Department of Molecular Biology & Immunology

1. Mobility Solutions and Innovative Collaborations for Healthcare ICT Harsh Verma, Ph.D. V.P. of Global Innovative Research Head, Mobility Solutions Monday, September 28, 2009 3:00-4:00 p.m. LIB-110, Dallas, North Texas Department of Molecular Biology & Immunology

2. Agenda • Why Mobile? • Mobile Applications and Eco-Systems today • Convergence Trends • Use Cases and Case Studies • Location Based Services for Innovation • Research Areas and Exploring • Future Goals for Collaboration

3. Healthcare professionals need to have instant access to patient records and test results Why Mobile? • Doctors need to enter diagnosis in emergency situations • Hospital Administration Staff needs to enter billing information during patient visits • Healthcare information needs to be synchronized in real-time • Mobile Technology provides ideal ‘Always-On’ features • Mobility Solutions will be driven by Discovery and Innovation

4. In advanced countries like US, conducting Clinical Research is becoming increasingly difficult and expensive Clinical Research - Why Mobile? • Doctors need to obtain Patient Data in emergency situations • Monitoring registered Patient Data for conducting Clinical Research • Remotely or thru Remote Management • Cooperation between Advance and Developing Countries • Mobile Devices can provide an ideal medium

5. Decentralization of Health Information Health Information Exchange - Why Mobile? • Mobile Device can provide ideal storage medium • Periodic synchronization • Mobile Device is ideal for Work Flow Management • Always-On and Connected with Patient

6. Why Mobile? • Today there are about 830 million users on 3G Networks • It is expected there will be about 5 Billion Users on 4G Networks by 2015 • Characteristics of Mobile Device • Always with you • Always-On • Location Aware • Highly Personalized • Processing Power • Small Screen • Battery Life

7. Why Mobile? • Mobile Networks are expanding their reach • Patients can remain under constant observation of expert physicians • Challenges of not being physically present at the hospital • Issues with Usability • Mobile Networks Infrastructure • Device Management and Fragmentation • Ethics and Identity Fraud • Application Management • Security and Privacy

8. About a hundred thousand patients die every year as a result of broken healthcare processes just in American healthcare [Grossman 2007] For physicians, having timely access to critical information can make the difference between life and death. This scenario projects a need for research in mobile Healthcare (m-Healthcare), which is an important extension of electronic healthcare (e-healthcare) Why Mobile?

9. Healthcare Providers– Improve Quality of Care, Workflow, Costs and Accessibility Benefits for all Stakeholders in Healthcare Enterprise • Molecular Biology & Biopharma Research– Accelerate Basic Science Research for Drug Discovery and optimize e-Clinical Trials • Payers – Improve Healthcare Quality and Cost • Government– Deliver Better Care for More People at Lower Cost

10. Everything is Connected…… • Technology Platforms for Mobile Healthcare Success • Omni-present and continuous access to patient’s HER and fast co-ordination among team members • Patients with chronic condition can remain under constant observation without the need of being physically present at a hospital

11. Innovative Collaborations in Healthcare ICT • Improve Precision in Research, Diagnosis and Cure • Intelligent Biometric Diagnostics – Freeing the patient and the System • Patient Records • Disease Monitoring • Communication • Workflow Management • Medical Surveys • Emergency Help and Alarms

12. Concept of Mobile Computing • Today mobile handset is the most preferred medium to stay connected with the world on move. • Mobile is connected to the data networks and Internet while moving from cell to cell. • Capability to deliver everything from an Alarm clock to the Video Stream on your finger tips anytime and anywhere. • 3G and 4G Networks are basically differentiated on the basis of their access technology and bandwidth • Mobile Devices are getting more processing capacity • Mobile entertainment application (like blogging, Social networking, games, multimedia application) are the best and comparatively cheap way to entertainment. • Mobile will make the world smaller and accessible.

