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Wisconsin’s eHealth Initiative and the ED Linking Project
November 8, 2008 WI ACHE Webinar
To Access Audio:
866-365-4406
Pass code: 2741820
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AgendaSecretary Kevin Hayden – 10 minutes
o Brief overview of Wisconsin eHealth Initiativeo Implications for acute care providerso Health Information Exchange
Dr. Edward Barthell - ED Linking - 10 minutes
o Overview of Project/timelineo Physician’s responseo Clinical improvements
Bill Bazan – 10 minutes
o Competitive Challengeo Business case for connectivityo Equal Partnership/Change in Culture
Gary Nicolas – 10 minutes
o IT considerationso Flexibility - Interoperabilityo 4 steps toward Adoption
Q& A – 10 minutes
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Kevin R. HaydenSecretary of Wisconsin’s Department of Health and
Family Service
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4A Discussion on Wisconsin’s
eHealth Initiative
Department of Health and Family Services
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Wisconsin's eHealth Initiative and the ED Linking Project
Kevin R. Hayden, Secretary
Department of Health and Family Services
http://ehealthboard.dhfs.wisconsin.gov/
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The eHealth Initiative Goal:
Successful implementation of a statewide health information exchange (HIE) system that is interoperable with the Nationwide Health Information Network (NHIN).
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eHealth Activities in DHFS: • Promote investment in adoption of electronic
medical records in health care settings to improve the quality, safety and value of health care;
• Promote investment in HIE to improve the quality, safety and value of health care;
• Assure patient privacy in the exchange of health information;
• Link HIT and HIE to public health, prevention and disease management activities;
• Collaborate with others; • Support the Governor's eHealth Care Quality
and Patient Safety Board.
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Promote investment in adoption of electronic medical records in health care settings to improve the quality, safety and value of health
• Statistics: – Overall, about 77% of ambulatory practice sites have
electronic practice management systems (billing, scheduling, etc.) -- includes about 84% of practice sites in large systems and 57% of practice sites that are independent or part of small systems.
– 16 % of ambulatory practice sites have totally electronic patient records systems – includes 17% of practice sites in large systems and 11% of practice sites that are independent or part of small systems.
– 69% of ambulatory practice sites have some combination of paper and electronic patient records.
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Promote investment in adoption of electronic medical records in health care settings to improve the quality, safety and value of health cont.
• Medicaid Transformation Grant – Wisconsin Health Information Exchange
(WHIE) – ~ $3 million grant from DHFS through CMS
Medicaid Transformation grant• Value – Driven Health Care Initiative - - align
WI’s Medicaid program’s quality measurement strategies with WCHQ’s.
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Promote investment in HIE to improve the
quality safety and value of health care
Request for Proposal Development
Purpose: • To obtain consulting services and expertise for
state-level HIE assessment, planning, and architectural (business & technical) design;
• Promote the development of secure, trusted, technically compatible statewide HIE across public and private sectors.
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11Assure patient privacy in the exchange of health information
• Allow disclosure without consent of the following information in 51.30 treatment record to all treating providers with a need to know: name, address, date of birth, name of mental health providers, dates of service, diagnosis, medications, allergies, other relevant demographic information and NEW – biometric diagnostics like lab and non-psych testing and symptoms.
• Eliminating barriers to documentation, re-disclosure and oral disclosure of information to those involved in care or treatment of patient e.g. family members.
Health Information Security and Health Information Security and Privacy Collaboration (in progress):Privacy Collaboration (in progress):
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Collaborate With Others
• Wisconsin Health Information Organization
• Wisconsin Collaborative for Health Care Quality
• Wisconsin Hospital Association
• Wisconsin Medical Society
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Support the Governor's eHealth Care Quality and Patient Safety
Board
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Implications: • Resources
– Governor Doyle’s Biennial Executive Budget
Resources: grants, tax credits
Governance: statutorily establish Council
• Certification and development of standards for interoperability
• Removing statutory and regulatory barriers
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Implications cont.:
• Alignment: – HIT platform with value-based
purchasing strategies – Population health with
disease/chronic care management
• Sustainability
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Acknowledgements:
• Dr. Barthell of the Wisconsin Health Information Exchange
• Bill Bazan of the Wisconsin Hospital association for their great dedication to this project
• Tom Wetzel for convening this webcast
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Dr. Edward BarthellExecutive Vice President for Infinity HealthCare Inc. and
Chief Medical Officer of EMSystem
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ED Linking ProjectInformation Sharing between
Emergency Departments and Community Health Centers
June, 2007Wisconsin Health Information ExchangeEMERGENCY DEPARTMENT LINKING
Manage AccessSystem Admin
ED Clinicians
Public Health Official
Participating Hospitals
Regional GAMP DB
EDS Medicaid
HMOs Medicaid Patient Info
Monitor/Audit Logs
Maintain PatientIndex (Matches)
Process PatientInformation
Publish PatientIndex
Locate PatientInformation
View PatientInformation
Enter PatientEncounter Narrative
View AggregatedPatient Information
Manage Help Desk
Public Health Case Manager
Query AggregatedPatient Information
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THE PROBLEM
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SOLUTION
Implement a health information exchange system that will allow multiple hospitals, clinics, and healthcare institutions to rapidly access past medical history data about patients.
