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.

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 http://healthcareguy.com)
• 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”
www.netspective.com
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3. Healthcare needs are changing
The Macro Environment

4. NETSPECTIVE
Life expectancy is increasing…
…but the rate of growth is slowing
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5. NETSPECTIVE
Bacteria used to kill us the most…
Per 100k population, Historical Statistics of the United States, Millennial Edition
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6. NETSPECTIVE
We’ve got most infections beat…
…except the flu and pneumonia
Per 100k population, Historical Statistics of the United States, Millennial Edition
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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
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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
http://siteresources.worldbank.org/INTHSD/Resources/topics/Health-Financing/HFRChap1.pdf
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9. NETSPECTIVE
Chronic Conditions
Almost half the U.S. population needs chronic disease management
Source: NCQA State of Healthcare Quality Report 2007 & Wellpoint
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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
http://www.cdc.gov/chronicdisease/resources/publications/AAG/chronic.htm
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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
http://www.census.gov/compendia/statab/cats/health_nutrition/health_expenditures.html
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12. NETSPECTIVE
Health services centralization tried
Source: Jason Hwang, Innosight, via Jeff Selberg of IHI
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13. NETSPECTIVE
…now comes decentralization and innovation
Source: Jason Hwang, Innosight, via Jeff Selberg of IHI
www.netspective.com
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14. NETSPECTIVE
Consumers will need do/pay more…
www.netspective.com
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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
www.netspective.com
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17. NETSPECTIVE
Patient Collaboration Maturity Model
Accountable Care
Integrated Care
Coordinated Care
Connected Care
Independent
Care
www.netspective.com
Choosing a single EHR vendor as your
platform for connected care won’t work
beyond integrated care scenarios.
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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
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Specific
Prevention
Hospital
Monitoring
Hospital
Diagnostics
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19. NETSPECTIVE
Is OSEHRA / VistA ready?
Improve speed of
response to new
patient/HCP needs
Reduce
permissionoriented culture
Reduce number of
Shadow IT systems
www.netspective.com
React faster to
regulatory and
market changes
Reduce
compliance-focus
in favor of
customer focus
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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
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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
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Digitize biology
Digitize
chemistry
Digitize physics
Predict
fundamental
behaviors
Petabytes and exabytes
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22. NETSPECTIVE
Consumerization of physiologics….
www.netspective.com
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23. NETSPECTIVE
Consumerization of labs / genes
Labs on chips
www.netspective.com
Personal Genomics
23

24. NETSPECTIVE
Consumerization of monitoring
www.netspective.com
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25. NETSPECTIVE
Data changes the questions we ask
Simple visual facts
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Complex visual facts
Complex computable
facts
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26. NETSPECTIVE
Implications for scientific discovery
The old way
Identify
problem
Identify
data
Ask
questions
Generate
questions
Collect
data
Mine data
Answer
questions
www.netspective.com
The new way
Answer
questions
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27. NETSPECTIVE
Wireless Body Area Network (BAN)
The cornerstone of mHealth
www.netspective.com
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28. NETSPECTIVE
Wireless BAN Ecosystem
Source: Qualcomm
www.netspective.com
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29. NETSPECTIVE
Wireless Protocols Comparison
http://acamp.ca/alberta-micro-nano/images/docs/Technology-Presentations/Ken-Fyfe-HealthMedical-Dec09.pdf
www.netspective.com
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30. NETSPECTIVE
ANT+ is winning ULP protocol battle
http://acamp.ca/alberta-micro-nano/images/docs/Technology-Presentations/Ken-Fyfe-HealthMedical-Dec09.pdf
www.netspective.com
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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
www.netspective.com
2013
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33. NETSPECTIVE
Needed from OSEHRA: Reimagined User Interactions
Data visualization requires integration and aggregation
What’s being offered to users
www.netspective.com
What users really want
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34. NETSPECTIVE
Needed from OSEHRA: diagnostic quality mHealth
www.netspective.com
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35. NETSPECTIVE
Needed from OSEHRA: sophisticated analytics
www.netspective.com
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36. NETSPECTIVE
Needed from OSEHRA: care team involvement
PATIENT/
CONSUMER
HEALTHCARE
PROVIDER
Care Team
FAMILY
CAREGIVER
CALL CENTERS AND
REMOTE SUPPORT
www.netspective.com
HOSPITAL
ALTERNATE
SITE OF CARE
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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
www.netspective.com
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38. NETSPECTIVE
Needed from OSEHRA: automated diagnostics
www.netspective.com
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39. http://healthcareguy.com
@ShahidNShah
Shahid.Shah@netspective.com
Questions?
Thank you