Transcript Healthcare Collaborative Network

IBM Software Group
IBM E-Health
Secure and Private Data Exchange for Quality Healthcare
June 7, 2005
Janko Cicin-Sain, Executive Consultant CEMA
© 2004 IBM Corporation
IBM Software Group
The Lack of Health Information Technology (Health IT) Can Be
Hazardous To Your Health
 Medical errors, many of which can be prevented, are too common - the Institute of Medicine
estimates that 98,000 to 190,000 people die each year from medical errors in the hospital[1]
 Medication errors are found in 1 of every 5 doses given in the typical hospital and skilled
nursing facility, and 7% of those are potentially harmful (more than 40 per day in a typical
300-patient facility)[2]
 Health insurance costs have risen over 10% in each of the past three years.[3] Better
information systems are essential to reducing health care costs
 One study concludes that 14% of hospital admissions occur because physicians do not have
access to complete patient information
 17 to 49% of diagnostic laboratory tests are performed needlessly, because medical history
and the results of earlier studies are not available when the new tests are ordered.[4],[5]
 We have no nationwide monitoring system to identify bio-terrorism in a timely manner, to
identify potential epidemics at an early stage, or to identify patterns of adverse drug
reactions
[1] “To Err Is Human: Building a Safer Health System (2000).” Institute of Medicine (IOM) http://www.nap.edu/openbook/0309068371/html/
[2] Barker KN, Flynn EA, Pepper GA, et al. Medication errors observed in 36 healthcare facilities. Arch Int Med. 2002;162:1897-1903.
[3] The 2003 Kaiser Family Foundation and the Health Research and Educational Trust Employer Health Benefits 2003 Annual Survey found that increases in health insurance premiums
were 10.9%, 12.9%, and 13.9% for 2001, 2002, and 2003 respectively. See http://www.kff.org/insurance/ehbs2003-1-set.cfm for details.
[4] Tierney WM, McDonald CJ, Martin DK, Hui SL, Rogers MP. Computerized display of past test results.: effect on outpatient testing. Ann Intern Med. 1987;107:569–74.
[5] HIMSS. “EHR and the Return on Investment.” 2003. http://www.himss.org/content/files/EHR-ROI.pdf
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Golden rules for the 21st- Century Health Care System
(defined by Institute of Medicine, USA 2001)
Current Approach
Care is based primarily on visits
Professional autonomy drives variability
Professionals control care
Information is a record
Decision making is based on training
and experience
Do no harm is an individual responsibility
Secrecy is necessary
The system reacts to needs
Cost reduction is sought
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New Rule
Care is based on continuous healing
relationships
Care is customized according to
patient needs and values
The patient is the source of control
Knowledge is shared and information
flows freely
Decision making is evidence-based
Safety is system property
Transparency is necessary
Needs are anticipated
Waste is continuously decreased
IBM Software Group
What is HCN ?
 Private and secure interoperable network for healthcare data
 Allows organizations to choose who to communicate with for example:
inter-hospital
intra-hospital (ex: primary care hospital to emergency room)
hospital to Federal or State Agency
 A foundation for detection and rapid response to bio-surveillance, adverse healthcare
events, and inappropriate care.
 An industry standards solution that enables changes to the way healthcare systems
disseminate and analyze clinical data
 A powerful collaboration tool to automate the sharing of desired clinical data between
entities, and especially delivers value for disease monitoring. It provides the 'pipes' for
these collaborations.
 How Does it Work?
 Message Oriented Integration Architecture - Secure “publish and subscribe” Using
standards based technologies and messaging (HL7, MAGE-ML, EDIFACT, etc.);
connects to existing clinical information systems applications, Lab, Pharmacy, and
Admission/Discharge systems
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Healthcare stakeholders are backing a collaborative technology solution,
supported through the eHealth Initiative, that enables rapid sharing of health
data and improved bio-surveillance
Healthcare Collaborative Network (HCN) Solution
• Enables rapid detection and response to
adverse healthcare events including biosurveillance
Federal Agencies
(DOD, CDC, CMS,
FDA)
Healthcare
Providers
(Hospital. Nursing
Homes, others)
• Creates lower cost capabilities for
collecting, aggregating, analyzing and
reporting clinical information at near real
time
• Establishes a common electronic
healthcare information highway that
supports government, non-profit, and
private industry needs
Health Plans and
Insurance Comp.
