Transcript Going Mobile at the Point of Care (MPoC): What is it?

GTSI Technology
Leadership Series
From Mobility to
Homecare
Dr. Mark Blatt
Director
Healthcare Industry Solutions
Digital Health Group, Intel
Agenda
• Mobility Now
– Mobile Point of Care Components and Trends
– Form Factors to fit Workflows
– Model for Measuring Business Value and ROI
– Network Design Considerations
– Customization vs. Standardization
– Use Case Studies
• Homecare: the next frontier
Closing Remarks
Mobile Point of Care (MPoC)
Workflow Transformation
PEOPLE
PROCESS
TECHNOLOGY
MPoC: Five Components to Get to Solution
1
2
3
4
5
Right Hardware (w/ refresh roadmap)
Right Software (needs to fit with workflow/use case)
Connectivity (robust network design)
Integrated Solution (needs to fit with other pieces)
Workflow Transformation (people need to use it)
Mega-Trend: Extending Wireless Spectrum
WiMAX
50km/31m
ZigBee
CDMA2000, GPRS, GSM, CDPD, EDGE
Bluetooth,
Wireless USB
35km/22mi max
100m/330ft max
IEEE 802.16
Wireless Wide Area
Network (WWAN)
30m/100ft
10m/30ft
Wireless Local Area
Network (WLAN)
WiFi: IEEE
802.11a/b/g
Personal Area
Network (PAN)
Radio Frequency Identification (RFID)
Varies in Range
Wireless Medical Telemetry Service (WMTS)
Healthcare ‘Shifts-Left’ & goes mobile without boundaries
Usage Models Drive Design of MPoC
Solution
“Walk Around”
“Wheel Around”
‘Grab & Go’ Patient-2-Patient
Room-2-Room
“Walk and Dock”
Patient Care & Office
Usage Model
What We Have Heard:
Workflow Optimization – Where are the Bottlenecks?
End of Shift
Handover
Admit
From ER
Asset Tracking
Medication
Management
Discharge
Mobile Use Cases
(what mobility can do at the bedside)
Reference Architectures (available)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Vital signs capturing using Bluetooth
Vital signs capturing using WiFi
Image capturing and input into EMR
RFID for user authentication and Single-Sign On (SSO)
Care team collaboration (communication using VoIP)
Patient and medication identification using barcode
Image (x-ray) review at bedside (PACS)
Bedside device ordering and patient transport request
Blood transfusion verification
Mobile ePaper
CPOE at bedside
Newborn tracking using RFID
MPoC in Action
Access 2 systems
Capture vitals
Drawing blood
Charting
Nurse data entry
Dr. data entry
What is the Best Device For My Needs?
Mobile Clinical
Assistant
Mobility
Vital sign, I & O entry
Medication Administration
Template data-entry
Free-format text data-entry
Large diagnostic images
Data Inquiry
Manageability
Tablet PC’s
Laptop’s
Fixed
PC’s
Improving Handwriting Recognition
• Improve handwriting recognition results by installing
Microsoft Dictionary Tool for Tablet PC (freeware) and
importing custom 9,883 Medical Term dictionary (.txt) from
Microsoft PowerToys for Windows XP Tablet PC Edition site
at:
• URL: http://www.microsoft.com/windowsxp/downloads/powertoys/tabletpc.mspx
eForms and the MCA
Skilled Nursing Visit
Signature Consent
Wound Care
Reimbursement
Medical Charge Capture
The synergy of eForms and the MCA can help optimize workflows
Industry-Tested Approach to
Identifying Business Value
• Business Value: Improved ability to achieve strategic business
objectives
• Improve quality of care, patient safety, staff productivity, revenue,
costs…
Business Value
= one or more of
Increased
Revenue
(Growth)
Monetizable
Quantifiable
All Benefits
Lower Costs/
Better Efficiency
Better Use of
Assets
(Productivity)
Not all benefits are quantifiable
Not all quantifiable benefits are monetizable
Business Value Model focuses on
monetizable benefits
Quick Summary TCO and ROI for MPOC
Workflow At the Royal Salford, UK
Salford Phlebotomy MCA Annual Savings
Phlebotomy
Lab
Total
People
2,574 hrs £24,612
468 hrs £4,475
3,042 hrs £29,086
Material
£12,355
£6,037
£18,392
Total
£36,967
£10,512
£47,479
• Gross annual savings of £47,000 through >20% time
savings in Phlebotomy, £70,000 3yr NPV
– Leading to one-year payback
• Equal mix of savings due to productivity and reduction in
errors leading to fewer draws
– Quality of Care aspect not quantified
• Opportunity to compress Phlebotomy Order Life Cycle
leading to Workflow Optimization and further Quality of
Care benefits
MPOC VM – Workflow Optimization
- After
Prior to
MCA
MCA
Deployment
Deployment
MPOC Workflow Optimization can
• Reduce number of phlebotomists (by 2)
• Increase the number of draws by 27-33% (50-60 draws)
• Improve capacity management and timeliness of blood draws
Measuring Up the MCA
60% clinician productivity
65% clinician productivity
83% manual transcription of
patient vital signs
62% clinician productivity
25% patient vital sign charting
accuracy
15% productivity and efficiency
Compliance with medication
administration guidelines
The MCA demonstrates results
Source: Intel News Release, Studies Show Mobile Clinical Assistant from Intel and Motion
Improves Care Delivery and Clinician Productivity, December 4, 2007
Mobile
Technologies
Network Design Considerations
• How do you handle multiple devices on the
network including personal devices?
