SMART HEALTHCARE Maccabi Healthcare Services

1. SMART HEALTHCARE Maccabi Healthcare Services

2. Maccabi Healthcare Services • Maccabi is the second largest HMO in Israel. It covers 1.85 million people (24.5% 0f the population) • It is a recognized health fund within the framework of the Israeli National Health Insurance Law • Maccabi is responsible for providing insurance cover for all services included in the public basket of services • It supplies services to its members both via its own facilities and through outside providers

3. Every provider uses the Maccabi Electronic Medical Record Every transaction with the patient is computerized The Central Medical Record contains all computerized patient data –gives doctor access to all information on the patient The E-Laboratory-electronic referrals, automatic test results to doctor’s computer, patient website The E- Prescription E- Consultation Telemedicine Alerts and Reminders Patient Website including Patient Health Record The MaccabiHeathcare System is Highly Computerized

4. Nearly 70-80% of health care costs are a result of chronicdisease Chronic Disease accounts for 60% of all deaths and 43% of the global burden of disease 70% of the disease burden is from 5 chronic conditions Congestive heartfailure Asthma Coronary artery disease. Diabetes Depression People with chronic conditions only receive 56.1% of recommended care Disease management is a High Priority everywhere to reduce complications and deaths Chronic Diseases Is the Major Threat and Challenge of our Century

5. Chronic Disease Management using edBPM • Modern approaches to disease management focus on “patient empowerment” • Two types of technologies in use today: • Remote monitoring of patients using sensors/devices that transmit to professional call center • Patient websites with structured programs for DM • The edBPM approach: complex event processing disease management web-based program to assimilate information from multiple source events (sensors, patient input, doctor’s electronic record), macro level analysis as complex event, take action in real time.

6. Scenario – Diabetes Management Harry Jung is a married man of 50 who was diagnosed with Diabetes Mellitus type 2 ten years ago. He is generally careful about his diet, has a regular exercise regimen and his HbA1c levels indicate that his disease is in control and stable. He is enrolled in an interactive web-based (EaSSYedBPM platform) diabetes disease management program. He weighs himself once a week and the results are transmitted to the program. Likewise, he measures his blood pressure once a week and he measures his sugar levels daily with a glucometer. These measures are transmitted and entered into his interactive disease management program. He has been instructed to enter the system once a month to monitor his overall trends and provide a subjective report about his well being.

7. This month, he entered the program, and upon entry it notified him that although he had not yet reached levels that would generate an alert, he is exhibiting a steady trend of increase in glucose levels as well as a small but steady increase in his weight. The program also informs him that he has not had an eye checkup in over a half a year, he has not had a foot checkup in more than a year and he is overdue for his HbA1c test. Therefore, he is instructed to make an appointment with his doctor. The program connects him automatically to the doctor's web-based appointment system so that he can schedule an appointment. In addition, the program will ask him additional questions about his diet and exercise regime and give him interim instructions to follow in the meantime until he has his appointment with his doctor.

10. Patient Nurse Doctor Input Drugs, Vital Signs Devices Report Case Management Record EMR Web within Parameters Input Analysis Confirmation Deviation from Parameters Moderate Severe within Parameters Re measure Re measure Continued Deviation from Parameters Doctor Ask for Additional info from Patient Update EMR and Case Management Record Alert Notify Nurse Nurse OR Instructions for Resting ,Changes in Drugs, Eating etc. Schedule Visit in Doctor`s Clinic Order Ambulance, Notify ER Follow Up

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