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ISIS Center Team of 15 faculty and 70 staff

IT: Transforming Power for Industries From Telemedicine to E-Health. Georgetown. Seong K. Mun, PhD ISIS Center Georgetown University smun01@georgetown.edu. ISIS Center Team of 15 faculty and 70 staff. Information Age. Under Formation Struggle Underway

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ISIS Center Team of 15 faculty and 70 staff

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  1. IT: Transforming Power for Industries From Telemedicine to E-Health Georgetown Seong K. Mun, PhD ISIS Center Georgetown University smun01@georgetown.edu ISIS Center Team of 15 faculty and 70 staff

  2. Information Age • Under Formation • Struggle Underway • Some Examples from Other Industries • Hard to Make any Projections • Still Very Young (About 100 years) • Outcome Unknown Very Powerful Transforming Capability

  3. Industries in Info Age • Transformed • successful and not so • New Industries • Industries on the net community What will happen to healthcare? Is it going to be a transformation?

  4. Stage 1 Development of Basic Technology Stage 2 Development of Relevant Applications Stage 4 Transformation of Operating Environment New Business Models Stage 3 Integration and Diffusion of Technical Tools Evolution of Business ModelsIT as a Transforming Tool Digital Devices Communication Video Conferencing Data/Image Processing Telemedicine Digital Information System Integrated Healthcare Teleradiology Filmless Hospital Virtual Clinic Global Radiology Transaction Management

  5. Goals of T-Med • Improve Access: • Doctors and Information • Access to Patients and Diseases • Improve Quality • Better Outcome • Reduce Cost: Overall Cost

  6. Two Types of ApplicationOperational • Real Time (VTC) • Acute Illness and Emergency • Other Specialty • Store and Forward • Chronically Ill: 70% of Health Budget • Routine Radiology, Pathology What is wrong with this? What is our assumption? One-way model.

  7. Drivers: Technology • Availability of High Speed Links • 19.2 kbps to T-1 lines • Availability of Digital Input Devices • Digital Imaging Devices • Digital Video Devices Emerging Digital Age

  8. Refugee Health Global MRI Network: NGI Congestive Heart Failure: Home Diabetes Management at Home Diplomatic Telemedicine in Africa Telemedicine Demo in Russia Disaster Relief in Kenya Medical Education in Latin America: ACTS Renal Dialysis Center and Home Dialysis Rural Health: Kidney Stone Disease Post Surgery Follow Up Mission Project & Diabetes Project with UH Teleradiology: DEPRAD, Bosnia, Hungary, Germany PACS: Filmless Digital Hospital

  9. General Assessment • Access to Care • Acceptable Technology • Demanding Logistics, TV Production • High Costs: Tech, Ops, Staffing • Technology Insertion Requires Appropriate Operational Environment • Access to Patient and Information • Not a primary focus – so far

  10. Key Issues • Technology: Good • Business Process (E): Poor • Business ($) : Very Poor • Clinical Relevance: OK • Overall Costs: High Technology is one of many requirements!

  11. Revisiting the Assumptions • Patient’s access to Physicians • Initial Focus • How about Physician’s access to Patient? • Health Record • Genetic Information • Life Style Information • Others

  12. Radiology Case Study Digital Filmless Hospital Teleradiology Global (Virtual) Radiology Service

  13. US DoD PACS North Atlantic Ft. Lewis (MAMC) Ft.Drum Western West Point Great Plains Ft. Greely Carlisle Barracks Ft. Monmouth SiteR Aberdeen Ft. Detrick Ft. Meade Ft. Wainwright WRAMC Ft.Knox Ft. Belvoir Ft. Leavenworth Ft. Lee Ft. Eustis Ft. Carson Ft. Leonard Wood Ft. Riley Ft. Irwin Ft. Bragg Ft. Campbell Ft. Richardson Southeast Ft. Gordon Ft. Sill Redstone Ft. Jackson Ft. McPherson Ft. Huachuca Ft. Stewart Ft. Benning Ft. Hood WBAMC Ft. Polk Ft. Rucker Ft. Sam Houston (BAMC) Pacific Shape Tripler (TAMC) Wuerzburg 121st General Hospital Landstuhl Heidelberg No PACS Activity 9 outlying locations Europe Activity In-Process Livorno Vincenza Camp Zama = PACS Implemented 5

  14. Global Teleradiology Stand-alone Nigh Hawk / On-call Coverage Expert / Second Opinion Global Virtual Radiology Service by Workload Sharing and Reallocation

  15. Enter Internet! • Easier Access to Communication • But Limited Band-width • Ubiquitous Computing • Beyond Point to Point Communication

  16. Expanding Enterprise Payers Clinical Research Mercy Hospital Government Agencies Public Health University Hospital City Hospital DPT Research and Education

  17. What is Information Economy?How is it powered? Followed by Agricultural Economy; Powered by Animals Manufacturing Economy: Powered by Engines on Fuels Powered By Ubiquitous Coordination Technology Information, Communication and Computing Technology New Industry Emerges and Old Ones Must Transform New Business Process Needed Where are we in healthcare?

