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Bringing Information to Life
dbMotion
© 2004-2009 dbMotion Ltd.
General 3.00
Transforming Healthcare with Information
– Patients should not be the primary source of information regarding their own medical histories
– Patients should not be given medications that interact with other medications they take because the allergies list in the hospital doesn’t match their doctor’s list
– Patients should not have to pay the deductible twice on a lab test just because it was done across town at a commercial lab and the hospital didn’t know it
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Healthcare executives face common goals - putting patients at the center of care
Transforming Healthcare with Information (cont.)
– Patients should not have surgery delayed because the care teams lack results from tests the patient did less then 48 hours earlier in a doctor’s office or clinic
– Patients should not have to worry about travelling from one city to another and not having all of their patient information with them
– Patients should not have to sue the hospital for a hospital caused wound that could have been prevented had the care provider known that they were prone to it
• Patients now expect to be treated differently• Patients are pleading for effective,
connected, consistent, aware and seamlessly integrated care
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Healthcare executives face common goals - putting patients at the center of care
Healthcare: Challenge & dbMotion’s Focus
The Challenge: People receive care in a highly distributed environment. Information is gathered and locked in isolated information systems.dbMotion’s Focus: Generate a patient-centric integrated patient record, on-demand, making patients’ relevant health information available to caregivers and systems, enabling safer, more efficient care with higher patient and physician satisfaction.
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Real interoperability is highly challenging
Technological, Financial, Regulatory, Political
Security, Ethics and Privacy
Willingness, Motivation, Incentives
Patient Identification
Standards
Many Barriers…
What’s Important
Question 1:
How do you integrate and make senseof the data?
Question 2:
How do you access and make useof the data?
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• Create an integrated view of patients’ medical information from within and across organizations and information systems(Cerner, EPIC, GE, McKesson, Siemens, etc.)
•Better information at the point of care
• Better and more efficient care
• Lower risk of medical errors
Caregivers
Integrated Patient Record
Multiple Needs… One Solution Architecture
© 2004-2009 dbMotion Ltd.
• Measure quality using information from across the continuum of care (rather than silo by silo)
• Effectively implement performance improvement plans (P4P in US, Payment by Results in UK, etc.)
• Manage key clinical and operational indicators closely
• Implement disease management programs
Quality Group,CEO, CMO, CFO
Measure& Manage
Quality
• Ever-changing reporting requirements pose a constant challenge to IT, Management and Clinicians
• With ubiquitous access to integrated medical information reports (e.g. hospital accreditation reporting required by JCAHO, CCHSA, ISQua) can be rapidly developed
• Meeting reporting requirements becomes easier, cheaper, more precise and is often otherwise impossible!
Compliance,CEO, CFO
Adhere toReportingMandates
• Create IT environment ready for constantly evolving requirements
• Leverage investments in existing clinical systems
• Rapidly deploy new applications – reuse of clinical information
• Manage growth more efficiently
• Smoothly progress towards standards harmonization
CIO, CMIO
Leverage IT Infrastructure
• Providing seamless access to clinical information to/from acute and ambulatory settings leads to
• Improved Hospital-Physician relationships and affiliations
•Better outcomes
•Faster and more effective care
Physicians,CEO, CMO
ImproveOut/In Patient
Continuity of Care
• Access to mass de-identified patient and outcome information unleashes endless research options
•Support clinical trials process
•Support various research programs in pharmaceutical industry and academic medical centers
•Enable the creation of research specific data warehouses
Dept. Chairs,CMO
SupportResearch &
Clinical Trials
• Integration of patients’ clinical data from multiple sources enables the implementation of enterprise and cross-enterprise clinical decision support tools that go beyond the boundaries that currently limit such tools
• A broad data set
• For a single patient
• For an entire population
Physicians,Quality Group, CxO
Enterprise Clinical Decision
Support
?
