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  • “Over a 2 year period, reduced prescription drug complications due to dispensing errors by over 30% from just over 6 errors per 1,000 patient-days to under 4” This statistic is a compilation over a 2 year period of approximately 22,000 inpatients per year. During this period from 2002 to 2004 there were 4 technologies which contributed to this dramatic improvement in patient care quality. First is the Pixas drug dispensing system which uses biometric authentication to control distribution of the right drugs to the right person. Second is improved drug checking software in the patient EMR which checks for adverse interaction between drug-drug, drug-food, and drug-patient allergies. Third is improved Pharmacy software guaranteeing Pharmacist verification before drug is given. Forth is the use of smart infusion pumps which include a computer system and data library guarding against the inadvertent delivery of drugs outside pre-set parameters.
  • {overview of solution here, coming from Joe}
    Key results of this implementation along with business process change include:
    Average Length of Stay has been reduced by nearly 10%
    Optimized bed management and capacity by 40%
    They have been able to cut their billing error rate from 20% to 5%
    Full deployment yields approx 150% ROI
    Admission, Discharge and Transfer Times decreased by 85%
    Discharges by Noon improved by 21%
    Improved safety and patient/staff satisfaction captured in hospital surveys
    Phase 2 of this roll-out is in progress
  • Average Length of Stay has been reduced by nearly 10%
    Optimized bed management and capacity by 40%
    They have been able to cut their billing error rate from 20% to 5%
    Full deployment yields approx 150% ROI
    Admission, Discharge and Transfer Times decreased by 85%
    Discharges by Noon improved by 21%
    Improved safety and patient/staff satisfaction captured in hospital surveys
  • <number>
    This case study is based off an Intel – Citrix solution showing real benefits to the end user by providing effective rich client management.
    EPIC EMR data base in the backend
    Citrix Presentation layer running off 1-way Intel-based blade servers, serving 100 max users per blade, avg. 30-40 users
    Rich clients run Citrix client software to interface with EPIC EMR Client.
    For full case study please visit the SSCC.intel.com: http://sscc.intel.com/docview.asp?FileId=8649&ClientType=1&sptId=671
    External link: http://cache-www.intel.com/cd/00/00/14/79/147907_147907.pdf
  • Referans

    1. 1. 1 Healthcare Transformation:Healthcare Transformation: Electronic Medical Records andElectronic Medical Records and Patient SafetyPatient Safety Mark Blatt MD Intel Corporation Digital Health Group Director Global Health Strategy June 2006 Mark.n.blatt@intel.com
    2. 2. 2 AgendaAgenda  IT in healthcare TrendsIT in healthcare Trends  CPOE, EMR’sCPOE, EMR’s  PACS / ImagingPACS / Imaging  Decision support systems (DSS)Decision support systems (DSS)
    3. 3. 3 Healthcare Business Pain PointsHealthcare Business Pain Points 1 1.5 2 2.5 3 3.5 4 4.5 5 Improve Relationship with Payers Improve Adminstrative Processes Improve Employee Productivity Comply with HIPAA Improve Customer Service Reduce Medical Errors Pain PointsIDC Healthcare Provider Survey. N=100 Top Business Issues Facing Healthcare Providers Handheld devices/EMR Handheld devices Security Outsourcing/Rev Cycle Mgmt Outsourcing/Billing Systems KM/CRM/Billing Systems IT Opportunities
    4. 4. 4 Healthcare Specific Top ITHealthcare Specific Top IT Investments 2005-06Investments 2005-06 1% 6% 11% 16% 21% 26% 31% 36% 41% 46% Portals Bedside scanners CIS SW Handheld devices Bar coding for medications CPOE Biometrics Telemedicine/remove monitoring Risk management Electronic medical records PACS/Image Management Rev Cycle Mgmt/Billing Systems IDC Healthcare Provider Survey. N=100 Q: Which of the following is your organization currently evaluating?
