CAS Quarterly Meeting Financials

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Advances in Mobile ComputingEmerging Technology
in eHealth Development Third Annual eHealth
Developers' Summit November 6 8, 2002, Tempe,
Arizona
Jeff Sutherland, Ph.D.Chief Technology
Officer http//www.patientkeeper.com/ Jeff.sutherl
and_at_computer.org
Turning the Promise of Mobile Computing into a
Reality
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Truckers can do it!They are concerned about
survival.

• 2 out of 3 trucking companies have disappeared in
  recent years
• Survivors tract costs down to every activity that
  matters on the loading dock and the truck
• Roadway Express sorts shipments from many
  customers and terminals, then loads rearranged
  goods into outbound trailers
• A barcode swipes the waybill, the location, and
  the ID badge of the loader. Years ago this would
  have been scrawled on paper.
• What will happen to hospitals who cant do this
  in the next decade? The patients?
• Cone, Edward and Carr, David. Unloading on the
  Competition. Baseline, Oct 2002

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On-Going Learning Required!

• The average large healthcare delivery system does
  not bill for gt10 of procedures rendered. As a
  result, many are losing money, losing staff, and
  losing quality of care.
• Medical error is the third leading cause of death
  in the U.S. after heart disease and cancer JAMA,
  July 26, 2000, p 483. Most of the largest group
  of lives lost, caused by medication error, can be
  saved by having the right information at the
  point of care.
• Mobilization of medical data is the fastest (and
  perhaps only) path to physician adoption of
  critical automation. Taking advantage of
  financial and clinical improvement opportunities
  depends on it.
• The right data on the right patient, at the right
  time and right place, for the right person is key
  to efficient operations and patient safety.
• The burden of harm conveyed by the collective
  impact of our healthcare quality problems is
  staggering Our present efforts resemble a team
  of engineers trying to break the sound barrier by
  tinkering with a Model T Ford. National
  Institute of Medicine, 2001

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Lots of lives to save

• Medical error is the 3rd largest cause of death
  in the U.S. exceeded only by heart disease and
  cancer. (JAMA, July 26, 2000, p 483)
• 12,000 deaths/year from unnecessary surgery
• 7,000 deaths/year from medication errors in
  hospitals
• 20,000 deaths/year from other errors in hospitals
• 80,000 deaths/year from nosocomial infections in
  hospitals
• 106,000 deaths/year from adverse effects of
  medications (4th leading cause of death)
• 50-90 of medication errors can be eliminated at
  time of installation of automation at the point
  of care.
• There is a growing conviction in all hospitals,
  even in those which are best conducted, there is
  a great and unnecessary waste of life.
  Florence Nightingale, 1859

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Mobile Patient Safety Solution

• Increases Revenue
• Reduces Medical Errors
• Improves Quality of Life Extra Time for Doctor

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ChargeKeeper ROI StudyNorth Shore/LIJ Health
System

• Study Background 86 Inpatient Physicians / 22
  Departments Participated in Study
• Results
• 888 increase in revenues/physician/month,
  primarily revenue captured that was previously
  lost through manual, inefficient processes (1
  million annually for physicians in study group
  3.5 million when applied across potential user
  base)
• 4.9-to-1.0 benefit to cost ratio demonstrated
  (cash flow)
• Excludes decrease in lag time 8 days
• Excludes enhanced productivity/workflow
• User Satisfaction Survey 4.5 on scale of 1-to-5

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Proven ROI Increased Revenue
AnnualRevenueIncrease
Benefit toCost Ratio
Participants
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Is There Really a Problem?
More than one million medication related errors
occur in US hospitals each year.
Dispensing
Transcribing
Administration
Ordering
Source Gartner Group, Healthcare Business and IT
Summit, April, 2002
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Mobile Patient Safety Solution

• Increases Revenue
• Reduces Medical Errors
• Improves Quality of Life Extra Time for Doctor

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Decision Support at Point of Care
I WANT NEED

• Access to only the data

• Right Data

• Right Time

• Right Place

• Right NOW

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Decision Support at Point of Care

• PERSONALIZED Information
• StatusKeeper MY Inbox of new patient data
• The most recent clinical results for only MY
  PATIENTS
• LabKeeper Access to MY patients lab result
• Flag an important lab to remain on the PDA
• Create personal lab panels with customized
  timeframes
• Display only critical results
• RxKeeper Access to MY patients medication
  profile
• View only new, active, D/C or held medications
• NoteKeeper Access to MY patients clinical
  notes
• View by desired note type progress, admitting,
  discharge, HP, RN, consults, etc.
• TestKeeper Access to MY patients diagnostic
  test
• Only the test results I WANT micro., path. and
  X-ray
• Key word search for desired text
• DxKeeper Access to MY patients Problem List
• View by problem category, i.e., resolved,
  inactive, etc.

