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Quality and Safety through Knowledge at the Point of Care

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Presentation on theme: "Quality and Safety through Knowledge at the Point of Care"— Presentation transcript:

1 Quality and Safety through Knowledge at the Point of Care
This session is about getting from Problems to Solutions and an approach called ‘Distinctive Innovation’ to get from problems to solutions with a focus on the point of care from a consumer centric fashion. Through out this presentation we are going explore a number of problems – distinctive innovative processes and solutions from inside health care and outside Douglas Goldstein eFuturist Lead…Innovate…Transform Copyright, All Rights Reserved, Douglas E. Goldstein

2 Driving Forces Accelerate…
Driving Forces – clinical advancement….medical knowledge doubling every 1 to 3 years. Medical Knowledge --there’s too much of it. It’s rapidly changing. Some (?) is of little use. 90% of what you learn today will be obsolete in 10 years. Lifelong learning is a necessity. New tools and technologies are needed by all of us. Access to people with knowledge is as important as access to info/knowledge. People spend 25% of their time looking for stuff they need to do their jobs and manage their lives. A mounting consensus that technology can impact better clinical decision making is driving powerful trends which will promote the use of decision support. Innovation. Tablet PCs, wireless technology, handheld devices, faster computers and voice-recognition, all available to doctors, are becoming smaller, lighter and more affordable. The Internet is allowing patients to access their electronic records and enabling new communication channels linking providers, payors and patients. Spending. Fueled by national awareness following the Institute of Medicine’s 1999 study ("To Err is Human: Building a Safer Health System"), hospitals are placing a high priority on purchasing clinical systems aimed at patient safety and quality outcomes. The health IT market will grow to over $30 billion by The disease management market is already well over $500 million. Over 15 percent of physicians in the U.S. already use EMR, with growth to 30 percent expected by The decision support market could grow to $1 billion in five years. The Bush Administration has committed $100 million, and Congressional bi-partisan efforts are forming to introduce legislation, to stimulate the purchase of EMR. Pay-for-Performance. Medical informatics opinion leaders believe that one way to address high health care costs and poor medical outcomes is the use of financial incentives to motivate provider behavior change. "Well crafted payment-for-performance initiatives are worth pursuing and may lead to substantial improvements in quality of care," concluded the authors of an article in the New England Journal of Medicine ("Paying Physicians for High-Quality Care", January 22, 2004). ANNUAL DEATH TOLLS FROM MEDICAL ERROR, TREATMENT, OR EXPOSURE… 106,00 Adverse reactions to properly prescribed prescription drugs 80,000 Infections in hospitals 20,000 Other errors in hospitals 12,000 Unnecessary surgeries 7,000 Medication errors in hospitals 199,000 Deaths from medical error in outpatient caren       TOTAL - 424,000  ANNUAL DEATHS  Reported in JAMA 2003 THEREFORE THE MEDICAL SYSTEM ITSELF BECOMES THE 3RD LEADING CAUSE OF DEATH IN AMERICA BEHIND HEART DISEASE AND CANCER! The quality program, which evolved in the late 1990s from a decades-long initiative to combat Medicare fraud, is operated by the Center for Medicare and Medicaid Services, which in turn contracts with 40 private firms known as Quality Improvement Organizations. These QIOs actually conduct the education efforts. The multibillion-dollar program aims to address the enduring problem that many patients don't get the most effective and up-to-date treatment. In fact, research shows that patients in the U.S. receive only half the care recommended by medical evidence. To improve that bleak statistic, the federal program educates health-care professionals about best practices in medicine that can improve patient outcomes. The efforts -- such as starting antibiotics for pneumonia patients within four hours of arrival at the hospital -- can lead to fewer days spent in the hospital and lower death rates. Understanding Quality Fatigue! In an article called “Managing Your Organization’s Key Assets: Knowledge,” J. Fitchett wrote that the healthcare industry is essentially knowledge based. “The quality and efficiency of work performed in healthcare institutes depends on their ability to both manage internally created knowledge about patients, i.e. healing practices, and available experiences as well as to enrich and integrate it with relevant external knowledge created worldwide by related institutes.” Get that? The quality of the healthcare you get depends directly upon your caregiver’s ability to “manage” internal knowledge about the patient and “enrich and integrate” it with external knowledge from some network of expertise. Your health depends upon knowledge management. When you put it that way, I bet you take it a little more seriously. (Smith 1996). It is reasonable to say that a doctor suffers from information overload. “Furthermore, most of the information doctors use when seeing patients is kept unrecorded in their heads and unfortunately some of this information is out of date or wrong. ‘New information may not have penetrated and the information may not be there to deal with patients with uncommon problems.’ “These problems have become more serious as the rate of change in medical knowledge has accelerated. There are new scientific findings everyday, and at the moment the amount of medical knowledge is estimated to increase fourfold during a professional lifetime (Healthfield and Louw 1999), which inevitably means that ‘doctors cannot practice high-quality medicine without constantly updating their knowledge and finding information to help them with particular patients' (Smith 1996).” The inescapable conclusion is that the healthcare industry—really a conglomerate of enterprises that produces and manipulates a vast spectrum of knowledge from mainly discrete and disconnected sources—Is awash in information, and challenged badly to leverage it into useful, actionable knowledge. It is information rich but knowledge poor. Medical errors in hospitals cause as many deaths each year as would 500 airline crashes--up to 100,000, according to the Institute of Medicine (iom.org). Estimates from other studies place the toll even higher. These numbers do not include fatal medical errors in settings outside of hospitals, such as outpatient clinics, nor do they include non-fatal outcomes such as injury or disability. The IOM’s 1998 landmark study, "To Err Is Human," identified the fragmented nature of medical information systems and the difficulty of providing “timely access to complete patient information” as obstacles to patient safety. The study also cited the need for better dissemination of medical information. Yet according to a more recent IOM study, "Crossing the Quality Chasm," adoption rates for comprehensive electronic health records systems are very low, and IT infrastructures remain inadequate. Keeping current A recognized source of medical errors is the long delay in moving research results that reflect the best available medical knowledge into daily practice. Evidence-based medicine (EBM) or evidence-based decision-making, advocated by the Institute of Medicine studies, relies on having good access to the latest body of research. EBM is focused on the explicit use of the best current evidence and patient values in making decisions about the care of individual patients. However, with textbooks at least five years out of date, bringing such evidence to new doctors is a challenging proposition. “Studies have shown that the treatment selected for hypertension by a given physician is correlated with the year the physician graduated from medical school,” asserts Dr. R. Eugene Bailey, assistant professor in the Department of Family Medicine at SUNY Upstate Medical University. “Physicians need to update medical evidence into their practices at a much faster rate than they have in the past.” Providers Fail to Tell Half of Patients Seeking Care About Recommended Treatments for Common Ailments – ‘Best Practice’ Guidelines Often Disregarded A comprehensive national study of health care quality has found a substantial gap between what medical scientists say is appropriate treatment for a wide range of illnesses and what medical practitioners actually recommend to their patients. According to a survey of medical records conducted by researchers at RAND, an independent health policy research organization, patients have only a 50-50 chance that their health problems will be addressed in an optimal way when they visit a doctor’s office or enter a hospital. The study showed that “underuse” of care was greater than “overuse,” with patients failing to receive recommended care about 46% of the time while 11% of patients received care that was not recommended and was potentially harmful. “We need to fundamentally re-engineer the way that health care is delivered,” said the lead author, with information technology systems, not individual health care practitioners, as the key to producing higher quality of care. The RAND study found that the quality of treatment differed markedly by disease. The percentage of time that patients got the recommended treatment for a selection of conditions was: 79% for cataracts, 76% for breast cancer, 73% for prenatal care, 65% for hypertension, 33% for peptic ulcer, and 23% for hip fracture. The percentage of time patients got the recommended intervention was: 69% for medication choices, 66% for immunizations, 62% for lab testing, 43% for getting medical history of the patients, and 18% for adequate counseling and teaching. (See table below for comparisons between RAND findings that looked at treatment practices recommended to individuals with all types of coverage and similartype findings from the National Committee for Quality Assurance (NCQA) that collects performance data from health plans.) Copyright, All Rights Reserved, Douglas E. Goldstein