    5. 5. 5 Business Processes IT Can Impact…Business Processes IT Can Impact… Clinical  Prescription Writing and Management  eDetailing  Order Entry  Results Reporting  Clinical Documentation and Record Retrieval  Dictation and Transcription  Remote Patient Monitoring  Disease Management  Schedule Management  Continuum of Care Coordination  Emergency Services Consumer Services  Disease Management  Remote Patient Monitoring  Clinical Trial Participation  Immunization / Appt Reminders & Scheduling  Drug Interactions  Access to customer information and services Revenue Cycle  Eligibility Confirmation  Authorizations and Notifications  Charge Capture  Formulary Management  Referrals  Scheduling (office and/or facility)  Claims Status  Denials and Appeals Management Administrative  Patient Services  Discharge & Bed Management  Ubiquitous Information Access  Asset Management  Portable Device Tracking  Medical Record Tracking  Instant Messaging  Inventory Management
    6. 6. 6 The Digital Hospital: Business UsesThe Digital Hospital: Business Uses for ITfor IT 1.1. Reduce medical errorsReduce medical errors 2.2. Improve data qualityImprove data quality 3.3. Improve patient servicesImprove patient services 4.4. Consolidate patient data and archivingConsolidate patient data and archiving 5.5. Drive workflow efficiencies through BPI re-useDrive workflow efficiencies through BPI re-use and integrating services architecturesand integrating services architectures 6.6. Standards compliance through serviceStandards compliance through service oriented architecture (SOA) orchestrationoriented architecture (SOA) orchestration 7.7. Modernize antiquated hospital informationModernize antiquated hospital information systems (HIS) structuressystems (HIS) structures 8.8. Disparate systems integrationDisparate systems integration 9.9. Integrating and automating external suppliers,Integrating and automating external suppliers, insurance aggregators and extended servicesinsurance aggregators and extended services 10.10. Automating administration – real time billingAutomating administration – real time billing for time and materials to manage costsfor time and materials to manage costs The Digital Hospital Healthcare Transformation New users, new usage models
    7. 7. 7 The BenefitsThe Benefits 1.1.The right information available to the rightThe right information available to the right people at the right timepeople at the right time 2.2.Increased ProductivityIncreased Productivity 3.3.Reduced Administration & Medical ErrorsReduced Administration & Medical Errors 4.4.Faster Patient Through-putFaster Patient Through-put 5.5.Shorter Waiting ListsShorter Waiting Lists 6.6.Precise Inventory ManagementPrecise Inventory Management 7.7.Knowledge Mining & Statistical DataKnowledge Mining & Statistical Data Analysis PossibleAnalysis Possible 8.8.Significant Cost SavingsSignificant Cost Savings
    8. 8. 8 AgendaAgenda  IT in healthcare TrendsIT in healthcare Trends  CPOE, EMR’sCPOE, EMR’s  PACS / ImagingPACS / Imaging  Decision support systems (DSS)Decision support systems (DSS)
    9. 9. 9 Healthcare IndustryHealthcare Industry ProfessionalsProfessionals PharmaPharma PayersPayers PatientsPatients Hospital ClinicalClinical SystemsSystems ProductivityProductivity SystemsSystems BusinessBusiness SystemsSystems MedicalMedical EquipmentEquipment *Other names and brands may be claimed as property of others
    10. 10. 10 NETNET The Healthcare EcosystemThe Healthcare Ecosystem EMREMR SystemsSystems PersonalPersonal HealthHealth DevicesDevices PHRPHR SystemsSystems HomeHome Nursing HomeNursing Home Assist LivingAssist Living HospitalHospital MobileMobile InternetInternet PCPC DeviceDevice Phone/PDAPhone/PDA DongleDongle Doctor/ProviderDoctor/Provider InsurerInsurer LabLab PharmacyPharmacy RHIORHIO MonitoringMonitoring EducationEducation GuidanceGuidance PerformancePerformance AssuranceAssurance CommunicationCommunication Sensor integrationSensor integration PrescribingPrescribing EducationEducation EmergencyEmergency Treatment PlanTreatment Plan CommunityCommunity Patient DiaryPatient Diary