gohcr presentation

Unified Medical InformaticsUnified Medical Informatics

Pennsylvania Health Information

Network


NetworkGOHCR & UMI Draft ProposalGOHCR & UMI Draft Proposal


GOHCRGOHCRPennsylvania Health Information NetworkPennsylvania Health Information Network

IntroductionIntroduction

Medical Informatics are a crucial and integral part of the Rx for Quality

Health Information Technology is at a ideological crossroads

Pennsylvania is poised to be a model for the rest of the country

Medical Informatics are a crucial and integral part of the Rx for Quality

Health Information Technology is at a ideological crossroads

Pennsylvania is poised to be a model for the rest of the country



Introduction to UMIIntroduction to UMI

Unified Medical Informatics is a PA C-Corp. as of Sept. 2006

We work in Medical Informatics Consulting, Technology Deployment, and Research

We are Consultant Principal to the NEPA-HRTF of the 121st Legislative District

Unified Medical Informatics is a PA C-Corp. as of Sept. 2006

We work in Medical Informatics Consulting, Technology Deployment, and Research

We are Consultant Principal to the NEPA-HRTF of the 121st Legislative District



UMI’s Mission StatementUMI’s Mission Statement

To empower physician clients with end-to-end solutions that empower their practices and improve the efficiency, quality, and excellence of their patient care

To be a research driven organization with a focus on emerging technology and best practices in health information technology

To empower physician clients with end-to-end solutions that empower their practices and improve the efficiency, quality, and excellence of their patient care

To be a research driven organization with a focus on emerging technology and best practices in health information technology



Project ProposalProject Proposal

Work in UNISON with Governor Rendell’s Prescription for Pennsylvania

Provide an end to end HIT solution for the plan to improve healthcare in the State

Create a State-wide Health Information Exchange with a focus on “last mile” infrastructure issues

Work in UNISON with Governor Rendell’s Prescription for Pennsylvania

Provide an end to end HIT solution for the plan to improve healthcare in the State

Create a State-wide Health Information Exchange with a focus on “last mile” infrastructure issues



ObjectivesObjectives

Enable Electronic Medical Records transport and exchange

Encourage the use of Electronic Medical Records State-wide

Empower healthcare workers with information at the point of care

Enable Electronic Medical Records transport and exchange

Encourage the use of Electronic Medical Records State-wide

Empower healthcare workers with information at the point of care



RationaleRationale

HIT has matured to a point of being able to measurably improve quality

Disease Management protocols can be embedded in broad scale networks

ROI is very clear in the context of the GOHCR Rx for Quality Plan

HIT has matured to a point of being able to measurably improve quality

Disease Management protocols can be embedded in broad scale networks

ROI is very clear in the context of the GOHCR Rx for Quality Plan



IBM Proved It...IBM Proved It...Benefit of efficiency with RHIN

Value Propositions As - Is Costs RHIO Costs

Percentage Savings

Specialist Cost of duplicate diagnostic tests $63,705 $21,235 66.67% Cost of unnecessary diagnostic tests $13,272 $3,318 75.00% Cost of duplicate diagnostic images $53,088 $26,544 50.00% Cost of unnecessary diagnostic images $99,539 $16,590 83.33% Cost of Adverse Drug Events $398,158 $79,632 80.00% Cost of Formulary errors $6,636 $3,318 50.00% Cost of lack of patient compliance $23,889 $5,309 77.78% ASC / Hospital Cost of duplicate diagnostic tests $10,618 $5,309 50.00% Cost of unnecessary diagnostic tests $6,636 $1,327 80.00% Cost of duplicate diagnostic images $13,272 $6,636 50.00% Cost of unnecessary diagnostic images $46,452 $6,636 85.71% Cost of unnecessary procedures $787,794 $157,559 80.00% Cost of unnecessary therapies $26,544 $5,309 80.00% Cost of Adverse Drug Events $398,158 $79,632 80.00% Cost of Formulary errors $159,263 $19,908 87.50% Cost of lack of patient compliance $564,460 $125,436 77.78%

Copyright 2005 IBM Healthcare & Life Sciences



Grand Total Savings?Grand Total Savings?

