GTSI Technology Leadership Series

From Mobility to Homecare

Dr. Mark BlattDr. Mark BlattDirector Director Healthcare Industry SolutionsHealthcare Industry SolutionsDigital Health Group, IntelDigital Health Group, Intel

Agenda

•Mobility Now– Mobile Point of Care Components and Trends– Form Factors to fit Workflows– Model for Measuring Business Value and ROI – Network Design Considerations– Customization vs. Standardization– Use Case Studies

•Homecare: the next frontier Closing Remarks

PROCESS TECHNOLOGY

PEOPLE

Mobile Point of Care (MPoC)Workflow Transformation

MPoC: Five Components to Get to Solution

Right Hardware (w/ refresh roadmap)1

Right Software (needs to fit with workflow/use case)

2

Connectivity (robust network design)3

Integrated Solution (needs to fit with other pieces)

4

Workflow Transformation (people need to use it)

5

Mega-Trend: Extending Wireless Spectrum

Personal Area Network (PAN)

Bluetooth, Wireless

USB

ZigBee

10m/30ft

WiFi: IEEE 802.11a/b/g

Wireless Local Area Network (WLAN)

30m/100ftWireless Wide Area Network (WWAN)

CDMA2000, GPRS, GSM, CDPD, EDGE

100m/330ft max

WiMAX

IEEE 802.16

50km/31m

35km/22mi max

Wireless Medical Telemetry Service (WMTS)

Radio Frequency Identification (RFID)

Varies in Range

Healthcare ‘Shifts-Left’ & goes mobile without boundaries

“Walk Around”‘Grab & Go’ Patient-2-Patient

“Wheel Around”Room-2-Room

“Walk and Dock”Patient Care & Office

Usage Model

Usage Models Drive Design of MPoC Solution

What We Have Heard:Workflow Optimization – Where are the Bottlenecks?

AdmitFrom ER

DischargeAsset Tracking

Medication Management

End of Shift Handover

Mobile Use Cases (what mobility can do at the bedside)

Reference Architectures (available)

1. Vital signs capturing using Bluetooth 2. Vital signs capturing using WiFi3. Image capturing and input into EMR4. RFID for user authentication and Single-Sign On (SSO)5. Care team collaboration (communication using VoIP)6. Patient and medication identification using barcode7. Image (x-ray) review at bedside (PACS)8. Bedside device ordering and patient transport

request9. Blood transfusion verification10. Mobile ePaper11. CPOE at bedside12. Newborn tracking using RFID

Access 2 systems Capture vitals Drawing blood

Charting Nurse data entry Dr. data entry

MPoC in Action

What is the Best Device For My Needs?

Vital sign, I & O entry

Free-format text data-entry

Template data-entry

Mobility

Mobile Clinical Assistant Tablet PC’s Laptop’

s

Large diagnostic images

Medication Administration

Data Inquiry

Manageability

FixedPC’s

Improving Handwriting Recognition

• Improve handwriting recognition results by installing Microsoft Dictionary Tool for Tablet PC (freeware) and importing custom 9,883 Medical Term dictionary (.txt) from Microsoft PowerToys for Windows XP Tablet PC Edition site at:

• URL: http://www.microsoft.com/windowsxp/downloads/powertoys/tabletpc.mspx

eForms and the MCA

Skilled Nursing Visit

Wound Care

Signature Consent

Reimbursement Medical Charge Capture

The synergy of eForms and the MCA can help optimize workflows

Industry-Tested Approach to Identifying Business Value

• Business Value: Improved ability to achieve strategic business objectives

• Improve quality of care, patient safety, staff productivity, revenue, costs…

Business Value Model focuses on monetizable benefits

Business ValueBusiness Value

Increased Revenue (Growth)

Increased Revenue (Growth)

Lower Costs/ Better Efficiency Lower Costs/

Better Efficiency Better Use of

Assets (Productivity)

Better Use of Assets

(Productivity)

= one or more of = one or more of Overtim

e

expenditure

Physicia

n-

patient

rela

tionsh

ip

Time sp

ent

with p

atients

All Benefits

Quantifiable

Monetizable

Not all benefits are quantifiable

Not all quantifiable benefits are monetizable

Quick Summary TCO and ROI for MPOC Workflow At the Royal Salford, UK

•Gross annual savings of £47,000 through >20% time savings in Phlebotomy, £70,000 3yr NPV– Leading to one-year payback

•Equal mix of savings due to productivity and reduction in errors leading to fewer draws– Quality of Care aspect not quantified

•Opportunity to compress Phlebotomy Order Life Cycle leading to Workflow Optimization and further Quality of Care benefits

Salford Phlebotomy MCA Annual Savings

People Material TotalPhlebotomy 2,574 hrs £24,612 £12,355 £36,967Lab 468 hrs £4,475 £6,037 £10,512Total 3,042 hrs £29,086 £18,392 £47,479

