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


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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.

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  • 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 Who is Shahid? • 20+ years of software engineering and multisite healthcare system deployment experience • 12+ years of healthcare IT and medical devices experience (blog at • 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” 2
  • 3. Healthcare needs are changing The Macro Environment
  • 4. NETSPECTIVE Life expectancy is increasing… …but the rate of growth is slowing 4
  • 5. NETSPECTIVE Bacteria used to kill us the most… Per 100k population, Historical Statistics of the United States, Millennial Edition 5
  • 6. NETSPECTIVE We’ve got most infections beat… …except the flu and pneumonia Per 100k population, Historical Statistics of the United States, Millennial Edition 6
  • 7. NETSPECTIVE Infectious diseases used to kill us… …but what’s left seem only to be “manageable” not easily “curable” Top killers in 1900 Pneumonia and influenza TB Diarrhea and enteritis Top killers today Heart disease Cancer Chronic lower respiratory diseases Per 100k population, Historical Statistics of the United States, Millennial Edition 7
  • 8. NETSPECTIVE From cures to management… …young people don’t dye of diseases often now Death by age group, 1900 Death by age group, Today 8
  • 9. NETSPECTIVE Chronic Conditions Almost half the U.S. population needs chronic disease management Source: NCQA State of Healthcare Quality Report 2007 & Wellpoint 9
  • 10. NETSPECTIVE Medicine has accepted lack of cures… …we’re now focused on prevention and wellness (below is CDC’s framework) Objectives: • Keep people out of the hospital ($$$) • Keep people from their docs ($$) • Keep people off drugs ($) • Keep people at home 10
  • 11. NETSPECTIVE Keep patients away from hospitals Hospitalization, physician and clinical services total more than $1.2 Trillion today $800 Hospital care, total $700 Physician and clinical services, total $600 Nursing care facilities and continuing care retirement communities, total Prescription drugs, total $500 $400 $300 $200 $100 $0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 11
  • 12. NETSPECTIVE Health services centralization tried Source: Jason Hwang, Innosight, via Jeff Selberg of IHI 12
  • 13. NETSPECTIVE …now comes decentralization and innovation Source: Jason Hwang, Innosight, via Jeff Selberg of IHI 13
  • 14. NETSPECTIVE Consumers will need do/pay more… 14
  • 15. What are some of the new requirements? Technological Implications for OSEHRA Community
  • 16. NETSPECTIVE The realities of patient populations Prevention • Education • Health Promotions • • Healthy Lifestyle Choices Health Risk Assessment Management • • Obesity Management Wellness Management • • • • • • • Assessment – HRA Stratification Dietary Physical Activity Physician Coordination Social Network Behavior Modification • • • 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 • • • 26 % of Population 35 % of Population 35 % of Population 4% of Population 4 % of Medical Costs 22 % of Medical Costs 37 % of Medical Costs 36 % of Medical Costs Source: Amir Jafri, PrescribeWell 16
  • 17. NETSPECTIVE Patient Collaboration Maturity Model Accountable Care Integrated Care Coordinated Care Connected Care Independent Care Choosing a single EHR vendor as your platform for connected care won’t work beyond integrated care scenarios. 17
  • 18. NETSPECTIVE The new world order General Wellness Self Service Physiologics Self Service Monitoring Healthcare Professional Monitoring Care Team Diagnostics Care Team Monitoring Self Service Diagnostics Healthcare Professional Diagnostics Specific Prevention Hospital Monitoring Hospital Diagnostics 18
  • 19. NETSPECTIVE Is OSEHRA / VistA ready? Improve speed of response to new patient/HCP needs Reduce permissionoriented culture Reduce number of Shadow IT systems React faster to regulatory and market changes Reduce compliance-focus in favor of customer focus 19
  • 20. NETSPECTIVE 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 20
  • 21. NETSPECTIVE We’re digitizing biology Last and past decades Digitize mathematics Digitize social behavior This and future decades Digitize literature Predict human behavior Gigabytes and petabytes Digitize biology Digitize chemistry Digitize physics Predict fundamental behaviors Petabytes and exabytes 21
  • 22. NETSPECTIVE Consumerization of physiologics…. 22
  • 23. NETSPECTIVE Consumerization of labs / genes Labs on chips Personal Genomics 23
  • 24. NETSPECTIVE Consumerization of monitoring 24
  • 25. NETSPECTIVE Data changes the questions we ask Simple visual facts Complex visual facts Complex computable facts 25
  • 26. NETSPECTIVE Implications for scientific discovery The old way Identify problem Identify data Ask questions Generate questions Collect data Mine data Answer questions The new way Answer questions 26
  • 27. NETSPECTIVE Wireless Body Area Network (BAN) The cornerstone of mHealth 27
  • 28. NETSPECTIVE Wireless BAN Ecosystem Source: Qualcomm 28
  • 29. NETSPECTIVE Wireless Protocols Comparison 29
  • 30. NETSPECTIVE ANT+ is winning ULP protocol battle 30
  • 31. How the OSEHRA Community Should Respond
  • 32. NETSPECTIVE VA, VHA, VistA, and OSEHRA Top-notch pedigree and a well funded buyer of innovation VA FY2012 IT Spend: $3.1 B VHA OSEHRA 2011 VistA EHR Code Community Convergence, Refactoring OSEHRA Core Free or Commercial 2013 Contributed Core Data 1 Facility 2 … OSEHRA Add-ons Contributed Add-ons Data 2 Facility 1 … IV&V (Test, Docs) Contributed Tests/Docs Certify Commercial Deployments Coordination Innovation OSEHRA Deployment Delivery 2013 32
  • 33. NETSPECTIVE Needed from OSEHRA: Reimagined User Interactions Data visualization requires integration and aggregation What’s being offered to users What users really want 33
  • 34. NETSPECTIVE Needed from OSEHRA: diagnostic quality mHealth 34
  • 35. NETSPECTIVE Needed from OSEHRA: sophisticated analytics 35
  • 37. NETSPECTIVE 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 37
  • 38. NETSPECTIVE Needed from OSEHRA: automated diagnostics 38
  • 39. @ShahidNShah Questions? Thank you