medical device integration for patient centered health care

MEDICAL DEVICE INTEGRATION (MDI) FOR PATIENT-CENTERED HEALTH CARE

John SqueoLazer Focus AdvisorsFind us on LinkedIn

MEDICAL DEVICE INTEGRATION (MDI) FOR PATIENT-CENTERED HEALTH

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Hospital Setting Perspective

Ambulatory & Home Settings Perspective

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Pressures driving Medical data convergence - Quality, Safety and Productivity



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Opportunities to achieve better outcomes leveraging Medical Device Integration (MDI)




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Medical Device Integration (MDI) Landscape -Industry Players and Technology Challenges



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Putting Hospital Device Integration Together






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Pressures toward extending patient monitoring beyond the hospital







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Emerging needs for Medical Device Integration (MDI) beyond hospital








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Overview of Patient & Care ProviderAlerting & Outreach Systems - “Events Bus”




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Proposed Plan of Action to begin journey

Overview of Patient & Care ProviderAlerting & Outreach Systems - “Events Bus”




TOPIC OUTLINE

INCREASING CLINICAL QUALITY, SAFETY & EFFICIENCY

During Acute Care Transformation



NURSES HAVE MANY NEW THINGSTO DO & LEARN IN ADDITION TO

DELIVERING EXCEPTIONAL PATIENT CARE



Clinical Documentation – Paper to EHR






Medication Administration – Scanned & Digitized







Process improvement programs e.g. LEAN







Achieving optimal Core Measures & HCAHPS scores








Heightened emphasis on patient discharge process









Trend - fewer nurses for each patient










Trend - fewer nurses for each patient




Can Information Technology DECREASE the burden of additional workload on nurses?



TREND – NURSE STAFFING RATIOS

Source: Hospital nurse staffing ratio trends 1993-2004.1 No significant trend in median hospital nurse to patient ratio 1993-99; chi square test for trend for median hospital nurse staffing ratio 1999-2004 (p _.001). Journal of Hospital MedicineVolume 3, Issue 3, Article first published online: 20 JUN 2008Nurse Staffing Ratios: Trends and Policy Implications for Hospitalists and the Safety Net, Patrick H. Conway, MD, MSc, et. al.

TREND – NURSE STAFFING RATIOS

Source: Hospital nurse staffing ratio trends 1993-2004.1 No significant trend in median hospital nurse to patient ratio 1993-99; chi square test for trend for median hospital nurse staffing ratio 1999-2004 (p _.001). Journal of Hospital MedicineVolume 3, Issue 3, Article first published online: 20 JUN 2008Nurse Staffing Ratios: Trends and Policy Implications for Hospitalists and the Safety Net, Patrick H. Conway, MD, MSc, et. al.

Source: Implications of the California nurse staffing mandate for other states. Health Serv Res. 2010 Aug;45(4):904-21. doi: 10.1111/j.1475-6773.2010.01114.x. Epub 2010 Apr 9., Aiken LH, et al.

MEDICAL DEVICE INTEGRATION GOALS

Human Error Avoidance with increased Efficiency


Ancillary Clinical Repository to housenon-truncated “atomic” data for analytical research

Human Error Avoidance with increased Efficiency


AUTOMATED EHR DATA ACQUISITION PROCESS

SpO2 Data


?ALGORITHM TO

SCRUB DATA POINTS FROM GOING INTO

RECORD

TREND – DISCRETE DATA DIRECTLY FROM PATIENT

SENSORS

PatientMonitor

Clinical Network Gatewa

yPhillips, GE, others

Clinical Info

System(s)

McKesson, EPIC, Cerner, MEDITECH others

HIS/ADT Info

System

McKesson, EPIC, Cerner, MEDITECH others

HL7 Interface Engine

Cloverleaf, Jcaps, others

Central

Station

Phillips, GE, others

Medical Device Integrat

or(MDI)

Cerner, Capsule, Nuvon, iSirona, [DAS] Data Acquisition Systems, others

Ancillary Medical Devices

Serial to Ethernet or Wi-Fi Convertor

MEDICAL DEVICE INTEGRATION (MDI) LANDSCAPE


RESULTS - 2012 Capsite Survey 300 US hospitals 44% had purchased MDI in recent years majority in 2011 &

2012 Breakdown of Current MDI adopters 400 + Beds = 63% in category implemented MDI 399 - 200 Beds = 75% in category implemented MDI 200 Beds or less = 33% in category implemented MDI


