínica, definiéndose cuatro nuevos objetivos estratégicos de TI. Se proponen diversos planes para administrar; la arquitectura del sistema, las aplicaciones necesarias, las personas, los procesos y la estructura interna de la organización. i Dedicatoria: Dedico este trabajo a las clínicas y hospitales del mundo entero en especial a la Fundación Arturo López Pérez para que continúen su lucha contra el cáncer. ii Agradecimientos: A mis padres por darme la libertad de poder lograr todas las metas que me proponga. A toda mi familia porque todos somos uno. Son mi mayor apoyo y fuente de confianza. A mis amigos, los Pikamil y el Alto Control que me acompañaron en esta gran aventura. ¿Cómo podría haber sobrevivido a la escuela sin ellos? A mi profesor Guía, Jorge Aravena, por su apoyo incondicional, casi parental, que me brindo todos estos meses. A la Unidad de Procesos de la Fundación Arturo López Pérez que son una gran familia compuesta por grandes personas. Agradezco especialmente a Gino Farías por compartir su talento y tiempo. A Rosemarie Menzel que me acompaña siempre. iii Tabla de contenido 1.Introducción ......................................................................................... 1 2.La Organización ................................................................................... 4 2.1Descripción General.............................................................................................. 4 2.2Historia ................................................................................................................... 5 2.3Tamaño de la FALP ............................................................................................... 6 2.4Historia Clínica en FALP ....................................................................................... 7 3.El Proyecto ........................................................................................... 9 3.1Justificación del proyecto .................................................................................... 9 3.2Descripción de la oportunidad ............................................................................. 10 3.3TI en la salud .......................................................................................................... 12 3.4Definición del problema ........................................................................................ 19 3.5Cuantificación del problema ................................................................................ 22 3.6Abordando el Problema ........................................................................................ 23 3.7Objetivo general .................................................................................................... 25 3.8Objetivos específicos............................................................................................ 25 3.9Factores Críticos de Éxito y Fracaso .................................................................. 26 3.10Marco de trabajo .................................................................................................. 35 3.11Alcance del proyecto .......................................................................................... 36 3.12Metodología ......................................................................................................... 37 3.12.1Justificación de la metodología .......................................................................... 37 3.12.2El método para la gestión integral del cambio .................................................... 37 3.13Plan de trabajo ..................................................................................................... 41 3.14Resultados esperados ........................................................................................ 43 4Marco Contextual ................................................................................. 44 4.1Sistema de salud en Chile .................................................................................... 44 5.Marco teórico ....................................................................................... 48 5.1Informática Médica ................................................................................................ 48 5.2La Información Clínica .......................................................................................... 49 5.2.1Historia Clínica ................................................................................................... 50 5.2.2Historia Clínica en Papel v/s Digital .................................................................. 51 5.3Historia Clínica Electrónica .................................................................................. 53 5.4Meaningful Use ...................................................................................................... 55 5.5EMRAM y la HIMSS ............................................................................................... 56 5.6Relación entre el modelo EMRAM y Meaningful Use ......................................... 59 5.7Uso de Estándares ................................................................................................ 60 5.7.1HL7 ....................................................................................................................... 62 6Estado del Arte ..................................................................................... 64 iv 6.1 Situación Interna .................................................................................................. 64 6.1.1Estrategia ............................................................................................................. 64 6.1.2Procesos .............................................................................................................. 69 6.1.3Estructura organizacional y relaciones ................................................................. 71 6.1.3.1Unidades Clínicas ............................................................................................. 73 Especialidades médicas ............................................................................................... 73 Medicina oncológica ....................................................................................................
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