Building a Clinical Information Continuum (Greg Lucier) (4.9 MB)
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Transcript of Building a Clinical Information Continuum (Greg Lucier) (4.9 MB)
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Building a Clinical Information Continuum
Presented by Greg Lucier, President and CEOGE Medical Systems Information TechnologiesMay 24, 2001
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Clinical Workflow
Today 2003-04 2006
Clin
ical
Work
flow
Stovepipe Solutions
Paper-based
Devices Unconnected
All Information Captured at POC
Inter-Department Convergence + Mobile Access
HIS/CIS Redefined
Personalization
Evidence Based Decisions
Closed-loop Control
Paper… Charges, Orders, Results...
Limited Connectivity
Archaic HIS
Complete Online Record… Data, Images, Consents, Meds, Charges...
Longitudinal, All Departments
Patient Portal
Physician Portal
Disease Management
Variance DrivesCost and Errors Productivity Productivity
Dispersed Paper Records
Online but Still Hospital Centric Beyond
Hospital
Ele
ctr
on
ic M
ed
ical
Record
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Clinical Information Management Model
Image Management
(PACS, GEMnet)
Data Management
(MUSE, Telemetry)
Monitoring Networks
Department Information
System
RISCVIS
OR / EDOB/NICU
Clinical Information
Systems
ChartViewScheduling
Order EntryBenchmarking
Charge CaptureData Repository
ClinicalWorkflowSystem
Clinical Productivity
Tools
DepartmentSolutions
EnterpriseSolutions
Healthcare Solutions…Workflow Consulting
IT Professional Services…Workflow Implementation
4,700 Software Engineers
1,000 IT Systems Implementation
Six Sigma Rigor
Healthcare Workflow Knowledge
Why GE…in IT?
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PACS Evolution
1980s
Physicians’ Workflow
1990s
Current Generation
2002 - Beyond
Voice Recognition
RIS/PACS CAD
Physicians’ cockpit – clinical and operational workflow integration
Integration with sub-specialty apps (neuro, ortho)
Full IT integration with radiology
Modality archiving – simple storage systems
Individual modality based systems
No workflow
Multi-modality systems
Focus on workflow Simple RIS integration
using interfaces/brokers
Limited enterprise workflow
No IT integration
Modality Archive
Clinical Workflow Enterprise solution –
hospitals, clinics Web-based
connectivity with referring physicians
Standalone advanced clinical apps
RIS/EMR integration
Department Workflow
RISDB
CR
MR/CT, etc.
WS
Web
EMR
InternetIntranet
From Stand Alone Workstation to Enterprise Image Management
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Cardiovascular IS Evolution
On-screen text only Analog ECG Signals Primitive SAR
Complete Non-Invasive Suite
Gold Standard SAR Digital Storage in
Cath Lab
Integrated CVIS Solution-Hospitals, Clinics
Web-based connectivity with referring physicians
EMR integration
Cardiologist Workflow
From Cardiology Information Management to Cardiologist Productivity
Cath
Stress
Echo
MR
CT
CartsMUSE
GEMnetNuclear
Holter
Cardiologists’ cockpit – clinical and operational workflow integration
Evidence-based Decision Making
Full IT integration with enterprise
DepartmentWorkflow
ECG Management
Non-Invasive &Cath Lab Workflow
1980s
1990s
Current Generation
2002 - Beyond
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All Paper to the Comprehensive Clinicians’ Desktop
Clinical IS / EMR Evolution
Next Generation CIS Longitudinal,
integrated, comprehensive on-line medical record
Full HIS/administrative integration
Decision Support and evidence based guidelines
Integration with medical devices
Web, wireless, mobile – anytime anywhere.
Innovation in “filing systems”
Lab and Pharmacy departments automated
No systems for clinicians
HIS Systems (lab, pharma, ADT) & silo solutions– OB
Brokers/interface engines growth
Limited enterprise workflow
No IT integration
Paper Medical Records
Back Office Automation
Fragmented, clinical area specific solutions : ICU, ED, OB, OR…
Minimal integration between clinical and administrative applications
Legacy IT architectures
Failed execution on integration and site configuration
Best of Breed Solutions
RISLab
ADT
Pharmacy
Paper Med Recs
PACS
ICU OB
ED
Transcription
OR
HISPACS OB ICU OR ED
1980s
1990s
Current Generation
2002 - Beyond
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From Basic Telemetry and Paging to Real-Time Access Anywhere
Evolution of Mobile Care
Web
• Unidirectional Telemetry• Unidirectional Text
Paging• Network Display for
Patient Data• Few beds set up for
telemetry
Unity CIC
Antenna
Telemetry
Text Pager
Telemetry
MobileCentral Station
Real Time Unity Network
• Bi-directional spread spectrum telemetry.
