Safran info sage & disruptive innovation

1© 2013 Charles Safran

InfoSAGE and Disruptive Innovation

Charles Safran, MD

Chief, Division of Clinical Informatics, Harvard Medical Faculty Physicians @ BIDMC

Associate Professor of Medicine, Harvard Medical School

2© 2013 Charles Safran

Disclosures

• Intelligent Medical Objects – Director and shareholder

• Elsevier – Physician Advisory Board

• Cerner Corporation – Consultant

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Outline

• Why do we need innovation• Personal Health Technology• InfoSAGE

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In the post‐EHR‐industrial era 

will innovation be stifled ?

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Clinical Informatics• Clinical informatics applies concepts, methods and tools that enable 

the optimal use of information and knowledge to measurably improve patient care. 

• Clinical informaticians transform health care by analyzing, designing, implementing, and evaluating information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician‐patient relationship.

• Clinical informaticians are at the intersection of clinical processes and business processes andcommunication & informationtechnology

• Clinical informatics is applied ‐‐ interventional

ClinicalProcesses

InformationTechnology

BusinessProcesses

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MR EMR EHR

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• Contain information about a patient's medical history, diagnoses, medications, immunization dates, allergies, radiology images, and lab and test results

• Offer access to evidence‐based tools that providers can use in making decisions about a patient's care

• Automate and streamline providers' workflow• Increase organization and accuracy of patient information• Support key market changes in payer requirements and 

consumer expectations

Electronic Health Records are real-time, patient-centered records. They make information available instantly, whenever and wherever it is needed.

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Goals of EHRs

• Quality and convenience• Accuracy of diagnoses and health outcomes• Practice efficiencies and cost savings• Care Coordination• Patient Participation

Largely un-met

9© 2013 Charles Safran9 NSF Patient Empowerment Workshop

Park City Utah, December 1-2, 2011

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“Patients are the least utilized resource in healthcare”- Warner Slack

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Personal Devices

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Continuous Glucose Monitoring

12

• Implanted in subcutaneous tissue

• Measure the level of interstitial levels of glucose NOT blood glucose levels– Q1‐10 minutes

• Using advance algorithms are able to predict current blood glucose levels and trends

• Currently device specific applications on desktops

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Sometimes visualization reveals nothing

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CureTogether

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CitiSense ‐ Open TransparencyAdapted from Bill Griswold

Crowd-Sourced Real-timeHealth Data

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Where is health data coming from?• Hospitals• Physician’s office• Payors• Commercial Labs• Pharmacies• Public Health/ Gov

• Mobile devices• Apps• Social media• Sensors• Computer games• Personal Health Records

In the future, health data will overwhelming come from outside the health system.

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Problems to Solve

• Aging creates healthcare decision‐making, information management, and communication challenges, for elders and their families 

• Care Coordination is exceptionally challenging • Respecting the elder’s preferences and priorities is often lost in transition

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• Population is Aging• Two‐Fifths Of U.S. Adults Care For Sick, Elderly Relative

• Logistics of Care is Time Consuming• Caregivers are at risk for burnout

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Goals of InfoSAGE• Identify the information needs elders and those helping to care for them,

• Create a “living laboratory”• Longitudinally study elder and family collaborative interactions and information management 

• Evaluate the extent to which InfoSAGE improves communication, coordination, and collaboration for elders and their family.

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Electronic Health Records

Health Informa on Systems

Visi ng Nurses

Pastoral

Home Services

Other Services

Social Networks PubMed Clinical

Trials Search

Physicians

Nurses

Personal Health Records

Health Care Insurer

Mass Media/Public

Ins tu ons

Electronic Health Records

Health Informa on Systems

Visi ng Nurses

Pastoral

Home Services

Other Services

Social Networks PubMed Clinical

Trials Search

Physicians

Nurses

Personal Health Records

Health Care Insurer

Mass Media/Public

Ins tu ons

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IdentityIdentity ConnectionConnection

ContentContent CoordinationCoordination

Event Bus

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• Innovation post‐commercial EHR acquisition is not only possible but necessary

• Clinicians will be overwhelmed by patient‐sourced data

• EHRs are too facility and physician centric to address the healthcare needs of elderly

• Caregivers need tools

26© 2013 Charles Safran

Charles_Safran@Harvard.Edu

1330 Beacon StreetBrookline MA 02446