EMC IIG Solutions for
Transforming Healthcare
A Strategy Paper & Solutions Showcase
Date: 1st March 2013
1
CONTENTS
1. EMC AT A GLANCE.................................................................................................................. 2
2. UNDERSTANDING YOUR EHEALTH STRATEGY ....................................................................... 3
3. LARGE EMC HEALTHCARE PROJECTS IN ACTION ................................................................... 5
4. EMC SOLUTIONS FOR COLLABORATIVE HEALTHCARE .......................................................... 7
4.1 Healthcare Integration Portfolio – Clinical Challenges .................................................. 7
4.2 Healthcare Integration Portfolio – Solution Description . .............................................. 8
4.3 Healthcare Integration Portfolio – Solution Components .............................................. 8
4.4 Healthcare Integration Portfolio – Solution Benefits . ................................................... 10
5. EMC IIG HEALTHCARE INTEGRATION PORTFOLIO (HIP) CAPABILITIES.................................. 11
5.1 Medical Image Management ......................................................................................... 11
5.2 Driving Efficiencies in Healthcare Business Processes . ................................................ 12
5.2.1 Capturing Paper to Digital Records ..................................................................... 12
5.2.2 Providing National Applications to Drive Process Efficiencies ............................ 12
5.3 Cloud Provisioned HIS Environment . ............................................................................ 13
5.4 Enabling Services to Mobile Citizens ............................................................................ 15
5.5 Introducing Telehealth & Home Care Capabilities ......................................................... 15
5.6 Introducing Clinical Applications managed nationally .................................................. 16
5.6.1 An Example Application – Stroke Management . ................................................. 16
5.6.2 An Example Application – HIV Management ....................................................... 16
5.6.3 An Example Application – Chronic Disease Management ................................... 16
5.7 Enabling National Healthcare Analytics ........................................................................ 16
5.7.1 Potentially Preventable Events . .......................................................................... 17
5.7.2 Decision Support Systems for Doctors ............................................................... 17
6. SUMMARY ............................................................................................................................. 18
1
1. EMC AT A GLANCE
EMC is a global leader in enabling businesses and service providers to transform their operations and
deliver Information Technology as a service. Fundamental to this transformation is cloud computing.
Through innovative products and services, EMC accelerates the journey to cloud computing, helping IT
departments to store, manage, protect and analyse their most valuable asset — information — in a more
agile, trusted and cost-efficient way.
EMC works with organisations around the world, in every industry, in the public and private sectors,
and of every size, from start-ups to the Fortune Global 500. Our customers include banks and other
financial services firms, manufacturers, healthcare and life sciences organisations, Internet service and
telecommunications providers, airlines and transportation companies, educational institutions, and
public-sector agencies. EMC also provides technology, products, and services to consumers in more than
100 countries.
Our differentiated value stems from our sustained and substantial investment
in research and development, a cumulative investment of approximately
$10.5 billion from 2003-2010. To strengthen our core business and extend our
market to new areas, EMC has invested $14 billion in acquisitions over the
same period and has integrated 36 technology companies since 2006 alone.
EMC is supported by thousands of technical R&D employees around the globe,
the industry’s broadest portfolio of systems, software, and services, our ability
to create total integrated solutions, and our commitment to delivering the best
Total Customer Experience in this or any industry.
EMC at a Glance
• Revenues (2012): $20B
• Fortune 500 Rank: 166
• Employees: ≈ 49,000
• Countries with EMC operations: >80
• R&D investment (2010): ≈ $2B
• Total cash and investments (2010): $9.5B
• Market capitalisation: ~$57B (3/31/11)
• Founded: 1979
EMC ranks 152 in the Fortune 500 based on total consolidated revenue of $20 billion in 2012, the largest
revenue year in EMC’s 30+ year history.
EMC employs approximately 48,500 people worldwide. We are represented by approximately 400 sales
offices and scores of partners in more than 80 countries around the world. We have the world’s largest
sales and service force focused on information infrastructure, and we work closely with a global network
of technology, outsourcing, systems integration, service, and distribution partners.
