Title: Establishment of E-Health Network for Disasters and Healthcare Improvement: Integrated Medical Information Technology System
1Establishment of E-Health Network for Disasters
and Healthcare Improvement Integrated Medical
Information Technology System Partner concept
between Academies and Medical entities Yukako
Yagi University of Pittsburgh Medical Center,
Pittsburgh, PA, USA
2Background Why E-Health Network?
- In March 1, 2001, the Institute of Medicine (IOM)
stated that - The American health care delivery system is in
need of fundamental change. Many patients,
doctors, nurses, and health care leaders are
concerned that the care delivered is not,
essentially, the care we should receive. Health
care today harms too frequently and routinely
fails to deliver its potential benefits. - The difficulty in maximizing the benefits of
increased clinical and business knowledge and
advanced diagnostic technologies comes from the
basic problem of collecting, integrating and
managing health information in various formats.
Further, this data is stored in multiple physical
locations that are often distant and hard to
access when treating individual patients,
especially those with critical medical needs. - use of information technology is key
3University of Pittsburgh Medical Center
4UPMC has established Telemedicine Network through
the system
Facts and Figures
5Overview Program Description
- looking increasingly towards technology-assisted
solutions to optimize how they manage and deliver
health care. - Non-Civilian Medical Facilities (NCMF) and UPMC
have created a partnership to collaborate on
developing technology-assisted solutions to
real-world medical problems - The partnership is defined as the Integrated
Medical Information Technology System (IMITS)
Program.
6Overview Program Description
- The IMITS program pioneers the application of
state-of-the-art information management (IM) and
information technology (IT) solutions, including
advanced business and clinical decision support
tools. This initiative brought together vast
clinical and information technology expertise of
both institutions and aids in the recognition and
treatment of many types of medical conditions.
In addition, the NCMS-UPMC partnership is
providing new opportunities for enhancing
expertise, evaluating solutions to technical
dilemmas, and deploying strategies to address key
medical issues.
7IMITS Project
- Congressional Special Interest Appropriation
- FY02 8.5M - Establish initial project
Integrated Medical Information Technology System - FY04 10.2M - Continue current projects
expand into Pacific Rim
8Scope
- The initial focus of the IMITS Program was on
telemedicine and associated advanced
technologies. The overall program objective is
the design of new state-of-the-art clinical and
business models supporting the delivery of fully
electronic multi-media enabled electronic health
records. The projects described below will be
organized under the umbrella of the IMITS Program.
9Scope Multi-specialty Tele-consultation Project
- Situations
- There are many medical facilities in locations
where specialty medical care is not readily
available. - Patients often must travel significant distances
and taking time off from work.
- Resulting in
- Expense to both the patient and the enterprise
- A delay in the diagnosis and treatment of the
presenting medical condition
Solutions
10Scope Multi-specialty Tele-consultation Project
Solutions
- Developing and refining computerized medical
records, enhancing medical information retrieval
and patient tracking, and creating clinical
decision support rapidly increases the capability
to provide high quality cost-effective medical
care to non-civilian beneficiaries and civilians
in even the most remote locations. - To design, build and test a multi-specialty
teleconsultation system on a common technology
platform. This system will provide widely
available, flexible, clinically relevant services
across multiple medical specialties on a secure,
stable low cost technology platform utilizing
asynchronous and synchronous communications.
This will allow general clinicians and medical
personnel access to remote expert advice,
diagnosis and mentoring and in so doing
contribute to providing a high-quality standard
of care independent of location.
11Scope
- The Multi-specialty Tele-consultation
Demonstration Project was divided into the
following areas - Distributed Radiology Imaging Demonstration
Project The design and implementation of a
distributed radiology imaging system utilizing
the Stentor platform at a medical facility in
Dayton, Ohio. The system was connected to UPMC
linking the radiology departments for education
and service opportunities. - Pathology Tele-consultation System Demonstration
Project The design and implementation of a
telepathology system at a facility in
Mississippi. The system is connected to UPMC
linking the pathology departments for education
and service opportunities. - Behavioral Health Tele-consultation System
Demonstration Project - The design and
implementation of a behavioral telehealth system
at a facility in Texas. The system connects to
UPMC linking the behavioral health resources for
education and service opportunities. - Pediatric Cardiology Tele-consultation System
Demonstration Project
12Approach/Strategy
- A high-level project work plan will be included
in the individual scope of work documents. The
main focus of the program will be on the
implementation of tele-consultation applications.
The tele-consultation implementation work plans
have been developed based on a standard
implementation methodology and are organized into
seven major segments with corresponding
activities as follows
13Approach/Strategy
I. Project Set-Up Confirm project governance and
organization structure. Confirm project roles and
responsibilities. Confirm communication
structures. Confirm methodology approach.
