Integrated Systems in Healthcare

1. Integrated Systems in Healthcare Mark VanderWerf President AMD Telemedicine

2. What I need is a medical record as good as my car • All I need is an ATM for my health

3. Healthcare is the largest industry in the world • In the US we spend 1.8 trillion dollars per year on healthcare • Unfortunately… Over half of it is wasted • Over 55% of healthcare costs have little to do with the healthcare of patients

4. Healthcare costs are continuing to rise!!!! • Healthcare costs are rising at 3-5 times inflation • Causing major burdens on all governments – largest part of most national budgets • A drag on businesses competitiveness • A GM car contains more cost for healthcare than for steel • SBC spends more on healthcare than on wires and switching • A handicap in a increasing competitive world

5. Just think of what we could do if we saved a half a trillion dollars a year: • Solve world hunger • Make industry more competitive • Create more and better jobs • Develop new sources of energy • Improve healthcare ……increase the pay of healthcare workers?? Why not??

6. Why is healthcare so inefficient? • Stovepipes – the system is filled with fiefdoms • Physician, nurses, administrators often at odds • Payers, providers, government have conflicting goals and … suspicions • Many guilty parties • Regulations – Payers and the government use rules to micro-manage • Much of it is counter productive • Over-reaction to privacy issues – unbalanced thinking risk vs. reward • Chronic under-investment in information technology and process engineering • All other modern industries have invested and benefited for decades • Healthcare has not – Investment is less than 1/3 of others

7. So sad… • My car has a better medical record than I do

8. We are now trying to do something about it • Not because we want to….because we are being forced to.. • Out of control costs… • Capitation… • Personnel shortages… • 77 million baby boomers will demand care very soon (in the US) 60 Million more in Europe • Pay for performance and report cards • Competition…Consumer expectation

9. Lots of systems / Lost in the systems • Patient Record Systems (EMR) • Hospital Management Systems • Scheduling Systems • Clinical Management Systems • Pharmacy Systems • ICU Management Systems • Practice Management Systems • Telemedicine Systems • Patient Monitoring Systems All of these systems offer value but most are separate and do not interact

10. What is it like today? • Every doctor’s office requires you to fill out a form • Departments within the same hospital can’t interact electronically • Few providers, physicians and hospitals have a complete medical record for patients – the patient doesn’t have one either • So we ask the patient to fill out a form…get a copy of their x-ray and bring it with them…wait for files that get lost…re-do testing and work that has already been done • Mistakes are made with data entry…wait for transcriptions…wait for results…miss-diagnose…miss-identify…fail our patients…cut off the wrong leg…the US Healthcare system kills 75 – 100,000 people per year • This would not be tolerated in any other service • There would be no ATMs or credit cards if Banks worked this way

11. My car has a better medical record than I do… • When I bring it to the car doctor, they plug it into a computer… • Instant, complete demographics (date, place of birth, model & ID#) • Complete medical history, diagnosis & recommended treatment • What other maladies are likely for this car and its similar population so preventive care can be delivered • When diagnostics are run (vital signs) both the results and the diagnosis are automatically entered into the record • It even tells if it has medical insurance (warranty) and who the payer is • If I go to a different car doctor in a different state, the “Plug In” provides the same complete history I want that too…..

12. Dare to dream…. • What would it be like if we could have a medical record as good as a car’s service record ? • We could eliminate redundancy in work and cost • Reduce errors • Enter automatically – no more forms, no more typing • Complete histories • diagnose more effectively • intervene more effectively • Provide preventive care – manage health rather than sickness • Stick in the Health ATM card and bingo…we get care

13. To do this: • All the parties and the systems must work together • Data must be collected accurately and efficiently at the first and every encounter • Information must be uniformly available to every payer, provider and ... each of us • There must be a continuum of information electronically available

14. I believe this will happen? (“Sometimes I feel very lonely in this belief”) Examples: The Veterans Administration • An integrated, multi-media medical record • One of the best in the world • Clinical outcomes better than most in the private sector…and improving Kaiser /EPIC An integrated, multi-media medical record All hospital systems linked Patient Smart ID card Patient on-line access to their own medical record and lab results Patients schedule appointments on line The UK NHS Moving toward a common record

15. How does what we do in telemedicine contribute to the big picture? • We understand: • Communications • Interoperability • How to integrate clinical technology to communications systems • We know how to send the data efficiently to a designated site and utilize it.

16. We have solved a critical piece of the puzzle • Automated, multi-media data collection at the patient encounter The tools we use every day to send patient information miles away can be used in the exam room to gather data directly into the patient record no matter where it is

17. A joint EPIC/AMD/Midmark Project designed this: A joint project with Cerner will implement this technology with two of their largest customers

18. Home Telemedicine • We now can monitor patients in their homes, track their vital signs and meds compliance, predict trends, identify exceptions, intervene proactively • Integration with OCS (masurement) shows outcomes performance and comparisons • A joint project with Practice Management Systems providers will integrate CareCompanion data to their Electronic Patient Record. The systems will share their data.

19. Data will flow from the patient encounter, through multi-disciplinary care, through treatment, discharge and home care.. A systems supported continuum of care. All in one electronic record Am I asking for too much?

20. What can you do? • Be informed – read • Don’t resist change – nurture it • Help others understand the benefits – do not contribute to the fears • Look beyond your fiefdom - see the big picture • Take a role - get involved - help lead the charge

21. Contact Information • AMD Telemedicine • Mark VanderWerf or Brenda Bourassa • Lowell, Massachusetts, USA • 978-937-9021 • www.amdtelemedicine.com