13. Mobile Applications and Eco-Systems today….. Video Streaming Location Based Services Sports and Wellness Android Application development Web Services Barcode & QR Code Analyzing Bluetooth, Wi-Fi,GPRS, EDGE Call Handling Privacy & Security

14. Emerging Convergence…… leading to Innovation Network Convergence 4G – WiMAX Wired Broadband BcN 3G Wireless Broadband WiFi Service Convergence Device/Platform Convergence Wired/Wireless Converged Device Broadband Wireless 3G DTV VoD, KoD PC, TV Voice/Data Functionally Converged Device Multiple Access Device IT/Broadcasting Mobile Devices

15. Innovation leading to Device and Market Fragmentation…… Internet (IP)-centric Google Android iPhone Mobile Internet WiFi, WiMAX, HSDPA, WCDMA, DVB-H, BlueTooth .jad /.jar Files .prc Files .cod/.jar Files .sis Files Web Browsers .html / .xml Files .cab Files

16. Location based Emergency Handling and Searching Leveraging Location-info from Mobile Networks Health Service Interfaces for Discovery Process Interactivity with Lab Environment and Content Dual Mode Mobile Devices provide interactivity using WiFi, Bluetooth User-created Content and Mobile Search Leveraging location to enhance Experience Mobile Work Force New ways to improve work operations, Always-on, Calendar and Contacts to increase Productivity Ref: http://mobile.rsystems.com Use Cases and Case Studies……

17. Data Flows to be watched…… • Defining the Data Management

18. Patient – Care-Provider – Opportunities for Innovative Collaborations Areas for Behavior Study and Mobile Interface – A Brainstorming • Scheduling • Registration • Admission • Diagnosis • Treatment • Patient Discharge • Post Discharge accounting Billing & Claims Creation Medical Records Management and Digitization * Insurance AR follow-up Tele – Scheduling * Registration, Demographic Data Entry, Charge Entry Patient Statements and Follow-up Electronic / Manual submission Coding Compliance [LMRP/LCD, CCI] * Denial Management Pre-encounter Eligibility Check EOB Posting Reconciliation • XML provides an ability for exchanging messages

19. Emergency Request Scenario Patient’s health information is displayed on the UMD Patient opens UMD Device and launches Mobile Emergency Request page Patient submits request for emergency with one click Patient’s current location is dispatched along with patient info and medical condition Confirmation is sent back to patient along with hospital information and current location e911 processes the request and sends information to nearest hospital Confidential Page

20. A Framework for Innovative Collaboration…… Multi-pronged Research Model Approach Concept, Ownership, IP Design, Development, Implementation, Support Demonstrate usefulness of Mobile Technology I terms of overall Healthcare CMMi Level 5 Develop, Build & Support MER

21. Everything is Connected…… HL7 • Standards for critical mass service • HL7 (Health Level 7) • Health Level Seven, Inc. (HL7) is the global authority on standards for interoperability of health information technology with members in over 55 countries. • HL7's vision is to create the best and most widely used standards in healthcare. • Standards Interfacing – • American Health Information Community (AHIC) • Centers for Disease Control and Prevention (CDC) • Healthcare Information Technology Standards Panel (HITSP) • Office of the National Coordinator (ONC) • American Dental Association (ADA) • ASTM International • Clinical Data Interchange Standards Consortium (CDISC) • Digital Imaging and Communications in Medicine (DICOM) • Many more…

22. Research and Development Case study 1 • RSI Berkeley Proof-of-Concept Framework • Participation in proposed UC Berkeley First US Mobile WiMAX PoC Lab • Best practices, White Papers in ITS World Congress • Support delivery of new technologies and high quality software • Industry Forums & Partners • Participation in Global Industry Forums – WiMAX, MIMITS,ITS CA • California Center for Innovative Transportation • Forge Knowledge Alliances with Key Technology Providers • Embedded Systems • EECS @ Berkeley addresses needs of Embedded Systems • Improve Time to Market • Lower Cost for Ultra-Mobile • Increase Competitive Advantage – Advanced Lab being set up

23. UC Berkeley Highway Lab Case study Source – CCIT, BHL

24. Case study Clearwire Innovation Network in Silicon Valley…… http://innovation.clear.com/innovation

25. Life Sciences and Clinical Research Client: The IT wing ofworld's largest biopharmaceutical Contract Research Organizations. Business Need  Vast Technology Span  Cost Effective Scalable Offshore Model  Ready work force trained on GCP/21CFR part 11/ and internal SOP  Adherence to CMM and ISO quality processes Challenges  Evolving Requirement Specifications.  Inaccessibility of client validation database for test case simulation.  Aggressive delivery timelines with a steep learning curve for the team.  Criticality of documentation required to meet the client and FDA/GCP guidelines. Solution  Setup of local and sanitized IT infrastructure for offshore team to simulate testing environment.  Domain expertise and rigorous in-house testing to deliver studies on time with quality.  Formal review process adopted by the offshore team to ensure that the documentation meets client and FDA process requirements.  Scalable team catering to changing business requirements • Anand Janakiraman, • R Systems Program Manager