Prior to RHIN Implementation Costs due to Inefficiencies:

✓$2,701,484After Implementing the RHIN Technologies and Connectivity:

✓$563,698PERCENTAGE COST SAVINGS:

✓79.2%

Prior to RHIN Implementation Costs due to Inefficiencies:

✓$2,701,484After Implementing the RHIN Technologies and Connectivity:

✓$563,698PERCENTAGE COST SAVINGS:

✓79.2%



Health Information Technology

Health Information Technology

No longer just an academic realm

Standards & Protocols have been simplified

Interoperability stands at the center of all current efforts

Medical Informatics has become useable

No longer just an academic realm

Standards & Protocols have been simplified

Interoperability stands at the center of all current efforts

Medical Informatics has become useable



History of HIEHistory of HIE

VA’s Vista

Community Health Information Networks

HL7

RHIOs

XML and CCR

VA’s Vista

Community Health Information Networks

HL7

RHIOs

XML and CCR



Current ProblemsCurrent Problems

Disease Management protocols are not standardized

EMRs have very poor penetration percentages in the State

No .emr file type exists

No way to exchange EMR files

Disease Management protocols are not standardized

EMRs have very poor penetration percentages in the State

No .emr file type exists

No way to exchange EMR files



Attempted SolutionsAttempted Solutions

RHIOs are burgeoning as successors to the CHINs to enable localized HIE

HL7 has been identified as the de facto standard for data transport in healthcare

Centralized/Federated stores of data have been proposed to address the lack of .emr standard

RHIOs are burgeoning as successors to the CHINs to enable localized HIE

HL7 has been identified as the de facto standard for data transport in healthcare

Centralized/Federated stores of data have been proposed to address the lack of .emr standard



Reasons for FailureReasons for Failure

RHIOs actually just make the problem BIGGER and ADD costs

HL7 is based on a 20 year old monolithic RIM with poor flexibility for new data types

Centralized stores are inherently insecure and represent a single point of failure and do not address import/export capability

RHIOs actually just make the problem BIGGER and ADD costs

HL7 is based on a 20 year old monolithic RIM with poor flexibility for new data types

Centralized stores are inherently insecure and represent a single point of failure and do not address import/export capability



Current InitiativesCurrent Initiatives

PAeHI

RHIOs (NEPA, UPenn, UPitt, etc.)

Senate Bill 8

House Bill 700

Grants for EMR implementation (State and Federal)

PAeHI

RHIOs (NEPA, UPenn, UPitt, etc.)

Senate Bill 8

House Bill 700

Grants for EMR implementation (State and Federal)



Emerging TechnologyEmerging Technology

XML

Continuity of Care Record

SOA & Web Services

P2P Generation 2

Web 2.0

XML

Continuity of Care Record

SOA & Web Services

P2P Generation 2

Web 2.0



Best PracticesBest Practices

Security & Auditing

Identity Management

Wellness Management

Point of Care CDSS

Digital Rights Management

Security & Auditing

Identity Management

Wellness Management

Point of Care CDSS

Digital Rights Management



What is Needed...What is Needed...

Comprehensive approach to ensure compatibility and future proof investments

Incentivized, interoperable, standards based EMR(s) to bring penetration up from 11% to at least 65-75% in 5 years

“Digital Toll Road” HIE managed by the State in preparation for NHIN Initiatives

Comprehensive approach to ensure compatibility and future proof investments

Incentivized, interoperable, standards based EMR(s) to bring penetration up from 11% to at least 65-75% in 5 years

“Digital Toll Road” HIE managed by the State in preparation for NHIN Initiatives



What Exists...What Exists...

Multiple RHIO efforts and PAeHI activities

Vendor locked providers

No clear path for interoperability

No NHIN mandates

No incentives at either the State or Federal level

Multiple RHIO efforts and PAeHI activities

Vendor locked providers

No clear path for interoperability

No NHIN mandates

No incentives at either the State or Federal level



What Can Be Done?What Can Be Done?

Establish CCR as the .emr “The Fuel”

Create Mandates and Incentives the “On Ramp”

Provide the “Vehicle” CDDL EMR

Build the “Turnpike”

“Passengers” as stakeholders

Establish CCR as the .emr “The Fuel”

Create Mandates and Incentives the “On Ramp”

Provide the “Vehicle” CDDL EMR

Build the “Turnpike”

“Passengers” as stakeholders



On The Ground...On The Ground...

