Transcript Technical requirements for comprehensive multimedia

IT:
Transforming Power for Industries
From Telemedicine to E-Health
Seong K. Mun, PhD
ISIS Center
Georgetown University
[email protected]
Georgetown
ISIS Center
Team of 15 faculty and 70 staff
Information Age
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Under Formation
Struggle Underway
Some Examples from Other Industries
Hard to Make any Projections
Still Very Young (About 100 years)
Outcome Unknown
Very Powerful Transforming Capability
Industries in Info Age
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Transformed
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successful and not so
New Industries
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Industries on the net community
What will happen to healthcare?
Is it going to be a transformation?
Evolution of Business Models
IT as a Transforming Tool
Digital Devices
Communication
Video Conferencing
Data/Image Processing
Telemedicine
Stage 1
Development
of Basic
Technology
Stage 4
Transformation
of Operating
Environment
New Business
Models
Virtual Clinic
Global Radiology
Transaction Management
Stage 2
Development
of Relevant
Applications
Stage 3
Integration and
Diffusion of
Technical Tools
Digital Information System
Integrated Healthcare
Teleradiology
Filmless Hospital
Goals of T-Med
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Improve Access:
 Doctors and Information
 Access to Patients and Diseases
Improve Quality
 Better Outcome
Reduce Cost: Overall Cost
Two Types of Application
Operational
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Real Time (VTC)
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Acute Illness and Emergency
Other Specialty
Store and Forward
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Chronically Ill: 70% of Health Budget
Routine Radiology, Pathology
What is wrong with this?
What is our assumption?
One-way model.
Drivers: Technology
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Availability of High Speed Links
 19.2 kbps to T-1 lines
Availability of Digital Input Devices
 Digital Imaging Devices
 Digital Video Devices
Emerging Digital Age
Refugee Health
Global MRI Network: NGI
Congestive Heart Failure: Home
Diabetes Management at Home
Diplomatic Telemedicine in Africa
Telemedicine Demo in Russia
Disaster Relief in Kenya
Medical Education in Latin America: ACTS
Renal Dialysis Center and Home Dialysis
Rural Health: Kidney Stone Disease
Post Surgery Follow Up
Mission Project & Diabetes Project with UH
Teleradiology: DEPRAD, Bosnia, Hungary, Germany
PACS: Filmless Digital Hospital
General Assessment
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Access to Care
Acceptable Technology
 Demanding Logistics, TV Production
 High Costs: Tech, Ops, Staffing
 Technology Insertion Requires Appropriate
Operational Environment
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Access to Patient and Information
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Not a primary focus – so far
Key Issues
Technology: Good
 Business Process (E): Poor
 Business ($) : Very Poor
 Clinical Relevance: OK
 Overall Costs: High
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Technology is one of many requirements!
Revisiting the Assumptions
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Patient’s access to Physicians
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Initial Focus
How about Physician’s access to
Patient?
Health Record
 Genetic Information
 Life Style Information
 Others
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Radiology Case Study
Digital Filmless Hospital
Teleradiology
Global (Virtual) Radiology Service
US DoD PACS
North Atlantic
Ft. Lewis
(MAMC)
Ft. Drum
Western
West Point
Great Plains
Ft. Greely
Ft.
Wainwright
Ft. Leavenworth
Ft. Carson
Ft. Riley
Ft. Irwin
Ft. Richardson
Ft. Leonard
Wood
Ft. Sill
Ft. Monmouth
Carlisle Barracks
Site R
Ft. Detrick
WRAMC
Ft. Knox
Ft. Lee
Ft. Belvoir
Ft. Eustis
Ft. Campbell
Ft. Bragg
Redstone
Ft. Gordon
Aberdeen
Ft. Meade
Southeast
Ft. Jackson
Ft. McPherson
Ft. Huachuca
WBAMC
Ft. Benning
Ft. Hood
Ft. Stewart
Ft. Polk
Pacific
Ft. Sam Houston
(BAMC)
Ft. Rucker
Shape
Tripler (TAMC)
Wuerzburg
121st
General
Hospital
Landstuhl
Heidelberg
No PACS Activity
9 outlying locations
Activity In-Process
Europe
Livorno
Camp Zama =
PACS Implemented
5
Vincenza
Global Teleradiology
Stand-alone
Nigh Hawk / On-call Coverage
Expert / Second Opinion
Global Virtual Radiology Service by Workload Sharing and Reallocation
Enter Internet!
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Easier Access to Communication
But Limited Band-width
Ubiquitous Computing
Beyond Point to Point Communication
Expanding Enterprise
Payers
Clinical Research
Mercy
Hospital
Government Agencies
Public Health
University
Hospital
DPT
City
Hospital
Research and Education
What is Information Economy?
How is it powered?
