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Wireless capable medical devices with significant software and data integration are the future of OSEHRA

Shahid N. Shah
September 06, 2013

Wireless capable medical devices with significant software and data integration are the future of OSEHRA

OSEHRA's position in the open source and EHR ecosystems is special because of its size, breadth, and scope. It's deployed in so many institutions with so many clinical users that whatever we can learn from it can affect the healthcare industry at large. Wireless technologies are disrupting many industries and healthcare is next.

This talk covers:
* The state of mHealth and wireless in OSEHRA
* Marketplace and industry challenges for device vendors connecting to VistA
* Why wireless connectivity to OSEHRA is good business
* Why wireless connectivity to OSEHRA is a potentially disruptive innovation

Key takeaways are:
* Wireless is a business enabler but there’s a lot to consider.
* Hardware, sensors, and software are transient businesses but data lives forever. He who owns, integrates, and uses data wins in the end.
* Data from devices is too important and specialized to be left to software vendors, managed service providers, and system integrators.

Shahid N. Shah

September 06, 2013


  1. 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
  2. NETSPECTIVE www.netspective.com 2 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”
  3. NETSPECTIVE www.netspective.com 5 Bacteria used to kill us the most…

    Per 100k population, Historical Statistics of the United States, Millennial Edition
  4. NETSPECTIVE www.netspective.com 6 We’ve got most infections beat… …except the

    flu and pneumonia Per 100k population, Historical Statistics of the United States, Millennial Edition
  5. NETSPECTIVE www.netspective.com 7 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
  6. NETSPECTIVE www.netspective.com 8 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
  7. NETSPECTIVE www.netspective.com 9 Chronic Conditions Almost half the U.S. population

    needs chronic disease management Source: NCQA State of Healthcare Quality Report 2007 & Wellpoint
  8. NETSPECTIVE www.netspective.com 10 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
  9. NETSPECTIVE www.netspective.com 11 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
  10. NETSPECTIVE www.netspective.com 16 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
  11. NETSPECTIVE www.netspective.com 17 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.
  12. NETSPECTIVE www.netspective.com 18 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
  13. NETSPECTIVE www.netspective.com 19 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
  14. NETSPECTIVE www.netspective.com 20 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
  15. NETSPECTIVE www.netspective.com 21 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
  16. NETSPECTIVE www.netspective.com 25 Data changes the questions we ask Simple

    visual facts Complex visual facts Complex computable facts
  17. NETSPECTIVE www.netspective.com 26 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
  18. NETSPECTIVE www.netspective.com 32 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
  19. NETSPECTIVE www.netspective.com 33 What’s being offered to users What users

    really want Needed from OSEHRA: Reimagined User Interactions Data visualization requires integration and aggregation
  20. NETSPECTIVE www.netspective.com 36 Needed from OSEHRA: care team involvement HEALTHCARE

  21. NETSPECTIVE www.netspective.com 37 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