Healthcare Transformation: Electronic Medical Records and Patient Safety

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Healthcare TransformationElectronic Medical
Records and Patient Safety
Mark Blatt MD Intel Corporation Digital Health
Group Director Global Health Strategy June
2006 Mark.n.blatt_at_intel.com
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Agenda

• IT in healthcare Trends
• CPOE, EMRs
• PACS / Imaging
• Decision support systems (DSS)

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Healthcare Business Pain Points
Top Business Issues Facing Healthcare Providers
IT Opportunities
IDC Healthcare Provider Survey. N100
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Healthcare Specific Top IT Investments 2005-06
IDC Healthcare Provider Survey. N100 Q Which of
the following is your organization currently
evaluating?
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Business Processes IT Can Impact

• Administrative
• Patient Services
• Discharge Bed Management
• Ubiquitous Information Access
• Asset Management
• Portable Device Tracking
• Medical Record Tracking
• Instant Messaging
• Inventory Management

• Clinical
• Prescription Writing and Management
• eDetailing
• Order Entry
• Results Reporting
• Clinical Documentation and Record Retrieval
• Dictation and Transcription
• Remote Patient Monitoring
• Disease Management
• Schedule Management
• Continuum of Care Coordination
• Emergency Services

• Revenue Cycle
• Eligibility Confirmation
• Authorizations and Notifications
• Charge Capture
• Formulary Management
• Referrals
• Scheduling (office and/or facility)
• Claims Status
• Denials and Appeals Management

• Consumer Services
• Disease Management
• Remote Patient Monitoring
• Clinical Trial Participation
• Immunization / Appt Reminders Scheduling
• Drug Interactions
• Access to customer information and services

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The Digital Hospital Business Uses for IT

• Reduce medical errors
• Improve data quality
• Improve patient services
• Consolidate patient data and archiving
• Drive workflow efficiencies through BPI re-use
  and integrating services architectures
• Standards compliance through service oriented
  architecture (SOA) orchestration
• Modernize antiquated hospital information systems
  (HIS) structures
• Disparate systems integration
• Integrating and automating external suppliers,
  insurance aggregators and extended services
• Automating administration real time billing for
  time and materials to manage costs

The Digital Hospital
Healthcare Transformation New users, new usage
models
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The Benefits

• The right information available to the right
  people at the right time
• Increased Productivity
• Reduced Administration Medical Errors
• Faster Patient Through-put
• Shorter Waiting Lists
• Precise Inventory Management
• Knowledge Mining Statistical Data Analysis
  Possible
• Significant Cost Savings

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Agenda

• IT in healthcare Trends
• CPOE, EMRs
• PACS / Imaging
• Decision support systems (DSS)

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Healthcare Industry
Other names and brands may be claimed as
property of others
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The Healthcare Ecosystem
Monitoring Education Guidance Performance Assuranc
e Communication Sensor integration
Prescribing Education Emergency Treatment
Plan Community Patient Diary Interactions Personal
Control Point
Diagnosis Chart/Notes Images Administration Presc
ribing/CPOE Treatment Plan Interactions Evidence
Base
Outbreak Detection Clinical Trials Diagnosis
Tools Population Analysis Pay for Performance
Life Sciences Tools Molecular Diagnostics Clinical
Trials
EMR Systems
Personal Health Devices
PHR Systems
Medical Informatics
Bio-Medical
NET


Home Nursing Home Assist Living Hospital Mobile
Internet PC Device Phone/PDA Dongle
Doctor/Provider Insurer Lab Pharmacy RHIO
Pharma Provider Government CDC
Laboratory University Hospital Consumer
Drive Personal, Private, Portable Health Records
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Integrated Digital Hospital

• Digital acquisition of information
• Automated monitoring, bar codes, RFID, CPOE,
  biometrics, digital x-ray modalities
• Digital display of information
• Desktops, tablets, PDAs, laptops
• Available everywhere and anywhere information is
  needed
• Displayed with clinical preferences in mind
• Digital Electronic Health Records
• Advanced XML integration of disparate information
  sources
• Comprehensive multimedia records that are
  platform-aware, secure, scalable, portable and
  can deliver value in both on-line and off-line
  modalities