Source: Medical Device Integration Software Surges in Hospitals, InformationWeek Healthcare, Ken Terry, August 15, 2012

Reasons Stated for MDI purchaseImprove Clinical Outcomes = 40%Improve Efficiency = 37%Meaningful Use for government EHR financial incentives =

17%Other reasons = 6%

RESULTS - 2012 Capsite Survey 300 US hospitals 44% had purchased MDI in recent years majority in 2011 &

2012 Breakdown of Current MDI adopters 400 + Beds = 63% in category implemented MDI 399 - 200 Beds = 75% in category implemented MDI 200 Beds or less = 33% in category implemented MDI


31%

19%

50%

MDI Industry Market Share

Cerner

Capsule

EpicGE MEDITECHSiemensiSironaNuvon

Source: Medical Device Integration Software Surges in Hospitals, InformationWeek Healthcare, Ken Terry, August 15, 2012

Source: Santa Rosa Consulting & BMoorman Consulting, LLC

THE DOWNSIDE TO MDI

ACUTE SETTING INTEGRATION COMPLEXITY = HIGHREQUIRES CROSS-FUNCTIONAL TEAMS TO

MAINTAIN


THE DOWNSIDE TO MDI


MAINTAIN


IT & TELECOM

THE DOWNSIDE TO MDI


MAINTAIN


IT & TELECOM

BIOMED

THE DOWNSIDE TO MDI


MAINTAIN


IT & TELECOM

BIOMED FACILITIES

THE DOWNSIDE TO MDI


MAINTAIN


IT & TELECOM

BIOMED FACILITIES VENDORS

THE DOWNSIDE TO MDI

ACUTE SETTING MDI TO CLINICIAN ALERTING

SYSTEM

PatientMonitoring system

Medical Device Alerts Sent directly to the phones or badges of the Nurses to elevate “situation awareness”

ACUTE SETTING MDI TO CLINICIAN ALERTING

SYSTEM

PatientMonitoring system

Medical Device Alerts Sent directly to the phones or badges of the Nurses to elevate “situation awareness”

BUTAlerts are “throttled” by

Middlewareto avoid “Alert Fatigue”

EMERGING CONSIDERATIONS FOR MDIOUTSIDE OF HOSPITAL

OPPORTUNITIES – WELLNESS AND FINANCIAL

REQUIREMENTS – TECHNICAL


Ability to monitor most “at risk” patients such as elderly and chronically ill to preemptively intervene before an ED visit is necessary





Emerging opportunity to get a broader glimpse of a patient’s health profile and living habits







REQUIREMENTS – TECHNICAL Requires – Scalable data network

100s OR 1000s of connections into monitoring center




Requires – Nimble data warehouse or core clinical repository. Able to parse structured and non-structured data with

lower confidence of data match via master “person” index


REQUIREMENTS – TECHNICAL Requires – Scalable data network

100s OR 1000s of connections into monitoring center

CHALLENGES WE FACE

1% of U.S. population consumes20% of ALL HEALTH CARE DOLLARS

Source: National Institute of Health Care Management 2012

CHALLENGES WE FACE

1% of U.S. population consumes20% of ALL HEALTH CARE DOLLARS


Total expenditure on healthcare:per capita per year: $7,960

Source: Organization for Economic Co-operation and Development on global health issues: Michael B. Sauter, Charles B. Stockdale, 24/7 Wall St. , 2012 - Countries that spend the most on health care, NBCNEWS.com, http://www.nbcnews.com/business/countries-spend-most-health-care-618241

Expenditure as percent of GDP: 17.4 percent

CHALLENGES WE FACE

$90,000

$41,000

$236

COST BREAK DOWNAverage Annual Healthcare

Spend in USAPer Person

1% OF INSURED

50% O

F

INSURED

5% OF INSURED

Heart Disease

Diabetes

Arthritis

Asthma


WHAT CAN THE DATA TELL US?