3 Distinctive Innovation
Let’s Explore… Distinctive Innovation Stories Continuum of Care – Knowledge at the Point of Care …and Beyond WHAT IS DISTINCTIVE INNOVATION EXPLORE ‘STORIES’ OF DISTINCTIVE INNOVATION THEN EXAMINE THE CONTINUUM OF CARE TODAY AND TOMORROW THE BOTTOM LINE – HEALTH CARE IS KNOWLEDGE INDUSTRY – THAT DOESN’T RECOGNIZE THE VALUE OF KNOWLEDGE MANAGEMENT Knowledge management has an important role to play in reducing errors in many contexts, from monitoring product recall information to presenting current medical research and patient data. In few other settings is it more important to provide the “right information to the right people at the right time." By 2005 innovation focused knowledge workers will represent 20 to 35% of the employed workforce in developed countries (source KM World October 2002 Manage the Other Half of Your Knowledge’ Tacit – Explicit Types of Knowledge - Through improved delivery of medical information and expanded use of mobile technology, KM is helping to reduce errors and improve patient care. Copyright, All Rights Reserved, Douglas E. Goldstein

4 A Combination of Deadly Medical Errors - Josie King
In January 2001, Josie King, age one and a half, climbed into a hot bath and burned herself, but that wasn’t what killed her. She made a marvelous recovery at the prestigious Johns Hopkins Children’s Center in Baltimore, Maryland, USA, and after ten days in the pediatric intensive care unit she was well enough to move to the intermediate-care floor. It was there that a series of catastrophic medical mistakes — what her mother would later call "a combination of many errors, all of which were avoidable" — ended her life. The first sign of trouble was Josie’s desperate thirst (dehydration, it was discovered later, from a preventable catheter infection). Her mother was told not to let her drink, but when she sucked at washcloths, the staff in charge of her care did not recognize the dehydration. Then her eyes rolled back in her head, and staff members assured her mother that Josie’s vital signs were fine and children just sometimes do that. And then there was the dose of methadone, which Josie’s mother questioned as there had been a previous order for no narcotics. It was administered by a veteran nurse who said the no-narcotics order had been changed. The methadone caused Josie to have a cardiac arrest, while her mother was at her bedside. Josie King returned to the intensive care unit, where she died of dehydration and misused narcotics. Source Josie King Foundation A Combination of Deadly Medical Errors - Josie King Copyright, All Rights Reserved, Douglas E. Goldstein

5 Initial Solutions… Medical Errors... A Human Made Epidemic
John Hopkins response included dedicated patient transport teams pharmacists in ICUs, medication reconciliation at the moment of nursing discharge daily short-term goal sheets for patient rounds, relabeling of Buretrol and epidural catheters. "This problem is unlike cancer, AIDS, or other diseases, where we must wait for a scientific breakthrough in order to save lives," Sorrel King told the audience in Boston. "Hospital errors are a man-made epidemic. Nurses and doctors make mistakes, and lives are being lost. These human errors need a human solution." AMERICAN APPROACH – problem – straight to solutions without processes Did Hopkins have a process map… Do you have a process map? Do you know where the holes are in your organization systems? Are you part of IHI Collaborative? What priority does ‘Quality’ have in your organization – or are you continually being financially driven? Copyright, All Rights Reserved, Douglas E. Goldstein

6 Distinctive… Something or process is ‘Distinct’ if it’s not equal to the previous state Distinctive - adj 1: of a feature that helps to distinguish a person or thing; "Jerusalem has a distinctive Middle East flavor"- Curtis Wilkie; "that is typical of you!" [syn: typical] 2: possible to classify [syn: classifiable] 3: serving to distinguish or identify a species or group; "the distinguishing mark of the species is its plumage"; "distinctive tribal tattoos"; "we were asked to describe any identifying marks or distinguishing features" [syn: distinguishing, identifying(a)] Source: WordNet ® 2.0, © 2003 Princeton University From Wikipedia, the free encyclopedia. Two or more things are distinct if no two of them are the same thing. In mathematics, two things are called distinct if they are not equal. There are two descriptors of innovation – nature and class. Nature describes what the innovation affects – product, process or procedure. And class describes haw large the departure of the innovation is from what existed before – incremental, distinctive or breakthrough. Scale of Innovation: Incremental – Distinctive -- Breakthrough Copyright, All Rights Reserved, Douglas E. Goldstein

