Alfred M. BareaUMMC Nursing Informatics

August 10, 2010

Technology’s Impact onHealthcare

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Agenda:

• Driving Forces

• Technology for Patients

• Technology for Clinicians

• Future Focus

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Patients

Community

Physicians

Suppliers

Employees

Payers

Driving Forces

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Driving Forces from Bio-Tech

Healthcare Dollars Spent

Resources ConsumedHealth Status

80%$$$

High

Low

Age

90%/10%

Future

Current

20% /$$$ $$$

High

Low

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• Internet use will continue to grow, and traditional business processes and methods of communication will be augmented or replaced by the Web.

• Consumers will expect “trusted” healthcare providers to deliver information, services and

transaction capability via the Internet.

• Physicians will look to “trusted” healthcare organizations to provide patient

results data and in depth health information via the Internet.

• To maintain a competitive advantage hospitals must continue to embrace and invest in

web technologies.

Driving Forces Perspective

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Ordering

39%

Transcribing

12%

Preparing

11%

Administering

38%

Leape LL et al. Systems analysis of adverse drug events. JAMA 1995;274:35-43.

Driving Forces from Think Tanks

Where Medication Errors Occur

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Consumer Web sites

PORTAL Technologies

Enterprise Intranet

CommunityCommunity

PhysiciansPhysicians

EmployeesEmployees

Perspectives I Focus on…

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Technology for… the Consumer

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Technology Evolution for the Consumer:

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Technology for the Patient

Decrease inter-departmental paper work Streamline communications Reduction of phone calls

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• Implementation of hospital based web sites• Online Nurseries• Career Center• Patient E-Cards• Health Encyclopedia• Pre-registration• Pregnancy Center• Membership Portal

Technology for… Consumers/Patients

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Personal Health Records

Personal Information

Emergency Contacts

Plus… insurance, reminders, visits, etc.

Medical Overview

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Tech… for Care and Safety

Standardized Order Entry

Clinical Documentation

Nurses have access to Electronic Medication Administration and are provided with automated MARS

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• Patient and Group Lists

• Order Lists

• Laboratory Results

• Final ICD9/CBT/Billing Codes

• Demographic Information

• Next of Kin

• Insurance Information

• Compliance Advisor

• Pathology Reports

• Rad and Gen Med Transcription

• Digital Radiology Integration (PACS)

• Discussion Forums

• Electronic Medical Record – e-signatures

• Health Encyclopedia

• Micromedex

Physician Portal

Technology for Clinicians…

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Web accessible from inside and outside our facilities.

Physicians and nurses will be able to view fetal strips from anywhere in the hospital.

OBIX Fetal Heart Monitoring provides nursing staff with the ability to chart by exception.

Tech… for Fetal Monitoring

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Physician Portal at my previous site

Practices 495+

Physicians 1339+

Physician Office Staff2356+

BHS Employees 1773+

Total as of 11/3/05 5963+

Tech… Clinician Utilization

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Tech… Clinician Use of Portal

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Employee Intranet• News and Announcements

• Desktop applications

• Calendar of Events

• Corporate Compliance

• Department / Employee Directories

• Document Library

• Discussion Forums

• Health Encyclopedia

• Human Resources

• Micromedex

• Policies and Procedures

• Training Center

• Executive Console

• A/R Dashboard

• Quality console

• eStations

• Paystubs

• MSDS

Tech… for Clinician Productivity

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Tech… for Patient Schedules

Track work loads, anticipate staff and supply needs.

Allows the ancillaries to notify the units if there are openings and to communicate equipment, room or staff downtime (unavailbility).

Allows a centralized schedule process so nursing units can contact one point of origin or entry for patient scheduling information.

Any PC Workstation in the facility can view the patient scheduling grid at any time.

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Tech… for Reference Material

Medical Databases

Medication Dosing Calculators &Therapeutic Tools

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Corporate Compliance

HIPAA

Annual safety program

Online testing and results tracking..

Tech… for Online Education

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Tech… for Physician Search

Nursing staff can look up all active staff physicians at their facility via the Intranet.

If not credentialed, the name does not display, instantly alerting the nurse that this is not an active staff physician.

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Tech… for Patient Educ & Tracking

Patient on Status Board

• create consents, discharge documents, etc.

Education•In Room Options

• pediatric or adult topics

(diets, medications, illnesses, activity limitations, dressing and wound care, equipment instructions, follow up information)

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Tech… for Improving OR Efficiency

Ability to create, edit, and print physician preference cards

Prepare for pending operating room procedures.

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Tech… for Materials Management

Getting rid of all the “stickers” that are traditionally used to track patient charges

Less time tracking lost charges and inventory.

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Tech… for Documents – PRN

Generate print on demand forms, that allow nurses to concentrate more on patient care

• Nurses Notes• Consent forms and • Facesheets • Form packets

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Future Technology and IdeasFrom Other Industries

Today you can schedule a flight, book a ticket, select a seat, pay for the ticket, check-in for the flight from a smart phone, waitlist for upgrades, check flight status, without ever having to wait in lines or interact with airline personnel. The airline will also link you with other travel partners-car rental agencies and hotels

The auto industry has moved to a proactive inventory management process where they predict their supply needs and view the processes of all players in the supply chain as one process. All players (raw material suppliers, manufacturers, distributors, assembly lines and retailers) are in constant communication and utilize continuous information feedback loops that optimize the supply chain at all levels, significantly improving efficiency and quality of the end product—the car

