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1
George Blumenthal
giovedì 22 marzo 2012
The Future of Healthcare IT Is in the
Clouds
1
George Blumenthal
giovedì 22 marzo 2012
Milano FinanzaFebruary 1999
2
giovedì 22 marzo 2012
Cellular Communications International, Inc.
3
giovedì 22 marzo 2012
“A Smashing Victory”Italia Oggi April 2, 1994
Omnitel Unitel*Points assigned by BAIN and Citibank 698.58 580.12Investments pledged Lit. 2 trillion Lit. 1.5 trillionFinancial bid Lit. 750 billion Lit. 707 billion
*Consortium led by Berlusconi 4
giovedì 22 marzo 2012
The HITECH Act$50,000,000,000+Funding To Revolutionize Healthcare I.T.
Grants$10 Billion
Entitlements$40 Billion
$25 Billion for Eligible Professionals
$15 Billion for Hospitals
For HIEs, Rural Broadband,Regional Extension Centers,Education and Training,Comparative Effectiveness Research
Sections 3011-3016Section 6001 and Titles I, XIISections 4101, 4102, 4201
5
giovedì 22 marzo 2012
USA Germany Italy Israel
Health Care Costs $ 7,900 $ 4,200 $3,100 $ 2,700% GDP 17% 12% 10% 8%
Life Expectancy 78 80 82 82
Smokers 16% 22% 23% 20%Obesity 34% 15% 10% 14%Ambulatory Visits/Capita 4 8 7 6
Gross National Income/Capita $47,000 $38,000 $31,000 $28,000
The Cost of Healthcare Is Destroying The USA
6Source: OECD Health Data 2011
giovedì 22 marzo 2012
Expenditure Disparities
Mayo Clinic Cleveland Clinic Johns Hopkins Hospital
UCLA Medical Center
Medicare Spending $53,430 $55,330 $85,730 $93,840
Physician Visits 24 33 29 53Days in Hospital 12 15 17 19Hospital Beds 58 66 78 86
Source: The Dartmouth Atlas of Health Care 2008, as printed in Time Magazine June 29, 2009
End of Life Care Costs
7
giovedì 22 marzo 2012
Front page – New York Times, 9-18-06
Elyria Has 3 Times the Rate of Angioplasties as Cleveland
8
giovedì 22 marzo 2012
Healthcare Wastes
• 57% of patients must recount medical or personal information
• 30% of all U.S. healthcare costs go to duplicative care
• 26% of patients receive conflicting information
Source: Markle Foundation, Robert Wood Johnson Foundation, Achieving Electronic Connectivity in Healthcare, 2004
9
giovedì 22 marzo 2012
U.S. Adults Receive 55% of
0
20
40
60
80
Overall Breast Cancer Hypertension Asthma Pneumonia Hip Fracture Diabetes Mellitus
45
2339
5465
76
55
Overall Breast Cancer HypertensionAsthma Pneumonia Hip FractureDiabetes Mellitus
McGlynn, June 26, 2003
10
giovedì 22 marzo 2012
Would You Fly Without a Checklist?
11
giovedì 22 marzo 2012
Would You Fly if a 747 Crashed Every 12 Hours?
Annual Deaths
Hospital Acquired Conditions 180,000Lung Cancer 158,000Breast Cancer 40,200Pancreatic Cancer 36,800Traffic Accidents 33,000Prostate Cancer 32,000 AIDS 18,000
Total 318,000
“Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries” HHS Office of Inspector General
November 201012
giovedì 22 marzo 2012
70%
92%
64%
91%
Pneumonia Heart Failure20062003 20062003
Medicare Demonstration ProjectRecommended Care
13Source: Medicare/Premier Hospital Quality Incentive Demonstration (HQID)
giovedì 22 marzo 2012
• The rate of death declined from 1.5% to 0.8%
• Inpatient complications declined from 11% to 7%
Surgical Checklist
January 29, 2009
A Surgical Safety Checklist to Reduce Morbidity and Mortality
14
giovedì 22 marzo 2012
0
2,0
4,0
6,0
8,0
16-18 months
1,4
7,7
Per 1000 Catheter Days
15
Catheter-Related Bloodstream Infections in the ICU
December 28, 2006
giovedì 22 marzo 2012
eRX Is a “No-Brainer”
16
giovedì 22 marzo 2012
Source: Kaushal, R. et al, “Electronic Prescribing Improves Mediation Safety in Community-Based Office Practices,” Journal of General Internal Medicine, 25(6): 530-6, February 26, 2010.
