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A New Vision for the EHR

Sam Brandt, MD Chief Medical Informatics Officer Siemens Health Solutions. A New Vision for the EHR. How Tall is K2?. How Tall is K2?. What Toxin is in the Skin of Poison Dart Frogs?. What Toxin is in the Skin of Poison Dart Frogs?.

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A New Vision for the EHR

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  1. Sam Brandt, MD Chief Medical Informatics Officer Siemens Health Solutions A New Vision for the EHR

  2. How Tall is K2?

  3. How Tall is K2?

  4. What Toxin is in the Skin of Poison Dart Frogs?

  5. What Toxin is in the Skin of Poison Dart Frogs?

  6. A pet store employee presents in the ER with rapid onset of confusion, hypotension, and decreased respiratory rate??

  7. The Place for Calculators in 1974? • Pros • Faster • Easier to use • More significant places • Eliminates decimal point transposition errors • Cons • Requires electricity • Floating point errors • Fosters “Laziness”

  8. The Place for EHR’s in 2009? • Pros • Faster & remote access to information • Easier to find data • Helps avoid double entry • Can help with billing • Cons • Requires electricity • Less portable • Doesn’t allow random data entry • ? Fosters laziness

  9. But….We Didn’t Stop with Calculators! • Spreadsheet programs allowed for “modeling” of financial data, with “what if” scenarios • Word processors eliminated retyping for corrections, and added spell checking

  10. And then…We Pushed the Envelope • Computers opened new possibilities • Expressing complexity • Simulating scenarios • Exploration and recognition • Solving exhaustive computions

  11. So…How Will EHR’s Push the Envelope? • Changing delivery system models • Point of care decision support • Personalized medicine – Genomics/Proteomics • Patient-centric delivery models

  12. Mar 5, 2009 7:45 pm US/Eastern Obama: Healthcare At 'Thelma And Louise' MomentPresident Borrows Dire Movie Metaphor To Describe U.S. System As Heading Toward Cliff CBS News Interactive: Healthwatch Obama said the participants - doctors, lawmakers, insurers, even skeptics - were universal in agreement that the need for health care reform "is here and now."

  13. Bundled payments for hospitals and providers Efficacy standards imposed with controls on utilization variance Emphasis on healthcare delegation to most cost-effective venues with incentive alignments Impacts

  14. Bundled payments for hospitals and providers Efficacy standards imposed with controls on utilization variance Emphasis on healthcare delegation to most cost-effective venues with incentive alignments Increased connectivity supports “Virtual” delivery systems Point of care decision support Enterprise research scheduling and process management Impacts EHR Contributions

  15. Genomics & Personalized Medicine • Numerous Genotype/Phenotype correlation efforts • Potentially thousands of significant variants • Genome sequencing for $100 within 5 years • Rising expectations for preemptive intervention • Physicians will need to consider all diagnostic and therapeutic decisions in the light of the patient’s gene sequence

  16. TGF-β1 gene polymorphisms D. Bučkova et al Volume 56 Issue 12, Pages 1236 – 1237 Published Online: 20 Dec 2001 • A Polymorphism* in the 5' Flanking Region of the CD14 Gene Is Associated with Circulating Soluble CD14 Levels and with Total Serum Immunoglobulin E Mauro Baldini, et alAm. J. Respir. Cell Mol. Biol., Volume 20, Number 5, May, 1999 976-983 • Gene polymorphism in Netherton and common atopic disease • Andrew J. Walley1 et alNature Genetics29, 175 - 178 (2001) Published online: 4 September 2001; | doi:10.1038/ng728 Managing the Avalanche of Genomic Information

  17. EHR and Personalized Medicine GeneSequence Patient Information Dx/Tx Selection Indications/Contraindications Patient Categorization Clinical Knowledge Variance DB

  18. Patient-Centric Delivery Models Workflow orchestration Dx/Tx Selections Patient Processes Cross-processoptimization (patient & resource) Patient-centric Process Sequence Patient Processes Patient Processes Patient Processes Workflow engine Simulation optimizer • Coordinates care across delivery system • Schedules • Tracks • Intervenes

  19. The Place for EHRs • 2009 • Brings valuable benefits compared with the limitations of paper charts • 2011 and beyond • Provides the needed framework for • Changing delivery system models • Point of care decision support • Personalized medicine – Genomics/Proteomics • Patient-centric delivery models

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