EMC has over 5000 healthcare provider customers globally including 1600 healthcare customers who
also utilise the EMC Healthcare software solutions globally. EMC is the number 1 U.S. healthcare storage
vendor with a 52% market penetration rate (Source: HIMSS Analytics). EMC was recognized by Healthcare
Informatics as 14th in 2011’s Top 100 Healthcare Information Technology (HIT) Vendors. (A rise from 21st
position in 2010).
EMC’s Healthcare division holds membership of the HL7 organisation and participation at Connectathon in
2010, 2011, 2012 for our EMC Healthcare Integration Portfolio (EMC HIP) solution for Healthcare.
Our Healthcare customers include government agencies, healthcare providers and healthcare insurance
companies. Examples of these across Europe include in the UK the NHS; in Finland, Kela
& Tampere Region; in France the University Hospital of Nancy and the CNAM National Health
Insurance Company; and in Belgium the University Hospital of Saint-Pierre and the Regional Hospital of
Jan Yperman.
2
2. UNDERSTANDING YOUR EHEALTH STRATEGY
We are keen to understand what the key objectives and main priorities are
for enhancing healthcare services at a national level.
Matching EMC’s solutions for healthcare around your Healthcare strategy
is the first step towards creating an effective partnership. We can assist in
building this strategy in collaboration with you. We have experience in this
area at a national, regional and hospital level.
In our experience from working with other nations key objectives in an
ehealth strategy are tightly linked to the national development programmes
at a political level. Improvements in the quality of healthcare and the consistency of the delivery of healthcare programmes have a direct effect on the
contribution of the population to GDP, and therefore the economic success of
the country. Education and Healthcare are the 2 pillars from which economic
development of a country can be improved.
One of the strategic aims of the government could be, “to improve population health through a reduction
of disease burden and mortality by 2015.” Expected results following the implementation of this strategy
would be;
• Increase of the average life expectancy of the population – by reducing mortality resulting from
averted premature death, primarily among children, as well as other age groups
• Improvement of the quality of life of the population of the country – by reducing general morbidity and
associated disabilities
KEY PRINCIPLES OF THIS STRATEGY WOULD INCLUDE;
1.
2.
3.
4.
5.
6.
7.
Reduction of inequalities in access to medical care
Creating a Patient focused health care system
Creating an Affordable and efficient health care system
Improvement of the quality of medical services
Protection of the patient’s rights
Prevention of diseases, readiness for response to health threats
Refinement of the health care system management and increase of the sector efficiency
INITIATIVES WHICH SUPPORT EACH OF THESE KEY PRINCIPLES WOULD INCLUDE;
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Hospital Sector development plan (Urban & Regional)
Development of the primary healthcare (Centralized Medical Records)
Increase of number of citizens with health insurance
Increase of access to medicines (Urban & Regional)
Increase of access to medical services for persons with special needs
New permit conditions for medical institutions (Controlling Quality)
Motivated and qualified medical staff (Controlling Quality)
Accreditation of programmes and clinical placements
Promotion of the evidence-­based clinical practice
Creation and development of telehealth capabilities (Enhancing Access)
Electronic portal for citizens (Internet Based, Mobile Device Based)
Electronic portal for doctors (Internet Based, Mobile Device Based)
Enhancement of public health system
Enhancement of maternal and child health services
Prevention and control of tuberculosis and HIV/AIDS (Disease Registers)
Prevention and screening of non-­communicable diseases
3
• Facilitation of health and healthy life-­style (Citizen Education)
• Emergency and Disaster preparedness (National Registers, Response Systems)
• Support health science, predictive medicine and national research programmes
The above are some examples of what has been seen with previous national customers in the healthcare
domain. A number of these initiatives may be precisely what you are looking into, whilst others might not
be relevant, and of course further programmes may be in place, or suitable for the future. We look forward
to discovering more about the regional/national strategy and feedback from this paper.
SOME FURTHER QUESTIONS INCLUDE;
1. Is the strategy for healthcare provision on a city / regional basis or national?
2. Do healthcare provider organisations (hospitals) have individual autonomy, act in groups or follow
closely to national guidelines?
3. Is it desirable to adapt your processes to suit a proposed system which has been developed for
another country’s healthcare system or is the desire to create a new system to automate existing
healthcare processes?