• 2 in 5 handwritten prescriptions had errors
• Prescription errors reduced from 43% to 7% with e-prescribing
Cornell Medical College
17
giovedì 22 marzo 2012
• 75% reduction in allergic drug reactions and excessive dosages
• 45% reduced in the average time spent in the ICU
Kaiser eRX and Safety
Source: Clinical Information: Achieving the Vision, 2002; Kaiser Permanente
18
giovedì 22 marzo 2012
Physician Benefits of eRX
• 50% of office phone calls are related to prescriptions1
• eRX can generate time savings of 1 hour per nurse and 30 minutes per file clerk per day2
1. The Physician’s eHealth Report, November/ December 20042. Rhode Island Electronic Prescribing Project
19
giovedì 22 marzo 2012
The HITECH Act$50,000,000,000+Funding To Revolutionize Healthcare I.T.
Grants$10 Billion
Entitlements$40 Billion
$25 Billion for Eligible Professionals
$15 Billion for Hospitals
For HIEs, Rural Broadband,Regional Extension Centers,Education and Training,Comparative Effectiveness Research
Sections 3011-3016Section 6001 and Titles I, XIISections 4101, 4102, 4201
20
giovedì 22 marzo 2012
Medicaid Is at the Center of Healthcare
The MITA Business Architecture, May 8, 2006
21
giovedì 22 marzo 2012
2010 2011 2012 2013 2014 2015 2016 2017
ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2
Bonus $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
ARRA Medicare3ARRA Medicare3ARRA Medicare3ARRA Medicare3ARRA Medicare3ARRA Medicare3
Bonus $44,000 $44,000 $39,000 $24,000Penalty -1% -2% -3%
ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4
Bonus 2% 1% 1% 0.5%Penalty -1% -1.5% -2%
PQRIPQRIPQRIPQRIPQRIPQRIPQRIPQRIPQRIPQRIBonus 2% 1% 0.5% 0.5% 0.5%Penalty -1.5% -2% -2%
Total Annual PenaltiesTotal Annual PenaltiesTotal Annual PenaltiesTotal Annual Penalties -1% -1.5% -2% -2.5% -4% -5%
Bonuses and Penalties for Eligible Professionals
1. American Recovery and Reinvestment Act of 20092. Assumes 30% of patient volume is in underserved areas or communities3. Assumes Medicare Part B revenues exceeds $25,0004. ePrescribing and PQRI bonuses and penalties are a percentage of Medicare Part B revenues received 22
giovedì 22 marzo 2012
15 Core Objectives
20 Objectives to Accomplish Stage 1 MU*
5 of 10 Menu Objectives
1 Core Objective Requires
Satisfying 6 of 44 Clinical Quality
Measures
23
*Meaningful Use
giovedì 22 marzo 2012
15 Core Objectives
20 Objectives to Accomplish Stage 1 MU*
5 of 10 Menu Objectives
1 Core Objective Requires
Satisfying 6 of 44 Clinical Quality
Measures
23
*Meaningful Use
giovedì 22 marzo 2012
15 Core Objectives
20 Objectives to Accomplish Stage 1 MU*
5 of 10 Menu Objectives
1 Core Objective Requires
Satisfying 6 of 44 Clinical Quality
Measures
23
*Meaningful Use
giovedì 22 marzo 2012
Clinical Quality Measures Numerators / Denominators
NQF 0013
Hypertension: Blood Pressure Measurement
1/1No exclusions
NQF 0028
Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention
1/1 for a1/1 for bNo exclusions
NQF 0421
Adult Weight Screening and Follow-Up
2/2Possible exclusions
NQF 0018
Controlling High Blood Pressure 1/1No exclusions
NQF 0027
Smoking and Tobacco Use Cessation, Medical Assistance
2/2No exclusions
NQF 0061
Diabetes: Blood Pressure Management
1/1Possible exclusions
Core ObjectivesC01 CPOE for Medication Orders 30%
C02 Drug Interaction Checks Enable functionC03 Maintain Problem List 80%
C04 Permissible Prescriptions 40%C05 Active Medication List 80%C06 Medication Allergy List 80%C07 Record Patient Demographics 50%C08 Record Vital Signs 50%C09 Record Smoking Status 50%C10 Clinical Quality Measures-CQMs
