Slide1: ISIS Center Team of 15 faculty and 70 staff Seong K. Mun, PhD ISIS Center Georgetown University smun01@georgetown.edu IT: Transforming Power for Industries From Telemedicine to E-Health Georgetown


Information Age: Information Age Under Formation Struggle Underway Some Examples from Other Industries Hard to Make any Projections Still Very Young (About 100 years) Outcome Unknown Very Powerful Transforming Capability


Industries in Info Age: Industries in Info Age Transformed successful and not so New Industries Industries on the net community What will happen to healthcare? Is it going to be a transformation?


Evolution of Business ModelsIT as a Transforming Tool: Evolution of Business Models IT as a Transforming Tool Digital Devices Communication Video Conferencing Data/Image Processing Telemedicine Digital Information System Integrated Healthcare Teleradiology Filmless Hospital Virtual Clinic Global Radiology Transaction Management


Goals of T-Med: Goals of T-Med Improve Access: Doctors and Information Access to Patients and Diseases Improve Quality Better Outcome Reduce Cost: Overall Cost


Two Types of ApplicationOperational: Two Types of Application Operational Real Time (VTC) Acute Illness and Emergency Other Specialty Store and Forward Chronically Ill: 70% of Health Budget Routine Radiology, Pathology What is wrong with this? What is our assumption? One-way model.


Drivers: Technology: Drivers: Technology Availability of High Speed Links 19.2 kbps to T-1 lines Availability of Digital Input Devices Digital Imaging Devices Digital Video Devices Emerging Digital Age


Slide8: PACS: Filmless Digital Hospital Teleradiology: DEPRAD, Bosnia, Hungary, Germany Mission Project & Diabetes Project with UH Post Surgery Follow Up Rural Health: Kidney Stone Disease Renal Dialysis Center and Home Dialysis Medical Education in Latin America: ACTS Disaster Relief in Kenya Telemedicine Demo in Russia Diplomatic Telemedicine in Africa Diabetes Management at Home Congestive Heart Failure: Home Global MRI Network: NGI Refugee Health


General Assessment: General Assessment Access to Care Acceptable Technology Demanding Logistics, TV Production High Costs: Tech, Ops, Staffing Technology Insertion Requires Appropriate Operational Environment Access to Patient and Information Not a primary focus – so far


Key Issues: Key Issues Technology: Good Business Process (E): Poor Business ($) : Very Poor Clinical Relevance: OK Overall Costs: High Technology is one of many requirements!


Revisiting the Assumptions: Revisiting the Assumptions Patient’s access to Physicians Initial Focus How about Physician’s access to Patient? Health Record Genetic Information Life Style Information Others


Radiology Case Study: Radiology Case Study Digital Filmless Hospital Teleradiology Global (Virtual) Radiology Service


US DoD PACS: US DoD PACS Western Ft. Irwin Ft. Lewis (MAMC) Ft. Wainwright Pacific Tripler (TAMC) 121st General Hospital Ft. Monmouth Ft. Sill Ft. Drum West Point Ft. Carson Ft. Huachuca Ft. Hood Ft. Sam Houston (BAMC) Ft. Polk Ft. Knox WRAMC Ft. Leonard Wood Ft. Riley Ft. Leavenworth Ft. Eustis Ft. Lee Ft. Belvoir WBAMC North Atlantic Great Plains Ft. Bragg Landstuhl Heidelberg Europe Southeast Ft. Jackson Ft. Campbell Ft. Stewart Ft. Gordon Ft. Rucker Ft. Benning Ft. Meade Carlisle Barracks Ft. Detrick Wuerzburg Aberdeen Redstone Ft. McPherson Vincenza Shape Site R Livorno Ft. Greely Ft. Richardson Camp Zama = 9 outlying locations No PACS Activity Activity In-Process PACS Implemented 5


Slide14: Global Teleradiology Stand-alone Nigh Hawk / On-call Coverage Expert / Second Opinion Global Virtual Radiology Service by Workload Sharing and Reallocation


Enter Internet!: Enter Internet! Easier Access to Communication But Limited Band-width Ubiquitous Computing Beyond Point to Point Communication


