Wireless capable medical devices with significant software and data integration are the future of OSEHRA

Transcription

1 Wireless capable medical devices with significant software and data integration are the future of OSEHRA 2 nd Annual OSEHRA Summit Shahid N. Shah Chairman of OSEHRA Advisory Board

2 This and many of my other presentations are available at 2

3 Who is Shahid? 20+ years of software engineering and multisite healthcare system deployment experience 12+ years of healthcare IT and medical devices experience (blog at years of technology management experience (government, non-profit, commercial) 10+ years as architect, engineer, and implementation manager on various EMR and EHR initiatives (commercial and non-profit) Author of Chapter 13, You re the CIO of your Own Office 3

4 Healthcare needs are changing The Macro Environment

5 Life expectancy is increasing but the rate of growth is slowing 5

6 Bacteria used to kill us the most Per 100k population, Historical Statistics of the United States, Millennial Edition 6

7 We ve got most infections beat except the flu and pneumonia Per 100k population, Historical Statistics of the United States, Millennial Edition 7

8 Infectious diseases used to kill us but what s left seem only to be manageable not easily curable Top killers in 1900 Pneumonia and influenza TB Diarrhea and enteritis Top killers today Heart disease Cancer Chronic lower respiratory diseases Per 100k population, Historical Statistics of the United States, Millennial Edition 8

9 From cures to management young people don t dye of diseases often now Death by age group, 1900 Death by age group, Today 9

10 Chronic Conditions Almost half the U.S. population needs chronic disease management Source: NCQA State of Healthcare Quality Report 2007 & Wellpoint 10

11 Medicine has accepted lack of cures we re now focused on prevention and wellness (below is CDC s framework) Objectives: Keep people out of the hospital ($$$) Keep people from their docs ($$) Keep people off drugs ($) Keep people at home

12 Keep patients away from hospitals Hospitalization, physician and clinical services total more than $1.2 Trillion today $800 $700 Hospital care, total Physician and clinical services, total $600 $500 Nursing care facilities and continuing care retirement communities, total Prescription drugs, total $400 $300 $200 $100 $

13 Health services centralization tried Source: Jason Hwang, Innosight, via Jeff Selberg of IHI 13

14 now comes decentralization and innovation Source: Jason Hwang, Innosight, via Jeff Selberg of IHI 14

15 Consumers will need do/pay more 15

16 What are some of the new requirements? Technological Implications for OSEHRA Community

17 The realities of patient populations Prevention Management Education Health Promotions Healthy Lifestyle Choices Health Risk Assessment Obesity Management Wellness Management Assessment HRA Stratification Dietary Physical Activity Physician Coordination Social Network Behavior Modification 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 26 % of Population 35 % of Population 35 % of Population 4% of Population 4 % of Medical Costs 22 % of Medical Costs 37 % of Medical Costs 36 % of Medical Costs Source: Amir Jafri, PrescribeWell 17

18 Patient Collaboration Maturity Model Integrated Care Accountable Care Coordinated Care Connected Care Independent Care Choosing a single EHR vendor as your platform for connected care won t work beyond integrated care scenarios. 18

19 The new world order General Wellness Specific Prevention Self Service Physiologics Self Service Monitoring Healthcare Professional Monitoring Care Team Diagnostics Care Team Monitoring Self Service Diagnostics Healthcare Professional Diagnostics Hospital Monitoring Hospital Diagnostics 19

20 Is OSEHRA / VistA ready? Improve speed of response to new patient/hcp needs Reduce permissionoriented culture React faster to regulatory and market changes Reduce number of Shadow IT systems Reduce compliance-focus in favor of customer focus 20

21 NEJM believes doctors are trapped It is a widely accepted myth that medicine requires complex, highly specialized information-technology (IT) systems. This myth continues to justify soaring IT costs, burdensome physician workloads, and stagnation in innovation while doctors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their civilian life. New England Journal of Medicine Escaping the EHR Trap - The Future of Health IT, June

22 We re digitizing biology Last and past decades This and future decades Digitize mathematics Digitize literature Digitize biology Digitize chemistry Digitize social behavior Predict human behavior Digitize physics Predict fundamental behaviors Gigabytes and petabytes Petabytes and exabytes 22

23 Consumerization of physiologics. 23

24 Consumerization of labs / genes Labs on chips Personal Genomics 24

25 Consumerization of monitoring 25

26 Data changes the questions we ask Simple visual facts Complex visual facts Complex computable facts 26

27 Implications for scientific discovery The old way Identify problem The new way Identify data Ask questions Generate questions Collect data Mine data Answer questions Answer questions 27

28 Wireless Body Area Network (BAN) The cornerstone of mhealth 28

29 Wireless BAN Ecosystem Source: Qualcomm 29

30 Wireless Protocols Comparison

31 ANT+ is winning ULP protocol battle

32 How the OSEHRA Community Should Respond

33 VA, VHA, VistA, and OSEHRA Top-notch pedigree and a well funded buyer of innovation VA FY2012 IT Spend: $3.1 B VHA OSEHRA Community VistA EHR Code 2011 Convergence, Refactoring OSEHRA Core 2013 Free or Commercial Contributed Core Facility 1 Facility 2 OSEHRA Add-ons Contributed Add-ons Data 1 Data 2 IV&V (Test, Docs) Contributed Tests/Docs OSEHRA Deployment 2013 Certify Commercial Deployments Delivery Coordination Innovation 33

34 Needed from OSEHRA: Reimagined User Interactions Data visualization requires integration and aggregation What s being offered to users What users really want 34

35 Needed from OSEHRA: diagnostic quality mhealth 35

36 Needed from OSEHRA: sophisticated analytics 36

37 Needed from OSEHRA: care team involvement PATIENT/ CONSUMER HEALTHCARE PROVIDER FAMILY CAREGIVER Care Team HOSPITAL CALL CENTERS AND REMOTE SUPPORT ALTERNATE SITE OF CARE 37

38 Needed: Self-service applications Patient Scheduling for Services Secure Social Patient Relationship Management (PRM) Patient Communications, SMS, IM, , Voice, and Telehealth Patient Education, Calculators, Widgets, Content Management Blue Button, HL7, X.12, HIEs, EHR, and HealthVault Integration E-commerce, Ads, Subscriptions, and Activity-based Billing Accountable Care, Patient Care Continuity and Coordination Patient Family and Community Engagement Patient Consent, Permissions, and Disclosure Management 38

39 Needed from OSEHRA: automated diagnostics 39

40 Questions? Thank you