Rex Osborn; Clinical Informatic

Idea Architect

Transparency in

A Clinical Informaticist & Strategist Approach

Healthcare Informatics

SECTIONS

1)Intro; Environment Market2)EHR Imperative 3)Laying the Foundation4)Continuity of Care / Patient

Safety5)Portals vs Integration Engines6)Starting With The End In Mind

1) Introduction; HealthcareEnvironment & Market

“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” - Buckminster Fuller

Chronic Disease Management

Point of Care; Access To Clinical Data

Patient Safety Patient

Empowerment Clinical Pathways Clinical Content

Management Cost Containment Patient

Population Management

Clinical Data Mining & AggregationGlobal HCIT

Challenges

FACTOID: In the US; The medical care costs of people with chronic diseases

account for more than 75% of the nation’s $2.8 Trillion USD medical care costs

HEALTHCARE CHALLENGES

In 2008, Healthcare spending in the United States reached $2.8 trillion

Healthcare spending is 4.3 times the amount spent on national defense

Healthcare spending is projected to Reach $4.2 trillion by 2016

HEALTHCARE COSTS = CATALYST

EMR vs EHR

FMSU CONFIDENTIAL - 13 September 2006

There are components of data classifications that are most associated with an EHR;1. Integrated view of the data2. Access to knowledge sources3. Physician order entry & clinical data entry 4. Integrated communication support & 5. Clinical decision support

EMR IS OWNED AND MAINTAINED BY A SINGLE

PROVIDER ORGANIZATION, WHEREAS AN

EHR SUMMARIZES CLINICAL DATA FROM MULTIPLE PROVIDER ORGANIZATIONS’

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HIMImaging

Lab

Rx

Hx

EMR vs EHR

VSIO

The EHR enables Continuity of Care; the

availability of information, clinician constancy with a goal of seamlessness in

transitions from one medical setting to

another.

Common Denominators

COMMON “HCIT” DENOMINATORS

Clinical

Admin.

GOVT

MultiMedia

M P I

C D R

HCIT Solutions Provide;WHOWHAT

WHEREWHENHOWWHY

GP

OP

I P

@ What Costs

Where HCIT Is & Where It Is Headed

3) Laying The Foundation

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HCIT EVOLUTION

Clin

ical &

Fin

ancia

l Val

ue

Complexity, Diversity & Comprehensiveness

Level 1

LegacyNon-Scalable

Solutions“Heavy Financial& Administration

Programs”

IDN Based HIS vendors

Level 2

IDN FocusedInitiated Clinical,

Admin & Financial Integration

Innovation: >> Bi-Directional

Integration>> Standards

DiscussionInitiated (1980’s)

ACIS - CPOE & EM

R Prevalence - Enterprise

Level 3

Ambulatory & AcuteInclusive w/ ACIS, CPOE & EMR Focus

Healthcare Standards are optional (low full

Adoption rate)

Innovation: >> Clinical

Pathways>> Clinical

Decision Support>> Point of Care

Devices (Access)

>> Internet Dependence>> Evidence Based

Medicine

Continuum Focused; Continuity of Care & PHR/CCR

Level 4

Continuum Focused Continuity of Care

Reduces barriers between GP / Specialist &

Hospital Clinicians

IT Standards BasedUniformed & Structured

Data Elements &Classification

Innovation: >> Chronic Disease

Management>> Outcomes based

Medicine>> Patient

Empowerment

Patient Focused CareVia

EHR for CliniciansPHR for Patient

INNOVATION

http://www.youtube.com/watch?v=t-aiKlIc6uk

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Defining; HCIT UTOPIA

That all clinical information is immediately available to

patients & caregivers at all points of care

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PATIENT UTOPIA

Patient participation & wellness programme involvement;

Clinicians& Patients working together… Mutually Beneficial

Collaboration

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MEDICINE UTOPIA

A world where debilitating chronic diseases - Alzheimer's, CHF, Diabetes, Hypertension, Cancer & Morbid Obesity were

significantly reduced or eliminated

True Collaboration & Data Availability

4) Continuity Of Care

CRADLE to GRAVE

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Source:

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INTEROPERABILITY & TRANSPARENCY

5) Portals

Beyond HL 7 Into The Realm of Data Collaboration

Vs Interface Engines

INTERFACE Portals VS Engines

Portals are empty vessels; Conduits for source data Rarely leveraging a relational DB. Lack intelligence to categorize or unify medical language & do not consider clinical relevance Challenged by multiple Pt ID domains & no clinical decision support Is a wonderful conduit for a unified view, coupled with an intelligent eCDR Can provide a unified view Primarily “Uni” directional, seldom interactional FUTURE: Will become essential tool for clinicians, payors / Govt & patients

IE’s are conduits for basic data elements from one system to another Provides a standard conveyer of MPI, Results, Order & Scheduling Events Catalyst for XML, as well as Intelligent data unification via ontology, medical language & clinical

relevance debates Lacks intelligence, no clinical decision support Cannot provide aggregation of data or mining capabilities Does not have MPI & Case delineators therefore unable to abstract relevance FUTURE: Will require infrastructure modifications to avoid becoming obsolete

6) Starting

He Who Manages The Most Clinical Data WINS!

With The End In Mind

LEVERAGE STANDARDS

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1. Leverage existing integration standards2. Uniformity of data and communication protocols, IT

standards3. Promote harmonization of medical vocabulary, allowing

a translation level of registry services to provide easier cataloguing & distribution

4. Support ANY IT standard that will break down barriers between clinicians

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Rad & CardioPACS

• Lab Results• Lab Referrals• Rad Dx Rpt• Rad Referrals• Rx Scripts• eRx

• Clinical Notes• Clinical Docs• Assessment• Results• Orders• Referrals

• DICOM • DICOM SR

Cerner GE Eclipsys AGFA

• Clinical Notes• Clinical Docs• Results• Orders• Care Plans

• Clinical Notes• Clinical Docs• Physiological• Monitors• Pathways

• DICOM • DICOM SR

CriticalCare Units

CISEMR

AmbulatoryPACS

PPMEMR

LISRISRx

ImagesImages EDMSEDMSDynamic

DataDynamic

Data

Enterprise“Results”

CDR

Enterprise“Results”

CDRD/WD/W

EBM, CDS,OBM & CDMEBM, CDS,

OBM & CDM

You never change things by fighting the existing reality. To change something, build a new

model that makes the existing model obsolete.

- Buckminster Fuller .. inventor, architect, engineer, mathematician, poet & cosmologist

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THE IDEA

The Global Clinical Data Archive, provides seamless interoperability between existing and future clinical informatic solutions. The GCDV provides transparency distribution of all clinical data elements in the appropriate nomenclature and ontology across the patient continuum of care. The GCDV

breaks down barriers between clinicians, enables true connectivity, reduces medical errors and makes your clinical IT solutions better. GCDV makes your healthcare IT environment

work!

A real time clinical data collector, master

distributor & manager of all clinical data

across the healthcare collective.

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Clinical Connectivity & Content Replication

= WORLD CLASS NATIONAL HEALTH

UAE Ministry of Health

National GCDV

Clinical DataManagers

Clinical DataManager & UMLS

Dubai

Clinical Data

Manager & UMLS

Object Replication

RDBMS – GCDV

Region(s) 1 & 2

Abu Dhabi

Clinical

Data Conduits

Clinical

Connectivity

FEDERATIED

RDBMS – GCDV

National

Region(s) 1, 2, 3, 4, 5 6 & 7