telemedicine discussion 5 may 2010 - old.ezdravotnictvo.sk · perspective shift from treatment of...

© 2010 IBM Corporation

Telemedicine discussion5 May 2010

02/10/2010


Building a smarter planet

Topics

Telemedicine

– Definitions

– What and Why

– Examples

Telemedicine in context of the healthcare IT ecosystem

Interoperability & Standards

References



Telemedicine definition and scope

Focus Doc-Doc Focus Doc-Patient Focus Care-Social

COCIR Telemedicine Toolkit,

http://www.cocir.org/content.php?level1=14&mode=24&id=58




Telemedicine was predicted 86 years ago…..



So why is the time right now for telehealth?

ConnectedPersonal Health

A new path to personal wellness, citizen productivity, and

sustainable health costs

Perspective Shift

From treatment of disease to proactive nurturing of personal wellness

New Knowledge

Modifiable lifestyles are key drivers for population

health and disease

Health Cost Burden

Increasing costs of the old model of health care become a national crisis

National Action

Economic pressures force nations to demand new

health solutions

Enabling Technology

Telehealth devices, personalized biometrics, device interoperability



Telemedicine – some recent examples

rBay

– Teleradiology network involving 6 European countries in remote medical image reporting

Irish Telestroke Service

– Remote emergency stroke diagnostics using MRI images and video

Providing medical care in remote areas

– Remote consultation in Pakistan using rugged hardware and satellite

– Use of mobile and SMS services to obtain expert advice



Fact: Accessing quality medical

care in remote locations is

difficult and time-consuming (in

this case no airstrip - 7 days

travel by sea to Capetown)

What‘s smart?

• Using telemedicine to provide access

to clinicians in University of Pittsburgh

Medical Center

• Provision of teleradiology,

telepathology, doctor-to doctor, and

doctor-to-patient consultations, all via

satellite link

Smarter Business Outcomes

• Immediate referrals and 2nd opinions

• Improves quality of patient care

• Eliminates need to travel (a very long

way!) for specialist consultations

Smart Healthcare Innovation

Telemedicine on the island of Tristan de Cunha



Brigham and Womens Hospital Radiology Theatre

Brigham Docs Share

Medical Scans

Remotely Using IBM

Web Browser

Technology

―We are not all in the same location, and the information that‘s needed to take care of

patients does not all come from the same place,‖ says Francine Jacobson, a thoracic

radiologist at Brigham and Women‘s who is the lead investigator working with IBM‘s

software engineers. ―Bringing together both the data and the radiologists in the same Web

browser in a truly interactive manner, and avoiding a lot of the compatibility issues we‘ve

had in the past, is truly exciting.



The Value of Telehealth

Source: Continua: The Impact of a Personal Telehealth Ecosystem

Frank Wartena, Johan Muskens and Lars Schmitt Philips Research Europe, Eindhoven,

The VA Home Telehealth Study found a 25% reduction in numbers of days of bed care and 19% reduction in

the number of admissions through a very cost effective TeleHealth program. (1)



TeleMonitoring Use Cases – Continua Health Alliance

End-to-end demo – Vancouver Q2 2009

Device InterfaceDevice Manager

XHR InterfaceSender Receiver

EHR

PHR

Pulse Oximeter

Glucose Meter

Disease

management

platform

Roche Accu-Chek 360

LNI Android-based G1 Cell

phone 20601 manager

WAN

Wi-fi or 3G

IP network

Web

services

xHR

Based upon

proposed

protocols for

Continua WAN



Cisco and IBM Innovating In Healthcare – Telemedicine

IBM leading Healthcare change in Healthcare forums and consortia (HITSPE, HIE Standards, Continua)

Investing and Innovating in new delivery models – Patient Centered Medical Home

Partnered in Google Health Providing Expertise in Clinical, Imaging,

Pharmacy, Nursing applications plus integration to ERP and HR

Partnering in new Models in Telemedicine with Cisco HealthPresence

IBM Watson Research – linked to pioneering ―Evidence Based Medicine‖

Providing Grid Computing for Research and Grid Medical Archiving Solutions

Leader in Network Infrastructure, resiliency, performance.