Followed by
Agricultural Economy; Powered by Animals
Manufacturing Economy: Powered by Engines on Fuels
Powered By
Ubiquitous Coordination Technology
Information, Communication and Computing Technology
New Industry Emerges and Old Ones Must Transform
New Business Process Needed
Where are we in healthcare?
What does/can IT do to business
processes?
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Bureaucracy to Ad-hoc-cracy
Flatter Organization
Info: Do it yourself
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Consumers do part of the job
Externalizing labor cost
Self care, home care
More Power to End Users
More Responsibilities to the End Users
Key Activities for Mass Production
Traditional Health System
Standardization
Specialization
Synchronization
Concentration
Centralization
Era of Bureaucracy
Serialization
Organizational Impact
“Adhocracy”
Information Age
Bureaucracy:
Mass Production
What is this?
Medical Center Model
Is It Obsolete?
Distributed
Patient Centric Model
Is it workable?
Attributes of Future Health Care
Distributed System
 Knowledge Based- Bidirectional
 Patient Driven, Customized
 More Self Care
 More Prevention
 More Choices: Patient Education
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Consistent with generic IT evolution
Analysis Results
Instructions
 Patient at Home or Work
Home Monitoring
Data, Questions
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Physician at GUMC
Good Technology
Not Compatible with Process
Great Self Management Tools
Advanced IT (I-2) Demonstration
Projects - NLM
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Fundamental Limitations on Internet
Quality of Service on the Net
 Authentication and Authorization
 Information Sharing in VO
 Network Security
 New Emerging Application
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Disease Surveillance
Project Sentinel
Baseline or Heightened Case
Project 6
Project 2 & 3
Applications
/use case
Project 4
Authentication
/Authorization
Middleware
Distribution Middleware/Web/Grid
Information
Distribution
Government Agencies
Hospitals
Acquiring
Sites
….
DOH
WHC
GU
Others
Project 5
Future Data Sources/Argus
Mosquito
Data
Sources
PIDS
Avian
Satellite International
Inquiry Threat Info
Patient Info
Project 1
IT-Architecture
App A
Application
TOMORROW
Authentication
/Authorization
Grid
App B
TODAY
App A
Virtual Organization
Gov
agency
App B
Hosp A
Hosp B
Web-based
Future Data Sources/Argus
Hosp A
Hosp A
Hosp B
Mosquito
PIDS
Hosp B
Satellite
Inquiry
Patient
Info A
Avian
Patient
Info B
Patient
Info A
Patient
Info B
International
Threat Info
• Web or Grid services allow for
sharing data and/or computing
resources
• Web-based Applications
• Highly scalable infrastructure
• Client-server applications
• Limited scalability
• Stand alone systems
• VPN access common
• Integrated data sources thru
Grid
• Clinical patient info only
• Limited integration of data
sources
• Access privileges thru VO
based on attributes and
agreements
• Users assigned to each system
w/separate login/access
• Dynamic adaptation to
diverging security requirements
• Users assigned to each system
w/separate login/access
Project Sentinel: Issues Demanding
Technical Solutions in Virtual Organization
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Different Organizational Missions & Activities
Different Operational Environment
Potential Distrustful Relationships
Client to Server or Peer to Peer
Different Rules of Delegation of Authorities
and Privileges
IT Industry and Healthcare
Similar Evolution Paths
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Standard interface of
machines
System Integration
Activity Automation
IT for Business Process
End to end productivity
New Business Model
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DICOM and HL-7
Filmless Operation
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IHE for Business Process
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Workflow
Department Productivity
Enterprise Info. Mgmnt
New Business Model?
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Evolution of Business Models
Hospital
IT Solutions
Departmental
IT Solutions
Stage 1
Development
of Basic
Technology
Stage 1
Development
of Basic
Technology
Stage 2
Stage 4
Development Transformation
of Relevant
of Operating
Applications
Environment
Stage 4
Transformation
of Operating
Environment
New Business
Models
New Business
Stage 3
Models
Integration and
Diffusion of
Technical
Tools
Stage 2
Development
of Relevant
Applications
Stage 3
Integration and
Stage 1
Diffusion of
Development
Technical
of Basic
Tools
Technology
Stage 4
Transformation
of Operating
Environment
New Business
Models
Physician Offices and Patients
Regional
National
IT Solutions
Stage 2
Development
of Relevant
Applications
Stage 3
Integration and
Diffusion of
Technical
Tools
Policy Directions for Congress?
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Patients
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Health Care Industry and Government
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Business Transforming R&D
Physicians and Offices
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Standards in Business Processes
Research Community and Partners
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Healthy & Responsible Life Style
IT Investment Incentives and Training
IT Industry
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Improved Infrastructure and Open Access
Acknowledgements
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National Library of Medicine, NIH
TATRC, US Army
National Cancer Institute, NIH
NIBIB, NIH
Health Affairs, Department of Defense
Department of State
DC Department of Health
Contact: [email protected]