BCS - Health Scotland - Bringing Information to Life › hs09 › Day1_Fettes_JohanHjord_db...People receive care in a highly distributed environment. Information is gathered and locked

Bringing Information to Life

dbMotion

© 2004-2009 dbMotion Ltd.

General 3.00

Transforming Healthcare with Information

– Patients should not be the primary source of information regarding their own medical histories

– Patients should not be given medications that interact with other medications they take because the allergies list in the hospital doesn’t match their doctor’s list

– Patients should not have to pay the deductible twice on a lab test just because it was done across town at a commercial lab and the hospital didn’t know it

© 2004-2009 dbMotion Ltd. 1

Healthcare executives face common goals - putting patients at the center of care

Transforming Healthcare with Information (cont.)

– Patients should not have surgery delayed because the care teams lack results from tests the patient did less then 48 hours earlier in a doctor’s office or clinic

– Patients should not have to worry about travelling from one city to another and not having all of their patient information with them

– Patients should not have to sue the hospital for a hospital caused wound that could have been prevented had the care provider known that they were prone to it

• Patients now expect to be treated differently• Patients are pleading for effective,

connected, consistent, aware and seamlessly integrated care


Healthcare executives face common goals - putting patients at the center of care

Healthcare: Challenge & dbMotion’s Focus

The Challenge: People receive care in a highly distributed environment. Information is gathered and locked in isolated information systems.dbMotion’s Focus: Generate a patient-centric integrated patient record, on-demand, making patients’ relevant health information available to caregivers and systems, enabling safer, more efficient care with higher patient and physician satisfaction.


Presenter

Presentation Notes

use animation to point out that we support any data architecture – Centralized, Hybrid and Pure federated.


Real interoperability is highly challenging

Technological, Financial, Regulatory, Political

Security, Ethics and Privacy

Willingness, Motivation, Incentives

Patient Identification

Standards

Many Barriers…

Presenter

Presentation Notes

Before getting into the architecture i.e. how we achieve interoperability - we need to first recognize the full breadth of the challenges/barriers that apply to achieving interoperability

What’s Important

Question 1:

How do you integrate and make senseof the data?

Question 2:

How do you access and make useof the data?


• Create an integrated view of patients’ medical information from within and across organizations and information systems(Cerner, EPIC, GE, McKesson, Siemens, etc.)

•Better information at the point of care

• Better and more efficient care

• Lower risk of medical errors

Caregivers

Integrated Patient Record

Multiple Needs… One Solution Architecture


• Measure quality using information from across the continuum of care (rather than silo by silo)

• Effectively implement performance improvement plans (P4P in US, Payment by Results in UK, etc.)

• Manage key clinical and operational indicators closely

• Implement disease management programs

Quality Group,CEO, CMO, CFO

Measure& Manage

Quality

• Ever-changing reporting requirements pose a constant challenge to IT, Management and Clinicians

• With ubiquitous access to integrated medical information reports (e.g. hospital accreditation reporting required by JCAHO, CCHSA, ISQua) can be rapidly developed

• Meeting reporting requirements becomes easier, cheaper, more precise and is often otherwise impossible!

Compliance,CEO, CFO

Adhere toReportingMandates

• Create IT environment ready for constantly evolving requirements

• Leverage investments in existing clinical systems

• Rapidly deploy new applications – reuse of clinical information

• Manage growth more efficiently

• Smoothly progress towards standards harmonization

CIO, CMIO

Leverage IT Infrastructure

• Providing seamless access to clinical information to/from acute and ambulatory settings leads to

• Improved Hospital-Physician relationships and affiliations

•Better outcomes

•Faster and more effective care

Physicians,CEO, CMO

ImproveOut/In Patient

Continuity of Care

• Access to mass de-identified patient and outcome information unleashes endless research options

•Support clinical trials process

•Support various research programs in pharmaceutical industry and academic medical centers

•Enable the creation of research specific data warehouses

Dept. Chairs,CMO

SupportResearch &

Clinical Trials

• Integration of patients’ clinical data from multiple sources enables the implementation of enterprise and cross-enterprise clinical decision support tools that go beyond the boundaries that currently limit such tools

• A broad data set

• For a single patient

• For an entire population

Physicians,Quality Group, CxO

Enterprise Clinical Decision

Support

?

