Demand connected medical devices to improve military EHRs

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Presented at Military and Government EHRs Symposium at Pentagon City.

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Demand connected medical devices to improve military EHRs:

Demand connected medical devices to improve military EHRs Change procurement of medical devices to help fill EHRs with clinically useful data for comparative effectiveness research and data interoperability

PowerPoint Presentation:

This and many of my other presentations are available at http://www.SpeakerDeck.com/shah @ ShahidNShah shahid@shah.org

Who is Shahid?:

Who is Shahid? 25+ years of software engineering and multi-site healthcare system deployment experience 20+ years of technology management experience (government, non-profit, commercial) 15+ years of digital health, healthcare IT and medical devices experience (blog at http://healthcareguy.com ) Author of Chapter 13, “You’re the CIO of your Own Office”

What’s this talk about?:

What’s this talk about? Miliary Health IT / MedTech Landscape Data has potential to solve some hard healthcare problems and change how medical science is done. The government & military are paying for the manual collection and clerk-like entry of clinical data. Current data collection is unreliable , slow, and error prone. Key Takeaways Medical devices are the best sources of quantifiable, analyzable, and reportable clinical data. New devices must be designed and deployed to support inherent connectivity . Government and military buyers have the procurement muscle to force vendors to become more connected.

What problems can data help solve?:

What problems can data help solve?

Patient populations need different solutions:

Patient populations need different solutions Obesity Management Wellness Management Assessment – HRA Stratification Dietary Physical Activity Physician Coordination Social Network Behavior Modification Education Health Promotions Healthy Lifestyle Choices Health Risk Assessment Diabetes COPD CHF Stratification & Enrollment Disease Management Care Coordination MD Pay-for-Performance Patient Coaching Physicians Office Hospital Other sites Pharmacology Catastrophic Case Management Utilization Management Care Coordination Co-morbidities Well Patient At Risk Chronic Care Acute Treatment Prevention Management 26 % of Population 4 % of Medical Costs 35 % of Population 22 % of Medical Costs 35 % of Population 37 % of Medical Costs 4% of Population 36 % of Medical Costs Source: Amir Jafri, PrescribeWell

The digital enterprise is revolving rapidly based on key trends, health systems’ evolution, and IT’s evolution:

The digital enterprise is revolving rapidly based on key trends, health systems’ evolution, and IT’s evolution Key Industry Trends . Health System Evolution IT Systems Evolution IT Role Evolution Fee For Service, Shared Risk, Bundled Payments, etc. Value, Care Management, Population Management PRESENT Full Risk, Integrated Health Plan & Care Delivery System Personalized Medicine, Wellness Management FUTURE Fee For Service Volume/Episodic Care PAST Integrated EHR Health Information Exchange (HIE) Enterprise Data Warehouse (EDW) Patient Engagement Mobile Health Connected Care Wellness Management Advanced Informatics Personalized Medicine Ancillary Systems (Lab/Rad/Pharmacy, etc.) Enterprise Resource Planning (HR, GL, SCM) Revenue Cycle Ambulatory EHR Hospital EHR Patient Access Enabler Innovator Installer Integrator Integrated Healthcare Network Integrated Healthcare Ecosystem Multi-Specialty Care Clinic & Hospital Integrated Healthcare System Source: Bruce Metz, CIO, Lahey Health

We’ve seemingly accepted lack of cures…:

We’ve seemingly accepted lack of cures… The Shift The clinical model is shifting away from treatment of chronic conditions and focusing more on prevention, wellness, obesity intervention, behavior and lifestyle modification . Objectives Keep people out of the hospital ($$$) Keep people from their docs ($$) Keep people off drugs ($) Keep people at home Implications Clinical operations are shifting to hospital and physician ‘centered’ services that will rely heavily on health information technologies to monitor, coordinate, and manage care . Successful Transition in Care resulting in Reduced Hospital Readmission Rates Proactive population management Patient engagement and collaboration Disease prevention through wellness and obesity management Chronic disease management Care coordination and collaboration Metrics and analytics

Data changes the questions we ask:

Data changes the questions we ask Simple visual facts Complex visual facts Complex computable facts

Data can change medical science:

Data can change medical science The old way The new way Old New

Data Comprehension is hard:

Data Comprehension is hard Biosensors Social Interactions

PowerPoint Presentation:

Data Medical Hardware Consumer Hardware Health Records Patient IT Social Media Health Literacy Retail purchases Behaviors IoT Sensors Hardware Software Pharma / Clinical Trials Labs / Imaging Payments Bioinformatics Health Info Exchg Provider Engagement Care Coordination Compliance Marketing IT Retrospective Prospective Med Devices Primary Data Collection Integration Comprehension Tools, Storage, Services Science, Discovery Value Creation Research Consent Digital Chemistry Secondary Aggregation Provider Stature Ratings/reviews

Unstructured phenotypic patient data sources:

Unstructured phenotypic patient data sources Patient Health Professional Labs & Diagnostics Medical Devices Biomarkers / Genetics Source Self reported by patient Observations by HCP Computed from specimens Computed real-time from patient Computed from specimens Errors High Medium Low Time Slow Slow Medium Reliability Low Medium High Data size Megabytes Megabytes Megabytes Data type PDFs, images PDFs, images PDFs, images Availability Common Common Common Uncommon Uncommon

Structured phenotypic patient data sources:

Structured phenotypic patient data sources Patient Health Professional Labs & Diagnostics Medical Devices Biomarkers / Genetics Source Self reported by patient Observations by HCP Specimens Real-time from patient Specimens Errors High Medium Low Low Low Time Slow Slow Medium Fast Slow Reliability Low Medium High High High Discrete size Kilobytes Kilobytes Kilobytes Megabytes Gigabytes Streaming size Gigabytes Gigabytes Availability Uncommon Common Somewhat Common Uncommon Uncommon

Demand medical device integration/connectivity:

Demand medical device integration/connectivity Most obvious benefit Least attention Most promising capability This talk focuses on connected devices

Procure poly-connectable devices:

Procure poly-connectable devices Option 1 (no cellular access or hospital IT integration required) Option 2 (cellular access and no hospital IT integration required) DDS REST HL7 X.12 DDS REST MPEG-21 MPEG-21 Could be a Home Network, too Wired Wireless Bluetooth, WiFi, Zibee , etc. Wireless , Cellular MQTT MQTT XMPP XMPP

Demand better manageability in devices:

Demand better manageability in devices

Demand extensibility:

Demand extensibility

Start procuring consumer-grade physiologics:

Start procuring consumer-grade physiologics

Invest in digital biology and digital chemistry:

Invest in digital biology and digital chemistry Labs on chips Personal Genomics

Start procuring consumer grade monitoring:

Start procuring consumer grade monitoring

Invest in predictive analytics and CEP:

Invest in predictive analytics and CEP

Demand Connected Architecture:

Device Components 3 rd Party Plugins App #1 App #2 Security and Management Layer Device OS (QNX, Linux, Windows) Sensors Storage Display Plugins Web Server, IM Client Connectivity Layer (DDS, HTTP, XMPP) Presence Messaging Registration JDBC, Query Cloud Services Management Dashboards Data Transformation (ESB, HL7) Device Gateway (DDS, ESB) Healthcare Enterprise Enterprise Data Demand Connected Architecture Plugin Container Event Architecture Inventory Workflow Notifications Patient Context Location Aware 1 2 3 4 5 6 7 8 9 SSL VPN

Ultimate Architecture Core:

Ultimate Architecture Core Device Components Security and Management Layer Device OS (QNX, Linux, Windows) Connectivity Layer (DDS, HTTP, XMPP) Plugin Container Don’t create your own OS! Security isn’t added later Think about Plugins from day 1 Connectivity is built-in, not added Build on Open Source Create code as a last resort

Connectivity components:

Connectivity components Device Components Security and Management Layer Device OS (QNX, Linux, Windows) Web Server, IM Client Connectivity Layer (DDS, HTTP, XMPP) Presence Messaging Registration JDBC, Query Plugin Container Surveillance & “remote display” Remote Access Alarms Event Viewer Design all functions as plugins

Demand enterprise integration:

Demand enterprise integration Cloud Services Management Dashboards Data Transformation (ESB, HL7) Device Gateway (DDS, XMPP, ESB) Enterprise Data Inventory Cross Device App Workflows Alarm Notifications Patient Context Monitoring Device Teaming Device Management Report Generation HIT Integration Remote Surveillance Device Data SSL VPN

Conclusion and Questions:

Conclusion and Questions @ ShahidNShah shahid.shah@netspective.com www.ShahidShah.com

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