From the Health IT Leadership Summit

1. The virtualization of the bricks and mortar
of the Healthcare delivery setting:
The impact and direction of Healthcare IT
Mark A Dente, md
CMIO 1/
GE Healthcare IT e-Infrastructure for the Future of Diagnostics
4 November 2011

2. The virtualization of the bricks and mortar of the
Healthcare delivery setting:
• Digitation & Connectivity of Data: Accessing and
integrating information from multiple sources
• Advanced Data Processing & Information Fusion:
Turning “Insight” into Action
• THE FUTURE is sooner than you think: Empower every
person to live an independent, confident, healthier life
through connected technologies

3. Healthcare Challenges: Improve Outcomes &
Avoid or Reduce Cost
• Meaningful Use & Quality Metrics - Clinical Decision
Support
• New delivery Models like ACO’s - Patient and Population
Health Mgmnt
• Shift care to lower cost settings - Chronic Disease
Mgmnt & Remote Monitoring
• Early identification of at-risk individuals - Genomics
Personalized therapy selection & Better therapy
monitoring (Surveillance Monitoring)
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e-Infrastructure for the Future of Diagnostics
4 November 2011

4. The Clinical Knowledge-Processing Burden
“Current medical
practice relies
heavily on the Knowledge processing requirement
unaided mind to
recall a great
amount of detailed
knowledge – a
process which, to
This gap
the detriment of all
injures patients
stakeholders, has
repeatedly been Knowledge processing capacity
shown unreliable”
Crane and Raymond
The Permanente Journal
Winter 2003 Volume 7 No.1
Kaiser Permanente Institute for
Health Policy
Many years ago Today
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e-Infrastructure for the Future of Diagnostics
4 November 2011

5. ‘The complexity of modern medicine exceeds the
inherent limitations of the unaided human mind.’
David M. Eddy
MD, Ph.D.
Patient
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e-Infrastructure for the Future of Diagnostics
4 November 2011

6. Meaningful use criteria reinforcing the need for
the Patient Centered Care Team
Care • Exchange key clinical information electronically
Document exchange of meds,
problems, allergies, labs, etc.
• Perform medication reconciliation for 80% of encounters
Coordination • Provide summary care record for 80% of care transitions
w/discharge summary
Portals for provider access
Document exchange of meds,
Engage • Provide patients w/electronic copy of health information
• Provide timely electronic access w/in 96 hours
problems, allergies, labs, etc.
w/discharge summary
Patients • Provide clinical summaries for each office visit
Portals for patient access
Improve • Leverage clinical decision support & interaction checking
• Send reminders to patients, outreach, reduce disparities
Decision support based on HIE
Alerting & secure messaging
Quality • Report ambulatory measures to CMS or states Quality reporting
• Protect electronic health information through technology Highest security standards
Privacy • Review security risks and implement security updates Audit trail of all HIE accesses
Document submission to state
• Submit electronic data to immunization registries
registries
• Electronically submit reportable lab results
Public Health • Provide syndromic surveillance data to public agencies
Quality reporting
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e-Infrastructure for the Future of Diagnostics
4 November 2011

7. The virtualization of the bricks and mortar of the
Healthcare delivery setting:
• Digitation & Connectivity of Data: Accessing and
integrating information from multiple sources

8. Data Interoperability
Why is it important?
• Real-time access to relevant
clinical intelligence across the
community
• Improve quality & coordination
of care with. Government
• Prepare organizations for
advanced stages of Meaningful
Use and an Accountable
Care model.
eHealth offers:
• eHealth Info Exchange
• eHealth Community Desk
• Centricity Patient Online
• eHealth Image Exchange
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e-Infrastructure for the Future of Diagnostics
4 November 2011

9. Population Health Management & Community of
Care Network Hospital Community Health
Center
Group Care Granular Care / Case
Network & Portal Information Managers
Practices Communication Exchange
Applications
Surveillance eReferrals
Services
Population Mgmt / Information
Analytics PATIENT Reconciliation
Decision Support /
Patient Image
Event Alerts Exchange
Care
Registries
Management
(disease, vax)
Medical
Home
Other HIE
Family
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e-Infrastructure for the Future of Diagnostics
4 November 2011