Future Needs

dbMotion

Presenter

Presentation Notes

JCAHO (US) - Joint Commission on Accreditation of Healthcare Organizations CCHSA (CAN) - Canadian Council on Health Services Accreditation ISQua (Int) - International Society for Quality in Healthcare

dbMotion - Health Interoperability and Intelligence

dbMotion Core Platform• Connect all of your IT solutions• Inpatient, Outpatient, Labs, Rx , Imaging +• Connect to local, regional & national RHIO/HIE• Aggregated & integrated data


Enterprise Clinical Data Repository (CDR)• All data in relational database/s• “Single Source of Truth”• Downtime Clinical Continuance Solution

Clinical Portal• All data in single thin client• Fully customizable to your needs• Integrated into EMR/other applications

A ComprehensivePlatform

Designed to address current &

future needs

Turns data into actionable

information

Field Proven

Differentiators

Semantic Framework• Unparalleled level of integration• Turns data into semantically integrated information• Enables advanced “information driven” applications• Makes integrated clinical data usable by other Apps

dbMotion is a SOA Solution for Healthcare

dbMotion Service Oriented Architecture enables consumers (applications and services) to build or make use of software services that hide the complexity of heterogeneous and non-standardized IT environments by logically connecting applications and data sources.

With dbMotion SOA, information in existing systems remains in its original format, location & ownership.


AncillarySystem A

Homegrown Applications

EMR AClinical Data

DSSAlerts &

Notifications

AncillarySystem B

Clinical Data Warehouse

EMR BClinical Data

DSSAlerts &

Notifications

dbMotionInteroperability

Platform

Extended ServicesApplication Development

ResearchDSS


A Vision of Connected Healthcare

dbMotion Core PlatformThe Complete HIE/Interoperability “Starter-Kit”dbMotion™ SmartConnect™EMR Integration Tools and ServicesdbMotion™ SmartIHE™A Smart Approach to Leveraging IHE ProfilesdbMotion™ SmartServices™Software Developers Kit (SDK)dbMotion™ Semantic Framework™Advanced Semantic InteroperabilitydbMotion™ SmartWatch™Enterprise Analysis and Monitoring EngineThe dbMotion Product Offering


Your EMR

EMPI

Connector Toolkit

dbMotion Clinical Views

Future Apps(Custom & dbMotion)

SmartIHE

Clinical DomainsDx Img Docs AllrgLabs Rx

SmartServices (SDK) Semantic Services

CTSCommon

Terminology Services

Medical Ontology

CDR

SmartConnect

Unified Medical Schema (UMS)

SmartLink

SmartWatch

dbMotion Security

Layer

Shared Services

dbMotion System

Management Layer

OperationalEnvironment

dbMotion Presentation Layer

dbMotion Business Layer

dbMotion Communication Layer – Message Bus

dbMotion Data Layer

dbMotion Data Integration Layer

dbMotion System Node


– Fully encapsulated software-based solution

– Information consumable in many formats (web, XML, etc.)

– Microsoft-based software

– Flexible deployment on COTS hardware

– Proven in high transaction volume environments

dbMotion Federated HIE… Grid-based Infrastructure

dbMotion’s Federated implementation approach allows data to reside in its original location and format. Each node is completely independent and

can stand alone. A Virtual Patient Record is created on-the-fly with integrated information presented and usable in real-time


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Security & Management

• Roles and profiles

• Auditing (e.g. Track Log)

• Patient Authorization System

– Supports Opt-in/Opt-out

• Content-based access control

• Integrated with existing securityand administration (e.g. active directory)

• Adheres to HIPAA guidelines

• System administration and configuration

• Monitoring tools and services

• Encryption

The dbMotion™ Unified Medical Schema™ (UMS)

Based on HL7 V3 RIM & other standards the UMS enables the integration and harmonization of information across different parties regardless of the systems and structures employed by each party.

© 2004-2009 dbMotion Ltd. 14

dbMotion HII System – Overall Characteristics

15

Flexible Service Oriented Architecture (SOA) Security, policies and management

Standards DrivenHL7 V3 based & multi-standard interfacing

Clinically Oriented – based on dbMotion™Unified Medical Schema™

High Performance – the entire process takes seconds

Designed for Changes, adaptations & rapid deployment

Grid based – highly resilient

© 2004-2009 dbMotion Ltd. 15

Turns best-of-breed into a suite

.

Portal

.

Interoperability

Semantic Interoperability, the Next Level Up…

© 2004-2009 dbMotion Ltd. 16

.

