Gohcr Presentation

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Presentation to the Governor\'s Office of Healthcare Reform in Harrisburg Pennsylvania.

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Gohcr Presentation

  1. 1. Unified Medical Informatics
  2. 2. P ennsylvania H ealth I nformation N etwork <ul><li>GOHCR & UMI Draft Proposal </li></ul>
  3. 3. Introduction <ul><li>Medical Informatics are a crucial and integral part of the Rx for Quality </li></ul><ul><li>Health Information Technology is at a ideological crossroads </li></ul><ul><li>Pennsylvania is poised to be a model for the rest of the country </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  4. 4. Introduction to UMI <ul><li>Unified Medical Informatics is a PA C-Corp. as of Sept. 2006 </li></ul><ul><li>We work in Medical Informatics Consulting, Technology Deployment, and Research </li></ul><ul><li>We are Consultant Principal to the NEPA-HRTF of the 121st Legislative District </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  5. 5. UMI’s Mission Statement <ul><li>To empower physician clients with end-to-end solutions that empower their practices and improve the efficiency, quality, and excellence of their patient care </li></ul><ul><li>To be a research driven organization with a focus on emerging technology and best practices in health information technology </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  6. 6. Project Proposal <ul><li>Work in UNISON with Governor Rendell’s Prescription for Pennsylvania </li></ul><ul><li>Provide an end to end HIT solution for the plan to improve healthcare in the State </li></ul><ul><li>Create a State-wide Health Information Exchange with a focus on “last mile” infrastructure issues </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  7. 7. Objectives <ul><li>Enable Electronic Medical Records transport and exchange </li></ul><ul><li>Encourage the use of Electronic Medical Records State-wide </li></ul><ul><li>Empower healthcare workers with information at the point of care </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  8. 8. Rationale <ul><li>HIT has matured to a point of being able to measurably improve quality </li></ul><ul><li>Disease Management protocols can be embedded in broad scale networks </li></ul><ul><li>ROI is very clear in the context of the GOHCR Rx for Quality Plan </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  9. 9. IBM Proved It... Unified Medical Informatics Pennsylvania Health Information Network Copyright 2005 IBM Healthcare & Life Sciences GOHCR
  10. 10. Grand Total Savings? <ul><li>Prior to RHIN Implementation Costs due to Inefficiencies: </li></ul><ul><ul><ul><ul><ul><li>$ 2,701,484 </li></ul></ul></ul></ul></ul><ul><li>After Implementing the RHIN Technologies and Connectivity: </li></ul><ul><ul><ul><ul><ul><li>$ 563,698 </li></ul></ul></ul></ul></ul><ul><li>PERCENTAGE COST SAVINGS: </li></ul><ul><ul><ul><ul><ul><li>79.2 % </li></ul></ul></ul></ul></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  11. 11. Health Information Technology <ul><li>No longer just an academic realm </li></ul><ul><li>Standards & Protocols have been simplified </li></ul><ul><li>Interoperability stands at the center of all current efforts </li></ul><ul><li>Medical Informatics has become useable </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  12. 12. History of HIE <ul><li>VA’s Vista </li></ul><ul><li>Community Health Information Networks </li></ul><ul><li>HL7 </li></ul><ul><li>RHIOs </li></ul><ul><li>XML and CCR </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  13. 13. Current Problems <ul><li>Disease Management protocols are not standardized </li></ul><ul><li>EMRs have very poor penetration percentages in the State </li></ul><ul><li>No .emr file type exists </li></ul><ul><li>No way to exchange EMR files </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  14. 14. Attempted Solutions <ul><li>RHIOs are burgeoning as successors to the CHINs to enable localized HIE </li></ul><ul><li>HL7 has been identified as the de facto standard for data transport in healthcare </li></ul><ul><li>Centralized/Federated stores of data have been proposed to address the lack of .emr standard </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  15. 