A FIRST STEP
Provide clinicians access to past medical history for patients that register for care at safety net facilities – emergency departments and community health centers.
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KEY REQUIREMENTS
Make data available to clinicians in a manner that is virtually transparent to current workflow.
Provide sufficient “hit ratio” and accuracy of record matching to make queries worthwhile.
Ensure security and confidentiality of all medical records and compliance with HIPAA and applicable state regulations.
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GOVERNANCE
What is (who are) WHIE? A collaborative group with a broad based board of advisors include representatives of health care providers, payors, patients, educational institutions, and other stakeholders
DATA SHARING PARTNERS
Aurora Health Care Children's Hospital of WisconsinColumbia - St. Mary's HospitalsFroedtert and Community HealthWheaton Franciscan HealthcareDHFS Medicaid
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MAKING IT WORK
Formal planning processProviders, HIT experts, Project managementImplementation plan completed fall 2006
Building a collaborative networkMeetings, Data sharing agreements
Arranging for fundingHealthcare provider investmentMedicaid transformation grantTechnical provider contributions
Evaluation – Sustainability planning
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CURRENT PROCESS
Patient Triage
Register
Treat Patient
Order Patient Chart
Clinician must think to ask for previous records
Previous records often unavailable
Manual or electronic process to retrieve local records
Labor intensive process to retrieve records from other institutions
Lack of previous records leads to errors and redundancy
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NEW PROCESS
Patient Triage
Register
Treat Patient
Order Patient Chart
Automatic regional query initiated by registration message
Available data displayed on pick list for clinicians or support staff
Includes summary info from both local hospital and outside facilities
Review on line or print to attach to paper chart
Decrease errors and redundancy
ED Linking System
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Q4 Q1Q3 Q2
2007
Q3
2008
Q4
Mobilize
Evaluate Solution
. . .
Establish Baseline
Legal Agreements
Review & Select Medicaid Data Fields
ED Workflow
Usability
HL7 Interface(s)
VPN Setup and Config
Azyxxi Setup and Config
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THE PLATFORM
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EVALUATION
Economic Modeling Workflow Impact
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Bill BazanVice President
Metro Milwaukee, Wisconsin Hospital Association
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EMERGENCY DEPARTMENT CARE
COORDINATION COMMITTEE…AND THE
IT LINKING PROJECT
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KEY CONCEPTS:Secure health information exchangeEnhance care managementProvide needed medical informationContinuity of care Med. Reconciliation/patient safetyConnection to primary care homeFinancial impact of doing nothing
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STEP 1:
WHO SHOULD BE AT THE
TABLE?
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ED PHYSICIANSINFORMATION SYSTEM PERSONELFEDERALLY QUALIFIED HEALTH CENTERSHOSPITAL/SYSTEM ADMINISTRATORSED NURSE MANAGERSSOCIAL WORKERS/CASE MANAGERS
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MILWAUKEE HEALTH CARE PARTNERSHIP
AURORA
CHILDREN’S
COLUMBIA - ST. MARY’S
FROEDTERT
WHEATON FRANCISCAN
4 FQHC’S
Recently, KEVIN HAYDEN & ROB HENKEN
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MHCP:
IMPROVE HEALTH CARE FOR THE UNDERSERVED POPULATIONS IN MILWAUKEE COUNTY
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GOALS: COVERAGE FOR ALL ACCESS TO PROVIDERS AND SERVICES ENHANCE CARE COORDINATION SYSTEM-
WIDE PROMOTE HEALTH AND WELLNESS IMPROVE COST EFFECTIVENESS OF CARE
FOR UNINSURED AND UNDERINSURED INDIVIDUALS
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OPERATING DELIVERABLES FOR EDCCC
Improve ED care coordination policies and procedures within and across the entire system of providers
Community-wide triage and referral policies Decrease in non-emergent ED utilization Increase in assignment to primary care homes Implement IT LINKING PROJECT
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IT LINKING PROJECT AND AZYXXI
TECHNOLOGY PLATFORM TO INTEGRATE DATA FROM MULTIPLE DIVERSE HEALTH CARE IT SYSTEMS
PRESENT MEDICAL INFORMATION TO ED CLINICIANS IN A USEFUL WAY
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Gary NicolasVice President, Healthcare Portfolio,
Technology Solutions Company
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IT Considerations for EHRGary V Nicolas
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41Build With A Blueprint•Standards Based
•Not finalized, yet…•Start now, incorporate changes to standards based on adoption by the market place as they develop.