26. Healthcare Regulatory Environment Solutions Administering mandated public health programs and benefits for California State Department of Health Services (DHS). As a part of ensuring these programs meet the needs of Californians, DHS audits the funded work of contracted providers and provides audit reports to state and federal oversight authorities. To manage audit workflow and documentation, the state built had 3 programs to handle medical service reviews (MedR), laboratory service reviews (LabR), and pharmacy service reviews (PharmR) by improving and cloning parts of the original MedR program. Problem: The program ran on a database system that was no longer supported by the vendor, provided no way to coordinate reviews across the 3 programs. Result: The OneR system upgrade provided by R Systems was successful in bringing together the functionality needed by the DHS and in eliminating legacy issues in the original program. R Systems continues to provide ongoing consulting and project management services to the California Department of Health Services and maintenance on the OneR program.

27. Compliance [HIPAA, BS7799] Transaction and Code Set Compliance Security Compliance • Documented and implemented security policy • Layered Physical and Network Security, with encryption [VPN] • Independent Audit by clients • Compliance with CPT-4 and ICD-9CM • Geared Up for ICD 10 transition • Standard Electronic Transaction with payers • [837, 835, 274/275, 271/272] HIPAA Business Associate Agreement with Covered Entity Privacy Compliance • Audit Trail for all information access • NDA with employees working on PHI • Employee Training • Comprehensive General Liability coverage • Security and privacy practice and documentation is a super-set of HIPAA Business Associate Agreement Client or Client’s Auditors are extended the right to inspect the facilities, remote-monitor systems, processes, books and records and interact with R Systems compliance team.

28. Overview NuVasive is a medical device company focused on the design, development, and marketing of products for the surgical treatment of spine disorders. Solution Neuro Vision is a nerve avoidance monitoring system to improve the safety of spine surgery. This system allows the surgeons to use “smart instruments” avoiding injury to vital nerves through audio and visual warning signals that let surgeons know nerve proximity and implant surgery. R Systems were given the task to create the remote monitoring application for this new version of NeuroVision – M5 which will be launched through their secure internet website which involved the following tasks: Enhancements to their secure website to provide support for the new Remote Monitoring (RM) application. Created a services framework based on WCF to interact with the NeuroVision M5 control unit stationed in the operation theatre to store the messages in the Database and fetch them to show on the remote monitoring application. Search and display database information about the tests running on the M5 control unit on the remote monitoring application. Created the Silver Light GUI in the remote monitoring website which allows doctors to interpret the results and also guide the surgeons in the OT about the nerve proximity and implant.

29. Intel Digital Healthcare Kirk Dunsavage, Intel Application Engineer http://www.intel.com/healthcare/hit/index.htm?iid=health+IT Intel Demo on Mobile Point of Care Solutions……

30. SyBase …… SyBase Demo on Mobile Healthcare Solutions…… • http://www.youtube.com/watch?v=uNcRST84Zlg&feature=player_embedded#t=56

31. How Partnership benefits you? • Basic Science Research Organizations can access huge skill diversityin R Systems, across technologies at a lower cost; against current skill-deficiency • Term-based projects can be manned with R Systems onsite developers and Co-PIs for 6-12 months, instead of perm position • Mix of Offshore and Onsite team will result significant lower development & implementation cost • Faster project execution through quick ramp-up and ramp-down, without employee liabilities • Better productivity with hourly billing

32. ` Dallas-Fort Worth Map showing UNTHSC……..

33. Create a Mobile Test Bed at UNTHSC Campus WiMAX Network in Dallas Mobile IP Test Devices Software and WorkFlow Creating a Mobile Network at UNTHSC……..

34. Please provide your Mobile WorkFlow Work Sheets Creating a Mobile Network at UNTHSC……..