Upload
prezi22
View
936
Download
3
Tags:
Embed Size (px)
DESCRIPTION
Citation preview
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
1
U.S. AU.S. ARMYRMY M MEDICALEDICAL R RESEARCH ESEARCH & M& MATERIELATERIEL C COMMANDOMMAND
MG Eric B. Schoomaker, Commanding
Deputy for Advanced Technologies
COL Karl Friedl, MC, USADirector, Telemedicine & Advanced Technology Research Center (TATRC)
LTC (Dr) Hon Pak, MC, USA Chief, Advanced Information Technology Group
MEDICAL MATERIEL DEVELOPERProtect the Warrior… Sustain the Force!
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
Disclosure
• Chairman, Standards and Guidelines of ATA• Deputy Chair, Telemedicine Taskforce, American
Academy of Dermatology• President-elect and Board of Directors, American
Telemedicine Association (ATA)• Teledermatology Consultant, Army Surgeon General• Chief, Advanced Information Technology Group,
TATRC
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
3
MISSION
Apply physiological and medical knowledge, advanced diagnostics, simulations, and effector systems integrated with information and telecommunications for the purposes of enhancing operational and medical decision-making, improving medical training, and delivering medical treatment across all barriers.
The program scope is to identify, explore, and demonstrate key technologies and biomedical principles required to overcome technology barriers that are both medically and militarily unique.
Department of Defense,Joint Warfighting Science and Technology Plan, Chapter IX, Joint Readiness and Logistics, 1999
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
4
TATRC Programs
• Congressional Special Interest RDT&E (70+ Programs)
• Office of the Surgeon General AMEDD Advanced Medical Technology Initiative (AAMTI) (70+ Projects)
• SBIR/STTR Small Business Innovative Research/Small Business Technology Transfer (50+ Projects)
• Telemedicine
• DARPA Programs (25+ Projects)
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
“Integrating Telehealth Technologies Into DoD EHR Network”
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
6
Agenda
• Current telemedicine investments
• Arrival of AHLTA- our EHR
• The “gap” of EHR
• Convergence of EHR and telemedicine
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
NAVYMEDCENS
SERMCDDEAMC
GPRMCBAMC
PRMCTAMC
Air ForceMEDCENS
WRMCMAMC 18th MEDCOM
121st General Hospital
NARMCWAMC
WRAMC
Iraq
Kuwait
Afghanistan
Balad (Army & Air Force)
Baghdad
Mosul Arifjan TMC (Army & Navy)
Beuhring
Ali Al Salem (Air Force)
Exams
Work over flow / Medevac
Radiologist
LEGEND
30 July 2002
Theater Teleradiology Business Process
A Theater Approach to SoldierHealth Care: Teleradiology
ERMCLRMC Germany
Bahrain (Navy)
Cropper
Bucca
Talil
Tikrit
Baghram
Kandahar
Salerno
Kabul (Projected)
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
8
Army Telepathology Program
• 13 new virtual slide scanners - $800K
• Infrastructure upgrade for AFIP Telemed - $250K
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
9
Western
Ft. Irwin
Ft. Lewis(MAMC)
Ft. Wainwright
PacificPacificTripler (TAMC)
121st General Hospital
GE PACS
Ft. Monmouth
Ft. Sill
Ft. Drum
West Point
Ft. Carson
Ft. Huachuca
Ft. Hood
Ft. Sam Houston(BAMC)
Ft. Polk
Ft. Knox
WRAMC
Ft. Leonard Wood
Ft. Riley
Ft. Leavenworth Ft. EustisFt. Lee
Ft. Meade
Ft. Belvoir
WBAMC
North AtlanticGreat Plains
Ft. Bragg
Redstone Arsenal
LandstuhlHeidelberg
Wuerzberg
Siemens PACS
Europee
Ft. Jackson
Ft. Campbell
Ft. Stewart
Ft. Gordon (DDEAMC)
Ft. Rucker
Ft. BenningFt. McClellan
Digital Radiology– Where are we today?
