Electronic Medical Records From Paperless to Big Data Initiatives

1. Electronic Medical Records
From Paperless to Big Data Initiatives
Komes Chandavimol
โกเมษ จันทวิมล
Data Scientist
Data Science Lab, Thailand
komes@datascienceth.com

2. Agenda
• Introduction
• Electronic Medial Records – Experience Sharing
• Beyond EMR
http://cdn.24x7mag.com/x7mag/2014/03/robot-stethoscope.jpg

3. Komes
• Komes Chandavimol
• Wanna be a Doctor
• Healthcare Analytics Consultant @M4SC
• Data Scientist @Data Science Lab, Thailand

5. Electronic Medical Records
• An electronic medical record (EMR) is a digital
version of the traditional paper-based medical
record for an individual.
http://health.usnews.com/health-news/most-connected-hospitals/articles/2011/07/18/most-connected-hospitals
http://curemd.wordpress.com/2012/07/23/emr-adoption-and-health-information-exchange/

6. Paperless
http://alterinspire.com/index.php/tag/electronic-medical-records/
http://www.chinatechnews.com/2015/01/30/21375-alibaba-health-reaches-cloud-deal-with-winning-software

7. Electronic Medical Records
Paperless
Basic EMR
Integrated
EMR
Meaningful
Uses
EMR + Big Data
http://ehnusa.com/solution/problem

8. Software
EMR Software helps doctors and medical
professionals keep track of health-
related information for their patients and
give staff access to these records
through centralized electronic systems
http://www.healthcareitnews.com/sites/default/files/hitn_ehr.jpg
http://www.capterra.com/infographics/top-emr-software

9. http://ihealthtran.com/images/Inforgraphic-traditional-paper-records-vs-Electronic-medical-records-EMR-Infographic-friday.jp

10. • As of 2015 Epic has 315 customers.
• 54% of patients in the United States*
• This includes 69% of Stage 7 U.S. Hospitals, 71% of
children's hospitals, and 83% of Stage 7 Clinics
• Employee 9000+
• Found in Verona, Wisconsin
http://learnhealthtech.com/epic-systems-modules/
https://en.wikipedia.org/wiki/Epic_Systems#cite_note-12

11. Epic Modules
http://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php
http://learnhealthtech.com/epic-systems-modules/
SEmergency R
ADTEpic Care Inpatient
PBRevenue
Cycle HB

12. Epic System
http://www.slideshare.net/VMworld/vmworld-2013-how-does-vmware-uniquely-enable-leaders-in-
healthcareelectronic-medical-records-to-improve-quality-of-care-and-meet-unique-industry-requirements

13. Epic Reporting System
http://www.slideshare.net/VMworld/vmworld-2013-how-does-vmware-uniquely-enable-leaders-in-
healthcareelectronic-medical-records-to-improve-quality-of-care-and-meet-unique-industry-requirements

14. Epic System หน้าจอของแพทย์
http://www.epic.com/

15. Epic System หน้าจอข้อมูลคนไข้
http://www.epic.com/

16. Electronic Medical Records
Paperless
Basic EMR
Integrated
EMR
Meaningful
Uses
EMR + Big Data
http://ehnusa.com/solution/problem

17. • Nemours ประกอบด้วย 3 กลุ่มโรงพยาบาล
– Nemours Alfred I. duPont Hospital for Children (129 Beds)
– Nemours Children's Clinics, Jacksonville, Florida
– Nemours Children’s Hospital , Orlando, Florida
• เป็น กลุ่มโรงพยาบาลแรกๆ ของ อเมริกาที่ลงระบบ Electronic Medical Records (2002)
• เริ่มต้นมีทีม 3-4 คน และ ขยายเพิ่มมากเพื่อรองรับ ความต้องการของลูกค้า ทั้งในด้านคนเตรียมรายงาน และ คนดูและระบบ
EMR System
Nemours – Children Hospital
R
S
PB

18. Lessons Learn
The promise is that they're going to help us
deliver better care with better outcomes. But
you can't just have an EMR—you have to learn
to use the tools in the right way.
http://health.usnews.com/health-news/most-connected-
hospitals/articles/2011/07/18/most-connected-hospitals

19. Lessons Learn
Assembling the Right EHR Project Teams
• A “Clinical Champion”
• An EHR Project Manager
• Evaluation & Selection Team Members
• EHR Implementation Team Members
http://www.schoolhealthcenters.org/wp-content/uploads/2011/06/1-Assembling-the-Right-EHR-Project-Teams-Tips-
for-Success.pdf

20. Electronic Medical Records
Paperless
Basic EMR
Integrated
EMR
Meaningful
Uses
EMR + Big Data
http://ehnusa.com/solution/problem

