Enabling Technologies for Healthcare Transformation & SOA

Transcription

1 Enabling Technologies for Healthcare Transformation & SOA Chalapathy Neti, Shahram Ebadollahi, Sridhar Iyengar, Henry Chang* IBM TJ Watson Research Centre 2010 IBM Corporation

2 A new Healthcare Ecosystem needs to Integrated Enabled by data-driven evidence Be measured and driven to deliver patient outcomes Be more efficient and economical Present growth opportunities for ecosystem participants Deliver better quality healthcare for all 2010 IBM Corporation

3 Healthcare Transformation IBM Point of View Thesis The industry is is moving towards an an -centric healthcare ecosystem to to drive healthcare transformation and yield lower costs and improved outcomes Change Implications Proper alignment of of payment and incentives to to evidence-centric healthcare delivery, along with large-scale comparative effectiveness evidence generation and delivery platforms is is critical to to drive this transformation IBM Response Participate and lead transformation of of Healthcare delivery models like Patient Centered Medical Home Deliver business analytics solutions that facilitate the implementation of of evidence-centric models through service, software and cloud computing capabilities 2010 IBM Corporation Healthcare Transformation 3

4 Healthcare Transformation The healthcare transformation at Geisinger is an example of how an evidence-centric ecosystem with novel incentives, comprehensive digitization of EHR, and analytics for identifying best practices can enable improved outcomes and operational efficiency Geisinger ProvenCare (CABG) Implemented EHR in 1995, CDIS in 2009 Developed best practice guidelines in 2008 ProvenCare/Acute episodic care program provides warranty on outcomes Benefits Readmission within 30 days (6.9% 3.8%) ; average total Length of Stay (LOS): (6.2d 5.7d) Reduced hospital mortality (1.5% 0%); number of Neurological complications (1.5% 0.6%) ; 2010 IBM Corporation Healthcare Transformation 4

5 Healthcare Transformation IBM is focused on four enabling capabilties for healthcare transformation Improve care delivery through useful evidence at the point of care Cognitive support and decision intelligence in the context of care delivery process Anticipate the need, tailor delivery centric Point of Care Enable transformation of Data to Generation Cloud and Data Trusts at the infrastructure level Analytics on federated data structures Novel security paradigms Workflow and Business process transformation Collaboration Information in context Feedback loop New businesses emerge to facilitate the collaboration and data analysis across the HC ecosystem Emerging Business Models Novel Incentives / Payment Models and outcome based payment models Optimization Tailoring payments to disease categories Provide incentives to enhance patient outcomes and reduce costs 2010 IBM Corporation Healthcare Transformation 5

6 Healthcare Transformation IBM is focused on four enabling capabilties for healthcare transformation Improve care delivery through useful evidence at the point of care Cognitive support and decision intelligence in the context of care delivery process Anticipate the need, tailor delivery centric Point of Care Enable transformation of Data to Generation Cloud and Data Trusts at the infrastructure level Analytics on federated data structures Novel security paradigms Workflow and Business process transformation Collaboration Information in context Feedback loop New businesses emerge to facilitate the collaboration and data analysis across the HC ecosystem Emerging Business Models Novel Incentives / Payment Models and outcome based payment models Optimization Tailoring payments to disease categories Provide incentives to enhance patient outcomes and reduce costs 2010 IBM Corporation Healthcare Transformation 6

7 Healthcare Transformation Emerging early diagnosis allows improved observation of the body s internal state before clinical symptoms appear. Earlier intervention results in improved outcomes and lower costs. Decision Support Assess Risk Refine Assessment Predict Diagnose Monitor Progression Predict Events Inform Therapeutics Disease Burden Baseline Risk Initiating Events Earliest Molecular Detection Proteomics Functional Imaging Earliest Clinical Detection Typical Current Intervention Cost 1/reversibility Time IBM Corporation Healthcare Transformation 7

8 Healthcare Transformation delivery at the point-of-care is enhanced by providing clinical decision intelligence via consumable delivery of evidence from up to date evidence sources and aggregators hub 1: e.g., Geisinger subscription hub 2: e.g., NCCN DRUGDEX in the context of patient care Process Analysis Collection Information Needs Analysis EMR/ CPOE hub N: e.g., National Registry Presentation Not for publication on OMG Web Site 2010 IBM Corporation Healthcare Transformation 8

9 Almaden Computer Science Example: Cardiac Clinical Decision Support System (contact: Dr. Tanveer Syeda-Mahmoud) Current diagnosis practice: 1. Physician makes a diagnosis based on a single patient s data and her prior experience. 2. No validation of diagnosis other than through second opinions. With a Clinical Decision Support System: 1. Physician makes a diagnosis as before. 2. A holistic model of the patient and his data EKG, echo video, heart sounds, demographics, is submitted to the CDI for feature extraction. 3. The patient s feature model is used to find pre-diagnosed (confirmed) patients with similar feature models. 4. System supplies statistics relating to diagnoses for these similar patients. 5. Physician validates/re-considers her diagnosis using the patient data, supplied statistics and similar patient data IBM Corporation