• Bi-directional paging with waveforms.• 2 Mbps wireless LAN for monitors• Reserved RF Space For Medical –
WMTS• Dedicating entire floors to telemetry• Point of care applications for PDAs
• Clinical and operational workflow
• Personalized digital cockpit
• Real-time connectivity to Unity II
• Integrated CIS-Monitoring Apps
• Patient & asset location services
• Wireless web access anywhere
• 40 Mbps wireless LAN (802.11a)
WaveformPager
Point of Care
Data Entry
Bedside Monitors
Patient Location
Telemetry
Devices
LabResults
MedsHistory
CaregiverProtocols
Patient Chart
Device Utilization
Unity IS
Mid-90s
Current Generation
2003 - Beyond
Early Adopters
Wireless Becomes Mainstream Enterprise Mobile Caregiver
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IS Convergenc
e
Vie
win
g S
ys
tem
s
Several workstations and platforms (Catalyst, GEMNet, Innova, PathSpeed, RadWorks, Advantage Windows, eNtegra, Integriti)
• PathSpeed+RadWorks; Catalyst+Muse +GEMNet+Innova rationalization underway
• Single clinical workstation in WWPP timeframe
Workstations
Current State Convergence Initiatives
WebMultiple web viewers for Image Mgmt
Ba
ck
-En
d S
ys
tem
s
Archive
Ex
ec
uti
on
Interfaces
Applications Several common areas – MPI, Order Entry, Scheduling, Structured Reporting
DatabasesMultiple independent databases and platforms (Oracle, Sybase, SQL, Btrieve)
Multiple image archives (PathSpeed, RadWorks, GEMNet); Disparate platforms and technologies
• Common Enterprise Archive for Cardiology/Radiology underway;
• From 3 archives 1
• Common ASP for archiving
• PathSpeed Web+RadWorks Web; Single cross-cardiology Web sign-on underway
• Common web viewer planned
• Common Master Patient Index
• Expand POE and Scheduling to OR and other depts develop Enterprise OE
• Convergence to Oracle/SQL planned in WWPP time frame
• Value of a single database questionable
Separate interfaces between HIS, RIS, ADT, EMR, etc, and GEMS IT systems
• Common data model for shared patient data
• Common HL7 engine
Implementation Tools
Several DICOM toolkits (Terra, Merge, Applicare, etc.) ; different UI styles and toolkits inconsistent UI
• Common HL7 Toolkit planned
• Adopting Picasso (UI) and Terra (DICOM)
Driving Common Capabilities to Achieve Enterprise Scale
Common scaleable hardware,
applications
ITPS Productivity
Use TrueRez technology; Single
web interface;
Track patients across all care areas
Infinite on-line storage, reliability,
redundancy
Common technology platform
ITPS/Engineering Productivity
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The Workflow Problem
Caregiver must search and collate data
Caregiver must integrate multiple data
sources
Huge Need to Converge Monitoring and CIS Information
Paper and Manual
Processes
• Real Time Events • Multiple Algorithms• Distinct Alarm Limits• Multiple Interfaces
Monitors and Devices
• Professional Fees• Supplies• Staffing • Equipment Failures
Operations
Caregiver divertedfrom therapeutic focus
• 10 -20% All Patient Data Lost• Medical Errors Driven by Med/Allergy Interaction• Case Delay from Missing Data average 25 minutes
• 40 to 70% False Alarms• Devices operate independently• Information and processing overload
• 60% Turn Around Variances• 2 Week Cycle Time on Professional Fees• 25 to 50% Overstaffing Common
• Identifying Patient • Obtaining Pt Consent• History and Complaints• Images / Test Results • Allergies
Monitoring and CIS Convergence
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All Information Available, Real Time, …Drives Better Care and Lower Cost
Monitoring and CIS Convergence
Information Integration
• Integrated Alarms• Real time device interfaces• Built in alerts and reminders• Suggestive interventions
Intelligent Monitors
• Automatic Fee Calculator• Supply Demand Matching• Staff Load Matching
Operations
• All information presented at
the point of care
• Real Time Events Coordinated Workflow Redefined
Improved Financials and Operations
Caregiver focused on patient outcome
GEMS IT Direction • Better Medical Decisions• Case delays reduced..Consents $500K/yr + exams, other paper• Cycle time improved 20 to 50%
• 80 - 90% fewer false alarms• All information available and
presented as needed
• 60% Turn around reductions• Same day professional fees submissions• 25% Overtime reductions
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Clinical Non-Near Patient
Pharma Lab
RIS CIS CVIS POC
Business AdminFinanceAdmin Decision Support
Hospital Specific AdminBilling Scheduling Charge Cap
HIS
Clin
ical
ADT OE MPI
Clinical Admin & Workflow
Clinical Near-Patient
NICU ICU OR ED
Looking at HIS Differently
Low High
Billing
ADT
MPI
ClinicalNearPatient
WorkflowImpact
Admin
Clinicians Patients
ProximityTo
Pharma / Lab
HIS Conventionally
Modalities / Devices
POE
CIS Collapses Traditional HIS... Now Targeting...