Agfa PACSIBM PACS
Southeast
Ft Buchanan, PR
JTF Bravo
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
10
Tele-Health Initiatives Tele-Echocardiology
• Availability of echo depends on access to sonographer, equipment and cardiologist
• Digital echo and telemedicine technology bridge the gap to specialty diagnostic imaging
• All echos are read at BAMC
• Cost savings for MEDDAC– Civilian cardiologist office echo plus
interpretation ~ $600 to $1000
– Our contractor: read cost is $73
• $434.4K funded as Venture Capital (ROI) on FY06 resource summary; transitions to base in FY07 ($452.2K)
Jan 2002 – Jun 2006 – 10,746 exams Purchased care would have cost $3,544,454
0
50
100
150
200
250
300
350
400
Jan-0
2
May
-02
Sep-0
2
Jan-0
3
May
-03
Sep-0
3
Jan-0
4
May
-04
Sep-0
4
Jan-0
5
May
-05
Sep-0
5
Jan-0
6
May
-06
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
AKO.Consult Program Summary
[email protected] Managed by the Institute for Surgical Research, Ft Sam Houston
[email protected] Managed by BAMC Cardiology
[email protected] 4 Call Teams: BAMC, Walter Reed, Western, and Atlantic
[email protected] On-call ophthalmologists based in Germany and Eastern US
[email protected] (Infectous Diseases) 3 Call Teams: BAMC, Walter Reed, and Western
[email protected] Managed by various Army, Navy, and Air Force call teams
[email protected] (Pediatrics Intensive Care) Walter Reed based with call teams from Hawaii to Germany
[email protected] Preventive Medicine and Occupational Medicine … managed by CHPPM
[email protected] BAMC based with participation by all DoD toxicologists
[email protected] Managed by TAMC with participation from many MTFs
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
AKO Teleconsultation Summary• Program Summary
10+ specialties with contact groups: [email protected]
1,886 teleconsultations (April 2004 to July 2006 – 29 months)
47 known evacuations prevented
3 evacuations prevented in August
42 known evacuations facilitated following consultant’s recommendation
5 evacuations facilitated in August
648 different referring health care professionals
250 teleconsultations on non - US patients Average Reply Time 5 hr 9 min
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
13
Tele-Dermatology
• 17,805 consultations since inception of program
• 18 reporting facilities– 188 Army consults or 62% of total
– 92 Air Force consults or 30% of total
– 23 Navy consults or 7% of total
• $825.4K funded as clinical deficiency on FY06 resource summary
Army Site
Air Force Site
Navy Site
GITMO
Feb 02 – May 05 – 12,428 consults answered
0
100
200
300
400
500
600
700
Feb-
02
APR JU
N
AU
G
OC
T
DE
C
Feb-
03
APR JU
N
AU
G
OC
T
DE
C
Feb-
04
APR JU
N
AU
G
OC
T
DE
C
Feb-
05
APR JU
N
AU
G
OC
T
DE
C
Feb-
06
APR JU
N
Total Consults Army Consults Air Force Consults Navy Consults
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
14
NARMC Tele-Neurosurgery Optimize Specialty Care
PA screening optimizes neurosurgeon
Conservative care improves clinical outcomes
Recapture related RAD/PT/surgery fees/lab
PA/Nurse Manager provide
case management
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
15
Tele-Behavioral Health (WRAMC) Clinical Business Process
Referral Management and Promotion• MTF managed care staff and Health Net support referrals• Market initiative to beneficiaries at each referring site• Establish referral process/rules to exceed access standards• Review civilian hospital behavioral health admissions daily
Psychiatrist Scheduling• New patients/follow-up/walk-ins/ER patients/MEBs• Therapist screening (triage) to prioritize patients• Immediate aftercare for early release of inpatients
Patient Follow-Up Care• Psychiatrist follow-up VTC visits are based on treatment plan• Psychiatric NP provides VTC med mgmt clinic for stable patients• Therapists take over care for long-term stable patients
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
16
DoD Telemedicine Summary
• Multiple Disparate Systems
• High and Low Bandwidth telemedicine systems
