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TRANSCRIPT
Information Technology Sector Highlights
Michael Gillam, M.D.Director of Research and PartnershipsAzyxxi Health Solutions GroupMicrosoft Corporation
IOM Roundtable on Evidence-Based MedicineLearning Healthcare System Workshop Series
Common Ground: Leadership Commitments to Improve Value in Health CareJuly 23-24, 2007
Members
¢ Jack Bates – Veteran’s Health Administration¢ Susan Dumais – Microsoft Research¢ Michael Gillam – Microsoft Health Solutions
Group¢ Gail Graham – Veteran’s Health Administration¢ Jim Karkanias – Microsoft Health Solutions Group¢ Jeff Sartori – Veteran’s Health Administration¢ Nina Schwenck – Mayo Clinic¢ Stephen Vinter – Google
Sector Profile
• Web-based patient/consumer information organizations/companies
• Personal health record organizations/companies & Electronic clinical record organizations/companies
• Administrative/claims data management organizations/companies
• Key cross-cutting trade associations and government organizations and initiatives
Evidence-Related Activities
l Improving consumer access to reliable health and disease management information
l Improving provider access to reliable health and disease management information
l Improving patient-provider communication and interaction
l Improving the application of best practicesl Improving provider operational effectiveness and
efficiencyl Improving the ability to manage and analyze large
quantities of datal Improving research on clinical effectiveness and
quality of care
Seven Sector Priorities
l Health IT Standardsl Common Vocabularyl Provider Workflowl Right-Time Evidence Deliveryl Clinical Decision Supportl Flexible Data Viewsl Connectivity
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Three Transformational Initiatives
l “Foundational Medical Informatics Ecosystem Initiative”
l “Core Measures in Information Technology Initiative”
l “Advanced Technical Strategies Innovations Initiative”
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Sector Priority
¢ Goal: Build and promote the foundational technologies needed to enable health IT assisted evidence based medicine.
¢ Standards & Common Vocabularyl The single most transformational step toward achieving the goal of
a learning healthcare system would be enhanced development and implementation of IT industry standards & common vocabularies inhealthcare
l Benefits• Support health IT at every level
• Building blocks for bringing computational intelligence to aid human cognition in EBM
l Barriers to utilization• NLM/UMLS/SNOMED (lexical variants, lexical and domain deficits,
allergy - RAST, bioterrorism)• Custom or commercial solutions
• Shuts out small vendors / impair innovation• MMTX - negation
l Goal:• Create the impetus from the Information Technology Industry to evolve
and implement these standards
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Slide 7
js1 List up to 3 transformational initiatives and describe (one 1 to 3 bullet points each).jskipper, 6/27/2007
Transformational Initiative #1
¢ “Foundational Medical Informatics Ecosystem Initiative”
¢ IOM support establishing a government-industry collaborative ecosystem for ongoing evolution and development of clinical IT standardsl Virtuous-cycle (i.e. eBay, Flickr, YouTube)
• More users of the standards < - >more feedback on the standardsl Ecosystem is both community and technology
• Blogs, Wikis¢ IOM support an evaluation of the technical barriers
to adoption of existing publicly supported open-standard vocabularies and tools by health information technology providers
• Initiatives to remedy technical barriers• Metrics of success are adoption and utilization
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Sector Priority
¢ Goal: Establish clinical data and analytic infrastructure necessary to enable evidence based medicine.
Library
Search
Revenue Cycle
Scanned Charts
Labs
Radiology
Old Records
EKGs
Medication Management
OR Management
AmbulatoryEmergency Department
Registration
CPOE
The notion that we can know everything and remember everything is ridiculous
Direct patient care
Otheractivities
Seekingdata
How clinicians spend time
Seekingdata
Direct patient care
Otheractivities
Heterogeneous Data
Today
¢ 1,500 live data streams from vastly heterogeneous data sources
¢ 88 Terabytes with 500 TB installed capacity
¢ Design aims for 1/8th sec response times
¢ 80,000 queries per day per hospital¢ 20,000 clinical and administrative users
Median Time in ED
012345678
1995 1996 1997 1998 1999 2000 2001
20000
40003000
1000 300 2000
5000
10000
15000
20000
1996 1997 1998 1999 2000 2001
Medical Records Requestsfrom the ED
14
40
90 94 95 100
0
20
40
60
80
100
1996 1997 1998 1999 2000 2001
PRC patient satisfaction percentile
0
10000
20000
30000
40000
50000
60000
70000
1995 1996 1997 1998 1999 2000 2001
ED Census
Transformational Initiative #2
¢ “IT Core Measures Initiative”l Goal: Establish an electronic patient data and analytic
infrastructure that is necessary to enable health IT aided evidence based medicine
l IOM convenes or supports initiatives to identify core measure metrics around accessibility to:
• Core clinical data• Example: Moonlighting and old EKG
• Core analytics• Reporting• “Mash ups”• Data visualization• Examples
• Regionalization: Microbiologic resistance• Evolving resistance patterns• Disease variation (pneumonia, meningitis)
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Sector Goals
¢ Establish an infrastructure to incentivizeongoing innovation in the evidence based medicine space.l Clinical Decision Support
• The ability to guide clinical decisions based on individual clinical and biologic data with relevant clinical evidence and experiential information gathered from mining data on previous patients with similar conditions
l “Just in time” evidence delivery l Alerts l Flexible Data views
Innovations Initiative
¢ DARPA Robot Racel Off road - Autonomous: 250 miles, 10
hoursl Year 1: $1 million prize, 21 entries, 15
finalists, $65 million by competitors• Carnegie Mellon $3 million – dozens of
corporate sponsorsl Year 2: $2 million (no winners), 118
entries, 23 qualified, 4 completed• Stanford – 50 people
l Year 3: Urban, $2 million prize, 53 teams
‘Stanley’ Volkswagen Touareg R5 TDI
Sector Initiative #3 andCross-Sectoral Collaboration¢ “Advanced Technical Strategies Innovations
InitiativeӢ IOM sponsor, support or establish demonstration
projects of advanced, strategic, evidence based medicine projects.l DARPA model for healthcare ITl Opportunity
• Multiplicative ROI• Knowledge from doing
• Robot form factors• Diverse participation – radical innovation• Goal: Challenge for the nearly impossible but
extremely valuable