HC Policy
advocates (AMA,
AAFP)
Healthcare HIS
Vendors
Industry Consortia
(eHealth Initiative)
One ultimate goal, supported by stakeholders, focuses on the creation of an
interconnected, electronic health information infrastructure, which creates the basis for a
National Healthcare Information Infrastructure
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The HCN architecture is designed leverage open standards, be flexible
and scalable, and facilitate easy adoption at participant sites
Architecture for HCN Solution
Data Source Organizations
Data Review Organizations
Internet Portal
HCN Gateway
HCN Gateway
for participant management
Hospitals
Discharge
Diagnosis
Integration Broker
and
other
providers
of
care
Laboratory
Results
Pharmacy
Orders
data routed quickly, reliably and securely
Participant
Network Firewall
Participant
Network Firewall
Network
Offices
Clinical
Directors
Others?
Alert
Receptor
At the participant site the gateway filters, links, and
maps data elements based on business rules
they approve
Key Design Elements
Infection
Control
Quality &
Adverse
Event
oversight
and
others
who
analyze
clinical
data
Others?
 HCN uses existing data available in most provider settings (ICD, CPT, LOINC, NDC via HL7)
 Data Review Organizations request data
 Data Source Organizations approve Reviewers’ requests for data
 Solution will be compliant with HIPAA regulations and transmit non-directly identifiable data; and meets highest security standards around
authentication and encryption
 The system uses open standards and a non-proprietary implementation approach
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Sample view of notifications on the HCN Portal
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HCN has benefits across the healthcare ecosystems that support
the needs of many stakeholder relationships
Three examples we are currently exploring
 Hospitals - Internal collaboration for:
Outcomes Analysis
Quality Improvement Studies
Adverse Event Detections
Research
 Hospitals and Payers
Improved coordination for case management
Improved identification of disease management candidates
Reduced administrative cost of clearing claims
Support for quality incentive programs
 Hospitals and Pharmaceutical Researchers
Identification of candidates for clinical trials
Post market population analysis
Compliance observation for outcomes analysis
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HCN applies to three distinct solution models for the Healthcare industry
CDC
CMS
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3
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HCN
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FDA
n
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Network
Monitoring
Activities
Federal Model
HCN Solution for disease
monitoring, clinical
performance monitoring,
bio-terrorism, and adverse
drug reactions
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1
3
4
HCN
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n
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Provider
• Medical
Event detection and
alerting across hospitals in a network
using HCN technology
• Clinical performance/quality monitoring
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Payer 1
2
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3
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HCN
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Payer 2
Payer n
n
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Payer
Medical management driven by
early diagnosis and
management of specific
disease conditions. Can be
proprietary or shared.
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eCHN - electronic child health network
 Funded as a ‘Proof of Concept.’
 The start of a comprehensive
electronic information sharing system.
 Flexible, scaleable and designed to work with
existing systems and other networks
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eCHN - responds to these issues:
 How can Patients get access to the latest health care
information?
 How can a Health Care Provider (HCP) have access to the
latest treatment guidelines and educational updates?
 How do patients avoid repeating all their information for each
new HCP ?
 How do HCPs find out what happened at another hospital last
week?
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Acure – an IBM Company
Integration via the e-health portal (sundhed.dk)
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Health Networks or e-Health is mandatory to cut across
organisational boundaries, integrate data, create the ‘health
system without walls’ and focus on patient-centric care.
 Prerequisites:
 National standards for: Core data set, Demographic Data, Health
profile
 National standards for: Authorization, Authentication, Privacy
 National standards for: minimal functional and data requirements of
IT solutions for providers (hospitals, primary care doctors,...)
 Synchronized activities between all health care sector
organizations and agencies (Master Project)
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Health Networks or e-Health is mandatory to cut across
organisational boundaries, integrate data, create the ‘health
system without walls’ and focus on patient-centric care.
In case of Bulgaria
 How to harmonize on-going and planned national projects:
– HIS
– Standards in health care sector
– Health Insurance core business
– Quality Improvement,...
And, most important, establish a consistent and long range strategic plan
which will be managed and implemented by career professionals.
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QUESTIONS?
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