15. Reasons for Failure <ul><li>RHIOs actually just make the problem BIGGER and ADD costs </li></ul><ul><li>HL7 is based on a 20 year old monolithic RIM with poor flexibility for new data types </li></ul><ul><li>Centralized stores are inherently insecure and represent a single point of failure and do not address import/export capability </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  16. 16. Current Initiatives <ul><li>PAeHI </li></ul><ul><li>RHIOs (NEPA, UPenn, UPitt, etc.) </li></ul><ul><li>Senate Bill 8 </li></ul><ul><li>House Bill 700 </li></ul><ul><li>Grants for EMR implementation (State and Federal) </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  17. 17. Emerging Technology <ul><li>XML </li></ul><ul><li>Continuity of Care Record </li></ul><ul><li>SOA & Web Services </li></ul><ul><li>P2P Generation 2 </li></ul><ul><li>Web 2.0 </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  18. 18. Best Practices <ul><li>Security & Auditing </li></ul><ul><li>Identity Management </li></ul><ul><li>Wellness Management </li></ul><ul><li>Point of Care CDSS </li></ul><ul><li>Digital Rights Management </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  19. 19. What is Needed... <ul><li>Comprehensive approach to ensure compatibility and future proof investments </li></ul><ul><li>Incentivized, interoperable, standards based EMR(s) to bring penetration up from 11% to at least 65-75% in 5 years </li></ul><ul><li>“Digital Toll Road” HIE managed by the State in preparation for NHIN Initiatives </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  20. 20. What Exists... <ul><li>Multiple RHIO efforts and PAeHI activities </li></ul><ul><li>Vendor locked providers </li></ul><ul><li>No clear path for interoperability </li></ul><ul><li>No NHIN mandates </li></ul><ul><li>No incentives at either the State or Federal level </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  21. 21. What Can Be Done? <ul><li>Establish CCR as the .emr “The Fuel” </li></ul><ul><li>Create Mandates and Incentives the “On Ramp” </li></ul><ul><li>Provide the “Vehicle” CDDL EMR </li></ul><ul><li>Build the “Turnpike” </li></ul><ul><li>“Passengers” as stakeholders </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  22. 22. On The Ground... <ul><li>Medgnosis </li></ul><ul><ul><li>Creation of a Tool to Enable and Empower the Clinical Environment </li></ul></ul><ul><ul><li>Complete Practice Management Platform </li></ul></ul><ul><ul><li>Integrated Electronic Medical Record System </li></ul></ul><ul><ul><li>Advanced Composition Engine for Encounter Documentation </li></ul></ul><ul><ul><li>Common Development & Distribution License </li></ul></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  23. 23. Above The Ground... <ul><li>“PHIN” - Codename: The Agora Project </li></ul><ul><ul><li>XML-CCR Based - The Language </li></ul></ul><ul><ul><li>Mirth Engine - The Translator </li></ul></ul><ul><ul><li>Federated Nodes - The Library Stacks </li></ul></ul><ul><ul><li>Central Indexing Server - The Librarian </li></ul></ul><ul><ul><li>Encrypted Backup Repository - The Labyrinth </li></ul></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  24. 24. Architecture Concept Unified Medical Informatics Pennsylvania Health Information Network Western Node South-Western Nodes Northern Node North-Eastern Node South-Eastern Node Central Indexing Server Mirth Connected Clients GOHCR
  25. 25. Technology Layer <ul><li>The Language of Interoperability & “The Last Mile” </li></ul><ul><ul><li>The Continuity of Care Record (ASTM) </li></ul></ul><ul><li>The Network Foundation </li></ul><ul><ul><li>Solaris 10 and Java (Open Source!) </li></ul></ul><ul><li>The Regional Nodes </li></ul><ul><ul><li>Buffer zones for load balancing </li></ul></ul><ul><li>Central Indexing Server </li></ul><ul><ul><li>Encrypted backup layer </li></ul></ul><ul><li>Triple Redundancy at each critical layer </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  26. 