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Integrated Digital Hospital

• Digital hospital
• Automates systems and workflow processes
• Paperless and filmless
• Integrated digital hospital
• Goes beyond digital hospital
• Links all its digital information into a secure
  infrastructure and can deliver information
  seamlessly to the point of care on any device
  thereby improving the speed and quality of
  decision making

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Integrated Digital Hospital

• Digital business intelligence
• Advance decision support that provides timely
  care critical assistance for better clinical
  outcomes
• Systems that learn from outcomes and drive for
  continuous quality assurance (CQA)
• Digital operational infrastructure support
• Integration of data needed to improve operational
  outcomes
• SCM, asset tracking w/ RFID, VoIP
• Advanced triage and scheduling support
• Real time outcomes management and financial
  reporting

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Clinical Systems
Image Management
Order Entry
Electronic Medical Record
Laboratory
Pharmacy
Other names and brands may be claimed as
property of others
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The Integrated Digital Hospital
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Business Summary
El Camino Hospital

• Upgraded Intel Xeon -based servers to Unisys
  ES7000 Itanium based servers to support
  multiple applications People Soft, SoftMed, Sun
  clinical data warehousing, Sunrise Clinicals
  v4.0 and Eclypsis e7000 clinical info system
• HP Compaq tablet PCs and Vocera wireless
  communications devices based on Intel Centrino
  mobile technology

• Improved access to hospitals patient care system
  from anywhere in the facility
• Increased adoption rate of wireless PC tablets
  among physicians
• Over a 2 year period, reduced prescription drug
  complications due to dispensing errors by over
  30 from just over 6 errors per 1,000
  patient-days to under 4

• Independent, 400 bed facility and first fully
  computerized hospital in U.S.
• Relies heavily on technology to improve quality,
  safety and efficiency of medical care
• Improve care providers access to patient data

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Productivity Systems
Collaboration
Messaging
Information Technology
Wireless Connectivity
Meeting Management
Other names and brands may be claimed as
property of others
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St.Vincents Hospital
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Impact of Mobile Computing RFIDSt. Vincents
Hospital, Alabama

• Optimized bed mgmt capacity ? by 40
• Avg Length of Stay ? by 10
• Billing error rates ? from 20 to 5
• Admission, Discharge Transfer Times ? by
  85
• Full deployment expected to achieve 150 ROI

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Business Systems
Workflow Management
Supplier Management
Data
Inventory Control
Financial
Other names and brands may be claimed as
property of others
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Business Summary
A Leading Non-profit Health Maintenance
Organization (HMO) Chooses Intel-based Rich
Clients

• Over three-years
• TCO of PC refresh over three years is 100 M
• MWI slashes labor costs by 56, a 49 M savings
• Windows XP migration reduces additional
  management costs by 51 to a 20 M savings
• Project net costs 31M

• Intel Solution Services and Microsoft Consulting
  Services implemented a Managed Workstation
  Initiative (MWI)
• Assets and inventory management software
• Tools for proactive remote management and remote
  control
• Down-the-wire software distribution
• Upgrade to Microsoft Windows XP
• 3-year desktop refresh
• 2-year notebook refresh

• Create standardized and centralized IT management
  practices and tools to manage clients
• 100,000 desktops
• 10,000 notebooks
• Dozens of hardware configurations
• 30 boot images

Full PC Best Practices case study available here
Customer wishes to remain anonymous
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Medical Equipment
Sensing
Actuation
Standards
Data Acquisition
Data Aggregation
Other names and brands may be claimed as
property of others
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IV Pumps
Drug delivery and infusion of vital fluids as
well as monitoring and regulation of same.

• OPPORTUNITIES?
• IMPROVE DATA COLLECTION
• IMPROVE TELEMETRY OPTIONS
• REDUCE ERRORS

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Vitals Monitoring

• A COMPOSITE CATEGORY
• Pulse
• Blood pressure
• Respiration
• Temperature
• Ventilation
• Muscle activity (emg)
• Secondary vitals
• Glucose
• Oxygenation

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Todays Equipment
Vitals/monitoring
Xray, etc. display
Records entry

• Bulky
• Wirebound
• Expensive
• Manually collected data
• Disconnected from one another

Telemetry
Infusion
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A New Environment
Processing, Storage Telemetry
Portable Universal UI device
Portable Universal UI device
Wireless patient monitors
Mobile bed monitor
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Healthcare Tablet Concept Platform

