IBM involvement in adoption of EHR, health data standards and epSOS - Matej Adam

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  • 1. IBM involvement in adoption of EHR,health data standards and epSOSMatej AdamHealthcare Leader EMEAmatej.adam@cz.ibm.com © 2012 IBM Corporation
  • 2. Let’s build a smarter planet: HealthcareAgenda1.IBM in healthcare2.Health data standards3.epSOS4.EHR adoption and value creation1 © 2012 IBM Corporation
  • 3. Let’s build a smarter planet: Healthcare IBM Healthcare & Life Sciences Team  4,000+ employees worldwide – Services, Systems, Software, Research, & Financing, Sales – Large Clinical Consulting Staff  Clients include: – Hospitals: 14 of the top 14 hospitals – Healthcare Insurance: 12 of top 13 companies – Government: significant projects in Canada, Singapore, Denmark, Germany, Ireland, Spain, Italy, China, India and US – Pharmaceutical: 30 of the top 30 companies – Biotech: 18 of top 20 companies – Also, medical research in Almaden/Watson, Haifa, Zurich, Japan2 © 2012 IBM Corporation
  • 4. Let’s build a smarter planet: Healthcare IBM Involvement in European eHealth  Large Scale EU Projects – epSOS – engaged in 3 working groups – Renewing Health – Supporting Smart Personal Health action (via Continua)  European Trade Associations – COCIR – 3 resources on HIT and Telemedicine Focus Groups – Continua Health Alliance – 1 resource on Policy/Strategy Work Group – EHTEL- ETSI- CEN/CENELEC- EuroRec  Other European ‘Centres of Excellence’ – Norway – Tromso Telemedicine Centre – N Ireland – European Centre for Connected Health  Major European Conferences and Exhibitions – eHealth Week - World of Health IT (7-9 May 2012, Copenhagen) – HIMSS CIO Summit (18-20 November 2012, Mallorca) – eHealth Week - World of Health IT (13-15 May 2013, Dublin)3 © 2012 IBM Corporation
  • 5. Let’s build a smarter planet: HealthcareNew Generation of Standards aim at ‘True’ Interoperability  “To provide standards for the exchange, e.g., HL7 mission: management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services.”  interoperability : ability of two or more systems or components to exchange information and to use the information that has been exchanged. Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990] Functional Semanticinteroperability interoperability4 © 2012 IBM Corporation
  • 6. Let’s build a smarter planet: HealthcareEnabling interoperability: Metadata, Ontologies, Standards… ? (Inter) nationally Accredited Standards Public Reference Ontology Inter- Database Metadata operability? Interface Registry Engine Metadata Metadata Metadata Metadata Enterprise Enterprise Enterprise Enterprise Data Data Data Data5 © 2012 IBM Corporation
  • 7. Let’s build a smarter planet: HealthcareIBM HCLS Standards Program An IBM “Standards Team” with experts on each key* SDO** Examples of innovative standards development led by or with IBM: • HL7 Clinical Genomics & Family History : lead Develop innovative standards • HL7 Clinical Document Architecture (CDA): co-editor • HL7 Continuity of Care Document (CCD): co-editor • IHE XCA, XCPD, XDS-SD, XD-Lab: lead Promote adoption of standards within IBM and outside Implement HCLS standards over open technology standards Foster a continuum/convergence of healthcare and life sciences standards Use model-driven approach, enabling customization through constraining Push industry to reduce overlaps where possible Show how standards fit together and support interoperable EHR * key = accredited, appointed, dominant or emerging SDOs6 © 2012 IBM Corporation ** SDOs = Standard Developing/Profiling Organizations
  • 8. Let’s build a smarter planet: Healthcare IBM Research Lab in Haifa - Activities with Standards Implementations Clinical Genomics Medical Imaging Management CG / BII / BioMIMS / Cli-G CMO, VNA Cross-facility intelligent archive Data mining analysis of massive amount of operational clinical- Admin HL7 Interface DICOM Interface User specific Interface Server genomic data yielding Agent Agent Agent Management decision support Consol components RMI/IIOP CM API CM API CM API SME CM CM API Hypergenes – exploring TSM the genetic background of hypertension EuResist – fine-tuning the AIDS drug cocktail by Tape Tape Tape the viral genome Raid Drive (local cache) Interoperability and PHREHR Health Standards Practice HIE&Initiate / MECIDS / uHealth HL7 / IHE / CEN / DICOM / HIPAA Offering Education & Services • Regional and national • Medical home and HL7 involvement: EHR initiatives collaborative care • Co-chair and facilitator of • Public health Clinical Genomics Group information exchange • Co-editor of the Pedigree spec • Patient Empowerment • Co-editor of CDA Release Two (clinical document) & CCD IG through connecting EHR and PHR systems • Co-chair of RIMBAA (RIM-based Application Architecture) CMO = Content management Offering HIE = Health Information Exchange7 BioMIMS = Biomedical Imaging Management MECIDS = Middle East Consortium on Infectious Disease Surveillance © 2012 IBM Corporation BII = Biomedical Information Infrastructure uHealth = Smart PHR and social-medical networks for the patient