• Live Interactive and Store and Forward System
• Lack of centralized portal for both military and network providers
• Shortage/maldistribution of specialists
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
17
Scope of MHS Operations
Average Weekly Statistics, 2005
• Direct Care Visits: 590,222• Direct Care Admissions: 5,486• Direct Care Dental Visits: 99,000• Direct Care Births: 1,070
• Direct Care and Purchased Care Visits: 1,885,555• Direct Care and Purchased Care Admissions: 20,667• Direct Care and Purchased Care Dental Visits: 104,000• Direct Care and Purchased Care Births: 2,228
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
18
AHLTA Deployment Statistics
• As of 25 Aug 2006:– Full use by 130 out of 138 MTFs
– 56,618 out of 63,000 users trained
– 27.3 million visits captured since Jan 2004
– Contains records for 8.4 million beneficiaries
– Documents 96,800 patient visits per day electronically (per 21-25 Aug 2006 survey)
– Contains 544,000 theater patient encounters
– 32,000 encounters sent from Theater to Garrison in July 2006
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
19
Telemedicine Gap of AHLTA
• The “gap” of EHR– Autoregistration of virtual patients– Workflow: Ability to route consults outside
network or facility– Ability to order consults with images– Workload capture/split
• Professional v. Acquisition
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
20
Integration effort
• Telehealth Portal
• Others– Tricare On Line– DFI– Document Engine (workflow)– EWRAM
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
21
TRICARE ON-LINE (TOL)
• Portal for MHS Clinicians and Beneficiaries• Single Sign On (SSO) to MHS Applications under
development• Linked to DEERs for eligibility checking• Primary Means To Support Consumer Empowerment
– Can make appointments– Pharmacy refill under development– Health Content for Patient Reference– Health Assessments– Deployment related links– Non-availability statements– Personal Health Manager (journal and tracker) and Personal Health
Record (demographics, allergies, medication and appointment profiles) under development
– Home Page being re-designed
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
22
TRICARE Online (TOL)Schema
BeneficiariesProviders/
Staff
External Support Contractors
Single Sign-OnMilitary Health System
(MHS) Portal SSO
Defense Medical Human Resources System – internet
(DMHRSi)
Patient Safety Reporting (PSR)
CHCS
Defense Enrollment and Eligibility Reporting System (DEERS)
Current TOL Applications and Services
Single Sign on to MHS Systems(in progress)
104 Military Treatment Facilities
Health Content
DeploymentRelated Links
Secure Provider Access CHCS (SPAC)
Portal to PortalSingle Sign-OnServices to TOL
Others
Health Assessment
Centralized Credentials & Quality Assurance System
(CCQAS)
Deployment Related Medical Records Online (DRMROL)
AHLTA/Clinical Data Repository
Non Availability Statements (NAS)
Composite Health Care System - CHCS
Service Portals
Appointing
ExternalSystems
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
23
TRICARE OnlineCurrent Capabilities
• Online appointing– Automatically checks eligibility for care
• Information on MHS Services and Benefits
• 18 million pages of Health Content
• Online drug interaction checking
• Non-Availability Statement (NAS) processing
• Secure Access to Composite Health Care System (CHCS)
• Access to Deployment Related Records Online (DRMROL)
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
24
Document,Files,Imaging (DFI)
• Provides ability to capture, identify, and present DFI to the clinical user within the context of clinical workflow.
• Current MHS environment presents numerous instances in which in hard copy and digital clinical encounter documentation originating from outside sources needs to be incorporated into AHLTA
• This project is essential for ensuring that the healthcare professional has a complete and comprehensive record for use while delivering quality patient care.