14Approach/Strategy
II. Analysis Conduct application education and
training. Document functional and technical
requirements. Assess hardware, interfaces and
network. Document software requirements,
conversion decisions, and data standard
initiatives. Identify training needs and sites.
15Approach/Strategy
III. Design Complete system design. Develop
conversion specifications and interface
specifications. Identify data standards and file
setups, customizations, and security requirements.
16Approach/Strategy
IV. Development Complete system build. Begin
programming conversions, interfaces, and
customizations. Develop new policies and
procedures. Develop menus, forms, reports and
screens.
17Approach/Strategy
V. Testing Define testing scope and
approach. Identify testing team. Develop
integrated and product specific test
plans/scenarios. Conduct testing system
acceptance, unit, application, integration,
stress, security and network/communications
testing.
18Approach/Strategy
VI. Training Develop training plan and
materials. Schedule and conduct user training.
19Approach/Strategy
VII. Conversion/Post-Live Support Develop
go-live plan. Identify support team for
go-live. Determine conversion downtime
requirements and system freeze dates. Prepare
contingency plans. Perform conversion. Identify
post-live issues team. Initiate post-live support
and transition.
20FY 01-02 IMITS
21FY 01-02 IMITS
- Business Problem
- Shortage of specialty physicians
- NCMF high priority Radiology
- Goal
- Improve access to care and provide quality
healthcare services to individuals regardless of
location
22FY 01-02 IMITS ProgramImplementation Overview
- Extended period to move money and negotiate
agreement - Pre-award implementation of Radiology project to
meet NCMF requirements to replace legacy systems - Rigorous security requirements that necessitated
adjustments to project timelines
23IMITS ProgramDistributed Imaging
- Dayton, OH
- Installation of Stentor iSite COTS
- UPMC customizations for NCMFs workflow, global
hub and spoke strategy - Replaces legacy PACs system
- Establishes footprint for global NCMF image
distribution infrastructure - Evaluation of provider acceptance and satisfaction
24FY 01-02 IMITS ProjectsDistributed Imaging
- Current Status
- July 1, 2003 - Technical go-live
- August 27, 2003 - Clinically live on private
subnet - November 14, 2003 Notified of impending final
security accreditation - November 24, 2003 Move from private subnet to
live radiology network - January 20, 2004 Clinical go-live
- February 2004 Begin UPMC customization
- March 2004 UPMC Radiologist wrapper installed
- May 2004 Clinician wrapper installed
- June 2004 STE for upgrade to iSite v3.2
25IMITS ProgramTelepathology
- Biloxi, MS
- Installation of UPMC Static Telepathology
(Mississippi, Florida, California) - Installation of dynamic telepathology for
educational purposes (Mississippi, Florida,
California) - RD on whole slide imaging (Mississippi,
Pittsburgh) - Progressive technology for imaging and storage of
pathology specimens - Evaluation of provider acceptance and satisfaction
26IMITS ProjectsTelepathology
- Current Status
- Feb 2003 Version 1 Security Documents submitted
for approval - July 2003 Updates to Version 1 submitted
- Sept 2003 Version 2 Security Documents
submitted for approval - Oct 2003 Initial lab certification at DSI
- Nov 2003 Awaiting report of certification
testing - Jan 2004 Certification re-test
- Feb 2004 Awaiting IATO
- April 2004 IATO obtained
- May 2004 Awaiting CTO
- June 2004 CTO obtained
- August 2004 Final STE scheduled
27IMITS ProjectsPediatric Tele-echocardiography
- Current Status
- Dec 2003 Installation equipment at all bases
- Jan 2004 Equipment installed
- Mar 2004 Awaiting ISDN re-install
- May 2004 Clinically live
- Jun 2004 Beta cases
28IMITS ProgramPediatric Tele-echocardiography
- Biloxi, MS
- Implementation of Pediatric Tele-echo system
modeled after Childrens Hospitals in Florida - Clinical implementation and support
- Evaluation of parent and provider acceptance and
satisfaction - No security requirements
29IMITS ProgramEmergency Services
- Emergency Communication Database
- Demonstration project using international
healthcare facility database in UPMC Command
Center - NCMF identified additional required information
in database - UPMC collecting data on health care facilities in
South America - NCMF will evaluate via secure web access
- Opportunity for future business relationship
30FY 01-02 IMITS ProjectsEmergency Services
- Expeditionary Medical Support (EMEDS)
- NCMF forward deployed treatment facilities
- Portable tents
- Large IT footprint
- Hard wired
- Subcontract with MountainTop Technologies
- Conduct needs assessment
- Make recommendations for wireless solution
31IMITS Program Discontinued Projects
- Telemental Health
- Internal NCMF issues
- Change in leadership Wilford Hall Medical Center
- Administrative changes in TRICARE
- Teleradiation Oncology
- Difficulty finding suitable site
- IMRT requires specific equipment on linear
accelerator
32FY 04 IMITS (Sept, 2004)
- 10.2M Congressional Appropriation
- Congressional intent to expand into the Pacific