•Flexibility•Realize there will be changes as adoption increases and standards are adapted
•Scalability•Pick one or two players that are committed to growing
•Interoperability•Build on Standards, Play by the Standards
•Integration•Achieved through standards, get the theme?
•Learn From Others•Partners Community Healthcare, Inc. (PCHI)
www.partners.org•NYC Health The Primary Care Information Project (PCIP)
www.nyc.gov/pcip
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Four Stage Maturity ModelThink Personal - Get Digital
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Overviewo Digitization – reduction of paper with unification and federation of all data
across standards based platforms
o Virtualization – providing tools and access for diagnosticians independent of location. Start digital, stay digital.
o Collaboration – Efficiently connecting resources throughout the care delivery process and reducing variation so as to enhance service. Sharing the data will improve the quality of care
o Personalization – enhancing the patient and family experience using electronic communities and support tools
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Four Stage Model Stage 1 Stage 2 Stage 3 Stage 4
ValueOrientation
Digitization Virtualization Collaboration Personalization
People Systems / Service Lines
Networks / Physicians
Communities / CareTeams
Global / Patients and Families Populations
ProcessRequisition-less, Paper Lean and
Filmless
Efficiency andCycle Time
Improvement
Reduced Variation, Increased
Predictability (eTAT)
Demand Forecasting, Dynamic Resource
Allocation
TechnologyEHR, Visual EMR,
CAD PACS, Speech Recognition
Visual EHR, Grids, Unified
Messaging, Archive Unification
Exchanges, Collaborative
Filtering, Internet Suspend and
Resume
Cloud Computing, Social “Open” Health Records, Interactive
Search and Diagnosis
Information and Measurement
Schemas / Operational Business
Intelligence / Dashboards
Taxonomies / Predictive
Modeling / Gauges
Ontological / Adaptive
Optimization / Visual Operations
Semantic Web / Perpetual
Optimization / Autonomic Systems
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Stage 1 - DigitizationTrends and Illustrative Examples
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46Digitization Buying Trends… Stage 1
Digitization
Systems / Service Lines
Requisition-less,
Paper Lean and Filmless
EHR, Visual EMR, CAD
PACS, Speech Recognition
Schemas / Operational
Business Intelligence / Dashboards
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47The Evolution of the Visual EHRStage 1
Digitization
Systems / Service Lines
Requisition-less,
Paper Lean and Filmless
EHR, Visual EMR, CAD
PACS, Speech Recognition
Schemas / Operational
Business Intelligence / Dashboards
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Source: Frost & Sullivan; HIMSS Analytics
Stage 1
Digitization
Systems / Service Lines
Requisition-less,
Paper Lean and Filmless
EHR, Visual EMR, CAD
PACS, Speech Recognition
Schemas / Operational
Business Intelligence / Dashboards
Where Are We Headed With Visual Health Records?
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49…What About IT Architecture and Standards?
