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9 th Global Information Technology Association (GITMA) World Conference June 22 - 24, 2008 Tim Rice, CEO Today • U.S. and Global Healthcare Industry Broad comments • Intro to Moses Cone Health System • Information Technology at Moses Cone Health System

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9th Global Information Technology Association (GITMA) World Conference

June 22 - 24, 2008

Tim Rice, CEO

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• U.S. and Global Healthcare Industry

Broad comments

• Intro to Moses Cone Health System

• Information Technology at

Moses Cone Health System

– The Good, the Bad and the Potential

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World Health Organization


Composition of world health payors, May 2008

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2007 Life Expectancy

Source: CIA World Factbook, September 2007

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2006 Infant Mortality Rates

Source: CIA World Factbook, September 2007

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Maternal Mortality

Maternal mortality ratio per 100,000 live births


Less than 10 deaths per 100,000

10 - 199 deaths per 100,000

200 - 499 deaths per 100,000

500 - 999 deaths per 100,000

Greater than or equal to 1,000 deaths per 100,000

Data not available, June 2008

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10 Million Children Die Annuallyfrom Lack of Healthcare

•Nearly all in third world countries.

•200 million under the age of five

get no healthcare.

•#1 Killer: Pneumonia

30 cents antibiotics = treatment.

•#2 Killer: Diarrhea – no oral rehydration.

• Large disparities within own countries between

well-off children and poor children.

• Immunizations. May 6, 2008

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Comprehensive Solution


Country by Country Solution


Philanthropist’s Solution

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World Health Organization (WHO)

Six Point Agenda

•Promote Development

– access for poor, disadvantaged,

vulnerable populations

• Health Security

– defend against outbreaks

• Strengthen health systems

• Harnessing research, information and evidence

– monitor and measure evolving global

health situation

• Enhancing partnerships

– international organizations, donors, civil society

and the private sector

• Improving performance

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Bi-modal Problem

Chronic diseases chief causes of death globally

World Economies

Developing Countries

Sub Sahara Africa

Preventable & treatable diseases (malaria and tb)

United StatesChronic Diseases


More people dying from heart disease than infectious diseases. (TB, malaria, HIV/AIDS)

World Health Organization, June 2008

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Bill and Melinda Gates Foundation

Primary Aims

•Largest, transparent charitable foundation

in the world.

•Founded in 2000.

•Doubled in size by Warren Buffet in 2006.

•$38.7 Billion endowment.

To globally enhance healthcare and reduce extreme

poverty, and, in the United States, to expand educational

opportunities and access to information technology.; June 2008

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Cost Trends Increasing Globally, May 2008

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U.S. Compared to

Other Countries

International Comparison of Spending on Health 1980 - 2004

Average spending on health

per capita ($US PPP)

Total expenditures on health

as percent of GDP

Data: OECD Health Data 2005 and 2006.

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.

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U.S. GDP Comparison

to Other Sectors

United States = $1.9 Trillion per Year

• Clothing - 2.7%

•Energy - 2.7%

• Defense - 4.8%

• Food - 9.8%

• Housing - 10.2%

• Healthcare - 15.6%

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Moses Cone Health System

Not-For-Profit • Community Based

Five Hospitals • 1057 Licensed Acute-Care Beds • 200 Employed Physicians

The Moses H. Cone

Memorial Hospital

Wesley Long

Community Hospital

The Women’s Hospital of Greensboro

Annie Penn Hospital


Health Center

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Moses Cone Health System

Not-For-Profit • Community Based

Five Hospitals • 1057 Licensed Beds • 200 Employed Physicians

•168,000 Emergency Visits

•35,600 Surgeries

•239,000 Inpatient Days

•906 Medical Staff

•$767M Revenue

•18 Joint Venture Operations

Fiscal Year 2007

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Where is Moses Cone Health System?

• 26 miles east of Winston-Salem • 50 miles west of Chapel-Hill, Durham, Raleigh

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Information Systems




in Salary



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Technology Examples

Purchases and Installations in Five Years

• Picture Archiving

Communication System ($10.2M)

- CR and DR Readers

• MD Data - PDA Project ($300K)

•IDX CareCast ($5.7M)

- Nurse Documentation

- Medication Reconciliation

• IDX FlowCast ($1.8M)

• Electronic Medical Record

• Safety Zone Portal ($75K)

•elink Critical Care ($6.4M)

• Diligent – Safe Patient Handling ($1.9M)

• Smart IV Pumps ($4.5M)

•Enterprise Master Patient

• Index ($1M)

•Data Repository ($3.4M)

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Picture Archiving

Communication System (PACS)

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Picture Archiving

Communication System (PACS)

• > $6.5 million system.

