Architektura mhealth služeb v rámci zdravotnických informačních sítí

Transcription

1 Architektura mhealth služeb v rámci zdravotnických informačních sítí MUDr. Pavel Kubů CEE Healthcare Business Development Manager 0

2 The Perfect Storm is here Rising Costs of Healthcare Aging Population Shortage of Healthcare Professionals New models of care forced to emerge 1

3 Quality of Life The Continuum of Care Shift Left Highest Quality of Life Lowest Cost of Care Health and Wellness Home Care Residential Care Cost of Care Acute Care 2

4 Healthcare Compute Continuum Cloud / Data Center Embedded Workstations/ Desktops Laptops Netbooks Tablets Smart- Phones & Handhelds Smart TVs One Architecture Across Connected Devices for Healthcare Enabling a Secure, High Performance, & Consistent User Experience 3

5 mhealth? Cloud / Data Center Embedded Workstations/ Desktops Laptops Netbooks Tablets Smart- Phones & Handhelds Smart TVs One Architecture Across Connected Devices for Healthcare Enabling a Secure, High Performance, & Consistent User Experience 4

6 Mobile Point of Care (MPOC)? Cloud / Data Center Embedded Workstations/ Desktops Laptops Netbooks Tablets Smart- Phones & Handhelds Smart TVs One Architecture Across Connected Devices for Healthcare Enabling a Secure, High Performance, & Consistent User Experience 5

7 mhealth Cloud / Data Center Embedded Workstations/ Desktops Laptops Netbooks Tablets Smart- Phones & Handhelds Smart TVs One Architecture Across Connected Devices for Healthcare Enabling a Secure, High Performance, & Consistent User Experience 6

8 What is mhealth? From the United Nations mhealth Alliance the use of mobile devices in health solutions Multiple form factors for the job Solution determined based on usage model Also critical to consider: Security requirements for healthcare data Future requirements for usage model as it evolves Infrastructure necessary to support usage model Cost of total solution Hardware, software (portability, interoperability), data plans 7

9 SIZE Mobile Device Summary In Hand Usage Frequent/ Short Sessions USER EXPERIENCE Disinfectable, sealed, rugged, Barcode, RFID, MPOC Table Top Usage Fewer/Longer Sessions Significant data entry, medium data collection/ viewing, media Content creation, MPOC Pocketable Portable Simple forms & data collection/viewing, small media Medium forms & data collection/viewing, media MCA* Netbooks Notebook Tablets Handheld or Smartphone Some Convergence Basic/Medium Internet FUNCTIONALITY Multi-Function Immersive/Visual Internet 8

10 MPOC: Five Components to Get to Solution Right Hardware (with refresh roadmap) Right Software (needs to fit with workflow/use case) Connectivity (robust network design) Integrated Solution (needs to fit with other pieces) Workflow Transformation (people need to use it) 9

11 Common MPOC Project Opportunities: Overcome Operational Bottlenecks in Any Setting Order Entry and CDSS Emergency Department Closed-loop Medication Management Discharge Emergency Transport 10

12 What is the Best Device For My Needs? Mobile Clinical Assistant Tablet PC s Laptop s Fixed PC s Smart phone Mobility Vital sign, I & O entry Medication Administration Template data-entry Free-format text data-entry Large diagnostic images Data Inquiry Manageability 11

13 MPOC in emergency care Car PC Tablet PC GEmMA Mobile Client 12

14 GEmMA Originality Added Value coming from interoperability with external systems getting place Interoperability with Central Electronic Health Record repository IZIP EMERGENCY DATASET Interoperability with national register of Insurance numbers of VZP (General Health insurance Company ) impact on billing Interoperability with Prague EMS internal Patient register 13

15 Healthcare IT Network of Networks Gov t / MOH Defense Medical Commercial IDNs Telco / Broadband Pharma / Life Sciences Rx, Lab & Imaging networks Claims processing networks Public Health Specialty CDM, Cardio, Cancer Regional/Local public/private Cloud->Data Center->Client Refresh 14 14

16 Care Coordination: What it Takes EMR Gather & Store Comprehensive Information CPOE CDSS PHR Empower the Patient vpro TxT Secure Access to Information Everywhere HIE Share Information Across Organizations AT, AESNI Patient Family MPOC MHealth Mobilize the Data TEAM Collaboration 15

17 Care Coordination Across the Continuum Health Checkup CPOE EMR MPOC Emergency Self Check & Control Clinic Electronic Health Record Data Repository Home Community Hospital Visiting Care Pharmacy Long term Care Academic Hospital Research Remote Diagnostic 16

18 Care Coordination Across the Continuum Health Checkup HIE National Networks Emergency Self Check & Control Data Exchange Personal Health Record Patient-Centric Care Data Exchange Clinic Electronic Health Record Data Repository Home Community Hospital Visiting Care Pharmacy Long term Care Academic Hospital Research Remote Radiology 17

19 Care Coordination Across the Continuum PHRs Health Checkup Emergency Self Check & Control Data Exchange Personal Health Record Patient-Centric Care Data Exchange Clinic Electronic Health Record Data Repository Home Community Hospital Visiting Care Pharmacy Long term Care Academic Hospital Research Remote Diagnostic 18