Semantic Interoperability

The Case for Semantic Interoperability

© 2004-2009 dbMotion Ltd. 17

Presenter

Presentation Notes

First Screen - This slide contains a typical med list from an actual in-patient EMR (it’s Cerner PowerChart) admitted for kidney stones. You will notice that while this presentation has some utility for the acute setting, it contains too much unnecessary information to be accepted in other situations. In reality, the only important information is the type and dose of the antibiotic and pain medication. This is a perfect example of a “data dump” actually clouding the clinical utility. Second Screen (taken from Misys) - Many of the listed allergies could have been grouped as a single penicillin allergy. Because there is no semantic interoperability, this could possibly lead to error. Note that the only true “life-threatening” allergy is to sulfa (listed last). Imagine if one other item appeared on the list and the sulfa was not visible without scrolling…

The toolset designed to collect, interpret, structure, and transform healthcare data into actionable information. Offers a complete solution for enabling semantic interoperability

© 2004-2009 dbMotion Ltd. 18

Comprised of:• Ontology based on standard

terminologies• Semantic information model • Rich set of semantic services• Management tools

• Data Unbounded• Physicians Empowered• Workflows Simplified and Enhanced

• Legacy Systems Leveraged• Enhanced Patient Care

Key BenefitsBy not only integrating the data but also understanding it, we enable multiple stakeholders to use the information and support clinical workflows and processes

dbMotion Platform

Semantic Framework

Information Model

Ontology

Management Tools

Semantic Services

dbMotion Semantic Framework

dbMotion SmartWatch

SmartWatch is a population-based dataanalysis and monitoring framework thatleverages the dbMotion platform, enablingorganizations and users to monitorpopulations of patients for a variety ofconditions

Four Steps:1. Population Identification – based on the VPO

assembled from across the dbMotion network, SmartWatch identifies the patients that meet the definition of the population in question

2. Information Collection – for each patient in a defined population SmartWatch collects the information that is being monitored

3. Event Identification – in this stage SmartWatch analyzes the information to decide if action is required or not

4. Action – SmartWatch can send an email or text message, add an alert to the medical record or perform any one or more of the other actions supported by the system

• Improve quality of care• Better compliance (P4P, regulatory)• Support for clinical trials & research• Simplify Biosurveillance

• Enable Preventive Health • Reduce administrative effort• Enhance Translational Medicine

Primary Benefits of SmartWatch

dbMotion Platform

SmartWatch


All patients above 65 who suffer from CHFAll patients currently admitted to EDs in the regionAll children below 12All patients over 50 who present in ED with history of AMI

For CHF … Sodium and Meds historyFor currently in ED … Zip code and chief complaintFor children … All ED visits during the last monthFor history of AMI … ASA & Beta Blocker at arrival

dbMotion SmartWatchStep 2: Information GatheringStep 3: Event Identification

For CHF … Sodium < 128For currently in ED … >5% (Zip code), >3% (C.Complaint)For children … >= 3 within the same month

Step 4: Action (e.g. Alert)Step 1: Population Identification

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Clinical ImpactImprove QualityDeliver EfficiencyReduce ErrorsHow…• Enterprise information instantly

available in complete web-based Virtual Patient Record

• Tightly integrated to existing workflows• Advanced Meds Rec, Population

Management, P4P• Time saver in ED, OR, Imaging


Business ImpactGrow RevenueGrow ShareImprove MarginHow…• Higher physician satisfaction• Productivity in business & clinical

processes• Improved positioning with payers• High patient satisfaction• Enhanced compliance in Coding, P4P etc

Semantically Connected Enterprise Information is a Game Changer

The Impact

Delivering ROI from Interoperability

© 2004-2008 dbMotion Ltd. 22

Regulatory and Industry Compliance • Increase POA reimbursement• Support quality reporting• P4P• Compliance audits

Positive Business Impact Increased revenue • Increased physician satisfaction

and referrals• Simplify acquisitions, merging and

joint ventures• Reduce legal risks

Operational Efficiencies Simplified non-clinical procedures• Reduce time of information

collection (admission, Pre-op etc.)• Simplify coding• Reduce procedure cancellation

rate• Retain existing infrastructure

Clinical Efficiencies Improve patient care quality & efficiency• More efficient encounters• Less errors and escalations• Reduce medication related

complications

Well implemented HII offers significant opportunities for cost reduction, increased revenue and improved results

Partners and Associations

© 2004-2009 dbMotion Ltd. 23

careon

Our Customer Successes

24© 2004-2009 dbMotion Ltd.