26. ASTM - CCR Unified Medical Informatics Pennsylvania Health Information Network Continuity of Care Record (CCR) is a health record standard specification in XML developed jointly by ASTM International, the Massachusetts Medical Society (MMS), the HIMSS (HIMSS), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and other health informatics vendors. The CCR standard is a patient health summary standard. It is a way to create flexible documents that contain the most relevant and timely core health information about a patient, and to send these electronically from one care giver to another. It contains various sections such as patient demographics, insurance information, diagnosis and problem list, medications, allergies and care plan. These represent a &quot;snapshot&quot; of a patient's health data that can be useful or possibly lifesaving, if available at the time of clinical encounter. The ASTM CCR standard is designed to permit easy creation by a physician using an electronic health record (EHR) system at the end of an encounter. GOHCR
  27. 27. EMR - EHR - PHR - CCR Unified Medical Informatics Pennsylvania Health Information Network C ontinuity of C are R ecord P ersonal H ealth R ecord E lectronic M edical R ecord E lectronic H ealth R ecord Patient Clinician Ancillaries Technologist GOHCR
  28. 28. Medgnosis is the “UMIP” Unified Medical Informatics Pennsylvania Health Information Network U nified M edical I nformatics P latform Comprehensively Addresses “ The Last Mile” <ul><li>Clinical Environments face a common problem: lack of investment or incentive to invest in a comprehensive end-to-end platform of technology upon which to operate all essential functions for maximum efficiency. </li></ul><ul><li>The ERP concept has not been adopted by healthcare. Medgnosis addresses this crucial last mile necessity. </li></ul>GOHCR
  29. 29. Advanced EMR Engine Unified Medical Informatics Pennsylvania Health Information Network Composition Engine GOHCR
  30. 30. CDDL - Open Source Licensing <ul><li>Common Distribution & Development License </li></ul><ul><li>Medgnosis is licensed to the State of Pennsylvania from UMI in exchange for grant for business development </li></ul><ul><li>Pioneered by Sun Microsystems as a protectable Open Source Distribution Model </li></ul><ul><li>Software is provided FREE of cost to ALL users </li></ul><ul><li>UMI has exclusive rights to professionally install, train, and support all clients who request/download the software under our standard fee structure </li></ul><ul><li>Enable State-wide development and contribution to improvements via project portal maintained by UMI </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  31. 31. Methodology Layer <ul><li>Market Education Initiative </li></ul><ul><ul><li>Teach Clinical Environments the Hows and Whys of the System </li></ul></ul><ul><li>Security & Identity Management Layer </li></ul><ul><ul><li>Digital Rights Management (OpenDRM) </li></ul></ul><ul><ul><li>RBAC - Role Based Access Control </li></ul></ul><ul><ul><li>WVPN - Wide Area Virtual Private Network Credentialing </li></ul></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  32. 32. Business Layer <ul><li>Focus on ROI and Sustainability </li></ul><ul><ul><li>Develop Subscription Model </li></ul></ul><ul><ul><li>Develop Transaction Model </li></ul></ul><ul><ul><li>Develop HR Requirements </li></ul></ul><ul><ul><li>10 Year Costing and Budgeting </li></ul></ul><ul><ul><li>Develop clear business case for adoption at all critical levels by all players in the value chain </li></ul></ul><ul><li>Streamline the Grant Application process for incentive funds to implement EMR and connectivity via online optioning and qualification (centralize resources) </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  33. 33. Deploying <ul><li>Regional Nodes with 4 person team to handle administration and sign-on </li></ul><ul><li>Software/Hardware translators and connection mechanisms for client sites </li></ul><ul><li>Provide EMR(s) to those physicians who need them </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  34. 34. Sustainability Considerations <ul><li>Solidifying the Revenue Model </li></ul><ul><li>Selling the “Digital Toll Road” Concept </li></ul><ul><li>Ensuring Long Term Technology Flexibility </li></ul><ul><li>Determining “Will this solve the problem or add to it?” </li></ul><ul><li>Will we succeed where others have failed? </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  35. 