Electronic Medical Records - Paperless to Big Data Initiative

Electronic Medical RecordsFrom Paperless to Big Data Initiatives

Komes Chandavimolโกเมษ จนัทวมิลData Scientist

Data Science Lab, [email protected]

Agenda

• Introduction

• Electronic Medical Records – Experience Sharing

• Beyond EMR

http://cdn.24x7mag.com/x7mag/2014/03/robot-stethoscope.jpg

Komes

• Komes Chandavimol

• Wanna be a Doctor

• Healthcare Analytics Consultant

• Data Scientist @Data Science Lab, Thailand

Electronic Medical Records

• An electronic medical record (EMR) is a digital version of the traditional paper-based medical record for an individual.

http://health.usnews.com/health-news/most-connected-hospitals/articles/2011/07/18/most-connected-hospitals

http://curemd.wordpress.com/2012/07/23/emr-adoption-and-health-information-exchange/

Paperless

http://alterinspire.com/index.php/tag/electronic-medical-records/http://www.chinatechnews.com/2015/01/30/21375-alibaba-health-reaches-cloud-deal-with-winning-software


Paperless

Basic EMR

Integrated EMR

Meaningful Uses

EMR + Big Data

http://ehnusa.com/solution/problem

Software

EMR Software helps doctors and medical professionals keep track of health-related information for their patients and give staff access to these records through centralized electronic systems

http://www.healthcareitnews.com/sites/default/files/hitn_ehr.jpg

http://www.capterra.com/infographics/top-emr-software

http://ihealthtran.com/images/Inforgraphic-traditional-paper-records-vs-Electronic-medical-records-EMR-Infographic-friday.jpg

• As of 2015 Epic has 315 customers.

• 54% of patients in the United States*

• This includes 69% of Stage 7 U.S. Hospitals, 71% of children's hospitals, and 83% of Stage 7 Clinics

• Employee 9000+

• Found in Verona, Wisconsin

http://learnhealthtech.com/epic-systems-modules/

https://en.wikipedia.org/wiki/Epic_Systems#cite_note-12

Epic Modules

http://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php

http://learnhealthtech.com/epic-systems-modules/

SEmergency R

ADTEpic Care Inpatient

PBRevenue Cycle HB

Epic System

http://www.slideshare.net/VMworld/vmworld-2013-how-does-vmware-uniquely-enable-leaders-in-healthcareelectronic-medical-records-to-improve-quality-of-care-and-meet-unique-industry-requirements

Epic Reporting System

http://www.slideshare.net/VMworld/vmworld-2013-how-does-vmware-uniquely-enable-leaders-in-healthcareelectronic-medical-records-to-improve-quality-of-care-and-meet-unique-industry-requirements


Paperless

Basic EMR

Integrated EMR

Meaningful Uses

EMR + Big Data


• Nemours ประกอบด้วย 3 กลุ่มโรงพยาบาล– Nemours Alfred I. duPont Hospital for Children (129 Beds)– Nemours Children's Clinics, Jacksonville, Florida– Nemours Children’s Hospital , Orlando, Florida

• เป็น กลุ่มโรงพยาบาลแรกๆ ของ อเมริกาท่ีลงระบบ Electronic Medical Records (2002)

• เร่ิมต้นมีทีม 3-4 คน และ ขยายเพิม่มากเพ่ือรองรับ ความต้องการของลกูค้า ทัง้ในด้านคนเตรียมรายงาน และ คนดแูละระบบ EMR System

Nemours – Children Hospital

R

S

PB

Lessons Learn

The promise is that they're going to help us deliver better care with better outcomes. But you can't just have an EMR—you have to learn to use the tools in the right way.