4. Have you thought about creating a nation-­wide repository for information that can be accessed via
cloud computing from any source?
5. Would it be helpful to provide the IT infrastructure to an international secure standard, vendor neutral,
from which organisations can develop their own systems dependent upon local need?
6. Based on the main public health issues facing your population, would it be sensible to think about
what national systems should be developed that make the most difference, and how to do this
at scale? Specifically, are you likely to concentrate on population identification, immunisation
programmes, and/or disease management programmes?
7. Have you considered an approach which includes a world-­wide recognised IT Infrastructure
Company in your thinking, and could we provide that consulting expertise?
8. What are likely to be your priorities based on current political thinking?
9. Should you be taking those areas of successful implementation from other countries, such as
telehealth and telemedicine, to create some quick wins which are demonstrable?
10. Has there been implemented, or decided to be implemented, medical
vocabularies as in many other countries across the world regarding classification
and terminology? For example, ICD-­10, CPT, Snomed, ICPC, LOINC, etc..
This diagram might help in illustrating the various vocabularies and their
disciplinary relevance.
4
3. LARGE EMC HEALTHCARE PROJECTS IN ACTION
This section outlines some of the success stories across Europe where EMC technology and services have
provided significant enhancements to healthcare service delivery.
In some cases we start with a large hospital in the major city of a country, deploy to a controlled
ecosystem representing multiple actors that participate in the landscape, and then expand to a wider
population. In other cases we start with a key functionality area (for example national immunization
programme) and deploy this nationally, then expand to add other services.
Central to all our solutions is the concept of creating what we call a Citizen Electronic Health Record. Many
countries call this an Electronic Health Record (EHR), Electronic Medical Record (EMR), National Medical
Record (NMR), Central Medical Record (CMR) or whatever the local language defines the acronym. The
EHR is the combination of the following;
EMC’s solutions provide the architecture, products, storage, security, cloud infrastructure and services
to realise this vision. The national electronic medical record is the heart of the system. All healthcare
providers and consumers have access points into this shared infrastructure which enables greater control
of medical information, and enables at a national level the ability to perform analytics on the data to
provide insight into the level of care provided as well as predictive analysis and the targeting of national
campaigns.
5
An interconnected system can initially be deployed in
a controlled environment representing many different
collaborators; the diagram below represents how this
can be achieved;
An alternative approach is to provide the system
from a case based perspective introducing a
key management capability; the diagram below
represents the management of insurance claims at a
national level.
In both cases the electronic medical record is central to the solution. This may include medical imaging,
allowing image creation, diagnosis and referral to be shared regionally, stored centrally. This enables
telemedicine services and removes the need for major healthcare physical infrastructure to be deployed
consistently across a population.
6
4. EMC SOLUTIONS FOR COLLABORATIVE HEALTHCARE
The picture above represents the full breadth of the products available from EMC for healthcare at a high
level. For each customer the best fit of hardware and software are selected based on their requirements.
EMC has a broad range of capabilities and through discussion with you we hope to target our Solutions for
Collaborative Healthcare stack with the priority areas most relevant.
As presented in the previous section, our Healthcare Integration Platform is central to building up the
national EMR. This could start from collecting patient demographic information to build up a national
patient registry and/or take a medical image management approach, consolidating hospital imaging
information and sharing this medical content.
The rest of this section goes into greater details of the EMC Healthcare Integration Portfolio. This is one of
the solutions within what we call Collaborative Healthcare.
4.1 HEALTHCARE INTEGRATION PORTFOLIO – CLINICAL CHALLENGES
Global healthcare organizations are increasingly being pressured to share information to improve the
delivery of patient care, coordinate patient financial services, and enable the adoption of the electronic
health record. An interoperable healthcare environment allows siloed patient health information to be
shared securely in order to gain a holistic view of the patient, improve the quality and efficiency of care,
and control HealthIT costs. HealthIT interoperability is not only “a must” for collaborative healthcare, but
it also greatly increases the value of technology investments made in healthcare organizations.
