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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
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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
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Transcript

  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

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  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”

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  3. The Macro Environment
    Healthcare needs are changing

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  4. NETSPECTIVE
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    Life expectancy is increasing…
    …but the rate of growth is slowing

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  5. 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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  6. 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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  7. 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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  8. 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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  9. 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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  10. 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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  11. 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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  12. NETSPECTIVE
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    Health services centralization tried
    Source: Jason Hwang, Innosight, via Jeff Selberg of IHI

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  13. NETSPECTIVE
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    …now comes decentralization and innovation
    Source: Jason Hwang, Innosight, via Jeff Selberg of IHI

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  14. NETSPECTIVE
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    Consumers will need do/pay more…

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  15. Technological Implications for OSEHRA
    Community
    What are some of the new requirements?

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  16. NETSPECTIVE
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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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  17. 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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  18. 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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  19. 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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  20. 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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  21. 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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  22. NETSPECTIVE
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    Consumerization of physiologics….

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  23. NETSPECTIVE
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    Consumerization of labs / genes
    Labs on chips Personal Genomics

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  24. NETSPECTIVE
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    Consumerization of monitoring

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  25. NETSPECTIVE
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    Data changes the questions we ask
    Simple visual facts Complex visual facts Complex computable
    facts

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  26. NETSPECTIVE
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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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  27. NETSPECTIVE
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    Wireless Body Area Network (BAN)
    The cornerstone of mHealth

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  28. NETSPECTIVE
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    Wireless BAN Ecosystem
    Source: Qualcomm

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  29. NETSPECTIVE
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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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  30. NETSPECTIVE
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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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  31. How the OSEHRA Community Should Respond

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  32. 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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  33. NETSPECTIVE
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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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  34. NETSPECTIVE
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    Needed from OSEHRA: diagnostic quality mHealth

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  35. NETSPECTIVE
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    Needed from OSEHRA: sophisticated analytics

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  36. NETSPECTIVE
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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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  37. 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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  38. NETSPECTIVE
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    Needed from OSEHRA: automated diagnostics

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  39. Thank you
    Questions?
    http://healthcareguy.com
    @ShahidNShah
    [email protected]

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