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© Copyright IBM Corporation 2003

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Information Technology Trends in Healthcare

DICOM Anniversary ConferenceSeptember 22-23, 2003

Neil de CrescenzoHealthcare Industry Leader

Information Technology Trends in Healthcare | DICOM Anniversary Conference | September 22-23, 20032



Increased Demand for Units of Care

WorkforceChallenges

Demands for Increased Quality

Incr

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Information technology trends in healthcare will be driven by operational challenges that must be addressed

Lower Surplus/Profit




Private and public efforts to manage costs by controlling supply are failing. Demand is driving the health care system.

The growing and aging baby boom population demands (and needs) more healthcare services- People > 65 utilize 3 - 5 times

more healthcare services than people < 65

Consumers demand new clinical technologies, including “lifestyle” therapeutics and devices

The insights and potential health benefits from genomics will drive demand for expensive testing

Rising wealth throughout the world has been proven to increase the demand for healthcare services Based upon PWC Healthcast Tactics: A Blueprint for the Future (The Healthcast 2010 SeriesSM)

Table 2-1 in "65+ in the United States," Current Population Reports, Special Studies, P23-190, by Frank B. Hobbs with Bonnie L. Damon, Bureau of the Census and the National Institute on Aging, 1966, page 2-3.





Increases in demand will follow a decade of significant rises for in-patient admissions and out-patient visits in the U.S.





The increased demand for out-patient services is recognized by hospital CEOs and is particularly significant in radiology

Source: “The Future of Health Care: Biennial Survey,” Ninth Edition, Nov. 2002, Deloitte & Touche

% Hospital CEOs Forecasting the Change in Outpatient Volumes, 2004 vs. 2002





Healthcare executives agree that demand will accelerate, as shown in recent surveys by the American Hospital Association

Source: “A Forecast of Healthcare Trends 2002-2006,” Society for Healthcare Strategy and Market Development

of the American Hospital Association, 2002





Recent and forecasted increases in demand have created serious nursing shortages for the U.S. healthcare system

WorkforceChallenges

The problem through 2010:Increase in demand: 36%

Increase in RN supply: 3.3%




Nevertheless, as hospitals expand their facilities they expect to add nurses, despite currently high nurse vacancy rates

WorkforceChallenges




Recent surveys have shown that hospital executives are aware of these challenges and believe technology can help

WorkforceChallenges






After the Institute of Medicine Reports in 2000-2001, efforts to quantify quality and stratify based on quality have increased

Demands forIncrease Quality

Other key events- An employer group in New York State

(IBM, Verizon, PepsiCo, Xerox, etc.) are combining with Wellchoice/Empire BCBS to offer up to 4% payment bonuses for hospitals that meet Leapfrog’s three standards

- The IOM, the National Quality Forum, and the Joint Commission have recommended the creation of a national medical error database

- Clinical quality is being increasing reported on by commercial entities (e.g., “HealthGrades®, the Health Care Quality Experts®”) and more academic-based efforts, such as John Wennberg, MD’s Dartmouth Atlas of Health Care

The Leapfrog Group: A large employer-led coalition formed to use their buyer power to implement healthcare change. Their goals are to

– Rate and compare provider safety efforts

– Educate employees– Use incentives and reward

performance– Drive computer physician order entry

Three initial recommendations for improving hospital quality (derived from the IOM reports)- Computerized Physician Order Entry- Intensivists in the ICUs- High volume for high risk procedures




Quality efforts will require increased information technology investments to meet corporate and government demands



Demands forIncrease Quality




As one answer to this challenge, federal agencies and industry leaders are piloting a Healthcare Collaborative Network (HCN)

Cerner

McKesson

Siemens

IBM

Additional Commercial Healthcare

leaders

CDC

CMS

FDA

Commercial Health Plans

NY Presbyterian Hospitals

Vanderbilt University Medical

Center

University of Illinois - Chicago Medical Center

Wishard Memorial

MedStar

Create & Refine Acceptable Data Sharing Protocols

Test & Refine Feasible Models for Building Data Brokers

Cur

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Agencies have identified data elements that they receive through HCN that enable fast detection of health risks

Quality of care monitoring:

Ace Inhibitors prescribed for

myocardial infarction patients

CMS FDA

FDA adverse drug event detections:

Pregnancy tests for thalidomide

recipients

Surveillance for outbreak triggers:

Anthrax

Respiratory Viral tests

CDC

Selected data element examples requested for the HCN demonstration project by Agencies

HHS has issued requirements on 3/21/03 for all federal agencies to follow key health information exchange standards (HL-7, NCDCP, IEEE1073, DICOM, LOINC)




HCN uses a low cost architecture based upon open standards to facilitate easy adoption and maintenance

Hospitals

andotherprovidersofcare

HC Agencies

Payersand

otherswho

analyzeclinical

data

Data Review OrganizationsData Source Organizations

HCN Gateway

HCN Gateway

ParticipantNetwork Firewall

ParticipantNetwork Firewall

Integration Brokerdata routed quickly, reliably and securely

DischargeDiagnosis

LaboratoryResults

PharmacyOrders

FDA

CDC

CMS

At the participant site the gateway filters, links, and maps data elements based on business rules

they approve

AlertReceptor

Internet Portalfor participant management

Key Design Elements HCN uses existing data available in most provider settings (ICD, CPT, LOINC, NDC via HL-7) Data Review Organizations request data

Data Source Organizations approve Reviewers’ requests for data and can publish to themselves

Solution will be compliant with HIPAA regulations and transmit non-directly identifiable data; and meets highest security standards around authentication and encryption

The system uses open standards and a non-proprietary implementation approach




While HCN provides data exchange among institutions, IDNs are now designing their own integrated clinical environments

DataContextInformationActions Knowledge

External

Finance

Research

Lab/Pharmacy

Clinical

Data Sources

Integration

Quality

Extract/ Transform/

Load

DataMarts

ODS

DW

DataWarehousing

Management

Research

Providers

Patients

InformationConstituents

Analytical Subject Areas

Inte

gra

ted

An

alyt

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Predictive Indications

Disease Management

Utilization Management

Patient Experience

Finance

Monitoring

Reporting

Investigative

Embedded

Modeling

Data Mining

Visualization

Scorecards

Analytical Techniques

Security and Data Privacy

Academic

Industry Standard Compliance





WorkforceChallenges

Demands for Increased Quality

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In summary, IT trends in healthcare will revolve around exchanging information to improve quality and reduce costs

Surplus/Profit

Wireless devices

Clinical and financial systems

Integrated ClinicalEnvironment

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