The EMC® Healthcare Integration Portfolio delivers healthcare standards-based integration, and enables
the interaction between any healthcare information application or system for the secure sharing and
exchange of information. Its massively scalable software architecture is based on open standards such as
XML, HL7, and XDS. When this solution is deployed, your HealthIT infrastructure will be durable and able
to handle your future needs as the volume of digital content created by your clinical applications grows.
Utilizing EMC’s registry and repository also provides your organization with just the breadth of technology
needed to meet changing requirements, for example, incorporating mainstream content management
capabilities such as digital imaging or compliance management to augment the patient record prior to
sharing it.
7
4.2 HEALTHCARE INTEGRATION PORTFOLIO – SOLUTION DESCRIPTION
The EMC Healthcare Integration Portfolio is one of EMC’s Solutions for Collaborative Healthcare,
providing patient-centric infrastructure to “content enable” PACS, HIS, and EMR applications for
access to all relevant clinical, financial, and operational data. It allows healthcare providers to improve
clinical workflow and productivity for safer, collaborative care decisions. This offering is based on open
standards in accordance with the “Integrating the Healthcare Enterprise” (IHE) initiative which promotes
the coordinated use of established standards such as DICOM, HL7, and XDS. The solution leverages
the EMC Documentum® Content Server to manage the storing, retrieval, updating, and archiving of
patient information and its metadata in an open, non-proprietary format. Documentum also provides the
appropriate retention policies, security policies, and services-oriented management policies to ensure the
compliance and availability of medical information during its lifecycle.
This solution helps improve clinical workflow and time to treatment by delivering integrated, unstructured
data at the point of care. The solution enhances operational agility and reduces costs through the
abstraction of applications and infrastructure, improves financial performance by managing physical and
virtual assets with highly automated tools, and secures access to and prevents loss of protected health
information (PHI) and personally identifiable information (PII).
As one of EMC’s Solutions for Collaborative Healthcare, the EMC Healthcare Integration Portfolio is a core
solution that can be enhanced with additional capability as new components are added.
4.3 HEALTHCARE INTEGRATION PORTFOLIO – SOLUTION COMPONENTS
The EMC Healthcare Integration Portfolio consists of the following components:
• J4Care enhanced IHE protocol support enables the coexistence of multiple implementations of DICOM
and HL7 standards, communication, and visualization and the J4Care Healthcare Connector (HCC)
software establishes an IHE compliant Image Archive and Report Repository integrated with the EMC
Documentum platform.
• EMC Documentum provides complementary capabilities to traditional RIS/PACS integrations—
allowing documents, patient records, prescriptions, invoices, and other unstructured content to
be easily accessed via a secure, virtual, and federated repository, while leveraging open standard
message formats to reduce the expensive point-­point integrations that are typically required.
• Documentum Content Server governs the Documentum content repository containing the data and
metadata and can manage HTML and XML, graphics, multimedia, other types of rich media, and
traditional documents created with desktop applications.
• Documentum Retention Policy Services (RPS) enables compliance with regulations for the retention
and disposal of patient information. RPS attaches the appropriate lifecycle policies to the different
types of medical information (i.e., DICOM, HL7, SAP, and scanned documents) stored in the
Documentum repository. Static and dynamic policies can be configured to support real-­life events
based on any metadata on the objects or through referenced objects such as the patient or the facility.
• Documentum Content Storage Services (CSS) stores each medical document in a file store when it
reaches the repository. CSS provides de-­duplication and compression without changing the original
file and both automated and policy-­based storage and migration of data across tiered storage layers of
the corporate network.
8
• Trusted Content Services (TCS) provides an additional security layer for controlling how content is
protected, accessed, and authorized under complex, dynamic conditions.
• EMC Archiving Solutions creates an accessible online medical image archive and lowers operational
costs, achieves regulatory and litigation requirements, and facilitates retrieval of patient information.
EMC offers a range of backup solutions, including purpose-­built cloud storage platforms that can
manage millions of objects per day and efficiently store and protect data at petabyte scale throughout
your healthcare organization.
• VMware vSphere dramatically reduces capital and operating costs and maximizes IT efficiency
while giving healthcare organizations the agility through automation and the freedom to choose
applications, operating systems, and hardware.
