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Wireless capable medical devices with
significant software and data integration are the
future of OSEHRA
2nd Annual OSEHRA Summit
Shahid N. Shah
Chairman of OSEHRA Advisory Board
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NETSPECTIVE
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Who is Shahid?
• 20+ years of software engineering and multi-
site healthcare system deployment experience
• 12+ years of healthcare IT and medical devices
experience (blog at http://healthcareguy.com)
• 15+ 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”
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The Macro Environment
Healthcare needs are changing
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NETSPECTIVE
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Life expectancy is increasing…
…but the rate of growth is slowing
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NETSPECTIVE
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Bacteria used to kill us the most…
Per 100k population, Historical Statistics of the United States, Millennial Edition
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NETSPECTIVE
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We’ve got most infections beat…
…except the flu and pneumonia
Per 100k population, Historical Statistics of the United States, Millennial Edition
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NETSPECTIVE
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Top killers today
Heart disease Cancer
Chronic lower
respiratory
diseases
Top killers in 1900
Pneumonia
and influenza
TB
Diarrhea and
enteritis
Infectious diseases used to kill us…
…but what’s left seem only to be “manageable” not easily “curable”
Per 100k population, Historical Statistics of the United States, Millennial Edition
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NETSPECTIVE
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Death by age group, 1900 Death by age group, Today
From cures to management…
…young people don’t dye of diseases often now
http://siteresources.worldbank.org/INTHSD/Resources/topics/Health-Financing/HFRChap1.pdf
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NETSPECTIVE
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Chronic Conditions
Almost half the U.S. population needs chronic disease management
Source: NCQA State of Healthcare Quality Report 2007 & Wellpoint
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NETSPECTIVE
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Medicine has accepted lack of cures…
…we’re now focused on prevention and wellness (below is CDC’s framework)
http://www.cdc.gov/chronicdisease/resources/publications/AAG/chronic.htm
Objectives:
• Keep people out of the hospital ($$$)
• Keep people from their docs ($$)
• Keep people off drugs ($)
• Keep people at home
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NETSPECTIVE
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Keep patients away from hospitals
$0
$100
$200
$300
$400
$500
$600
$700
$800
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Hospital care, total
Physician and clinical services, total
Nursing care facilities and continuing care
retirement communities, total
Prescription drugs, total
Hospitalization, physician and clinical services total more than $1.2 Trillion today
http://www.census.gov/compendia/statab/cats/health_nutrition/health_expenditures.html
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NETSPECTIVE
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Health services centralization tried
Source: Jason Hwang, Innosight, via Jeff Selberg of IHI
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…now comes decentralization and innovation
Source: Jason Hwang, Innosight, via Jeff Selberg of IHI
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Consumers will need do/pay more…
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Technological Implications for OSEHRA
Community
What are some of the new requirements?
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The realities of patient populations
• 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 & 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
Prevention Management
26 % of Population
4 % of Medical Costs
35 % of Population
22 % of Medical Costs
35 % of Population
37 % of Medical Costs
4% of Population
36 % of Medical Costs
Source: Amir Jafri, PrescribeWell
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NETSPECTIVE
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Patient Collaboration Maturity Model
Independent
Care
Connected Care
Coordinated Care
Integrated Care
Accountable Care
Choosing a single EHR vendor as your
platform for connected care won’t work
beyond integrated care scenarios.
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NETSPECTIVE
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The new world order
General
Wellness
Specific
Prevention
Self Service
Physiologics
Self Service
Monitoring
Self Service
Diagnostics
Care Team
Monitoring
Care Team
Diagnostics
Healthcare
Professional
Monitoring
Healthcare
Professional
Diagnostics
Hospital
Monitoring
Hospital
Diagnostics
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NETSPECTIVE
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Is OSEHRA / VistA ready?
Improve speed of
response to new
patient/HCP needs
Reduce
permission-
oriented culture
React faster to
regulatory and
market changes
Reduce number of
Shadow IT systems
Reduce
compliance-focus
in favor of
customer focus
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NETSPECTIVE
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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 2012
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NETSPECTIVE
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Digitize biology
Digitize
chemistry
Digitize physics
Predict
fundamental
behaviors
Digitize
mathematics
Digitize
literature
Digitize social
behavior
Predict human
behavior
We’re digitizing biology
Last and past decades This and future decades
Gigabytes and petabytes Petabytes and exabytes
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Consumerization of physiologics….
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Consumerization of labs / genes
Labs on chips Personal Genomics
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Consumerization of monitoring
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Data changes the questions we ask
Simple visual facts Complex visual facts Complex computable
facts
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Implications for scientific discovery
The old way
Identify
problem
Ask
questions
Collect
data
Answer
questions
The new way
Identify
data
Generate
questions
Mine data
Answer
questions
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Wireless Body Area Network (BAN)
The cornerstone of mHealth
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Wireless BAN Ecosystem
Source: Qualcomm
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Wireless Protocols Comparison
http://acamp.ca/alberta-micro-nano/images/docs/Technology-Presentations/Ken-Fyfe-HealthMedical-Dec09.pdf
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ANT+ is winning ULP protocol battle
http://acamp.ca/alberta-micro-nano/images/docs/Technology-Presentations/Ken-Fyfe-HealthMedical-Dec09.pdf
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How the OSEHRA Community Should Respond
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NETSPECTIVE
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VA, VHA, VistA, and OSEHRA
Top-notch pedigree and a well funded buyer of innovation
VHA OSEHRA Community
VistA EHR Code
Data 1
Facility 1 Facility 2 …
Data 2 …
OSEHRA Core
IV&V (Test, Docs)
Certify
OSEHRA Add-ons Contributed Add-ons
Contributed Core
OSEHRA Deployment
Contributed Tests/Docs
Convergence, Refactoring
2011
2013
Free or Commercial
2013
Commercial Deployments
VA FY2012 IT Spend: $3.1 B
Innovation
Coordination
Delivery
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What’s being offered to users What users really want
Needed from OSEHRA: Reimagined User Interactions
Data visualization requires integration and aggregation
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Needed from OSEHRA: diagnostic quality mHealth
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Needed from OSEHRA: sophisticated analytics
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Needed from OSEHRA: care team involvement
HEALTHCARE
PROVIDER
PATIENT/
CONSUMER
HOSPITAL
FAMILY
CAREGIVER
ALTERNATE
SITE OF CARE
Care Team
CALL CENTERS AND
REMOTE SUPPORT
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NETSPECTIVE
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Needed: Self-service applications
Patient Scheduling
for Services
Secure Social Patient
Relationship
Management (PRM)
Patient
Communications,
SMS, IM, E-mail,
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
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Needed from OSEHRA: automated diagnostics