Evidence-based Patient Empowerment Smart Healthcare...

IBM Research

Smart Healthcare Platform(Medical Information & Care System)

Kyriacos Kokkinos

IBM

Evidence-based Patient Empowerment

© 2011 IBM CorporationUniversity of Piraeus

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Healthcare Transformation

1University of Piraeus

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I Problem Statements

II IBM Healthcare Platform : Overview

Agenda


III IBM Healthcare Platform : Key Use Cases

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Focus on Value

Market trends and their implications present the need for transformation

Escalating Costs

3University of Piraeus3

Information liquidity and

transparency

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Problem Statements


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Problem Statement

� Time : Only few minutes per encounter (Only 1 minute for

informing the patient)

� Information : Large volume of information to consider

� Access to data : No single point of access

� Specialization : Doctors are specialized in their own domain

� Regulations : No access to all of the patient information

� ROI of Hospital : Increased patient safety usually leads to

Physicians have “limitations”“I am hesitating to

use the decision

support tool. Can it

make more income

and provide

meaningful

information?”


� ROI of Hospital : Increased patient safety usually leads to

decrease in ROI

� Patients want to manage their health information as

they manage their finance – with full control

� Patients are not passive any more – become important

part of the decision making flow

� Patients want to know more

� Patients want maximum access to all kind of information

– both personal and public

Patients are entering the conversation about their health

“Give me the tools to

be better prepared

for my next

encounter with my

doctor”

information?

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Changes of Healthcare Provider

� Physicians who share medical information by using web 2.0 are increasing

– Physician, patient, and scientist get medical information from web such as Blog, YouTube, Twitter, etc.

– Medical Blog competes with medical mass media and academic journal

– Sharing information each others through websites and SmartPhones

� Promote public health policy and hospital by web

– Centers for Disease Control and Prevention (CDC) promotes their policies through Twitter.

– Attract foreign patients by taking advantage of IT marketing from domestic hospitals


[Source] Social Media and Changes of Healthcare Environment (Yang, Guang Mo)

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Changes of Healthcare Consumer

� Increased use of health information through the Internet

– In 2000 : 25% of adults searched online health information.

– In 2009 : 74% of American citizen used internet, 61% of adults use online health information.

� Growth of active utilization medical information

– Medical customers search their particular experienced disease, treatment, and drug through internet.

– The rate of looking for drug information on internet is increasing annually.

� Obtain and share medical information by using social media

– Get or share people’s illness information through social media. (Ex. PatientsLikeMe)


Ask advice about which hospital should I

go or what treatment should I get…

Search on the internet what my physician

said to me….

[Source] Edelman Health Engagement Barometer 2008

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Empowering The Patients


Empowering the patients Empowering the physiciansWell-informed patient with self-management skills Evidence-based medicine

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How can we empower the patients?

Patient

Analysts Physician Auditors

To realize evidence-based patient centric health care services requires an innovative system supporting

various patient data integration, knowledge base with standard clinical guidelines, real-time data

analysis and health care information delivery customized for individual patients.

MEDICAL CONTENT PUBLISHERS,

DRUGS COMPENDIA COMPANIESPHYSICIANS AND PATIENTS INSURERS & REGULATORY

Patient

Medical knowledge acquisition and generation Collaboration between

physician and patient

Evidence-based assessment and

reporting adverse drug reaction

FDA


Evidence-based Clinical Knowledge Base

Gu

ide

line

R

eco

mm

en

da

tio

ns

& E

vid

en

ce

Physician

Analysts Physician

Guideline adherence

Auditors

Content Recommendation

[Reference] IBM GTO 2011 Services Implications

Guideline Generation Assistant

Clinical Guidelines Delivery &

Recommendation

Clinical Guidelines Auditor

EHR(PHR, EMR, Genome)

Physician

op

tim

ized

hea

lth

car

e in

form

atio

n

Clinical data

integration

FDA

ADE Report

Patients’ Records

DrugsMedical

Literature

Audit policies

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Medical Information & Care System


IBM Healthcare Platform : Overview

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Healthcare Solution toward CDSS Platform

IBM Healthcare Platform is a medical diagnosis model-based intelligent clinical system to empower

individual patients with valuable information to play an active role in decision making and implement

their own health care

Evidence DeliveryData ManagementKnowledge

Management

Data Sources

UsersIBM Healthcare Platform


� HL7 Rim-based

Semantic Data

Warehouse

� Adaptable data

connection with

various healthcare

system (EMR / PHR /

Genomic services, Sensor

devices)

