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Vaibhav Bhandarivaibhavb@microsoft.com(Microsoft, Health Solutions Group),[object Object],across,[object Object],Programming   Healthcare Silos,[object Object],^,[object Object],?,[object Object],@vaibhavb#oscon #silostalk,[object Object]
Agenda,[object Object],Challenges of Health IT,[object Object],Standards exist but..,[object Object],Open Solutions Exist,[object Object],Opportunities in Health IT,[object Object]
Silos of Health Information,[object Object]
Silos in the Enterprise – “On the Floor” ,[object Object],Electronic Medical Record,[object Object],Nursing Workflow/ Documentation,[object Object],Clinical Notes,[object Object],Emergency Department,[object Object],Procedure Documentation,[object Object],ICU/Critical Care,[object Object],OR Management,[object Object],Dictation,[object Object],Pharmacy,[object Object],CPOE,[object Object],Advanced Analytics,[object Object],Cardiology,[object Object],Labs,[object Object],Medication Administration,[object Object],Hemodynamics,[object Object],Pathology,[object Object],Imaging,[object Object],Charting,[object Object],Medication Dispensing,[object Object],RIS,[object Object],Orders,[object Object],Image Distribution,[object Object],PACS,[object Object],Mobile Data,[object Object]
Silos in the Enterprise – “Behind the Scenes”,[object Object],Contract Management,[object Object],Enterprise Scheduling,[object Object],Claims Management,[object Object],Financial/ERP,[object Object],Business Decision Support,[object Object],Inventory,[object Object],Medical Records Coding,[object Object],Purchasing,[object Object],Revenue Management,[object Object],Document Imaging,[object Object],Bed Management,[object Object],Registration,[object Object],Transcription,[object Object],Call Management,[object Object],Staff/Nurse Scheduling,[object Object],Outcomes Management,[object Object],Physician Practice,[object Object],Access Management,[object Object]
Meaningful Use,[object Object],ICD-9 to ICD-10 Translation,[object Object],SNOMED-CT,[object Object],Master Patient Index,[object Object],EMR/EHR,[object Object],IHE,[object Object],HL7,[object Object]
Meet Jim,[object Object]
 Jim’s ER visit..,[object Object]
Lab,[object Object],Emergency ,[object Object],EMR,[object Object],HL7 Lab Order,[object Object],MSH|^~amp;|EMERGENCYEMR|RC90|INSIGHT.LAB|GUH.ER|20080114085834||ORU^R01|H20010816374944.7274|P|2.1|1,[object Object],PID|01||1430043|1572c552-f02b-49bf-b7e2-acc74765cb3e|SMITH^JIM||19790127|F||1||||||||cfd9ce6b-dc81-459d-9415-7913eb4635ec|804171277,[object Object],PV1|01|O|TPC||||331|||||||HIS|||331|O||||||||||||||||||||||||||20060721|19990921,[object Object],OBR|1||1234^LAB|88304,[object Object]
Lab,[object Object],Emergency ,[object Object],EMR,[object Object],Lab Result,[object Object],MSH|^~amp;|EMERGENCYEMR|RC90|INSIGHT.LAB|GUH.ER|20080114085834||ORU^R01|H20010816374944.7274|P|2.1|1,[object Object],PID|01||1430043|1572c552-f02b-49bf-b7e2-acc74765cb3e|SMITH^JIM||19790127|F||1||||||||cfd9ce6b-dc81-459d-9415-7913eb4635ec|804171277,[object Object],PV1|01|O|TPC||||331|||||||HIS|||331|O||||||||||||||||||||||||||20060721|19990921,[object Object],OBR|1||1234^LAB|88304,[object Object],OBX|1|CE|88304|1|T57000^GALLBLADDER^SNM OBX|2|TX|88304&MDT|1|MICROSCOPIC EXAM SHOWS HISTOLOGICALLY NORMAL GALLBLADDER TISSUE,[object Object]
Creating & Processing Lab Order,[object Object],HAPI HL7 Parsing Library ,[object Object],http://hl7api.sourceforge.net,[object Object]
X12 Message for Eligibility Request,[object Object],ST*270*1234*005010X203~,[object Object],BHT*0022*13*10001234*20060501*1319~,[object Object],HL*1**20*1~,[object Object],NM1*PR*2*ABC COMPANY*****PI*842610001~,[object Object],HL*2*1*21*1~,[object Object],NM1*1P*2*EMERGENCY CLINIC*****SV*2000035~,[object Object],HL*3*2*22*0~,[object Object],TRN*1*93175-012547*9877281234~,[object Object],NM1*IL*1*SMITH*JIM****MI*11122333301~,[object Object],DMG*D8*19430519~,[object Object],DTP*291*D8*20060501~,[object Object],EQ*30~,[object Object],SE*13*1234~,[object Object],Lab,[object Object],Emergency ,[object Object],EMR,[object Object],Health Plan,[object Object]
