dbMotion: Virtual Health Community
Gadi Gilon1; Ziv Ofek, Assaf Halevy2;
1. Clalit Health Services, Israel; 2. Ness-ISI Ltd., Beer Sheva, Israel;
Key Words:
• Virtual Health Community
• Clinical Information Integration
• Intelligent Real Time Notifications
• Generic Object Oriented Patient Schema
• DSS Infrastructure
Introduction
The large amount of medical information systems, combined with the growing number of
different medical information technologies, have created the need for complete, uniform,
accessible and reliable medical information at points where service is provided and
decisions are made (points of care). This information is essential for ensuring a high
standard of medical care, based on all relevant historical and up-to-date information about
the patient.
The key obstacle to achieving this goal is the fact that the information is created by
different systems, in different work environments, and stored in many databases often
scattered over a wide geographical area. In addition, the encoding methods vary between
the medical information systems that create and store the information, so that, usually, they
cannot communicate with each other.
The above problem is further exacerbated in cases where the customer has many points of
contact with the service providers in the organization (hospital, laboratories, primary care,
specialist care, institutes, self-employed physicians, etc.), who are not interconnected in
terms of the information systems and databases.
This forces the patient to be the carrier of the information; it is the patient who hands the
relevant information/documents over to the various service providers, who then have only
this information to rely on in making medical decisions, and administering medical care.
Information not directly handed over by the patient is generally information that medical
service providers never get to see.
To illustrate this point, in the USA alone, approximately 75,000 patients die each year as a
result of errors in medical treatment. In most cases this is due to the lack of complete,
available and reliable information, as well as to the lack of medical tracking, and poor
communications between physicians.
The present situation, and the aforesaid problems, indicates an urgent need for a
comprehensive computerized architecture, capable of interconnecting heterogeneous
medical information systems, and creating a virtual homogenous environment, in which
complete, reliable and qualitative information is available to the service provider at the
point of care, at the right time.
This is precisely the goal that the dbMotion system achieves.
Meeting the Market Demands
The amounts of client data accumulated, especially in the medical area, is increasing
rapidly every year. The data is stored in a variety of different applications or systems within
departments or organizations that are physically dispersed and remote. Such large
organizations need to provide their clients with the best medical care and service while
avoiding diagnostic mistakes and double-testing. These errors can result in the spending of
millions of dollars, due to lack of available, up-to-date information. Hence, there is a need
for a unified, logical infrastructure that will make it possible for all important information
about a client to be accessible from any point in the organization.
The dbMotion platform provides a state of the art breakthrough in this area.
The system collects information from various data sources, held on a variety of
applications, and located in various branches, clinics and even countries, without the need
to establish a centralized database. The dbMotion system induces a “quiet evolution” in the
organization, bringing it to a new era without causing major changes to existing systems or
infrastructure. Organizations benefit from comprehensive, unified, pan-enterprise
information while they can continue using their existing operational systems. This happens
without disruption of day-to-day operations.
Business Challenge
The healthcare IT (HCIT) industry has its roots in “product-centric” vertical software
development; as administrative, financial or basic clinical needs were identified, standalone
applications were developed to address them individually. This vertical application
approach has been implemented to such an extent today, that on average, US hospitals have
more than thirty distinct information systems, handling information for disparate
departments and divisions. Since each application is designed with different structures,
codes and protocols, the result is that currently, fewer than 25 percent of these systems are
able to share medical information with each other, and patient caregivers continue to
struggle with inefficiencies stemming from the silos of irretrievable information caused by
disparate legacy systems.
The result is:
• Wasted Time. Large amounts of time is consumed by physicians and their
assistants on tasks such as locating charts, searching for specific clinical
information, following-up on consultations, making phone calls to get results and/or
tracking down a nurse to get information, either inside or outside the hospital.
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• Wasted Money. Unnecessary testing and procedures contributes to billions of
wasted healthcare dollars every year.
• Reduced Quality of Care. Doctors may prescribe a drug that is not appropriate
for a particular patient without realizing that the patient is allergic to the drug, or
prescribe a therapy that is less effective than another option. In addition, emergency
cases in the ER may be delayed due to inaccessible lab results that are stored in
legacy systems at a hospital.