Market Leader in Wireless Infrastructure for Healthcare

Leader in New ―Presence‖ technology for Healthcare delivery

Leading Energy Management for Hospital Buildings supported through the IP Infrastructure and Data Center

Leading Smart and Connected Buildings for Healthcare – Clinics and Hospitals

Innovating with healthcare organizations for new Delivery Models – United Health Group, Orion

IBM Cisco



Telemedicine definition and scope

Focus Doc-Doc Focus Doc-Patient Focus Care-Social

COCIR Telemedicine Toolkit,





Chronic Disease Management – Example - DiaLog Shared Care

Targeting chronically ill patients with IT-technology in order to:

Improve planning and treatment

Follow the patient everywhere – in hospital, in their home, at GP

Involve and motivate the patient

Let the patient take more responsibility and participate more actively

Strenghten GP knowledge of hospital treatments and procedures

- with the objective to create a better quality of life for the patient, improve clinical

treatment, save hospitalresources and strengthen cooperation in healthcare.

Diabetes

Heart related diseases

Respiratory diseases

Depression

Typical diseases:

Disease management can target 80% of medical expense patients with chronic illnesses (20 %)



Business challenge

The HUMC–Pediatric Nephrology Department provides home dialysis treatment

for children suffering from kidney diseases. In an attempt to identify

complications, the department had been requiring parents to measure their

children‘s blood pressure, pulse and weight at home—before and after nightly

dialysis—and report the results via phone, e-mail or fax. But the data was often

skewed by miscalculations and had to be compiled by staff, preventing doctors

and nurses from viewing it immediately. With bimonthly checkups onsite being

the only dependable way to monitor health conditions, the department started

looking for a better way to assess the day-to-day treatment needs of its patients.

Solution

Families and physicians are now able to better monitor patient health remotely

through an automated telemedicine solution. Patients analyze their health using

blood-pressure cuffs and scales implanted with special Bluetooth chips that

transmit readings wirelessly to a smart phone. IBM Global Technology Services

implemented the system, which is based on IBM monitoring technology.

Configured with IBM software, the phone aggregates the data and sends it via

the Web to an IBM System x server, enabling doctors and nurses to view the

data instantly on PCs or PDAs.

Benefits

Shortened treatment time for complications from 2 weeks to half a day

Reduced administrative workload, improving the focus on patient care

Optimized monitoring makes HUMC more attractive to dialysis patients

“The IBM solution enables us

to receive a much more

precise picture of the

current health conditions

while reducing the effort for

the medical staff.”

— Professor Schaefer, head

of the Pediatric Nephrology

department, Heidelberg

University Medical Center

Chronic Disease Management –Heidelberg University Medical Center

Speeding medical treatment for kids with first-of-a-kind monitoring solution

http://www.klinikum.uni-heidelberg.de/index.php



Analytics: Program Management, Demonstrate Benefit

Example: NCQA Diabetes criteria based scorecard



What would you do with an open, industry standard Web 2.0 application model that is…

…highly distributed

…designed to be portable

…inherently embeddable

…formalized the concept of the user

…is designed to support relationships between users and groups

…is inherently built to provide information, or “streams”, about user activity

17

―Health 2.0‖ – Consumer technologies



Get Care Now

…allow the patient to decide if they want to share their feeds with friends where they choose to socialize?

Would you…

…automatically post an update (feed) to your community when you accomplish a goal?

…allow the patient to let their achieved wellness goals become part of their health record?

18

Big Blue Health

The best fictional care provider ever!



COCIR 5 Recommendations for Better Deployment of Telehealth:

1. European Commission and Member States to establish an appropriate legal framework

with effective transposition at country level

2. Strengthen cooperation between healthcare stakeholders to ―best practice health

strategies‖ supporting telehealth adoption in routine clinical practice

3. Finance more and sustainable large scale projects with health economic evaluation to

assess the impact of telehealth solutions

4. Integrate telehealth into existing care delivery structures and ensure interoperability of

telehealth solutions

5. Establish sustainable economic model for telehealth by starting dialogue between

healthcare stakeholders

5/3/2010 20

The Continua Health Alliance Mission



Open Standards: Value Proposition

Choice – The choice I make today doesn‗t limit the choices I can make in the future.