Medgnosis

Creation of a Tool to Enable and Empower the Clinical EnvironmentComplete Practice Management PlatformIntegrated Electronic Medical Record SystemAdvanced Composition Engine for Encounter DocumentationCommon Development & Distribution License

Medgnosis

Creation of a Tool to Enable and Empower the Clinical EnvironmentComplete Practice Management PlatformIntegrated Electronic Medical Record SystemAdvanced Composition Engine for Encounter DocumentationCommon Development & Distribution License



Above The Ground...Above The Ground...

“PHIN” - Codename: The Agora Project

XML-CCR Based - The LanguageMirth Engine - The TranslatorFederated Nodes - The Library StacksCentral Indexing Server - The LibrarianEncrypted Backup Repository - The Labyrinth

“PHIN” - Codename: The Agora Project

XML-CCR Based - The LanguageMirth Engine - The TranslatorFederated Nodes - The Library StacksCentral Indexing Server - The LibrarianEncrypted Backup Repository - The Labyrinth



Architecture ConceptArchitecture Concept

Western NodeWestern Node

South-Western NodesSouth-Western Nodes

Northern NodeNorthern Node

North-Eastern NodeNorth-Eastern Node

South-Eastern NodeSouth-Eastern Node

Central Indexing ServerCentral Indexing Server

Mirth Connected ClientsMirth Connected Clients



Technology LayerTechnology Layer

The Language of Interoperability & “The Last Mile”

The Continuity of Care Record (ASTM)The Network Foundation

Solaris 10 and Java (Open Source!)The Regional Nodes

Buffer zones for load balancingCentral Indexing Server

Encrypted backup layerTriple Redundancy at each critical layer

The Language of Interoperability & “The Last Mile”

The Continuity of Care Record (ASTM)The Network Foundation

Solaris 10 and Java (Open Source!)The Regional Nodes

Buffer zones for load balancingCentral Indexing Server

Encrypted backup layerTriple Redundancy at each critical layer



ASTM - CCRASTM - CCRContinuity of Care Record (CCR) is a health record standard specification in XML developed jointly by ASTM International, the Massachusetts Medical Society (MMS), the HIMSS (HIMSS), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and other health informatics vendors.

The CCR standard is a patient health summary standard. It is a way to create flexible documents that contain the most relevant and timely core health information about a patient, and to send these electronically from one care giver to another. It contains various sections such as patient demographics, insurance information, diagnosis and problem list, medications, allergies and care plan. These represent a "snapshot" of a patient's health data that can be useful or possibly lifesaving, if available at the time of clinical encounter. The ASTM CCR standard is designed to permit easy creation by a physician using an electronic health record (EHR) system at the end of an encounter.

Continuity of Care Record (CCR) is a health record standard specification in XML developed jointly by ASTM International, the Massachusetts Medical Society (MMS), the HIMSS (HIMSS), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and other health informatics vendors.

The CCR standard is a patient health summary standard. It is a way to create flexible documents that contain the most relevant and timely core health information about a patient, and to send these electronically from one care giver to another. It contains various sections such as patient demographics, insurance information, diagnosis and problem list, medications, allergies and care plan. These represent a "snapshot" of a patient's health data that can be useful or possibly lifesaving, if available at the time of clinical encounter. The ASTM CCR standard is designed to permit easy creation by a physician using an electronic health record (EHR) system at the end of an encounter.



EMR - EHR - PHR - CCREMR - EHR - PHR - CCR

Continuity of Care RecordContinuity of Care Record

Personal Health Record

Personal Health Record

Electronic MedicalRecord

Electronic MedicalRecord

EElectronic lectronic HHealth ealth RRecordecordEElectronic lectronic HHealth ealth RRecordecord

PatientPatientPatientPatientClinicianClinicianClinicianClinician

Ancillari Ancillarieses

Ancillari Ancillarieses

Technologi Technologistst

Technologi Technologistst



Medgnosis is the “UMIP”Medgnosis is the “UMIP”

Unified Medical Informatics PlatformUnified Medical Informatics PlatformComprehensively Addresses

“The Last Mile”Comprehensively Addresses

“The Last Mile”

•Clinical Environments face a common problem: lack of investment or incentive to invest in a comprehensive end-to-end platform of technology upon which to operate all essential functions for maximum efficiency.

•The ERP concept has not been adopted by healthcare. Medgnosis addresses this crucial last mile necessity.