• Point of Care Charge Capture • Computer-Based Physician Order Entry• Integration Scheduling/Supplies
ChargeCapture
Scheduling
Redefining HIS
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Enterprise SchedulingE
D
OR
Cri
tic
al
Ca
re
Sta
ff
Eq
uip
me
nt
Entitlement• Know Care Plan Progress Real Time• Know Equipment Usage / Location Real Time• Know Supply Requirements / Usage Real Time• IB Position important, but...• …is more about Technology… Optimization Engine Key
•Objective Function
•Real Time Simulation
•Optimization Engine...–Equipment Availability–Case Mix–Staff Availability/Skills–Anomalies–Business Objective
EnterprisePlanning
Dept Resources
Resource Movements
Resource ConstraintsOR
Planning
Room 1…NPlanner
RadiologyPlanning
StaffPlanner
MR 1…NPlanner
CT 1…NPlanner
Scheduling in a Hospital
Competent Department solutions available… Few/None are Enterprise scoped
Still need telephone/FTEs to place an order from outside the department (95%)
Humans prioritizing… Anomalies the norm… uneven case loading, cancellations,… Havoc
Booking time 5 minutes per case * 700 procedures per day = 8 FTE at best
Booking time variance 5 minutes to 2 days
Schedule Chaos Big source of staff dissatisfaction
How It’s Done...
An Approach...
Hard Stovepipe WallsVerbal Negotiation
...What’s NeededPackage with Order Entry System… Enterprise view
Departmental Details Hidden to Outsiders
Computer based Prioritization
Provide Real Time Input
Difficult Problem… Depth and Breadth Needed…Technology Key… Impact is FTE Productivity
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Security & Privacy Requirements Devices IS Systems ServiceAuthentication and Authorization
Locally Managed Individual Logins MandatoryCentrally Managed Individual Logins Recommended MandatoryCustomer Managed Service Authentication MandatoryPassword Control Mandatory Mandatory MandatoryOptional Strong Authentication Conditional RecommendedUser Account Maintenance Conditional Mandatory MandatoryAuthorizations on User, Group or Context Conditional Mandatory MandatoryAuto Logoff Mandatory Mandatory MandatoryDevice to Device Authentication Mandatory Mandatory Mandatory
Audit Trails & MiningLog All Security Events Mandatory Mandatory MandatoryLog All PHI Views Conditional RecommendedLog All PHI Modifications Recommended Recommended MandatoryLog All Changes to the Configuration Conditional Mandatory MandatoryRestricted Access to Audit Logs Conditional Mandatory RecommendedAudit Log Mining RecommendedSecurity Event Alarms Recommended Recommended
Secure ConfigurationsConfiguration Lockdown Mandatory Mandatory MandatorySecurity Fixes from OS and Tool Vendor Mandatory Mandatory MandatoryAnti-Virus Recommended MandatoryIntegrity Controls on Data Mandatory Mandatory MandatoryBackup and Recovery MandatoryEmergency Access Availability Mandatory Mandatory MandatoryEncryption on Open Networks Conditional Recommended Mandatory
Driving HIPAA Readiness… Supporting Our Customers
2002 2003• Biometric user authentication• Contextual Access Controls• Digital Signatures• Consent tracking• Audit Trail Mining
• Central Users• Role based Access control• Strong Password rules• Audit Log on data• Audit Log management tools• SSL Encryption
•Local Users•Password protected•Auto – logoff•Device to Device ID •Security Event Audit trail•Configuration Lock down•OS Security Patches
2001
HIPAA
Convergence
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Summary
• Healthcare IT architecture will be changed in the next five years
• Driving IS convergence• More flexible, more
point of care, more web-based
• Strong, trusted partner with IT expertise
• Six Sigma rigor
GE Offering End-to-End CIS Solutions