The healthcare integration portfolio is comprised of building block components, including:
• EMC Documentum XDS Registry is the directory or “white pages” for medical and administrative
content and allows applications within the enterprise to discover and then access information. It
provides a central catalog for documents that may reside in a federated system or repositories, either
heterogeneous or geographically distributed.
• EMC Documentum XDS Repository stores structured and unstructured healthcare information
where all patient-­centric documents, images, and media are available via the XDS-­specification for
applications to consume—even when the clinical, financial, and operational content was not created
via an XDS specification.
• EMC Documentum XCA Gateway is an interface that enables multiple healthcare organizations to
federate and share information based on the IHE’s Cross-­Community-­Access (XCA) specification. The
XCA gateway facilitates the secure access of information by participants from various user domains,
e.g., regions within a country.
• EMC Identity Mapping is a solution that meets one of the key requirements in patient centric
healthcare—the reconciliation of patient identity.
• Connectors provides a library of connectors for on-­boarding information to be shared in addition to the
standards-­based integration through XDS messaging. An example is an XDS-­I Connector, where DICOM
images are processed for storage or retention and the XDS-­I objects are provided to the repository.
9
4.4 HEALTHCARE INTEGRATION PORTFOLIO – SOLUTION BENEFITS
The EMC Healthcare Integration Portfolio simplifies internal healthcare IT
processes by providing an integrated, virtualized, and services-oriented IT
environment for the management of all the information in the healthcare
organization. Clinicians gain a 360-degree view of the patient that is
secure, easy to access, and compliant-ready. In addition, this solution
provides:
• Rapid access to patient health data at the point of care and across the
healthcare exchange for collaborative healthcare.
• A modular approach to provide the breadth of technology needed to
meet your requirements now and in the future.
• Scalable software architecture based on open standards allows easy
data exchange.
• Supports for healthcare standards such as HL7 and XDS for ease of
compliance.
This solution accelerates clinical workflow and time to treatment through
the delivery of integrated, unstructured data to the point of care. It also
enhances operational agility through the abstraction of applications and
infrastructure; improves financial performance by managing physical and
virtual assets with highly automated tools; and secures access to and
prevents loss of protected health information.
10
5. EMC IIG HEALTHCARE INTEGRATION PORTFOLIO (HIP) CAPABILITIES
There are 3 fundamental drivers for improving eHealth capabilities at a regional/national level.
Improving the access to quality healthcare for all citizens
• Enabling mobile and home based applications
• To improve processes and ultimately their experience of care when visiting clinics and hospitals
• To feel empowered with information and be more participative in their own care
Improving the tools for medical professionals in your region/country
• Providing up to date and modern systems for Doctors
• Enable sharing of medical data and images at a regional and national level
• Improving the continuity of care through access of the wider electronic health record
• Enable more informed decision making from better access to trusted information
Improving the healthcare service for citizens whilst controlling the cost
• Optimising processes to avoid duplicated costs and wasted effort
• Enabling sharing of medical records and images to avoid duplicated procedures
• Reducing errors, mistakes and fraud by moving from paper to digital records
• Enabling healthcare analytics with greater governance, control and understanding of the healthcare
network, providing new insight into healthcare transformation
5.1 MEDICAL IMAGE MANAGEMENT
One of the core functions of the HIP platform is to enable the storage of medical images through the
support of DICOM standards. Also part of the landscape is a medical image viewer which can retrieve
studies and provide a clinical view for diagnostics and referrals. A common challenge for all hospitals is
the management of medical images. PACS systems are used within hospitals to manage medical images,
quickly these environments become costly to manage and constantly upgrade to store more images. The
challenge for most PACS solutions is that they are primarily concerned with serving and storing studies.
They are not designed for hierarchical storage management, they do not allow for sophisticated retention
rules and they are not designed for enabling XDSi/XCA sharing.
The EMC HIP solution can be used as a central image archive, to reduce the reliance on specific vendors
for PACS systems and storage at the hospital level, and to also allow for access to medical image studies
at a shared regional/national level. This promotes not only patient mobility, but also enables teleradiology and tele-referalls such that clinicians can remotely diagnose. For a large hospital, this also
enables PACS systems to be smaller, and they can realised cost savings through the use of a Vendor
Neutral Archive (VNA), which is what the EMC HIP provides.