  • 9. Let’s build a smarter planet: HealthcareepSOS - Goals & Challenges Goal for the epSOS eHealth Project: – “to develop a practical eHealth framework and ICT infrastructure [based on existing national infrastructures] that will enable secure access to patient health information, particularly with respect to a basic patient summary and ePrescription, between European health care systems” Challenges to get there (based on the EIF (European Interoperability Framework)): – Legal Interoperability – Organisational Interoperability – Semantic Interoperability – Technical Interoperability8 © 2012 IBM Corporation
  • 10. Let’s build a smarter planet: Healthcare Why is epSOS important? eHealth Governance Initiative and the adoption of the Directive 2011/24/EU on the application of patients rights in cross-border healthcare Deploy Telemedicine solutions for Chronic Disease Management Identifies 5 political goals for this digital agenda: – Patient Safety (evidence based healthcare, reduced risk of patient harm) – Quality of Care (patient satisfaction, effectiveness of care service provision) – Availability (equal access, reduced waiting times and better utilisation of resources) – Empowerment (patient-centricity and direct involvement in the patient’s own care) – Continuity of Care (coordination of activities & information sharing w/ caregivers) 9 © 2012 IBM Corporation
  • 11. Let’s build a smarter planet: HealthcareFrom Strategies to ServicesProvide concrete cross border services that ensure safe, secure and efficient medical treatment for citizens when travelling across Europe Focus on services close to the patient: – Patient Summary for EU Citizens Occasional Visit Regular Visit – ePrescribing for EU Citizens Medication ePrescription Medication eDispensation Build on existing National eHealth Projects and use experiences and knowledge from all Member States10 © 2012 IBM Corporation
  • 12. Let’s build a smarter planet: HealthcareepSOS – European Patients Smart Open Services Country B Country A POC epSOS POC (Pharmacy) (Pharmacy) Circle of Trust NCP B NCP A POC POC (Hospital) (Hospital) POC POC (General Practioner) (General Practioner) IHE & CDA are key standards! National Circle of Trust National Circle of Trust Source: epSOS project documentation11 © 2012 IBM Corporation
  • 13. Let’s build a smarter planet: Healthcare The epSOS participating nations20 EU Member States3 Non EU Member States12 © 2012 IBM Corporation
  • 14. Let’s build a smarter planet: Healthcare The epSOS Industry Team as per 15.05.2013 3M Agfa HealthCare Alert Life Sciences Apollo Information Computing Technologies Boston Life Labs CareCom Cisco Conet AG dbMotion Dedalus Healthcare Engineering S.p.A GE Healthcare Systems Group Gnomon Informatics IBM IHE Europe* Indra Insiel S.p.A. Intel Corporation Mawell MediCognos Microsoft Netsmart Oracle Posam RISE Steria Tiani-Spirit TrebleM T-Systems UBM Medica X-tention *Industry Team Coordinator, Industry Team Steering Group members are underlined no member of Industry Team13 © 2012 IBM Corporation
  • 15. Let’s build a smarter planet: HealthcareIBM involvement in epSOS project IBM joined the project in January 2010 We have one representative in the Steering Group of the Industry Vendor team Weve been active in a number of Work Packages during the Analysis & Technical Specification phases, sharing our experience and promoting eHealth standards that have proven their value in some of IBM projects. Were in contact with several Member States to help them build and run their epSOS pilot Were in contact with epSOS to provide additional security/privacy services14 © 2012 IBM Corporation
  • 16. EHR Adoption – Risks and Opportunities © 2012 IBM Corporation
  • 17. Let’s build a smarter planet: HealthcareEHR adoption improvements – why it is important16 © 2012 IBM Corporation
