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Advances in Mobile Computing Emerging Technology in eHealth Development Third Annual eHealth Developers' Summit November 6 – 8, 2002, Tempe, Arizona. Jeff Sutherland, Ph.D. Chief Technology Officer http://www.patientkeeper.com/ [email protected]

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Advances in Mobile ComputingEmerging Technology in eHealth DevelopmentThird Annual eHealth Developers' Summit November 6 – 8, 2002, Tempe, Arizona

Jeff Sutherland, Ph.D.Chief Technology Officer

http://www.patientkeeper.com/

[email protected]

Turning the Promise of Mobile Computing into a Reality


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Truckers can do it!They are concerned about survival.

2 out of 3 trucking companies have disappeared in recent years

Survivors tract costs down to every activity that matters on the loading dock and the truck

Roadway Express sorts shipments from many customers and terminals, then loads rearranged goods into outbound trailers

A barcode swipes the waybill, the location, and the ID badge of the loader. Years ago this would have been scrawled on paper.

What will happen to hospitals who can’t do this in the next decade? The patients?

Cone, Edward and Carr, David. Unloading on the Competition. Baseline, Oct 2002


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On-Going Learning Required!

  • The average large healthcare delivery system does not bill for >10% of procedures rendered. As a result, many are losing money, losing staff, and losing quality of care.

  • Medical error is the third leading cause of death in the U.S. after heart disease and cancer [JAMA, July 26, 2000, p 483]. Most of the largest group of lives lost, caused by medication error, can be saved by having the right information at the point of care.

  • Mobilization of medical data is the fastest (and perhaps only) path to physician adoption of critical automation. Taking advantage of financial and clinical improvement opportunities depends on it.

  • The right data on the right patient, at the right time and right place, for the right person is key to efficient operations and patient safety.

  • The burden of harm conveyed by the collective impact of our healthcare quality problems is staggering… Our present efforts resemble a team of engineers trying to break the sound barrier by tinkering with a Model T Ford. National Institute of Medicine, 2001


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Lots of lives to save

  • Medical error is the 3rd largest cause of death in the U.S. exceeded only by heart disease and cancer. (JAMA, July 26, 2000, p 483)

    • 12,000 deaths/year from unnecessary surgery

    • 7,000 deaths/year from medication errors in hospitals

    • 20,000 deaths/year from other errors in hospitals

    • 80,000 deaths/year from nosocomial infections in hospitals

    • 106,000 deaths/year from adverse effects of medications (4th leading cause of death)

  • 50-90% of medication errors can be eliminated at time of installation of automation at the point of care.

  • “There is a growing conviction in all hospitals, even in those which are best conducted, there is a great and unnecessary waste of life. “ Florence Nightingale, 1859


Mobile patient safety solution l.jpg
Mobile Patient Safety Solution

  • Increases Revenue

  • Reduces Medical Errors

  • Improves Quality of Life: Extra Time for Doctor


Chargekeeper roi study north shore lij health system l.jpg
ChargeKeeper ROI StudyNorth Shore/LIJ Health System

  • Study Background:86 Inpatient Physicians / 22 Departments Participated in Study

  • Results:

    • $888 increase in revenues/physician/month, primarily revenue captured that was previously lost through manual, inefficient processes ($1 million annually for physicians in study group; $3.5 million when applied across potential user base)

    • 4.9-to-1.0 benefit to cost ratio demonstrated (cash flow)

    • Excludes decrease in lag time: 8 days

    • Excludes enhanced productivity/workflow

    • User Satisfaction Survey: 4.5 on scale of 1-to-5


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Proven ROI – Increased Revenue

AnnualRevenueIncrease

Benefit toCost Ratio

Participants


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Is There Really a Problem?

More than one million medication related errors occur in US hospitals each year.

Dispensing

Transcribing

Administration

Ordering

Source: Gartner Group, Healthcare Business and IT Summit, April, 2002


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Mobile Patient Safety Solution

  • Increases Revenue

  • Reduces Medical Errors

  • Improves Quality of Life: Extra Time for Doctor


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Decision Support at Point of Care

HOW DO WE DO THAT?

I WANT & NEED:

Access to only the data

  • Right Data

  • Right Time

  • Right Place

  • Right NOW


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Decision Support at Point of Care

PERSONALIZEDInformation:

  • StatusKeeper: MY “Inbox” of new patient data

    • The most recent clinical results for only MY PATIENTS

  • LabKeeper: Access to “MY patient’s” lab result

    • “Flag” an important lab to remain on the PDA

    • Create personal lab panels with customized timeframes

    • Display only critical results

  • RxKeeper: Access to “MY patient’s” medication profile

    • View only new, active, D/C or “held” medications

  • NoteKeeper: Access to “MY patient’s” clinical notes

    • View by desired note type: progress, admitting, discharge, H&P, RN, consults, etc.

  • TestKeeper: Access to “MY patient’s” diagnostic test

    • Only the test results I WANT – micro., path. and X-ray

    • Key word search for desired text

  • DxKeeper: Access to “MY patient’s” Problem List

    • View by problem category, i.e., resolved, inactive, etc.


