11Health Enterprise Computingand Patient Identification6.872/HST.950February 13, 2003Peter Szolovits(with first half contentfrom David Margulies)Community HospitalsHome HealthLong Term CareTertiary CareClinicsPrimary Care DocsPharmacyReference LabSpecialistsXXX Health SystemIntegrated Delivery System...Integrated Delivery System...KnowledgeKnowledgeAssetsAssetsPlanPlanTertiaryTertiaryClinicsClinicsPlansPlansPHOPHOPPOPPOMSOMSOAffiliationsAffiliationsContractsContractsIDSIDSPPOPPOCarveCarve--OutsOutsPurveyorsPurveyorsPSOPSOTHE GOVERNMENTTHE ENROLLEETHE HOMETHE EMPLOYERComplexity now Complexity now within...within...Context: Evolution of Clinical Computing...• Focus evolved from automating AR process in hospitals, to LAN-based SI of departmental systems, to enterprise clinical computing, toward region- and system-level process automation• Changing healthcare organizational models and economic models ---> changing clinical computing priorities and designs22Phase 2: LAN-based SI -- Automate Data Distribution to MDs...CaseCaseMixMixMaterial MgmtMaterial MgmtPayrollPayrollGeneral LedgerGeneral LedgerAccounts PayableAccounts PayableLaboratoryLaboratoryNursingNursingPharmacyPharmacyRadiologyRadiologySurgerySurgeryInternal MedicineInternal MedicineOrder CommOrder CommATDsATDsPatient AcctPatient AcctEntryEntryPhysicianPhysicianPhase 3: Data-based SI to Create an EMR...CaseCaseMixMixMaterial MgmtMaterial MgmtPayrollPayrollGeneral LedgerGeneral LedgerAccounts PayableAccounts PayableLaboratoryLaboratoryNursingNursingPharmacyPharmacyRadiologyRadiologySurgerySurgeryIntIntMedMedOrder CommOrder CommATDsATDsPatient AcctPatient AcctDataDataRepositoryRepository“Electronic“ElectronicMedicalMedicalRecord”Record”Paradigm 1Paradigm 1Paradigm 2Paradigm 2PatPatAcctAcctLaboratoryLaboratoryNursingNursingPharmacyPharmacyRadiologyRadiologySurgerySurgeryIntIntMedMedOrderOrderCommCommATDsATDsViewerViewerDocumentDocumentExpertExpertSystemsSystemsClinician’s SystemClinician’s SystemInterface EngineInterface EngineOrderOrderMgmtMgmtDATA REPOSITORYGroupGroup--PatientPatientRelationshipsRelationshipsPatientPatient--ProviderProviderEncountersEncountersPatientPatient--Provider Provider RelationsRelationsClinical Events:Clinical Events:Procedures, Results Procedures, Results & Documents& DocumentsClinicalClinicalOrdersOrdersClinicalClinicalProblemsProblemsClinicalClinicalCareplansCareplansStyles ofStyles ofPracticePracticeProviders Providers & Other & Other PersonnelPersonnelGroupsGroupsFacilities Facilities & & LocationsLocationsPatientsPatientsFacilityFacility--GroupGroupAffiliationsAffiliationsVisitsVisitsGroupGroup--ProviderProviderRolesRolesInstitutional Institutional Care Care Standards Standards & Protocols& ProtocolsSettlementSettlementMembershipMembershipCareCareTeamTeamInt.Int.MedMedRadRadLabLabPharmPharmSurgerySurgeryAccountAccountPlanPlanDesignDesignDischargeDischargeDismissDismissEpisodeEpisodeActivationActivationAuthorizationAuthorizationHealthHealthStatusStatusMgt.Mgt.CommunityCommunityCareCareSelfSelfCareCareEvaluateEvaluateAssessAssessPlanPlanActActScheduleScheduleReferReferVisitVisitActivationActivationMgt.Mgt.TeamTeamHealth Health Mgt.Mgt.HealthHealthRecordRecordMeasureMeasurePhase 4: Enterprise-level Clinical Process Automation...33Most Installations...DismissDischrgFollow-UpAccountPlanActEvaluateAssessRegisterAdmitCheckHistorySchedulePharmSurgeryIntMedLabRadReferCareCareTeamTeamMedicalMedicalRecordRecordClinical Data Clinical Data Repository Repository Based...Based...Clinicians’ Clinicians’ WorksystemWorksystemMayo GenesysSOMEMMCHMW…...SamaritanDifferent Imperatives, Different IT StrategiesWorldWorld--WideWideCommunityCommunity--WideWideMultiple FacilitiesMultiple FacilitiesCritiqueingCritiqueingSchedulingSchedulingCommon Clinical OrderingCommon Clinical OrderingElectronic Chart ViewerElectronic Chart ViewerClinical Data RepositoryClinical Data RepositoryMPI/ADT SynchronizationMPI/ADT SynchronizationIndependent Departmental SystemsIndependent Departmental SystemsComputerComputer--Based Patient RecordBased Patient RecordCare Team SupportCare Team SupportEvolutionary Stages DepartmentalDepartmentalSystemSystemStagesStagesVirtualVirtualDatabaseDatabaseIntegratedIntegratedDatabaseDatabaseComputerComputer--BasedBasedPatient RecordPatient RecordCare ProcessCare ProcessIntrarelationIntrarelationProPro--ActiveActiveManagementManagementConcurrentConcurrentEventEventCritiquingCritiquingCharacteristicsCharacteristicsExamplesExamplesAccess Directly Via ProgramAccess Directly Via Program• highly structured• powerfulWorkstation Access Via NetworkWorkstation Access Via Networkdistribution datadistribution datadisparate databases and user interfacedisparate databases and user interfacePathNetPathNetLaboratoryLaboratoryInformation SystemInformation SystemHL7 Query ToolsHL7 Query ToolsCopy Data into Central DepositoryCopy Data into Central Depositoryrelationships possiblerelationships possiblecommon user interfacecommon user interfacemultimediamultimediaORACLEORACLEControl Access and EncodeControl Access and Encodenomenclature supportnomenclature supportsecurity and audit controlsecurity and audit controldata successiondata successiondate authenticitydate authenticityOpen ClinicalOpen ClinicalFoundation DataFoundation DataRepositoryRepositoryDiagnoses, Care Plans and OrdersDiagnoses, Care Plans and Orderscontext for resultscontext for resultsexpectations possibleexpectations possiblerequirements for recordsrequirements for recordsOperations DataOperations Datacare managementcare managementfiscal managementfiscal managementEISEISNormative Data and RulesNormative Data and Rulesextrapolationsextrapolationsmanagement by protocolmanagement by protocolProNetProNetOrdersOrdersCareNetCareNetPlansPlansMRNetMRNetOperationsOperationsOpen ManagementOpen ManagementFoundation DataFoundation DataRepositoryRepositoryDiscern RulesDiscern RulesAPACHEAPACHEMEDIQUALMEDIQUALBeyond the Enterprise: CHINsValid needs, No Buyer...CommunityCommunityHealthHealthInformation Information ServicesServicesPhysiciansClinics, HMOsHospitalsUtilityProvidersRepositoryCore Services• E-MailDatabase Systems• Membership Server• Health Plan Server• Health Record Index• Outcomes ManagementTransaction Systems• Scheduling Services• Report Management• Claims Consolidation• Utilization ReviewBusiness Systems•