software engineering and multi-site healthcare system deployment experience • 20+ years of technology management experience (government, non-profit, commercial) • 15+ years of digital health, healthcare IT and medical devices experience (blog at http://healthcareguy.com) Author of Chapter 13, “You’re the CIO of your Own Office”
/ MedTech Landscape • Data has potential to solve some hard healthcare problems and change how medical science is done. • The government & military are paying for the manual collection and clerk- like entry of clinical data. • Current data collection is unreliable, slow, and error prone. Key Takeaways • Medical devices are the best sources of quantifiable, analyzable, and reportable clinical data. • New devices must be designed and deployed to support inherent connectivity. • Government and military buyers have the procurement muscle to force vendors to become more connected.
per patient per procedure / treatment going up but without ability to explain why Cost for same procedure / treatment plan highly variable across localities Unable to compare drug efficacy across patient populations Unable to compare health treatment effectiveness across patients Variability in fees and treatments promotes fraud Lack of visibility of entire patient record causes medical errors
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
key trends, health systems’ evolution, and IT’s evolution Key Industry Trends . Health System Evolution IT Systems Evolution IT Role Evolution Fee For Service, Shared Risk, Bundled Payments, etc. Value, Care Management, Population Management PRESENT Full Risk, Integrated Health Plan & Care Delivery System Personalized Medicine, Wellness Management FUTURE Fee For Service Volume/Episodic Care PAST Integrated EHR Health Information Exchange (HIE) Enterprise Data Warehouse (EDW) Patient Engagement Mobile Health Connected Care Wellness Management Advanced Informatics Personalized Medicine Ancillary Systems (Lab/Rad/Pharmacy, etc.) Enterprise Resource Planning (HR, GL, SCM) Revenue Cycle Ambulatory EHR Hospital EHR Patient Access Enabler Innovator Installer Integrator Integrated Healthcare Network Integrated Healthcare Ecosystem Multi-Specialty Care Clinic & Hospital Integrated Healthcare System Source: Bruce Metz, CIO, Lahey Health
Shift The clinical model is shifting away from treatment of chronic conditions and focusing more on prevention, wellness, obesity intervention, behavior and lifestyle modification. Objectives • Keep people out of the hospital ($$$) • Keep people from their docs ($$) • Keep people off drugs ($) • Keep people at home Implications Clinical operations are shifting to hospital and physician ‘centered’ services that will rely heavily on health information technologies to monitor, coordinate, and manage care. • Successful Transition in Care resulting in Reduced Hospital Readmission Rates • Proactive population management • Patient engagement and collaboration • Disease prevention through wellness and obesity management • Chronic disease management • Care coordination and collaboration • Metrics and analytics
mean? How do I use it? • Must be continuously recomputed • Difficult today, easier tomorrow • Super-personalized • Prospective • Predictive Bio IT and Genomics Secondary Aggregation • Can be collected infrequently • Personalized • Prospective • Potentially predictive • Digital • Family history is easier Phenotypics Primary Data Collection • Continuously collected • Mostly Retrospective • Useful for population health • Part digital, mostly analog • Family History is hard Admin Data Collection • Business focused data • Retrospective • Built on fee for service models • Inward looking and not focused on clinical benefits Biosensors Social Interactions
IT Social Media Health Literacy Retail purchases Behaviors IoT Sensors Hardware Software Pharma / Clinical Trials Labs / Imaging Payments Bioinformatics Health Info Exchg Provider Engagement Care Coordination Compliance Marketing IT Retrospective Prospective Med Devices Integration Comprehension Tools, Storage, Services Science, Discovery Research Consent Digital Chemistry Provider Stature Ratings/reviews
Professional Labs & Diagnostics Medical Devices Biomarkers / Genetics Source Self reported by patient Observations by HCP Computed from specimens Computed real- time from patient Computed from specimens Errors High Medium Low Time Slow Slow Medium Reliability Low Medium High Data size Megabytes Megabytes Megabytes Data type PDFs, images PDFs, images PDFs, images Availability Common Common Common Uncommon Uncommon
Professional Labs & Diagnostics Medical Devices Biomarkers / Genetics Source Self reported by patient Observations by HCP Specimens Real-time from patient Specimens Errors High Medium Low Low Low Time Slow Slow Medium Fast Slow Reliability Low Medium High High High Discrete size Kilobytes Kilobytes Kilobytes Megabytes Gigabytes Streaming size Gigabytes Gigabytes Availability Uncommon Common Somewhat Common Uncommon Uncommon
Gateway External Cloud Hospital Systems Option 1 (no cellular access or hospital IT integration required) Device External Cloud Option 2 (cellular access and no hospital IT integration required) DDS REST HL7 X.12 DDS REST MPEG-21 MPEG-21 Could be a Home Network, too Wired Wireless Bluetooth, WiFi, Zibee, etc. Wireless, Cellular MQTT MQTT XMPP XMPP
Management Layer Device OS (QNX, Linux, Windows) Connectivity Layer (DDS, HTTP, XMPP) Plugin Container Don’t create your own OS! Security isn’t added later Think about Plugins from day 1 Connectivity is built-in, not added Build on Open Source Create code as a last resort
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