10 Almaden Computer Science AALIM: A System for Diagnostic Decision Support for Cardiac Patients AALIM Server AALIM CDS Portal AALIM Health Informatics The Aalim Cardiac Clinical Decision Support Application AALIM Data Warehouse AALIM Information Integration AALIM ETL workflows CIPS Drug database Oracle EMR Phillips EKG TraceMaster Siemens KinetDX Echo CIPS Cardiology reports 2010 IBM Corporation

11 A fictitious patient

12 Healthcare Transformation IBM is focused on four enabling capabilties for healthcare transformation Improve care delivery through useful evidence at the point of care Cognitive support and decision intelligence in the context of care delivery process Anticipate the need, tailor delivery centric Point of Care Enable transformation of Data to Generation Cloud and Data Trusts at the infrastructure level Analytics on federated data structures Novel security paradigms Workflow and Business process transformation Collaboration Information in context Feedback loop New businesses emerge to facilitate the collaboration and data analysis across the HC ecosystem Emerging Business Models Novel Incentives / Payment Models and outcome based payment models Optimization Tailoring payments to disease categories Provide incentives to enhance patient outcomes and reduce costs 2010 IBM Corporation Healthcare Transformation 12

13 Healthcare Transformation services platforms (e.g., Cloud) enable data aggregation, evidence extraction, synthesis and dissemination to consumers, providers, payers, pharmas, individuals, regulators EHR PHR Repositories & Registries Trends Claims RCT Synthesis Engine HSM Analytics Aggregators & providers Emergence of large scale consortia for data and evidence sharing Emergence of innovative companies for evidence generation & delivery Devices Not for publication on OMG Web Site 2010 IBM Corporation Healthcare Transformation 13

14 Example - EUResist: HAART Therapy Prediction (Dr. Michal Rosen-Zvi, IBM Research, Haifa) Predicts in-vivo efficacy of antiretroviral drug regimens, i.e., reduction in viral load. Combines 3 Machine Learning Predictive Technologies Uses Viral Genome and Patient demographic and clinical data Outperforms leading available resistance interpretation system Available on-line at: Computerworld Honors Program Finalist Prediction System 65,000 Therapies EuResist database Integrating IBM s HRL with EU researchers from Germany, Italy, Hungary, and England. 18,000 HIV-B patients DB2 V9 ARCA Arevir Karolinska Siena, Italy Cologne, Germany Stockholm, Sweden

15 Healthcare Transformation IBM is focused on four enabling capabilties for healthcare transformation Improve care delivery through useful evidence at the point of care Cognitive support and decision intelligence in the context of care delivery process Anticipate the need, tailor delivery centric Point of Care Enable transformation of Data to Generation Cloud and Data Trusts at the infrastructure level Analytics on federated data structures Novel security paradigms Workflow and Business process transformation Collaboration Information in context Feedback loop New businesses emerge to facilitate the collaboration and data analysis across the HC ecosystem Emerging Business Models Novel Incentives / Payment Models and outcome based payment models Optimization Tailoring payments to disease categories Provide incentives to enhance patient outcomes and reduce costs 2010 IBM Corporation Healthcare Transformation 15

16 Healthcare Transformation Outcome based payment incentives lead to improved outcomes and demand for evidence at point of care. This requires large scale evidence generation and comparative effectiveness clouds. Generation Platform Use at Point of Care EHR PHR Claims RCT Data Collection and Curation Comparative Effectivenes s Engine Registry Service Provision packet subscription Information Need Analysis Collection and Curation Consumable Delivery Use Monitoring Clinical Decision Intelligence EMR packet Outcome and -informed Payment Models Incentive + Incentives Improved Outcomes 2010 IBM Corporation Healthcare Transformation 16

17 Healthcare Transformation Availability of up-to-date evidence from evidence-aggregators enables the development of evidence-informed, outcome-based payment modeling and contract optimization services Trends subscription -informed incentives outcome Fee-for-service Incentives for Patient Outcome Incentives for Efficiency time Contract Optimization Services Fraud & Abuse Management Simulation Services informed Payment modeling Services Not for publication on OMG Web Site Payment Preferences 2010 IBM Corporation Healthcare Transformation 17

18 What-if analytics for chronic disease care optimization Selection of process and outcome targets and corresponding payments can be optimized to yield cost savings and better quality of care Should goals be relative or absolute? Bundle Parameters How should different goals be weighted? Scope of Episode Process Goals Outcome Goals Incentives to Providers Number of Episodes Number of Complications Compliance Rate Cost to Payer How does compliance impact short and long term costs? Provider Operating Expense Other Factors Patient Mix Patient Risk Factors How to design incentives to maximize compliance? Intensity of care required to comply Revenue to Provider What are reasonable outcome goals for patients with different risk factors? IBM Corporation 18