� Ontology-based

CDSS Knowledge

Base platform

� Real-time clinical

analysis engine

� Web-based clinical

rule authoring

toolkit

� Social-Medical

discovery platform

� Clinical mashup

service platform

� Collaborative and

adaptive user

interface framework

�PHR Data

�EMR Data

�Sensor Data

�Genomic Data

�Social Data

�Life style

�Family history

�Patient

�Family

�Physician

�Pharmacist

�Researcher

�Executive

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IBM Healthcare Platform Features

Clinical data integration Clinical knowledge management

�Dynamic incorporation of public knowledge

- Structure, unstructured and semi-structured

- Various knowledge sources : FDA, LODD etc

�Horizontal : Integration of various data sources

- EMR System, PHR System, Genetic testing agency

system, sensor devices etc

�Knowledge authoring toolkit

�Vertical : Integration of heterogeneous

medical data

- Medical records, PHR data, Genetic data,


Scalable enablement platform Evidence delivery

�Large-scale data and standards-based

knowledge management

�Support analytical services

�3rd-Party service providers

�Rule-based medical data analysis environment

�Leverage social networks for the benefits of

physicians and patients

�User interface framework for personalized UI

- Medical records, PHR data, Genetic data,

Image data, Test results, Sensor data etc

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Medical Information & Care System


IBM Healthcare Platform : Key Use cases

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Key Use Cases

Smart ADE System

Advanced ADE system to provide personalized contents

and ADE monitoring service in conjunction with various

sources which reflect latest clinical information

Chronic Disease Management System

Remote monitoring system to improve the quality of life

of chronically ill patients by enabling them to be cared at

home rather than have to be admitted to hospitals


CP Monitoring System

Provides the toolkit which supports clinical pathway

modeling and analyzes the differences between realistic

medical treatment and the pattern of clinical pathway

Prescription Assistance System

Medical diagnosis and treatment planning and

monitoring system to provide the clinical guidelines and

evidence data based on the historical patient records

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Key Use Cases > Prescription Assistance System

CDSS PlatformPrescription

Assistance

Sensor Gateway

Sensor

Adapter

CDSS Applications

IBM Healthcare Platform supports to establish the medical diagnosis and treatment planning and

monitoring system which provides the clinical guidelines and evidence data based on the historical

patient records.


Patient Data

(EMR,OCS etc)

HIS Interface

HIS AdapterClinical Expert

Group

Knowledge Source

Medical

Knowledge

Historical

Data

Remote Patient

Monitoring

ICU Monitoring

Outpatient

SensorDigital Guideline

Physician

Inpatient

Sensor

Sensor Gateway

Sensor

AdapterClinical Data

Management

Knowledge

Model

Management

Clinical Event

Engine

Knowledge

Toolkit

Social Medical

Discovery

Knowledge

Acquisition

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Denmark Case: The Challenges

Drugs cost rising !

Source: OECD

What medicine is Prescribed?

Is the cheapest drug Prescribed?

Is every doctor prescribing the same medicine?

16University of Piraeus 16

Prescriptions are misinterpreted

In Denmark 15 mill prescriptions every year

15 mill prescriptions to be reimbursed

15 mill prescriptions manually handled by Family

doctors, Pharmacies, Health Insurance…

Clarifications has to be made…

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Is every doctor prescribing the same medicine?

Contributions of ePrescription

Drugs cost rising !

Source: OECD

What medicine is Prescribed?

Is the cheapest drug Prescribed?


Prescriptions are misinterpreted

In Denmark 15 mill prescriptions every year

15 mill prescriptions to be reimbursement

15 mill prescriptions manually handled by Family

doctors, Pharmacies, Health Insurance…

Clarifications has to be made…

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For whom is ePrescription?

Health Insurance

Government

� Higher quality in medication� Low cost

� Transparency in medication

� Optimize work routines & reduce time and cost


Family doctor

Pharmacy

Patient

Hospital

� Optimize work routines & reduce time and cost

� Higher quality in service

� Higher quality in medication

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Key Use Cases > Smart ADE System > Why Adverse Drug Event (ADE) ?

