Demand connected medical devices to improve military EHRs

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<ol><li> 1. Demand connected medical devices toimprove military EHRsChange procurement of medical devices to help fill EHRs withclinically useful data for comparative effectiveness researchand data interoperability </li><li> 2. This and many of my other presentations are available at 2 </li><li> 3. @ShahidNShahWho is Shahid? 25+ years of software engineering andmulti-site healthcare system deploymentexperience 20+ years of technology managementexperience (government, non-profit,commercial) 15+ years of digital health, healthcare IT andmedical devices experience (blog at of Chapter 13, Yourethe CIO of your Own 3 </li><li> 4. @ShahidNShahWhats this talk about?Miliary Health IT / MedTech Landscape Data has potential to solve some hardhealthcare problems and change howmedical science is done. The government &amp; military are payingfor the manual collection and clerk-likeentry of clinical data. Current data collection is unreliable,slow, and error prone.Key Takeaways Medical devices are the best sources ofquantifiable, analyzable, and reportableclinical data. New devices must be designed anddeployed to support inherentconnectivity. Government and military buyers have theprocurement muscle to force vendors tobecome more 4 </li><li> 5. @ShahidNShahWhat problems can data help solve?Cost per patient perprocedure / treatmentgoing up but withoutability to explain whyCost for sameprocedure / treatmentplan highly variableacross localitiesUnable to comparedrug efficacy acrosspatient populationsUnable to comparehealth treatmenteffectiveness acrosspatientsVariability in fees andtreatments promotesfraudLack of visibility ofentire patient recordcauses medical 5 </li><li> 6. @ShahidNShahPatient populations need different solutionsPrevention Management 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 &amp; Enrollment Disease Management Care Coordination MD Pay-for-Performance Patient Coaching Physicians Office Hospital Other sites Pharmacology Catastrophic CaseManagement Utilization Management Care Coordination Co-morbidities26 % of Population4 % of Medical Costs35 % of Population22 % of Medical Costs35 % of Population37 % of Medical Costs4% of Population36 % of Medical CostsSource: Amir Jafri, 6 </li><li> 7. The digital enterprise isrevolving rapidly basedon key trends, healthsystems evolution, andITs evolutionKey IndustryTrends.Health SystemEvolutionIT SystemsEvolutionIT RoleEvolutionFee For Service, Shared Risk,Bundled Payments, etc.PRESENTValue, Care Management,Population ManagementFUTUREFull Risk, Integrated HealthPlan &amp; Care DeliverySystemPersonalized Medicine,Wellness ManagementPASTFee For ServiceVolume/Episodic CareIntegrated HealthcareIntegratedEHRIntegrated HealthcareHealth InformationExchange (HIE)NetworkEnterprise DataWarehouse (EDW)PatientEngagementIntegrated HealthcareAdvancedInformaticsMobile HealthEcosystemConnectedCareWellnessManagementPersonalizedMedicineMulti-Specialty CareClinic &amp; HospitalAncillary Systems(Lab/Rad/Pharmacy, etc.)Enterprise ResourcePlanning (HR, GL, SCM)RevenueCycleSystemHospital EHRAmbulatory EHRPatient AccessInstaller Integrator Enabler InnovatorSource: Bruce Metz, CIO, Lahey 7 </li><li> 8. @ShahidNShahWeve seemingly accepted lack of curesThe ShiftThe clinical model is shifting away fromtreatment of chronic conditions andfocusing more on prevention, wellness,obesity intervention, behavior andlifestyle modification.Objectives Keep people out of the hospital ($$$) Keep people from their docs ($$) Keep people off drugs ($) Keep people at homeImplicationsClinical operations are shifting to hospital andphysician centered services that will rely heavilyon health information technologies to monitor,coordinate, and manage care. Successful Transition in Care resulting inReduced Hospital Readmission Rates Proactive population management Patient engagement and collaboration Disease prevention through wellness andobesity management Chronic disease management Care coordination and collaboration Metrics and 8 </li><li> 9. @ShahidNShahData changes the questions we askSimple visual facts Complex visual facts Complex 9 </li><li> 10. @ShahidNShahData can change medical scienceThe old wayIdentifyproblemAskquestionsCollectdataAnswerquestionsThe new wayIdentifydataGeneratequestionsMine 10 </li><li> 11. @ShahidNShahData Comprehension is hardWhat does itmean?How do I useit? Must be continuouslyrecomputed Difficult today, easier tomorrow Super-personalized Prospective