• How do you manage to secure your wireless
environment?
• How do you create a wireless environment robust
enough to handle current and future demands?
• What’s the point of a wireless environment
anyway?
When Wireless is Deployed Poorly
• Loss of connectivity
– Cold spots -> poor roaming
– Crashed applications and systems -> lower clinical
satisfaction
• Low Throughput
– Slow system responsiveness
– Application time-out
• Security loop hole
– Data theft -> Hospital Liability
Takes very little to frustrate customers
Mobile Usage Model Characteristics
Walk-around
Room-to-room
Roaming
Level of Mobility
Wheel-around
Room-to-room
Roaming
Hybrid Room
and Office
Roaming
Targeted User
Nurse/Clinician/MD
MD/Specialist
Characteristics
Roaming Aggressiveness
Authentication and Encryption
Virtual Private Networking
Throughput Requirements
Application Sensitivity to Latency
Quality of Service
Remote Manageability
Relevance to User: Low
Medium
High
Usage models dictate wireless requirements
Office
Roaming
Office Worker,
or Remote MD
Site Survey
• Conducted before deployment
and production
• Analyzes
– Signal Strength (coverage)
– Signal-to-Noise Ratio
– Data Rate
– Signal Overlap
– Signals in a specific channel
– Roaming Prediction
• SW Tools available:
– www.ekahau.com
– www.airmagnet.com
The most crucial step in a wireless deployment
RF Spectrum Noise
Frequency
Source
50/60 Hz
All mains powered electrical equipment
~200 kHz
Magnetic card security readers
~1 MHz
Surgical diathermy (heating tissue via EM induction)
27 MHz
Continuous shortwave physiotherapy diathermy
~50 MHz
Pagers
~70-200 MHz
Ambulance radios
~400 MHz
TETRA radios
850, 900, 1800, 1900
MHz
Cell phones (GSM mobile phones)
2.45 GHz
Microwave physiotherapy diathermy and microwave
ovens, consumer cordless phones, Bluetooth devices,
802.11 b/g
5.0 GHz
802.11 a/n
20 GHz
Automatic doors
Numerous sources of electromagnetic interference
exists; site surveys are very critical
Coverage Areas
Key External Spaces
Nurses Station
Patient Rooms
Building Connectors,
Elevators, Staircases
Others:
Hallways
• OR Theaters
• Waiting rooms
Common Spaces (for shift
changes)
• Cafe/Cafeteria
Follow the workflows to determine coverage areas to
provide roaming availability
Customization vs. Standardization
• How much customization do you allow?
• Do you drive for uniformity and standardization or
do you support individual customizations?
• When you change one workflow, how does it
affect the adjacent workflows?
• Why do we need to address this issue?
As Much As You Can Drink!!!
