9 Information%20 Technology%20 Sector%20 Presentation%20(F)

Information Technology Sector Highlights

Michael Gillam, M.D.Director of Research and PartnershipsAzyxxi Health Solutions GroupMicrosoft Corporation

IOM Roundtable on Evidence-Based MedicineLearning Healthcare System Workshop Series

Common Ground: Leadership Commitments to Improve Value in Health CareJuly 23-24, 2007

Members

¢ Jack Bates – Veteran’s Health Administration¢ Susan Dumais – Microsoft Research¢ Michael Gillam – Microsoft Health Solutions

Group¢ Gail Graham – Veteran’s Health Administration¢ Jim Karkanias – Microsoft Health Solutions Group¢ Jeff Sartori – Veteran’s Health Administration¢ Nina Schwenck – Mayo Clinic¢ Stephen Vinter – Google

Sector Profile

• Web-based patient/consumer information organizations/companies

• Personal health record organizations/companies & Electronic clinical record organizations/companies

• Administrative/claims data management organizations/companies

• Key cross-cutting trade associations and government organizations and initiatives

Evidence-Related Activities

l Improving consumer access to reliable health and disease management information

l Improving provider access to reliable health and disease management information

l Improving patient-provider communication and interaction

l Improving the application of best practicesl Improving provider operational effectiveness and

efficiencyl Improving the ability to manage and analyze large

quantities of datal Improving research on clinical effectiveness and

quality of care

Seven Sector Priorities

l Health IT Standardsl Common Vocabularyl Provider Workflowl Right-Time Evidence Deliveryl Clinical Decision Supportl Flexible Data Viewsl Connectivity

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Three Transformational Initiatives

l “Foundational Medical Informatics Ecosystem Initiative”

l “Core Measures in Information Technology Initiative”

l “Advanced Technical Strategies Innovations Initiative”

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Sector Priority

¢ Goal: Build and promote the foundational technologies needed to enable health IT assisted evidence based medicine.

¢ Standards & Common Vocabularyl The single most transformational step toward achieving the goal of

a learning healthcare system would be enhanced development and implementation of IT industry standards & common vocabularies inhealthcare

l Benefits• Support health IT at every level

• Building blocks for bringing computational intelligence to aid human cognition in EBM

l Barriers to utilization• NLM/UMLS/SNOMED (lexical variants, lexical and domain deficits,

allergy - RAST, bioterrorism)• Custom or commercial solutions

• Shuts out small vendors / impair innovation• MMTX - negation

l Goal:• Create the impetus from the Information Technology Industry to evolve

and implement these standards

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Slide 7

js1 List up to 3 transformational initiatives and describe (one 1 to 3 bullet points each).jskipper, 6/27/2007

Transformational Initiative #1

¢ “Foundational Medical Informatics Ecosystem Initiative”

¢ IOM support establishing a government-industry collaborative ecosystem for ongoing evolution and development of clinical IT standardsl Virtuous-cycle (i.e. eBay, Flickr, YouTube)

• More users of the standards < - >more feedback on the standardsl Ecosystem is both community and technology

• Blogs, Wikis¢ IOM support an evaluation of the technical barriers

to adoption of existing publicly supported open-standard vocabularies and tools by health information technology providers

• Initiatives to remedy technical barriers• Metrics of success are adoption and utilization

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Sector Priority

¢ Goal: Establish clinical data and analytic infrastructure necessary to enable evidence based medicine.

Library

Search

Revenue Cycle

Scanned Charts

Labs

Radiology

Old Records

EKGs

Medication Management

OR Management

AmbulatoryEmergency Department

Registration

CPOE

The notion that we can know everything and remember everything is ridiculous

Direct patient care

Otheractivities

Seekingdata

How clinicians spend time

Seekingdata

Direct patient care

Otheractivities

Heterogeneous Data

Today

¢ 1,500 live data streams from vastly heterogeneous data sources

¢ 88 Terabytes with 500 TB installed capacity

¢ Design aims for 1/8th sec response times

¢ 80,000 queries per day per hospital¢ 20,000 clinical and administrative users

Median Time in ED

012345678

1995 1996 1997 1998 1999 2000 2001

20000

40003000

1000 300 2000

5000

10000

15000

20000

1996 1997 1998 1999 2000 2001

Medical Records Requestsfrom the ED

14

40

90 94 95 100

0

20

40

60

80

100

1996 1997 1998 1999 2000 2001

PRC patient satisfaction percentile

0

10000

20000

30000

40000

50000

60000

70000

1995 1996 1997 1998 1999 2000 2001

ED Census

Transformational Initiative #2

¢ “IT Core Measures Initiative”l Goal: Establish an electronic patient data and analytic

infrastructure that is necessary to enable health IT aided evidence based medicine

l IOM convenes or supports initiatives to identify core measure metrics around accessibility to:

• Core clinical data• Example: Moonlighting and old EKG

• Core analytics• Reporting• “Mash ups”• Data visualization• Examples

• Regionalization: Microbiologic resistance• Evolving resistance patterns• Disease variation (pneumonia, meningitis)

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Sector Goals

¢ Establish an infrastructure to incentivizeongoing innovation in the evidence based medicine space.l Clinical Decision Support

• The ability to guide clinical decisions based on individual clinical and biologic data with relevant clinical evidence and experiential information gathered from mining data on previous patients with similar conditions

l “Just in time” evidence delivery l Alerts l Flexible Data views

Innovations Initiative

¢ DARPA Robot Racel Off road - Autonomous: 250 miles, 10

hoursl Year 1: $1 million prize, 21 entries, 15

finalists, $65 million by competitors• Carnegie Mellon $3 million – dozens of

corporate sponsorsl Year 2: $2 million (no winners), 118

entries, 23 qualified, 4 completed• Stanford – 50 people

l Year 3: Urban, $2 million prize, 53 teams

‘Stanley’ Volkswagen Touareg R5 TDI

Sector Initiative #3 andCross-Sectoral Collaboration¢ “Advanced Technical Strategies Innovations

InitiativeӢ IOM sponsor, support or establish demonstration

projects of advanced, strategic, evidence based medicine projects.l DARPA model for healthcare ITl Opportunity

• Multiplicative ROI• Knowledge from doing

• Robot form factors• Diverse participation – radical innovation• Goal: Challenge for the nearly impossible but

extremely valuable