Rex Osborn

SECTIONS

FACTOID: In the US; The medical care costs of people with chronic diseases

account for more than 75% 75% of the nation’s $2.8 Trillion USD medical care costs

HEALTHCARE CHALLENGES

EMR vs EHR

FMSU CONFIDENTIAL - 13 September 2006

There are components of data classifications that are most associated with an EHR;

1.1.Integrated view of the dataIntegrated view of the data

2.2.Access to knowledge sourcesAccess to knowledge sources

3.3.Physician order entry & clinical data entry Physician order entry & clinical data entry

4.4.Integrated communication support & Integrated communication support &

5.5.Clinical decision supportClinical decision support

COMMON “HCIT” DENOMINATORS

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OUR CURRENT MODELOUR CURRENT MODEL

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HCIT HCIT EVOLUTIONEVOLUTION

Clin

ical &

Fin

ancia

l Val

ueCl

inica

l & F

inan

cial V

alue

Complexity, Diversity & Comprehensiveness

Level 1Level 1

LegacyNon-Scalable

Solutions“Heavy Financial& Administration

Programs”

IDN Based HIS vendors

Level 2Level 2

IDN FocusedInitiated Clinical,

Admin & Financial Integration

Innovation:Innovation: >> Bi-Directional

Integration>> Standards

DiscussionInitiated (1980’s)

ACIS - CPOE & EM

R Prevalence - Enterprise

Level 3Level 3

Ambulatory & AcuteInclusive w/ ACIS, CPOE & EMR Focus

Healthcare Standards Healthcare Standards are optional (low full are optional (low full

Adoption rate)Adoption rate)

Innovation:Innovation: >> Clinical

Pathways>> Clinical

Decision Support>> Point of Care

Devices (Access)

>> Internet Dependence

Continuum Focused; Continuity of Care & PHR/CCR

Level 4Level 4

Continuum Focused Continuity of Care

Reduces barriers between GP / Specialist &

Hospital Clinicians

IT Standards BasedUniformed & Structured

Data Elements &Classification

Innovation:Innovation: >> Evidence based

Medicine>> Outcomes based

Medicine>> Patient

Empowerment

Patient Focused CareVia

EHR for CliniciansPHR for Patient

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Defining; HCIT UTOPIADefining; HCIT UTOPIA

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PATIENT UTOPIAPATIENT UTOPIA

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MEDICINE UTOPIAMEDICINE UTOPIA

CRADLE to GRAVE

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INTEROPERABILITY & INTEROPERABILITY & TRANSPARENCYTRANSPARENCY

INTERFACE Portals VS Engines

LEVERAGE STANDARDS

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1. Leverage existing integration standards2. Uniformity of data and communication protocols, IT

standards3. Promote harmonization of medical vocabulary, allowing

a translation level of registry services to provide easier cataloguing & distribution

4. Support ANY IT standard that will break down barriers between clinicians

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Rad & CardioPACS

Rad & CardioPACS

• Lab Results• Lab Referrals• Rad Dx Rpt• Rad Referrals• Rx Scripts• eRx

• Clinical Notes• Clinical Docs• Assessment• Results• Orders• Referrals

• Clinical Notes• Clinical Docs• Assessment• Results• Orders• Referrals

• DICOM • DICOM SR

• DICOM • DICOM SR

Cerner GEGE EclipsysEclipsys AGFAAGFA

• Clinical Notes• Clinical Docs• Results• Orders• Care Plans

• Clinical Notes• Clinical Docs• Results• Orders• Care Plans

• Clinical Notes• Clinical Docs• Physiological• Monitors• Pathways

• Clinical Notes• Clinical Docs• Physiological• Monitors• Pathways

• DICOM • DICOM SR

• DICOM • DICOM SR

CriticalCare Units

CriticalCare Units

CISEMR

CISEMR

AmbulatoryPACS

AmbulatoryPACS

PPMEMR

PPMEMR

LISRISRx

Images EDMS DynamicData

Enterprise“Results”

CDRD/W EBM, CDS,

OBM & CDM

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THE IDEATHE IDEA

The Global Clinical Data Archive, provides seamless interoperability between existing and future clinical informatic solutions. The

GCDV provides transparency distribution of all clinical data elements in the appropriate nomenclature and ontology across the

patient continuum of care. The GCDV breaks down barriers between clinicians, enables true connectivity, reduces medical errors and makes your clinical IT solutions better. GCDV makes

your healthcare IT environment work!