35. Collaborators and Supporters <ul><li>PAeHI </li></ul><ul><li>MRI </li></ul><ul><li>DMAA </li></ul><ul><li>Emdeon, ProxyMed, ZirMed </li></ul><ul><li>SureScripts, Connexion </li></ul><ul><li>Google Health </li></ul><ul><li>Sun Microsystems </li></ul><ul><li>Cisco Systems </li></ul><ul><li>PennTeleData </li></ul><ul><li>Mirth Project / Web Reach </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  36. 36. Potential Detractors <ul><li>Existing RHIOs / Efforts </li></ul><ul><li>Insurers </li></ul><ul><li>Privacy Advocates / Hawks </li></ul><ul><li>“Digital Objectors” </li></ul><ul><li>Political Capitalists </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  37. 37. Mandates Required <ul><li>Interoperability </li></ul><ul><li>Communications </li></ul><ul><li>Usage </li></ul><ul><ul><li>Implications: </li></ul></ul><ul><ul><li>Most comprehensive attempt ever in the history of Medical Informatics / HIE </li></ul></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  38. 38. Relationship Structure <ul><li>Unified Medical Informatics will endeavor a relationship of Consultant Principal with the following entities: </li></ul><ul><ul><ul><ul><li>PHIN Committee (GOHCR) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>PHC4? ‘Seat of Project’ </li></ul></ul></ul></ul><ul><ul><ul><ul><li>End Users </li></ul></ul></ul></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  39. 39. Budget & Timeline Unified Medical Informatics Pennsylvania Health Information Network Phase 0 - Two Years Phase 1 - 8 mths Phase 2 - 10 mths Phase 3 - 14 mths Phase 4 - 14 mths Phase 1.5 - 8 mths 5 Year Grand Total: $65 Million Dollars GOHCR Phase/Year Price Result Pre-Operative Phase 0 $2.5M C.I.S & Medgnosis Year 1 - Phase 1 $875K 10 Clinics & 1 Hospital Year 2 - Phase 1.5 $2.75M 2 Counties Year 3 - Phase 2 $11.8M 10 Counties Year 4 - Phase 3 $47M PHIN Beta Year 5 - Phase 4 Self Sustaining PHIN Live Yr1 Yr2 Yr3 Yr4 Yr5
  40. 40. Utilization & Allocation Plan <ul><li>1 C.I.S (8 Staff Members) </li></ul><ul><li>6 Regional Nodes (x4 Staff Members) </li></ul><ul><li>Triple Redundancy (Automated Failover) </li></ul><ul><li>Off Grid Backup </li></ul><ul><li>Majority of Costs are in Upfront Infrastructure and Long Term Manpower </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  41. 41. Next Steps? <ul><li>Choose the Office that will be the “Seat” of the Project? </li></ul><ul><li>Decide Definitive Timeline for Execution? </li></ul><ul><li>Determine Budgetary Availability of Finances? </li></ul><ul><li>Craft Executive Order(s)? </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  42. 42. Caveats and Assurances <ul><li>Massive Undertaking </li></ul><ul><li>Multiple Points of Failure </li></ul><ul><li>Requires ‘Leap of Faith’ </li></ul><ul><li>Extremely Detail Oriented Planning </li></ul><ul><li>Technology utilization is significant </li></ul><ul><li>Skilled Manpower required </li></ul><ul><li>Education of Clinical Environments necessary to achieve success </li></ul>Unified Medical Informatics Pennsylvania Health Information Network <ul><li>5 Years of Research Conducted </li></ul><ul><li>Huge base of Academic Support </li></ul><ul><li>Experience with Broad Scale Projects </li></ul><ul><li>Pinnacle of Technical Expertise </li></ul><ul><li>Clinical Background of Consultants </li></ul><ul><li>Live Market Awareness </li></ul><ul><li>Indefatigable Enthusiasm for Reform and positive social impact </li></ul>GOHCR
  43. 43. Implications... (Post Success) <ul><li>Biosurveillance & Epidemiology </li></ul><ul><li>Disease Fingerprinting and Mapping </li></ul><ul><li>Comprehensive Research Data Mine </li></ul><ul><li>Powerful Evidence to drive down Insurance Premiums </li></ul><ul><li>Reduced Underwriting Risks for Malpractice Insurers to drive down costs for Physicians </li></ul><ul><li>Job Creation for implementation consultants at various levels of the value chain </li></ul>Unified Medical Informatics Pennsylvania Health Information Network GOHCR
  44. 44. P ennsylvania H ealth I nformation N etwork <ul><li>Thank You!!! </li></ul>Dr. Sanjay M. Udoshi Consultant Principal Unified Medical Informatics, Inc. 7 South Main Street, Suite 203 Wilkes Barre, PA 18702 [email_address] 570-877-7780

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