Intelligent Information Management for Healthcareehealth.org.hk/forum2011/ppt/07oct/6 Lalith...

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Intelligent Information Management for Healthcare

October 2011

Greater China eHealth Forum, 2011

Lalith Subramanian

Vice President, Strategy and New Ventures, IIG

EMC Corporation


Topics

• Challenges in Healthcare IT

• Future Landscape

• Adapting to Future

• Making the Right Choices

• Q&A


Business allenges Challenges facing Healthcare

IT Information Mgmt.

• Pressure to control costs without

sacrificing outcome – Flat –to-lower budgets

– Compliance and regulation costs

• Expanded sharing needs – Across departments e.g. DICOM

images to clinicians

– External - To patients, other

physicians

– Mobile access

• Newer medical technologies – E.g. Remote surgery, telemedicine

Medical Needs

• Enormous information growth – >70% each year

– Storage cost decreasing <30%

• Integration & workflow

complexity – Too many loosely coupled systems

in medical workflow

• Information Security challenges – Patient consent vs. sharing

– Cross-community access e.g.

national/regional boundaries


• “Communications and Document Management will be top investment areas….Investments will ensure that Information is effectively used to reduce costs and improve outcomes”

• “Corollary investments in BI and actionable advice solutions”

Widely Acknowledged Need for Intelligent Information Management


Faxed medication orders

Renewal requests

Patient plan of care

Daily care record

Incident reports

Insurance forms

Insurance ID cards

Patient billing

Insurance billing

Accounts receivable

Explanation of benefits

Medical charts

Physician orders or procedures

Physician order for medications

Prescriptions

Dermatology photos

Psychiatric videos

Patient consent forms

Patient health questionnaires

Physician referrals

Prior medical history

HIPAA compliance

PACS images

MRI

X-ray

Pathology reports

Lab reports

Contracts

HIPAA, regulatory

Compliance

HR employee files

IT project management

Corporate intranet

Website

Case report forms

Lab tests

Clinical images

Medical evaluations

Adverse events reports

Treatment

Therapy

Typically, only 30%-50%

is currently in an

electronic health record

Patient Care (Nursing)

Patient Financial Services

Medical Departments (e.g., Cardiology,

Oncology, Radiology, Surgical)

ADT (Admissions/

Discharge Transfer)

Diagnostics (e.g., Lab Testing)

Clinical Research

Administration, HR, IT,

Marketing Compliance

The Myth – “We Already Have an Electronic Health Record!”


Patient Arrives at Hospital or is scheduled for appointment

Records and Located and Pulled from Records Store Records are Transported to clinic and prepared for consultation

Clinician & Patient Consultation from Paper Record

Patient is referred for next stage treatment plan Paper Records are sent and referral process continues

Treatment Plan is carried out until complete Treatment Complete & Patient is discharged Process is repeated for every visit or episode

Example of holes in current patient record

NEXT

http://www.sciencephoto.com/media/187246/enlarge


Topics

• Challenges in Healthcare IT




• Q&A


Clinics

Ambulatory

Ambulatory

Insurers

Lab

Pharmacy

Hospital Hospital

Hospital

From current fragmented healthcare system with islands

of connectivity...

Citizens

Public health entities

Research organizations

Pharmacy

Ambulatory Payer

Ambulatory Lab

Hospital

The Target - Open and Integrated eHealth

...RHIOs/HIEs connecting medical ecosystem members

HIE

Member State



HIE Hospital

Lab Payer

Hospital

PBM Pharmacy

Ambulatory Ambulatory

Hospital

Lab Payer

Hospital

Pharmacy

Ambulatory Ambulatory

...to national connectivity

HIE

National Health Archive or Network



Citizens

HIE

*HIE – Health Information Exchange


The Information Management Goals

AGGREGATE

• HL-7, EDI Integration

• Digitization & Capture workflows

•Classification

• EHR

• Secure sharing (XDS, BPPC, XCA)

• Clinical Doc.Viewer

• Dashboards and actionable analytics

• Workflows for exceptions, HR, etc.

MANAGE OPTIMIZE


Business Overview: Based in Boston, Massachusetts,

Partners Healthcare is an integrated

health system in 1994.

In addition to two leading academic

medical centers, the Partners Healthcare

system includes community hospitals,

specialty hospitals, community health

centers, a physician network, home

health and long-term care services and

other health-related entities.

Challenge

To provide decision support that improves both the quality of care for patients and the performance of clinicians with existing computer-based clinical decision support systems

Solution

Clinical Knowledge Management solution comprised of collaboration for continuous evaluation and update of evidence-based clinical content

Automatic compliance/governance over collaboration

Results

Reduced the cost and increased the speed of translation of clinical innovation and evidence into current clinical practices

Improved organizational effectiveness as a learning organization through data-driven performance improvement

Partners Healthcare (USA) Improve quality of care for patients through collaboration


Business Overview: The Social Insurance Institution of

Finland (KELA) serves as many as

300,000 professionals within the Finnish

public healthcare and pharmacies, as well

as private medical clinics plus 5.3 million

Finnish citizens.

