Advances in Mobile Computing Emerging Technology in eHealth Development Third Annual eHealth Developers' Summit Novembe

1. Advances in Mobile ComputingEmerging Technology in eHealth DevelopmentThird Annual eHealth Developers' Summit November 6 – 8, 2002, Tempe, Arizona Jeff Sutherland, Ph.D.Chief Technology Officer http://www.patientkeeper.com/ Jeff.sutherland@computer.org Turning the Promise of Mobile Computing into a Reality

2. Truckers can do it!They are concerned about survival. 2 out of 3 trucking companies have disappeared in recent years Survivors tract costs down to every activity that matters on the loading dock and the truck Roadway Express sorts shipments from many customers and terminals, then loads rearranged goods into outbound trailers A barcode swipes the waybill, the location, and the ID badge of the loader. Years ago this would have been scrawled on paper. What will happen to hospitals who can’t do this in the next decade? The patients? Cone, Edward and Carr, David. Unloading on the Competition. Baseline, Oct 2002

3. On-Going Learning Required! • The average large healthcare delivery system does not bill for >10% of procedures rendered. As a result, many are losing money, losing staff, and losing quality of care. • Medical error is the third leading cause of death in the U.S. after heart disease and cancer [JAMA, July 26, 2000, p 483]. Most of the largest group of lives lost, caused by medication error, can be saved by having the right information at the point of care. • Mobilization of medical data is the fastest (and perhaps only) path to physician adoption of critical automation. Taking advantage of financial and clinical improvement opportunities depends on it. • The right data on the right patient, at the right time and right place, for the right person is key to efficient operations and patient safety. • The burden of harm conveyed by the collective impact of our healthcare quality problems is staggering… Our present efforts resemble a team of engineers trying to break the sound barrier by tinkering with a Model T Ford. National Institute of Medicine, 2001

4. Lots of lives to save • Medical error is the 3rd largest cause of death in the U.S. exceeded only by heart disease and cancer. (JAMA, July 26, 2000, p 483) • 12,000 deaths/year from unnecessary surgery • 7,000 deaths/year from medication errors in hospitals • 20,000 deaths/year from other errors in hospitals • 80,000 deaths/year from nosocomial infections in hospitals • 106,000 deaths/year from adverse effects of medications (4th leading cause of death) • 50-90% of medication errors can be eliminated at time of installation of automation at the point of care. • “There is a growing conviction in all hospitals, even in those which are best conducted, there is a great and unnecessary waste of life. “ Florence Nightingale, 1859

5. Mobile Patient Safety Solution • Increases Revenue • Reduces Medical Errors • Improves Quality of Life: Extra Time for Doctor

6. ChargeKeeper ROI StudyNorth Shore/LIJ Health System • Study Background:86 Inpatient Physicians / 22 Departments Participated in Study • Results: • $888 increase in revenues/physician/month, primarily revenue captured that was previously lost through manual, inefficient processes ($1 million annually for physicians in study group; $3.5 million when applied across potential user base) • 4.9-to-1.0 benefit to cost ratio demonstrated (cash flow) • Excludes decrease in lag time: 8 days • Excludes enhanced productivity/workflow • User Satisfaction Survey: 4.5 on scale of 1-to-5

7. Proven ROI – Increased Revenue AnnualRevenueIncrease Benefit toCost Ratio Participants

8. Is There Really a Problem? More than one million medication related errors occur in US hospitals each year. Dispensing Transcribing Administration Ordering Source: Gartner Group, Healthcare Business and IT Summit, April, 2002

9. Mobile Patient Safety Solution • Increases Revenue • Reduces Medical Errors • Improves Quality of Life: Extra Time for Doctor

10. Decision Support at Point of Care HOW DO WE DO THAT? I WANT & NEED: Access to only the data • Right Data • Right Time • Right Place • Right NOW

11. Decision Support at Point of Care PERSONALIZEDInformation: • StatusKeeper: MY “Inbox” of new patient data • The most recent clinical results for only MY PATIENTS • LabKeeper: Access to “MY patient’s” lab result • “Flag” an important lab to remain on the PDA • Create personal lab panels with customized timeframes • Display only critical results • RxKeeper: Access to “MY patient’s” medication profile • View only new, active, D/C or “held” medications • NoteKeeper: Access to “MY patient’s” clinical notes • View by desired note type: progress, admitting, discharge, H&P, RN, consults, etc. • TestKeeper: Access to “MY patient’s” diagnostic test • Only the test results I WANT – micro., path. and X-ray • Key word search for desired text • DxKeeper: Access to “MY patient’s” Problem List • View by problem category, i.e., resolved, inactive, etc.