• GE System.

• Necessity in this digital age.

• 21 Diagnostic Quality Monitors ($24,000 each).

• Communicates with other systems.

• ~ 450 internal and external log-ins.

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Picture Archiving

Communication System (PACS)

Computed Radiography vs. Direct Radiography

• Computed Radiography (CR) Readers

- Digital plates in portable units - the plate is

removed to download into PACS.

- Analogy: take the disk into Target to print pictures.

• Direct Radiography (DR) Readers

- Direct capture and downloads into PACS.

- Four in System at $390,000 each.

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PACS Benefits

• Images instantly available – real time.

• Radiologist and Physician can review same image

at the same time.

• Immediate magnification.

• No film processing.

• Burn images to a CD and take to referring hospital.

• Radiologist can review from anywhere; offshore?

• ED “Digital” Sticky Note - Radiologist can type note

right on image telephone call is not required.

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PACS Drawbacks

• Different PACS that do not communicate

with one another.

• Archived images may be off-site from where images are taken.

eg. Compare year-to-year mammograms

• Hardware requirements, Storage, Transmission.

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MD Data – PDA Project

• Created by two Duke neurosurgeons.

• First hospital pilot –

The Moses H. Cone Memorial Hospital

• PDA / Smartphone: now wireless syncing.

• Allows physicians to view clinical

documentation anywhere at anytime.

• More than 300 physicians use it while

industry average is 10% utilization.

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Registration System

Includes scheduling and billing

• Five hospitals: all had different systems.

• 24 outpatient clinics.

• Outpatient formerly different

from inpatient.

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Electronic Medical Record

• GE product – interface someday

with clinical documentation and

registration systems?

• All hospital outpatient clinics.

• 200 licenses for community physicians.

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Safety Zone Portal

On-line, web-based occurrence/incident reporting system

Average 220 incidents reported per week.

Report near misses - opportunities.

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Safety Zone Portal

  • Top 10 Occurrences

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elink Critical Care

Continuous Monitoring Via Cameras

and Remote Computers

• 11 intensivists and 12 critical nurses.

• $4.2 million initial cost.

• 107 beds, six critical care departments, two EDs.

• Appropriate interventions sooner.

• 38 hospitals in the country – only one in NC.

• Becoming the standard of care.

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Sanitation, Nutrition,

Basic Healthcare


Information Technology

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United States

• Fragmented medical record except for

the military system.

• Soldier’s medical information whether in

United States, Iraq or on a submarine.

• 47 million uninsured.

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Moses Cone Health System

• Quality of vendor code and functionality.

eg. customization, reliability, shortfalls

• Ability to keep up with technology requests

and/or requirements.

• $2 million lab mistake.

• Staff burnout due to pace of installations.

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From Patient Perspective

• No common ID in System.

• Medical history, allergies multiple times.

• Manual progress notes, physician orders.


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• Healthcare without borders.

• Best practice adoption at a

faster pace.

• As part of global economy

- Radiology reading

- Transcription

- Medical Tourism

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Computerized physician order entry.

• Document imaging.

• Interoperability of non-core vendor systems.

• Personal health records.

• National initiatives for patient

information sharing.

U.S. Healthcare

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IT to Leverage Quality Improvement

Since 2006

• Over Sedation Task Force.

• Tracheotomy Care Task Force.

• Pathology Specimen-PDCA.

• First Dose Antibiotic-PDCA.

• Peri-operative Antibiotic-PDCA.

• Reducing Surgical Site Infections-Six Sigma Project.

• Behavioral Health Center Admission

Process-Six Sigma Project.

• Medication Reconciliation-Six Sigma Project.

• Falls Reduction-Six Sigma Project.

• National Patient Safety Goals Compliance Monitoring.

• Patient Handling Initiatives to

Decrease Employee Injury.

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The Potential

Congestive Heart Failure

Wireless sensor

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Bar coded Meds Administration

• Reduces ADEs 25% – 85%.

• Patient bar coded for two years already.

• 15% of all medications we individually barcode on-site.

• $834,000: cost of IT to barcode, manage inventory, electronic ordering from departments to the pharmacy, electronic invoice payment, electronic receiving and picking of items.

• Elapsed time to get technology into productive use eg. Barcode on patients throughout system = 15 months. Still not managing medication administration using bar codes.

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Moses Cone Health System

Nosocomial HAI MRSA Transmission Rate Overall Rate (with SSIs)

Number of VAPs by

Quarter in ICUs



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“This film cost $31 million. With that kind of money

I could have invaded some country.”

- Clint Eastwood

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Clint, I Feel Your Pain


in five years, andwe’ve got a ways to go!