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Demand connected medical devices to improve military EHRs

Demand connected medical devices to improve military EHRs

Presented at Military and Government EHRs Symposium at Pentagon City.

Shahid N. Shah

November 06, 2014
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  1. Demand connected medical devices to
    improve military EHRs
    Change procurement of medical devices to help fill EHRs with
    clinically useful data for comparative effectiveness research
    and data interoperability

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  2. www.netspective.com 2
    @ShahidNShah
    Who is Shahid?
    • 25+ years of 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”

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  3. @ShahidNShah
    www.netspective.com 3
    What’s this talk about?
    Miliary Health IT / 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.

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  4. www.netspective.com 4
    @ShahidNShah
    What problems can data help solve?
    Cost 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

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  5. @ShahidNShah
    www.netspective.com 5
    Patient populations need different solutions
    • 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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  6. www.netspective.com 6
    The digital enterprise is
    revolving rapidly based
    on 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

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  7. @ShahidNShah
    www.netspective.com 7
    We’ve seemingly accepted lack of cures…
    The 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

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  8. @ShahidNShah
    www.netspective.com 8
    Data changes the questions we ask
    Simple visual facts Complex visual facts Complex computable
    facts

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  9. @ShahidNShah
    www.netspective.com 9
    Data can change medical science
    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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  10. www.netspective.com 10
    @ShahidNShah
    Data Comprehension is hard
    What does it
    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

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  11. www.netspective.com 11
    Data
    Medical Hardware
    Consumer Hardware
    Health Records
    Patient 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

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  12. www.netspective.com 12
    @ShahidNShah
    Unstructured phenotypic patient data sources
    Patient Health
    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

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  13. www.netspective.com 13
    @ShahidNShah
    Structured phenotypic patient data sources
    Patient Health
    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

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  14. www.netspective.com 14
    @ShahidNShah
    Demand medical device integration/connectivity
    Most obvious benefit Least attention
    Most promising
    capability
    This talk focuses on
    connected devices

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  15. www.netspective.com 15
    @ShahidNShah
    Procure poly-connectable devices
    Device
    Hospital
    Network
    Corporate
    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

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  16. www.netspective.com 16
    @ShahidNShah
    Demand better manageability in devices
    Security
    • Is the device
    authorized?
    Inventory
    • Where is the device?
    Presence
    • Is a device connected?
    Teaming
    • Device grouping

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  17. www.netspective.com 17
    @ShahidNShah
    Demand extensibility
    Legacy
    Devices
    Future
    Devices

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  18. @ShahidNShah
    www.netspective.com 18
    Start procuring consumer-grade physiologics

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  19. @ShahidNShah
    www.netspective.com 19
    Invest in digital biology and digital chemistry
    Labs on chips Personal Genomics

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  20. @ShahidNShah
    www.netspective.com 20
    Start procuring consumer grade monitoring

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  21. www.netspective.com 21
    @ShahidNShah
    Invest in predictive analytics and CEP

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  22. @ShahidNShah
    www.netspective.com 22
    Device Components 3rd Party Plugins
    App
    #1
    App
    #2
    Security and Management Layer
    Device OS
    (QNX, Linux, Windows)
    Sensors Storage Display Plugins
    Web Server, IM Client
    Connectivity Layer (DDS, HTTP, XMPP)
    • Presence
    • Messaging
    • Registration
    • JDBC, Query
    Cloud
    Services
    Management
    Dashboards
    Data Transformation (ESB, HL7)
    Device Gateway (DDS, ESB)
    Healthcare Enterprise
    Enterprise
    Data
    Demand Connected Architecture
    Plugin Container
    Event Architecture
    Inventory
    Workflow
    Notifications
    Patient Context
    Location
    Aware
    1 2
    3
    4
    5
    6
    7
    8
    9
    SSL VPN

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  23. @ShahidNShah
    www.netspective.com 23
    Ultimate Architecture Core
    Device Components
    Security and 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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  24. @ShahidNShah
    www.netspective.com 24
    Connectivity components
    Device Components
    Security and Management Layer
    Device OS
    (QNX, Linux, Windows)
    Web Server, IM Client
    Connectivity Layer (DDS, HTTP, XMPP)
    • Presence
    • Messaging
    • Registration
    • JDBC, Query
    Plugin Container
    Surveillance &
    “remote display”
    Remote Access
    Alarms Event Viewer
    Design all
    functions as
    plugins

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  25. @ShahidNShah
    www.netspective.com 25
    Demand enterprise integration
    Cloud
    Services
    Management
    Dashboards
    Data Transformation (ESB, HL7)
    Device Gateway
    (DDS, XMPP, ESB)
    Enterprise
    Data
    Inventory
    Cross Device
    App Workflows
    Alarm
    Notifications
    Patient Context
    Monitoring
    Device
    Teaming
    Device
    Management
    Report
    Generation
    HIT
    Integration
    Remote
    Surveillance
    Device
    Data
    SSL VPN

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  26. Conclusion and Questions
    @ShahidNShah [email protected]
    www.ShahidShah.com

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