Future Needs
dbMotion
dbMotion - Health Interoperability and Intelligence
dbMotion Core Platform• Connect all of your IT solutions• Inpatient, Outpatient, Labs, Rx , Imaging +• Connect to local, regional & national RHIO/HIE• Aggregated & integrated data
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Enterprise Clinical Data Repository (CDR)• All data in relational database/s• “Single Source of Truth”• Downtime Clinical Continuance Solution
Clinical Portal• All data in single thin client• Fully customizable to your needs• Integrated into EMR/other applications
A ComprehensivePlatform
Designed to address current &
future needs
Turns data into actionable
information
Field Proven
Differentiators
Semantic Framework• Unparalleled level of integration• Turns data into semantically integrated information• Enables advanced “information driven” applications• Makes integrated clinical data usable by other Apps
dbMotion is a SOA Solution for Healthcare
dbMotion Service Oriented Architecture enables consumers (applications and services) to build or make use of software services that hide the complexity of heterogeneous and non-standardized IT environments by logically connecting applications and data sources.
With dbMotion SOA, information in existing systems remains in its original format, location & ownership.
© 2004-2009 dbMotion Ltd.
AncillarySystem A
Homegrown Applications
EMR AClinical Data
DSSAlerts &
Notifications
AncillarySystem B
Clinical Data Warehouse
EMR BClinical Data
DSSAlerts &
Notifications
dbMotionInteroperability
Platform
Extended ServicesApplication Development
ResearchDSS
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A Vision of Connected Healthcare
dbMotion Core PlatformThe Complete HIE/Interoperability “Starter-Kit”dbMotion™ SmartConnect™EMR Integration Tools and ServicesdbMotion™ SmartIHE™A Smart Approach to Leveraging IHE ProfilesdbMotion™ SmartServices™Software Developers Kit (SDK)dbMotion™ Semantic Framework™Advanced Semantic InteroperabilitydbMotion™ SmartWatch™Enterprise Analysis and Monitoring EngineThe dbMotion Product Offering
© 2004-2009 dbMotion Ltd.
Your EMR
EMPI
Connector Toolkit
dbMotion Clinical Views
Future Apps(Custom & dbMotion)
SmartIHE
Clinical DomainsDx Img Docs AllrgLabs Rx
SmartServices (SDK) Semantic Services
CTSCommon
Terminology Services
Medical Ontology
CDR
SmartConnect
Unified Medical Schema (UMS)
SmartLink
SmartWatch
dbMotion Security
Layer
Shared Services
dbMotion System
Management Layer
OperationalEnvironment
dbMotion Presentation Layer
dbMotion Business Layer
dbMotion Communication Layer – Message Bus
dbMotion Data Layer
dbMotion Data Integration Layer
dbMotion System Node
© 2004-2009 dbMotion Ltd.
– Fully encapsulated software-based solution
– Information consumable in many formats (web, XML, etc.)
– Microsoft-based software
– Flexible deployment on COTS hardware
– Proven in high transaction volume environments
dbMotion Federated HIE… Grid-based Infrastructure
dbMotion’s Federated implementation approach allows data to reside in its original location and format. Each node is completely independent and
can stand alone. A Virtual Patient Record is created on-the-fly with integrated information presented and usable in real-time
© 2004-2009 dbMotion Ltd.
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Security & Management
• Roles and profiles
• Auditing (e.g. Track Log)
• Patient Authorization System
– Supports Opt-in/Opt-out
• Content-based access control
• Integrated with existing securityand administration (e.g. active directory)
• Adheres to HIPAA guidelines
• System administration and configuration
• Monitoring tools and services
• Encryption
The dbMotion™ Unified Medical Schema™ (UMS)
Based on HL7 V3 RIM & other standards the UMS enables the integration and harmonization of information across different parties regardless of the systems and structures employed by each party.
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dbMotion HII System – Overall Characteristics
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Flexible Service Oriented Architecture (SOA) Security, policies and management
Standards DrivenHL7 V3 based & multi-standard interfacing
Clinically Oriented – based on dbMotion™Unified Medical Schema™
High Performance – the entire process takes seconds
Designed for Changes, adaptations & rapid deployment
Grid based – highly resilient
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Turns best-of-breed into a suite
.
Portal
.