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Reducing Medical Errors Step 1Aggregate
Results from Backend Systems
Clinical Suite
ChargeKeeper

• Quick access to critical results and patient
  information.
• LabKeeper
• DxKeeper
• RxKeeper
• NoteKeeper
• TestKeeper
• AllergyKeeper
• VitalsKeeper
• OrderStatus
• StatusKeeper

• Capture charges at the point of care with
  advanced code edits and transaction management.

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Reducing Medical Errors Step 2Update Selected
Results on Backend Systems
Clinical Suite
ChargeKeeper

• Quick access to critical results and patient
  information. Update relationships.
• LabKeeper
• DxKeeper
• RxKeeper
• NoteKeeper
• TestKeeper
• AllergyKeeper
• VitalsKeeper
• OrderStatus
• StatusKeeper

• Capture charges at the point of care with
  advanced code edits and transaction management.

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Order Capture Step 3 Generate electronic orders

• Order capture based on
• Simple and intuitive based on order sets for
  majority of orders
• Mobile order capture a hybrid application
• Most data resides on the device from
  synchronization
• Multiple transactions occur in real time for
  order submission
• Drug interaction checking and decision support
  rules sent to the mobile device works in tandem
  with backend clinical systems.
• Real time transaction submits order to
  appropriate back end processor back end alerting
  and messaging sent to the mobile device provides
  warnings and order status.
• When connectivity not available order is queued
  on mobile device for immediate processing when
  backend available.

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Malcolm, B. Carlson, R.A. Tucker, C.L.
Willette, C. Veterans Affairs Eliminating
Medication Errors Through Point of Care Devices.
Proceedings of HIMSS 2000, Session 73, Dallas.
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Mobile Patient Safety Solution

• Increases Revenue
• Reduces Medical Errors
• Improves Quality of Life Extra Time for Doctor

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Quality of Life

• Question How much better is your workday when
  you can find your patients on rounds and you have
  their information at your fingertips?

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Quality of Life

• Question How important is it for you to see
  abnormal and critical lab values as soon as the
  results are available?

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Quality of Life

• Question How much additional comfort would you
  have knowing you had the most current critical
  patient information?

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Quality of Life

• Question How much time would you save if only
  the data you wanted to see, on only your
  patients, was sent to you REAL TIME?

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The Proof is in the Pudding

• "Glens Falls is a community hospital offering a
  wide range of specialty treatment through a
  number of regional facilities. Within months, we
  will have a fully installed CPOE system, accented
  and supported by remote, mobile
  enterprise capability offered by PatientKeeper of
  Boston.
• PatientKeeper Enterprise mapped perfectly to our
  clinical IT strategy in two ways    
• At Glens Falls, we believe that you have to
  leverage technology to advance technology.
• If our physicians aren't driving it, we won't put
  our money in it. Our doctors want mobile
  capability and find PatientKeeper incorporates
  clinical decision support into their workflow
  easily and seamlessly from wherever they are in
  the Glens Falls region. 

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Mobile Patient Safety Solution
Increases Revenue
Reduces Medical Errors

• Improves Quality of Life Extra Time for Doctor

Provides a robust platform for independently
authored third party applications which
interoperate with clinical systems.
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Mobile Platform RequirementsAggregate,
Integrate, Interoperate

• A common mobile platform is required to
  third party and end user applications on
  a single device. This allows standardization of
  data for reporting and organization wide
  implementation of quality initiatives.
• Open standards are required to
  independently authored third party applications
  on a single handheld device. Physicians want
  single signon, patient context management, and
  seamless interoperability of patient data
  modules.
• Supporting a faster, cheaper, mobile solution for
  patient safety initiatives requires an open
  mobile platform that allows independently
  authored applications to ,
  integrates with previously installed systems, and
  supports evolutionary replacement or upgrade of
  existing infrastructure.