X12 Response for Eligibility Request,[object Object],ST*271*1234*005010X203~,[object Object],BHT*0022*13*10001234*20060501*1319~,[object Object],HL*1**20*1~,[object Object],NM1*PR*2*ABC COMPANY*****PI*842610001~,[object Object],HL*2*1*21*1~,[object Object],NM1*1P*2*EMERGENCY CLINIC*****SV*2000035~,[object Object],HL*3*2*22*0~,[object Object],TRN*1*93175-012547*9877281234~,[object Object],NM1*IL*1*SMITH*JIM****MI*11122333301~,[object Object],DMG*D8*19430519~,[object Object],DTP*346*D8*20060101~,[object Object],EB*1**30**GOLD 123PLAN~,[object Object],…,[object Object],Lab,[object Object],Emergency ,[object Object],EMR,[object Object],Health Plan,[object Object]
Jim’s Ready to Go Home,[object Object],Lab,[object Object],Emergency ,[object Object],EMR,[object Object],Health Plan,[object Object]
CCR For Jim’s Visit,[object Object],Lab,[object Object],Emergency ,[object Object],EMR,[object Object],Health Plan,[object Object]
CCD or C32,[object Object]
HealthVault Interaction,[object Object]
Direct To Clinical,[object Object]
Data In Jim’s Account,[object Object],Jim,[object Object],Lab,[object Object],Emergency ,[object Object],EMR,[object Object],Health Plan,[object Object],Jim,[object Object]
NHIN-D,[object Object],@ HealthVault address,[object Object], Easy integration through SMTP S-MIME,[object Object],Exciting Future,[object Object]
HealthVault Medical Imaging,[object Object],[object Object]
http://bit.ly/hv-medical-imaging,[object Object]
Leaving the Clinical Silo,[object Object],Clinical Silo,[object Object],While in enterprise your application need to comply with HIPAA 5010,[object Object],When Jim log’s in to HealthVault then the data is flowing in to consumer domain,[object Object],Lab,[object Object],Emergency ,[object Object],EMR,[object Object],Health Plan,[object Object]
HealthVault Open Source Resources,[object Object],Community Promise,[object Object],Open Source SDKs,[object Object],Java : CodePlex,[object Object],Ruby : RubyForge,[object Object],Python : Google Code,[object Object],PHP: SourceForge,[object Object],Reference License .NET SDK,[object Object],http://msdn.microsoft.com/healthvault ,[object Object]
Connected Health Platform Open Source Resources,[object Object],Microsoft Health Common User Interface (MSCUI),[object Object],[object Object]
Main site: http://www.mscui.net
Toolkit: http://mscui.codeplex.comIHE Cross-Enterprise Document Sharing XDS.b ,[object Object],[object Object]

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Programming Healthcare Silos

Editor's Notes

  1. Welcome!I’m Vaibhav Bhandari, Program Manager in Microsoft Health Solutions Group. Over the last three years I have worked various aspects of Microsoft HealthVault and Medical Terminologies. Over the next 20 minutes I’m going give you a feel of working with various healthcare technologies and interface them with customers! Programming “across” HealthCare Silos. Quick show of hands –How many of you have worked in HealthCare IT for more than 5 years? Well that’s a good number!
  2. The healthcare landscape is very complicated and often times very disjointed. Silos are characteristic of data in the HealthCare Ecosystem. When you get sick you go your family Physician who (if at all) stores data for your visit in a local electronic medical record system.  Your prescriptions get filled by a prescriptions network and Labs by the Lab network, which have their own interchange protocols and data standards. The payers or Health Plans pay for you visit using their own Electronic data interchange based standards. There are consumer service like WebMD which you use to get information from. And then there are the big Enterprise Hospitals which have a set of Silos themselves!