A real time clinical data A real time clinical data collector, master collector, master distributor & manager of distributor & manager of all clinical data across all clinical data across the healthcare collective.the healthcare collective.

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= WORLD CLASS NATIONAL HEALTH

UAE Ministry of HealthUAE Ministry of Health

Clinical DataClinical DataManagersManagers

Clinical DataClinical DataManager & UMLSManager & UMLS

DubaiDubai

Clinical DataClinical Data

Manager & UMLSManager & UMLS

Object Replication

RDBMS – GCDVRDBMS – GCDV

Region(s) 1 & 2Region(s) 1 & 2

Abu DhabiAbu Dhabi

Clinical

Data Conduits

RDBMS – GCDVRDBMS – GCDV

NationalNational

Region(s) 1, 2, 3, 4, 5 Region(s) 1, 2, 3, 4, 5 6 & 76 & 7

Source: The Computer-Based Patient Record: An Essential Technology for Healthcare, Institute of Medicine, 1997

““

””

The EHR will be a The EHR will be a computer-based, computer-based, multimedia record capable multimedia record capable of supporting & of supporting & managingmanaging free text, structured / free text, structured / unstructured report, high-unstructured report, high-resolution images, resolution images, sound, full-motion video, sound, full-motion video, & elaborate coding schemes.& elaborate coding schemes.

Tele-radiology Focus Early DICOM Standards

Radiology Department Focus No Standards, “Experimental”

Web-Based Departmental SolutionsOpen Systems Standards (Proprietary, IHE, HL7-CCOW), Focus on Enterprise Workflow and Image Access

Enhanced Departmental Workflow, Standards (DICOM and HL7 )Faster Networks, Affordable Workstations

1st Generation1988

2nd Generation1990

3rdGeneration1998

4GLWeb-Open2003

ClinicianPortals ACIS / HIS EHR

ClinicalImages

ClinicalClinicalSystemsSystems DICOMDICOM

ElectronicElectronicHealthHealthRecordRecord

InternetInternetAccessAccess

Enterprise View, Multi-Disciplinary , Departmental & Clinical DisciplinesOpen Systems Standards (DICOM, IHE, HIE, LOINC, SnoMed CT, MeSH, HL7-CCOW),

Focus on Enterprise Workflow and CLINICAL DATA Access

CurrentGeneration2007

FaxCD-Rom

Print

Client

WirelessPortals

Archival, Retention,Lifecycle and Storage

Security and audit trails

Lifecycles

Transformations

Native support for PDF/A, XML, XDS, HTML,

DICOM, JPEG2000, SSL,

.MPEG, .MOV, .AU, .WAV,

MP3, PIP, .TIF, .GIF, ASCII,

.txt, .WMV all multi-media files…

21May212036

May

Index, Virtualization,

Library, Content,

Registry, Interoperable

& Search ServicesEDMS

Digital Imaging

HIS

MasterPatient Index

ImageDepartments & Disciplines

Adherence

• Supported IHE ActorsSupported IHE Actors– Image Manager/Archive– Report Manager– Report Repository– Performed Procedure Step

Manager– Secure Node– Audit Record Repository

• Pending IHE ActorsPending IHE Actors– Export Manager – Information Source – Document Repository – Imaging Document Source – Patient Identifier Cross-reference

Consumer • Pending IHE Integration Pending IHE Integration

ProfilesProfiles– Cross-Enterprise Document

Sharing – Cross-Enterprise Document

Sharing for Imaging – Patient Identifier Cross-referencing – Retrieve Information for Display– Retrieve ECG for Display

• Supported IHE Integration Supported IHE Integration ProfilesProfiles– Scheduled Workflow– Patient Information Reconciliation– Cath Workflow– Echo Workflow– Stress Testing Workflow– Post-Processing Workflow– Reporting Workflow– Mammography Image– NM Image– Consistent Presentation of Images– Image Fusion– Evidence Documents– Key Image Notes– Simple Image and Number Report– Audit Trail and Node Authentication

http://www.edgemed.com/content/sc_ehr_workflow.htm

http://www.edgemed.com/content/sc_ehr_workflow.htm

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