PredictiveBio IT andGenomicsSecondary AggregationSocial InteractionsBiosensors Can be collected infrequently Personalized Prospective Potentially predictive Digital Family history is easierPhenotypicsPrimary Data Collection Continuously collected Mostly Retrospective Useful for population health Part digital, mostly analog Family History is hardAdmin DataCollection Business focused data Retrospective Built on fee for service models Inward looking and not focusedon clinical 11 </li><li> 12. Hardware SoftwareDataMedical HardwareIoT SensorsConsumer HardwareHealth RecordsPaymentsPharma / Clinical TrialsBioinformaticsLabs / ImagingMed DevicesHealth Info ExchgProvider EngagementComplianceCare CoordinationMarketing ITDigital ChemistryConsentPatient ITSocial MediaHealth LiteracyRetail purchasesBehaviorsRetrospectiveProspectiveIntegrationComprehensionTools, Storage, ServicesScience, Discovery ResearchProvider StatureRatings/ 12 </li><li> 13. @ShahidNShahUnstructured phenotypic patient data sourcesPatient HealthProfessionalLabs &amp;DiagnosticsMedical Devices Biomarkers /GeneticsSource Self reported bypatientObservations byHCPComputed fromspecimensComputed real-timefrompatientComputed fromspecimensErrors High Medium LowTime Slow Slow MediumReliability Low Medium HighData size Megabytes Megabytes MegabytesData type PDFs, images PDFs, images PDFs, imagesAvailability Common Common Common Uncommon 13 </li><li> 14. @ShahidNShahStructured phenotypic patient data sourcesPatient HealthProfessionalLabs &amp;DiagnosticsMedical Devices Biomarkers /GeneticsSource Self reported bypatientObservations byHCPSpecimens Real-time frompatientSpecimensErrors High Medium Low Low LowTime Slow Slow Medium Fast SlowReliability Low Medium High High HighDiscrete size Kilobytes Kilobytes Kilobytes Megabytes GigabytesStreaming size Gigabytes GigabytesAvailability Uncommon Common SomewhatCommonUncommon 14 </li><li> 15. @ShahidNShahDemand medical device integration/connectivityMost obvious benefit Least attentionMost promisingcapabilityThis talk focuses onconnected 15 </li><li> 16. @ShahidNShahProcure poly-connectable devicesOption 1 (no cellular access or hospital IT integration required)DeviceHospitalNetworkMQTTXMPPCorporateGatewayMPEG-21ExternalCloudHospitalSystemsCould be a HomeNetwork, tooWiredWirelessBluetooth,WiFi, Zibee, etc.Option 2 (cellular access and no hospital IT integration required)DeviceRESTDDSHL7X.12ExternalCloudMQTT XMPPDDS RESTMPEG-21Wireless, 16 </li><li> 17. @ShahidNShahDemand better manageability in devicesSecurity Is the deviceauthorized?Inventory Where is the device?Teaming Device groupingPresence Is a device connected? 17 </li><li> 18. @ShahidNShahDemand 18 </li><li> 19. @ShahidNShahStart procuring consumer-grade 19 </li><li> 20. @ShahidNShahInvest in digital biology and digital chemistryLabs on chips Personal 20 </li><li> 21. @ShahidNShahStart procuring consumer grade 21 </li><li> 22. @ShahidNShahInvest in predictive analytics and 22 </li><li> 23. @ShahidNShahDemand Connected Architecture5Device Components 3rd Party PluginsApp#1App#2Sensors Storage Display PluginsWeb Server, IM Client Presence Messaging Registration JDBC, Query6Connectivity Layer (DDS, HTTP, XMPP)Plugin ContainerEvent Architecture31 24Device OS Security and Management LayerLocationAware(QNX, Linux, Windows)SSL VPNCloudServicesHealthcare EnterpriseDevice Gateway (DDS, ESB)InventoryManagementDashboardsWorkflowNotificationsData Transformation (ESB, HL7)EnterpriseData8Patient 23 </li><li> 24. @ShahidNShahUltimate Architecture CoreDevice ComponentsConnectivity isbuilt-in, not addedConnectivity Layer (DDS, HTTP, XMPP)Plugin ContainerThink aboutPlugins from day 1Device OS Security and Management Layer(QNX, Linux, Windows)Dont createyour own OS!Security isntadded laterBuild onOpen SourceCreate code asa last 24 </li><li> 25. @ShahidNShahConnectivity componentsDevice ComponentsSurveillance &amp;remote displayRemote AccessAlarms Event ViewerWeb Server, IM Client Presence Messaging Registration JDBC, QueryConnectivity Layer (DDS, HTTP, XMPP)Plugin ContainerDesign allfunctions aspluginsDevice OS Security and Management Layer(QNX, Linux, Windows) 25 </li><li> 26. @ShahidNShahDemand enterprise integrationCloudServicesDevice Gateway(DDS, XMPP, ESB)ManagementDashboardsDeviceDataData Transformation (ESB, HL7)EnterpriseDataDeviceReport ManagementGenerationInventorySSL VPNCross DeviceApp WorkflowsAlarmNotificationsDeviceTeamingPatient 26 </li><li> 27. @ShahidNShah shahid.shah@netspective.comwww.ShahidShah.comConclusion and Questions </li></ol>