7 Innovation New ‘Idea’ ‘Product’ or ‘Process’ that is useful and practical ‘different’ ‘improved’ Your Ideas! Innovation = Creating New Knowledge that Works Smarter! Innovation is the introduction of new ideas, goods, services, and practices which are intended to be useful (though a number of unsuccessful innovations can be found throughout history). The main driver for innovation is often the courage and energy to better the world. An essential element for innovation is its application in a commercially successful way. Innovation has punctuated and changed human history (consider the development of electricity, steam engines, motor vehicles, et al). Economic planners now tout innovation as the route to technological fixes to the crises of capitalism (for instance, achieving environmental sustainability and cleaning up damage), and it is a central element of many policies to increase competitiveness at corporate and national levels. Diffusion of innovations theory, the way in which innovations get accepted by new groups of consumers, was pioneered by Everett Rogers, who drew from early studies by Gabriel Tarde. A powerful approach to understanding and addressing the challenges to successfully bringing innovations to market in modern highly inter-connected and networked markets was pioneered by Bhaskar Chakravorti in his book "The Slow Pace of Fast Change" [1](see reference below). From Wikipedia, the free encyclopedia. Two or more things are distinct if no two of them are the same thing. In mathematics, two things are called distinct if they are not equal. Innovation Classes - There are two descriptors of innovation – nature and class. Nature describes what the innovation affects – product, process or procedure. And class describes haw large the departure of the innovation is from what existed before – incremental, distinctive or breakthrough. Scale of Innovation – Let’s focus on Distinctive and Breakthrough Diffusion of innovations is the social sciences theory for how and why new ideas spread through cultures. French sociologist Gabriel Tarde originally claimed that sociology was based on small psychological interactions among individuals, especially imitation and innovation. Diffusion of innovations theory was formalized by Everett Rogers in a 1962 book called Diffusion of Innovations. Rogers stated that adopters of any new innovation or idea could be categorized as innovators (2.5%), early adopters (13.5%), early majority (34%), late majority (34%) and laggards (16%), based on a bell curve. Each adopter's willingness and ability to adopt an innovation would depend on their awareness, interest, evaluation, trial, and adoption. Rogers showed these innovations would spread through society in an S curve. Characteristics of product adopters: --innovators - venturesome, educated, multiple info sources --early adopters - social leaders, popular, educated --early majority - deliberate, many informal social contacts --late majority - skeptical, traditional, lower socio-economic status --laggards - neighbours and friends are main info sources, fear of debt Other adopters of diffusion of innovations theory include Geoffrey Moore.Innovation might be enhanced by following specific theories and practices such as TRIZ, the theory of inventive problem solving. "(Innovation is) an idea, practice, or object that is perceived as new by an individual or other unit of adoption." - Everett M. Rogers, 1995 "Innovation is the sequence of activities by which a new element is introduced into a social unit, with the intention of benefiting the unit, some part of it, or the wider society. The element need not to be entirely novel or unfamiliar to members of the unit, but it must involve some discernable change or challenge of the status quo." - Michael A. West; James L. Farr, 1990 Innovation according to Regis Cabral Innovation, according to Regis Cabral, for a particular network is a new element introduced in the network which changes, even if momentarily, the costs of transactions between at least two actors, elements or nodes, in the network. Sources: Cabral, R. (1998) ‘Refining the Cabral-Dahab Science Park Management Paradigm’, Int. J. Technology Management, Vol. 16, pp ; Cabral, R. (2003) ‘Development, Science and’ in Heilbron, J. (ed.), The Oxford Companion to The History of Modern Science, Oxford University Press, New York, pp Innovation in an organization The creation and development of creative ideas is of great importance for innovative firms. As Amabile et al. (1996) state: "All innovation begins with creative ideas…creativity by individuals and teams is a starting point for innovation; the first is necessary but not sufficient condition for the second". (p ). As like other researchers (e.g. Stein, 1974; Woodman, Sawyer, & Griffin, 1993) Amabile et al. define creativity as the production of novel and useful ideas in any domain (p.1155). Creativity is seen as the basis for innovation and so they define innovation as the successful implementation of creative ideas within an organization (p.1155) Copyright, All Rights Reserved, Douglas E. Goldstein

8 Is Your Innovation a Product or Process?
Types of Innovation Breakthrough Distinctive No we are not all Thomas Edisons, but we all know how to use tools. But we all need to be lifelong learners who are constantly learning to use new tools and techniques in empowered teams to address our challenges. Is Your Innovation a Product or Process? Copyright, All Rights Reserved, Douglas E. Goldstein

9 …happens in complex systems by teams working smarter with appropriate tools and technology
Distinctive Innovation -- Is improving a process (incrementally or through complete redesign) to achieve what you do with tools (methodology and appropriate technology using an improvement toolset such as Six Sigma. How many organizations represented in the room have a common quality improvement methodology that is engrained in your culture? What system are you using? Impact of Defects on Costs Six Sigma LevelDefects Per Million Opportunities (DPMO)Cost of Poor Quality 2= 308,537 Not Applicable 3 = 66, % of Sales 4= 6, % of Sales 5= % of Sales 6=3.4 (World Class)<1% of Sales Each sigma shift provides a 10% net income improvement. 2 Six Sigma = 308,357 DPMO 6 Six Sigma = 3.4 DPMO Copyright, All Rights Reserved, Douglas E. Goldstein

10 Take a Moment to… Describe a recent ‘Distinctive Innovation’ that you contributed to or developed AMERICANS – PROBLEMS to SOLUTIONS without process - e.g. 30 minute fixes, lone ranger t.v. episodes AUDIENCE INTERACTION - ILLUSTRATE THE USE OF TOOLS…AND INNOVATIONS ASK THE QUESTION____________________________AND ELICIT ‘___________________’ Share Your Distinctive Innovation with the person next to you. Copyright, All Rights Reserved, Douglas E. Goldstein

11 ER Diversion – Losing Admissions
Problem: Loss of admissions through ER diversion Solution: Two consulting engagement with outside cost of $250,000 that never got implemented or Internal Six Sigma analysis with internal team where the same people who identified the problem could also fix it Does your organization teach people to fish….or fish for them and then direct. How do you liberate the potential of people in your organization? What is going to give you the greatest ROI? Distinctive Innovation in Healthcare means liberating the potential of people by giving them the tools and support to do their jobs better which may mean redesigning broken processes that lead to so many errors. ‘We Do’ it better thus resulting in better processes, less variations, reduced errors ultimately improves outcomes ALL BECAUSE WE TRAINED AND EMPOWERED PEOPLE Copyright, All Rights Reserved, Douglas E. Goldstein

12 …it smarter, better with the right tools and technology…
We Do! …it smarter, better with the right tools and technology…

13 Knowledge Transfer …Online! Beyond Email… …Smart Collaboration
PROBLEM: LIVING IN SILOS With Distinctive Innovation -- you have system methodology to create fixes …then how do you accelerate the diffusion for rapid cycle change through complex health care organizations – Knowledge Transfer, Smart Collaboratives and Online Communities of Practice – KNOWLEDGE MANAGEMENT or a better term that Ascension Health executives use is ‘facilitated knowledge transfer’ Just look at the Health Care Advisory Board’s Business Model – reselling your own collective knowledge back to you because you pay them to ‘facilitate knowledge transfer’ but you won’t in many cases staff the same functions inside your organization. STORY 2001 CIO AROUND THE TABLE DISCUSSING SHARING TECHNOLOGY…. shares one to one, but not one to everyone! Addiction = Loss Knowledge to the Organization The fuel and tools to support Distinctive Innovation = knowledge, resources and wisdom So how do we go beyond , fax and fedex???? Knowledge and capability transfer through multi- media Smart Collaboratives = online and offline Copyright, All Rights Reserved, Douglas E. Goldstein