InteractionsInteractions Personal Control PointPersonal Control Point DiagnosisDiagnosis Chart/NotesChart/Notes ImagesImages AdministrationAdministration Prescribing/CPOEPrescribing/CPOE Treatment PlanTreatment Plan InteractionsInteractions Evidence BaseEvidence Base MedicalMedical InformaticsInformatics PharmaPharma ProviderProvider GovernmentGovernment CDCCDC Outbreak DetectionOutbreak Detection Clinical TrialsClinical Trials Diagnosis ToolsDiagnosis Tools Population AnalysisPopulation Analysis Pay for PerformancePay for Performance Bio-MedicalBio-Medical LaboratoryLaboratory UniversityUniversity HospitalHospital ConsumerConsumer Life Sciences ToolsLife Sciences Tools Molecular DiagnosticsMolecular Diagnostics Clinical TrialsClinical Trials DriveDrive Personal, Private, PortablePersonal, Private, Portable Health RecordsHealth Records
    11. 11. 11 ““Integrated” Digital HospitalIntegrated” Digital Hospital – Digital acquisition of informationDigital acquisition of information – Automated monitoring, bar codes, RFID, CPOE,Automated monitoring, bar codes, RFID, CPOE, biometrics, digital x-ray modalitiesbiometrics, digital x-ray modalities – Digital display of informationDigital display of information – Desktops, tablets, PDAs, laptopsDesktops, tablets, PDAs, laptops – Available everywhere and anywhere information isAvailable everywhere and anywhere information is neededneeded – Displayed with clinical preferences in mindDisplayed with clinical preferences in mind – Digital Electronic Health RecordsDigital Electronic Health Records – Advanced XML integration of disparate informationAdvanced XML integration of disparate information sourcessources – Comprehensive multimedia records that are platform-Comprehensive multimedia records that are platform- aware, secure, scalable, portable and can deliver valueaware, secure, scalable, portable and can deliver value in both on-line and off-line modalitiesin both on-line and off-line modalities
    12. 12. 12 ““Integrated” Digital HospitalIntegrated” Digital Hospital  Digital hospital:Digital hospital: – Automates systems and workflow processesAutomates systems and workflow processes – Paperless and filmlessPaperless and filmless  ““Integrated” digital hospital:Integrated” digital hospital: – Goes beyond digital hospitalGoes beyond digital hospital – Links all its digital information into a secureLinks all its digital information into a secure infrastructure and can deliver informationinfrastructure and can deliver information seamlessly to the point of care on any device;seamlessly to the point of care on any device; thereby improving the speed and quality ofthereby improving the speed and quality of decision makingdecision making
    13. 13. 13 ““Integrated” Digital HospitalIntegrated” Digital Hospital – Digital business intelligenceDigital business intelligence – Advance decision support that provides timely careAdvance decision support that provides timely care critical assistance for better clinical outcomescritical assistance for better clinical outcomes – Systems that “learn” from outcomes and drive forSystems that “learn” from outcomes and drive for continuous quality assurance (CQA)continuous quality assurance (CQA) – Digital operational infrastructure supportDigital operational infrastructure support – Integration of data needed to improve operationalIntegration of data needed to improve operational outcomesoutcomes – SCM, asset tracking w/ RFID, VoIPSCM, asset tracking w/ RFID, VoIP – Advanced triage and scheduling supportAdvanced triage and scheduling support – Real time outcomes management and financialReal time outcomes management and financial reportingreporting
    14. 14. 14 Clinical SystemsClinical Systems ImageImage ManagementManagement LaboratoryLaboratory OrderOrder EntryEntry PharmacyPharmacy Electronic Medical Record *Other names and brands may be claimed as property of others