Our medical image viewer also provides a view to non DICOM image documents within the same viewer.
Therefore in this way, the physician can view the medical study images as well as associated documents,
for example clinician notes, that make up the patient health record.
Also key to the sharing of medical image studies is cost avoidance. Through sharing, studies and exams
can be reused and reviewed by many practitioners through a patient’s diagnosis. This approach helps to
avoid the duplication of exams when a patient seeks a similar procedure for the same condition in a short
time frame.
11
5.2 DRIVING EFFICIENCIES IN HEALTHCARE BUSINESS PROCESSES
5.2.1 CAPTURING PAPER TO DIGITAL RECORDS
Another core function of the HIP platform is to enable the capture of
paper records and store them digitally. We have a number of customers
worldwide who use the capabilities of EMC Captiva attached to EMC
Documentum to automate the scanning of medical records which have
traditionally been stored in large paper archives either in a hospital,
clinic or held at remote paper warehouses. These records are scanned,
automatically detected to capture structured data and filed into
Documentum against the proper patient folder.
This paper to digital journey enables the “paperless” experience
for current patients, and also is a method for removing large paper
warehouses to reclaim space and reduce manual errors by scanning in
existing paper, validating it has been captured successfully, and then
destroying the paper.
When to scan is quite important in this drive for efficiency. If physical
storage costs are prohibitive, then batch scanning an archive makes
sense. More recently is the concept of Scan On Demand. This approach
only scans paper records when a patient is planning to visit a healthcare
provider. The full paper history of that patient is scanned into the HIP and
then that patient’s health record is fully digital going forward. Scanning
linked to business processes, linked to providing healthcare service
ensures paper to digital transformation is optimised for the current
citizens of your region.
Reducing paper flow has a significant impact to enhancing clinical & administrative processes, reduces
errors and lost time for administration to convert paper notes to digital records. The solutions available
include the use of dedicated multi-function devices which can scan directly to the HIP, web based tools
to allow already scanned documents to be analysed and imported into the HIP, and email inboxes so
documents can be sent to a general email account for automatic import into the HIP.
5.2.2 PROVIDING NATIONAL APPLICATIONS TO DRIVE PROCESS EFFICIENCIES
Utilising the HIP platform but extending it through our healthcare case management capabilities we
can also drive efficiencies in sharing information. Examples of this are the 6PM partner solution named,
HRVision. This application tracks the human resource requirements of healthcare practitioners, doctors,
nurses – not only managing their HR factors like entitlements, leave, remuneration, but also manages
their career appraisals, certification and registration. Taken at a national level this ensures all medical
professionals are certified and registered, have demonstrated current experience and credentials, but
also ensure doctors who have been identified as not able to practice due to certain medical failings of
performance to highlight this at a national level.
Another solution using this environment could be enhanced collaborative scheduling. Through the
integration of doctor clinics and hospitals, a citizen could log into their portal and only be offered
appointments which correlate the availability of all healthcare delivery actors, for example an operation
is only offered based on matching the service required with hospital bed availability, clinician availability
and anaesthetist availability. This typically involves many systems and is paper based, so bringing this all
together empowers the patient, allows for better healthcare service & optimisation, and reduces errors.
12
5.3 CLOUD PROVISIONED HIS ENVIRONMENT
Another priority for many providers is to be able to provide a cloud provisioned HIS environment for
those regional hospitals which would benefit from utilising national ehealth services as an alternative in
procuring their own localised system. This would have considerable benefits – not only for the regional
hospital, but also as a potential revenue stream for providers as well as enhancing governance and control
from a regional/national standpoint.
An example HIS integrated with the HIP is wHospital from our partner Laserbiomed. wHospital is able
to deliver HIS applications “in the cloud” to all healthcare providers consuming the service. The clinical
features which can be provided through this cloud HIS can be selected based on appropriateness. The
standard HIS features would include; patient case management, reservations, bed management, multi
disciplinary views & order management.