10. eHealth Community Desktop
A web-based clinical portal that enables collaborative care
across a community of clinicians without EMRs
Widen community access with an easy,
browser-based user interface
Enable care teams, including case
managers, to facilitate care coordination
Bring various in-house applications
together in one place
Extend your HIE investment over time
with add-on workflow and performance
apps
Increase HIE use with flexible screen
layouts to match your look-and-feel
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e-Infrastructure for the Future of Diagnostics
4 November 2011

11. Patient Engagement – Centricity PT online
Patient Online is a single channel of communications that
extends the provider workflow to the patient’s home to
reduce costs, increase quality, and increase access to care.
Strengthens the HCO’s
market/competitive position
Improves efficiency of the
patient management process
Strengthens the patient-
provider relationship
Extends the HCO’s reach for
proactive care management
Enables HCO’s to meet all
ARRA criteria for patient &
family engagement
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e-Infrastructure for the Future of Diagnostics
4 November 2011

12. Community Desktop
Image Exchange
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e-Infrastructure for the Future of Diagnostics
4 November 2011

13. The virtualization of the bricks and mortar of the
Healthcare delivery setting:
• Advanced Data Processing & Information Fusion:
Turning “Insight” into Action

14. + +
Mayo
Key Partners:
Intermountain Healthcare
Mayo - Rochester
Holistic approach
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e-Infrastructure for the Future of Diagnostics
4 November 2011

15. Holistic approach to Data
Knowledge
Workers
Knowledge Repository
Maps Models Codes Rules Constraints Queries Forms
HL7
XDS
ATNA Interface
Manager
PIX
1 Interface (e.g. Terminology Unified Data Applications
PDQ HL7) to Model Translation, Repository of Assembled from
Transforms Decision Models & User Generated
CDA Support &
Business Rules
Terminology
Based Data
Alerts, Queries
and Forms
2 3 4 5
Standard Models & Coded, Computable Configured by Shareable &
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Terminology Clinical Data Knowledge Workers e-Infrastructure for Assets of Diagnostics
Reusable the Future
4 November 2011

16. Transforming data into insight: Advanced
processing & Information fusion
Clinical Data Fusion: Qualibria Terminology Services
The Terminology Foundation contains services and rich
management tools for code mapping, browsing and querying:
•Loadexternal code systems, including: SNOMED-CT, LOINC, ICD-9, ICD-10, CPT, RxNorm, HL7
Vocabularies, HCPCS, Genomics Ontologies, NCI Metathesaurus, Open Biomedical Ontologies,
etc.
Many entry forms for
one concept
• myocardial infarction
• MI
• S/P MI 1987
• hx of heart attacks
4500 Elemental terms
available today
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e-Infrastructure for the Future of Diagnostics
4 November 2011

17. Value Created by Cardiology Program
Defining the best practice clinical protocol
• Impact of Discharge Med Program on Heart Failure
Readmissions/Mortality
• ACE inhibitor prescription at hospital discharge increased from 65%
to 95% in 5 years
• How did these Intermountain heart failure patients do?
• One-year readmissions reduced from 46.5 % to 38.5%
• 551 readmissions prevented per year
• $2,480,000 saved based on avoided
readmissions
• One-year mortality rate reduced from
Dr. Don Lappe 22.7% to 17.8%
Chair, Cardiology
• 331 lives saved per year
• Quality is cheaper, safer, better all around ! 17 /
e-Infrastructure for the Future of Diagnostics
4 November 2011

18. Acute Care Program demonstrated Proof of
Ventilator Weaning Protocol Effectiveness
• Acute Respiratory Distress
Dr. Alan Morris, LDS Hospital Syndrome (ARDS) survival rate
used to be <10%
• Intermountain physicians
created a software based
protocol to help patients wean
from the ventilators faster
• Patients weaned a full 24 hours
Outcome Physician Protocol
earlier than before from
Median Weaning Time 28 8
(hrs)
ventilator
Time on Ventilator (hrs) 118 94 • Acute Respiratory Distress
Blood Gas Orders 93 45 Syndrome survival rate
Chest X-Ray Orders 12 3 increased from 10% to over
44%
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e-Infrastructure for the Future of Diagnostics
4 November 2011