21. Nemours – Children Hospital
RVU-based Reports
Revenue Cycle Reports
Registration/Scheduling Reports
Clinical Reports

22. • University of Illinois Medical แยก บริษัทออกมาเพื่อบริหาร รายรับ รายจ่าย ของ แพทย์
• เน้นการให้บริการข้อมูล EMR สาหรับรายรับ รายจ่ายของ แพทย์ (Revenue Cycle)
SC Scheduling
PBProfessional
Billing
• Anesthesiology
• Dermatology
• Emergency Medicine
• Family Medicine
• Medicine
• Neurology
• Neurosurgery
• Obstetrics and Gynecology
• Orthopedics
• Otolaryngology
• Pathology
• Pediatrics
• Pharmacology
• Psychiatry
• Radiology
• Surgery
• Urology
Physician Group (University of Illinois)
Credit: University of Illinois Hospital, www.wwtps.com

23. • วางแผนการพัฒนาระบบเดิม และเพิ่มเติมระบบใหม่ เพื่อรองรับความต้องการ
• มีการจ้างพนักงานเพิ่ม และ จ้าง ที่ปรึกษาเพิ่มเติม
SC Scheduling
PBProfessional
Billing
• Anesthesiology
• Dermatology
• Emergency Medicine
• Family Medicine
• Medicine
• Neurology
• Neurosurgery
• Obstetrics and Gynecology
• Orthopedics
• Otolaryngology
• Pathology
• Pediatrics
• Pharmacology
• Psychiatry
• Radiology
• Surgery
• Urology
Physician Group (University of Illinois)
Dashboards
Operational Reports
Self-Service Reports
Credit: SAP Business Object software, www.sap.com

24. Seattle Children Hospital
Safety Net Payment Reimbursement
พัฒนา ระบบ เพื่อประเมิน การเบิกคืนจากรัฐบาล
• Flat rate per patient visit
• 6.3%, 7% increased reimbursement rates
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242845/
HB
Hospital
Billing
$$$
Government Reports
$$
Medicaid

25. Cedars-Sinai Medical Center
http://clinfowiki.org/wiki/index.php/Epic
I Inpatient
EEmergency
Legacy
System
• Non-profit, tertiary 958-bed hospital and multi-specialty academic
health science center
• พัฒนาระบบเดิม และเพิ่มเติมระบบใหม่ เพื่อรองรับความต้องการทางข้อมูล
Legacy
System

26. SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey and National Ambulatory Medical Care
Survey, Electronic Health Records Survey.
Percentage of office-based physicians with EHR systems: United
States, 2001–2013
? ??

27. Electronic Medical Records
Paperless
Basic EMR
Integrated
EMR
Meaningful
Uses
EMR + Big Data
http://ehnusa.com/solution/problem

29. EHR Incentive Program
29
http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/ehr-incentive-
program/financial-penalties-nearing-physician-incentive?page=full
The Medicare and Medicaid Electronic Health Records (EHR) Incentive
Programs will provide incentive payments to eligible PROFESSIONALS and
eligible HOSPITALS as they demonstrate adoption, implementation,
upgrading, or meaningful use of certified EHR technology.
Penalties

30. 30http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/ehr-incentive-
program/financial-penalties-nearing-physician-incentive?page=full

31. How to Award the Incentive?
http://www.sfms.org/NewsPublication/SFMSBlog/TabId/467/PostId/1179/mu-audit-ca.aspx
Measurement?

32. 32
Core Measure for MU
Core Measures
The goal of "core measures," is not to measure. Rather, it's to drive
improved performance across health care organizations and
depending on whom you ask, it's to police hospitals to ensure certain
patients are treated in line with what has been determined to be
standard and necessary based on their diagnosis.
• Acute Myocardial Infarction (AMI) – Heart Attack
• Heart Failure
• Pneumonia
• Surgical Care Improvement Project (SCIP)
• Computerized Provider Order Entry (CPOE)
http://www.huffingtonpost.com/janet-dillione/easing-core-measure-pain-_b_1573695.html

33. 33
Meaningful Use of Data
CPOE
http://www.huffingtonpost.com/janet-dillione/easing-core-measure-pain-_b_1573695.html

34. EHR $$$
http://www.huffingtonpost.com/janet-dillione/easing-core-measure-pain-_b_1573695.html

35. • 12 hospitals, 27 Senior care facilities,
• 6 Urgent care/immediate care centers
• Presence Medical Group
• Hospital with 191 beds
• 24 acute care hospitals
• 8 physician foundations
• Cancer centers, Long-term Care
• University, Research institutes
Credit Resurrection Healthcare, Sutter Health, Children Hospital Oakland www.wiki.com

36. The impact of Meaningful Uses!

37. Open Government
Credit Healthgrade, MedWatcher, NHS

38. Healthcare Startup

39. Quality of Hospital Care
Reduce Rate of Readmission
1.Collecting EHR
2.Integrate financial and clinical data
3.Structure the data elements Diagnosis,
Procedure, Billing information, patient
info)
4.Predictive Modeling Attached a risk score
% to readmit)
HB
I
PB
S
O
Credit: Adventis Medical Center (demo)

40. • 17,791 physicians
• 9 millions patients
• 49,778 nurses,
• 38 medical centers
• 620 medical offices
30 petabytes of EMR data
3000+ IT staff
Credit Kaiser Permanente, www.kp.com www.wiki.com