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
25
AHLTA Client
DFI module
• DFI List• DFI View
Scan/Import Tool
DFI Management Sub-System
DFI Repository
• DFI Retrieval Service•DFI Import Service
View Purchased Care Data
ElectronicDocument
[Future]MTF PACS (Agfa Web)
Broker for person Identifier
(DEERS PIDS fetch)Indicates Scanning/Import Tool ECP 915Indicates Digital Imaging ECP 920Indicates View Purchased Care Data ECP 919
DFI Registry
• DFI Registry Query Service
• DFI Registration Service
• Scan/Import
Paper Document
Document, Files, Imaging (DFI), continued
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
26
Document Engine/AHLTA Integration System Architecture
DE
Legends:AvailableTo BeImplemented
Oracle HTTP Server
Document Engine Server
OC4J (J2EE) ContainerDE Application
DE WebServices
TranscriptionSystem
LCS S
erv
er
JDBC
Tra
nscri
bed d
ocs
HL7
Messag
es:
A
DT,
SC
H …
HL7
Messag
es:
A
DT,
SC
H …
HL7
DocumentCapture Driver
AHLTA Client WS
DocumentCaptureApplet
IntegrationB2B
HL7Engine
Syst
em
Pri
nt
Serv
ices
Port 443Port 443
Listener Port (e.g. 1521)
LGSFEP #2 Server
GenericInterface
Port
443
Pulmonary FunctionSystem
Medical Records Printers
CHCS
AHLTA DE Web Services
AHLTADE
Module
ICD
CoreModule
DE
XML Proxy CDR
Listener Port (e.g. 1521)
CWSFEP
ICD Enc.Mapper
CDR Enc.Mapper
EncounterMapper
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
27
Document Engine (DE)
• DE module provides a universal, standard interface for incorporating clinical documents into patient records. Comprehensive information capture is provided from the following:
– Clinical text Health Level Seven (HL7) messages,
– Print jobs from other Windows applications, and
– Print jobs via serial port data from legacy hardware devices.
• Project to integrate GOTS Document Engine (DE) into AHLTA to provide interface to import documents from external vendors, other print-capable Windows software, and legacy hardware.
• Allows users to manage unsigned documents through a delegation, review, and signing workflow.
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
28
Enterprise Wide Referral and Authorization Module (EWRAM)
• Background:– Per HIPAA Law, covered Entities are Required to use
Standard Transactions (X12 278) for all Electronic Referral & Authorization Requests
– If MHS Sends / Receives Electronic Referral Request, (X12 278) Required
– Faxing Not Considered Electronic
– Long History of Development of CONOPS through Flag-led WIPT and negotiations with MCSCs on what is required
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
29
Enterprise Wide Referral and Authorization Module (EWRAM)
• HIPAA R&A WIPT: HIPAA OIPT Referral & Authorization (R&A) WIPT Created to Address Direct Care Business Process & HIPAA R&A Transactions Between MTF and MCSC
• EWRAS: Enterprise Wide Referral and Authorization System
• NAS: Non Availability Statements: Permits TRICARE Non-enrolled Beneficiaries to Receive Inpatient Care in the Civilian Market (NDAA 2002 – Mental Health Care only); Europe Uses NAS System For Referrals
• EWRM: Enterprise Wide Referral Management IPT
• EWRAP: Enterprise Wide Referral and Authorization Process IPT
• M-EWRAS: Modified-EWRAS as a CHCS II Module
• EWRAM: Enterprise Wide Referral and Authorization Module
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
30
EWRAS Interfaces
MCSCTOL
CENTRALSERVER(at DISA)
REFERRINGPROVIDER ENTERS
REFERRAL INTOEWRAS
MTF HUB
DEERS
CHCS
Ref.
Approved to
Direct C
are A
ppointmen
t
271
270
HL
7
278Civ Net
INT
ER
FA
CE
E
NG
INE
Referral Request,Status Updates,& Results
271270
INT
ER
FA
CE
E
NG
INE
MCP Request, Appointment
Specialty Provider or Transcriptionist Enters & Verifies
result intoEWRAS
• High Reliability & Availability
• Local Redundancy
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
31
Telehealth Convergence
• Telehealth as portal into AHLTA• Single Point of Entry
– Network providers– MHS providers
• Deployed Environment• Fixed Facilities• From Specialist’s Home or remote location
• Seamless workflow with AHLTA– Single view/ desktop– Leveraging existing and ongoing functionalities– Process over existing infrastructure
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
32
Telehealth Portal
• Outsourcing Specialists– Most of our patients are seen by our network providers
(Tricare)– Leveraging telehealth to optimize delivery of healthcare– Contract Process (Tricare Contract)
• Ensure that Telehealth is used especially when specialty access is not available by traditional means
• Second Opinion– CDC– Subspecialty Care
• Pediatric genetics
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
33
Summary
• Telehealth Portal from Walter Reed– Require backend integration with Tricare On Line
• Gap Analysis and Convergence– Tricare On Line– Document, File, Images– Document Engine– EWRAM
Telemedicine & Advanced Technology Research Center Cutting Edge Medical Technology
TATRC
34
Questions
• Hon Pak
• 301-619-7923