MCA in Home Care
Value Proposition
• Improved documentation
• Quicker time to reimbursement
• Increased patient face time
• Lower operational costs
Challenges
• Lower and slower
reimbursements due to
documentation errors and
omissions
• Patient care errors from
incomplete information
• Low patient satisfaction due to
longer wait times
•
•
•
•
POC Documentation
Wireless Access to EMR
E -E Claims Submission
Real Time Dynamic
Scheduling
• Task Based Charge
Capture
Technology Partners
Home Care EMR
OEM
Infrastructure
eforms
MCA in Pharma
Value Proposition
• Research and Development
• Clinical Trials
• Sales Force Automation
• Lower operational costs
Challenges
• R&D processes costly, slow,
often paper based. Real time
collaboration less than ideal
• Clinical trails management
tools and processes remain
manually intensive, costly and
slow
• Sales force gets minimal FTF
time with clinicians
• R&D Documentation
• RT Wireless data synch
• Ultra mobile eClincials
documentation
• Real Time Dynamic
Scheduling
• Improved meds
sampling SCM
Partners
Big Pharma
MCA provides new workflow options for Pharma
eforms
Merck: Mobile Convergence Device Project
Background
• Heavy reliance on inefficient paper based workflows in evaluated labs
–
No access to eNotebook; Risk of contamination from paper
• Prior deployments of mobile technology devices in labs unsuccessful
–
Opportunity with Intel’s new Mobile Clinical Assistant (MCA) platform and C5 from Motion Computing
Description and Prediction
• Hypothesis is that a mobile convergence device will lead to increase in
productivity and optimization of workflows, while reducing data errors
and waste when deployed in the research laboratory environment
–
–
–
–
–
Prototyping methodology employed for the project
Time studies were conducted with selected users to develop baselines for evaluation of productivity gains
MCA C5 devices and wireless infrastructure were deployed for use by the test groups
After a period of utilization the time study was repeated to gather updated metrics and process changes
A survey was conducted to gather qualitative data from test users
Outcome
• C5 with supporting wireless network proven a success in research labs
–
Enables our scientists to focus on value added research work in labs
–
100% electronic records and electronic lab notebook (ELN) integration;
–
Demand for device exists now and positioned well for future demand
–
–
Reduces inefficient processes, waste, protocol submission time
Increase searchability of researcher data; Maximizes ELN investment
Challenges Facing Research Labs
• Research labs face many
inefficiencies because:
– No access to eNotebook
within the lab
– Large reliance on paper-based
processes
– Limited access to information
technology at the bench
– Contamination / Safety Risks
Print protocol
process
Scanning photos
process
Recopy paper
records process
Photo
taking
process
Manual
calculation
process
Biochemistry PCR Protocol
Before C5
Biochemistry PCR Protocol
After
Before
C5 with
C5ELN
Experiment Analysis
ONE PROCESS (PCR Protocol)
Process: Taking picture of amplified gels
Without C5
With C5
1. Retrieve hood/stand for
camera
2. Setup hood on light
3. Load film into empty camera
4. Mount camera on hood
5. Take picture
6. Wait for Polaroid to develop
7. Evaluate picture for shutter
quality
8. Carry photo to scanner
9. Startup software
10. Scan picture
11. Save image to network share
1. Take picture of
gels with C5
2. Save picture to
network share
Single Process: 9 min
Single Process: 1.10 min
TOTAL EXP 2:35:00
TOTAL EXP
2:03:00
AVERAGE PROTOCOL (ENTIRE
PROCESS)
Average amount of time required to sign and
submit completed protocol in ELN
Without C5
With C5
2 weeks
1 day
TIME SAVINGS \ COST AVOIDANCE (Differences)
One FTE
Time Savings
Cost Avoidance *
Department (20 FTE)
Time Savings
Cost Avoidance *
Day
32 min
$40.60
10.67 hrs
$811
Week
160 min
$203
53.3 hrs
$4,051
Month
12 hrs
$879
231 hrs
$17,583
Printing /
hanging sheets
Recopy paper
results into ELN
Contamination
Monitoring
Report
Referencing
sheets
Binding Assay Experiment
Before C5
Binding
Binding Assay
Assay Experiment
Experiment
After
Before
C5 with
C5ELN
Experiment Analysis
4 PROCESS ANALYSIS
PROCESS
Without C5
AVERAGE PROTOCOL (ENTIRE
PROCESS)
With C5
Setup
experiment
11.32 min
5.33 min
Referencing
Protocols
2.7 min
35 sec
Beta Counter
interactions
7.5 min
1.42 min
Finalize
protocol
in ELN
11.37
Average amount of time required to sign and
submit completed protocol in ELN
Without C5
With C5
3 – 4 months
2 days
GOING GREEN – SAVINGS WITH C5
1 min
One FTE
Paper
Gloves
Department (20 FTE)
Paper
Gloves
4 Processes: 32.89 min
4 Processes: 8.33 min
Day
9
10
TOTAL EXP
5:45:00
TOTAL EXP
3:36:00
Week
45
50
Mont
h
203
225
4050
4500
Year
2430
2700
48600
sheets
54000
TIME SAVINGS \ COST AVOIDANCE (Differences)
One FTE
Time Savings
Cost Avoidance *
Department (20 FTE)
Time Savings
Cost Avoidance *
Day
129 min
$163.58
43 hrs
$3,271
Week
645 min
$818
215 hrs
$16,358
Experiment Analysis
Survey Results
• Surveys were deployed to users at
conclusion of pilot
– Four users of C5 devices in study surveyed
Top 10 Do’s and Don’ts
Do
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Understand intended use case(s) for going Mobile
Software and Form factor must fit with intended use case
Wireless Network must be upgraded for ultra mobile
Plan for iterations
Look for “ripple effects”
Focus on workflows and how they overlap
Consider both current and future (unknown) needs
Seek input from all customers
Engage executive leadership and governance processes
Do more!!