  • 18. Let’s build a smarter planet: HealthcareIt is NOT about Information Technology!17 © 2012 IBM Corporation
  • 19. Let’s build a smarter planet: HealthcareProject Risks in Healthcare IT 80% 20%18 © 2012 IBM Corporation
  • 20. Let’s build a smarter planet: HealthcareChange Management is key driver of Successful Healthcare implementations The key success factors for transformation are organizational rather than technical Change Management is a key driver of success Sponsoring of senior management 82% Fairness with staff 82% Involvement of staff in change programs 75% Honest communications 70% Good training programs 68% Usage of performance management 65% Usage of super users 60% Availability of resources for program 48% Software functionality 44% System performance 35% Realistic program planning 31% Source: IBM Institute for Business Value19 © 2012 IBM Corporation
  • 21. Let’s build a smarter planet: HealthcareNeed Help? Being a Physician is Only Getting More Difficult. NoOne Individual Can Do Everything that’s Needed or Expected.20 © 2012 IBM Corporation
  • 22. Let’s build a smarter planet: HealthcareOn the way for clinical value and meaningfulnessImportance of defining the Clinical Value of the EHR around: Improving Quality of Care Increasing Access to Services Increasing Patient Safety Managing Costs Providing Proactive rather than Reactive Health Care Chronic Disease Prevention Management Patient Self Management21 © 2012 IBM Corporation
  • 23. Let’s build a smarter planet: HealthcareGenerations of EHR capabilities Functionality Generation 5 The Mentor Predictive / Watson Generation 4 The Colleague Generation 3 The Helper Generation 2 The Documentor DiaLog Shared Care (Denmark) Generation 1 The Collector Basic Health Portal Shared Repository Time22 © 2012 IBM Corporation 22
  • 24. Let’s build a smarter planet: HealthcareHIMSS Europe adoption model23 © 2012 IBM Corporation
  • 25. Let’s build a smarter planet: HealthcareHIMSS adoption 2012 status - Poland Source: HIMSS Analytics Europe 201224 © 2012 IBM Corporation
  • 26. Let’s build a smarter planet: HealthcareFocus on a how to leverage datacollection base for more value addclinical and operational functions on the way to patient centric Deliver collaborative care Personalized for prevention and wellness Healthcare Value Retrospective to Prospective to Achieve better quality and Predictive Care Management outcomes Collaboration and Automation Integration / Information compliance, Interoperability availability and security Improve operational effectiveness EMRs, Images, Records, Forms Lifecycle Management, Clinical Trials, Safety IBM Health Integration Framework25 25 © 2012 IBM Corporation
  • 27. IBM aPatient Healthcare and InsightsLet’s build smarter planet: CareCapture, Analyze, Activate Raw Information IBM Content and IBM Content Analytics IBM Similarity Analytics (e.g. EMR and Claims) Predictive Analytics Recommended DTIC Patient Age: 65 Risk of 47% Add’l Gender: Male metastasi Treatment Race: White s Diagnosi Melanoma s Stage: 210’s of thousands of Social Marital status: singlepatients One Patient A 65-year old white male Labs AJCC: T2 100’s or 1000’s of has been diagnosed with patients stage 2 melanoma. He is widowed and lives alone. IBM Care Manager AJCC: T2 Goals Avoid remission Activities Avoid UV radiation Regular screening 100’s or 1000’s of Transportation patients assistance26 26 © 2012 IBM Corporation
  • 28. Casea smarter planet: Healthcare Really Caused Readmissions at SetonLet’s build Study: What The Data We Thought Would Be Useful … Wasn’t • 113 candidate predictors from structured and unstructured data sources • Structured data was less reliable then unstructured data – increased the reliance on unstructured data New Insights Uncovered by Combining Content and Predictive Analytics • LVEF and Smoking are significant indicators of CHF but not readmissions • Assisted Living and Drug and Alcohol Abuse emerged as key predictors (only found in unstructured data) • Many predictors are found in “History” notations and observations Top 18 Indicators 18. Jugular Venous Distention Indicator 17. Paid by Medicaid Indicator Predictor Analysis % Encounters % Encounters 16. Immunity Disorder Disease Indicator Structured Data Unstructured 15. Cardiac Rehab Admit Diagnosis with CHF Indicator Data 14. Lack of Emotion Support Indicator Ejection Fraction (LVEF) 2% 74% 13. Self COPD Moderate Limit Health History Indicator 12. With Genitourinary System and Endocrine Disorders Smoking Indicator 35% 81% 11. Heart Failure History (65% Accurate) (95% Accurate) 10. High BNP Indicator 9. Low Hemoglobin Indicator Living Arrangements <1% 73% 8. Low Sodium Level Indicator (100% Accurate) 7. Assisted Living (from ICA Extract) 6. High Cholesterol History Drug and Alcohol 16% 81% 5. Presence of Blood Diseases in Diagnosis History Abuse 4. High Blood Pressure Health History 3. Self Alcohol / Drug Use Indicator (Cerner + ICA) Assisted Living 0% 13%27 Heart Attack History 2. 27 © 2012 IBM Corporation 1. Heart Disease History