19 Healthcare Transformation IBM is focused on four enabling capabilties for healthcare transformation Improve care delivery through useful evidence at the point of care Cognitive support and decision intelligence in the context of care delivery process Anticipate the need, tailor delivery centric Point of Care Enable transformation of Data to Generation Cloud and Data Trusts at the infrastructure level Analytics on federated data structures Novel security paradigms Workflow and Business process transformation Collaboration Information in context Feedback loop New businesses emerge to facilitate the collaboration and data analysis across the HC ecosystem Emerging Business Models Novel Incentives / Payment Models and outcome based payment models Optimization Tailoring payments to disease categories Provide incentives to enhance patient outcomes and reduce costs 2010 IBM Corporation Healthcare Transformation 19

20 Healthcare Transformation We envision the emergence of brokerage businesses that aggregate evidence and provide customized delivery to various constituents (e.g. disease-specific evidence) Platforms and services Storage Services Service Provisioning Tools Hubs evidence Analytic Tools evidence monitor report Regulators Not for publication on OMG Web Site WebMD, SimulConsult, InfoButton could all evolve into this role 2010 IBM Corporation Healthcare Transformation 20

21 Healthcare Transformation and SOA 2010 IBM Corporation

22 SOA Reference Architecture Business Innovation and Optimization Services Facilitates better decision-making with real-time business information Development Services Interaction Services Process Services Information Services Enables collaboration between people, processes, and information Orchestrates and automates business processes Manages diverse data in a unified manner Our focus IT Service Management Integrated environment for design and creation of solution assets Partner Services Connects with trading partners Facilitates communication ESB between services Business App Services Builds on a robust, scaleable, and secure services environment Access Services Facilitates interactions with existing information and application assets Apps and Info Assets Manages and secures services, applications, and resources Infrastructure Services Optimizes throughput, availability, and performance Model, Assemble Deploy Manage 2010 IBM Corporation 22

23 Health Integration Framework Model The Health Integration Framework (HIF) provides a unifying structure (architecture and mindset) for our solution offerings, go-to-market, partner enablement and asset development strategies. This SOA-based approach enables our customers greater flexibility and enhances the effective use of their previously siloed departmental islands of data. Healthcare Provider and Payer Solutions Industry oriented solutions Solutions IBM Assets Partner Assets IBM and Partner Solution Assets Industry specific accelerators SOA Foundation Products and Brands SOA Reference Architecture Development Services Industry Content and Products Data Models and Industry Optimized Products Interaction Services Process Services Information Services ESB Partner Service Business App Service Access Services Infrastructure Services IT Service Mgmt SOA Foundation Products Health Integration Framework IBM Corporation 7/23/

24 Key SOA Standards from OMG and OASIS Relevant to Healthcare Business Modeling : Business Process Model & Notation (OMG BPMN) Design and simulate Healthcare Business Processes is becoming more common Application & Service Design : Unified Modeling Language (OMG UML), Service Oriented Architecture Modeling Language (OMG SoaML) Design of Application Architecture using UML is also becoming more common Design of Services using OMG SoaML is emergent SOA Infrastructure standards Service Component Architecture (Oasis SCA) Business Process Execution Language (Oasis BPEL) 2010 IBM Corporation 24

25 Data Sources TWINS Master Data Service Platform Consuming Applications & Development Environment Customer Portal Sales Marketing Call Center Workflow Dev Tools ORCL Oracle Reporting Legacy Metadata Data templates Domain-specific algorithms Relationship Management Relationship views Hierarchical tree view Data Quality Address Cleansing Name Parsing TRILLIUM Analytics Other 3 rd Party Data High-performance execution High-volume data processing High-accuracy match & link Integration Java or.net Web Services/SOA Data Stewardship Human Resolution Enforce Data Governance Data Warehouse & Data Marts ESB, EAI, MOM 2010 IBM Corporation 25

26 Rapid Deployment Initiate Exchange SAAS + Appliance 2010 IBM Corporation 26

27 IBM s Collaborative Care Cloud Solution Cloud/SaaS EMR/PMS PHR Patient Consumer Physician Portal Care Team Portal Health Plan Portal (future) Health Analytics and Clinical Decision Support Clinical & Claims Data NCQA PCMH Accountable Care Package Claims Fraud and Abuse Mgmt PQRI quality measures Bio-Surveillance Care Engine Population Care and Patient Risk Stratification & Risk Management Bi Directional Orders and Results HSP Initiate MPI, Consent Policy, Audit Log, Provider Registry, Policy Repository Initiate Physician Connect CCHIT and EMR Adapters to rapidly Implement exchange Document and Image Sharing 27 Reference Labs Hospital Systems EMR Shared Registration For EMR & Paper Based Practices Results Delivery Health Plan Claims Tx Pharmacy Systems & PBM 2010 IBM Corporation 27

28 IBM Information Agenda Strategic Business Drivers Industry Solutions Industry Framework SOA Foundation & Infrastructue Governance 2010 IBM Corporation 28 28

29 The transformed Healthcare Ecosystem Is integrated Is enabled by data-driven evidence Is measured and driven to deliver patient outcomes Is more efficient and economical Presents growth opportunities for ecosystem participants Should deliver better quality healthcare for all 2010 IBM Corporation 29