Flexibility – I can connect to internal departments and external partners that made different technology choices.

Speed – I can build new solutions that involve multiple hardware and software platforms quickly.

Agility – I can adjust to changing business parameters (new opportunities, new partners, new employees) quickly.

Skills – I can find skilled resources that understand these solution

Open Standards Value Proposition

Choice - The choice I make today doesn’t limit

the choices I can make in the future.

Flexibility – I can connect to internal departments

and external partners that made different

technology choices.

Speed – I can build new solutions that involve

multiple hardware and software platforms

quickly.

Agility – I can adjust to changing business

parameters (new opportunities, new partners,

new employees) quickly.

Skills – I can find skilled resources that

understand these solutions.

Speed of Development

Fair play

ChoiceSkills reuse

Speed of Adjustment

to changes

Flexibility

See speaker notes



Industry Vertical Standards Address Specific Challenges

Industry Vertical Standards:– Standardized processes within an industry

– Standardized data formats, system interoperability within an industry

– Integrate infrastructure standards to support industry-specific requirements/regulations

Benefits:– Consistency of processes within an industry

– Interoperability internally and externally (with customers / suppliers / partners, etc.)

– Elimination of vendor lock-in

– Ease of regulatory compliance, submittals

– Quicker, easier completion – no one company, no one vendor, no single standards organization can do it alone



Home Care

PHARMACIES

Health &

Wellbeing

PROVIDERS

RADIOLOGY LABS

PAYERS

PBMs

PHYSICIANS’ OFFICES

PUBLIC HEALTH

EMPLOYERS

LIFE SCIENCESSMALL CORPORATIONS

Value

Competitive

Ability

New Care

Delivery

Models

Advances

in Medicine

LARGE

CORPORATIONS

Patient

Telemedicine and the larger healthcare ecosystem

Scenarios drive the need for

Healthcare IT systems to

leverage data & interoperability

standards to:

Connect – integrate sytems across the

enterprise boundary

Share – high value data among

communities

Accelerate innovation – rapid

deployment of new services

Improve Efficiency - reuse existing

assets and infrastructure

Address business problems –

transparently allow business

requirements to be captured and

realized in the IT System



Business Problem: US Healthcare

crisis. US Government is committed

to reducing HC cost through the use

of IT. Goal is to provide longitudinal

electronic health records to improve

quality of care, reduce costs and

support public health issues such as

bio-surveillance and health epidemics

Business Value: Complete information

for point of care, eliminate duplication

of labs, reduce medical errors

Solution: Secure interoperable

community healthcare exchange

Healthcare Standards Used: IHE

PIX/PDQ, ATNA, XDS, XDS-I, HL7

v2/v3, Eclipse OHF, Security Std:

SAML, WS-Security,TLS/SSL, XML

dSIG, XAdES, XMLenc, WS-Policy,

WS-Trust

U.S. National Healthcare Information Network

DUAP -

Durham

Medical

Center

Pinehurst

Surgical

Pinehurst

Medical

Southern

Pines

Women’s Ctr.

Moore

Free Care

ClinicFirstHealth

Duke University

Medical Center

Research

Triangle /

Pinehurst

Community

Hub

Spectrum Labs

LabCorp

Morehead

Memorial

Moses Cone

Eden

Internal

Pulmonary

Clinic of

Danville

Moses Cone

Outpatient

Clinic

Family

Tree

OB/GYN

Rockingham

Co, NC/

Danville

Community

Hub

THINC

Communit

y Hub

Kingston

Hospital

St.

Francis

Hospital

Vassar

Brothers

Medical

Ctr

5/3/2010 25

Remote Patient Monitoring: Standards

• Continua founded to organize and push market in one direction.

•

• Structure (Working groups) is to model real-world Use Cases from industry and healthcare.