Challenge

To keep the most essential digital information protected,

secure and continuously available

Improve clinical productivity while lower costs

Solution

National Health Record solution for a centralized

national patient record with Captiva and Documentum

with sharing using XDS

Results

By streamlining the information management processes

of the entire healthcare sector, the system is predicted to

improve clinical productivity

while generating major financial savings

A “citizen view” provides access to 5.3 million Finnish

citizens to information concerning their personal medical

information

Kela (Finland) Radically boosts efficiency of the entire national eHealth system


Technology Considerations for Collaboration

• Patient/Citizen records in the Cloud – Virtualization and management technologies – Scalability of catalogs (XDS)

• Security – Patient Privacy and Informed Consent – Encryption, authorization policies – IHE Standards –BPPC (basic patient privacy/content),XCA (cross-

community access)

• Political and operational questions – Centralized vs. Hybrid vs. Federated records – Pay-for-performance vs. Pay-for-procedure


Topics

• IT Challenges in Healthcare




• Q&A


Adoption of a

Platform Strategy

Step 1

Build an Information

Ecosystem Provider Payer Supplier

Public Health

Step 3

Implementation of

Point Solutions in a

Phased Approach

Step 2

Ensuring Long-Term Success


Enterprise

Content

Management

Infrastructure

Deliver Create/Capture

Archive and Dispose

Manage

Archive Dispose

Security, Access and Compliance

Library and Rendition Services

Discovery and Analytics

Workflow and BPM

Lifecycle Management

E-mails

Enterprise Data Scanned

Images

Collaborative Desktop Authoring

Rich Media

Web PDF

Paper Fax

iPad

Platform for content management

DICOM Images


HIS

Digital Capabilities

Patient Communication Capture Clinical Processes

Connecting Healthcare - Interoperability Standards (DICOM, HL7 and XDS)

Healthcare Intelligent Framework Elements of Information Infrastructure

Security

Compliance

Lifecycles

Taxonomy

Classifications Business Rules

Standards-based Unified Data & Content Repository

Private Clinics Diagnostic Center PACS Physician Office Local EPR

Connecting to clinical information lifecycle


CNAMTS (France) Improve public health through effective vaccination records

Business Overview: The National Health Insurance Fund for Salaried Employees (CNAMTS) is a national public administrative establishment supervised by two separate bodies (the ministry responsible for Social Security and the ministry of Economics and Finance). It sets a national plan, the health insurance policy in France and controls bodies responsible implementing.

55 million citizens and 300,000 healthcare professional.

Challenge

The need improve productivity to cope with the constant

increase in the amount of data and reduction in the

workforce to process

Compelling Event – Need for effective citizen

vaccination against swine and bird flu

Solution

Authorization & Reimbursement Processing with

Captiva (InputAccel, Dispatcher) and Documentum xCP

case management, providing a complete end to end

processing solution

Results

Improved service quality by increasing efficiencies in the

local agencies with

digitalization of incoming information at the

data source

standardization of business processes


G123456/3 Fred Bloggs dob: 1/2/70

Outpatient letter

Outpatient letter

Outpatient letter

Logged in as: Nurse Ratchett

Example of simple point solution - Virtual Patient Folder

RETURN


Medical Information – Truly BIG Data!

2100

Patient Lifecycle

Patient is born

Patient death

2010

2100

Data Growth +75% YoY

Cost per TB -30% YoY

2010 2014 2022 2018 2026 2030 2034

1 1

9

2

88

5

825

9

Storage Capacity Growth (75% YoY)

2010 1 TB

2020 269 TB

2030 72571 TB

2040 19549761 TB

2050 5266498289 TB

2060 1418738761551TB

2070 382193169531939TB

2080 102958784799226000 TB

2090 27736004231356500000 TB

2100 7471785260694010000000 TB


Advanced Retention and Disposition

Apply retention policy

of four years (example)

to DICOM content in

OSA and then delete

DICOM data

* HIE – Health

Information Exchange

Example: Interface

with metadata

properties of a

DICOM exam


Secure Sharing of Logitudinal Patient Record Hospital

RIS

Private Clinics

Diagnostic Center

RIS

Physician Office

Local EPR Local EPR

Local EPR

Local EPR

Central Catalog (IHE Standards)

XDS

XCA

BPPC

Patient Portal


Topics

• IT Challenges in Healthcare




• Q&A


Technology Decisions for Success

• Choice of Information Management Platform – Content types(paper and digital), sophistication of policies, security,

classification

– Support for cloud infrastructures

– Right content to the right person through the right device

• Interoperability with other HIT systems – Push for open standards (IHE - XDS, XCA, HL7) vs. point-to-point

• Scalability for future needs – eHealth will require massive scale of information management

– Proven repository, catalog/registry, diversity of deployment

landscapes (centralized, federated, hybrid)


THANK YOU

Intelligent Information Management for Healthcareehealth.org.hk/forum2011/ppt/07oct/6 Lalith...

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