20 Care Coordination Across the Continuum Health Checkup CDSS Emergency Self Check & Control Data Exchange Personal Health Record Patient-Centric Care Data Exchange Clinic Electronic Health Record Data Repository Home Community Hospital Visiting Care Pharmacy Long term Care Academic Hospital Research Remote Diagnostic 19

21 Intel Technology Supports Care Coordination HIT Infrastructure PHR EMR Gather & Store Comprehensive Information Embedded, MPOC, Server, DC, Performance, Rendering, Security CDSS CPOE HIE Empower the Patient Share Information Across Organizations Provider Family Continua MPOC CPOE, MPOC, MCA, Security, WiFi, 3G, 4G, RFID, RLS Patient Enable Care Team Collaboration 20

22 HIE Deployment Models Data Liquidity All models will naturally occur, all must be supported Centralized Federated Hybrid Optimal sustainable business model; suboptimal for local control Optimal for semantic normalization, secondary use of data Provides transition path for standards adoption Better model for patient consent/auth, privacy and security Optimal for local control; suboptimal for sustainable business model No semantic normalization unless all end-points adopt common standards Significant burden on endpoints to support SLAs Inconsistent enforcement of privacy and security Compromise to improve performance over Federated Same considerations for local control, sustainable business model Same considerations for semantic normalization and high availability Same considerations for patient consent/auth, privacy and security 21

23 Identifying Security & Privacy Needs Security & Privacy Regulations Influence Healthcare Standards Influence Healthcare Needs Approves Organization Security & Privacy Policy Drives Security & privacy goals and objectives Approves Security & Privacy Risk Assessment Prioritizes Security & Privacy Countermeasures Creates Need For Includes a cost / benefit analysis Products & Services 22 22

24 The Chronology of an Attack Patch saturation is delayed due to PC s being unreachable, powered down or inoperable Accelerating patch saturation and minimizing the window of attack is key to mitigating risk of a breach and improving compliance with security & privacy policy 23 23

25 Client Initiated Remote Access Remote management using vpro AMT 1 (Active Management Technology) over the Internet Triggered on the Mobile Client PC by The User, or A Scheduled Maintenance Event, or A Platform Event / Alert 1. Requires the client PC to have an AMT-enabled chipset, network hardware and software, connection with a power source, a network connection, and setup and activation. 24

26 Is Full Disk Encryption 100% Secure? Security Layers Yes. Administrative Technical Physical If 51% of end users didn t write down their passwords on Post-It Notes and if 56% of business managers didn t disengage their encryption solution 25 25

27 BIG QUESTION: PHI on the Client? As data is more portable it is more susceptible to being lost or stolen. NO PHI on Client/ Thin only Improved Security Central Manageability Fast Provisioning Network Security and Reliability Bandwidth Requirements PHI on Client/ Rich compute Flexible compute models Online/Offline data access Remote access Cost of Downtime / Data Loss Security Regulatory requirements Choosing client compute models requires balancing multiple tensions including usage models. Organizations often have a mix

28 Intel Anti-Theft Technology for PC Protection Services Hardware Based Works with/without Network connectivity (wired or wireless) Rendezvous timer Failed login threshold Poison pill Protections Responses Recovery Encryption keys in Hardware Centrally trigger PC to display recovery message Disable PC (prevent boot) Disable access to data by either: Deleting encryption keys, or Deleting user credentials Recovery passphrase established at PC setup time to reenable PC One time token generated centrally to re-enable PC Leading Intel Anti-Theft Technology Enabled Software Services: Computrace, LoJack and WinMagic 27

29 Přínosy mhealth v dlouhodobé péči Cukrovka (1) 42% snížení nákladů na pacienta Chronická obstrukční plicní nemoc (1) 50% redukce přijetí k hospitalizaci 55% snížení akutních exacerbací v domácnosti 17% snížení výdajů nemocnic Městnavé srdeční selhání (2) 35% zkrácení délky hospitalizace 10% redukce návštěv v ambulanci 65% snížení návštěv u pacienta (1) Max E. Stachura, MD, and Elena V. Khasanshina, MD, PhD. Telehomecare and Remote Monitoring: An Outcomes Overview. The Advanced Medical Technology Association, October 31, 2007, accessed July 29, 2010, (2) John G.F. Cleland, MD, Amala A. Louis, Alan S. Rigby, PhD, Uwe Janssens, MD, Aggie H.M.M. Balk, MD, and others. Noninvasive Home Telemonitoring for Patients with Heart Failure at High Risk of Recurrent Admission and Death, Journal of the American College of Cardiology 45,no.10 (2005):

30 Shrnutí Transformace zdravotnictví potřebuje mhealth Před výběrem ICT řešení je nutné pochopit uživatelský model > jedno zařízení nevyhovuje všem Měření výsledků je nezbytné pro udržitelnost a popularitu řešení Jednoduché řešení může mít rozsáhlý přesah > je třeba začít teď Požadavky na bezpečnost a důvěrnost dat vytvářejí potřebu nových produktů a služeb 29