12. Reducing Medical Errors – Step 1Aggregate Results from Backend Systems MobilePatient Index (mPI) MobilePatient Index (mPI) CoreApplication Components Demographics AlertKeeper DesktopCompanion Clinical Suite ChargeKeeper • Capture charges at the point of care with advanced code edits and transaction management. • Quick access to critical results and patient information. • LabKeeper • DxKeeper • RxKeeper • NoteKeeper • TestKeeper • AllergyKeeper • VitalsKeeper • OrderStatus • StatusKeeper

13. Reducing Medical Errors – Step 2Update Selected Results on Backend Systems MobilePatient Index (mPI) MobilePatient Index (mPI) CoreApplication Components Demographics AlertKeeper DesktopCompanion Clinical Suite ChargeKeeper • Capture charges at the point of care with advanced code edits and transaction management. • Quick access to critical results and patient information. Update relationships. • LabKeeper • DxKeeper • RxKeeper • NoteKeeper • TestKeeper • AllergyKeeper • VitalsKeeper • OrderStatus • StatusKeeper

14. Order Capture – Step 3 Generate electronic orders • Order capture based on: • Simple and intuitive based on order sets for majority of orders • Mobile order capture a hybrid application: • Most data resides on the device from synchronization • Multiple transactions occur in real time for order submission • Drug interaction checking and decision support rules sent to the mobile device works in tandem with backend clinical systems. • Real time transaction submits order to appropriate back end processor; back end alerting and messaging sent to the mobile device provides warnings and order status. • When connectivity not available order is queued on mobile device for immediate processing when backend available.

15. Malcolm, B.; Carlson, R.A.; Tucker, C.L.; Willette, C. Veterans Affairs: Eliminating Medication Errors Through Point of Care Devices. Proceedings of HIMSS 2000, Session 73, Dallas.

16. Mobile Patient Safety Solution • Increases Revenue • Reduces Medical Errors • Improves Quality of Life: Extra Time for Doctor

17. Quality of Life Question: How much better is your workday when you can find your patients on rounds and you have their information at your fingertips?

18. Quality of Life Question: How important is it for you to see abnormal and critical lab values as soon as the results are available?

19. Quality of Life Question: How much additional comfort would you have knowing you had the most current critical patient information?

20. Quality of Life Question:How much time would you save if only the data you wanted to see, on only your patients, was sent to you – REAL TIME?

21. “The Proof is in the Pudding” • "Glens Falls is a community hospital offering a wide range of specialty treatment through a number of regional facilities. Within months, we will have a fully installed CPOE system, accented and supported by remote, mobile enterprise capability offered by PatientKeeper of Boston. • PatientKeeper Enterprise mapped perfectly to our clinical IT strategy in two ways:     • At Glens Falls, we believe that you have to leverage technology to advance technology. • If our physicians aren't driving it, we won't put our money in it.Our doctors want mobile capability and find PatientKeeper incorporates clinical decision support into their workflow easily and seamlessly from wherever they are in the Glens Falls region. 

22. Mobile Patient Safety Solution Improves Quality of Life: Extra Time for Doctor Increases Revenue Reduces Medical Errors Provides a robust platform for independently authored third party applications which interoperate with clinical systems.

23. Mobile Platform Requirements:Aggregate, Integrate, Interoperate aggregate integrate interoperate • A common mobile platform is required to third party and end user applications on a single device. This allows standardization of data for reporting and organization wide implementation of quality initiatives. • Open standards are required to independently authored third party applications on a single handheld device. Physicians want single signon, patient context management, and seamless interoperability of patient data modules. • Supporting a faster, cheaper, mobile solution for patient safety initiatives requires an open mobile platform that allows independently authored applications to ,integrates with previously installed systems, and supports evolutionary replacement or upgrade of existing infrastructure.