Interoperability
Semantic Interoperability, the Next Level Up…
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Semantic Interoperability
The Case for Semantic Interoperability
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The toolset designed to collect, interpret, structure, and transform healthcare data into actionable information. Offers a complete solution for enabling semantic interoperability
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Comprised of:• Ontology based on standard
terminologies• Semantic information model • Rich set of semantic services• Management tools
• Data Unbounded• Physicians Empowered• Workflows Simplified and Enhanced
• Legacy Systems Leveraged• Enhanced Patient Care
Key BenefitsBy not only integrating the data but also understanding it, we enable multiple stakeholders to use the information and support clinical workflows and processes
dbMotion Platform
Semantic Framework
Information Model
Ontology
Management Tools
Semantic Services
dbMotion Semantic Framework
dbMotion SmartWatch
SmartWatch is a population-based dataanalysis and monitoring framework thatleverages the dbMotion platform, enablingorganizations and users to monitorpopulations of patients for a variety ofconditions
Four Steps:1. Population Identification – based on the VPO
assembled from across the dbMotion network, SmartWatch identifies the patients that meet the definition of the population in question
2. Information Collection – for each patient in a defined population SmartWatch collects the information that is being monitored
3. Event Identification – in this stage SmartWatch analyzes the information to decide if action is required or not
4. Action – SmartWatch can send an email or text message, add an alert to the medical record or perform any one or more of the other actions supported by the system
• Improve quality of care• Better compliance (P4P, regulatory)• Support for clinical trials & research• Simplify Biosurveillance
• Enable Preventive Health • Reduce administrative effort• Enhance Translational Medicine
Primary Benefits of SmartWatch
dbMotion Platform
SmartWatch
© 2004-2009 dbMotion Ltd.
All patients above 65 who suffer from CHFAll patients currently admitted to EDs in the regionAll children below 12All patients over 50 who present in ED with history of AMI
For CHF … Sodium and Meds historyFor currently in ED … Zip code and chief complaintFor children … All ED visits during the last monthFor history of AMI … ASA & Beta Blocker at arrival
dbMotion SmartWatchStep 2: Information GatheringStep 3: Event Identification
For CHF … Sodium < 128For currently in ED … >5% (Zip code), >3% (C.Complaint)For children … >= 3 within the same month
Step 4: Action (e.g. Alert)Step 1: Population Identification
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Clinical ImpactImprove QualityDeliver EfficiencyReduce ErrorsHow…• Enterprise information instantly
available in complete web-based Virtual Patient Record
• Tightly integrated to existing workflows• Advanced Meds Rec, Population
Management, P4P• Time saver in ED, OR, Imaging
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Business ImpactGrow RevenueGrow ShareImprove MarginHow…• Higher physician satisfaction• Productivity in business & clinical
processes• Improved positioning with payers• High patient satisfaction• Enhanced compliance in Coding, P4P etc
Semantically Connected Enterprise Information is a Game Changer
The Impact
Delivering ROI from Interoperability
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Regulatory and Industry Compliance • Increase POA reimbursement• Support quality reporting• P4P• Compliance audits
Positive Business Impact Increased revenue • Increased physician satisfaction
and referrals• Simplify acquisitions, merging and
joint ventures• Reduce legal risks
Operational Efficiencies Simplified non-clinical procedures• Reduce time of information
collection (admission, Pre-op etc.)• Simplify coding• Reduce procedure cancellation
rate• Retain existing infrastructure
Clinical Efficiencies Improve patient care quality & efficiency• More efficient encounters• Less errors and escalations• Reduce medication related
complications
Well implemented HII offers significant opportunities for cost reduction, increased revenue and improved results
Partners and Associations
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careon
Our Customer Successes
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University of Pittsburgh Medical Center - Pennsylvania
• Large IDN consisting of 20 hospitals (4000+ beds) 400+ outpatient locations, 4700+ physicians (2475 employed) Over 190,000 inpatient admissions and 4.5 million outpatient visits annually