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PatientKeeper PersonalTestbed of 45,000 Clinical
Users

• All essential medical data on a Palm Pilot or
  PocketPC.
• Designed to integrate with global medical data
  system.
• Provider care, home care, and military care.
• Harvard Medical School students are graded on
  information in this application. 100 adoption.

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Platform BenefitManaging Application Portfolios

• TaskKeeper
• NoteKeeper
• PlanKeeper
• RxKeeper
• Procedure-Keeper
• 3rd Party Apps

• ChargeKeeper
• LabKeeper
• DxKeeper
• InfoKeeper
• MemoKeeper
• 3rd Party Apps

Personal Applications
Enterprise Applications
mPI
One Mobile Device
One User Interface
Any Device

• Any Transport
• Ethernet cradles
• 802.11
• Bluetooth
• Cellular

Single Signon Context sharing Hard encryption
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Mobile Platform Features
MultipleDevice Types
N Applications
SDK
SingleSign on
ApplicationInteroperability
Patient ContextManagement
MobileDevice
Security
Application Framework
Handheld Data Store
MobileCommunications
MobilePatient Index
Mobile Services
TransportWireless orEthernet
HIPAA Security
CentralAdministration
Messaging Alerting
Web Facilities
Personalization
Transactions
Web Services Integration Interfaces
JAVA
XML
HTML
Business Logic
Patient Objects
Cerner
Wellogic
UCR/Meditech
Adapter Components/Open API
CareGroup
Mobile Legacy Integration
Mobile ClinicalRepository
MobilePatient Index
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Layered Security
Mobilizer Platform Components

• Secure storage
• Secure transmission
• Audit trails and non-repudiation
• Authentication
• Token-based IR beaming of data
• Mirroring of HIS permissions
• Certification of applications

PatientKeepersSoftwareDevelopment Kits
Common User Interface
Messaging Alerts
DataSharing
InfraredPrint
BarcodeScanning
Security
Encryption Transport
Wired
Wireless
Encryption Transport
CentralAdministration
Personalization
Audit Trail
Security
Reporting
Clinical DataRepository
HIS Scheduling
HIS Pharmacy
HIS Billing
HIS Lab
Back-End Systems
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Platform Solutions
PatientKeeperLite Solution
PatientKeeper/Cerner Solution
PatientKeeper/UCR Solution
PatientKeeper Handheld
PatientKeeper Handheld
PatientKeeper Handheld
UCR NetResultDesktop
CernerDesktop
PK Desktop
PK Mobilizer
PK Mobilizer
PK Mobilizer
UCR NetResult Server
WDAC
Millennium Objects
XML / JAVA Transactions
DBOne
MediTech Magic System
CernerMillenniumRepositories
Synapse
MediTech Magic Repositories
Incoming HL7 Messages
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SDK Expands Portfolio
MobilizerSDK
Developedby PatientKeeper
Developedby Third-Party
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Driving Platform LeadershipGartnerGroup Magic
Quadrant
Gartner, Inc. Advisory Services Draft Market
RU 09/25/2002 0401 PM Kenneth Kleinberg
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Clinician Value Proposition

• An intelligent mobile framework
• Portfolio of multiple, independently authored
  applications integrated on a single mobile device
  (More and better functionality sooner)
• Common UI and patient-centricity(Increase
  adoption and reduce training)
• Not painted in a corner integrate best of
  breed mobile applications
• Flexibility to create own applications(e.g.,
  protocols to influence physician behavior)

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Hospital Value Proposition

• Value to hospital decision makers
• Centralized administration
• Enterprise-wide controls to help manage the
  organic growth of PDAs (e.g., HIPAA)
• Not painted in a corner
• Integrate best of breed mobile applications
• Develop own applications
• Force another vendor to port their application to
  a common framework
• Often PatientKeeper Personal is already in use

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Developer Value Proposition

• Value to the developer community
• Lowered barrier to entry for application creation
• Shorten time to market
• Create portfolio effect Crossing the Chasm
• A installed base to sell into distribution
  channel
• Leverage with component technology vendors
  (e.g., encryption, Infrared printing, barcode
  scanning, wireless networks, etc.)

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Advances in Mobile ComputingEmerging Technology
in eHealth Development Third Annual eHealth
Developers' Summit November 6 8, 2002, Tempe,
Arizona
Thank You