2. 1760’s……. Late 1990’s…….
What’s Going On?
Steam and coal
Railways
Factories
Printing press –
mass education
1.0 Electrification, co
mms, oil, combusti
on engine
New materials
Highways, automo
biles
Mass production
Internet, molecular
biology, renewable
energy sources
Super information
highways
Smart “everything”
2.0 3.0
We are still at the dawning of the third era…
...A new economic narrative is being
written.
1860’s…….
* The Third Industrial Revolution: How Lateral Power is Transforming Energy, the Economy, and the World by Jeremy Rifkin, president of the Foundation
on Economic Trends
*
5. … Re-imagining the World at Light
Speed
From the Obvious…
Knowledge
Educating
Shopping
Travelling
Sharing
Industries established over a Century
re-architected in under a Decade
Communicating
Entertaining
to
to
to
to
to
to
to
7. 1. A team approach
mHealth drives Coordinated Care
with Collaborative Workflows
Collaboration requires a reliable, secure IT infrastructure
at a reasonable cost
2. Comprehensive
information
3. Data exchange and
information sharing
4. Data access everywhere
7
8. 33%
27%
44%
26%
24%
65%
21%
39%
39%
39%
25%
15%
67%
26%
43%
44%
50%
33%
31%
73%
28%
0% 20% 40% 60% 80%
Helping me choose treatment paths for patients
Helping me diagnose patients
Learning about new treatments & clinical research
Helping me educate patients
Accessing patient information & records
Looking up drug & treatment reference material
Making decisions about ordering labs or imaging…
Both smartphone & tablet Smartphone Tablet
N=2985
How Providers Currently Use
Mobile Device(s)
Source: QuantiaMD* Research Report, “Tablets Set to Change Medical Practice,” June 15, 2011.
http://www.quantiamd.com/qqcp/QuantiaMD_Research_TabletsSetToChangeMedicalPractice.pdf
“Super-mobile” physicians drive higher utilization and demand
tablet access to sensitive patient data
8
9. Care Coordination Gets Results
†Sweeney L, Halpert A, Waranoff J. Patient-Centered Management of Complex Patients Can Reduce Costs Without Shortening Life.
American Journal of Managed Care. 2007; 13:84-92.
38%
fewer
admissions
36%
fewer
inpatient days
30%
fewer
ED visits
26%
lower
cost
756 patients with “life-limiting illnesses”
Prospective cohort study†, California, 2007
“Patient-centered” group (358)
9
10. Care Coordination Gets Results
*Arvantes, J. Geisinger Health System Reports That PCMH Model Improves Quality, Lowers Costs. AAFP News Now. May 26, 2010.
40%
reduction
in 30-day
readmissions
20%
reduction
in total
admissions
7%
lower
costs
Geisinger Health System* in Pennsylvania
36 primary care practices with NCQA; level 3
PCMH certification vs. control practices
10
11. Support Care Coordination for Better
Outcomes, Mobilized Data is Critical
GATHER &
Store Data
SHARE
the Data
MOBILIZE
Data
EMPOWER
Citizens
11
13. Possible Collaborative Workflows
to Consider
EMS: Treat in Place
EMT / Doc / Homecare nurse / Community care worker
ED Discharge to Home
Doc / Homecare nurse / Community care worker
ED Admit
ED nurse / Floor nurse / Transportation
Consults Acute Inpatient
Doc / Doc / Therapists / Pharmacist / etc.
Consults Chronic Disease Outpatient
Doc / Therapists / Homecare nurse / Community care worker / etc.
Homecare
Doc / Homecare nurse / Community care worker
EMS Video
13
14. Theme 2: Perceived improved patient
knowledge and self-care
• Improved understanding of health issues
• Greater insight into provider assessments and
recommendations
• Improved sense of control of health issues
• Prompt to use the Internet to understand information
Patient Experiences With Full Electronic Access
to Health Records and Clinical Notes Through the
My HealtheVet Personal Health Record Pilot:
14
(J Med Internet Res 2013;15(3):e65) doi:10.2196/jmir.2356
Summary of themes on patient experiences with full record access.
Theme 1: Perceived enhanced
communication with providers and
health care teams
• Supplements in-person communication
• Improved recall of appointments
• More prepared for encounters with providers
• Greater ability to share information with non-VA
providers
Theme 3: Perceived greater patient
participation in care
• Prompt to remind health care team for appropriate
care or follow-up
• More engaged to discuss health and health care
issues
• More able to participate in decisions if care is needed
or not
Theme 4: Perceived challenges from
viewing records and electronic
documentation
• Stress related to information not routinely disclosed
• Concern about language in notes
• Inconsistencies or errors in documentation
• Observations on electronic records and PHR technical
problems
15. Patients Reading Doctors Notes
15
Delbanco, Tom MD, Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead, Annals of Internal
Medicine, Oct. 2, 2012, http://annals.org/article.aspx?articleid=1363511.
Design: Quasi-experimental trial of PCPs and patient volunteers in a year-long program that provided
patients with electronic links to their doctors' notes.