19. Healthcare associated infections: Qualibria
Annual U.S. cost of healthcare associated
infections
1.7 million occurrences
A 250-bed
$35 billion
hospital…
99,000 lives
473 occurrences
$11 million
27 lives
Annual Cost in Lives by Cause (US)
124,583 $9
$8 US
99,000 $635.0
Per capita HC exp. (000)
$7 Japan
72,449 $6
Germany
56,326 $5
40,598 $4 UK
29,093 $3
Spain
$2
$1 China
Prostate Breast Influenza Diabetes Healthcare Chronic $-
cancer cancer associated lower 0% 5% 10% 15% Brazil
infections respiratory
diseases Healthcare infection rate
For GE internal use only. Not for external distribution 19 /
e-Infrastructure for the Future of Diagnostics
4 November 2011

20. • Disseminate best
practices
• Increase adherence to
protocols
• Decrease time on
ventilator
• Improve medication
utilization
• Reduce length of stay
• Decrease patient costsGE internal use only. Not for external distribution
For
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e-Infrastructure for the Future of Diagnostics
4 November 2011

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e-Infrastructure for the Future of Diagnostics
4 November 2011

22. 22 /
e-Infrastructure for the Future of Diagnostics
4 November 2011

23. Real-time best practice dashboard
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e-Infrastructure for the Future of Diagnostics
4 November 2011

24. The virtualization of the bricks and mortar of the
Healthcare delivery setting:
• THE FUTURE is sooner than you think: Empower every
person to live an independent, confident, healthier life
through connected technologies

25. Achieving Patient & Population Health
Management
Proactive
Interoperability Collaboration Analytics Accountability Population
Management
Cost &
One Patient, Communication Population Care
Utilization
One Record & Transparency Stratification Management
Management
Resource Health
Workflow Care Predictive
Management & Maintenance &
Integration Transitions Modeling
Productivity Wellness
Guideline &
Actionable & Patient Evolving Care
Gaps in Care Standards
Usable Systems Activation Plan
Driven
Longitudinal
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e-Infrastructure for the Future of Diagnostics
4 November 2011

26. e Health - Beyond HIE Information Exchange
Care Management targets the sickest-of-the-sick (5% of US pop = 49% of cost)
Hospital Community Health
Population Health Center
Management &
Community of Care Care / Case
Group Granular
Care Network Practices
Network &
Communication
Portal Information
Exchange
Managers
Applications
Surveillance eReferrals
Services
Geisinger Health Plan
Geisinger’s Proven Population Mgmt / Information
Reconciliation
Health & ProvenCare Analytics
• Preventative care bundle Patient
Decision Support / Image
9.2 14.7% Event Alerts Exchange
• Aligns incentives across Care
Registries
provider, patient and payer Management
Medical
(disease, vax)
• 18 % admission, 36% Home
Other HIE
readmissions
Family
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e-Infrastructure for the Future of Diagnostics
4 November 2011

27. The Medical Quality Improvement Consortium (MQIC)
MQIC is a continuously updated database of 20 million unique, de-identified
patients – aimed at helping identify and inform industry best practices
• Make data-driven decisions at the point of care
• Enhance management of specific conditions
and populations
• Benchmark against similar practices for quality
of care information
• Participate more easily in PQRS, CMS eRx, and
Bridges to Excellence Diabetes Recognition
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e-Infrastructure for the Future of Diagnostics
4 November 2011

