The Perfect Storm: CE and IT Convergence without Collaboration John Glaser, PhD Vice President and CIO Partners HealthCare April 4, 2009 It was an Unprecedented Set of Circumstances (Bob Case, NOAA) The Unprecedented Set of Health Care Circumstances Quality Safety Costs Access Technology innovation and convergence 1
US EMR Adoption Effectiveness of Use CAD/DM Smart Form Pilot Results Deficiency Addressed When Present at Index Visit Preintervention Visit Smart Form Visit P value Up to date blood pressure result (within 12 months) documented in vital signs 43/133 (32.3%) 14/15 (93.3%) < 0.001 Smoking status documented in health < 0.001 21/339 (6.2%) 11/46 (23.9%) maintenance or problem list Up to date A1c result (within 12 months) 24/226 (10.6%) 5/28 (17.9%) 0.34 Antiplatelet prescribed or < 0.001 10/309 (3.2%) 13/42 (31.0%) contraindication documented Beta-blocker prescribed or contraindication documented 1/24 (4.2%) 2/3 (66.7%) 0.03 Change in diabetic therapy if A1c > 7.0 44/413 (10.7%) 14/83 (16.9%) 0.11 % deficiencies addressed 7.9% 13.6% 0.0004 6 2
Proper Display of Genetic/Genomic Information Maintenance of Patient Genetic Profile Real Time Clinical Decision Support Population Based Clinical Decision Support Infrastructure to Manage Fast Emerging Knowledge Clinician Systems Enterprise Service Bus From PGP LMR Decision Support Event/Workflow Engine Patient Data Warehouse CPOE Patient Genome Browser Genetics Runtime Services Data Access Assessment Engine Knowledge Access Result Receiver Master Order Catalog Genetic Test Coverage PEPR Family History, Genetic-based Problems To Pt Data Warehouse PEAR Genetic-based Drug Allergies CDR Genetic Test Reports State Mgmt. Genetic Assessments GMR Genetic Markers Patient Genetic Profile GVIE Bus. Rules Gene Mgmt. Sys. Insight Genetics Reference & Authoring Svcs. Ensemble VariantWire Post Market Medication Surveillance Brownstein, PLoS ONE, 2007 Access to Your Medical Record 3
Clinical Data Exchange Across the Community Patient s Practitioners / Physicians Commercial Third Parties Application Clearinghouse Service / Aggregator Provider Hospitals / IDNs Integrated Academic Community Delivery Medical Hospital Network Center Specialty Community Hospital / Health Center Emergency Dept. / Clinic Secure Internet / Leased / Private Network Payers MassHealth Medicare (Medicaid) (CMS) Commercial Behavioral Health Plan Health, etc. Pharmacy Pharmacy Retail Drug Benefit Store Manager State / Public Health Entities Department of Public State Labs Health RLS / MAeHC Community Utility Help Desk & Portal Operations Support Hosted and Distributed Integration Services Labs & Diagnostic Centers Commercial Diagnostic Reference Imaging Lab Center HIT Stimulus Legislation 4
Information Technology IT Needs CE Clinical Engineering Ambulatory EHR Inpatient acute care documentation Decision support knowledge management Personal health records Physician practice device integration ICU device integration Infusion smart pump logic Integration of home monitoring equipment Clinical Engineering RFID-based asset tracking Results access CE Needs IT Information Technology Network infrastructure Clinical data repository Intensive care monitoring Networked monitoring Physician practice testing Flowsheets and order entry Wired and wireless networks IT EHR support teams Shared Goals 5
Shared Infrastructure KNOWLEDGE ASSET MANAGEMENT Committee Vetting & Sanctioning Shared Knowledge Management Clinical Knowledge Champions work with Subject Matter Experts KNOWLEDGE APPLICATION Applications for Virtual, Asynchronous Collaborative Authoring, Inventory, Updating and Maintenance KNOWLEDGE EDITORS WORKFLOW APPLICATIONS Knowledge Repository: Human Readable Specifications, Screen Shots, Process Flow Diagrams, References, and Data/Reports on Clinical Outcomes and Usability Organized by Clinical Discipline, Role, Venue, Process, and Mode of Application ANALYTIC DATA WAREHOUSE KNOWLEDGE DISCOVERY Shared Applications 6
Shared Regulations Potential Responses to the Convergence Establish an IT/CE high level committee Engage in joint strategy and project planning discussions Evaluate and approve new clinical and information technologies and medical device systems that will connect to the enterprise network Define approach to managing joint application projects Define the general technical requirements for device access to the enterprise network Determine management approaches to shared infrastructure Delineate responsibilities for special case situations/systems Noga, Volpe, Cooper Solving System Crashes, 24x7, March 2008 Potential Responses to the Convergence Identify individual(s) responsible for managing integrated device-it systems Establish clear IT/CE reporting and communication structure(s) for planning and issues resolution Establish appropriate service level agreements with vendors Establish test environments and disaster recovery capabilities 7
Potential Responses to the Convergence CE and IT professional organizations should work with the FDA and device manufacturers to define appropriate regulations CE and IT professional organizations should work with device manufacturers and network providers to establish standards and conventions for utilization of the wireless spectrum CE and IT professional organizations should collaborate on professional development and best practice compilation CE Reporting Relationship CE Reports To: IT Facilities Shared service Supply chain Outsourced Multiple groups Number (%) 7 (24%) 11 (38%) 2 (7%) 3 (10%) 2 (7%) 4 (14%) Spooner, B. Information Survey of 29 US Large Health Systems, 2009. Culture Regulation Support Care proximity Vendors Domain practices Be Mindful Of 8
Summary We are facing the perfect storm of healthcare pressures and demands. Addressing these challenges will require an effective collaboration between IT and CE. This collaboration can be facilitated by establishing some core management mechanisms and professional society joint activities. 9