Top 10 Do’s and Don’ts
Don’t
1. Don't make decisions about workflow just from IT perspective
(include all stakeholders to map priority workflows)
2. Don’t try to do this by the “seat of your pants”
3. Don’t let IT be the Champion of this effort
4. Don’t ignore existent RF devices and patterns
5. Don’t forget to make security discussions broad-based
6. Don’t forget to broadly survey wireless technologies and their
purported “next steps”
7. Don’t ignore your application vendors – engage them early and
often
8. Don’t forget to test the technologies with your “stuff”
9. Don’t leave SLAs out of your environment and planning
10. Don’t avoid asking numerous questions – the answers often
change!
Intel Health
Homecare: The Next Frontier
Copyright © 2008, Intel Corporation. All rights reserved.
What is Telemedicine?
Here in Abuja (capital of
Nigeria) we have immediate
access to a vast amount of
medical experts, healthcare
education & information, and
support from other
physicians…
How can we take all these
resources and share them
immediately and
effectively with our rural
hospitals and
clinics?...Telemedicine
Using technology to connect people to healthcare
Telemedicine Models: Improving Access
Case Complexity
Asynchronous model:
•Tele-radiology
•Tele-pathology
•Tele-psychiatry
•Tele-ophthalmology
Industry efforts
over last 20 years
Real-time model:
A different
approach
•Colds/Flu’s
•Diarrhea
•Hypertension checkups
•AID’s/HIV/Malaria
•Maternal/Child health
Clinic Patient Volume
Homecare: Personal Health Technologies
• PHRs: a good start
• Video conferencing (secure video phone)
• Remote Sensors
• DSS: Patient education and empowerment
• Virtual encounters
• Web base Services….
–Reminders
–Patient education
•
Promoters
Telemedicine Stages
Face-Face
Stage 0
Traditional face
to face visits
with clinician at
the medical
mainframe
(hospital or
clinic)
Follow ups and
CDM require
repeat return
visits
Very little
interaction
between
clinicians and pt
between visits
Infrastructure
Remote data
Gathering by LOB
Stage 1
Office may be
(electronically)
linked to ancillary
care providers
like lab or
pharmacy to get
inter-visit data on
pts.
May have sensor
in pts home (e.g.
scale / BP cuff);
Pt sends data &
doctor responds.
Structured chat.
May be ICD
device that is
remotely
checked betwn
visits
Non regulated
Regulated
Basic
Multiple
Vitals Gathering
Stage 2
Multiple sensors
with integrated
data screens
Clinical Decision
Support SW ;
clinical
treatment plans;
branching
algorithms
Managed by
exception: CDM
Patient
empowerment
with data
feedback
Pt education
Sensor
standards
(Continua)
Multimedia
Virtual Care
AV Conferencing
Stage 3
V-care Networks
Stage 4
Increased access
to care; Cost
avoidance;
Improved quality
of care
Increases access
to care, Dramatic
cost avoidance
(v-care = minimal
overhead),
improved quality
of care
Convenience
Patient data
integrated with
EMR and PHR
Complex
Continua
compliant
peripherals
Greater scope of
remote medical
services (PT, OT,
Nutritional,
Specialty
Consults)
EMR / PHR,
integrated w/ labs,
pharmacy,
radiology, long
term care
Improved med
adherence;
automated refills
Alliances with
bricks and mortar
systems
E-Commerce
Legal Disclaimer
The Intel Health Guide
a) requires a broadband connection in the
patient’s home to enable communications
with the care team and back-end data
hosting;
b) is designed for use by health care
professionals and their patients and should
only be used under the guidance of a
health-care professional;
c) is not intended for emergency medical
communications or real-time patient
monitoring.
Intel Confidential
Intel® Health Guide
The Intel® Health Guide connects patients and their care teams
for personalized care management at home
Intel® Health
Guide
Intel® Health Care
Management Suite
Medical
Peripherals
Patient Educational
Content
Intel Confidential
CLOSING
REMARKS
Summary
• Mobility in healthcare matters (more and more)
• Mobile Workflow transformation requires:
– Clear understanding of the preexisting workflows
– Clear vision of what you are trying to accomplish
– Strong stakeholder involvement; pick the right
processes; pick the best technologies
• Homecare and virtual encounters are coming
– Rising costs and growing issues with access will
demand new care delivery models
Q&A
Dr. Mark Blatt
Director
Healthcare Industry Solutions
Digital Health Group, Intel