Additional modules of the cloud HIS, called Clinical Application (cApp), which could be provided by
wHospital include the following;
cApp Nurse Care Needs
• “Nurse Care Needs” module gives the opportunity to nurses to indicate for each patient all the
activities performed during the shift to complete the clinical log for deliveries.
• The purpose of the plan of assistance is to give vision of patients’ needs of care – that can be
opportunely set up – and of activities performed by nurses in each shift of each day of hospitalization
in response to those needs: it was therefore created as a table in which are summarized the three daily
shifts within nurses mark their interventions.
• This module has also usefulness for statistical purposes aiming to evaluate the workload spent over
each single patient: in fact, thanks to the reporting tools integrated in wHospital®, data collected
by nursing staff can be exported in a structured format data collected and carry them into tools of
Business Intelligence and analysis able to support later nursing care plans.
• The “cross-running activities” horizontal module gives the list of all the patients currently present in
ward allowing the rapid completion of all the activities performed.
cApp Chemotherapy
• The modules of the Chemotherapy Suite support the complete management of outpatient / day
hospital and ward processes, from the prescription to the administration of oncological drugs.
• This Suite has an intuitive module for the definition of chemotherapy cycles that allows authorized
personnel to implement specific protocols, defining various drugs, time of perfusion, methods of
calculation of chemotherapy compared to the more modern standards of care.
• The Chemotherapy Suite is perfectly integrated dedicated to the management of hospitalized patients,
and with the management of outpatient and day hospital patients.
• Prescription module: it lets define therapeutic programs , prescribe single cycles, customizing doses
and infusion rates.
• Workflow management module of healthcare process: it allows the planning of appointment schedule
and days of administration keeping an eye on the entire organization of the prescribed treatment. By
means of this module it is possible to administer the healthcare process involving the carrying out
of a visit for each day of administration or for each cycle and a first level of eligibility for the patient,
foreseeing a following level of eligibility, very often taken from blood tests, and the final approval to
the administration of various drugs, with its customization to the patient. The workflow management
module also coordinates the final evaluation of the treatment, which may be managed both for each
cycle and for each day of treatment.
• Administration module: according to the cycle defined and personalization received, it shows to
the nursing staff the daily schedule of administration using specific alerts that signal the timing of
administration both on the individual patient and in an “horizontal” vision of the entire department.
13
cApp Vital Signs
• The “Vital signs” suite is very large and composed of several health record modules (“signs setting”,
“shift monitoring” – typically morning, afternoon and night monitoring, “Values display” and “HL7
parameters validation”), of one module “horizontal” to the entire ward (“parameters detection”) and
configuration modules (“wHospital® configuration parameters”, “parameters configuration in OU”,
“HL7 parameters configuration in wH” and “HL7 parameters configuration in OU”).
cApp Lab Exams
• Among the most common processes managed by wHospital® there is the one for the request and
automatic receive of the results of laboratory tests (blood chemistry and microbiology): these requests
need to be done inside the system because they have to be digitally signed to ensure they are a
suitable substitute to paper.
• Clinicians can select from a tree of requests, pre-configured in a special module (“configuration of the
lab exams tree”) a set of types of examinations.
• All associated parameters, necessary for the proper completion of the request, are inserted
automatically by the system and submitted to the user for the affixing of digital signature.
cApp Drug Therapy
• The section of drug-prescribing holds great importance for its clinical implications in the perspective of
automation and risk management process.
• Given the complexity of this process there are different application modules suited to supply effective
and efficient as possible the entire process from the prescription to the therapy administration: the suite
is very wide and is composed of several health record modules
• treatment plan
• therapies to be administered
• delivered therapies
• and several configuration modules:
• types of therapies
• types of therapies in OU
• routes of administration
• routes of administration in OU
• association types of therapy – routes of administration
• The most important module from an operational point of view is the one able to show the whole plan of
therapy (where instructions are given on monitor with a wizard-type procedure), day by day, highlighting
parameters monitored and prescribed, deleted or confirmed drugs.
A healthcare cloud provider could enable any or all features in the cloud HIS, and then a healthcare
institution will decide which feature to enable for their use and contract service with you as a provider in a
“service per user” model (for example).