• Implementation– Integrating data from: Cerner, EPIC, McKesson, MEDITECH, Siemens,
Misys, Quest Labs and dozens of ancillary systems
– Clinical Domains: demographics, problems list, allergies, medications, labs, diagnoses, documents (transcription data, PDFs, large “blobs”/text, notes and other documents)
– Accessible by 22,000 users
• Goals– Provide physicians with access to comprehensive integrated
patient information within their workflow– Build a SOA platform for Interoperability across UPMC
to enable the rapid delivery of composite applications– Achieve Semantic Interoperability
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UPMC Solution Architecture
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Clinical Impact is Business ImpactMeasurements at UPMC
82% reduction of time spent
50% improvement in patient readiness
Efficiency Difference Using Interop Platform Before After
Time Seeking Information 1 – 41 mins 1-5 minsTime Waiting for Information 5 mins – 20 hrs 5 secs – 12 hrsPercentage of Patients Not Ready for OR 30% 15%
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UPMC Interop: Accolades Across the Industry
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dbMotion is successfully implemented at Clalit Health Services (Israel) -one of the world’s largest HMOs
• Serving− 14 hospitals (5500 beds), 1,300 clinics− 9,000 physicians and 9,500 nurses
• Operational at most hospitals and clinics since 2001• 15,000+ active users• Benefiting close to 5 million patients • 26,000,000 pages viewed per year• ISO 17799 certified Information Security Management• Average response time (end-to-end) < 5 Sec.
dbMotion – A Proven Solution
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A Proven National Scale Solution
dbMotion’s Solution forms a network of independent care providers in Israel:Clalit HMO, Rambam MC, Sheba MCTotal of 16 hospitals, 100s of clinics & and specialty centers• Each working with their own systems
and standards– Complete HIS solution vs. dept.
solutions– Different coding, clinical language,
data structures and OS
• Short setup time to connect the new institutions to the operational network
• Requires minimal training and IT support
IRIS Group – Brussels, Belgium
• Group of 5 hospitals and clinics spread across 11 sites in the Brussels region. Delivering public healthcare services to over 1.5 million residents
• Initial Implementation– Integrating data from: AGFA QDOC, AGFA PACS, GLIMS labs, DIAMIC Pathology labs,
Siemens and IBM ADT as well as other ancillary systems – Clinical Domains: demographics, procedures, diagnoses, labs, documents, imaging– Documents include: PDFs, large “blobs”/text, notes and documents
• Goals:• Establish a unified information platform that enables the sharing of patients’ clinical
information across the enterprise • Enable IRIS physicians to explore medical data of a given patient within the IRIS
system using dbMotion Clinical Views.• Provide IRIS with a web based portal as the main entry point for all clinical information• Unique Patient ID• Provide a solution for exchanging structured data as well as documents• Provide a clinical viewer to help healthcare professionals
navigate complex medical records
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Customers & Impact
© 2004-2009 dbMotion Ltd.
82% reduction of time spent50% improvement in patient readiness
Efficiency Difference Using Interop Platform Before After
Time Seeking Information 1 – 41 mins 1-5 mins
Time Waiting for Information 5 mins – 20 hrs 5 secs – 12 hrs
Percentage of Patients Not Ready for OR 30% 15%
University of Pittsburgh Medical Center
dbMotion – Company Overview
• Originally established in 1996, integrated into Ness Technologies (NASDAQ: NSTC) in 1999• Spun-off from Ness Technologies in 2004 after successful
implementation of the product at Clalit Health Services (Israel)
• Venture capital funded: Vertex, Pitango, Gemini, UPMC - 3 rounds
• Revenue stage
• 130+ Employees
• Strong infrastructure, ISO 9001 certified
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ConnectEnterprise - ClinicalsHospital - Hospital
Ambulatory – AcuteIDN - CommunityState - Federal
ImpactDesktop EMR UsersDirect Web Access
Emergency Services Specialty Applications
Quality Programs
EvolveDecision Support
PHR ServicesPopulation
ManagementSOA Connectivity
ResearchSDK
Phased Approach to Delivering Clinical Transformation
Getting Started: Connect – Impact - Evolve
© 2004-2009 dbMotion Ltd.
Thank You For Listening
© 2004-2009 dbMotion Ltd.