The Vision for Connected Healthcare
The Israeli National Network
By: Eitan Melamed
14/07/ 2011
For7/14/11
an idea that does not at first seem insane, there is no hope”
(Albert Einstein)
Population is aging and intensifying
Patients have become much more mobile
patients assume a larger role in managing their health
•
Medicalofproviders
continue
to face
pressures into
concept
“comparison
shopping
” iscost
introduced
•
Constituents
pushing for higher clinical-care quality
the
health careare
industry
More
technologies,
more systems,
•
Multiple
chronic conditions
increasing more information
about
patients….
isolated medical records
Population
is aging More
and intensifying
•
•
•
•
•
Patients have become much more mobile
patients assume a larger role in managing their health
concept of “comparison shopping” is introduced into the
health care industry
More technologies, more systems, more information
about patients…. More isolated medical records
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There is a clear need for a change
 Efficiency & Productivity
 Healthcare Costs
 Clinical Outcomes
 Patient Care Quality (Medical Errors)
 Unnecessary & Duplicate Tests
 Patient Satisfaction
 Patient Engagement
 Population Management
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Healthcare In Israel
 Every Israeli citizen (Jews and Arabs) is covered
 Defined State funded set of services (“the Basket”)
 Freedom to enroll to any of the four Health Service Providers
(Sick Funds / HMO)
 Individual Health Tax payments proportional to income (approx
3.8% - 4.8%)
 Finances distributed among the health service providers on a
capitation basis (# of enrollees, age, severe diseases)
 Providers may offer complementary health insurance for services
not included in the “basket”
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The 4 HMOs in Israel
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The Vision For Connected Healthcare…
Click to edit Master subtitle style
.. First was Clalit
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Clalit Health Services
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One of world’s largest HMOs
3.8 million patients – among 8 Districts
14 hospitals (5,500 beds)
600 departments
1,300 clinics
400 pharmacies
30,000 employees / 5,500 physicians / 9,000 nurses
9 subsidiaries – research, diagnostics, etc.
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ER visits
Admissions
Surgical Procedures
Births
•
Primary Care Encounters
•
Ambulatory Care Visits
•
ER visits
•
Admissions
•
Surgical Procedures
•
Births
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910,000
400,000
145,000
40,000
60,000,000
2,200,000
910,000
400,000
145,000
40,000
Challenges to Medical Information
Sharing (1999)
•
•
Diverse local EMR systems & hardware platforms
25+ legacy/departmental systems (ADT, LIS, ORS, RIS,
Pathology, Imaging, Scanned documents…)
•
Isolated information repositories
•
Lack of integration between operational systems
•
•
Lack of integration between community care and
hospitals
Privacy, security, & data ownership issues
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The Reality (in 1999)
Manual collection of data from diverse locations leads to…
The patient (or guardian) being the primary
messenger of his/her medical history
Leading to partially available information
at the point of care
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Longer care-cycle
Test duplication
Unnecessary
procedures
•
Medical decisions
based on partial information
Physician frustration & low self-esteem
•
Challenges in providing high quality patient care
Patient’s loss of faith in caregiver & health service
•
Decreased patient safety & high probability of medical
errors
•
Longer care-cycle
•
Test duplication
•
Unnecessary procedures
•
Physician frustration & low self-esteem
•
Patient’s loss of faith in caregiver & health service
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Clalit’s Vision (Year 1999)
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•
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Full medical information at every point of care
• Availability of relevant data in real time
• Integrity of the medical record
Quality improvement in care & services
Proactive/preventive care
Optimal use of resources
Better Health and Better Care
at Every Point of Care
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Taking on the
Challenges
• Define goals and objectives to make the vision a reality
• Define prerequisites and outline for a desired solution
• Set-up committees:
• Steering Committee
• Legal & Medical Ethics Committees
• Users Committee
• CMO in charge (Executive level)
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Defining the
Prerequisites (1999)
• No single point of failure
• No need to replace existing information
systems
•
•
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Adherence to security and privacy standards
Performance
Defined Minimal Data Set
Drill-down ability into data
Ease of Implementation
• minimal training & support staff
• Scalability, flexibility, robustness
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Defining the
Prerequisites (cont’d)
• Data to remain in original location & format
• Data only available for specific patient-centric
queries
• Data only available at time of medical care
• Data available on view-only basis
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Obstacles to Finding a Product
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Large quantity of legacy, RIS, EMR systems
Heterogeneous tech environment
Different ‘languages’ (terminologies)
Extra large organization
Competing & different needs
Finding the right answers to sensitive, complex issues:
•
Ethics, security, privacy, performance, standards, coding systems
and more…
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Obstacles to Finding a Product
•
•
•
•
•
•
Large quantity of legacy, RIS, EMR systems
Heterogeneous tech environment
Different ‘languages’ (terminologies)
Extra large organization
Competing & different needs
Finding the right answers to sensitive, complex issues:
•
Ethics, security, privacy, performance, standards, coding systems
and more…
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How dbMotion addresses this challenge…
PCP creates Office Chart
In Allscripts
Specialist creates another Chart
In 2nd hospital in McKesson
Hospitalist creates Acute Chart
In Cerner
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Create a Single, Organized & Comprehensive Patient
Record – Everybody Connected & Coordinated
Aggreg
ate
Apply
Semantic
Integrat
e
The dbMotion Process…
Medication
Semantic Level
Coumadin 2 mg oral tablet
Domain
Concepts
Medication
Therapeutic
Bactrim DS oral tablet
Thyroid
Reconciliation
Duplication
Function
Date
Source system
07/15/2008 10:00
CernerH1
01/11/2008Anemia
08:30
Level
Drug CernerH2
Allergy Diabetes
PRAVACHOL 80 MG TAB
09/06/2007 13:30
WARFARIN 1 MG TAB
04/27/2008 15:00
EPIC
Pravastatin 80 mg oral tablet
07/15/2008 10:00
CernerH1
04/27/2008 15:00
Discharge
EPIC
LIPITOR 20 MG TAB
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Apply
Knowledg
e
Thyroid
Function
Toxemia
EPIC
Letter
Drugs
Interaction
Serve
The Ultimate goal of Computer Science is
having machines ACT UPON data they
process and interpret.
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The dbMotion Semantic VPO