14 Ascension Health Exchange
Elevating Quality and Service through Knowledge Transfer and Innovation Ascension Health is doing it better online in delivering knowledge…and tools. Profiled recently by the Healthcare Advisory Board as a key strategy – Innovation Intranet! The Problem – A need to support communications and collaboration across 31 Health Ministries that include 85+ hospitals and healthcare facilities, and in critical affinity groups – such as Chief Nursing Officers, Chief Medical Officers, Clinical Excellence Team, and Ministry Operating Executives. A need to support achievement of the organization’s Integrated Scorecard Measure related to innovation advancement. The Solution – Engage Medical Alliances for planning, development, and launch of an interactive, online knowledge transfer portal - the Ascension Health Exchange (www.ascensionhealthexchange.org) - then evolve the scope of the project to include ongoing operational support. The Ascension Health Knowledge Transfer Strategic Initiative is a multi-year, enterprise-wide program designed to facilitate knowledge sharing, stimulate innovation, encourage collaboration, foster new ways of thinking within the Health Ministries, and promote thought leadership among Ascension Health associates. Its focus is to create a sustainable culture of pervasive Innovation and Knowledge Transfer to achieve Ascension Health’s 5 year Call to Action: Healthcare that’s Safe, Healthcare That Works, and Healthcare That Leaves No One Behind. In the 'Phase 0/Development' portion of this project, Medical Alliances worked with a core group of key Ascension Health leaders to interview more than 75 executives, physicians, nurses, managers, and other leaders across the Ascension Health Ministries. During these interviews, we identified needs and subsequently matched technology tools and other collaboration methodologies that would allow these leaders to share knowledge and diffuse innovations more effectively. The result was the Ascension Health Exchange: a Web-based portal with a comprehensive suite of communication and collaboration tools that include an Innovation Database, Knowledge and Community Libraries, Alerts, Events/Calendar, Links, Online Survey, Listserv, and Site Search capabilities. Ascension Health selected a Web-based, technology tool developed by Park City Solutions as the platform for the Exchange. Medical Alliances worked with Park City Solutions to customize this content and community management tool using Park City Solutions' administrative interface, as well as third party applications. For example, the open source application MailMan was initially used to provide Listserv services for Members. And, HTML pages were developed to create sophisticated content management "libraries" when the Park City tool did not meet Member needs. The Exchange originally launched in April of 2003, with an Exchange Community - available to all Members - and 5 Communities of Excellence: Chief Medical Officers, Chief Nursing Officers, Clinical Excellence Team, Ministry Operating Executives, and Healthcare Environments of the Future. These Communities of Excellence (Communities) were focused around corporate business function and/or key topics and goals. Medical Alliances professionals were, and still are, responsible for content development in the Exchange and clinical Communities. At the end of June 2005, there were nearly 30 active Communities on the Exchange - from Clinical Excellence, Supply Chain Management, and Spirituality, to Associate Health & Safety, Access Models, and Finance. These Communities are effectively supporting communication, collaboration, rapid knowledge/capability diffusion and quality improvement across Ascension Health. Value Proposition at Ascension Health Ascension Health Exchange (www.ascensionhealthexchange.org) – During development, more than 500 Innovations, Effective Practices, Best Practices and Resources were inventoried, representing the tip of the Ascension Health Innovation Iceberg. Fifty were selected for the initial population of the database. Of these, four of the innovative programs had strongly demonstrated ROIs in their first hospital deployment. For instance, a Blood Conservation Program at one hospital saved $3M and increased quality; diffusion to another 10 member hospitals holds the potential for savings that exceed $15M. Additional value propositions and metrics have been developed for Ascension Health by the Medical Alliances team and are available based on request. Results at 36 Months Growth from 5 initial Communities to 28 active Communities A total of nearly 2,700 Members from across Ascension Health A total of 439 Innovations and Effective Practices shared in the Innovation Database 12,404 Downloads of Innovations and Associated Resources 100+ HTML "Mini-Libraries" and Knowledge Bundles that provide easy access to vital resources Training, development and support of 40 Community Coordinators and Mayors Estimated annualized savings in excess of $2M with 5:1 ROI Value Management survey results indicate that Members believe the information and resources related to the Innovations and Effective Practices in the Exchange’s Database: saved research time = 44% saved time on the telephone = 32% saved time and effort implementing changes at your health ministry = 19% avoided the need for, or decrease the scope of, a planned consulting engagement = 3% saved money = 2% Copyright, All Rights Reserved, Douglas E. Goldstein

15 https://kx.afms.mil/demo
The Air Force Medical Service is doing it better to deliver knowledge online …. AIR FORCE FLASH DEMO https://kx.afms.mil/ctb/groups/dotmil/documents/afms/ctb_ swf Copyright, All Rights Reserved, Douglas E. Goldstein

16 Distinctive Innovation Bon Secours Health System QUALITY FIRST Energized by Six Sigma & Knowledge Transfer The Problem – No system wide Knowledge Transfer program to support greater efficiencies and best practices spread and no Intranet to support rapid cycle knowledge transfer to achieve the goals set out in the Premier/CMS HQI Pay for Performance Demonstration Project. The Solution – Engage the entrepreneurial healthcare experts at Medical Alliances to support planning, development and ongoing operational support using BSHSI Share and then transitioning to IRIS, an enterprise Intranet. After completing an enterprise wide Knowledge Transfer for Performance Excellence business plan the Medical Alliances team was asked to support Bon Secours Health System (BSHSI) with several key initiatives – Quality/Care Management, Supply Chain and Nursing Collaborative. BSHSI is the largest health system in the CMS Pay for Performance demonstration project being facilitated by Premier Inc. Eighteen months ago BSHSI had not selected or implemented a system wide Intranet, so within 45 days the Medical Alliances team had deployed a no license fee open source Web portal content management system (www.BSHSIShare.org) at low cost and initiated Web based knowledge transfer, online performance reporting, search, online data collection, knowledge library for approved franchise practices, Resource Topics aligned with the CMS clinical conditions where members can share on a real time basis with members and more efficient and lower cost method of holding virtual meetings. Medical Alliances works as an integrated element of the quality team as we support continuous process improvement and ongoing operational support of the knowledge transfer efforts. This Knowledge Transfer Performance Excellence (KTPE) initiative facilitates communication, collaboration and sharing among the various facilities within the Bon Secours system with the goal of improving HQI - CMS scores across the system. Medical Alliances delivers operational support for the Quality - Care Management team. We also provide training and management support for Supply Chain, Nursing, Six Sigma and a Length of Stay Reduction Initiative. Copyright, All Rights Reserved, Douglas E. Goldstein

17 Knowledge Transfer - Quality
BEFORE Distinctive Innovation... Knowledge Transfer - Quality Processes: Print Based Toolkit of Resources – Photocopied and Mailed Photocopying and distribution within local systems and Phone – for progress reporting Technologies: Paper U.S. Mail Copy machines Phones KM is quite similar in that it is a broad and systemic change process. APQC defines KM as the conscious strategy of putting tacit and explicit knowledge into action by creating context, an infrastructure, and learning cycles that enable people to find and use the collective knowledge of the enterprise. Organizations use many of the steps from APQC's Road Map to Knowledge Management Results: Stages of ImplementationTM (Figure 2) in their Six Sigma process as well (e.g., developing key strategies, designing and launching initiatives, and making sure pilots work to expand and institutionalize a process). Copyright, All Rights Reserved, Douglas E. Goldstein

