Integrated Medical Environment
Decision Support, IMEDS™
Reducing healthcare costs
through improved patient outcomes
August 23, 2012
Engineering Healthcare
Len Polizzotto, Ph.D.
Draper Laboratory
617-258-4624 [email protected]
U.S. Healthcare Today
• Challenges
– Access (addressed by the Affordable Care Act)
– Quality
• More and more technology causing data overload
– Increase in errors
– EHRs don’t deal with data overload
• Focus on profits rather than the patient
– Convenience
• Too many vendors selling proprietary systems
• No standardization or device interoperability
– Costs
• Too many hospitals buying as individuals
• No economies of scale
• Many needless procedures
U.S. Healthcare Today
• Issues
– Waste*
• Lack of adoption of best practices
• Failure of care coordination
• Overtreatment
– Doctor shortage**
• Physician shortages may reach 90,000 in the next decade
• Use of Nurse Practitioners (NPs) to grow 94%
– What will be the impact on quality of care?
– How will provider team performance be optimized?
*Berwick, D.M. and Hackbarth, A.D., JAMA, April 11, 2012 – Vol 307, No. 14:1513-1516
**Auerbach, D.I., PhD, Med Care. 2012;50:606-610
Opportunity to make a difference
• Electronic health records (EHR), laboratory tests, imaging, and
bedside monitors are important. However these data sets are not
integrated to provide interpretable and actionable information.
• Caregivers need to understand the data and its implications in
order to make the best choices about treatment.
IMEDS™, Integrated Medical
Environment Decision Support
4
IMEDS will transform medicine by enabling clinicians to
provide proactive care before patients worsen instead
of reacting to life-threatening events already in
progress.
Goal is to transform medicine
"The success of the NASA-led glass cockpit work is reflected in the total acceptance of
electronic flight displays... Safety and efficiency of flight have been increased with
improved pilot understanding of the airplane's situation relative to its environment. The cost
of air travel is less than it would be with the old technology and more flights arrive on time.”
Traditional Cockpit Data-Integrated Glass Cockpit
www.nasa.gov/centers/langley
The Need for Enhanced Situational Awareness Translating Raw Data into Actionable Information results in less waste
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Present all information in readily interpretable form, much as a
GPS receiver takes data from satellites and creates situational
awareness to provide a map back to health for each patient
Data vs Information
• IMEDS™ will provide real-time decision support to clinicians at the
point of care
– Codify best practice protocols
– Enable efficient treatment decisions
– Reduce needless procedures
– Optimize coordination among care givers
– Reduce the probability of mistakes being made
• IMEDS™ will provide the platform for continuous improvement
– New application development
– Sharing of best practices
• IMEDS™ will work in any clinical setting
– Hospitals (ICUs, ORs, ERs)
– Primary care
• IMEDS™ will enable telemedicine and remote patient care
– Bring expertise to rural settings
– Military care
IMEDS™ Will Optimize Patient Care
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IMEDS™ Will Fulfill IOM’s Vision
Institute of Medicine’s Vision for 21st Century Health
• Comprehensive data on patients’ conditions, treatments,
and outcomes
• Cognitive support to help integrate patient-specific data, evidence-
based practice guidelines and research results into daily practice
• Tools that highlight problems as they arise
• Rapid integration of new instrumentation, biological knowledge,
treatment modalities into a “learning” health care system that
encourages early adoption of promising methods but also analyzes all
patient experience as experimental data
Institute of Medicine, Crossing the Quality Chasm: A
New Health System for the 21st Century, The National
Academies Press, Washington, D.C., 2005
Taking Healthcare IT to the Next Level – Beyond EHRs
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The IMEDSTM Approach
• Focus on the data overload problem – make it actionable information
• Start with the ICU, the most data intensive of all medicine
• Form a nation wide team of leading clinicians and engineers
– Enable the full potential of EHR and device interoperability efforts
– Leverage successful approaches from other disciplines
– Approach the problem as a total system
– Establish an open architecture that will become the standard
• Build a demonstration
– To Synchronize, integrate, and process medical data from all sources
– Based on an open middleware architecture
– Facilitates device interoperability (“plug and play”)
– Allows clinicians to index, search, and assemble data
– Enable connections between seemingly disparate information
– Provides patient-centered cognitive support through the continued development
of “clinical apps”
• Transition the results to commercial partners for wide-scale
implementation
Integrated Medical Environment
Decision Support, IMEDS™
Data
Corr
ela
tion (
Info
rmation)
Patient State DB
Data Conditioning
Unified
Display
Treatment
Decision
Support
Diagnosis
Support
Physiological
Models
Da
ta S
yn
ch
ron
iza
tio
n a
nd
Ali
gn
me
nt
• Present Illness
• Past history
• Medications
• Physician Exam
• Nursing notes
• Lab data
• Cultures
• Imaging data
Phenotypic Data
• BP, HR, RR
• Temperature
• O2 Saturation
• ICP, CPP
• CBF
• Brain Tissue PO2
• Microdialysis
• Continuous EEG
Physiologic Data
Collaborate
Synchronize Integrate Process Present
Omics
Use Contexts – Patient-centric
• IMEDS Collects Patient-Specific Data from Devices
• Time-Synchronizes and Convolves Device Data with EHR-based Data
• Performs Patient-Specific Data Analysis
• Presents Data, Analysis in Context-Specific, Meaningful Visualizations
• Provides Decision Support
• Bedside or tele-medicine
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Use Contexts – Unit, Hospital, or Network
• IMEDS Enables Analysis
Across Patients
• Centralizes
Management
• Enables Machine and
Human Learning
• Enables development of
new methods,
algorithms etc.