•Clinical Environments face a common problem: lack of investment or incentive to invest in a comprehensive end-to-end platform of technology upon which to operate all essential functions for maximum efficiency.

•The ERP concept has not been adopted by healthcare. Medgnosis addresses this crucial last mile necessity.



Advanced EMR EngineAdvanced EMR Engine

Composition EngineComposition Engine



CDDL - Open Source Licensing

CDDL - Open Source Licensing

Common Distribution & Development LicenseMedgnosis is licensed to the State of Pennsylvania from UMI in exchange for grant for business developmentPioneered by Sun Microsystems as a protectable Open Source Distribution ModelSoftware is provided FREE of cost to ALL usersUMI has exclusive rights to professionally install, train, and support all clients who request/download the software under our standard fee structureEnable State-wide development and contribution to improvements via project portal maintained by UMI

Common Distribution & Development LicenseMedgnosis is licensed to the State of Pennsylvania from UMI in exchange for grant for business developmentPioneered by Sun Microsystems as a protectable Open Source Distribution ModelSoftware is provided FREE of cost to ALL usersUMI has exclusive rights to professionally install, train, and support all clients who request/download the software under our standard fee structureEnable State-wide development and contribution to improvements via project portal maintained by UMI



Methodology LayerMethodology Layer

Market Education InitiativeTeach Clinical Environments the Hows and Whys of the System

Security & Identity Management LayerDigital Rights Management (OpenDRM)RBAC - Role Based Access ControlWVPN - Wide Area Virtual Private Network Credentialing

Market Education InitiativeTeach Clinical Environments the Hows and Whys of the System

Security & Identity Management LayerDigital Rights Management (OpenDRM)RBAC - Role Based Access ControlWVPN - Wide Area Virtual Private Network Credentialing



Business LayerBusiness Layer

Focus on ROI and SustainabilityDevelop Subscription ModelDevelop Transaction ModelDevelop HR Requirements10 Year Costing and BudgetingDevelop clear business case for adoption at all critical levels by all players in the value chain

Streamline the Grant Application process for incentive funds to implement EMR and connectivity via online optioning and qualification (centralize resources)

Focus on ROI and SustainabilityDevelop Subscription ModelDevelop Transaction ModelDevelop HR Requirements10 Year Costing and BudgetingDevelop clear business case for adoption at all critical levels by all players in the value chain

Streamline the Grant Application process for incentive funds to implement EMR and connectivity via online optioning and qualification (centralize resources)



DeployingDeploying

Regional Nodes with 4 person team to handle administration and sign-on

Software/Hardware translators and connection mechanisms for client sites

Provide EMR(s) to those physicians who need them

Regional Nodes with 4 person team to handle administration and sign-on

Software/Hardware translators and connection mechanisms for client sites

Provide EMR(s) to those physicians who need them



Sustainability Considerations

Sustainability Considerations

Solidifying the Revenue Model

Selling the “Digital Toll Road” Concept

Ensuring Long Term Technology Flexibility

Determining “Will this solve the problem or add to it?”

Will we succeed where others have failed?

Solidifying the Revenue Model

Selling the “Digital Toll Road” Concept

Ensuring Long Term Technology Flexibility

Determining “Will this solve the problem or add to it?”

Will we succeed where others have failed?



Collaborators and Supporters

Collaborators and Supporters

PAeHIMRIDMAAEmdeon, ProxyMed, ZirMedSureScripts, ConnexionGoogle HealthSun MicrosystemsCisco SystemsPennTeleDataMirth Project / Web Reach

PAeHIMRIDMAAEmdeon, ProxyMed, ZirMedSureScripts, ConnexionGoogle HealthSun MicrosystemsCisco SystemsPennTeleDataMirth Project / Web Reach



Potential DetractorsPotential Detractors

Existing RHIOs / Efforts

Insurers

Privacy Advocates / Hawks

“Digital Objectors”

Political Capitalists

Existing RHIOs / Efforts

Insurers

Privacy Advocates / Hawks

“Digital Objectors”

Political Capitalists



Mandates RequiredMandates Required

✓Interoperability✓Communications✓Usage

Implications:Most comprehensive attempt ever in

the history of Medical Informatics / HIE

✓Interoperability✓Communications✓Usage

Implications:Most comprehensive attempt ever in

the history of Medical Informatics / HIE



Relationship StructureRelationship Structure

Unified Medical Informatics will endeavor a relationship of Consultant Principal with the following entities:

PHIN Committee (GOHCR)

PHC4? ‘Seat of Project’

End Users

Unified Medical Informatics will endeavor a relationship of Consultant Principal with the following entities:

PHIN Committee (GOHCR)

PHC4? ‘Seat of Project’

End Users



Budget & TimelineBudget & Timeline

Phase/Year Price Result

Pre-Operative Phase 0 $2.5M C.I.S & Medgnosis

Year 1 - Phase 1 $875K 10 Clinics & 1 Hospital

Year 2 - Phase 1.5 $2.75M 2 Counties

Year 3 - Phase 2 $11.8M 10 Counties

Year 4 - Phase 3 $47M PHIN Beta

Year 5 - Phase 4 Self Sustaining PHIN Live

Phase 0 - Two Years

Phase 1 - 8 mthsPhase 2 - 10 mths

Phase 3 - 14 mths

Phase 4 - 14 mths

Yr1 Yr2 Yr3 Yr4 Yr5

Phase 1.5 - 8 mths

5 Year Grand 5 Year Grand Total: Total:

$65 Million $65 Million DollarsDollars

5 Year Grand 5 Year Grand Total: Total:

$65 Million $65 Million DollarsDollars



Utilization & Allocation Plan

Utilization & Allocation Plan

1 C.I.S (8 Staff Members)

6 Regional Nodes (x4 Staff Members)

Triple Redundancy (Automated Failover)

Off Grid Backup

Majority of Costs are in Upfront Infrastructure and Long Term Manpower

1 C.I.S (8 Staff Members)

6 Regional Nodes (x4 Staff Members)

Triple Redundancy (Automated Failover)

Off Grid Backup

Majority of Costs are in Upfront Infrastructure and Long Term Manpower



Next Steps?Next Steps?

Choose the Office that will be the “Seat” of the Project?

Decide Definitive Timeline for Execution?

Determine Budgetary Availability of Finances?

Craft Executive Order(s)?

Choose the Office that will be the “Seat” of the Project?

Decide Definitive Timeline for Execution?

Determine Budgetary Availability of Finances?

Craft Executive Order(s)?



Caveats and AssurancesCaveats and Assurances

Massive UndertakingMultiple Points of FailureRequires ‘Leap of Faith’Extremely Detail Oriented PlanningTechnology utilization is significantSkilled Manpower requiredEducation of Clinical Environments necessary to achieve success

Massive UndertakingMultiple Points of FailureRequires ‘Leap of Faith’Extremely Detail Oriented PlanningTechnology utilization is significantSkilled Manpower requiredEducation of Clinical Environments necessary to achieve success

5 Years of Research ConductedHuge base of Academic SupportExperience with Broad Scale

ProjectsPinnacle of Technical ExpertiseClinical Background of

ConsultantsLive Market AwarenessIndefatigable Enthusiasm for

Reform and positive social impact

5 Years of Research ConductedHuge base of Academic SupportExperience with Broad Scale

ProjectsPinnacle of Technical ExpertiseClinical Background of

ConsultantsLive Market AwarenessIndefatigable Enthusiasm for

Reform and positive social impact



Implications... (Post Success)

Implications... (Post Success)

Biosurveillance & EpidemiologyDisease Fingerprinting and MappingComprehensive Research Data MinePowerful Evidence to drive down Insurance PremiumsReduced Underwriting Risks for Malpractice Insurers to drive down costs for PhysiciansJob Creation for implementation consultants at various levels of the value chain

Biosurveillance & EpidemiologyDisease Fingerprinting and MappingComprehensive Research Data MinePowerful Evidence to drive down Insurance PremiumsReduced Underwriting Risks for Malpractice Insurers to drive down costs for PhysiciansJob Creation for implementation consultants at various levels of the value chain


Network


NetworkThank You!!!Thank You!!!

Dr. Sanjay M. UdoshiConsultant Principal

Unified Medical Informatics, Inc.7 South Main Street, Suite 203

Wilkes Barre, PA [email protected]

570-877-7780

Dr. Sanjay M. UdoshiConsultant Principal

Unified Medical Informatics, Inc.7 South Main Street, Suite 203

Wilkes Barre, PA [email protected]

570-877-7780

gohcr presentation

Documents

central indexing

unified medical

digital rights

disease management

health information

medical informatics

emerging technology

care record