© 2007 EAC
Emery Stephans, [email protected]
AACC, San DiegoJuly 17, 2007
Health Care Information Technology
in Transition
v.8
Is IT driving health care? Or is health care driving IT?
© 2007 EAC
2Observations
•Hard to do “new” medicine without sophisticated IT on an enterprise-wide foundation–Other industry sectors experienced similar transitions
–Banking, supply chain management, airlines
•Health care networks–Efforts to combine knowledge from clinical medicine and life science
–Deploy EMR, clinical systems
•Large integrators and major health care IT companies–Heavily engaged in EMRs, content vs. care process, development partnerships
–Continuing to support imaging modalities, departmental systems, care domains
•Electronic medical record programs gaining ground in Europe and US–Government spending–Institutional investment
•US Federal Government program appears to be real; 2004 presidential directive–EMR for every patient–Nationwide data exchange and integration
–Good goals; behind schedule
•States more aggressive –e.g. California
•Large integrated health care networks adjusting strategy for next decade
© 2007 EAC
IVD IndustryIVD Industry
© 2007 EAC
4
Technicon Revlon(1980)
Bayer(1989)
Siemens(2006)
Beckman SmithKline(1982)
Coulter
Beckman Coulter(1997)
BoehringerMannheim
Roche(1997)
Abbott Dx GE (2007)
Dade Baxter(1985)
BerhingwerkeDade Behring(1997)
Phase 1Phase 1IndependentIndependent
Phase 2Phase 2Pharma Pharma
Phase 3Phase 3ITIT--ImagingImaging
Mergers and Acquisitions in the IVD Sector
© 2007 EAC
5Selected IVD Acquisition Investments in Past Year: $33 $25 Billion
Company Acquired by Date 2006 Revenues Transaction Value Multiple
DPC Siemens July 2006 $551m $1,860m x3.4
Phadia Cinven Nov. 2006 297 1,610 x5.4
Vision Systems Danaher Dec. 2006 80 520 x6.5
Tripath Becton Dickinson Dec. 2006 100 350 X3.5
Bayer Diagnostics Siemens Jan. 2007 1,907 5,200 x2.7
Abbott Diagnostics GE Healthcare Jan. 2007 2,643 8,130 x3.1
Hemocue Quest Diagnostics Feb. 2007 88 420 x4.8
Adeza Cytyc Feb. 2007 52 450 x8.7
Cytyc Hologic May 2007 608 6,200 x10.2
Dako EQT May 2007 311 1,300 x4.2
Diamed Bio-Rad May 2007 200 490 x2.5
Biosite IMI June 2007 303 1,690 x5.6
Cholestech IMI June 2007 69 320 x4.7
Digene Qiagen June 2007 176 1,600 x9.1
Ventana Roche June 2007 238 3,000 x12.6
$7,623m$4,980m
$33,140m$25,010m
x4.3x5.0
© 2007 EAC
6In Vivo vs. In Vitro
103
102
101
100
PET
MRICT
X-RayUltrasound
EKG
Genetic
CardiacImmuno
Clin Chem
Glucose
Owning both sectors provides higher confidence
for investment decisions
Owning both sectors provides higher confidence for investment decisions
© 2007 EAC
72007: IVD Industry at Crossroads
Integrate in vivo and in vitro and
IT
Rx and Dx
Decentralized Rapid
Diagnostic Testing
Traditional Central
Laboratory IVD
•GE-Abbott•Siemens-(DPC +Bayer)
•Beckman Coulter•Dade Behring•Ortho Clinical Diagnostics•Abbott
Philips Roche
© 2007 EAC
8
Health Care ITHealth Care IT
© 2007 EAC
9Goals for the “National Health Information Infrastructure” Project
Presidential Directive•An EMR for every US citizen
in a decadeA longitudinal electronic health recordLifetime
•Nationwide interoperability•Regional information
interchanges•Patient data portability•Patient data protection•De-identified patient data
available for medical research
•Tie together acute and ambulatory care (hospitals, physician practices)
Target Benefits•Essentially – combine the
benefits of European-style, single payer systems with US-style market-driven health care practices
•Reduce overhead and transaction costs
•Synchronize service and reimbursement
… provide service at 10:00 am; get paid at 11:00 am …
•Reduce fraudulent claims
© 2007 EAC
10Emergence of EMRs: 32% Operational, Another 37% Started Installation
Source: HIMSS 2007 Leadership Survey, Harris Interactive
© 2007 EAC
11IT Budgets Continue to Increase
Source: HIMSS 2007 Leadership Survey
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12Top Three 2008-2009 Priorities: Medical Errors, Clinical Systems, EMR
Source: HIMSS 2007 Leadership Survey
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13CPOE, EMR, and Clinical Information Systems the Top Three Applications
Source: HIMSS 2007 Leadership Survey
© 2007 EAC
14Hospital IT Priorities; Viewed by a Different Survey
2000 2005 2010
• Electronic medical records
• Administrative systems• Financial systems
• Insurance claims processing
• Integrated financial and administration modules
• PACS and radiology information systems
• Computerized physician order entry
• Surgical information systems
• Fully integrated clinical information systems
• Decision support systems
• Web-based interactive systems
• Robotic dispensing systems
Source: “Hospital Information Systems” Frost & Sullivan, 2006
© 2007 EAC
15Health Care IT Spending in US
•2007 US Health Care IT roughly $50 billion•US about 40% of worldwide spending
•2007 WW spending est. $125 billion•$125 billion roughly 6% of all IT spending
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16Spending by Sector
Source: Gartner, Dorenfest, 2005
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17
Selected IT Case Selected IT Case StudiesStudies
© 2007 EAC
18US Health Care IT Sales
Source: IDG, 2006
© 2007 EAC
19Selected Partnerships Between Large Integrators and Large Health Care Networks
GE Healthcare
Intermountain Health Care (IHC), Salt Lake City, Utah
• Convert proprietary IHC rules-based EMR to GE standardized “Centricity” architecture
• Comprehensive EMR and decision support system
Partners Health System, Boston, Massachusetts
• Integrated enterprise-wide clinical and process management system
