1

Building a Clinical Information Continuum

Presented by Greg Lucier, President and CEOGE Medical Systems Information TechnologiesMay 24, 2001

2

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

3

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?

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

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