Stage 1
Digitization
Systems / Service Lines
Requisition-less,
Paper Lean and Filmless
EHR, Visual EMR, CAD
PACS, Speech Recognition
Schemas / Operational
Business Intelligence / Dashboards
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50Interoperability Standards Become Mature
Gartners’ Hype cycle for Healthcare Provider Technologies – 7/2006
Stage 1
Digitization
Systems / Service Lines
Requisition-less,
Paper Lean and Filmless
EHR, Visual EMR, CAD
PACS, Speech Recognition
Schemas / Operational
Business Intelligence / Dashboards
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51Drivers for adopting IT Standards in
eHealth
• Clear separation of concerns :– Healthcare specific needs -> healthcare standards – IT common needs -> IT standards
• Leverage experiences from other industries– Security : finance , e-commerce– Workflow : ERP business
• SDO resources are scarce – SDO development effort is large (1-5 FTE/ profile)– Focus scarce resources to healthcare specific standards
• Customer demand– Healthcare authorities demand for open (ISO) standards
*Source IHE Interoperability Workshop Author Charles Parisot (GE Healthcare)
Stage 1
Digitization
Systems / Service Lines
Requisition-less,
Paper Lean and Filmless
EHR, Visual EMR, CAD
PACS, Speech Recognition
Schemas / Operational
Business Intelligence / Dashboards
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52
Service Bus Blueprint Transactions)Integration Based on HCIT Standards
For more information on IHE standards see www.ihe.net
Stage 1
Digitization
Systems / Service Lines
Requisition-less,
Paper Lean and Filmless
EHR, Visual EMR, CAD
PACS, Speech Recognition
Schemas / Operational
Business Intelligence / Dashboards
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53
Stage 2 - VirtualizationTrends and Illustrative Examples
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54Source Data Is AvailableStage 2
Virtualization
Networks / Physicians
Efficiency andCycle Time
Improvement
Visual EHR, Grids, Unified
Messaging, Archive
Unification
Taxonomies / Predictive Modeling /
Gauges
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55Industry Is Demanding VirtualizationStage 2
Virtualization
Networks / Physicians
Efficiency andCycle Time
Improvement
Visual EHR, Grids, Unified
Messaging, Archive
Unification
Taxonomies / Predictive Modeling /
Gauges
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56Expectation Management? Example of
Radiology Report TATExam Complete to Report Final
Observation: Based upon a review of actual Turn Around Time (TAT) data for one month we observe that reports are taking from a few minutes up to 24 hours to complete. The majority of reports are taking 20 – 40 minutes to complete. Are your patients seeing this?
Stage 2
Virtualization
Networks / Physicians
Efficiency andCycle Time
Improvement
Visual EHR, Grids, Unified
Messaging, Archive
Unification
Taxonomies / Predictive Modeling /
Gauges
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57Virtual Radiology (Example)Stage 2
Virtualization
Networks / Physicians
Efficiency andCycle Time
Improvement
Visual EHR, Grids, Unified
Messaging, Archive
Unification
Taxonomies / Predictive Modeling /
Gauges
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58Example: Batch and Flow Processes in Radiology
Stage 2
Virtualization
Networks / Physicians
Efficiency andCycle Time
Improvement
Visual EHR, Grids, Unified
Messaging, Archive
Unification
Taxonomies / Predictive Modeling /
Gauges
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59
Stage 3 - CollaborationTrends and Illustrative Examples
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60Research Access To A GridStage 3
Collaboration
Communities / Care
Teams
Reduced Variation, Increased
Predictability (eTAT)
Exchanges, Collaborative
Filtering, Internet
Suspend and Resume
Ontological / Adaptive
Optimization / Visual
Operations
ftp://ftp.globus.org/pub/incubator/medicus/Globus_MEDICUS.pdf
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61Patient Authorized Access to Image Grid
ftp://ftp.globus.org/pub/incubator/medicus/Globus_MEDICUS.pdf
Stage 3
Collaboration
Communities / Care
Teams
Reduced Variation, Increased
Predictability (eTAT)
Exchanges, Collaborative
Filtering, Internet
Suspend and Resume
Ontological / Adaptive
Optimization / Visual
Operations
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62
What comes after Collaborative records?M
illio
ns o
f Pro
cedu
res/
Year
Source: Frost & Sullivan; HIMSS Analytics
Stage 3
Collaboration
Communities / Care
Teams
Reduced Variation, Increased
Predictability (eTAT)
Exchanges, Collaborative
Filtering, Internet
Suspend and Resume
Ontological / Adaptive
Optimization / Visual
Operations
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63Visual Search for Health 2.0
http://diamond.cs.cmu.edu/papers/mi2007.pdf
Stage 3
Collaboration
Communities / Care
Teams
Reduced Variation, Increased
Predictability (eTAT)
Exchanges, Collaborative
Filtering, Internet
Suspend and Resume
Ontological / Adaptive
Optimization / Visual
Operations
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64Visual Search for Health 2.0Stage 3
Collaboration
Communities / Care
Teams
Reduced Variation, Increased
Predictability (eTAT)
Exchanges, Collaborative
Filtering, Internet
Suspend and Resume
Ontological / Adaptive
Optimization / Visual
Operations