28. Chronic Disease Example
Anomaly detection and guidelines decision support
Personalized weight gain
detection algorithms
Moving Averages Example
230 70
220 60
210 50 weight
200 40 short-term ave
long-term ave
190 30
difference
180 20
Search f or best l ong-t erm window and cut off
170 10
Alert limit 9 0.0%
160 0 8 0.0%
Stable fit
7 0.0%
150 -10 6 0.0%
sea rch
5 0.0%
T ru e
Base lne
i
Only 2 day s war ning Pro spects
140 -20 4 0.0%
3 0.0%
on e v nt # 2
e New winner
8/11 9/30 11/19 1/8 2/27 4/18 2 0.0%
1 0.0%
0.0%
0 .0% 0 .5% 1.0% 1.5% 2.0% 2.5% 3.0%
F alse
Scale Precision Accuracy Compliance e
Effe ct of Patient Complianc
Effect of scale precision E ffect of Measurement Accuracy
70% 5% 70% 5% 80% 5%
60% 60% 70%
4% 4% 4%
50% 50% 60%
Fal se Alert %
Fal se alert %
Fal se Alert %
T rue alert %
True alert %
True al ert %
3% 3% 50% 3%
40% 40% TRUE TRUE TR UE
40% FALSE
30% 30% FA LSE 2% FALS E
2% 30% 2%
20% 20%
1% 20%
1% 1%
10% 10%
10%
0% 0% 0% 0%
0% 0%
0 1 2 3 0 1 2 3 50% 60% 70% 80% 90% 100%
S ca le Preci si on Extra noi se in readi ngs (un it=1lb stdev) Comp li can ce: % days wei ght record ed
Home Health Data Detection
Algorithms
Chronic Disease Monitoring
Beta Blockers
Application BB:br adycardia
Taking bet a
blocker?
[21]
no
yes
[38,53]
input
codes
Br adycardia? 2 n d o 3 rd
r BB:titrat ion
(pulse < 60) de g e heart
re
block? (E KG) [82]
[43]
Pulse > 60?
Br adycar dia? Pat i nt n ds
e ee [43]
(pulse < 50) imme di te a te ntio
a t n.
[43]
Discont i u be ta
ne
blocke and othe r
r Lower than
Bradycar dia?
dr u that may cause
gs
(pulse < 55) target dose?
he tblock (di oxin,
ar g
and CCB, sotal l,
o [21]
upt it rat ing amiodarone ) BB:fatigue
on BB? BB:HFsymptoms
[21,43] Consi er cardiol gy
d o
r e fer ral (pac mak r ).
e e Highe r dose
alr e ady tr ie d?
Possibl to
e BB:he artblock Wit hin 2 w e eks S e ve re fat igue ?
[21]
de cre as ot h r
e e aft er BB (act ivit y-r e late d
Or de r E KG medst ha may
t initiat ion / que stions)
cause upt it rat ion? 4 we e ks si ce
n
for he ar t rhyt hm. bradycar di ?a [64] last tr y and OK
Pe r for m (digoxi , CCB,
n [21] t o re - ry (not
t
TS H/digoxin labs . sot al l,
o pr e vi usly
o
amiod arone ) BB:l ungpatient de cre as d or
e
[25] discon inued
t
Fatigue for dyspne in a
Dyspnea in l ng
u lung patie )? nt
laste d
pat i n wi hi 2
e t t n F luid [21]
daysafte r B B ret o n?
enti for ove r 6
Consi er
d S ymptoms of initiat ion? we e ks?
br adycar di ?
a [64]
de cre asi g no
n n- [21,66,84] 1-4 we e ks
HFme dstha t (Dizzine ss?
may cause Lighthead d-
e passe d since
bradycar di a ne ss? Fatigu ?)
e last
[60,62,64] incre ase ?
Conside r
discontinuing BB. [21]
Conside r Conside r de cr easing
incr easing be ta blocke r.
Pulse <
Conside r swit ching diure t ic(s).
45?
t o cardiac-se lect ive Conside r ot he r Conside r
[43]
BB. Conside r sour ces of fat igue incr e asing be ta
de cr e asing be ta (thyroid, de pre ssion, blocke r.
Conside r de cre asing or discont inuing BB. Conside r blocke r s. wor se ning HF, sle e p Consi e small r
dr e
Pe rform TS H/ digoxin labs. spir ome tr y. apnea, ane mia) incre m ents ift his is
Conside r car diology re fe rr al a re-try.
(pace make r).
GE Confi dential & Proprietary
Electrolytes
Medical Guidelines
Medical Records Advanced Data:
Activity
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e-Infrastructure for the Future of Diagnostics
4 November 2011

29. Physician to the Patient Chronic Dx Management
Approach
Tiny Sensors pick up activity data in the residence and Basic Package
send to GE Server
The Algorithm
knows if the activity
is “normal” – if not, Intelligent software:
an alert is created Z-wave technology alerts, algorithms, etc.
and sent to
caregiver
Benefits
• Peace of Mind for
Family
• Customizable Alerts
• Delay of Continued
Care/Skilled Nursing
• Extended Care
The Well Check is Coverage without
Made and the loop is additional staff
Closed • Attraction/Retention
of residents
Patient Level Tools for the Care Team 29 /
e-Infrastructure for the Future of Diagnostics
4 November 2011