Unambiguous
Structurally Unified
Semantically Harmonized
Intelligent

Computable

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Complete
Consumable
The dbMotion Semantic VPO
Commercial Lab
Primary Care &
Specialized Clinics
Multi-Hospital
Organization
HIN
Tertiary Medical Center
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Pharmacies
dbMotion Platform
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Brussels, Belgium (IRIS Network)
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2626
Carmel
Sahlvata
Israeli Network (dbMotion)
520 beds
114 beds
Beit Rivka
Yoseftal
300 beds
70 beds
Levinshtei
n
HaEmek
240 beds
520 beds
Harzfeld
Meir
900 beds
Sheba
1,700 beds
310 beds
800 beds
Golda
Beilinson
360 beds
900 beds
Schneider
Kaplan
260 beds
640 beds
Geha
Soroka
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166 beds
1,100 beds
17 Hospitals
1,200 Clinics
Wolfson
660 beds
Governmental Hospitals
Clalit Health Services Hospitals
Rambam
Usage Metrics:
Carmel



Sahlvata
Israeli Network (dbMotion)
Rambam
520 beds
beds
14,000114active
users (clinicians) on a daily basis
Beit Rivka
Sheba
70 beds
38.5 million
clinical views in 2009
HaEmek
Levinshtei
n
1,700 beds
240 beds
520 beds
Harzfeld
Meir
310 beds
800 beds
Golda
Beilinson
360 beds
900 beds
Schneider
Kaplan
260 beds
640 beds
Geha
Soroka
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166 beds
1,100 beds
17 Hospitals
1,200 Clinics
Wolfson
660 beds
Governmental Hospitals
900 beds
33 million patients files have been viewed between 2005-2010
300 beds
Clalit Health Services Hospitals
Yoseftal
Extending the Network to the National Level
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2929
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Sahlvat
a
520
beds
Beit
Rivka
114
beds
Yoseftal
300
beds
Levinsht
ein
70 beds
240
beds
Harzfeld
Israeli National Network
Rambam
900 beds
Assaf
Harofe
Naharia
Barzilai
M.Yeshua
Sheba
Hadassah
Misgav
Ladach
Hilel Yafe
Bnei Zion
Ichilov
Shaarey
Zedek
HaEmek
520
beds
Meir
310
beds
Golda
800
beds
Beilinso
n
360
beds
Schneid
er
900
beds
Kaplan
260
beds
Geha
640
beds
Soroka
166
1,100
Alin
17 Hospitals
1,200 Clinics
1,700 beds
Ziv
Wolfson
660 beds
Governmental Hospitals
Clalit Health Services
Hospitals
Carmel
Lanyado
Poriya
Nazareth
Q&A and Open Discussion
Thank you for listening
[email protected]
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