Expanding Enterprise: Expanding Enterprise University Hospital DPT City Hospital Mercy Hospital Clinical Research Government Agencies Public Health Research and Education Payers


What is Information Economy?How is it powered?: What is Information Economy? How is it powered? Powered By Ubiquitous Coordination Technology Information, Communication and Computing Technology New Industry Emerges and Old Ones Must Transform New Business Process Needed Where are we in healthcare? Followed by Agricultural Economy; Powered by Animals Manufacturing Economy: Powered by Engines on Fuels


What does/can IT do to business processes?: What does/can IT do to business processes? Bureaucracy to Ad-hoc-cracy Flatter Organization Info: Do it yourself Consumers do part of the job Externalizing labor cost Self care, home care More Power to End Users More Responsibilities to the End Users


Key Activities for Mass ProductionTraditional Health System: Key Activities for Mass Production Traditional Health System Standardization Serialization Specialization Synchronization Concentration Centralization Era of Bureaucracy


Organizational Impact: Organizational Impact What is this? Bureaucracy: Mass Production “Adhocracy” Information Age Medical Center Model Is It Obsolete? Distributed Patient Centric Model Is it workable?


Attributes of Future Health Care: Attributes of Future Health Care Distributed System Knowledge Based- Bidirectional Patient Driven, Customized More Self Care More Prevention More Choices: Patient Education Consistent with generic IT evolution


Slide22: Physician at GUMC Patient at Home or Work Data, Questions Analysis Results Instructions Home Monitoring Good Technology Not Compatible with Process Great Self Management Tools


Advanced IT (I-2) Demonstration Projects - NLM: Advanced IT (I-2) Demonstration Projects - NLM Fundamental Limitations on Internet Quality of Service on the Net Authentication and Authorization Information Sharing in VO Network Security New Emerging Application Disease Surveillance


Project Sentinel: Project Sentinel Baseline or Heightened Case Project 6 Applications /use case Project 2 & 3 Authentication /Authorization Middleware Information Distribution Project 4 WHC GU Others …. Project 1 Acquiring Sites Government Agencies Mosquito Avian Satellite Inquiry International Threat Info Hospitals Future Data Sources/Argus DOH Patient Info Data Sources Project 5 PIDS Distribution Middleware/Web/Grid


IT-Architecture: IT-Architecture App A Patient Info A Hosp B Patient Info B App B Hosp A Web-based App A App B Patient Info A Hosp B Patient Info B Hosp A TODAY TOMORROW Client-server applications Stand alone systems Clinical patient info only Users assigned to each system w/separate login/access Web-based Applications Limited scalability VPN access common Limited integration of data sources Users assigned to each system w/separate login/access Web or Grid services allow for sharing data and/or computing resources Highly scalable infrastructure Integrated data sources thru Grid Access privileges thru VO based on attributes and agreements Dynamic adaptation to diverging security requirements


Project Sentinel: Issues DemandingTechnical Solutions in Virtual Organization: Project Sentinel: Issues Demanding Technical Solutions in Virtual Organization Different Organizational Missions & Activities Different Operational Environment Potential Distrustful Relationships Client to Server or Peer to Peer Different Rules of Delegation of Authorities and Privileges New Business Model Needed? Desired? Non-Technical Barriers


IT Industry and HealthcareSimilar Evolution Paths: IT Industry and Healthcare Similar Evolution Paths Standard interface of machines System Integration Activity Automation IT for Business Process End to end productivity New Business Model DICOM and HL-7 Filmless Operation IHE for Business Process Workflow Department Productivity Enterprise Info. Mgmnt New Business Model?


Evolution of Business Models: Evolution of Business Models Departmental IT Solutions Hospital IT Solutions Regional National IT Solutions Physician Offices and Patients


Policy Directions for Congress?: Policy Directions for Congress? Patients Healthy & Responsible Life Style Health Care Industry and Government Standards in Business Processes Research Community and Partners Business Transforming R&D Physicians and Offices IT Investment Incentives and Training IT Industry Improved Infrastructure and Open Access


Acknowledgements: Acknowledgements National Library of Medicine, NIH TATRC, US Army National Cancer Institute, NIH NIBIB, NIH Health Affairs, Department of Defense Department of State DC Department of Health Contact: smun01@georgetown.edu