30. Technology Enablers
Healthcare Desires Technology Enablers
• Flexibility – systems for full acuity range; • Miniaturization
equipment stays with patient (Nano, MEMS, EE, RF, CMUT)
• Efficiency – productivity and improved • Sensors/Parameters
quality/reduced errors (Fusion, Implants, New Types)
• Home/Remote Monitoring – also disruptive • Wireless Technologies
to Hospital Monitoring (Reliability, Capacity, Power)
• Wearable – “Don’t know it’s there” • Expert Systems
(Intelligence, Decisions, CAD)
• Tracking – Patients, Parameters, Assets,
Employees • Info/Data/Apps Architecture
(Workflow, Integration, Apps)
• Extremely Wireless – Zero Wires
• Use/Human Factors
• New Sensors /Parameters /Disease States
(Goof Proof, Ease of Use)
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e-Infrastructure for the Future of Diagnostics
4 November 2011

31. Home Health Activity
Heart Failure
• Actigraphy sensors
• Correlated to HF status healthy
• 60 person field trial
• Columbia University
Activity as a Vital Sign
Fall Risk Assessment
Sleep disorder
• Research effort
• “Automate” PT instruments
• Daily assessments
• University of Mo. – Columbia
Prevent Falls Thru Identification Dementia the Future of Diagnostics/
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e-Infrastructure for
4 November 2011

32. GE HCIT: Chronic Dx, Social Networking & Consumerism
Solving disparity of care challenges
Enterprise Direct To Consumer
Corporate Stakeholders: Pharma, Employers Existing NBC health
• EMR based intervention studies enables outcomes driven ecosystem
brand/marketing strategies
enables broad & localized
Consumer reach
Model is proven,
enables our ability to extend SHARED
to adjacent stakeholders INFRASTRUCTURE
[CDS + Clinical HIE + Consumer
Decision Support + Motivation]
HEALTH-WEALTH IMPACT
eHealth Health@Home
Physicians, Hospitals, IDNs, RHIOs
• Leverages the richness of the physician to patient interaction; Connects HCIT within the home
enables longitudinal approach to care
to enable care and communicate
w/ patient/family members
Health information Disease
management tools
POL POL is an existing
building block
to access Centricity IB
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Physicians & patients e-Infrastructure for the Future of Diagnostics
4 November 2011

33. The Dundee Courier, 13th April, 2007
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e-Infrastructure for the Future of Diagnostics
4 November 2011

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e-Infrastructure for the Future of Diagnostics
4 November 2011

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e-Infrastructure for the Future of Diagnostics
4 November 2011

36. Many diseases have an underlying genetic
connection
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Detail of Gene - Disease Network e-Infrastructure for the Future of Diagnostics
Goh et al. PNAS4 104 (2007) November 2011

37. Alzheimer’s Clinical Data AD BioSignature
Prognostic Modeling
Rate of Cognitive Time To Survival/Progression
Decline Progression/Death Probability
• Early diagnosis
• Personalized treatment
• Therapy monitoring
AD Prognostic Model Clinical
In-vivo Imaging
Informatics
PET, MRi, SPECT
APOE4 (>0)
Cognitive
%Supra. CNS (+)
Intracranial
Genetics Clinical
%Supra. CNS(-)
%Ventricular (-)
IVD, Genetics,
circulating markers %Ventricular (-)
%Subar. CSF
Team of 10+ research scientists %TemporalCSF (-)
%Subar. Lobe (+)
committed in 2011
Algorithms, statistics, informatics %Total HSIA (-)
%Temporal Lobe
%Hippocampal(-)
%Total HSIA (+)
Adak, Illouz, Gorman, Tandon, Zimmerman, Guariglia,
Moore, Kaye, “Predicting the rate of cognitive decline in %Hippocampal
aging and early Alzheimer disease”, Neurology. 2004 Jul 37 /
13;63(1):108-14. e-Infrastructure for the Future of Diagnostics
4 November 2011

38. July 4th Boston: USS Constitution (Old Iron Sides)
Thank you
mark.dente@ge.com
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e-Infrastructure for the Future of Diagnostics
4 November 2011