18 Beyond Email to Web Services
has benefits but it creates thousands of silos knowledge and resources. Ever had trouble finding something Web Services centralizes knowledge and resources and also creates online Communities of Excellence that support knowledge/capability transfer and rapid cycle Distinctive Innovation. Distinctive Innovations - More: Today many organizations are managed by . This = ease of communication but leads to high levels disconnection because of the lack of centralization of the organization’s explicit and tacit knowledge resources. Distinctive Innovation is a systematic approach that supports rapid cycle change transformation of complex health care organizations through Knowledge Transfer, Smart Collaboratives and Online Communities of Excellence. Using multi-modal approaches including advanced Web collaboration services results in the centralization of knowledge and resources. These knowledge repositories are integrated with online Communities of Excellence that support facilitated knowledge/capability transfer and rapid cycle Distinctive Innovation. Copyright, All Rights Reserved, Douglas E. Goldstein

19 Performance Metrics Online – One Click Access

20 Less than 10 minute to complete
‘Share Resource’ – Structure Makes it Easy to Share Innovations, Tools and Resources 5 Steps Less than 10 minute to complete

21 Smart Collaboratives & Online Community of Excellence
Provides Learning/Working Environment Delivers Point of Need Supports Behavior Change from to Web Sharing Search Support Share Search Smart Collaborative Community of Excellence Innovate 365 x 24 Air space + Cyberspace Let’s focus on Search for a few minutes… Is there a powerful internal search engine at the finger tips of your associates in your organization that will let you search: Internal knowledge Access performance data Access licensed database Search the Web Etc. Imagine if you did and you could examine the thousands of search strings every day being inserted into the search engine by your associates… EG --- Google collects intelligence on 2 billion searches a month – DO YOU KNOW THE POWER OF THIS? THREE LEVELS OF HEALTH CARE SEARCH KTPE Search Level #1– Your internal answer to ‘Google.’ In the first phase, KTPE Search delivers effective browse and keyword search of the internal knowledge and innovation resources deposited in the online Web portal and any Collaborative databases. KTPE Search Level #2 - Integration Engine – In the second phase, KTPE Search expands the internal search to external licensed databases and the Web. After systematic analysis and software integration, external databases (e.g. clinical outcomes measures database, financial reporting, market statistics, customer satisfaction, etc.) would also be accessed with a single sign-on approach. External licensed databases include entities such as Hayes, Healthcare Advisory Board, SG2, Health Technology Center, etc. KTPE Search Level #3 – Internal Search – Today it’s easier to search five billion Web pages external to your organization through Google then it is to search the hard drives of every computer in your organization. The ‘Internal’ search strategy properly planned and executed promises to unlock the intellectual capital resources sitting in your organization’s computer networks. Knowledge Collaborate Copyright, All Rights Reserved, Douglas E. Goldstein

22 Current State Point of Care Right Knowledge Right Person Right Time Right Form Right Technology Real Fast Beyond the 3 R’s to the 6 R’s Copyright, All Rights Reserved, Douglas E. Goldstein

23 Provider Centric Continuum of Care
This is the focus today – A Production Focus – A provider centric focus. Now this is necessary because of the structure of the financial and reimbursement system This is the practical present…and we have a ton of work to figure out how to get knowledge at the point of care to help heal. It’s a big challenge to figure out how to change processes and workflow to deliver medical information at the Point of Care POINT OF CARE ENHANCEMENT EXAMPLES --For instance here is an ICU bed that is capable of complete ICU monitoring (Smart Bricks – Smart Beds) --Smart Phone --Wiring the Provider --Infobutton In fact this entire conference is dedicated to knowledge at the point of care and figuring out how to use TOOLS – TECHNOLOGY AND MOST IMPORTANTLY THE ABILITY DISTINCTIVELY INNOVATIVE THAT LIVES WITHIN EACH OF YOU. CONCURRENT SESSION EXAMPLE #1 INFOBUTTON - Solutions are being created such as the MicroMedex Infobutton I trust all of you are up to the challenge otherwise you would not be here in Vail today. So what I want to do with the remaining time is to discuss what I believe is the most disruptive innovation in health care that is on the radar screen and go a bit into the future and discuss a critical paradigm shift that is absolutely necessary in how we view patients and deliver care! OR Room of Tomorrow Smarter technology such as voice activated equipment Integration of OR and hospital information systems Overhead fixtures supporting surgical equipment Techniques and Devices of Tomorrow Image guided surgery – real-time imaging with MRIs Robotic surgery New implants, especially in neurosciences Stem cells Organs mechanical, grown from stem cells or Xenotransplants Source - Copyright, All Rights Reserved, Douglas E. Goldstein

24 Right When I Want… Anywhere!
Future State Point of Need! Right When I Want… Anywhere! AGE OF THE HEALTH CARE CONSUMER/PATIENT IS HERE – ARE YOU A LEADER OR A FOLLOWER Retailization of health care Consumer directed health plans Consumers paying out of pocket – higher copays but $$$ for alternatives, etc discretionary dollars With my consumer/patient hat on I sure would like this to be the current state! Healthcare providers will use patient specific genetic profiles to diagnose and prescribe therapies. Genotyping will become commonplace. Genomic Medicine will make medicine more predictive, allowing doctors and care providers to anticipate diseases and their onset Personalized – With the proliferation of tests to identify genetic differences patients’ predispositions to diseases and treatments, genotyping will common as blood typing over the next few years. Providers will be collect and evaluate patient-specific genetic information and to use and therapeutically in acute care. For example, medications for patients cholesterol problems will need to be matched with genetic characteristics individual lipid profiles. Patients scheduled for surgery will need to be genetic compatibility with anesthetics. Predictive – Rapidly expanding knowledge of relationships between and diseases will ultimately extend providers’ obligations beyond personalizing episodes of acute care. Health systems and caregivers are likely to corresponding responsibility for anticipatory services, such as informing about symptoms that may indicate onset of a disease in the indefinite sending periodic inquiries about the patient’s health. Active promotion medicine is likely to become a “best practices” standard of care. Growth in personalized predictive medicine will generate several corresponding changes in clinical practice. • Drug development activity is already being directed toward finding proteins (the focus of the biotechnology industry) or “small” molecules (the pharmaceutical industry’s main product) that delay or prevent dysfunctional changes in cellular reproduction. Several new classes of drugs are being created in the process. Physicians and other caregivers will need to understand new therapeutic models in order to prescribe appropriately these new pharmaceuticals. • Information technology will also be called upon to improve disease management. Providers will be expected to maintain data bases that will tell them when and how to follow up with patients who have the precursor genes for future health problems. The ability to communicate this information—literally, to inform their practice—is likely to become a significant differentiator for physicians and other practitioners who have the opportunity to practice in more than one system. • Public awareness of PPM will grow rapidly due to media coverage of genetic medicine, direct-to-consumer advertising of biological drugs, and availability of Web-based information about heredity and health. Caregivers will need to help their “The genetics revolution is already underway. In time we should be able to assess the risk an individual has of developing disease -- not just for single gene disorders like cystic fibrosis but for our country's biggest killers -- cancer and coronary heart disease -- as well as those like diabetes which limit people's lives.”  The Rt Hon Alan Milburn, MP Secretary of State for Health, January 2002 [1] Better, easier screenings for diseases: less invasive cancer tests that use saliva or urine to detect molecular changes in cells that are indicative of cancer Molecular Screening for Caners and other less invasive techniques such as the Electron Beam Colonography Better Imaging \ capabilities will allow physicians to quickly and more accurately diagnose cardiac abnormalities. New 64 slice CT scanners can produce hi-resolution images of the heart in just seconds, allowing patients with severe pulmonary conditions and congestive heart failure to hold their breath for the required amount of time. Furthermore, a faster scan time reduces motion artifacts and provides an image of the entire coronary tree. And already under development are 128 and 256 slice scanners that will produce even more detailed images. Cancer Drugs – “Smart Drugs” that target just cancer cells instead of the entire body like the chemo of the 1980s Better targeting reduces collateral damage to other body tissues and side effects Copyright, All Rights Reserved, Douglas E. Goldstein