Banking today is a “bank wherever you happen to be” business. With automatic deposit, wire transfers, debit cards, online bill paying, eLoans and ATM’s everywhere the need for physical banks and tellers is almost nonexistent. The consumer no longer needs to go to a bank, the bank has been brought to the consumer

These industries have leveraged the disruptive nature of information technology and have radically changed their business models. They have used technology to automate and improve core processes, expanded their market reach, provide 24 hour access to customers, and improved profitability

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Future Technology – Gartner

Trough ofDisillusionment

Slope ofEnlightenment

Plateau ofProductivity

TechnologyTrigger

Peak of Inflated

Expectations

Maturity

Visibility Will reach “plateau” in:

Less than two years

Two to five years

Five to ten years

More than ten years

Biometrics

PDAs integrated w/CPRs

Workflow

WLAN

NLP - “Text to facts”

Tablet Computers

Handwriting recognition

Speech Rec - transcription

Integration broker

SSO

HL7 CDA

HC Industry PKIService-Oriented Architecture

Web Services

Document Imaging

Rules Engine

Speech Rec “Once and Done”HL7 3.0 Messages

Enterprise PKI

Standard CMV

Secure e-mail

HL7 CCOW

NLP - “Document Classification”

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IMAGine a Precise and EfficientHealth System where…

Patient information is input once, and available for all care activities in all sites.

Activities and decisions are prioritized in a standard workflow, with alerts serving only as reminders

Medical information is pushed at the right time, to the right place, in the right form, to the right people to support effective patient care

Consultation with external providers is common, with all pertinent patient information and images available to both parties

Nurses spend 5-10% of their time on administration,rather than 50%

Patients have access to same information as theirproviders and are active participants in their care

Care is based on best current knowledge and is as safe as it can be

Care is available when needed -- as defined by the patient

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IMAGine the Future of Health Care

Continuous healing relationships - access to care Customization based on patient needs and values The patient as the source of control - information access Shared knowledge and the free flow of information Evidence-based decision making - reduced care variation Safety as a system property The need for transparency-public accountability for quality Anticipation of needs-care management Continuous decrease in waste-right care at the right time Cooperation among clinicians

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The Future of Health Care: Where Are We Now?

Lots of rethinking for facilities on the drawing board

Highly publicized “digital hospitals” - many seem like old hospitals with lots of new technology

Some focused implementation of next generation pieces: new hospital design, OR, ER

Skepticism that this is just a way to sink money on consultants and IT

There are some early success stories….

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Source: Health Management Technology, December 2004

Next Generation Hospital

New heart hospital construction

Building and technology infrastructure follow patient and clinical workflow.

All services except surgery provided in private patient rooms

Automated capture of patient weight, vital signs, cardiac output etc. with

wireless transmission to the CIS

Smart cards for single sign-on access (double as debit cards for cafeteria)

Surgery documentation at the point of care, fully integrated with PACS,

Materials Management and Billing applications

Impact: ALOS reduced 1.8 days, increased annual patient volume by 56%

with same staff, 97% patient satisfaction ratings

At : Nebraska Heart Institute Heart Hospital

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Next Generation OR

Equipped with voice activated software and video taping to enable hands free data entry and retrieval during surgery

Rooms sized for image guided minimally invasive procedures

Robotic controlled instruments - either on site or distant

At : Sentara Norfolk General, Wake Forest, Massachusetts General Hospital

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Next Generation ER

Access to data and images from throughout the facility, views personalized for different users

Wireless monitoring of Blood Oxygen, Blood Pressure, and Temperature

Voice recognition for documentation

Impact: Patent load increased by 32% - no increase in space or staff, 70% of patients discharged in 2 hours, .001% missing information for billing

At : Washington Hospital Center

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Patient as Provider

Reliable and Safe

Continuous Care

Accountable

IMAGine a Future of theseHealth Care Principles

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What do you see, nurses, what do you seeWhat are you thinking when you're looking at me?A crabby old woman, not very wise,Uncertain of habit, with faraway eyes?Who dribbles her food and makes no reply.When you say in a loud voice,"I do wish you'd try!"

Who seems not to notice the things that you do,And forever is losing a stocking or shoe.....Who, resisting or not, lets you do as you will,With bathing and feeding, the long day to fill....Is that what you're thinking? Is that what you see?Then open your eyes, nurse; you're not looking at me.

I'll tell you who I am as I sit here so still,As I do at your bidding, as I eat at your will.

I'm a small child of ten, with a father and mother,Brothers and sisters, who love one another.A young girl of sixteen, with wings on her feet,Dreaming that soon now a lover she'll meet.A bride soon at twenty -- my heart gives a leap,Remembering the vows that I promised to keep.At twenty-five now, I have young of my own,Who need me to guide and a secure happy home.

A woman of thirty, my young now grown fast,Bound to each other with ties that should last.At forty, my young sons have grown and are gone,But my man's beside me to see I don't mourn.At fifty once more, babies play round my knee,Again we know children, my loved one and me.

Dark days are upon me, my husband is dead;I look at the future, I shudder with dread.For my young are all rearing young of their own,And I think of the years and the love that I've known.

I'm now an old woman ...and nature is cruel;Tis jest to make old age look like a fool.The body, it crumbles, grace and vigor depart,There is now a stone where I once had a heart.

But inside this old carcass a young girl still dwells,And now and again my battered heart swells.I remember the joys, I remember the pain,And I'm loving and living life over again.I think of the years, all too few, gone too fast,And accept the stark fact that nothing can last.

So open your eyes, nurses, open and see,Not a crabby old woman; look closer, see ME!! .

An Old Lady's Poem....

Thank You