• Process then deconstructs requirements and selects best industry standards

• Then vet processes and fill holes either with direct work within SDO’s or add definitions and refinements

• Ballot and then publish program and guidelines

• Certification program for interoperability of devices

5/3/2010 26

Working Group Structure – Internal

Board

Of

Directors

Use Case

WG

Technical

WG

Test &

Certification

WG

Wellness

Solutions

WG

VTM

Admin

Expert Group

NHS, AAFP,

ATA, AHA…

Sub-

Committees

PR &

Marketing

agency

Marketing

WG

Regulatory

WG

Policy

Strategy

WG

Australia

Policy

WG

EU

Policy

WG

Japan

Policy

WG

Latin

America

Policy

WG

U.S.

Policy

WG

Executive

Director

Over 2,000 members

participating

in the various

Working Groups

Testing

and

Certification

Lab

Focused on

guidelines and

certification

development

Promoter Members Open

International

http://www.medtronic.com/

5/3/2010 28

RPM market now: Current Participants

• Continua membership shows across the board interest both from supply and demand sides:

– Medical devices

– Governmental Agencies

– Fitness

– Pharma

– Health care providers

– Health insurers

– Telecommunications

– IT

– Integrators

– Applications (PHR, EHR, desktop)



May 3, 2010 2929

EU Program for Personal Health

Jan, 2010- Continua selected for EU Smart Personal Health Grant

Berlin,

September 2010

Brussels,

December 2010

Barcelona,

March 2010

Belfast,

June 2010

Continua- working to raise awareness of standards-based

interoperable personal health solutions by providing

education and demonstrations across the EU.

Partner organizations

http://images.google.com/imgres?imgurl=http://ecbf.eu/imagenes/ETSI Blanco.jpg&imgrefurl=http://ecbf.eu/20yearsECBF.html&usg=__qJYVzOCWSnbsZ93CO9F-qCdOLwo=&h=731&w=1772&sz=131&hl=en&start=2&um=1&itbs=1&tbnid=9JhuJhoAPxa-qM:&tbnh=62&tbnw=150&prev=/images?q=ETSI&hl=en&um=1



EU - Renewing Health Project

EU funded telehealth project

Goal

– 7 pilot projects – ―implementing large-scale real-life

test beds for the validation of innovative telemedicine

services using a patient centred approach and a

common rigorous assessment methodology ‖

– ―In view of their subsequent scaling up at national

and European levels, integration of the service

solutions at regional levels is a priority for the Project

partners, through the use of international standards

and progressive convergence towards common

interoperable architecture‖

Starting 1Q 2010

Continua owns leadership of Industry Advisory

Board for interoperability

Number Full name Short name Country

1 Regione Veneto VENETO Italy

2 Region Syddanmark RSD Denmark

3 County Council of Norrbotten CCN Sweden

4 Centre for Distance-spanning Healthcare CDH Sweden

5 Northern Norway Regional Health Authority

NORNORWAY Norway

6 Departament de Salut de la Generalitat de Catalunya

DSGC Spain

7 Catalan Agency for Health Technology Assessment and Research

CAHTA Spain

8 South Karelia Social and Health Care District

SKARELIA Finland

9 Digital Cities of Central Greece S.A. DCCG Greece

10 e-Trikala e-TRIKALA Greece

11 Municipality of Trikala TR Greece

12 Regional Health Authority of Sterea & Thessaly

5TH DYPE Greece

13 European Patient‘s Forum EPF Belgium

14 European Health Telematics Association EHTEL Belgium

15 Continua Health Alliance CHA Belgium

1.List of Beneficiaries

Latest Continua Certified™ Products

Nonin Wireless

Fingertip Pulse

Oximeter

Nonin Pulse

Oximeter

Roche Accu-Chek® Smart Pix

Device Reader

A&D Medical Blood

Pressure Monitor

A&D Medical Weight

Scale

A&D Blood Pressure

Monitor w/ CPX186

Converter Cable

A&D Weight Scale

w/ CYPAK

Converter Cable

Omron Blood

Pressure Monitor

Omron Body

Composition

Monitor

Omron Pedometer

Texas Instruments

MSP430 USB Agent

Platform

TB named HRN

interface has

been approved

Industry Liaisons

32

PUCC



IBM and Continua

Joined 2006 when Continua launched

Promoter level member

Key Contributor award 2007, 2009

Technical – Lead the WAN working group

– Co-led security working group, HRN working group

Also participate in – marketing & policy working groups

Plugfest participant

Continua certification testing

Continua demonstrations incl.– World of Health IT (2010) IHE Interoperability Showcase