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65Visual Search for Health 2.0
http://download.intel.com/technology/techresearch/research_day/2006/rai_diamond.pdf
Stage 3
Collaboration
Communities / Care
Teams
Reduced Variation, Increased
Predictability (eTAT)
Exchanges, Collaborative
Filtering, Internet
Suspend and Resume
Ontological / Adaptive
Optimization / Visual
Operations
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66
Stage 4 - PersonalizationTrends and Illustrative Examples
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67Consumer Driven Patient CareStage 4
Personalization
Global / Patients
and Families Populations
Demand Forecasting,
Dynamic Resource Allocation
Cloud Computing,
Social “Open” Health
Records, Interactive Search and Diagnosis
Semantic Web /
Perpetual Optimization /
Autonomic Systems
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68Not Helpful….Stage 4
Personalization
Global / Patients
and Families Populations
Demand Forecasting,
Dynamic Resource Allocation
Cloud Computing,
Social “Open” Health
Records, Interactive Search and Diagnosis
Semantic Web /
Perpetual Optimization /
Autonomic Systems
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69That’s a little better…Stage 4
Personalization
Global / Patients
and Families Populations
Demand Forecasting,
Dynamic Resource Allocation
Cloud Computing,
Social “Open” Health
Records, Interactive Search and Diagnosis
Semantic Web /
Perpetual Optimization /
Autonomic Systems
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70This is Interesting…Stage 4
Personalization
Global / Patients
and Families Populations
Demand Forecasting,
Dynamic Resource Allocation
Cloud Computing,
Social “Open” Health
Records, Interactive Search and Diagnosis
Semantic Web /
Perpetual Optimization /
Autonomic Systems
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71
Ahh, That’s Better!Stage 4
Personalization
Global / Patients
and Families Populations
Demand Forecasting,
Dynamic Resource Allocation
Cloud Computing,
Social “Open” Health
Records, Interactive Search and Diagnosis
Semantic Web /
Perpetual Optimization /
Autonomic Systems
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72
Information Outside:
• Belongs to Community
• Visible
• Public
Knowledge Inside:
• Invisible
• Private
SSN Total View of the Patient
Medical SearchBlogs and Communities
Teaching Files
Digital ImagesElectronic Health Records
Under the WaterlineStage 4
Personalization
Global / Patients
and Families Populations
Demand Forecasting,
Dynamic Resource Allocation
Cloud Computing,
Social “Open” Health
Records, Interactive Search and Diagnosis
Semantic Web /
Perpetual Optimization /
Autonomic Systems
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73Health 2.0 Patient PowerStage 4
Personalization
Global / Patients
and Families Populations
Demand Forecasting,
Dynamic Resource Allocation
Cloud Computing,
Social “Open” Health
Records, Interactive Search and Diagnosis
Semantic Web /
Perpetual Optimization /
Autonomic Systems
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74Connections for Families and FriendsStage 4
Personalization
Global / Patients
and Families Populations
Demand Forecasting,
Dynamic Resource Allocation
Cloud Computing,
Social “Open” Health
Records, Interactive Search and Diagnosis
Semantic Web /
Perpetual Optimization /
Autonomic Systems
http://www.moreaboutmaddie.com/index.cfm
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75The Rise of the e-PatientStage 4
Personalization
Global / Patients
and Families Populations
Demand Forecasting,
Dynamic Resource Allocation
Cloud Computing,
Social “Open” Health
Records, Interactive Search and Diagnosis
Semantic Web /
Perpetual Optimization /
Autonomic Systems
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76
• Standards based design and integration to support– Visual EHR with Bi-directional integration with AEHRs– Integration of Cardiology, Pathology, Oncology, Pathology, others– Portable documents using IHE PID specification and CCR/CCD– Standardize naming conventions and rationalize data elements– Unification of archives (take the ‘A’ out of PACS)– Workflow virtualization
• Paper lean– Requisition-less Workflow– Paperless workflow for Physicians, Nurses, technologists…– Use digital pens, electronic clipboards, portals and kiosks
• Measurement and Optimization of Patient Experience– Turn Around Time (TAT) and Results Reporting to patients– Flow efficiency and wait time – from the Patient’s perspective
Summary Example: From Digital to Virtual
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77
Q & A
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78Contact InformationDr. Edward BarthellInfinity Healthcare1035 Glen Oaks LaneMequon, WI [email protected]
Bill BazanVP, Metro Milwaukee, WHA 3200 W. Highland Ave.Milwaukee, 53208 414-431-0105 [email protected]
Donald L. DavisLean Value Stream Manager, Installation ServicesGE Healthcare 2607 N Grandview BlvdSN-472, Pole b6Waukesha, WI 53188 262 544 [email protected]
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79
Contact Information Cont’dKevin R. Hayden
Secretary
Wisconsin Department of Health & Family Services
1 West Wilson Street, Room 650
P.O. Box 7850
Madison, WI 53707-7857
608/266-9622
Gary V Nicolas
Vice President, Healthcare
Technology Solutions Company
55 East Monroe Street
Chicago IL 60603
219.531.5747