Lessons Learn

Assembling the Right EHR Project Teams

• A “Clinical Champion”

• An EHR Project Manager

• Evaluation & Selection Team Members

• EHR Implementation Team Members

http://www.schoolhealthcenters.org/wp-content/uploads/2011/06/1-Assembling-the-Right-EHR-Project-Teams-Tips-for-Success.pdf


Paperless

Basic EMR

Integrated EMR

Meaningful Uses

EMR + Big Data


Nemours – Children Hospitals

RVU-based Reports

Revenue Cycle Reports

Registration/Scheduling Reports

Clinical Reports

• University of Illinois Medical แยก บริษัทออกมาเพื่อบริหาร รายรับ รายจ่าย ของ แพทย์

• เน้นการให้บริการข้อมลู EMR ส าหรับรายรับ รายจ่ายของ แพทย์ (Revenue Cycle)

SC Scheduling

PBProfessional Billing

• Anesthesiology• Dermatology• Emergency Medicine• Family Medicine• Medicine • Neurology• Neurosurgery• Obstetrics and Gynecology• Orthopedics• Otolaryngology• Pathology• Pediatrics • Pharmacology• Psychiatry• Radiology• Surgery• Urology

Physician Group (U of Illinois)

Credit: University of Illinois Hospital, www.wwtps.com

• วางแผนการพฒันาระบบเดิม และเพ่ิมเติมระบบใหม่ เพ่ือรองรับความต้องการ

• มีการจ้างพนกังานเพ่ิม และ จ้าง ท่ีปรึกษาเพิ่มเติม

SC Scheduling

PBProfessional Billing

• Anesthesiology• Dermatology• Emergency Medicine• Family Medicine• Medicine • Neurology• Neurosurgery• Obstetrics and Gynecology• Orthopedics• Otolaryngology• Pathology• Pediatrics • Pharmacology• Psychiatry• Radiology• Surgery• Urology

Physician Group (U of Illinois)

Dashboards

Operational Reports

Self-Service Reports

Credit: SAP Business Object software, www.sap.com

Seattle Children Hospital

Safety Net Payment Reimbursement

พฒันา ระบบ เพ่ือประเมิน การเบิกคืนจากรัฐบาล

• Flat rate per patient visit

• 6.3%, 7% increased reimbursement rates

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242845/

HB

Hospital Billing

$$$Government Reports

$$

Medicaid

Cedars-Sinai Medical Center

http://clinfowiki.org/wiki/index.php/Epic

I Inpatient

EEmergency

Legacy System

• Non-profit, tertiary 958-bed hospital and multi-specialty academic health science center

• พฒันาระบบเดิม และเพ่ิมเติมระบบใหม่ เพ่ือรองรับความต้องการทางข้อมลู

Legacy System

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey, Electronic Health Records Survey.

Percentage of office-based physicians with EHR systems: United States, 2001–2013

? ??


Paperless

Basic EMR

Integrated EMR

Meaningful Uses

EMR + Big Data


26

U.S Government HITECH Act

Focus on • Meaningful Use of Electronic Health Records • EHR Incentive Program • $$ Incentive (Reward) vs $$ Penalty • Core Measure (to award Incentive)

http://www.sfms.org/NewsPublication/SFMSBlog/TabId/467/PostId/1179/mu-audit-ca.aspx

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) legislation was created in 2009 to stimulate the adoption of Electronic Health Records(EHR)

EHR Incentive Program

27

http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/ehr-incentive-program/financial-penalties-nearing-physician-incentive?page=full

The Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs will provide incentive payments to eligible PROFESSIONALS and eligible HOSPITALS as they demonstrate adoption, implementation, upgrading, or meaningful use of certified EHR technology.

Penalties

28http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/ehr-incentive-program/financial-penalties-nearing-physician-incentive?page=full

How to Award the Incentive?


Measurement?

30

Core Measure for MU

Core Measures

The goal of "core measures," is not to measure. Rather, it's to drive improved performance across health care organizations and depending on whom you ask, it's to police hospitals to ensure certain patients are treated in line with what has been determined to be standard and necessary based on their diagnosis.