� ADE is a harm associated with the use of given medications at a normal dose

� ADEs result in more than 770,000 injuries and deaths every year

� Cost up to $5.6 millions per hospital per year

� Between 28% to 95% of ADEs can be prevented

� Knowledge about interactions is already out there

* From the Agency for Healthcare Research and Quality (USA)


[Source] Health Study 2010 | How to engage in the conversation with empowered patients

by © InSites Consulting, 2010

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Key Use Cases > Smart ADE System

ADE Portal established on IBM Healthcare Platform optimizes knowledge management process and

provides real-time drug side effect monitoring service. Also, it provides personalized healthcare contents

as linked with various sources which reflect latest information to knowledge base.

FDAKnowledge

ADE System(Hospital)

③ Confirmed /Adjusted

Knowledge

⑨⑩

⑤ ADE Request ⑤ ADE Request

Knowledge Search Knowledge Generation


Smart Health

PortalPatient

Clinical Data

Analysis⑪ Personalized

Contents

KFDA

PublicationKnowledge

Toolkit

Knowledge

Base Knowledge Expert

PHR System

Genomic

s

EMR System

Clinical Data(PHR, EMR, Genome)

Doctor

(Hospital)

① Knowledge (Text File)

② Knowledge Annotation

Search Engine

Web

sites

④ Clinical Data,

Medication

④ EMR Data, PHR Data, Genomic Data

⑤ ADE

Request

⑩ Latest Information

⑧Analysi

s Result

⑨Personalize

d ADE

⑩Personalized

Contents

⑦ Patient Data

Future Plan

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Deliver collaborative care:

Portals for connecting Patients


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Achieve better quality and outcomes:

Anatomical representation of patient and health information


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Towards a smarter healthcare

The information technology is not the solution…

… but, whatever it is, will be based on intensive use of Information Technology and Communications


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Thank you!!!!

www.ibm.com/healthcare


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IBM Healthcare & Life Sciences Team� 5,000+ employees worldwide

– Services, Systems, Software, Research, & Financing,

Sales

– Large Clinical Consulting Staff

� Clients include:

– Hospitals: 14 of the top 14 US hospitals from the 2010

"U.S. News & World Report" honor roll

– Healthcare Insurance: 12 of top 13 companies

– Government: significant projects in Canada, Singapore,

Denmark, Germany, Ireland, Spain, Italy, China, India


Denmark, Germany, Ireland, Spain, Italy, China, India

and US

– Pharmaceutical: 30 of the top 30 companies

– Biotech: 18 of top 20 companies

– Also, medical research, state and local, and other

emerging countries’ governments

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IBM’s Commitment to Healthcare and Life Sciences

Recent History� Designated Life Sciences an IBM Emerging Business Oppty Unit -Spring 2000

– $100M initial investment

� IBM Research

– IBM Computational Biology Research Center

– Deep Computing Institute

– Blue Gene Project

� IBM Business Consulting Services

– Healthcare Consultants (2500)


– Healthcare Consultants (2500)

� Strategic partnerships with industry leaders (Mayo Clinic, Karolinska Institutet, Duke, Johns Hopkins, Pfizer, Affymetrix, etc.)

� Created IBM Healthcare & Life Sciences (1/10)

– $1.350M Investment

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Patient is the Center

UNIQUE SOURCE OF DATA

– Family history

– Life style (nutrition, multi

vitamins, exercise habits,

drinking, smoking...)

– Over the counter (OTC)