    15. 15. 15 Built on Intel® based Architecture Using Intel’s vast Ecosystem Supported by strong medical professionals Beginning with The Patient Using new innovative business processes & technologies The Integrated Digital HospitalThe Integrated Digital Hospital New Healthcare Mobile Device Form Factors Integrating Legacy HIS Environments igitizing, Storing and outing Images RFID Patient & Asset Tracking XMLXML SOAPSOAP SOASOA Standards-based Data integration Data Mining: Prognosis Support Integrated & Safe Prescription Dispensing Replacing Paper With eForms
    16. 16. 16 Customer Profile/Challenge Solution Results • Improved access to hospital’s patient care system from anywhere in the facility • Increased adoption rate of wireless PC tablets among physicians • Over a 2 year period, reduced prescription drug complications due to dispensing errors by over 30% from just over 6 errors per 1,000 patient-days to under 4 • Independent, 400+ bed facility and first fully computerized hospital in U.S. • Relies heavily on technology to improve quality, safety and efficiency of medical care • Improve care providers’ access to patient data • Upgraded Intel® Xeon™ -based servers to Unisys ES7000 Itanium ® based servers to support multiple applications: People Soft, SoftMed, Sun clinical data warehousing, Sunrise Clinicals* v4.0 and Eclypsis e7000* clinical info system • HP Compaq tablet PCs and Vocera wireless communications devices based on Intel Centrino™ mobile technology Business Summary El Camino Hospital
    17. 17. 17 Productivity SystemsProductivity Systems Information Technology CollaborationCollaboration WirelessWireless ConnectivityConnectivity MessagingMessaging MeetingMeeting ManagementManagement *Other names and brands may be claimed as property of others
    18. 18. 18 St.Vincent’s HospitalSt.Vincent’s Hospital
    19. 19. 19 • Optimized bed mgmt & capacity ▲ by 40% • Avg Length of Stay ▼ by ~10% • Billing error rates ▼ from 20% to 5% • Admission, Discharge & Transfer Times ▼ by 85% Full deployment expected to achieve ~150% ROI Impact of Mobile Computing & RFIDImpact of Mobile Computing & RFID St. Vincent’s Hospital, AlabamaSt. Vincent’s Hospital, Alabama
    20. 20. 20 Business SystemsBusiness Systems Data WorkflowWorkflow ManagementManagement FinancialFinancial SupplierSupplier ManagementManagement InventoryInventory ControlControl *Other names and brands may be claimed as property of others
    21. 21. 21 Customer Profile/Challenge Solution Results Over three-years • TCO of PC refresh over three years is $100 M • MWI slashes labor costs by 56%, a $49 M savings • Windows XP migration reduces additional management costs by 51% to a $20 M savings • Project net costs $31M • Intel Solution Services and Microsoft Consulting Services implemented a Managed Workstation Initiative (MWI) • Assets and inventory management software • Tools for proactive remote management and remote control • Down-the-wire software distribution • Upgrade to Microsoft Windows XP • 3-year desktop refresh • 2-year notebook refresh Business Summary  Create standardized andCreate standardized and centralized ITcentralized IT management practicesmanagement practices and tools to manageand tools to manage clientsclients – 100,000 desktops100,000 desktops – 10,000 notebooks10,000 notebooks – Dozens of hardwareDozens of hardware configurationsconfigurations – 30 boot images30 boot images A Leading Non-profit Health Maintenance Organization (HMO)*A Leading Non-profit Health Maintenance Organization (HMO)* Chooses Intel-based Rich ClientsChooses Intel-based Rich Clients *Customer wishes to remain anonymous*Customer wishes to remain anonymous Full PC Best Practices caseFull PC Best Practices case study available herestudy available here
    22. 22. 22 Medical EquipmentMedical Equipment Standards DataData AcquisitionAcquisition SensingSensingActuationActuation DataData AggregationAggregation *Other names and brands may be claimed as property of others
    23. 23. 23 •OPPORTUNITIES? •IMPROVE DATA COLLECTION •IMPROVE TELEMETRY OPTIONS •REDUCE ERRORS Drug delivery and infusion of vital fluids as well as monitoring and regulation of same. IV Pumps
    24. 24. 24 Vitals Monitoring A COMPOSITE CATEGORY: •Pulse •Blood pressure •Respiration •Temperature •Ventilation •Muscle activity (emg) •Secondary vitals: •Glucose •Oxygenation