24. PatientKeeper PersonalTestbed of 45,000 Clinical Users • All essential medical data on a Palm Pilot or PocketPC. • Designed to integrate with global medical data system. • Provider care, home care, and military care. • Harvard Medical School students are graded on information in this application. 100% adoption.

25. Platform Benefit:Managing Application Portfolios • TaskKeeper • NoteKeeper • PlanKeeper • RxKeeper • Procedure-Keeper • 3rd Party Apps • ChargeKeeper • LabKeeper • DxKeeper • InfoKeeper • MemoKeeper • 3rd Party Apps Personal Applications Enterprise Applications mPI One Mobile Device One User Interface Any Device • Any Transport • Ethernet cradles • 802.11 • Bluetooth • Cellular Single Signon Context sharing Hard encryption

26. Mobile Platform Features MultipleDevice Types N Applications SDK SingleSign on ApplicationInteroperability Patient ContextManagement MobileDevice Security Application Framework Handheld Data Store MobileCommunications MobilePatient Index Mobile Services Transport:Wireless orEthernet HIPAA Security Web Facilities CentralAdministration Messaging& Alerting Personalization Transactions Web Services Integration Interfaces JAVA XML HTML Business Logic Patient Objects Cerner Wellogic UCR/Meditech Adapter Components/Open API CareGroup Mobile Legacy Integration Mobile ClinicalRepository MobilePatient Index

27. Layered Security Mobilizer Platform Components • Secure storage • Secure transmission • Audit trails and non-repudiation • Authentication • Token-based IR beaming of data • Mirroring of HIS permissions • Certification of applications PatientKeeper’sSoftwareDevelopment Kits Common User Interface Messaging& Alerts DataSharing InfraredPrint BarcodeScanning Security Encryption & Transport Wired Wireless Encryption & Transport CentralAdministration Personalization Security Audit Trail Reporting Clinical DataRepository HIS –Scheduling HIS –Pharmacy HIS –Billing HIS – Lab Back-End Systems

28. Platform Solutions PatientKeeperLite Solution PatientKeeper/Cerner Solution PatientKeeper/UCR Solution PatientKeeper Handheld PatientKeeper Handheld PatientKeeper Handheld UCR NetResultDesktop CernerDesktop PK Desktop PK Mobilizer PK Mobilizer PK Mobilizer WDAC UCR NetResult Server Millennium Objects XML / JAVA Transactions DBOne MediTech Magic System CernerMillenniumRepositories Synapse MediTech Magic Repositories Incoming HL7 Messages

29. SDK Expands Portfolio TaskKeeper TestKeeper Mobile PatientIndex (mPI) VitalsKeeper ChargeKeeper ScribbleKeeper ProcedureKeeper LabKeeper RxKeeper DxKeeper PlanKeeper MemoKeeper InfoKeeper DemograhicsKeeper NoteKeeper statcoder Medical Reporting mobileMICROMEDEX MobilizerSDK Developedby PatientKeeper Developedby Third-Party

30. Driving Platform Leadership:GartnerGroup Magic Quadrant Gartner, Inc. Advisory Services Draft Market RU 09/25/2002 04:01 PM Kenneth Kleinberg

31. Clinician Value Proposition • An intelligent mobile framework: • Portfolio of multiple, independently authored applications integrated on a single mobile device (More and better functionality sooner) • Common UI and patient-centricity(Increase adoption and reduce training) • Not “painted in a corner”; integrate best of breed mobile applications • Flexibility to create own applications(e.g., protocols to influence physician behavior)

32. Hospital Value Proposition • Value to hospital decision makers: • Centralized administration • Enterprise-wide controls to help manage the “organic growth” of PDAs (e.g., HIPAA) • Not “painted in a corner” • Integrate best of breed mobile applications • Develop own applications • Force another vendor to port their application to a common framework • Often PatientKeeper Personal is already in use

33. Developer Value Proposition • Value to the developer community: • Lowered barrier to entry for application creation • Shorten time to market • Create “portfolio effect” – Crossing the Chasm • A installed base to sell into & distribution channel • Leverage with component technology vendors (e.g., encryption, Infrared printing, barcode scanning, wireless networks, etc.)

34. Advances in Mobile ComputingEmerging Technology in eHealth DevelopmentThird Annual eHealth Developers' Summit November 6 – 8, 2002, Tempe, Arizona Thank You