• Hospitals, ambulatory treatment centers, telemedicine• Interpretation and decision support for clinicians on
genetic testing
Siemens Medical Systems
SAP • Soarian-SAP Process integration• Global alliance
Mayo Clinic, Rochester, Minnesota
• Integrate data from life-science and clinical medicine domains
• Single architecture to support clinicians and research staff
Cleveland Clinic, Cleveland, Ohio
• Integrate data from life-science and clinical medicine domains
• Single architecture to support clinicians and research staff
IBM
Geisinger, Danville, PA
• Enterprise-wide EMR with decision support• Metrics and “Best Practices” parameters for “Pay for
Performance”• Telemedicine
© 2007 EAC
20
Piet C. de Groen, MD, Mayo Clinic, Rochester, Minnesota
IBM-Mayo Clinic Life Sciences System (MCLLS)
Conceptual Overview Architecture; Phase I and IIConceptual Overview Architecture; Phase I and II
Mayo IBM Other
© 2007 EAC
21
Clinical LaboratoryClinical Laboratory
© 2007 EAC
22Classification of Broad Needs – as Seen in EAC Research
Category DescriptionInterfaces Ability to transfer data to the LIS for all platforms
regardless of test volume and location
Integration of Data Ability to transmit (report to clinicians) data from multiple data sets: images, graphics and text
Order Entry and Results Distribution
Ability to receive electronic orders from anywhere and distribute results back to the ordering location end-user
Specimen Tracking Draw to result tracking of specimens to reduce errors, improve turnaround time and improve processes
Laboratory Process Control
Ability to improve lab processes by monitoring productivity data, improved documentation
Quality Control Reporting
Ability to automate qc reporting and to be able to respond to QC issues in real time
Auto-Validation Ability to result specimens more quickly, to add diagnostic value and support clinicians
Source: EAC research
© 2007 EAC
23Top IT Needs in the Hospital Clinical Laboratory (EAC 2006 Study, N=22 Hospitals)
Functional Needs Description %
InterfacesAbility to transfer data to the LIS for all platforms regardless of test volume and location 79%
Integration of Data
Ability to transmit (report to clinicians) data from multiple data sets: images, graphics and text
68%
Order Entry and Results Distribution
Ability to receive electronic orders from anywhere and distribute results back to the ordering location end-user
68%
Specimen Tracking
Draw to result tracking of specimens to reduce errors, improve turnaround time and improve processes
63%
Lab Process Controls
Ability to improve lab processes by monitoring productivity data, improved documentation etc. 58%
Quality Control Reporting
Ability to automate QC reporting and to be able to respond to QC issues in real time 53%
Auto-ValidationAbility to result specimens more quickly, to add diagnostic value and support clinicians 47%
Source: EAC research
© 2007 EAC
24Classification of Broad Needs; the Geisinger View
Category DescriptionWide Area Network
Readily available; security (not the same as privacy) a growing concern
Data Centers Enterprise hardware security; “rack & stack” client servers; “lights out” backup and mirrored applications
Lab Connectivity POCT and centralized instruments connected with harmonized test codes
Enterprise Analytics
“Eggs in one basket” model emerging; easier to harmonize and group purchase; builds important results database
Client Servers Drives enterprise analytics, facilitates standardization and maintenance; enterprise IT increasingly chooses hardware
Clinical DSS Enterprise results (and specimen!) repositories; informatics standardization (HL7, LOINC, XML) needed for specificity
IT Interoperability Emergence of EHRs to integrate departments and RHIOs to integrate healthcare systems; coding for CMS reporting
Outcomes Organized by government, regional systems to discover actionable information for disease management
Best Practice Harnessing outcome data to EHR care delivery; incentives for “pay-for-performance” reduces cost & improves population health
Source: Geisinger
© 2007 EAC
25Middleware Initiative
•An IVD industry service to clinical laboratories•Kicked off at AACC 2005•Objectives
–Confirm “middleware gap”–Establish IVD industry willingness to consider prospective solutions–Define framework for collaboration –Determine initial level of standardization (connectivity, data interchange)
•Objectives largely attained–11 IVD companies active
•Final meeting of “initiative” held yesterday, Monday, July 16, 2007 at AACC•Made decision to proceed to next stage: organize an industry consortium•Organizing meeting October 10-11, 2007 in Tarrytown, New York
© 2007 EAC
26
SummarySummary
© 2007 EAC
27Summary
•Hard to do “new” medicine without sophisticated IT on an enterprise-wide foundation–Other industry sectors experienced similar transitions
–Banking, supply chain management, airlines
•Health care networks–Efforts to combine knowledge from clinical medicine and life science
–Deploy EMR, clinical systems
•Large integrators and major health care IT companies–Heavily engaged in EMRs, content vs. care process, development partnerships
–Continuing to support imaging modalities, departmental systems, care domains
•Electronic medical record programs gaining ground in Europe and US–Government spending–Institutional investment
•US Federal Government program appears to be real; 2004 presidential directive–EMR for every patient–Nationwide data exchange and integration
–Good goals; behind schedule
•States more aggressive –e.g. California
•Large integrated health care networks adjusting strategy for next decade