MPOC VM – Workflow Optimization

MPOC Workflow Optimization can• Reduce number of phlebotomists (by 2)• Increase the number of draws by 27-33% (50-60 draws)• Improve capacity management and timeliness of blood draws

- Prior to MCA Deployment- After MCA Deployment

Measuring Up the MCA

The MCA demonstrates results

65% clinician productivity60% clinician productivity

83% manual transcription of patient vital signs

62% clinician productivity

15% productivity and efficiency

25% patient vital sign charting accuracy

Compliance with medication administration guidelines

Source: Intel News Release, Studies Show Mobile Clinical Assistant from Intel and Motion Improves Care Delivery and Clinician Productivity, December 4, 2007

Mobile Technologie

s

Network Design Considerations

•How do you handle multiple devices on the network including personal devices?

•How do you manage to secure your wireless environment?

•How do you create a wireless environment robust enough to handle current and future demands?

•What’s the point of a wireless environment anyway?

When Wireless is Deployed Poorly

•Loss of connectivity – Cold spots -> poor roaming

– Crashed applications and systems -> lower clinical satisfaction

•Low Throughput– Slow system responsiveness

– Application time-out

•Security loop hole– Data theft -> Hospital Liability

Takes very little to frustrate customers

Mobile Usage Model Characteristics

Authentication and Encryption

Application Sensitivity to Latency

Throughput Requirements

Roaming Aggressiveness

Quality of Service

Virtual Private Networking

Remote Manageability

Characteristics

Walk-around Room-to-room

Roaming

Hybrid Room and Office Roaming

Office Roaming

HighLow MediumRelevance to User:

Targeted User

Level of Mobility

Nurse/Clinician/MD MD/SpecialistOffice Worker, or Remote MD

Wheel-around Room-to-room

Roaming

Usage models dictate wireless requirements

Site Survey• Conducted before

deployment and production• Analyzes

– Signal Strength (coverage)– Signal-to-Noise Ratio– Data Rate– Signal Overlap– Signals in a specific

channel– Roaming Prediction

• SW Tools available: – www.ekahau.com– www.airmagnet.com

The most crucial step in a wireless deployment

RF Spectrum NoiseFrequency Source

50/60 Hz All mains powered electrical equipment

~200 kHz Magnetic card security readers

~1 MHz Surgical diathermy (heating tissue via EM induction)

27 MHz Continuous shortwave physiotherapy diathermy

~50 MHz Pagers

~70-200 MHz Ambulance radios

~400 MHz TETRA radios

850, 900, 1800, 1900 MHz

Cell phones (GSM mobile phones)

2.45 GHz Microwave physiotherapy diathermy and microwave ovens, consumer cordless phones, Bluetooth devices, 802.11 b/g

5.0 GHz 802.11 a/n

20 GHz Automatic doorsNumerous sources of electromagnetic interference

exists; site surveys are very critical

Coverage Areas

Common Spaces (for shift changes)

Nurses Station

Building Connectors, Elevators, Staircases

Hallways

Patient Rooms

Key External Spaces

Others:

• OR Theaters

• Waiting rooms

• Cafe/Cafeteria

Follow the workflows to determine coverage areas to provide roaming availability

Customization vs. Standardization

•How much customization do you allow?

•Do you drive for uniformity and standardization or do you support individual customizations?

•When you change one workflow, how does it affect the adjacent workflows?

•Why do we need to address this issue?

As Much As You Can Drink!!!As Much As You Can Drink!!!

MCA in Home CareValue Proposition

• Improved documentation• Quicker time to reimbursement

• Increased patient face time• Lower operational costs

Challenges• Lower and slower

reimbursements due to documentation errors and omissions

• Patient care errors from incomplete information

• Low patient satisfaction due to longer wait times

• POC Documentation• Wireless Access to EMR • E -E Claims Submission• Real Time Dynamic

Scheduling• Task Based Charge Capture

Technology PartnersTechnology Partners

OEM Home Care EMR

eformsInfrastructure

MCA in PharmaValue Proposition

• Research and Development• Clinical Trials

• Sales Force Automation • Lower operational costs

Challenges

• R&D processes costly, slow, often paper based. Real time collaboration less than ideal

• Clinical trails management tools and processes remain manually intensive, costly and slow

• Sales force gets minimal FTF time with clinicians

• R&D Documentation• RT Wireless data synch• Ultra mobile eClincials

documentation • Real Time Dynamic

Scheduling• Improved meds

sampling SCM

Partners

Big Pharma eforms

MCA provides new workflow options for Pharma

Merck: Mobile Convergence Device Project

Background• Heavy reliance on inefficient paper based workflows in evaluated labs