Market forces such as mergers and acquisitions, government regulation (HIPAA in the US,
and the European Privacy Standards), decentralization and globalisation, are forcing the
HCIT landscape to change and to create a “patient-centric” environment that emphasizes
the need for information sharing more than ever before.
The healthcare industry worldwide strives for advanced information technologies that will
restructure inefficient data collection from modes that “collect many times, use once”, to a
“collect once, use many times” arrangement.
It is difficult, on the other hand, to circulate information within a large and decentralized
organization. Even if the entire organization works within just one building, each
department may work independently and produce its own data on the same subject.
Moreover, many enterprises consist of several geographically remote units or branches,
with little exchange of critical information between them. For example, a local hospital may
generate, over time, a file that contains critical medical information on a patient. When that
patient has to be treated in a different hospital, all the information has to be gathered again.
In this case, although the two hospitals may not belong to the same health fund or area, they
do belong to the same enterprise: national healthcare.
dbMotion solves these issues, and even allows different healthcare organizations in
different countries to share information seamlessly.
dbMotion is not just one application, it is a versatile collection of modules and network
components, which work together in seamless synchronization. Together, they form a
comprehensive system for processing and sharing information throughout the organization,
and across organizational barriers.
The dbMotion Overview
The principle underpinning the dbMotion Virtual Health Community is as follows:
The Community is a virtual collection of members (hospitals, districts,
institutes, labs, etc.) in which all of the information stays in the same place
and format that it was created (in each member). The uniqueness of the
system is in its capacity to gather information on demand, from all of the
information systems dispersed in the organization, to unite the information
into a single "package", and to transfer it within seconds to the service
provider at the Point of Care. This offers the service provider an up-to-date,
reliable and complete picture of the relevant information for making
decisions, and providing effective medical care at very high standards.
The dbMotion system is an innovative and advanced n-tier application, which is derived
from knowledge and experience in the development of complex multi-user Internet
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systems. The system was built using new technology, and conforms to all the standards and
requirements expected of these types of systems for: performance, robustness, userinterface, extremely strict information security (using advanced methods for applying
authorization, authentication, encryption etc.), and more.
The dbMotion platform enables the design, implementation, operation and management of
a web-based Virtual Health Community. dbMotion enables online gathering of medical
information components from different, distributed sources, and their transfer within
seconds to authorized users according to different usage profiles. dbMotion also has a
unique mechanism for supporting DSS (Decision Support Systems).
dbMotion is also an advanced Web-based medical information environment, combining
sets of exclusive methodologies and tools for managing all the medical information
lifecycle. This includes:
• On-line retrieval of the patient’s clinical data from decentralized diverse clinical
databases
• Intelligent Real Time Notification (IRTN) provides predefined alerts and notifications
to your SMS, email, or browser. Instead of looking for the information you need, it will
look for you
• Data mapping and conversion, merging of data sources
• Web-based viewing information engine
• Monitoring and control of information traffic
• Aligned with the security, confidentiality, and user authentication of the
organisation
The dbMotion product includes a viewer which is an innovative web-based system, based
on the dbMotion platform that enables the care provider to browse through the patient
history. One of dbMotion’s greatest strengths is that it supports Wireless LAN while using
mobile platforms, such as the Tablet PC, at Point-of-Care.
The dbMotion Intelligent Real Time Notification (IRTN) intelligently draws conclusions
out of raw data, and then creates Alerts and Notifications. Notifications are provided to the
user in a push manner upon subscribing to an event. Additionally, IRTN is capable of
triggering an event based on the rules of another event. The unique approach of monitoring
events over distributed geographical locations creates a wide range of new possibilities to
improve quality of care and ROI.
Case Study: Implementation in Clalit Health Services
Client
: Clalit Health Services, Israel
Industry
: Healthcare Management Organizations
Key Solution : Virtual Health Community
Key Benefit : Improving the quality of care, lower costs.
Region: Israel
Background
Clalit Health Services is the largest health organization in Israel and the second largest in
the world. It is a decentralized organization that provides services to approximately 3.7
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million clients through 14 hospitals, 1,300 clinics and medical centres. The organization
employs approximately 20,000 care providers, each of which can create medical data and,
more importantly, request up-to-date data about patients. The medical information systems
in the organization differ from one another and lack unification between the systems.