  • Reducing medical errors step 1 aggregate results from backend systems l.jpg
    Reducing Medical Errors – Step 1Aggregate Results from Backend Systems

    MobilePatient Index

    (mPI)

    MobilePatient Index

    (mPI)

    CoreApplication

    Components

    Demographics

    AlertKeeper

    DesktopCompanion

    Clinical Suite

    ChargeKeeper

    • Capture charges at the point of care with advanced code edits and transaction management.

    • Quick access to critical results and patient information.

      • LabKeeper

      • DxKeeper

      • RxKeeper

      • NoteKeeper

      • TestKeeper

      • AllergyKeeper

      • VitalsKeeper

      • OrderStatus

      • StatusKeeper


    Reducing medical errors step 2 update selected results on backend systems l.jpg
    Reducing Medical Errors – Step 2Update Selected Results on Backend Systems

    MobilePatient Index

    (mPI)

    MobilePatient Index

    (mPI)

    CoreApplication

    Components

    Demographics

    AlertKeeper

    DesktopCompanion

    Clinical Suite

    ChargeKeeper

    • Capture charges at the point of care with advanced code edits and transaction management.

    • Quick access to critical results and patient information. Update relationships.

      • LabKeeper

      • DxKeeper

      • RxKeeper

      • NoteKeeper

      • TestKeeper

      • AllergyKeeper

      • VitalsKeeper

      • OrderStatus

      • StatusKeeper


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    Order Capture – Step 3 Generate electronic orders

    • Order capture based on:

      • Simple and intuitive based on order sets for majority of orders

    • Mobile order capture a hybrid application:

      • Most data resides on the device from synchronization

      • Multiple transactions occur in real time for order submission

    • Drug interaction checking and decision support rules sent to the mobile device works in tandem with backend clinical systems.

    • Real time transaction submits order to appropriate back end processor; back end alerting and messaging sent to the mobile device provides warnings and order status.

    • When connectivity not available order is queued on mobile device for immediate processing when backend available.


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    Malcolm, B.; Carlson, R.A.; Tucker, C.L.; Willette, C. Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.


    Mobile patient safety solution16 l.jpg
    Mobile Patient Safety Solution Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    • Increases Revenue

    • Reduces Medical Errors

    • Improves Quality of Life: Extra Time for Doctor


    Quality of life l.jpg
    Quality of Life Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    Question: How much better is your workday when you can find your patients on rounds and you have their information at your fingertips?


    Quality of life18 l.jpg
    Quality of Life Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    Question: How important is it for you to see abnormal and critical lab values as soon as the results are available?


    Quality of life19 l.jpg
    Quality of Life Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    Question: How much additional comfort would you have knowing you had the most current critical patient information?


    Quality of life20 l.jpg
    Quality of Life Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    Question:How much time would you save if only the data you wanted to see, on only your patients, was sent to you – REAL TIME?


    The proof is in the pudding l.jpg
    “The Proof is in the Pudding” Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    • "Glens Falls is a community hospital offering a wide range of specialty treatment through a number of regional facilities. Within months, we will have a fully installed CPOE system, accented and supported by remote, mobile enterprise capability offered by PatientKeeper of Boston.

    • PatientKeeper Enterprise mapped perfectly to our clinical IT strategy in two ways:    

      • At Glens Falls, we believe that you have to leverage technology to advance technology.

      • If our physicians aren't driving it, we won't put our money in it.Our doctors want mobile capability and find PatientKeeper incorporates clinical decision support into their workflow easily and seamlessly from wherever they are in the Glens Falls region. 


    Mobile patient safety solution22 l.jpg
    Mobile Patient Safety Solution Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    Improves Quality of Life: Extra Time for Doctor

    Increases Revenue

    Reduces Medical Errors

    Provides a robust platform for independently authored third party applications which interoperate with clinical systems.


    Mobile platform requirements aggregate integrate interoperate l.jpg
    Mobile Platform Requirements: Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.Aggregate, Integrate, Interoperate

    aggregate

    integrate

    interoperate

    • A common mobile platform is required to third party and end user applications on a single device. This allows standardization of data for reporting and organization wide implementation of quality initiatives.

    • Open standards are required to independently authored third party applications on a single handheld device. Physicians want single signon, patient context management, and seamless interoperability of patient data modules.

    • Supporting a faster, cheaper, mobile solution for patient safety initiatives requires an open mobile platform that allows independently authored applications to ,integrates with previously installed systems, and supports evolutionary replacement or upgrade of existing infrastructure.


    Patientkeeper personal testbed of 45 000 clinical users l.jpg
    PatientKeeper Personal Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.Testbed of 45,000 Clinical Users

    • All essential medical data on a Palm Pilot or PocketPC.

    • Designed to integrate with global medical data system.

    • Provider care, home care, and military care.

    • Harvard Medical School students are graded on information in this application. 100% adoption.