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More than 5 million Americans with life-threatening conditions are
admitted to Intensive Care Units each year. Critical care saves lives but it
is complex, error prone, and very expensive.
Example - Today’s ICU
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Too Much Data. Not Enough Information.
“Computational Technology for Effective Health Care:
Immediate Steps and Strategic Directions,” NRC, 2009
• Data Overload. There are staggering amounts of data, beyond the
capability of any person to absorb, integrate and act upon reliably.
• Lack of Integration. Device
interoperability is limited.
• Lack of Processing. Basic
statistical analyses are elusive.
More sophisticated analyses and
correlations are unavailable at the
bedside.
• Inability to Search. It is difficult for data to be indexed, searched,
and assembled to provide accurate information to treat patients,
because the original context of the data is lost.
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A 73-year old woman is
admitted from the emergency
department to the intensive
care unit with high fever and a
rapid heart rate. Her medical
conditions include mild chronic
kidney insufficiency and a
penicillin allergy.
One week ago, she had an operation to remove a cancer
from her colon.
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IMEDSTM in Action
• Optimized efficiency
IMEDS constructs a display of the clinical events, physiology, lab data, and
images from the recent admission, helping the ED and ICU physicians rapidly
recognize the current changes in her clinical course.
• Improved situation awareness
The “glass panel” collects and displays additional data including blood pressure,
total CO2 and white blood count all suggest not only an infection, but sepsis.
• Real-time decision support
Search of the practice and patient databases identify that the patient needs fluid
resuscitation and antibiotics. The data predict the source of the sepsis to be
surgical (62% probability), pneumonia (31% probability), or C.difficile colitis (7%).
Given the high probability of a surgical abscess, obtaining a CT scan becomes
the most immediate diagnostic procedure.
• Communicating best practices
With a penicillin allergy, IMEDS recommends avoidance of the first-line antibiotic
regimen and suggests the best alternatives given the likely sources of the
infection.
IMEDSTM in Action
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IMEDS™ Will Reduce Costs
Reduced costs
Enhanced Situational Awareness Improved Team Collaboration
Reduced length of stay Reduced readmissions
Improved outcomes Reduced Errors
If IMEDS can reduce length of an ICU stay by a single
day, it would save $5 billion annually 17
Collaborate
Synchronize Integrate Process Present
Do for the ICU What Draper Did for Others*
• Intelligence – Synchronize and align multi-modal data sources to
provide actionable information
– Developed algorithms that provide cognitive support
throughout intelligence community
– Implemented Human Systems Collaboration tools to
improve communication
• Military – Integrated C4ISR systems
– Deploying state-of-art-art navigation systems from
submarine to missile guidance
– Distributed situational awareness & collaboration
across battlespace (TacDroid)
• Space – Collected and consolidated hundreds of data inputs
for Shuttle program and International Space Station
– Currently, Draper’s Timeliner system automates
payload and operations for ISS
* Always in partnership with both customers and collaborators 18
• Energy – Capture multi-modal, multi vendor data
– Consolidate outputs into single display
– Provide decision support to plant operators
– Enable efficient integration of the variable power supplies
associated with renewable energy
• Medical – Developed the draft standard for the Integrated Clinical
Environment (ICE) as part of the Center for Integrative
Medicine and Innovative Technology (CIMIT) Medical
Device Plug-and-Play program team.
– Awarded the Kennedy Award for Healthcare Innovation.
– Developed Neurovascular (3D + t) image processing for
situation awareness during surgery (intelligent angiography)
– Developed retinal image analysis algorithms to identify
lesions (automating diagnosis)
Do for the ICU What Draper Did for Others*
* Always in partnership with both customers and collaborators 19
Why is IMEDS™ Different? The Approach
– “Bottom-up” development with clinicians and engineers
working side-by-side (working also with ONC to help guide top-
down design choices)
– Open source architecture design
– Total integrated, “plug-and-play” system solution
– Unbiased approach
– Unified effort, rather than stove-piped, “one-off” solutions to
small pieces of the problem
– Non profit nation-wide consortia
– Builds on existing infrastructures
– Leverages best available technology, regardless of source
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