Rim - Pacific Telehealth and Technology Hui
- University of Hawaii
- Expanded relationship with Wilford Hall Medical
Center
33FY 04 IMITS (Sept, 2004)
Extracorporeal Membrane Oxygenation (ECMO)
Platelet Gel Therapy
Telepathology
Simulation and Training
Teleaudiology
IMITS
Telemental Health
Evaluation
Distributed Imaging and Workload Balancing
Teleophthalmology
Education
34FY 04 IMITS ProjectsECMO
- Extracorporeal Membrane Oxygenation
- Invasive procedure for maintaining oxygenation of
the blood when lungs and/or heart are failing - Requires specialized equipment and specially
trained individuals
35FY 04 IMITS ProjectsECMO
- ECMO programs generally found in urban academic
medical centers. - 145 ECMO centers in the world
- 112 in the US
- Only 2 NCMF in Texas
- No centers located in the Pacific
36FY 04 IMITS ProjectsECMO
- Interest in establishing a regional ECMO Center
for the Pacific in Honolulu - Senator Inouye
- Non Civilian Medical Center
- Kapiolani Womens and Childrens Hospital
- Pacific Telehealth and Technology Hui
- University of Hawaii
37FY 04 IMITS ProjectsECMO
- FY 04 ECMO project is feasibility and planning
study - Evaluation of existing resources
- Requirements
- Budget
- Deliverable will be a plan for implementation of
the center with the support of FY 05
appropriations sponsored by Senator Inouye
38FY 04 IMITS Projects Distributed Imaging and
Workload Balancing
- NCMF experiencing a severe shortage of
radiologist - 160 billets (FTE) as of July 1, 2004 only 60
filled - Need to maximize resources and distribute
workload - Hub and spoke teleradiology model no longer
useful - Symmetrical load balancing model more appropriate
39Distributed Imaging and Workload Balancing
- UPMC implemented distributed workload model one
year ago - Shared worklist
- Radiologists read films from facilities other
than the one they are assigned to for the day - Same model implemented
- Shared worklist
- Appropriate cases for civilian readings
40Distributed Imaging and Workload Balancing
- Designated Non Civilian Medical Center
- Scale up model developed for the hospital in OH
- Attempt to keep readings within the US Gov
41Distributed Imaging and Workload Balancing
- IMITS 04 project scope
- Assess the current workflow at NC Medical Center
- Recommend changes based on UPMC workflow model
- Implement a prototype system
42Teleaudiology
- Cochlear implants are utilized to improve hearing
in severe to profound hearing loss - Once implanted the devices require monitoring and
adjustment - This must now be done in person
43Teleaudiology
- UPMC and NCMF both have cochlear implant programs
- Only one MTF that has a cochlear implant program
- NCMF treats patients globally
- Interested in developing a means to remotely
access and adjust implants
44Teleaudiology
- FY 04 deliverables
- Feasibility study
- Vendor evaluation
- Determine regulatory impact in civilian world
- Plan for technology development
- Pilot project
45Teleophthalmology
- Joint project with Type 2 diabetes
- NCMF requested that retinal screening images
captured for the diabetes project be stored in a
DICOM archive - Consistent with newly released ATA guidelines
Telehealth Practice Recommendations for Diabetic
Retinopathy
46Teleophthalmology
- UPMC Radiology Informatics has done work with
visible light images - Image archive for melanoma photographs
- Customized viewer
47Teleophthalmology
- FY 04 IMITS Teleophthalmology Deliverables
- Create DICOM object with associated metadata from
acquired image - Transport the DICOM object form point of
acquisition - Store image in a DICOM archive irrespective of
vendor
48Telemental Health
- A major component of dealing with catastrophic
events is Post Traumatic Stress Disorder - Victims of disasters
- Critical incident stress management has been
unsuccessful in management of PTSD - Cognitive Behavioral Therapy has been show to be
successful
49Telemental Health
- FY 04 Project
- Initial data collection and assimilation for
analysis - Partnership with simulation center in San Diego
50Telepathology
- Three initiatives under this heading
- Telepathology Needs Assessment Pacific Rim
- Development of Whole Slide Imaging Capability
- Incorporation of pathology images in enterprise
image archive
51TelepathologyPacific Rim Needs Assessment
- Telepathology needs of the Pacific Rim differ
from CONUS - Static vs. dynamic
- Multiple time zone changes, international date
line - Staffing at MTFs
- FY 04 Deliverables
- Needs assessment and feasibility study for
telepathology in the Pacific Rim
52TelepathologyWhole Slide Imaging
- Technologies that allow rapid and automatic
imaging of entire slides at high resolution,
storage of the image and display - Equipment developed but technology has not been
integrated into clinical practice - FY 04 project
- Development and implementation of a fully
integrated WSI clinical application at UPMC
53TelepathologyImage Archive
- Native telepathology images are not in DICOM
format - File size for WSI is rather large
- FY 04 project
- Leverage work done to date at UPMC with visible
light images for melanoma and ophthalmology to
integrate pathology images into a DICOM archive
54Simulation and Training