University of Pittsburgh Medical Center - Pennsylvania

• Large IDN consisting of 20 hospitals (4000+ beds) 400+ outpatient locations, 4700+ physicians (2475 employed) Over 190,000 inpatient admissions and 4.5 million outpatient visits annually

• Implementation– Integrating data from: Cerner, EPIC, McKesson, MEDITECH, Siemens,

Misys, Quest Labs and dozens of ancillary systems

– Clinical Domains: demographics, problems list, allergies, medications, labs, diagnoses, documents (transcription data, PDFs, large “blobs”/text, notes and other documents)

– Accessible by 22,000 users

• Goals– Provide physicians with access to comprehensive integrated

patient information within their workflow– Build a SOA platform for Interoperability across UPMC

to enable the rapid delivery of composite applications– Achieve Semantic Interoperability

© 2004-2009 dbMotion Ltd. 25

UPMC Solution Architecture

© 2004-2007 dbMotion Ltd. 26© 2004-2009 dbMotion Ltd.

Clinical Impact is Business ImpactMeasurements at UPMC

82% reduction of time spent

50% improvement in patient readiness

Efficiency Difference Using Interop Platform Before After

Time Seeking Information 1 – 41 mins 1-5 minsTime Waiting for Information 5 mins – 20 hrs 5 secs – 12 hrsPercentage of Patients Not Ready for OR 30% 15%


UPMC Interop: Accolades Across the Industry

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http://www.healthcareitnews.com/

© 2004-2009 dbMotion Ltd. 29

dbMotion is successfully implemented at Clalit Health Services (Israel) -one of the world’s largest HMOs

• Serving− 14 hospitals (5500 beds), 1,300 clinics− 9,000 physicians and 9,500 nurses

• Operational at most hospitals and clinics since 2001• 15,000+ active users• Benefiting close to 5 million patients • 26,000,000 pages viewed per year• ISO 17799 certified Information Security Management• Average response time (end-to-end) < 5 Sec.

dbMotion – A Proven Solution

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A Proven National Scale Solution

dbMotion’s Solution forms a network of independent care providers in Israel:Clalit HMO, Rambam MC, Sheba MCTotal of 16 hospitals, 100s of clinics & and specialty centers• Each working with their own systems

and standards– Complete HIS solution vs. dept.

solutions– Different coding, clinical language,

data structures and OS

• Short setup time to connect the new institutions to the operational network

• Requires minimal training and IT support

IRIS Group – Brussels, Belgium

• Group of 5 hospitals and clinics spread across 11 sites in the Brussels region. Delivering public healthcare services to over 1.5 million residents

• Initial Implementation– Integrating data from: AGFA QDOC, AGFA PACS, GLIMS labs, DIAMIC Pathology labs,

Siemens and IBM ADT as well as other ancillary systems – Clinical Domains: demographics, procedures, diagnoses, labs, documents, imaging– Documents include: PDFs, large “blobs”/text, notes and documents

• Goals:• Establish a unified information platform that enables the sharing of patients’ clinical

information across the enterprise • Enable IRIS physicians to explore medical data of a given patient within the IRIS

system using dbMotion Clinical Views.• Provide IRIS with a web based portal as the main entry point for all clinical information• Unique Patient ID• Provide a solution for exchanging structured data as well as documents• Provide a clinical viewer to help healthcare professionals

navigate complex medical records

31© 2004-2009 dbMotion Ltd.

Customers & Impact


82% reduction of time spent50% improvement in patient readiness

Efficiency Difference Using Interop Platform Before After

Time Seeking Information 1 – 41 mins 1-5 mins

Time Waiting for Information 5 mins – 20 hrs 5 secs – 12 hrs

Percentage of Patients Not Ready for OR 30% 15%

University of Pittsburgh Medical Center

dbMotion – Company Overview

• Originally established in 1996, integrated into Ness Technologies (NASDAQ: NSTC) in 1999• Spun-off from Ness Technologies in 2004 after successful

implementation of the product at Clalit Health Services (Israel)

• Venture capital funded: Vertex, Pitango, Gemini, UPMC - 3 rounds

• Revenue stage

• 130+ Employees

• Strong infrastructure, ISO 9001 certified

© 2004-2009 dbMotion Ltd. 33

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ConnectEnterprise - ClinicalsHospital - Hospital

Ambulatory – AcuteIDN - CommunityState - Federal

ImpactDesktop EMR UsersDirect Web Access

Emergency Services Specialty Applications

Quality Programs

EvolveDecision Support

PHR ServicesPopulation

ManagementSOA Connectivity

ResearchSDK

Phased Approach to Delivering Clinical Transformation

Getting Started: Connect – Impact - Evolve


Thank You For Listening