25 Health@Anywhere What we need is the empowered consumer
…a ‘ConsumerMD’ sorts …supported and empowered with a consumer directed continuum of care.. Copyright, All Rights Reserved, Douglas E. Goldstein

26 Consumer Centric Continuum of Care
Let’s explore this continuum. The Patient’s Point of Care = Healthcare Anywhere: Today we pay lip service to patient centered, but health care is truly mired in a production or a provider centric medical delivery system. This is now changing with Pay for Performance. Being locked into the provider centric mode is a practical present…and we have a tons of work to figure out how to get right clinical knowledge in time to help heal. It’s a huge challenge to figure out how to change processes and workflow to deliver medical information at the Point of Care. HOWEVER, the continuum will transform (sooner than most think) to the patient’s “Point of Need.” Health and Medical Care…Right When I Want…Anywhere!” Go out and be a leader in building customer relationships and delivering Distinctive Innovation in both processes and clinical care. Patients will thank you and love you. Copyright, All Rights Reserved, Douglas E. Goldstein

27 Mercy Health System Uses HealthBuddy to Increase Medication Compliance from 34% to 94%; Reduces Hospitalization Rates 41% Per Patient Per Year Used grant funding to study behavior change in 57 economically disadvantaged patients with chronic conditions. Used the HealthBuddy appliance to allow patients to self-manage their condition by answering daily questions and submitted data to physicians and nurses. Copyright, All Rights Reserved, Douglas E. Goldstein

28 PLUS: Charges for CHF encounters decreased from $25,013 to $11,854
Mercy’s Return on Care Medication compliance increased from 34% to 94% Hospitalizations per patient per year decreased to 1.18 from 1.99 93% said they had a better understanding of their condition 93% believed Health Buddy helped them better manage their disease PLUS: Charges for CHF encounters decreased from $25,013 to $11,854 After six months in the program, patients scored a highly significant in the mental subscale of the SF-12 of More than 95% reported increased satisfaction communicating with their doctors or nurses. 97% had no difficulty using the Health Buddy to answer daily questions. Copyright, All Rights Reserved, Douglas E. Goldstein

29 Anywhere Disease Management, But Not By Your Doctor
Doctor patient relationship of today vs tomorrow. Who will be the patient’s gatekeeper? Will it be his primary care doctor? Or cyber doc? Story: Back in the 2000 during the age of DrKoop.com and AmericasDoctor.com – my perspective was…. Copyright, All Rights Reserved, Douglas E. Goldstein

30 500,000 Medical Information Access Cards and Counting
MyelectricMD.com Why Twice is Never Nice for Customers Never force the customer to tell you anything twice. It's a cardinal rule of customer-focused business. Yet for all the companies now remembering interaction data, most people find themselves having to repeat information at some of the most important places and times. It's one sure way to annoy customers and promote dissatisfaction. Take a hospital visit, for instance. Few things are more aggravating than having to complete lengthy medical history forms and provide health insurance information time and again. This can be tough on the hospital too. Large amounts of redundant paperwork result in unnecessary costs and headaches for medical staff in terms of addressing patient needs and processing the bevy of medical information. A paperwork remedy A network of six hospitals in Southern California has improved this process dramatically, but the road wasn't easy. Memorial Care Medical Center's goal was to house a patient's medical and insurance information on a single smart card. One lesson quickly emerged, recalls Annette Walker, SVP of strategy and physician integration: "We knew if we wanted it, we had to create it." So Memorial launched its own Medical Information & Access Card program in "We were looking for a means of creating stronger relationships with the customer, to grow the brand and to provide value to the relationship, as well as to improve operations in the facility," says Walker. More than 500,000 network patients now use the system, which embeds medical histories, emergency data and insurance information onto a card. Hospitals can access everything about a patient with one swipe. The program has been so successful that Memorial Care has licensed the card to other hospitals. A reprieve from redundancy A patient swipes the card upon entering a hospital emergency room, or one of the 500 doctors' offices in the network. The system then reads the embedded information, such as medications, physician contact information, health insurance data, and medical conditions. "It makes things run a lot more accurately and eliminates paperwork and filing," Walker explains. The card also strengthens the customer-hospital relationship by providing patient data upon which custom communications are based. For example, the system will send asthma information only to cardholding patients registered with that condition. The company believes that a patient is more likely to read a message from Memorial Care if it is relevant. "Like all loyalty programs, [the card] strengthens the relationship with the consumer," explains Walker. "We hope that because of the card, we will remain their hospital. Every time they open their wallet and see our name, it reinforces the brand." This, in turn, creates revenue, which keeps the hospital itself in good financial health. Keeping the relationship healthy The hospital also has created an online customer touchpoint to maintain relationship momentum. MyelectricMD is an interactive health screening tool on memorialcare.com, which allows patients to locate symptoms and to receive possible diagnoses, relevant medical tests, and physician contact information. Online education is a powerful interaction tool in the health industry, and Walker says Memorial has been "looking for tools on the Internet that were interactive so users will spend more time on the Web site, which adds value." Memorial Care plans to adopt more tools, such as the recent installation in Anaheim Memorial of Internet access terminals. For $2 per half hour, visitors can check and surf the Internet, as well as connect to Microsoft Office applications from the medical center's main lobby and ICU waiting room. "We were one of the first hospitals to provide these types of tools," Walker says. "We have a vision about consumer empowerment and a CEO who understands that." Copyright, All Rights Reserved, Douglas E. Goldstein

31 A Driving Force for EHRs
“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” President George W. Bush, State of the Union Address, January 2004 President Bush has outlined a plan to ensure that most Americans will have electronic health records within the next 10 years. The President believes that better health information technology is essential to his vision of a health care system that puts the needs and the values of the patient first and gives patients information they need to make clinical and economic decisions – in consultation with dedicated health care professionals. This will address longstanding problems of preventable errors, uneven quality, and rising costs in the Nation’s health care system. The President’s Health Information Technology Plan, April 2004 “Within 90 days, the Secretary of Veterans Affairs and the Secretary of Defense shall jointly report on the approaches the Departments could take to work more actively with the private sector to make their health information systems available as an affordable option for providers in rural and medically underserved communities.” President Executive Order - Incentives for the Use of Health Information Technology, April 2004 QUESTION FROM 2002 What is Your Opinion? VA, HHS and DoD Officials stated “that by 2010 they would like to see 90% of physician offices operating ‘Electronic Medical Record” that is aligned with a ‘National Health Information Infrastructure?’ Do agree with the goal? Yes - No Do you view that an interconnected health information infrastructure is a top priority issues for reasons of… __National Security __Public Health __Patient Safety and Quality __Not a top priority issue (check all that apply) Copyright, All Rights Reserved, Douglas E. Goldstein