– No access to eNotebook; Risk of contamination from paper

• Prior deployments of mobile technology devices in labs unsuccessful– Opportunity with Intel’s new Mobile Clinical Assistant (MCA) platform and C5 from Motion Computing

Description and Prediction• Hypothesis is that a mobile convergence device will lead to increase in

productivity and optimization of workflows, while reducing data errors and waste when deployed in the research laboratory environment

– Prototyping methodology employed for the project – Time studies were conducted with selected users to develop baselines for evaluation of productivity gains – MCA C5 devices and wireless infrastructure were deployed for use by the test groups– After a period of utilization the time study was repeated to gather updated metrics and process changes– A survey was conducted to gather qualitative data from test users

Outcome• C5 with supporting wireless network proven a success in research

labs– Enables our scientists to focus on value added research work in labs

– Reduces inefficient processes, waste, protocol submission time– 100% electronic records and electronic lab notebook (ELN) integration;

– Increase searchability of researcher data; Maximizes ELN investment– Demand for device exists now and positioned well for future demand

Challenges Facing Research Labs

• Research labs face many inefficiencies because:– No access to eNotebook

within the lab

– Large reliance on paper-based processes

– Limited access to information technology at the bench

– Contamination / Safety Risks

Photo taking

process

Scanning photos process

Biochemistry PCR ProtocolBefore C5

Biochemistry PCR ProtocolBefore C5

Print protocolprocess

Manualcalculation

process

Recopy paperrecords process

Biochemistry PCR ProtocolBefore C5

Biochemistry PCR ProtocolBefore C5

Biochemistry PCR ProtocolAfter C5 with ELN

Biochemistry PCR ProtocolAfter C5 with ELN

Experiment Analysis

ONE PROCESS (PCR Protocol)

Process: Taking picture of amplified gels

Without C5 With C5

1. Retrieve hood/stand for camera

2. Setup hood on light3. Load film into empty

camera4. Mount camera on hood5. Take picture6. Wait for Polaroid to

develop7. Evaluate picture for

shutter quality8. Carry photo to scanner9. Startup software10.Scan picture11.Save image to network

share

1. Take picture of gels with C5

2. Save picture to network share

Single Process: 9 min Single Process: 1.10 min

TOTAL EXP 2:35:00 TOTAL EXP 2:03:00

TIME SAVINGS \ COST AVOIDANCE (Differences)

One FTE Department (20 FTE)Time Savings Cost Avoidance * Time Savings Cost Avoidance *

Day 32 min $40.60 10.67 hrs $811

Week 160 min $203 53.3 hrs $4,051

Month

12 hrs $879 231 hrs $17,583

Year 138 hrs $10,550 2773 hrs $210,998• * Costs assume 46 working weeks per year after vacation/holidays/sick; Employee at $76 per hour• * Costs are based on time differences in order to complete tasks, and does not factor in other hardware/support/supplies

costs

AVERAGE PROTOCOL (ENTIRE PROCESS)

Average amount of time required to sign and submit completed protocol in ELN

Without C5 With C5

2 weeks 1 day

ContaminationMonitoring

Report

Recopy paper results into ELN

Printing / hanging sheets

Referencing sheets

Binding Assay ExperimentBefore C5

Binding Assay ExperimentBefore C5

Binding Assay Experiment Before C5

Binding Assay Experiment Before C5

Binding Assay ExperimentAfter C5 with ELN

Binding Assay ExperimentAfter C5 with ELN

Experiment Analysis

4 PROCESS ANALYSIS

PROCESS Without C5 With C5

Setup experiment

11.32 min 5.33 min

ReferencingProtocols

2.7 min 35 sec

Beta Counter

interactions

7.5 min 1.42 min

Finalize protocol

in ELN

11.37 1 min

4 Processes: 32.89 min

4 Processes: 8.33 min

TOTAL EXP 5:45:00

TOTAL EXP 3:36:00

TIME SAVINGS \ COST AVOIDANCE (Differences)

One FTE Department (20 FTE)Time Savings Cost Avoidance * Time Savings Cost Avoidance *

Day 129 min $163.58 43 hrs $3,271

Week 645 min $818 215 hrs $16,358

Month

46.58 hrs $3,544 931 hrs $70,882

Year 558.96 hrs $42,529 11,179 hrs $850,587• * Costs assume 46 working weeks per year after vacation/holidays/sick; Employee at $76 per hour• * Costs are based on time differences in order to complete tasks, and does not factor in other hardware/support/supplies

costs

AVERAGE PROTOCOL (ENTIRE PROCESS)

Average amount of time required to sign and submit completed protocol in ELN

Without C5 With C5

3 – 4 months 2 daysGOING GREEN – SAVINGS WITH C5

One FTE Department (20 FTE)

Paper Gloves Paper Gloves

Day 9 10

Week

45 50

Month

203 225 4050 4500

Year 2430 2700 48600 sheets

54000

Experiment Analysis

Survey Results• Surveys were deployed to users at

conclusion of pilot– Four users of C5 devices in study surveyed

Top 10 Do’s and Don’ts

Do1. Understand intended use case(s) for going Mobile2. Software and Form factor must fit with intended use case3. Wireless Network must be upgraded for ultra mobile 4. Plan for iterations5. Look for “ripple effects”6. Focus on workflows and how they overlap7. Consider both current and future (unknown) needs8. Seek input from all customers9. Engage executive leadership and governance processes10. Do more!!