    25. 25. 25 Today’s Equipment Xray, etc. display •Bulky •Wirebound •Expensive •Manually collected data •Disconnected from one another Telemetry Infusion Records entry Vitals/monitoring
    26. 26. 26 A New EnvironmentA New Environment Mobile bed monitor Portable Universal UI device Portable Universal UI device Processing, Storage Telemetry Wireless patient monitors
    27. 27. 27 Healthcare TabletHealthcare Tablet Concept PlatformConcept Platform  Healthcare rugged, ergonomic design, shift long usageHealthcare rugged, ergonomic design, shift long usage  Secure wireless access, connectivity to measurement devicesSecure wireless access, connectivity to measurement devices  Pen-enabled interface, “soft” keys, voice recognition, cameraPen-enabled interface, “soft” keys, voice recognition, camera  Built on IntelBuilt on Intel®® architecturearchitecture Investigational device, not presently available for commercial distribution
    28. 28. 28 Future Vision VideosFuture Vision Videos Hospital BeforeHospital Before Hospital Post Op BeforeHospital Post Op Before
    29. 29. 29 Future Vision VideosFuture Vision Videos Hospital AfterHospital After Hospital Post Op AfterHospital Post Op After
    30. 30. 30 AgendaAgenda  IT in healthcare TrendsIT in healthcare Trends  CPOE, EMR’sCPOE, EMR’s  PACS / ImagingPACS / Imaging  Decision support systems (DSS)Decision support systems (DSS)
    31. 31. 31 Medical Imaging UsesMedical Imaging Uses – Basic researchBasic research – Applied medical researchApplied medical research – ScreeningScreening – DiagnosisDiagnosis – Treatment planningTreatment planning – Image-guidedImage-guided interventionsinterventions
    32. 32. 32 PAC – Picture Archiving &PAC – Picture Archiving & CommunicationCommunication  VisionVision – Integration of patient, study, and image dataIntegration of patient, study, and image data – Single view of image contentSingle view of image content – Mobile PACs deliveryMobile PACs delivery  ScenarioScenario – Image capture via Ultrasound, MRI, etcImage capture via Ultrasound, MRI, etc – Meta-Data driven main storage archiveMeta-Data driven main storage archive – Viewing workstations for Radiologists andViewing workstations for Radiologists and CliniciansClinicians – Physician views and provides verbal annotationsPhysician views and provides verbal annotations – Nurse accessNurse access  Business DrivesBusiness Drives – No film cost (development, storage, loss, etc.)No film cost (development, storage, loss, etc.) – Quicker diagnosis due to faster delivery of imagesQuicker diagnosis due to faster delivery of images – Ability to share images consistently across clinicalAbility to share images consistently across clinical environmentsenvironments
    33. 33. 33 Medical Imaging SegmentationMedical Imaging Segmentation – Create images (modalities)Create images (modalities) – X-ray, CT, MRI, ultrasound, nuclear medicineX-ray, CT, MRI, ultrasound, nuclear medicine (PET/SPECT)(PET/SPECT) – Store and manage imagesStore and manage images – PACS, RIS, storage, compression, archive, network,PACS, RIS, storage, compression, archive, network, architecturearchitecture – View and analyze imagesView and analyze images – Monitors, video cards, rendering, 3-D/4-D software,Monitors, video cards, rendering, 3-D/4-D software, PACSPACS – Computer aided diagnosis (CAD), speech recognitionComputer aided diagnosis (CAD), speech recognition
    34. 34. 34 Viewing the ImagesViewing the Images – LocationsLocations – Dedicated reading facility (mini PACs)Dedicated reading facility (mini PACs) – Emergency room, operating room, doctorEmergency room, operating room, doctor office, point of care (distributed PACs)office, point of care (distributed PACs) – Compute engineCompute engine – High-end workstation, desktop, mobile,High-end workstation, desktop, mobile, PDAPDA – MonitorsMonitors – Medical-grade (2-5 MPixels) to commercialMedical-grade (2-5 MPixels) to commercial or diagnostic qualityor diagnostic quality – Video cardsVideo cards – Various: special-purpose to gamingVarious: special-purpose to gaming – SoftwareSoftware – 2-D, 3-D, 4-D2-D, 3-D, 4-D – Segmentation, registration, quantification,Segmentation, registration, quantification, renderingrendering – Image fusionImage fusion