(from within this Objective you must choose six measures)
C11 Clinical Decision Support Rule 1
C12 Electronic Copy of Health Information
50%C13 Clinical Summaries 50%C14 Electronic Exchange of Clinical
Information1 test
C15 Protect Electronic Health Information
1 risk analysis
Menu Objectives
M01 Drug Formulary Checks Enable function
M03 Patient Lists 1 report
M04 Patient Reminders 20%
M07 Medication Reconciliation 50%
M09 Immunization Registries Data Submission
1 test
ChecklistObjectives for Stage 1 MU
24
giovedì 22 marzo 2012
Rules-Based Engines
• Measures are added each year• Measures are adjusted from year
to year• Measures are retired
25
giovedì 22 marzo 2012
26
Imagine MD Secure N-Tier Architecture
giovedì 22 marzo 2012
Imagine MD Provides 4 Real-Time Levels of Assurance of MU
1. MU Indicators2. Patient level compliance dashboard3. Provider level compliance dashboard4. Dashboards provide necessary steps
to achieve compliance for each MU objective
27
giovedì 22 marzo 2012
Real-Time Meaningful Use Dashboard
28
giovedì 22 marzo 2012
Multiple Language Capability
English
29
giovedì 22 marzo 2012
Italian
30
giovedì 22 marzo 2012
Russian
31
giovedì 22 marzo 2012
Page Code with place holders
User Preferred
Language
P h r a s e Code
LanID1 (English)
LanID2 (German) L a n I D 2 (Portuguese)
1 Personal Details Persönliche Angaben Detalhes pessoais
2 Show History Historie anzeigen Mostrar Histórico
3 MRN MRN MRN
4 Status Status Status
5 Primary Provider Primary-Anbieter Provedor primário
Phrases Data Table
Page Display Engine
Multiple Language Capability
English German Portuguese
giovedì 22 marzo 2012
Prescription Code
Personal ID
Note for Pharmaceutical Association
Exceptions
Data of Filings
Type of Prescription
Transmission to Central Repository
Prescription
Diagnosis and ICD 9-CM Code
Electronic Interconnection of Doctors
Regulatory Reference – Mandatory Data To Be Transmitted Electronically
33
giovedì 22 marzo 2012
Progetto Tessera Sanitaria Web Services per la Trasmissione dei Certificati di Malattia all’INPS
34
giovedì 22 marzo 2012
35
giovedì 22 marzo 2012
36
giovedì 22 marzo 2012
Linkem Overview
42MHz of frequency spectrum
84MHz of frequency spectrum
License holder of 84MHz of spectrum covering 80% of the population and 42MHz of spectrum covering the remaining 20%
Over €190 million of capital funded to date
FOR MORE INFORMATION PLEASE VISIT OUR WEBSITE:
WWW.LINKEM.COM
37
giovedì 22 marzo 2012
Brescia
Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have
reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem’s BTS 38
giovedì 22 marzo 2012
Brescia
39
Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have
reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem’s BTS
giovedì 22 marzo 2012
Latina
Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have
reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem’s BTS 40
giovedì 22 marzo 2012
Latina
41
Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have
reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem’s BTS
giovedì 22 marzo 2012
Avezzano
Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have
reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem’s BTS 42
giovedì 22 marzo 2012
Avezzano
43
giovedì 22 marzo 2012
Avezzano
44
Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have
reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem’s BTS
giovedì 22 marzo 2012
WiMAX “Dish” for WiFi in
45
giovedì 22 marzo 2012
Outdoor “Dish”
46
giovedì 22 marzo 2012
47
George Blumenthal
giovedì 22 marzo 2012
The Future of Healthcare IT Is in the
Clouds
47
George Blumenthal
giovedì 22 marzo 2012