COST

DRIVERS

HEALTHCARE REFORM

#1 Biggest Issue – Financial Challenges

#2 Biggest Issue – Healthcare Reform Implementation

#3 Biggest Issue – Patient Safety & Quality

2011 Results - Biggest Issue Facing Hospital CEOs

Source: American College of Healthcare Executives, Annual Poll – Top Issues Confronting Hospitals: 2012

Annual Survey American College of Healthcare Executives

HEALTHCARE REFORM

#1 Biggest Issue – Financial Challenges

#3 Biggest Issue – Healthcare Reform Implementation

#2 Biggest Issue – Patient Safety & Quality

2012 Results - Biggest Issue Facing Hospital CEOs

Source: American College of Healthcare Executives, Annual Poll – Top Issues Confronting Hospitals: 2012

Annual Survey American College of Healthcare Executives

TRENDS TOWARD VALUE-DRIVEN HEALTHCARE

• Hospital Readmissions– Hospital DRGs 1% in 2013 3% by 2015• Medicaid DSH cuts - $18.1Billion 2014 – 2020 (Pres. Obama

proposed delay to 2015)• Value-Based Purchasing• 70% - Core Measures: Heart Failure, Acute Myocardial Infarction

(AMI), Pneumonia & Surgical Care• 30% - HCAHPS score: Patient Satisfaction

• Physician (SGR) Sustainable Growth Rate – 27%

Reduced Reimbursements CMS & Commercial Carriers

• Accountable Care – Provider Risk Acceptance & Shared Savings• Bundled payment for episodic care

Global Payments Innovations – CMS & Carriers

• Payers setting up Accountable Care Organizations• Hospital Systems offering health insurance on public Health Insurance

Exchanges (HIX)

Payer/Provider Convergence

SHIFTING FOCUSPRE & POST ACUTE AND HOME SETTINGS

REDESIGNING PRIMARY CARE

Source: Southcentral Foundation, “The Trust for Health Excellence’s Better Health Initiative”

PATIENT-CENTERED MEDICAL HOMES

Looking “in” on the patient Looking “out” to the Health Care Environment

PATIENT-CENTERED MEDICAL HOMES

Looking “in” on the patient Looking “out” to the Health Care Environment

Patient-centered medical homes (PCMH) – Not necessarily a “place” rather a central point from which assistance is provided to navigate the fragmented healthcare system Source: Oliver Wyman, Tom Main & Adrian Slywotzky

DECENTRALIZED BUT CONNECTEDREMOTE SURVIELLENCE CAN BE A

“LIFE SAVER”

Aging in PlaceSILVER TSUNAMI - Growth of Senior Citizen Population 78 Million Baby Boomers turned 65 in 2011 9 out of 10 seniors want to stay in the home they retired in.

Source: AARP

Alzheimer’s Patients

Care At Home

DECENTRALIZED BUT CONNECTED

Care At Home

HEALING AND AGING IN THE HOME – REMOTE MONITORING PILOT PROGRAM Leverage Home Care nursing augmented by remote sensor monitoring Good Samaritan – LivingWell@Home [Pilot of 40 connected assisted living

facilities] study 1/2011 through 6/2013 WellAware – motion sensors detect movement in bed, showering,

toileting etc. Phillips Lifeline – auto-alert function detects falls Honeywell Hommed Telehealth monitoring: Heart rate, Blood

pressure, Weight, Oxygen saturation, Temperature, ECG rhythm, Spirometry, Prothrombin time/INR

Source: ‘The Matrix’ Meets Medicine: Surveillance Swoops Into Health Care, Michael Millenson, January 9, 2013


Care At Home

HEALING AND AGING IN THE HOME – REMOTE MONITORING PILOT PROGRAM Leverage Home Care nursing augmented by remote sensor monitoring Good Samaritan – LivingWell@Home [Pilot of 40 connected assisted living

facilities] study 1/2011 through 6/2013 WellAware – motion sensors detect movement in bed, showering,

toileting etc. Phillips Lifeline – auto-alert function detects falls Honeywell Hommed Telehealth monitoring: Heart rate, Blood

pressure, Weight, Oxygen saturation, Temperature, ECG rhythm, Spirometry, Prothrombin time/INR

Source: ‘The Matrix’ Meets Medicine: Surveillance Swoops Into Health Care, Michael Millenson, January 9, 2013

Source: Iboun Taimiya Sylla, Texas Instruments NantLife by NantCare


COMPLEXITY – CONNECTIVITY CONFUSIONIs home monitoring technically scalable

& clinically reliable?

Source: Current and Future Trends in Medical Electronics, Steven Dean, Texas Instruments, September 23, 2009

HOME SETTING Connectivity

HOSPITAL SETTING Connectivity

TELEMEDICINE FOR “Wired Homes”

Qualcomm Life 2net

Sensors


Qualcomm Life 2net

Sensors

Implantable

In Vivo Glucose Monitor


Qualcomm Life 2net

Sensors

Implantable


Wearable

fitbit


Qualcomm Life 2net

Sensors

Implantable


Wearable

fitbit

Behavior Tracking

Glowcaps

QUESTION FOR YOUR MDI VENDOR….