– IHE Europe

– HIMSS (2009, 2010) IHE Interoperability Showcase

– TicSalut

– Partners Healthcare Symposium

– eHealth Conference (Canada)

Created open source reference implementation

34

Interfaces & Standards

Health

Record

Network

(HRN)

Interface

Personal Device

Weight Scale

Pulse Oximeter

Independent

Living Activity

Cardio /

Strength

Medication

Adherence

Glucose Meter

Pulse /

Blood Pressure

Thermometer

Physical Activity

Peak Flow

Electrocardiogram

Insulin PumpVersion 2

(underway)

Aggregation

Manager

Personal

Area

Network

(PAN)

Interface

Wide

Area

Network

(WAN)

Interface

Telehealth

Service

Center

Health

Records

EHR

PHR

http://images.google.com/imgres?imgurl=http://www.medicationmonitors.net/pp03116aa8.jpg&imgrefurl=http://www.medicationmonitors.net/page8.html&usg=__nxidjqXxCQhpDUCLlCKhYjpk3zA=&h=395&w=700&sz=39&hl=en&start=12&tbnid=WSMVl9Zcdp_tdM:&tbnh=79&tbnw=140&prev=/images?q=Medication+Monitor&gbv=2&ndsp=20&hl=en&sa=N

http://images.google.com/imgres?imgurl=http://www.homeheartcare.co.uk/acatalog/fr2_ecg_cable.jpg&imgrefurl=http://www.homeheartcare.co.uk/acatalog/HeartStart_FR2__Defibrillators.html&usg=___Dzp8OooxeLJL6O-Rnn707N-90U=&h=435&w=300&sz=17&hl=en&start=72&um=1&tbnid=tn6YXJEA-QRHJM:&tbnh=126&tbnw=87&prev=/images?q=3+Lead+ECG+device&start=60&ndsp=20&um=1&hl=en&rlz=1T4SUNA_enUS265US291&sa=N

http://images.google.com/imgres?imgurl=http://images.vnunet.com/v7_images/generic/medium/v7_n_zigbee.gif&imgrefurl=http://www.v3.co.uk/vnunet/analysis/2132125/zigbee-homes-short-range-wireless&usg=__Lt3B48Kw-SBQbLXMVKqFrHoiWSs=&h=110&w=185&sz=3&hl=en&start=7&tbnid=Ww8WGf99xQZ2bM:&tbnh=61&tbnw=102&prev=/images?q=ZigBee+logo&gbv=2&hl=en

http://images.google.com/imgres?imgurl=http://alabut.com/nonsense/images/w3c.jpg&imgrefurl=http://alabut.com/nonsense/archive/2007_03_01_index.html&usg=__Z-PsQzjVqNttrVx46ni5uIwxPQg=&h=173&w=140&sz=6&hl=en&start=4&um=1&tbnid=_N2x6-vfVJfzfM:&tbnh=100&tbnw=81&prev=/images?q=W3C&gbv=2&hl=en&um=1

Continua Health Alliance 355/3/2010 355/3/2010 35

Continua Uses CDA for EMR/EHR Integration

Device

manager

Device

PatientDisease management

nurse or home care nurse

PAN

interface

WAN

interface

Remote

Monitoring

System

HRN

interface

Health system e.g.

RHIO/HIE/NHIN,

EMR/EHR/PHR,

Payers,

Pharmas

CDA PHM Specification

IHE Infrastructure Profiles

(XDR)



ABOUT HL7 (Health Level Seven)

HL7 Vision: to create the best and most widely used standards in healthcare.

Wide range of HC standards: Clinical, clinical genomics, administrative, clinical trial,

electronic claims attachments, etc

Standards and Implementation Guides built on Standards

Most widely used healthcare standards used in hospitals around the world

500+ organizational members, over 2000 total members

400 to 600 attend Three Working Group Meetings per year

Source: HL7



Key HL7 Standards include: Messages, Documents, RIM, SOA, Clinical Context

Management CCOW, Functional Models, and more

Messages Documents

A message is event

driven and includes

workflow.