The dbMotion system is currently installed at all Clalit hospitals, and in some specialty
hospitals. The system is also in use at in all the districts and clinics. Since the system is
Intranet-based, it is accessible to any service or care provider for whom an account has
been defined in the organizational network.
The Solution
The dbMotion solution, implemented at Clalit, was based on the requirement to collect
data from the existing legacy systems without the need to replace them, change their
function or the way they are utilized. dbMotion integrates data from clinical sources that
are dispersed geographically all throughout the Clalit, and contain various types of
information. For example, the solution integrates data from the hospital Emergency Room
and wards, the local clinics, as well as the several Clalit laboratories.
In addition, the solution needed to utilize existing infrastructures for communication and
data transfer such as the LAN and WAN networks or the Internet, as well as a web-based
viewer, where the physician can browse through his patient's history.
The solution provides available, up-to-date medical information while maintaining the
highest level of information security. In addition, the solution provides the combination of
clinical guidelines collected by the system for decision support and is capable of
connecting the user to various databases.
Dr Yaari, Using dbMotion on a Wireless Tablet PC at Point-of-Care
The Results
The dbMotion solution is operational in “Clalit Health Services” for the last 30 months, and
is installed in most of Clalit Health Services’ hospitals (14 hospitals) and in most districts
(each district controls clinics, labs and institutes – 8 districts, more than 1,300 clinics and
8,300GPs) constantly grows and provides up-to-date information at the point of care. The
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system has thousands of users and millions of hits and has required minimal investment in
training and implementation. The solution has contributed to the efficiency of processes and
to the improvement in quality and availability of medical information.
The system has reduced the general concern regarding medical negligence due to the lack
of available information. In addition, the system saves major costs by preventing “doubletesting” and unnecessary procedures, which were previously done, due to lack of cross site
up-to-date information. The adoption of the system has been extremely easy and
consequently the number of users grew from a few dozen to thousands in a matter few
months.
The Customer Value Proposition
Stated below, are the highlights of the added value that dbMotion provides to the customer:
•
Fully-integrated clinical picture given to the care provider in near real-time.
•
Single point of access to distributed and diverse existing data systems
•
Supports the model of the unified patient medical object, including infrastructures for
data input into the patient's record from every medical facility.
•
Easy access to all the relevant clinical information for treating patients
•
Profile-based security model gives the ability to allow different users at different
authorization levels access to different types of data, varying historical depths, different
methods of presentation, etc
•
Flexible data views with the ability to choose to display only the local hospital system
or opt for online display of all the major medical centres and hospitals without the need
to create a single, central repository.
•
Improving comprehensive information flows from disparate legacy systems will
significantly increase the quality of care and may lead to early detection of disease,
rapid treatment response time and overall cost savings in the long run.
•
Monitoring and tracking capabilities allows an organization to observe and trace
everything a user is doing in the system, in a very high resolution. The system can
follow and record what clinical subjects were viewed, by whom, from what machine,
when, if something was printed, how long the information was viewed, under what
permissions, etc.
•
Supports the medical decision-making process with Rule-Based CAI and, ultimately,
improves the quality of medical care provided to the patient.
Financial Benefits Gained
IT Cost Benefits
The ability to continue the use of existing operational systems, applications and
infrastructure combined with increased user functionality and capability means dbMotion
comes at a relatively low cost compared with the cost of replacing all existing systems.
(Clalit still uses about 5-10 old central systems). The dbMotion solution is implemented
with minor client end installation costs since it is based on a Web browser user interface.
This can help minimize the installation and ongoing maintenance/support costs. The
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utilization of existing global networks such as the Internet can eliminate the need to
purchase new equipment.
Patient Care Cost Benefits
Today, when patients pass from one doctor to another or from one department to another in
the hospital, results of the lab tests they underwent often fail to reach the new doctor or
department. This means the tests have to be performed all over again. Even if the
percentage of the double-tests avoided reaches only one or two percent of all tests
performed, it still saves enormous costs. The average number of lab tests performed in a
typical Clalit general hospital is about 1.25 million per year; Clalit Health Services operates
eight general hospitals and six specialized hospitals, so that even at a minimal cost of $10
per test (and only at the general hospitals), the organization saves one million dollars every
year. It is important to note that this does not include regional clinics; there the situation is
even more critical since patients visit some hospitals and switch from doctor to doctor
regularly.
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