Maccabi is the second largest HMO in Israel. It covers 1.85 million people (24.5% 0f the population)

It is a recognized health fund within the framework of the Israeli National Health Insurance Law

Maccabi is responsible for providing insurance cover for all services included in the public basket of services

It supplies services to its members both via its own facilities and through outside providers

Maccabi Healthcare Services

The Maccabi Heathcare System is Highly ComputerizedThe Maccabi Heathcare System is Highly Computerized

Every provider uses the Maccabi Electronic Medical Record

Every transaction with the patient is computerized

The Central Medical Record contains all computerized patient data –gives doctor access to all information on the patient

The E-Laboratory-electronic referrals, automatic test results to doctor’s computer, patient website

The E- Prescription

E- Consultation

Telemedicine

Alerts and Reminders

Patient Website including Patient Health Record

Chronic Diseases Is the Major Threat and Challenge of our Century

Nearly 70-80% of health care costs are a result of chronic disease

Chronic Disease accounts for 60% of all deaths and 43% of the global burden of disease

70% of the disease burden is from 5 chronic conditions Congestive heart failure Asthma Coronary artery disease. Diabetes Depression

People with chronic conditions only receive 56.1% of recommended care

Disease management is a High Priority everywhere to reduce complications and deaths

Chronic Disease Management using Chronic Disease Management using edBPM edBPM

Modern approaches to disease management focus on “patient empowerment”

Two types of technologies in use today: Remote monitoring of patients using sensors/devices

that transmit to professional call center Patient websites with structured programs for DM

The edBPM approach: complex event processing disease management web-based program to assimilate information from multiple source events (sensors, patient input, doctor’s electronic record), macro level analysis as complex event, take action in real time.

Scenario – Diabetes ManagementScenario – Diabetes Management

Harry Jung is a married man of 50 who was diagnosed with Diabetes Mellitus

type 2 ten years ago. He is generally careful about his diet, has a regular

exercise regimen and his HbA1c levels indicate that his disease is in control

and stable. He is enrolled in an interactive web-based (EaSSY edBPM

platform) diabetes disease management program. He weighs himself once a

week and the results are transmitted to the program. Likewise, he measures

his blood pressure once a week and he measures his sugar levels daily with a

glucometer. These measures are transmitted and entered into his interactive

disease management program. He has been instructed to enter the system

once a month to monitor his overall trends and provide a subjective report

about his well being.

This month, he entered the program, and upon entry it

notified him that although he had not yet reached levels that

would generate an alert, he is exhibiting a steady trend of

increase in glucose levels as well as a small but steady

increase in his weight. The program also informs him that he

has not had an eye checkup in over a half a year, he has not

had a foot checkup in more than a year and he is overdue for

his HbA1c test. Therefore, he is instructed to make an

appointment with his doctor. The program connects him

automatically to the doctor's web-based appointment system

so that he can schedule an appointment. In addition, the

program will ask him additional questions about his diet and

exercise regime and give him interim instructions to follow in

the meantime until he has his appointment with his doctor.

Scenario

Action 1: Weekly transmission glucose levels, Blood Pressure to internet DM program

Event Type: Date, time, Data - glucose level, BP, height, weight

Source: Sensors and medical devices in patient’s home

Business processes: Comparison of input with norms. Time series comparison

Human Dialogue: Trend analysis and result

Action 2: Bimonthly update of program from doctor’s electronic medical record

Event Type: Date, time, test results, treatments, date last performed, drugs

Source: Electronic medical record doctor’s computer

Business processes: Comparison of information with business rules for required intervals for performing tests, treatments, visits, compare test results with norms

Human Dialogue: Generation of exception list ( lack of conformity to rules)

Action 3: Henry Jung opens internet DM site for monthly review

Event Type: Date, time, recognition of patient entry (user name, password)

Source: patient’s home computer

Business processes: processing of accumulated results of information, correlation between trends of results from devices, tests, exception list from EMR

Human Dialogue: Presentation of results to Henry

Scenario

Action 4: Henry Initiates interactive program, questions and answers

Event Type: alerts: steady increase in glucose levels and weight; notification that he is overdue for tests, checkups

Source: Disease management program

Business processes: answers to Henry’s questions, automatic connection with Henry’s doctor’s web appointment schedule

Human Dialogue: Options for appointments

Action 5: Henry chooses a time and date for doctor appointment and eners it

Event Type: makes appointment in response to patient choice of date and time

Source: Henry’s input from home computer

Business processes: Process and confirm time and date op appointment in doctor’s appointment calendar according to rules governing the appointment

Human Dialogue: Notification of doctor’s clinic and confirmation to Henry of appointment with optional reminder to cellular phone

EMR

Doctor InputDoctor Input

Case Management Record Devices

NurseNursePatientPatient

Drugs, Vital Signs

Input Analysis Confirmation within

Parameters

Deviation from Parameters

Moderate Severe

Re measure within

Parameters

Continued Deviation from Parameters

Ask for Additional info from Patient

Notify Nurse Update EMR and Case Management Record

Instructions for Resting ,Changes in Drugs,

Eating etc.

Follow Up

Re measure

Schedule Visit in Doctor`s Clinic

Alert

Order Ambulance, Notify ER

OR

WebReport

Doctor

Nurse