• Healthcare rugged, ergonomic design, shift long
  usage
• Secure wireless access, connectivity to
  measurement devices
• Pen-enabled interface, soft keys, voice
  recognition, camera
• Built on Intel architecture

Investigational device, not presently available
for commercial distribution
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Future Vision VideosHospital Before

• Hospital Post Op Before

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Future Vision Videos Hospital After

• Hospital Post Op After

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Agenda

• IT in healthcare Trends
• CPOE, EMRs
• PACS / Imaging
• Decision support systems (DSS)

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Medical Imaging Uses

• Basic research
• Applied medical research
• Screening
• Diagnosis
• Treatment planning
• Image-guided interventions

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PAC Picture Archiving Communication

• Vision
• Integration of patient, study, and image data
• Single view of image content
• Mobile PACs delivery
• Scenario
• Image capture via Ultrasound, MRI, etc
• Meta-Data driven main storage archive
• Viewing workstations for Radiologists and
  Clinicians
• Physician views and provides verbal annotations
• Nurse access
• Business Drives
• No film cost (development, storage, loss, etc.)
• Quicker diagnosis due to faster delivery of
  images
• Ability to share images consistently across
  clinical environments

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Medical Imaging Segmentation

• Create images (modalities)
• X-ray, CT, MRI, ultrasound, nuclear medicine
  (PET/SPECT)
• Store and manage images
• PACS, RIS, storage, compression, archive,
  network, architecture
• View and analyze images
• Monitors, video cards, rendering, 3-D/4-D
  software, PACS
• Computer aided diagnosis (CAD), speech
  recognition

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Viewing the Images

• Locations
• Dedicated reading facility (mini PACs)
• Emergency room, operating room, doctor office,
  point of care (distributed PACs)
• Compute engine
• High-end workstation, desktop, mobile, PDA
• Monitors
• Medical-grade (2-5 MPixels) to commercial or
  diagnostic quality
• Video cards
• Various special-purpose to gaming
• Software
• 2-D, 3-D, 4-D
• Segmentation, registration, quantification,
  rendering
• Image fusion

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Agenda

• IT in healthcare Trends
• CPOE, EMRs
• PACS / Imaging
• Decision support systems (DSS)

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Data Rich, Information Poor

• Data explosion and its impact
• Enterprise data volumes are doubling every 12-18
  months
• Examples of 5X-10X growth Channel and
  manufacturing
• Richer formats dramatically increasing storage
• Data quality issues grow logarithmically w/2X-10X
  growth of data

We see data explosion 2 yrs earlier
Enablers/Accelerators - Real-time data - VoIP -
Web services/XML
Relative Impact on IT
Data Explosion
Data Explosion Accelerators
2003 2004 2005 2006 2007 2008 2009 2010
We must manage our data before it manages us!
Last Updated 28-JUl-2004
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Decision Support Systems

• General Practitioners (GPs) find decision support
  beneficial
• A study into acceptance of clinical decision
  support in primary care has revealed that while
  suggestions of the software are not always
  followed by GPs, many still feel it worthwhile
• Researchers at the Department of Medical
  Informatics at Oregon-based healthcare provider
  Northwest Permanente based their conclusions on a
  survey of 110 GPs, 41 of whom said they were
  more likely to take heed of notifications when
  treating an elderly patient.
• However, 80 said that they tended not to use the
  system in a hurry.
• HTTP//www.ehiprimarycare.com/o.cfm?o7,0,20193,32
  19,3226

A survey of factors affecting clinician
acceptance of clinical decision supportDean F
Sittig, Michael A Krall, Richard H Dykstra, Allen
Russell and Homer L ChinBMC Medical Informatics
and Decision Making 2006, 66     doi10.1186/1472
-6947-6-6 Published February 1, 2006
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Summary Benefits of technology implementation

• IT can help healthcare reduce medical errors,
  improve data quality, and improve patient
  services
• Information flows faster and more accurately
• Data collection is automated, removing
  opportunities for errors
• Clinicians freed up to focus on diagnosis care
• The integrated digital hospital goes beyond
  automated, paperless and filmless environment of
  the digital hospital
• EMRs are the center piece for the Integrated
  Digital Hospital
• PACs improves diagnostic efficiency and is IT
  intensive
• Decision Support Systems drive data volumes and
  improve clinical decision making