IS YOUR MDI SOLUTION “READY NOW” OR “FUTURE-PROOFED” TO ACCEPT HOME BASED AND

REMOTE DATA?

WHAT IS YOUR ROADMAP FOR MOBILE HEALTH (mHealth) DATA?

WHAT TO DO WITH ALL THE SENSOR DATA ONCE YOU CAPTURE

& CONVERT IT TO CLINICAL KNOWLEDGE?



SET THE DATA COLLECTION SYSTEM “IN REVERSE” TO CONDUCT PATIENT OUTREACH, INFLUENCE HABITS AND PREEMPTIVELY MONITOR ADVERSE TRENDS



SET THE DATA COLLECTION SYSTEM “IN REVERSE” TO CONDUCT PATIENT OUTREACH, INFLUENCE HABITS AND PREEMPTIVELY MONITOR ADVERSE TRENDS

THIS REQUIRES AN “EVENTS BUS”

PATIENT ACTIVATION TRIGGERS

Driving change…from a distance


PATIENT ACTIVATION TRIGGERS

Driving change…from a distance


Influence the RIGHT PEOPLEat theRIGHT TIMEat theRIGHT PLACEby theRIGHT METHOD

USE PATIENT OUTREACH TO

R4

Web Email Text/

MobileMail

Social Communities IVRTelephonic Face-to-

FaceHome Care

REACH THE TARGET -

THE PREFERRED WAY

COACH THE PATIENT

Web Email Text/

MobileMail

Social Communities IVRTelephonic Face-to-

FaceHome Care

REACH THE TARGET -

THE PREFERRED WAY

COACH THE PATIENT

Fall Risk

CREATE PROVIDE TEACHA SINGLE POINT OF HEALTH NAVIGATION

Source: Oliver Wyman, The Volume-To-Value Revolution, Rebuilding the DNA of Health from the Patient in, Tom Main & Adrian Slywotzky, 2012

EVENTS BUS ARCHITECTURE

AGGREGATE - MAP & ANALYZE DATA


OLAP/SQL


RISK SCORESEpisode Risk Groups (ERGs)Episode Treatment Groups (ETGs)Hierarchical Condition Categories (HCC)

OLAP/SQL

EVENTS BUS ARCHITECTURECONTINUED

EVENTS BUS DELIVERY TOPOLOGY


MIDDLEWAREConnexall, EXTENSION,

ASCOM,Phillips Emergin, Amcom


Perfec

tS

erve

IDEALLY……. LAYER INSELF-SERVICE MESSAGE ROUTING & AVAILABILITY

STATUS

MEDICAL DEVICE INTEGRATIONFOR PATIENT-CENTERED HEALTH CARE

PLAN OF ACTION


HOW TO BEGIN THE JOURNEY IN A HOSPITAL

PLAN OF ACTION



PLAN OF ACTION

Which perspective is your organization?

Hospital only? Hospital, SNF, Ambulatory,

Home Health, Other? Converging service lines?



Include all stakeholders early on

Administrative Leadership Physicians Nurse Leaders Informaticists Clinical Engineering/BioMed Information Systems Telecommunications Facilities/Maintenance Others

PLAN OF ACTION





HOW TO BEGIN THE JOURNEY IN A HOSPITAL HOW TO BEGIN OUTSIDE OF A HOSPITAL



PLAN OF ACTION





Which perspective is your organization? Not closely affiliated with hospital(s)? Closely Integrated with hospital(s)? Integrated Delivery Network? Accountable Care Organization?




PLAN OF ACTION





Which perspective is your organization? Not closely affiliated with hospital(s)? Closely Integrated with hospital(s)? Integrated Delivery Network? Accountable Care Organization?


Include all DATA source/destination stakeholders early on

IPA or PHO (Case Managers) Home Health Agency(s) Durable Medical Equipment (DME) providers Local retail and outpatient pharmacies Hospital based & stand alone outpatient clinics ASCs - Labs - Radiology clinics/Imaging

centers WorkCenter health partners (ASOs/Self-insured

Co’s.) Information systems staff or partner(s) EHR & PMS vendor(s) Registry vendor Care Coordination Software vendor Others



PLAN OF ACTION




Questions?


REACH ME AT LinkedIn: John Squeo

medical device integration for patient centered health care

Health & Medicine

hospital device integration

hospital pressures

better outcomes

extending patient monitoring

emerging needs