A fragment of information

The Clinical Document Architecture (CDA) can facilitate clinical document exchange within and between medical institutions.

CDA can be used to a bring patient‘s clinical documents into to

patient-centric EHR.

A collection of information

about an encounter

Can be digitally signed

Order Lab

Tests

Lab Test

Results



IHE – Integrating the Healthcare Enterprise

IHE is a healthcare industry organization promoting coordinated use of established standards to improve healthcare IT system integration

IHE produces healthcare integration profiles which:– Address a given healthcare integration scenario– Build upon one or more existing, established standards– Define constraints which limit the options available when using underlying standards– To reduce the effort and cost to integrate systems spanning a diverse set of healthcare

IT vendors

IHE Infrastructure Profiles used for Healthcare Information Exchanges, within and across enterprises

e.g. IHE Patient Care Devices Profile

Sponsor ―Connect-a-thon‖ to demonstrate standard‘s based interoperability between industry vendors



Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

Future Domains

IHE

IT Infrastructure

17 Integration Profiles



1144 IInntteeggrraattiioonn PPrrooffiilleess

Patient Care

Coordination 5 Integration Profile

Patient Care

Devices

Pathology Eye Care

Endoscopy

IHE Domains

5 Technical Frameworks, 49 Integration Profiles,

Close to 200 vendors involved world-wide,

Testing at Connectathons in North-America, Europe and Asia



Continua WAN - A Milestone for device interoperability

Source: http://geekdoctor.blogspot.com/2009/08/milestone-for-device-interoperability.html

―Bravo! All device stakeholders will now benefit from a single universal set of standards used to connect devices to EHRs and PHRs.‖

– John Halamka, HITSP Chair, CIO Harvard Medical

―Together, Continua and IHE have finally made it possible for vendors of Medical Devices and Personal Health Devices to efficiently send patient data to the Personal and Electronic Health Records vendors using a single unified interoperability standard that is endorsed by HITSP."

- Elliot B. Sloane, PhD, IHE Co-Chair, International Executive Director, Center for Healthcare Information Research and Policy

This will facilitate an ecosystem of connected technologies, devices, and

services that provide a compelling way to meet the challenges of increased

access, improve outcomes for patients, and ultimately reduce overall

healthcare costs."

- Rick Cnossen, President, Continua Health Alliance, Director, Personal Health

Enabling, Intel Digital Health Group

http://geekdoctor.blogspot.com/2009/08/milestone-for-device-interoperability.html









41

Open source software –IBM Sponsored projects for CDA, IHE, & Continua implementations

IHE Profiles Implementation of IHE profiles used in health information

exchanges

Stepstone – remote patient monitoring Personal telehealth for improved chronic disease mgmt.

Reference implementation using healthcare standards and

SOA

Model Driven Health Tools ( joint with Veterans Affairs) UML platform with healthcare standards. Produce tools for

developers, e.g. HL7 CDA tooling

•Open Health Tools – IHE Profiles

https://iheprofiles.projects.openhealthtools.org/

•Open Health Tools – Stepstone

https://stepstone.projects.openhealthtools.org/

•Open Health Tools – MDHT

https://mdht.projects.openhealthtools.org/

https://iheprofiles.projects.openhealthtools.org/

https://stepstone.projects.openhealthtools.org/

https://mdht.projects.openhealthtools.org/



Implementing Industry Standards: The CDA* Example

CDA

Human-to-Human

Machine-to-Machine

Printed

Bedside

…

EMR

Transcription

…

Medical Records

Transformation

…

Clinical Decision Support

Patient held-records alerts

…

* CDA – Clinical Document Architecture, co-edited by Amnon Shabo



Example: CDA usage in epSoS

CDA Supports Translation and Transcoding through ICD10

Document ACountry

A

ep

SO

S

Te

rmin

olo

gy

se

rve

r A

Document E Document BNCP A NCP B

ep

SO

S

Te

rmin

olo

gy

se

rve

r B

Country

B

CDA

Language A

ICD-10 4-digits codes

CDA

English


CDA

Language B


Transformation ICD-10 4-digit to 3-digits codes

Accession to epSOS Terminology Server A

Translation of displayName A to displayName E

Creation of pivot Document E*

Accession to epSOS Terminology Server B

Translation of displayName E to displayName B

Creation of local Document B*

* Initial 4-digits code with displayName A are kept into CDA documents E and B and are still available