Setting: Primary care practices at Beth Israel Deaconess Medical Center (BIDMC) in
Massachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC)
in Washington.
Participants: 105 PCPs and 13 564 of their patients who had at least 1 completed note available during
the intervention period.
Measurements: Portal use and electronic messaging by patients and surveys focusing on participants'
perceptions of behaviors, benefits, and negative consequences.
At the end of the experimental period, 99% of patients wanted open
notes to continue and no doctor elected to stop.
Results: 11 797 of 13 564 patients with visit notes available opened at least 1 note (84% at
BIDMC, 92% at GHS, and 47% at HMC).
• Of 5391 patients who opened at least 1 note and completed a post intervention survey, 77% to 87%
across the 3 sites reported that open notes helped them feel more in control of their care;
• 60% to 78% of those taking medications reported increased medication adherence; 26% to
36% had privacy concerns;
…
• 1% to 8% reported that the notes caused confusion, worry, or offense;
…
21. Summary
The Age of Virtual Care Delivery is Coming
Mobile tools enable Collaboration and
Collaborative workflows are where you want to go
Patient Empowerment improves Outcomes and Lowers costs
21
22. Call to Action
In order to improve care
delivery, shorten delays, reduce
rework, and improve patient
satisfaction, IDENTIFY a workflow
within your organization that might be
improved with real-time collaborative
communications and data sharing
22
23. Resources
23
www.intel.com/healthcare pavel.kubu@intel.com
How Mobile Tools Enable
Collaborative Workflows
Mobile Health Tools Enable
Collaborative Care
Enabling Collaborative
Workflows to Shape Mobile
Healthcare
Mobility and Collaboration in
Health IT
Intel Healthcare Innovation
Summit
Mobile Point of Care:
Choosing Devices for
Collaborative Workflows
Nigerian Healthcare Access
Increases in Underserved
Areas
Intel Mobile Point of Care
Device Selector Tool
Mobilizing Health Workers:
On the Go with an
Ultrabook™
Collaborative
Workflows, Coordinated
Care
Choosing the Right Health
IT Mobile Device
Using Mobile Point of Care
to Improve Healthcare
Delivery
mHealth – Powering the
Health Workforce
Mobile IT Infrastructure
Enhances Pediatric Health
Care
Streaming and Virtual
Hosted Desktop Study:
Phase 2
Mobility and Security in
Health IT
Editor's Notes
So I mentioned transformation and disruption – let me try and clarify that and put the change that is occurring in perspective What we’re going through right now is akin to the 3rd industrial revolution …….. 1752 – Ben Franklin proved that static electricity and lightning were the same – this paved the way for the future1800 - first electric battery introduced 1821 – Faraday invented the first electric motor1835 – First electric relay invented 1844 – Morse invented the telegraph 1879 – first light bulb – Thomas Eddison1903 – First power stationNoyce and Kilby invented the integrated circuit in the 1950s but it wasn’t until the 2000’s where we crossed the threshold where compute and communications based on this technology passed a level of affordability that meant it was not longer a luxury item but became pervasive and a necessity – and we surpass not only technological boundaries but economic ones – making the impossible, possible (and affordable and almost required to remain competitive …) A new economic narrativeAlters the spatial and temporal dynamic of societyhttp://en.wikipedia.org/wiki/The_Third_Industrial_RevolutionJeremy RifkinJeremy Rifkin is president of the Foundation on Economic Trends and the bestselling author of nineteen books on the impact of scientific and technological changes on the economy, the workforce, society, and the environment.
So, lets apply the hockey-stick analogy to the world of Computing and Communications.Noyce and Kilby invented the integrated circuit in the 1950s but it wasn’t until the 2000’s where we crossed the threshold where compute and communications based on this technology passed a level of affordability that meant it was not longer a luxury item but became pervasive and a necessity – and we surpass not only technological boundaries but economic ones – making the impossible, possible (and affordable and almost required to remain competitive …) A new economic narrativeAlters the spatial and temporal dynamic of societyhttp://en.wikipedia.org/wiki/The_Third_Industrial_RevolutionJeremy RifkinJeremy Rifkin is president of the Foundation on Economic Trends and the bestselling author of nineteen books on the impact of scientific and technological changes on the economy, the workforce, society, and the environment.
We’ve hit the tipping point but there’s still a huge way to go. Half the world is not connected. And the scope in developed economies for “connected everything” from farmers’ fields, to signs, transport systems… etc is enormous.2011- 11% retail sales done on-line; 8% in 2008.2012 – WTC.
The transformation is everywhere. The pace of change is unrelenting and unless you want to rapidly become a relic you have to change ………. In ways you hadn’t likely considered even a few years ago!!!
