The Vision for Connected Healthcare
The Israeli National Network
By: Eitan Melamed
14/07/ 2011
For an idea that does not at first seem insane, there is no hope”
(Albert Einstein)
Last Decade’s Trends…
• Medical providers continue to face cost pressures
• Constituents are pushing for higher clinical-care quality
• Multiple chronic conditions increasing
• Population is aging 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
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
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”
The 4 HMOs in Israel
The Vision For Connected Healthcare…
.. 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.
Clalit Health Services - On an Annual Basis….
• Primary Care Encounters
• Ambulatory Care Visits
60,000,000
2,200,000
• ER visits
910,000
• Admissions
400,000
• Surgical Procedures
145,000
• Births
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
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
The Consequences…
• Medical decisions based on partial information
• Challenges in providing high quality patient care
• 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
Clalit’s Vision (Year 1999)
• 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
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)
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
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
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…
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…
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
Create a Single, Organized & Comprehensive Patient
Record – Everybody Connected & Coordinated
Aggregate
Apply
Apply
Integrate
Knowledge
Semantic
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
04/27/2008Toxemia
15:00
Discharge
EPIC
LIPITOR 20 MG TAB
Thyroid
Function
EPIC
Letter
Drugs
Interaction
Serve
The Ultimate goal of Computer Science is
having machines ACT UPON data they
process and interpret.
The dbMotion Semantic VPO
 Complete
 Unambiguous
 Structurally Unified
 Semantically Harmonized
 Intelligent
Computable
Consumable
The dbMotion Semantic VPO
Commercial Lab
Primary Care &
Specialized Clinics
Multi-Hospital
Organization
HIN
Tertiary Medical Center
Pharmacies
dbMotion Platform
Brussels, Belgium (IRIS Network)
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Carmel
Sahlvata
Israeli Network (dbMotion)
520 beds
114 beds
Beit Rivka
Yoseftal
300 beds
70 beds
Levinshtein
HaEmek
240 beds
520 beds
Harzfeld
Meir
310 beds
800 beds
Golda
Beilinson
360 beds
900 beds
Schneider
Kaplan
260 beds
640 beds
Geha
Soroka
166 beds
1,100 beds
900 beds
Sheba
1,700 beds
Wolfson
660 beds
Governmental Hospitals
Clalit Health Services Hospitals
Rambam
Carmel
Sahlvata
Usage Metrics:

520 beds
Israeli Network (dbMotion)
114 beds
14,000
active users (clinicians) on a daily basis
Beit Rivka
Yoseftal
33 million patients files have been viewed between 2005-2010
Clalit Health Services Hospitals
300 beds
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900 beds
70 beds
Sheba
HaEmek
38.5 million
clinical views in 2009
Levinshtein
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
166 beds
1,100 beds
Wolfson
660 beds
Governmental Hospitals

Rambam
Extending the Network to the National Level
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Sahlvata
520 beds
114 beds
Beit Rivka
Yoseftal
300 beds
70 beds
Levinshtein
HaEmek
Israeli National Network
Rambam
900 beds
Assaf Harofe
Naharia
Barzilai
M.Yeshua
Lanyado
Hadassah
Misgav Ladach
Hilel Yafe
Bnei Zion
Poriya
Sheba
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
166 beds
1,100 beds
Governmental Hospitals
Clalit Health Services Hospitals
Carmel
Alin
Ichilov
Shaarey Zedek
Ziv WolfsonNazareth
660 beds
Q&A and Open Discussion
Thank you for listening
[email protected]