A Tech Entrepreneur Meets Academic Pathology

Transcription

1 A Tech Entrepreneur Meets Academic Pathology David Nessl, PMP, MBA, Adj. Professor of Business Chief Technology Officer (CTO) Dept. of Pathology / UF PathLabs University of Florida 01/31/2013 A Tech Entrepreneur Meets Pathology 1

2 My Background I come to Pathology IT/Informatics as an outsider from many other industries Early career: enterprise academic IT Manager of worldwide marketing group at Lexmark Project manager of enterprise software development (finance industry, DoD) Created 2 tech startups Adjunct business professor Trailing spouse of neurology professor 01/31/2013 A Tech Entrepreneur Meets Pathology 2

3 Cracking the Political Environment 01/31/2013 A Tech Entrepreneur Meets Pathology 3

4 Pathology Dept Labs vs University Hospitals University President College of Medicine VP Health Affairs University Hospital Dept of Pathology Pathology Dept Lab Mostly AP. Outreach patients. Hospital Pathology Lab Mostly CP. No/low outreach. 01/31/2013 A Tech Entrepreneur Meets Pathology 4

5 Is UF PathLabs Non-Clinical or Part of the Hospital? Neither! Clinical Non-Clinical (Academic/Research) Hospital UF PathLabs Dept of Pathology UF PathLabs is clinical, but not part of the hospital! 01/31/2013 A Tech Entrepreneur Meets Pathology 5

6 Old Reality: EMR/HIS/LIS Controlled By The Hospital University Healthcare System Patients Ordering Physicians Hospital HIS LIS Pathology Dept Lab Faculty Clinics Etc. 01/31/2013 A Tech Entrepreneur Meets Pathology 6

7 Target Reality: EMR Must Be Business-Unit Neutral University Healthcare System Ordering Physicians EMR Hospital Pathology Dept Lab Faculty Clinics Etc. Patient registration ADTs Orders Results Billing Clinical data mining Inpatient, Outpatient Outreach patients Outpatient 01/31/2013 A Tech Entrepreneur Meets Pathology 7

8 Outsider s View of Clinical Healthcare IT 01/31/2013 A Tech Entrepreneur Meets Pathology 8

9 Outsider s View of Clinical Healthcare IT Like going back in time years EMRs like Epic are like ERPs of 15 years ago Healthcare industry thinks it s special Banks and Fortune 500 companies would never settle for the IT systems that clinical healthcare thinks are A-OK Top EMR & LIS systems remain at the top only because of marketing and a captured customer base, not from merit 01/31/2013 A Tech Entrepreneur Meets Pathology 9

10 Fixing Clinical Healthcare IT: What s A Pathologist To Do? 1. Don t be fooled by EMR/LIS vendor marketing More customers doesn t mean happy customers: they re just captured 2. Tell your CIO that you know how bad and old the LIS or EMR technology really is. 3. But: It s too late to switch EMRs, so all you can do is help push the vendor for change With luck, EMRs will evolve like ERPs have, just 15 years delayed. 4. Alternate route: UF PathLabs will get a LIMS for next-gen (molecular/genetic) instruments, then gradually move AP tests from LIS to LIMS 01/31/2013 A Tech Entrepreneur Meets Pathology 10

11 The Big Pathology IT Goals 01/31/2013 A Tech Entrepreneur Meets Pathology 11

12 The Big Pathology IT Goals What it s about: Productivity, i.e. getting your mission done What it s not about: Technology, e.g. No inventing ways to handle big data for genetics and omics other fields like quantum physics have been there, done that. Clinical healthcare IT has to stop reinventing the wheel. 01/31/2013 A Tech Entrepreneur Meets Pathology 12

13 The Big Pathology IT Goals 1. Help clinicians make better test selections. 2. Help pathologists make better diagnoses and provide treatment recommendations 3. Make pathology results easier for clinicians to make good treatment decisions The Pathology Circle of Life 01/31/2013 A Tech Entrepreneur Meets Pathology 13

14 Goal 1: Help clinicians make better test selections. Computerized physician order entry (CPOE) should be like ordering a book on Amazon Search by test name, drug name, disease name (title, author, etc) Decision support: 80% of physicians who looked at ordering this test instead ordered the XYZ test 90% of physicians who ordered this test also ordered the XYZ test 01/31/2013 A Tech Entrepreneur Meets Pathology 14

15 Goal 2: Help pathologists make better diagnoses and treatment Pathologist cockpit recommendations In the AP LIS, an initial diagnosis of looks like maybe XYZ cancer should cause the LIS to automatically search the patient s full medical record to find correlating evidence, e.g. past cancer history or past CP tests or past genetic tests. 01/31/2013 A Tech Entrepreneur Meets Pathology 15

16 Goal 3: Make pathology results easier for clinicians to make good treatment decisions Formatted reports and rich data AP results reported as discrete values Integrating lifetime test results into the EMR E.g. new patient reports their current meds, the EMR a. Checks for patient s past genetic tests that contraindicate their current meds b. Suggest new genetic tests that can show if any of those meds are contraindicated 01/31/2013 A Tech Entrepreneur Meets Pathology 16

17 Creating Informaticists 01/31/2013 A Tech Entrepreneur Meets Pathology 17

18 Creating Informaticists Desired knowledge base: 1. Healthcare a. Clinical b. Research 2. Information Technology (IT) a. Healthcare industry b. And other industries 3. Project management 01/31/2013 A Tech Entrepreneur Meets Pathology 18

19 Creating Informaticists Knowledge base requirements Healthcare MD? PhD? Fellowship in Informatics? Executive MBA-like program in Informatics? 01/31/2013 A Tech Entrepreneur Meets Pathology 19

20 Creating Informaticists Knowledge base requirements IT Enterprise size experience Both healthcare & other industries Systems architecture Large software development experience Enterprise infrastructure admin experience Problem: No training programs! 01/31/2013 A Tech Entrepreneur Meets Pathology 20

21 The Mythical Informaticist Can we reasonably expect to find people with these skills? NO! Very rare. Can we reasonably expect to create people with these skills? NO! Would just create people who falsely think they understand. 01/31/2013 A Tech Entrepreneur Meets Pathology 21

22 The Mythical Informaticist So what do we do? Informatics partnerships! (Pairs!) One healthcare professional who has the credentials (MD) to influence clinicians and trump central IT managers The lead due to politics One IT professional with broad IT systems architect experience Both need project management training Two people, single voice. 01/31/2013 A Tech Entrepreneur Meets Pathology 22

23 Handling Clinical Genetic Data 01/31/2013 A Tech Entrepreneur Meets Pathology 23

24 Handling Clinical Genetic Data: What We Know (Based on UF s Personalized Medicine Program): Actionable results (phenotypes) can be sent into an LIS/EMR E.g. patient is low metabolizer of drug X ACTG data too big for LIS/EMR LIMS systems may be off-the-shelf solution Needs to be in a CAP/CLIA environment 01/31/2013 A Tech Entrepreneur Meets Pathology 24

25 Handling Clinical Genetic Data: What We Don t Know If research later identifies a drug-gene relationship in ACTG data that we ve recorded from past patients 1. Are we liable if we don t go back and mine for new results? 2. Do we report that result to the patient and/or the medical record in the EMR? 3. Do we amend or addend the old report, or create a new report? 4. Or do we need a new lifetime results medical record in the EMR that we just update? 01/31/2013 A Tech Entrepreneur Meets Pathology 25

26 Questions? 01/31/2013 A Tech Entrepreneur Meets Pathology 26