32 EHRs & PHRs = Disruptive Innovation
I want you to imagine for a moment if every one in the country had a personal EHR that contained all their medical information! Veterans Health Administration Story How would care delivery be different?????????? Audience Discussion and Contribution…. For Everyone! EHRs & PHRs = Disruptive Innovation Copyright, All Rights Reserved, Douglas E. Goldstein

33 My Health eVet Interactive Medical Record
About My HealtheVet My HealtheVet is the VHA Health Portal created for you, the veteran and your family, and for VA employees. This new health portal will enable you to access health information, tools and services anywhere in the world you can access the Internet. MHV Communications and Resources Please feel free to download and print copies of the My HealtheVet flyers and promotional materials. My HealtheVet One Anniversary 2 page flyer (MS PowerPoint) Trifold promotional flyer (MS PowerPoint) My HealtheVet table tents (MS PowerPoint) My HealtheVet business cards (MS Word) My HealtheVet Veterans Partnering with Providers poster (PDF) MHV in the News Opinion: Technology Can Help Lower Health Costs An opinion piece in the Sacramento Bee on Tuesday examined the potential for information technology to help reduce rising health care costs. "Information technology - a digital revolution - could cut costs as fast as other changes in health care are pushing them higher. The Sacramento Bee, (11/23/04) Veterans Can Personalize Medical Records On VA Web Site The Department of Veterans Affairs on Thursday will launch the first features of a personal health record on its Web site to help provide veterans with greater access to and control over their health records. Government Computer News, (11/9/04) VA to Let Vets Personalize Health Records Online The Veterans Affairs Department will launch the first features of a personal health record on its My HeatheVet Web site Thursday, Veterans Day. The goal: expand veterans’ access to and control over their health information. Government Computer News,11/08/ VA Launches Health Portal The Department of Veterans Affairs has launched a Web site that allows veterans to access health and benefits information, reorder prescriptions, view appointments and keep health records. Federal Computer Week. (11/3/04) MHV Virtual Tour The My HealtheVet Virtual Tour can now be downloaded onto your PC or saved on a CD, click here to download. Please feel free to use our online instructions for downloading zipped files. MyHealtheVet History My HealtheVet Launched Veterans Day, 2003 My HealtheVet was launched on Veterans Day, November 11, It delivered a doorway for VA benefits, healthcare information, special programs and other services. It was designed to provide health information developed especially for veterans. A prescription checker, health calculators and self-assessment tools, access to a health education library, and links to Federal and VA benefits and resources, were all introduced on the new My HealtheVet web site. Registration was required to have full access to all features. Personal Health Journal Launched Veterans Day, 2004 A year in the making, My HealtheVet presents the Personal Health Journal – a convenient and secure on-line register for your health information. Just log in and click the My Care tab to access these exciting features*: Personal Information - record your contact information, emergency contacts, health care providers, treatment locations, and health insurance information. Wallet ID Card is a printable card that is automatically filled out with important information from your personal health record. It also has open spaces for you to list allergies and other critical medical conditions. Military Health History - record important events from your military service, exposures you think you may have experienced, and assignments related to your health history. Medications, over-the-counter drugs, herbals and supplements - record the name, starting and ending date, prescription number, and dosage. Allergies - keep track of your allergies by date, severity, reaction, diagnosis, and comments. Tests - keep track of your tests by test name, date of test, location test was performed, provider's name, results, and any comments. Medical Events - keep track of illnesses, accidents or other events by logging their date, treatment prescribed or comments regarding the event. Immunizations - record the immunization, date received, method used, and any reactions you might have. Health eLogs provide the ability to track your readings for: Blood pressure Blood sugar Cholesterol Body temperature Body weight Heart rate Pain *You must register to use the Personal Health Record features. Those who previously registered for a My HealtheVet account need to re-register to access all the features. Coming Soon You will be able to refill your VA prescriptions on-line, view your co-pay balances and appointments. All your personal data will be secure and private in your own eVAult. And you will be able to share your online information with anyone you designate. Later, you will be able to receive copies of your VA health information online. On the horizon are secure clinician/patient messaging, moderated discussions on the web and web-based training/education opportunities. Today's healthcare is really a strategic partnership between patients and providers. My HealtheVet is a powerful tool to help you better understand and manage your health. It is a powerful tool for sharing information with your family, with your caregivers, with anyone you choose. My HealtheVet puts you at the center of your VA care. If you are a TriCare Online registrant, you can get there directly from the My HealtheVet Health Info tab. Copyright, All Rights Reserved, Douglas E. Goldstein

34 TeleHealth by Veterans Health
VIDEO CLIP AVAILABLE… Return on Care: Decrease of 5.15 outpatient clinic visits per patient Reduced BDOC of 2.05 per patient. Return on Investment 50% reduced cost per patient Every VSB can potentially save $3, per patient/year Product cost is offset in 1.75 years, and the remaining 1.25 years of life cycle of each machine can further reduce the expenditures of patients utilizing this technology. VitalSign Monitoring Unit by Panasonic Copyright, All Rights Reserved, Douglas E. Goldstein

35 Mike Manages His Heart Disease Using Digital Technology
@anywhere eCare ePHR Predictive Genetics Testing will give a patient information about their susceptibility to heart disease Patient stem cells will be used to manufacture a new heart or blood vessel Nanomachines will be able to repair damaged vessel cells continuously throughout the body Doctors recommend preventative measures to prevent heart disease: don’t or stop smoking, eat healthy, exercise regularly Can use family history and lifestyle data to predict Heart Disease and cardiovascular events In case of occurrence, have new tools to make sure that patient is treated appropriately: evidence based medicine, technologies such as Infobutton that enable physicians to have instant access to relevant diagnostic information and allow real-time charting, better imaging capabilities to better diagnose Online Disease Management: Can use the American Heart Associations Heart Healthy Tracker to record you glucose, cholesterol and blood pressure and then print out and take to doctor. Newer technologies use computers and then Web to instantly send information to healthcare providers for around the clock monitoring Web DES Copyright, All Rights Reserved, Douglas E. Goldstein

36 Smart In-Home Monitoring
MARC Smart In-Home Monitoring System has the following unique characteristics: low-cost sensor technology, retrofits easily in existing homes Data-mining yields unique health status reports Patient Family Doctor customizable to needs individual cultural. MARC Smart In-Home Monitoring System has the following unique characteristics: Implemented in simple low-cost sensor technology, which makes it affordable to the lowest 30% of income earners. EXAMPLES Adaptively retrofits into existing home structures, with minimal impact, modification and cost. The data-mining component yields unique health status reports that can be made available to the occupants, their medical advisors and their family members. The system is customizable to the individual’s needs, as well as different cultural needs. It is anticipated that the use of this technology will result in: --Improved informal care effectiveness without increasing intrusion. --Reduced cost of informal care, which is particularly high for older adult populations. --Reduced burdens on the informal caregiver, and hence reduced stress and improved mental and physical health conditions. Involving the care recipient in health promoting activities and decision-making. An extended healthy, active and dignified life for the elders that can be widely accessible to the low-income strata of society. Delayed admittance to specialized institutions, and hence a reduced cost of formal elder care. Reduced formal care burdens, and hence improved formal care. Copyright, All Rights Reserved, Douglas E. Goldstein