    Platform benefit managing application portfolios l.jpg
    Platform Benefit: Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.Managing Application Portfolios

    • TaskKeeper

    • NoteKeeper

    • PlanKeeper

    • RxKeeper

    • Procedure-Keeper

    • 3rd Party Apps

    • ChargeKeeper

    • LabKeeper

    • DxKeeper

    • InfoKeeper

    • MemoKeeper

    • 3rd Party Apps

    Personal

    Applications

    Enterprise

    Applications

    mPI

    One Mobile Device

    One User Interface

    Any Device

    • Any Transport

      • Ethernet cradles

      • 802.11

      • Bluetooth

      • Cellular

    Single Signon

    Context sharing

    Hard encryption


    Mobile platform features l.jpg
    Mobile Platform Features Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    MultipleDevice Types

    N

    Applications

    SDK

    SingleSign on

    ApplicationInteroperability

    Patient ContextManagement

    MobileDevice

    Security

    Application Framework

    Handheld

    Data Store

    MobileCommunications

    MobilePatient Index

    Mobile Services

    Transport:Wireless orEthernet

    HIPAA

    Security

    Web

    Facilities

    CentralAdministration

    Messaging& Alerting

    Personalization

    Transactions

    Web Services

    Integration

    Interfaces

    JAVA

    XML

    HTML

    Business Logic

    Patient Objects

    Cerner

    Wellogic

    UCR/Meditech

    Adapter Components/Open API

    CareGroup

    Mobile Legacy

    Integration

    Mobile ClinicalRepository

    MobilePatient Index


    Layered security l.jpg
    Layered Security Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    Mobilizer Platform Components

    • Secure storage

    • Secure transmission

    • Audit trails and non-repudiation

    • Authentication

    • Token-based IR beaming of data

    • Mirroring of HIS permissions

    • Certification of applications

    PatientKeeper’sSoftwareDevelopment

    Kits

    Common User

    Interface

    Messaging& Alerts

    DataSharing

    InfraredPrint

    BarcodeScanning

    Security

    Encryption & Transport

    Wired

    Wireless

    Encryption & Transport

    CentralAdministration

    Personalization

    Security

    Audit Trail

    Reporting

    Clinical DataRepository

    HIS –Scheduling

    HIS –Pharmacy

    HIS –Billing

    HIS –

    Lab

    Back-End Systems


    Platform solutions l.jpg
    Platform Solutions Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    PatientKeeperLite Solution

    PatientKeeper/Cerner Solution

    PatientKeeper/UCR Solution

    PatientKeeper Handheld

    PatientKeeper Handheld

    PatientKeeper Handheld

    UCR NetResultDesktop

    CernerDesktop

    PK Desktop

    PK Mobilizer

    PK Mobilizer

    PK Mobilizer

    WDAC

    UCR NetResult Server

    Millennium Objects

    XML / JAVA

    Transactions

    DBOne

    MediTech Magic System

    CernerMillenniumRepositories

    Synapse

    MediTech Magic

    Repositories

    Incoming HL7 Messages


    Sdk expands portfolio l.jpg
    SDK Expands Portfolio Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    TaskKeeper

    TestKeeper

    Mobile PatientIndex (mPI)

    VitalsKeeper

    ChargeKeeper

    ScribbleKeeper

    ProcedureKeeper

    LabKeeper

    RxKeeper

    DxKeeper

    PlanKeeper

    MemoKeeper

    InfoKeeper

    DemograhicsKeeper

    NoteKeeper

    statcoder

    Medical Reporting

    mobileMICROMEDEX

    MobilizerSDK

    Developedby PatientKeeper

    Developedby Third-Party


    Driving platform leadership gartnergroup magic quadrant l.jpg
    Driving Platform Leadership: Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.GartnerGroup Magic Quadrant

    Gartner, Inc.

    Advisory Services

    Draft Market RU

    09/25/2002 04:01 PM

    Kenneth Kleinberg


    Clinician value proposition l.jpg
    Clinician Value Proposition Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    • An intelligent mobile framework:

      • Portfolio of multiple, independently authored applications integrated on a single mobile device (More and better functionality sooner)

      • Common UI and patient-centricity(Increase adoption and reduce training)

      • Not “painted in a corner”; integrate best of breed mobile applications

      • Flexibility to create own applications(e.g., protocols to influence physician behavior)


    Hospital value proposition l.jpg
    Hospital Value Proposition Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    • Value to hospital decision makers:

      • Centralized administration

      • Enterprise-wide controls to help manage the “organic growth” of PDAs (e.g., HIPAA)

      • Not “painted in a corner”

        • Integrate best of breed mobile applications

        • Develop own applications

        • Force another vendor to port their application to a common framework

      • Often PatientKeeper Personal is already in use


    Developer value proposition l.jpg
    Developer Value Proposition Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

    • Value to the developer community:

      • Lowered barrier to entry for application creation

      • Shorten time to market

      • Create “portfolio effect” – Crossing the Chasm

      • A installed base to sell into & distribution channel

      • Leverage with component technology vendors (e.g., encryption, Infrared printing, barcode scanning, wireless networks, etc.)


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    Advances in Mobile Computing Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.Emerging Technology in eHealth DevelopmentThird Annual eHealth Developers' Summit November 6 – 8, 2002, Tempe, Arizona

    Thank You