  • 29. Let’s build a smarter planet: HealthcareHow Similarity Analytics Work Create personalised profile based on longitudinal data, determine risk factors Find the most similar patients (or dynamic cohort) from entire population Analyze the attributes and outcomes for this cohort (across 30,000+ dimensions) Predict the probability of the desired outcome for patient in question Suggest a personalized care plan based on the unique needs of this patient Historical Observation Window Prediction Window This Patient’s Longitudinal Data Predicted Outcome For This Patient Desired Outcomes Dynamic Cohort Longitudinal Data with Outcomes28 © 2012 IBM Corporation
  • 30. Let’s build a smarter planet: HealthcareIBM Competency in Health IT Structured and formalised method Many years of experience for benefits of our clients IBM delivers e-health in Denmark for 15 years E-health adoption framework IBM delivers e-health ROI driven healthcare program in Canada for 10 years management IBM building Smart Healthcare ROI data from IBM own in US, UK, Spain, Germany, projects and combined Norway, Sweden, Ireland, Italy, industry expertise CEE, Middle East, SA, Asia ... Health Integration Framework IBM Institue for Business Value and Smarter Health solutions Healthcare Industry Practice IBM expert team helping clients to define national and IBM Center for Applied Insights regional e-health strategies ROI for Healthcare based on ROI32 © 2012 IBM Corporation
  • 31. Improving patient safety and care quality while improving the bottom line >> Achieving quality, safety, cost, and revenue improvements Let’s build a smarter planet: Healthcare IBM Center of Applied Insights Healthcare ROI Econometric Model Business leader interviews Value of the •27 interviews representing: Collaborative Care Econometric Model •Titles: CMIO, CIO •Sizes: range from 60 to  Holistic: Takes a holistic perspective 1000 beds unlike other studies •Locations: 5 countries Econometric Model  Financial impacts: Quantifies clinical • Analyze business and business impacts as costs or Subject matter expert model, sources of value, revenues interviews economic impact,  Research: Leverages academic and • 35 healthcare analysts and competitive alternatives thought leaders, including industry research and results of • Identify value and ROI notable authors and interviews with healthcare leaders delivered to Healthcare speakers Providers  Outlook: Accounts for transition path and steady state benefits Academic and industry  Flexible: Can accommodate alternative studies meta analysis technology functionalities and • >200 peer-reviewed articles implementation scenarios • Journals include New England Journal of Medicine,  Vendor neutral: Takes a functional, Health Affairs, JAMA rather than vendor-driven approach Source: IBM Market Insights 33 10 January 2013 © 2012 IBM Corporation
  • 32. Let’s build a smarter planet: HealthcareSummary - Ingredients for success in EHR adoption Learn from the past and other countries – best practices Design a rock solid Governance process – Direction – Project oversight – Stakeholder buy-in – Manage the Change – Allocate 20 to 25% of project budgets on Change Management – Build in motivation criteria Focus on clinical meaningfulness – Improvements in quality, safety, costs of care – Decisionmaking support – Proactive rather than Reactive Health Care Use Standards and methods across the program – Project management – Common project phases & gates – Alignment with a national E-Health Architecture using a Design Authority Value Measurement – Define outcomes – Establish Benefits Realization mechanism – KPIs37 © 2012 IBM Corporation
  • 33. Let’s build a smarter planet: Healthcare... and please don‘t forget Technology is just a tool ... ... how much value we create is up to us all!38 © 2012 IBM Corporation
  • 34. Thank you matej.adam@cz.ibm.com © 2012 IBM Corporation