41. Lessons Learn
The promise is that they're going to help us
deliver better care with better outcomes. But
you can't just have an EMR—you have to learn
to use the tools in the right way.
http://health.usnews.com/health-news/most-connected-
hospitals/articles/2011/07/18/most-connected-hospitals

42. Lessons Learn
Assembling the Right EHR Project Teams
• A “Clinical Champion”
• An EHR Project Manger
• Evaluation & Selection Team Members
• EHR Implementation Team Members
http://www.schoolhealthcenters.org/wp-content/uploads/2011/06/1-Assembling-the-Right-EHR-Project-Teams-Tips-
for-Success.pdf
Within the right supports
Within knowledge, skills
With teamwork
With experience

43. Electronic Medical Records
Paperless
Basic EMR
Integrated
EMR
Meaningful
Uses
EMR + Big Data
http://ehnusa.com/solution/problem

44. Implement HealthConnect , the a new computer system to
ensure data exchange across all medical facilities and promote
the use of electronic health records.
The integrated system has improved outcomes in cardiovascular
disease and achieved an estimated $1 billion in savings from
reduced office visits and lab tests.
Credit Kaiser Permanente, www.kp.com www.wiki.com

45. • Need a solution to manage and extract valuable insights from vast
amounts of complex data.
• Implement an emergency dashboard system to track patients and
populations across all visits and interactions. This dashboard enables
Seattle Children’s to analyze massive volumes of hospital and patient data
to gain a holistic view and improve care.
This dashboard enables Seattle Children’s to analyze massive
volumes of hospital and patient data to gain a holistic view and
improve care.
http://www.ibmbigdatahub.com/presentation/seattle-childrens-hospital-turns-big-data-better-care

46. The enterprise master patient index or EMPI that allows for
"patient centric" care
Using the Master Data Management to integrate several patient-
related records and identify the single Patient ID. This benefits to
Sutter Health Facilities and affiliates to understand patient data
and provide the right care
http://www.prnewswire.com/news-releases/sutter-health-to-spend-12-billion-on-advanced-technologies-to-
support-clinicians-improve-care-72616447.html

47. Credit: www.epic.com

48. https://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf
The Future: Connecting Health to Care

49. The Future: Connecting Health to Care
https://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf
A Shared Nationwide Interoperability Roadmap

50. http://blogs.oliverwyman.com/healthcare/wp-content/uploads/sites/6/2015/02/shared-nationwide-interoperability-roadmap.png

51. http://blogs.oliverwyman.com/healthcare/wp-content/uploads/sites/6/2015/02/shared-nationwide-interoperability-roadmap.png

52. https://goo.gl/bdJcqy
Big Data

54. Big Data
http://www.adweek.com/prnewser/how-many-times-do-the-worlds-social-media-users-click-every-minute/117427
https://www.domo.com/learn/data-never-sleeps-3-0

55. http://www.adweek.com/prnewser/how-many-times-do-the-worlds-social-media-users-click-every-minute/117427
https://www.domo.com/learn/data-never-sleeps-3-0
Big Data

56. www.hortonwork.com

57. Data Lake
www.Microsoft.com

58. Big Data
http://www.adweek.com/prnewser/how-many-times-do-the-worlds-social-media-users-click-every-minute/117427
https://www.domo.com/learn/data-never-sleeps-3-0
How to start?

59. http://www.sfms.org/NewsPublication/SFMSBlog/TabId/467/PostId/1179/mu-audit-ca.aspx
But Why we Need Big Data?

60. http://www.sfms.org/NewsPublication/SFMSBlog/TabId/467/PostId/1179/mu-audit-ca.aspx
Volume? Varieties? Velocity?

61. http://www.sfms.org/NewsPublication/SFMSBlog/TabId/467/PostId/1179/mu-audit-ca.aspx
Value!

62. http://www.adweek.com/prnewser/how-many-times-do-the-worlds-social-media-users-click-every-minute/117427
https://www.domo.com/learn/data-never-sleeps-3-0
How to start?

63. How to Start?
Big Data + Analytics = Values

64. How to Start?
Big Data + Analytics = Values

65. How to Start?
Big Data + Analytics = Values

66. How to Start?
Big Data + Analytics = Values
(Science)

67. Lessons Learn
The promise is that they're going to help us
deliver better care with better outcomes. But
you can't just have an EMR—you have to learn
to use the tools in the right way.
http://health.usnews.com/health-news/most-connected-
hospitals/articles/2011/07/18/most-connected-hospitals

68. Lessons Learn
Assembling the Right EHR Project Teams
• A “Clinical Champion”
• An EHR Project Manager
• Evaluation & Selection Team Members
• EHR Implementation Team Members
http://www.schoolhealthcenters.org/wp-content/uploads/2011/06/1-Assembling-the-Right-EHR-Project-Teams-Tips-
for-Success.pdf
Within the right supports
Within knowledge, skills
With teamwork
With experience
+ Academics
+ Researcher
+ Scientists