  3. Before I started working with Microsoft Software Health Solutions I was developer dealing with embedded Operating systems, file systems and device drivers! The whole world of HealthIT seemed a little overwhelming to me. Various terms like HL7, SNOMED-CT, Meaningful-use, ICD9-toICD10 Conversion, EMR & EHR were all new to me!OpenSoft Inc. has developed a solution which bridges various silos through open-source and first principles.
  4. Meet Jim – he is just going to walk through a component developed by OpenSoft Health Inc. for an Emergency EMR system.Meet Jim, he just dropped down at a Bus stop with an acute gastric problem, and rushed to the ER. Jim visited an ER for a sudden gastric attack. Your software need to handle Jim’s fairy ride through the hospital and give him the details of visit once he is back! When Jim walks in to the hospital ER nurse gets his vital and order an lab-test for him.
  5. Now HL7 is a enables disparate systems in the hospital to talk to each other. In this typical HL7 message what you see isMSH – Message Header, showing our fictitious company – EmergencyEMR.Patient Identifier – PID, showing patient identifiers for JoePV1 – Patient Visit details -OBR – Request for an observationPoint to note – this message is in HL7 2.x format which is currently the used widely. The next version, HL7 v3 is entirely based on XML instead of pipe delimited segments.
  6. Note the new OBX segment.Talk about LOINC Code in the OBX showing code-system and code-value. LOINC is a medical terminology which is widely used for laboratories and observations.
  7. This code uses the HAPI HL7 parser to transform data from emergency EMR system to a HL7 message when is sent to the Lab Order System.
  8. You system also sends a simple message to the claims management.Briefly glance over the X12 message and talk about ICD-9 code used in this message to communicate the procedures and tests done on Jim.
  9. You system also sends a simple message to the claims management.Briefly glance over the X12 message and talk about ICD-9 code used in this message to communicate the procedures and tests done on Jim.
  10. Jim would love to get more information on the care. The labs feature application which you added to the outpatient system can now be extended to send the information to the patient through one of the Personally Controlled Health Records (Google, Dossia or Indivo).Why this is a bug business opportunity?
  11. Now, that Jim is ready to go home – we want to send an CCR/CCD/C32 to his Personally Controlled Health record. Lets take example of HealthVault.Your application create a CCR for Jim’s visit which shows his Vital signs, Lab Results.For a developer HealthVault has a number community managed Open Source libraries, we will work with the Python library on code.google.com or Jave on Codeplex.Our emergency EMR takes the information from its database and converts it to a CCR using CCR xsd.
  12. This snippet show how the application can drop-off the CCR in to HealthVault
  13. Once Jims get’s to his home computer or Mobile phone be can enter the code given to him by the Emergency EMR and receive this CCR in to his HealthVault account. He can choose further refine it by reconciling it to HealthVault data types...
  14. This is a great opportunity for developers in general to enable a cheap and easy way for providers to send information directly to end users. Providers are eagerly looking for such capabilities as meaningful use requires that capability.Employer sends 834 to HealthPlan for enrolling a patient.HealthPlan or Mediclaim or Medicare maintain a member index which Hosiptal can query using 271.278 – Is authorization request (in some states and Canada this is pre-determination).The claims processing system sends message 837/835 (Claims Processing message) which includes patients demographics, details of plan and details of the transaction (how much the plan paid and how much is co-pay).Vendors in space – Unisys, ACS, MUMPs (open source).
  15. Microsoft is actively participating and contributing to NHIN-D project. The process of moving clinical information to consumer silo will be as easy as initiating an e-mail transaction from the source system!
  16. If your application wanted you could also have sent the medical images from Jim’s Visit to his HealthVault account. We have recently enabled storing large data in HealthVault.We have a detailed walk through for using this functionality with Java.
  17. In addition to Medical Images your application can also use the Client Capability of HealthVault platform and in-fact create client applications for Android or Windows Mobile. Details of this can be found on my blog.May be the future phone can detect and transact with hospital devices to get a care record instead of going through a CCR/CCD hoops.
  18. The data is now flowing out of the hospital in to HealthVault. A critical distinction is that its no longer HIPAA covered.
  19. Summary of what we just saw – an end to end scenario of implementing a new capability in a complicated system and deliver it to the consumer!-- Lots of Silos-- Open Source Solutions Exist-- Consumers Matter-- HealthVault Plays a Role--