  18. What does/can IT do to business processes? • Bureaucracy to Ad-hoc-cracy • Flatter Organization • Info: Do it yourself • Consumers do part of the job • Externalizing labor cost • Self care, home care • More Power to End Users • More Responsibilities to the End Users

  19. Key Activities for Mass ProductionTraditional Health System Standardization Specialization Synchronization Concentration Centralization Era of Bureaucracy Serialization

  20. Organizational Impact “Adhocracy” Information Age Bureaucracy: Mass Production What is this? Medical Center Model Is It Obsolete? Distributed Patient Centric Model Is it workable?

  21. Attributes of Future Health Care • Distributed System • Knowledge Based- Bidirectional • Patient Driven, Customized • More Self Care • More Prevention • More Choices: Patient Education Consistent with generic IT evolution

  22. Analysis Results Instructions Data, Questions • Patient at Home or Work • Physician at GUMC Good Technology Not Compatible with Process Great Self Management Tools Home Monitoring

  23. Advanced IT (I-2) Demonstration Projects - NLM • Fundamental Limitations on Internet • Quality of Service on the Net • Authentication and Authorization • Information Sharing in VO • Network Security • New Emerging Application • Disease Surveillance

  24. Project Sentinel Baseline or Heightened Case Project 6 Project 2 & 3 Applications /use case Project 4 Authentication /Authorization Middleware Distribution Middleware/Web/Grid Information Distribution Government Agencies Hospitals Acquiring Sites …. WHC GU Others DOH Project 5 Future Data Sources/Argus PIDS Mosquito Avian Data Sources Satellite Inquiry International Threat Info Patient Info Project 1

  25. Application Authentication /Authorization Grid Virtual Organization Gov agency Hosp A Hosp B Future Data Sources/Argus PIDS Mosquito Avian Satellite Inquiry International Threat Info IT-Architecture TOMORROW App B App A TODAY App B App A Web-based Hosp B Hosp A Hosp A Hosp B • Web or Grid services allow for sharing data and/or computing resources • Highly scalable infrastructure • Integrated data sources thru Grid • Access privileges thru VO based on attributes and agreements • Dynamic adaptation to diverging security requirements Patient Info A Patient Info B Patient Info A Patient Info B • Web-based Applications • Limited scalability • VPN access common • Limited integration of data sources • Users assigned to each system w/separate login/access • Client-server applications • Stand alone systems • Clinical patient info only • Users assigned to each system w/separate login/access

  26. Project Sentinel: Issues DemandingTechnical Solutions in Virtual Organization • Different Organizational Missions & Activities • Different Operational Environment • Potential Distrustful Relationships • Client to Server or Peer to Peer • Different Rules of Delegation of Authorities and Privileges New Business Model Needed? Desired? Non-Technical Barriers

  27. Standard interface of machines System Integration Activity Automation IT for Business Process End to end productivity New Business Model DICOM and HL-7 Filmless Operation IHE for Business Process Workflow Department Productivity Enterprise Info. Mgmnt New Business Model? IT Industry and HealthcareSimilar Evolution Paths

  28. Stage 1 Development of Basic Technology Stage 1 Development of Basic Technology Stage 1 Development of Basic Technology Stage 2 Development of Relevant Applications Stage 2 Development of Relevant Applications Stage 2 Development of Relevant Applications Stage 4 Transformation of Operating Environment New Business Models Stage 4 Transformation of Operating Environment New Business Models Stage 4 Transformation of Operating Environment New Business Models Stage 3 Integration and Diffusion of Technical Tools Stage 3 Integration and Diffusion of Technical Tools Stage 3 Integration and Diffusion of Technical Tools Evolution of Business Models Hospital IT Solutions Regional National IT Solutions Departmental IT Solutions Physician Offices and Patients

  29. Policy Directions for Congress? • Patients • Healthy & Responsible Life Style • Health Care Industry and Government • Standards in Business Processes • Research Community and Partners • Business Transforming R&D • Physicians and Offices • IT Investment Incentives and Training • IT Industry • Improved Infrastructure and Open Access

  30. Acknowledgements • National Library of Medicine, NIH • TATRC, US Army • National Cancer Institute, NIH • NIBIB, NIH • Health Affairs, Department of Defense • Department of State • DC Department of Health Contact: smun01@georgetown.edu

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