37 @ Home AirWatch from iMetrikus allows a patient to shares their respiratory data immediately with their doctors Online Disease Management is focused towards chronic conditions such as Diabetics, Cancer, Heart Disease Products such as AirWatch from iMetrikus allows a patient to share their respiratory data Immediately with their health care provider Patients are better suited to make healthcare decisions through the use of the web, from finding the right doctor or hospital, to finding advice on HSA plans, to learning how to receive better care. The Web has made it very easy for patients to learn about healthcare and how to improve the quality of their care. Copyright, All Rights Reserved, Douglas E. Goldstein

38 Tele Presence & More Assisting the elderly by: reminding connecting
tele-presence technology collecting data & monitoring manipulating objects Helping them feel less isolated. Pearl and other robotic nurses will someday assist the elderly by: --reminding elderly patients to visit the bathroom, take medicine, drink, or see the doctor. --connecting patients with caregivers through the Internet. The robot is a platform for tele-presence technology whereby professional caregivers can interact directly with remote patients, reducing the frequency of doctor visits. --collecting data and monitoring the well-being of patients. Emergency conditions, such as heart failure or high blood sugar levels, can be avoided with systematic data collection. --manipulating objects around the home such as the refrigerator, washing machine, or microwave. Researchers say arthritis is the main reason elderly give up independent living. --taking over certain social functions. Many elderly people are forced to live alone, deprived of social contacts. The nursebot may help shut-ins feel less isolated. Pearl, created by the University of Michigan, Pittsburgh, Carnegie Mellon, and Stanford Copyright, All Rights Reserved, Douglas E. Goldstein

39 I Wear My Health (Sensor)
Smart Sensors Continuous glucose monitoring Depth of anesthesia monitoring Heart failure monitor --BodyMedia --Glucose Watch --Sensors The BodyMedia Body Monitoring System provides researchers and clinicians with a highly accurate, easy-to-use, and cost-effective alternative for continuously monitoring energy expenditure, sleep, and other important physiological data vital to a wide array of research subjects. GLUCOSE WATCH Are making it easier and less painful for diabetic to monitor glucose Use electrical currents or photoacoustics to measure levels Copyright, All Rights Reserved, Douglas E. Goldstein

40 Drug Delivery - BioMEMs
Implantable devices that deliver drugs via nano-sized valves and pumps that are controlled by sensors that regulate delivery rates Schematic of Self Regulating Responsive Therapeutic System Environmental Monitoring Automatic detectors of airborne bacteria within facility’s ventilation system Drug Delivery - Inhalation Drugs Currently in Testing Insulin - example is Exubera by Pfizer Antibiotics Copyright, All Rights Reserved, Douglas E. Goldstein

41 Nanomedicine Rx What if doctors could search out and destroy the very first cancer cells that would otherwise have caused a tumor to develop in the body? What if a broken part of a cell could be removed and replaced with a miniature biological machine? What if pumps the size of molecules could be implanted to deliver life-saving medicines precisely when and where they are needed? These scenarios may sound unbelievable, but they are the long-term goals of the NIH Roadmap's Nanomedicine initiative that we anticipate will yield medical benefits as early as 10 years from now. Nanoparticles, seen here joined by strands of DNA, can be programmed to identify and deliver medication to specific cells. Copyright, All Rights Reserved, Douglas E. Goldstein

42 Distinctive Innovation
Your Ingenuity x (Tools x Technology ) = Better Processes Knowledge, know-how and best practices PROCESS IMPROVEMENT VS PROCESS REDESIGN – is your process capable of supporting the desired state. What is Distinctive Innovation? It’s Applied Creativity! A process is ‘Distinct’ if it’s not equal to the previous state. Something is ‘Innovative’ if it is a new ‘Idea’ ‘Product’ or ‘Process’ that is useful, practical, different and improved. A ‘Distinctive Innovation’ does not necessarily mean a breakthrough invention like the electric light bulb. It’s a dynamic problem solving process that leverages tools such as Six Sigma and appropriate technology combined with a individual’s and team’s ingenuity. Our Healthcare System is Transforming… into a high performance network to meet the demands of our customers -- patients and payers. The question is who will lead and who will follow. Customer demands (patient and payer), exponential explosion of medical knowledge and an unacceptable rate of medical errors are driving forces of change. To prosper you need 20/20 forward vision to be the kind of health care organization that patients want connected with their care All organizations are capable of delivering a culture of ‘Distinctive Innovations’ that continuously improve processes, systems and outcomes … that saves time and money…but that depends on leaders leading. The health system of 2020 will be a consumer centered system that supports care anywhere a patient wants anytime of the day! Stories Shared: Josie King Foundation, ER Diversion, Ascension Health Exchange, Air Force Medical Services Knowledge Exchange, BSHSI Share, Mercy Health System, Memorial Care, My Health eVet, MARC In Home Monitoring, Air Watch, Gluco Watch, Robo Nurse and Jazz the DreamDog Tools and Technology: Six Sigma --Medical Informatics…Facilitated Knowledge Transfer Distinctive Innovation Copyright, All Rights Reserved, Douglas E. Goldstein

43 For Everyone! Better Outcomes
I want you to imagine for a moment if every one in the country had a personal EHR that contained all their medical information! How would care delivery be different?????????? Audience Discussion and Contribution…. For Everyone! Copyright, All Rights Reserved, Douglas E. Goldstein

44 Liberate Your Potential…
Distinctive Innovation It’s a ‘KNOWLEDGE’ not information economy! Go forth and gather the tools, ideas, approaches etc. to transform health care and save lives From Knowledge to …‘Know How’ Knowledge is Social …the power of social and informal networks in your organization Have an Enterprise Knowledge Management and Innovation Strategy and Plan Capturing and Packaging Critical Quality Knowledge & capabilities requires multi-year investment Fund the treasure hunt! Capability transfer depends on multi-media support Audio & video online and live interactions! Virtual community building takes dedicated human resources with experience …is the Way! Copyright, All Rights Reserved, Douglas E. Goldstein

45 Douglas E. Goldstein eFuturist…Beyond Theory to Action
Speaker - Lead..Innovate…Transform Consultant and Author New Book: Medical Informatics 20/20: Quality and EHRs through Collaboration, Innovation and Open Solutions Other Recent Publications: Quality, Safety and Cost Effectiveness through Leadership and Health Information Technology eHealthcare: Harness the Power of Internet e-Commerce & e-Care Best of the Net Guides to Health and Wellness and Healthcare and Medicine


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