drugs

– Sensors

DATA HUB OF EXTERNAL

SOURCES

– Clinical Data : Records from

Hospital, Clinics

– Genetic Data- Today, Genetic tests

- In the future, Sequencing per

patient


– Sensors

KNOWLEDGE CONSUMER

– Drugs interactions

– Available Therapies and

medications

– Clinical Trials

patient

NODE IN SOCIAL MEDICAL

NETWORK

– Family, Friends

– Other Patients, Physicians

– Medical profile

– Genetic Profile

– Documents

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HealthcareSystem

IBM Healthcare Platform Architecture

Data Sources Data Collection

HomeSensor

Sensor Device

HospitalSensor

Healthcare System

Rule Repository• Clinical Rules• Operational Rules

•Medical Records•PHR data•Genomic Data

CDA Repository

Clinical EventEngine

ClinicalRule Generator

ClinicalRule Processor

Clinical Rule Manager

Clinical DataManagement

Sensor DataDelivery

Sensor Gateway

Sensor Data Transformer

Device Adapters

CDA Transformer

Clinical DataManager

CDA Summarizer

Sensor event

Event

Smart Health Portal

StakeholdersEvidence Delivery

ContentsManagement

User DataManagement

Patient

Executive

Event

Personalized UIFramework

Event

Event

Sensor event

Data Management & Analysis

Portal Service Repository

•User Data•UI Preference


EMR OCS

PACS DW

PHR Genome

StandardGuideline

Publication

LODD

KnowledgeSources

HealthContents

Healthcare SystemInterface

Clinical DataAdapters

• Operational Rules• Provenance Rules

•Genomic Data•Sensor Data

Knowledge SourceAdapters

Knowledge Data

Knowledge

Hospital event

Event

Semantic Query

Reasoner

Knowledge Base• Ontology Store• Triple Store• Content Store

Evidence SearchKnowledge

Verification Toolkit

Doctor

Executive

Admin

Hospital event

Knowledge•Medical Terminology•Medical Dictionary•Mining Algorithm

Text Analysis Rule

KnowledgeAcquisition

LinkageConstructor

Entity Extractor

Knowledge Model Management

Knowledge Management

Knowledge

Knowledge

Social MedicalDiscovery

•UI Preference•Contents

SMD Repository•Search algorithm•SMD index data•SMD Configuration

Social MedicalIndexing

Social MedicalPrivacy

Social MedicalSearch

Knowledge

Knowledge

SMD Data

Future Plan

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Key Use Cases > Chronic Disease Management System

Family

• Provide real-time health

status information

• Family Portal services

• Emergency alerts (SMS)

Emergency Center

Patient

Home G/W

At Home

Hospital

Emergency Service

• Emergency call for help

• Providing patient data

EMR

HospitalNetworkPatient DataRequest

Remote monitoring system helps improve the quality of life of chronically ill patients by enabling them

to be cared at home rather than have to be admitted to hospitals. IBM Healthcare Platform supports the

system environment to collect, analyze and monitor the biological data from home health sensor devices

and provide personalized health information for multiple patients and caregivers.


Contents ProviderService Provider

Sensor data acquisition

and transmission

Internet

U-Health Center

Sensor Device

Moving

Smart Phone

Sensor data acquisition

and transmission

Patient Portal Services

(PHR services)

Emergency service

Video Chat Service

Measuring Vital Signs

(Blood pressure,

glucose, motion,

electrocardiogram,

falls, etc.)

Wireless

Communication

U-Health Platform

DataManagement

KnowledgeManagement

EvidenceDelivery

Data

Service

Internet

Data

Treatment

Clinical Data management

Collection, storage, retrieval of knowledge data

Clinical data analysis and context-awareness service

Evidence delivery based on social data

User interface framework for personalized UI

• Provides healthcare

services in conjunction

with u-Health Center

• Provides healthcare

contents in conjunction

with u-Health Center

U-Health Center Interface

Integration with U-Health Center(Transmitting EMR data, Receiving the

patient data from u-Health Center)

Physician’s Device

Physician Portal Service

(Patient history data query,

emergency response, etc.)

Video Chat Service

Service Contents

HospitalNetwork

Wireless

Communication

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Key Use Cases > CP Monitoring System

Clinical Pathway Monitoring System

IBM Healthcare Platform provides the toolkit which supports clinical pathway modeling and analyzes

the differences between realistic medical treatment and the pattern of clinical pathway.


Variation

Detection Engine

Variation Evaluation

Engine

Alerts

Reports

Historic Data Reference

Patterns

Physicians

CP Modeler

Variation

&outcomes

Care activities

Re

po

stin

g a

nd

da

shb

oa

rds

Service Outcomes

Patients

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ENROLLINGin healthcare programs

SHARINGindividual healthinformation

MEASURINGyour progress and plan

IMPROVINGyour long-term health and

everyday experience

Smarter Healthcare enables a more collaborative care process

centered around the wellness of the individual


UNDERSTANDING

health risks

ACTIVATINGpreventive and value-conscious behavior

ENGAGINGin a self-directed

system of care

BENEFITINGfrom an interconnected

care-giving team

COMPLYINGfulfilling your part of

the patient-doctor covenant

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We approach Healthcare as an ecosystem centered around the needs of

patients and consumers

Healthcare Providers

Drug Health Plans /

Clinical Trial Support

Advocacy Groups

Patients /


Drug Developers

Health Plans / Payers

Government Agencies

Solution / Equipment Providers

Pharmacies / Retailers

Patients /

Consumers

Evidence-based Patient Empowerment Smart Healthcare...

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