Local document A is coded with ICD-10

4-digit codes and sent to NCP A



Health Information Exchange – Clinical Documents



45

EMR

Physician Office

EHR System

Teaching Hospital

Community Hospital

Lab Info.

System

Retrieve Document

Provide &

Register

Document

Register Document

Query Document

Document

Registry

Document

Repository

Document

Repository

ED System

14355M8354673993

L-716

A87631

Patient Identity Manager

Audit record

repository

EHR System

Community

Document

Repository

HIE Community Hub

HL7-CDA

Gateway

Health Information Exchange – Clinical Documents & Continua

Personal Telehealth Service

Remote

monitoring system



Example: RIMON - CDA, and CEN EHR 13606

i

XDS Repository

Interface

XML-Based

Repository

V2V3

transformation

HL7 V3

Messages

HL7 V2.x

Data Source

HL7 V3

Data Source

XDS Document

Source

XDS Document

Consumer

HL7 v3 & QED

ConsumerHealth Information

WarehouseStandard HL7

RIM Query Service

XDS Provide & RegisterIf source is not CDA, perform

XDS Document CDA

2-step transformation:

• XDS Submission set Header

• XDS Document Body

HL7 RIM & QED

Interface

XDS Retrieve

Mass &

non-XML

data types,

e.g.,

genomic,

imaging,

binaries

Longitudinal

and Cross-

institutional

CEN EHR

13606 Layer

EHR

Consumer

Healthcare ConsumersHealth Data Sources

Messages

Documents

Imaging

Proprietary

CDA Diagnostic Imaging Report & DICOM SR

HL7 V3

Clinical Genomics

Genomic

Data Source

Transform data to HL7v3 or XDS

Secondary Consumers

Clinical Research Insurers & Payers

Public HealthPharma

Persistency

XDS Registry

(Metadata)

Ongoing

update

RIMification

Analysis, enrichment,

interpretation and

bubbling-up (including

genomic data)

Ongoing

analysis

DOMAINification



Sensor Solutions can be a key enabler for Smarter Healthcare

Our world is becoming

INSTRUMENTED

Our world is becoming

INTERCONNECTED

All things becoming

INTELLIGENT

Sensors

Event Processing &

Integration

Visualization &

Tuning

Leading companies in Healthcare can benefit from new sensor data when combined

with IBM's business process management, event processing & business optimization capabilities

New Data

New Insights

Process

Innovation

New & OptimizedBusiness Processes



48

Teva USA: Improved product visibility and authenticity to ensure a safe and secure pharmaceutical supply chain. Enhanced operational efficiency by reducing manual processes.

Honda Italia: Implemented RFID component tracking solution to improve production efficiency and quality.

DHL: Developed and implemented a real-time monitoring system using RFID and sensing technology to monitor temperature sensitive shipments while in transit.

Airbus: In a strategic move, RFID is being utilized to automate the tracking of aircraft segments while improving supply chain visibility and reducing costs.

Matiq: Employs RFID tags to trace meat and poultry from the farm to store shelves to ensure safety and freshness and provide more transparency to consumers.

Metro: Using RFID technology throughout its entire supply chain to help them get the merchandise the customers want on the shelves when they want them.

IBM is a leader in Sensor Solutions



Sensor SolutionsCreating value through the integration of new and existing capabilities

Process

Models

Process &

Adapter Modules

Rules &

Patterns

Device

Interfaces

Sensor Event

Services

Asset &

Service

Management

Analytics &

Reports

KPIs &

Dashboards



Sensor Solution for Telehealth



Example: Detecting Significant Events

Central services are available at

Provider to monitor results,

respond to alerts, evaluation

and respond to trends, support

technologies, and answer ‗how

to‘ questions from patients and

family

Central Support

IBM software technologies

track events (and non-

events) and measurements

and provide automated

feedback when outliers are

detected.