• Acute Myocardial Infarction (AMI) – Heart Attack• Heart Failure • Pneumonia • Surgical Care Improvement Project (SCIP) • Computerized Provider Order Entry (CPOE)

http://www.huffingtonpost.com/janet-dillione/easing-core-measure-pain-_b_1573695.html

31

Meaningful Use of Data

CPOE


EHR $$$


• 12 hospitals, 27 Senior care facilities, • 6 Urgent care/immediate care centers• Presence Medical Group

• Hospital with 191 beds

• 24 acute care hospitals• 8 physician foundations• Cancer centers, Long-term Care • University, Research institutes

Credit Resurrection Healthcare, Sutter Health, Children Hospital Oakland www.wiki.com

http://www.wiki.com/

The impact of Meaningful Uses!

Open Government

Credit Healthgrade, MedWatcher, NHS

Healthcare Startup

Quality of Hospital Care

Reduce Rate of Readmission

1.Collecting EHR

2.Integrate financial and clinical data

3.Structure the data elements Diagnosis, Procedure, Billing information, patient info)

4.Predictive Modeling Attached a risk score % to readmit)

HB

I

PB

S

O

Credit: Advertis Medical Center

• 17,791 physicians

• 9 millions patients

• 49,778 nurses,

• 38 medical centers

• 620 medical offices

30 petabytes of EMR data1000+ IT staff

Credit Kaiser Permanente, www.kp.com www.wiki.com

http://www.kp.com/


Lessons Learn



Lessons Learn



• An EHR Project Manger




Within the right supports

Within knowledge, skills

With teamwork

With experience


Paperless

Basic EMR

Integrated EMR

Meaningful Uses

EMR + Big Data


Implement HealthConnect , the a new computer system to ensure data exchange across all medical facilities and promote the use of electronic health records.

The integrated system has improved outcomes in cardiovascular disease and achieved an estimated $1 billion in savings from reduced office visits and lab tests.

Credit Kaiser Permanente, www.kp.com www.wiki.com

http://www.kp.com/


• Need a solution to manage and extract valuable insights from vast amounts of complex data.

• Implement an emergency dashboard system to track patients and populations across all visits and interactions. This dashboard enables Seattle Children’s to analyze massive volumes of hospital and patient data to gain a holistic view and improve care.

This dashboard enables Seattle Children’s to analyze massive volumes of hospital and patient data to gain a holistic view and improve care.

http://www.ibmbigdatahub.com/presentation/seattle-childrens-hospital-turns-big-data-better-care

The enterprise master patient index or EMPI that allows for "patient centric" care

Using the Master Data Management to integrate several patient-related records and identify the single Patient ID. This benefits to Sutter Health Facilities and affiliates to understand patient data and provide the right care

http://www.prnewswire.com/news-releases/sutter-health-to-spend-12-billion-on-advanced-technologies-to-support-clinicians-improve-care-72616447.html

Credit: www.epic.com

https://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf

The Future: Connecting Health to Care

The Future: Connecting Health to Care

https://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf

A Shared Nationwide Interoperability Roadmap

http://blogs.oliverwyman.com/healthcare/wp-content/uploads/sites/6/2015/02/shared-nationwide-interoperability-roadmap.png

http://blogs.oliverwyman.com/healthcare/wp-content/uploads/sites/6/2015/02/shared-nationwide-interoperability-roadmap.png

https://goo.gl/bdJcqy

Big Data

Big Data

http://www.adweek.com/prnewser/how-many-times-do-the-worlds-social-media-users-click-every-minute/117427

https://www.domo.com/learn/data-never-sleeps-3-0



Big Data

www.hortonwork.com

Data Lake

www.Microsoft.com

Big Data



How to start?


But Why we Need Big Data?


Volume? Varieties? Velocity?


Value!

Big Data



How to start?

How to Start?

Big Data + Analytics = Values

How to Start?


How We Start?


How We Start?


(Science)

Lessons Learn



Lessons Learn



• An EHR Project Manager




Within the right supports

Within knowledge, skills

With teamwork

With experience+ Academics + Researcher+ Scientists

Data & Analytics

Electronic Medical Records - Paperless to Big Data Initiative