Top 10 Do’s and Don’ts

Don’t1. Don't make decisions about workflow just from IT perspective

(include all stakeholders to map priority workflows)2. Don’t try to do this by the “seat of your pants”3. Don’t let IT be the Champion of this effort4. Don’t ignore existent RF devices and patterns5. Don’t forget to make security discussions broad-based6. Don’t forget to broadly survey wireless technologies and their

purported “next steps”7. Don’t ignore your application vendors – engage them early and

often8. Don’t forget to test the technologies with your “stuff”9. Don’t leave SLAs out of your environment and planning10. Don’t avoid asking numerous questions – the answers often

change!

Copyright © 2008, Intel Corporation. All rights reserved.

Intel HealthHomecare: The Next Frontier

What is Telemedicine?Here in Abuja (capital of Nigeria) we have immediate access to a vast amount of medical experts, healthcare education & information, and support from other physicians…How can we take all these resources and share them immediately and effectively with our rural hospitals and clinics?...Telemedicine

Using technology to connect people to healthcare

Telemedicine Models: Improving Access

Clinic Patient Volume

Case

Com

ple

xit

y

Real-time model:•Colds/Flu’s•Diarrhea•Hypertension checkups•AID’s/HIV/Malaria•Maternal/Child health

A differentapproach

Asynchronous model:•Tele-radiology•Tele-pathology•Tele-psychiatry•Tele-ophthalmology

Industry efforts over last 20 years

Homecare: Personal Health Technologies

•PHRs: a good start •Video conferencing (secure video phone)•Remote Sensors •DSS: Patient education and empowerment

•Virtual encounters•Web base Services….

–Reminders –Patient education

•

Promoters

Telemedicine Stages

Non regulated Regulated

Infrastructure Basic Multimedia Virtual CareFace-Face

Multiple Vitals Gathering

Stage 2AV Conferencing

Stage 3V-care Networks

Stage 4

Remote data Gathering by LOB

Stage 1Stage 0

Office may be (electronically) linked to ancillary care providers like lab or pharmacy to get inter-visit data on pts.

May have sensor in pts home (e.g. scale / BP cuff);

Pt sends data & doctor responds.

Structured chat.

May be ICD device that is remotely checked betwn visits

Multiple sensors with integrated data screens

Clinical Decision Support SW ; clinical treatment plans; branching algorithms

Managed by exception: CDM

Patient empowerment with data feedback

Pt education

Sensor standards (Continua)

Increased access to care; Cost avoidance; Improved quality of care

Convenience

Patient data integrated with EMR and PHR

Complex Continua compliant peripherals

Greater scope of remote medical services (PT, OT, Nutritional, Specialty Consults)

Increases access to care, Dramatic cost avoidance (v-care = minimal overhead), improved quality of care

EMR / PHR, integrated w/ labs, pharmacy, radiology, long term care

Improved med adherence; automated refills

Alliances with bricks and mortar systems

E-Commerce

Traditional face to face visits with clinician at the medical mainframe (hospital or clinic)

Follow ups and CDM require repeat return visits

Very little interaction between clinicians and pt between visits

Intel ConfidentialIntel Confidential

Legal Disclaimer

The Intel Health Guide

a) requires a broadband connection in the patient’s home to enable communications with the care team and back-end data hosting;

b) is designed for use by health care professionals and their patients and should only be used under the guidance of a health-care professional;

c) is not intended for emergency medical communications or real-time patient monitoring.

Intel ConfidentialIntel Confidential

Intel® Health Guide

The Intel® Health Guide connects patients and their care teams for personalized care management at home

Intel® Health Guide

Intel® Health Care Management Suite

MedicalPeripherals

Patient EducationalContent

CLOSING REMARKS

Summary

•Mobility in healthcare matters (more and more)

•Mobile Workflow transformation requires:– Clear understanding of the preexisting workflows– Clear vision of what you are trying to accomplish– Strong stakeholder involvement; pick the right

processes; pick the best technologies

•Homecare and virtual encounters are coming– Rising costs and growing issues with access will

demand new care delivery models

Q&A

Dr. Mark BlattDr. Mark BlattDirector Director Healthcare Industry SolutionsHealthcare Industry SolutionsDigital Health Group, IntelDigital Health Group, Intel