    35. 35. 35 AgendaAgenda  IT in healthcare TrendsIT in healthcare Trends  CPOE, EMR’sCPOE, EMR’s  PACS / ImagingPACS / Imaging  Decision support systems (DSS)Decision support systems (DSS)
    36. 36. 36 Data Rich, Information PoorData Rich, Information Poor  Data explosion and its impactData explosion and its impact – Enterprise data volumes are doubling every 12-18 monthsEnterprise data volumes are doubling every 12-18 months – Examples of 5X-10X growth: Channel and manufacturingExamples of 5X-10X growth: Channel and manufacturing – Richer formats dramatically increasing storageRicher formats dramatically increasing storage – Data quality issues grow logarithmically w/2X-10X growthData quality issues grow logarithmically w/2X-10X growth of dataof data 2003 2004 2005 2006 2007 2008 2009 2010 RelativeImpactonIT Data Explosion Data Explosion Accelerators Enablers/Accelerators: - Real-time data - VoIP - Web services/XML We see data explosion ~2 yrs earlier We must manage our data before it manages us! Last Updated: 28-JUl-2004
    37. 37. 37 Decision Support SystemsDecision Support Systems General Practitioners (GPs) find decisionGeneral Practitioners (GPs) find decision support beneficialsupport beneficial  A study into acceptance of clinical decision support inA study into acceptance of clinical decision support in primary care has revealed that while suggestions of theprimary care has revealed that while suggestions of the software are not always followed by GPs, many still feel itsoftware are not always followed by GPs, many still feel it worthwhileworthwhile  Researchers at the Department of Medical Informatics atResearchers at the Department of Medical Informatics at Oregon-based healthcare provider Northwest PermanenteOregon-based healthcare provider Northwest Permanente based their conclusions on a survey of 110 GPs, 41% ofbased their conclusions on a survey of 110 GPs, 41% of whom said they were more likely to take heed ofwhom said they were more likely to take heed of notifications when treating an elderly patient.notifications when treating an elderly patient.  However, 80% said that they tended not to use theHowever, 80% said that they tended not to use the system in a hurry.system in a hurry. HTTP://www.ehiprimarycare.com/o.cfm?o=7,0,20193,3219,3226HTTP://www.ehiprimarycare.com/o.cfm?o=7,0,20193,3219,3226 A survey of factors affecting clinician acceptance of clinical decision support Dean F Sittig, Michael A Krall, Richard H Dykstra, Allen Russell and Homer L Chin BMC Medical Informatics and Decision Making 2006, 6:6 doi:10.1186/1472-6947-6-6 Published February 1, 2006
    38. 38. 38 Summary: Benefits of technologySummary: Benefits of technology implementation:implementation: 1.1. IT can help healthcare: reduce medical errors,IT can help healthcare: reduce medical errors, improve data quality, and improve patientimprove data quality, and improve patient servicesservices – Information flows faster and more accuratelyInformation flows faster and more accurately – Data collection is automated, removing opportunities for errorsData collection is automated, removing opportunities for errors – Clinicians freed up to focus on diagnosis & careClinicians freed up to focus on diagnosis & care 2.2. The “integrated” digital hospital goes beyondThe “integrated” digital hospital goes beyond automated, paperless and filmless environment ofautomated, paperless and filmless environment of the “digital” hospitalthe “digital” hospital 3.3. EMRs are the center piece for the “IntegratedEMRs are the center piece for the “Integrated Digital Hospital”Digital Hospital” 4.4. PACs improves diagnostic efficiency and is ITPACs improves diagnostic efficiency and is IT intensiveintensive 5.5. Decision Support Systems drive data volumes andDecision Support Systems drive data volumes and improve clinical decision makingimprove clinical decision making

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