Tablet Adoption by Physicians May Soon Exceed 50%Years of Practice Not a Barrier to Mobile AdoptionMobile Devices Support Core Physician ActivitiesIn professional settings, physicians most often use their mobile devices to access drug and treatment reference information. Also high on the list is obtaining new information about treatments and research, and making decisions about patient treatment and diagnosis. Emerging areas of use include medical testing decisions, patient education materials, and accessing patient records and information Access online resources: research drugs (73%), treatments (50%), clinical research (50%), patient diagnosis (44%)When asked how they would prefer to use their mobile devices for peer-to-peer activities, physicians’ top interest is access to EMR data. They also prioritize receiving treatment protocols alerts, and sharing and discussing cases with other physicians. For physician-to-patient activities, physicians value “e-prescribing,” sharing patient education materials, getting paid for time devoted to email and chats with patients, and receiving alerts when patients need follow-up treatment Among barriers that may impede use of mobile devices, physicians are most concerned about patient privacy and physician liability, and lack of financial reimbursement for physician time and investment in using this technology. Physicians also cite limited institutional support for peer-to-peer engagement using mobile technology. Concerns about patient privacy and liability also feature as physician-patient barriers. Interestingly, though, just 37% of physicians cite lack of technology among patients as a barrier. This would have been much higher just a year ago Twenty-five percent of physicians in our survey report using both smartphones and tablet devices for their work. These “Super Mobile” physicians are using online resources at significantly higher rates than physicians who use either a smartphone or a tablet alone. Among the top professional activities for these very mobile physicians are searches for drug and treatment reference materials, learning about new treatments and research, and diagnosing and choosing treatment for patients. While these activities are similar to those pursued by other physicians who are online, “Super Mobile” physician are using online resources much more frequently across a broad range of core professional activities, pushing physician online usage upward. One notable impact of tablets is that physicians are much more interested in accessing patient data and records via a mobile device with a tablet than with their smartphone.QuantiaMD® Research Report, “Tablets Set to Change Medical Practice”, June 15, 2011. See www.quantiamd.com/q-qcp/QuantiaMD_Research_TabletsSetToChangeMedicalPractice.pdf
Sweeney,L., Halpert,A., Waranoff,J. (2007). Patient-centered management of complex patients can reduce costs without shortening life. The American Journal Of Managed Care, 13 (2), 84-92.OBJECTIVE: To determine the effect of intensive patient-centered management (PCM) on service utilization and survival. STUDY DESIGN: Prospective cohort study of 756 patients in California who had a life-limiting diagnosis with multiple comorbid conditions (75% were oncology patients) and who were covered by a large commercial health maintenance organization from February 2003 through December 2004. METHODS: Group membership determined assignment to the PCM cohort versus the usual-management cohort after blindly screening for clinical complexity. Both cohorts accessed the same delivery system, utilization management practices, and benefits. Intervention was intensive PCM, involving education, home visits, frequent contact, and goal-oriented care plans. RESULTS: Roughly half (358) of the 756 patients received PCM. Fewer PCM oncology patients elected either chemotherapy or radiation (42% increase over usual-management oncology patients). PCM patients had reductions in inpatient diagnoses indicative of uncoordinated care: nausea (-44%), anemia (-33%), and dehydration (-17%). PCM patients had utilization reductions: -38% inpatient admissions (95% confidence interval [CI] = -37%, -38%), -36% inpatient hospital days (95% CI = -35%, -37%), and -30% emergency department visits (95% CI = -29%, -31%). PCM patients had utilization increases: 22% more home care days (95% CI = 20%, 23%) and 62% more hospice days (95% CI = 56%, 67%). Overall costs were reduced by 26% (95% CI = 25%, 27%). Patients' lives were not shortened (26% of PCM patients died vs 28% of patients who received usual management) (P = .80). CONCLUSION: Comprehensive PCM can sharply reduce utilization and costs over usual management without shortening life. (Source: PubMed)
Design: Quasi-experimental trial of PCPs and patient volunteers in a year-long program that provided patients with electronic links to their doctors' notes.Setting: Primary care practices at Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Washington.Participants: 105 PCPs and 13 564 of their patients who had at least 1 completed note available during the intervention period.Measurements: Portal use and electronic messaging by patients and surveys focusing on participants' perceptions of behaviors, benefits, and negative consequences.Results: 11 797 of 13 564 patients with visit notes available opened at least 1 note (84% at BIDMC, 92% at GHS, and 47% at HMC). Of 5391 patients who opened at least 1 note and completed a post intervention survey, 77% to 87% across the 3 sites reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to 36% had privacy concerns; 1% to 8% reported that the notes caused confusion, worry, or offense;20% to 42% reported sharing notes with others. The volume of electronic messages from patients did not change. After the intervention, few doctors reported longer visits (0% to 5%) or more time addressing patients' questions outside of visits (0% to 8%), with practice size having little effect; 3% to 36% of doctors reported changing documentation content; and 0% to 21% reported taking more time writing notes. Looking ahead, 59% to 62% of patients believed that they should be able to add comments to a doctor's note. One out of 3 patients believed that they should be able to approve the notes' contents, but 85% to 96% of doctors did not agree. At the end of the experimental period, 99% of patients wanted open notes to continue and no doctor elected to stop.
Mobilniaplikacepodporujicipotrebne workflow v kontextusituace