Dashboard

Alert; John, you are past due on

your INR reading

Alert; John is past due on his

INR reading

Event tracking and rule set

Alerts



Example: Case Manager Portal



Example: Analytics incorporated into the Portal from remote

monitoring



54

Achieving smarter outcomes in Healthcare

Imagine the possibilities …

SMART IS …

A sensor enriched, patient-centric dashboard that

provides a healthcare organization improved

visibility for evidence-based care

SMART IS …

A home healthcare organization monitors

thousands of home patients and detects an

adverse reaction to a new prescription while

one of the patients is home alone.

And today we are …

SMART IS …

Letting your medical devices populate

your personal health record for you

SMART IS …

Identifying preventable health issues

before a patient arrives at the ER

Western North Carolina Health Network: Implemented

an electronic health record exchange that enables patient

data to be securely shared across hospitals, providing

faster, better patient treatment and reducing medical

errors and unnecessary treatments.

Shanghai First People’s Hospital: Developed a

reliable identity repository to eliminate duplicate and

erroneous data, aggregating a patient‘s historical care

information and improving care through the sharing of

trusted information.



References

Applications of Telemedicine and Wireless Technology to Underserved and Disadvantaged Populations, IBM Center for the Business of Government, http://www.businessofgovernment.org/pdfs/GeislerApplications.pdf

Continua Health Alliance, http://continuaalliance.org

Laying a Foundation for True Patient Intelligence, http://www.initiate.com/resources/exec_summary/downloads/Documents/Laying-a-Foundation-for-True-Patient-Intelligence.pdf

COCIR Telemedicine Toolkit, http://www.cocir.org/content.php?level1=14&mode=24&id=58

European Commission Smart Personal Health Project, http://sph.continuaalliance.org/project.html

epSoS project

Renewing Health Project

IHE Europe, http://www.ihe-europe.net/organisation/

Building a Smarter Medical Device Monitoring Solution, http://www.ibm.com/developerworks/websphere/techjournal/1001_hanis/1001_hanis.html

Using Collaborative Technologies for Healthcare in the Home, http://www.ibm.com/developerworks/data/library/techarticle/dm-0910purexmlhealthcare/

Healthcare Information Integration: Considerations for Remote Patient Monitoring, http://www.drdobbs.com/web-development/221600073;jsessionid=UPYJDOCARTXIBQE1GHPSKH4ATMY32JVN?pgno=1

Creating Telemedicine-Based Medical Networks for Rural and Frontier Areas, Leonard R. Graziplene, IBM Center for Business of Government, http://www.businessofgovernment.org/pdfs/graziplene_magazine.pdf

A Milestone for Device Interoperability, John Halamka, Healthcare IT News, http://www.healthcareitnews.com/blog/milestone-device-interoperability

Kirsch C., et. Al. : Monitoring chronically ill patients using mobile technologies. IBM Systems Journal Vol 46 No 1 2007, http://w3.research.ibm.com/journal/sj/461/kirsch.pdf

http://www.businessofgovernment.org/pdfs/GeislerApplications.pdf

http://continuaalliance.org/

http://www.initiate.com/resources/exec_summary/downloads/Documents/Laying-a-Foundation-for-True-Patient-Intelligence.pdf














http://sph.continuaalliance.org/project.html

http://www.ihe-europe.net/organisation/



http://www.ibm.com/developerworks/websphere/techjournal/1001_hanis/1001_hanis.html

http://www.ibm.com/developerworks/data/library/techarticle/dm-0910purexmlhealthcare/



http://www.drdobbs.com/web-development/221600073;jsessionid=UPYJDOCARTXIBQE1GHPSKH4ATMY32JVN?pgno=1



http://www.businessofgovernment.org/pdfs/graziplene_magazine.pdf

http://www.healthcareitnews.com/blog/milestone-device-interoperability





http://w3.research.ibm.com/journal/sj/461/kirsch.pdf



Ďakujem!

Rich Rogers

Healthcare standards & emerging technology

IBM Software Group

[email protected]