- Three initiatives under this heading
- Wilford Hall Simulation Center
- University of Hawaii Simulation Center
- UPMC Nursing Injury Prevention Program
- All projects will involve WISER
55Simulation and TrainingWilford Hall Simulation
Center
- Wilford Hall has simulation capabilities
distributed in various departments throughout the
MTF - Wants to consolidate existing capabilities and
build a Simulation Center - FY 04 deliverable
- Assessment of current capabilities and
recommendations for an integrated simulation
center
56Simulation and TrainingUH Simulation Center
- University of Hawaii will be opening a new
Medical School Building in 2005 - One floor dedicated to advanced simulation and
training - UH interested in WISER applications
- FY 04 deliverable
- Development of a collaborative partnership and
implementation of a WISER pilot at UH
57Simulation and TrainingUPMC Nursing Injury
Prevention
- Work related injuries are a significant issue for
nursing - Simulated situations can assist with assessment
and prevention of injuries - FY 04 project
- UPMC Nursing in collaboration with WISER will
develop and implement a work related injury
prevention simulation
58Platelet Gel Therapy
- Wound healing therapy
- Creation of platelet rich plasma that enhances
wound healing and decreases healing time - Applicability to non-healing diabetic ulcers
- FDA approved
- Not reimbursed by Medicare or private insurers
59Platelet Gel Therapy
- Additional studies needed to validate efficacy
- FY 04 project
- Planning and development of multi-center clinical
trial comparing platelet gel therapy to standard
wound care treatments - Literature review
- Protocol development
- Vendor negotiations
- IRB approvals
60Education
- Three initiatives under this heading
- Nursing Leadership training
- Nursing Magnet Program
- Type 2 Diabetes Education in Italy
61EducationNursing Leadership
- UPMC and the NCMF have similar objectives for
leadership training - UPMC has established the Beckwith Leadership
Institute - FY 04 project
- Review Joint Leadership Core Curriculum to
determine synergies between NCMF and UPMC - Make recommendations for joint curriculum
development
62EducationType 2 Diabetes Italy
- Incidence of type 2 diabetes increasing in Italy
- Need Diabetes Self Management Tools
- Partner with the hospital in Italy and
Mediterranean Institute for Transplantation and
Advanced Specialized Therapies (UPMC) - FY 04 project
- Initiate an on-line diabetes education program
for type 2 diabetes
63Evaluation
- Leadership from Center for Biomedical Informatics
- Conduct rigorous and professional evaluation of
the IMITS projects - User acceptance
- Technology integration
64Evaluation
- Oversight of all evaluation activity
- Protocol development
- Protection of humans subjects
- IRB approvals
- Federal and state regulations
65Conclusions
- 1. The civilian counterparts, particularly in
developing countries are interested in
implementing information technology that
eliminates inefficiencies, increases utilization
and improves quality of care, while also lowering
administration costs. Given the limited manpower
and resources facing the military non-civilian
and private sectors, improved information
technology and management will be the foundation
for quality health care.
66Conclusions
- 2. University of Pittsburgh Medical Center has
also some other partnership models and close
cooperation with Italy, Czech Republic, Brazil
and China and is looking forward to cooperate
with Arab Region as well - 3. One of these models of partnership between
the university and medical entities can be
applied in case of Arab nations region.
67Background
- The IOM committee believes the development and
application of information systems is essential
to enhance quality and improve efficiency.
Information technology must play a central role
in the redesign of the healthcare system if a
substantial improvement in quality is to be
achieved over the coming decade. - These problems are even more acute when applied
to a military service population for a number of
reasons. First, service men and women and their
families are among the most mobile members of our
society. Second, due to their exposure to
diseases and environmental factors in a multitude
of geographic locations, they are subject to a
wider variety of difficult-to-diagnose medical
conditions. Complicating this is the likelihood
that relevant medical data is stored in
incompatible health information systems increases
with the time spent deployed outside CONUS. In
addition, the drawdown in military forces and the
closure of medical treatment centers in the 1990s
has resulted in a reduction in funding and
staffing for medical care applied against a
stable but aging population of beneficiaries. - Like its civilian counterparts, the Air Force is
interested in implementing information technology
that eliminates inefficiencies, increases
utilization and improves quality of care, while
also lowering administration costs. Given the
limited manpower and resources facing the
military and private sectors, improved
information technology and management will be the
foundation for quality health care.