New features provided by the wHospital Cloud HIS extend the Central EMR and guarantee native
integration between hospitals and clinics taking up the service and the Central EMR.
14
5.4 ENABLING SERVICES TO MOBILE CITIZENS
As personal consumer technology continues to evolve, the rise of smartphones demands that service
delivery must be made available to citizens. The empowered patient expects services to be made available
to them at their demand, including when they are mobile, and they should have secured access to their
personal data. The EMC HIP platform recognises this trend and a mobile service add on is available from
EMC and its partners.
For one of our national customers, the EMC HIP also exposes a mobile device application infrastructure for
EMR connectivity. The application provides access to a citizens’ personal medical record, and also includes
a location aware feature to expose healthcare institutions and providers within proximity of the citizen.
The mobile application, developed for iPhone and Android, acts as an XDS consumer application that pulls
relevant patient data from the HIP. This mobile platform also includes contactless payment technology
which enables the delivery of enhanced eHealth applications and service.
Connecting the HIP to ePrescriptions and extending the mobile Mokipay application to provide this
service, together with contactless payment is an example of a service to be offered to citizens.
This would enable a “paperless” prescription, where the citizen is alerted on their mobile phone that
they have a prescription available from their doctor. This would connect to the HIP to provide a remote
view of the prescription; the application would provide them a contact number of the doctor if they would
like to ask questions, it would also offer them a map to show where the drugs can be dispensed. The
phone could be handed to the chemist and the prescription could be scanned. Also on the phone is the
contactless payment technology, which the citizen would use for payment.
These systems would all be integrated. Live drug dispensary information stored in the HIP. Payments
made securely and without cash, and drug fraud/errors reduced significantly.
5.5 INTRODUCING TELEHEALTH & HOME CARE CAPABILITIES
The availability of at home health monitoring and the explosion of telecare devices have enabled the point
of care to move from the hospital bed and into the home, whilst continuing to delivery health services.
Our partners at 6PM are deploying “emCare” across the whole country of Malta. These devices are
issued by emCare at request from the citizen, but soon to be extended for issuing by hospitals, elderly
care homes, with metrics being collected at regular intervals defined by the doctor. These metrics are
collected centrally, stored in the HIP, and events outside threshold triggers events to contact the patient,
the secondary contact, the doctors and the emergency services. The at home hub device or software
application also has a loudspeaker functionality so the Tele Health call centre worker can attempt to
provide first line of contact with the patient to check they are conscious and able to provide information.
The delivery of telehealth services is the future in managing citizens with chronic conditions and an aging
population and also freeing up bed space in hospitals and appointments at clinics. This reduces costs to
provide healthcare services whilst prioritising care for patients with complicated conditions.
With improvements in mobile network technology, exploiting this connectivity to improve overall delivery
of care is critical. Connected then to the HIP enhances the central EMR and also enables all healthcare
providers that are connected to understand the recent history of a patient more closely monitored and
evidenced by real data than ever in the past.
15
5.6 INTRODUCING CLINICAL APPLICATIONS MANAGED NATIONALLY
The HIP embraces healthcare standards in IHE. Profiles for connectivity of XDS, HL7 & DICOM enables
clinical applications which also utilise these standards can therefore interconnect with the HIP and share
data.
5.6.1 AN EXAMPLE APPLICATION – STROKE MANAGEMENT
Care Solutions StrokePad is a clinical application developed by 6PM which meets all the Stroke
assessments needs, developed by clinicians for clinicians. It removes the need for paper in a stroke unit
inside a hospital, which is a high pressurised time sensitive environment. Managing Stroke within the first
hours of arriving to the hospital can make the difference between up front thrombilising in time which has
a high rate of success, and will save long term costs associated with stroke rehabilitation.
StrokePad manages the entire point of care clinical process from admission to discharge using a tablet
device for use bed-side in the Stoke Unit. It removes the need for paper records, eliminates duplicate data
creation, enforces correct coding and optimises time and recovery process.
Connecting this application to the HIS and to the HIP is an example where we can have a transformational
impact to healthcare delivery at the point of care, whilst also allowing for monitoring, reporting and
managing Stoke at a national level.
5.6.2 AN EXAMPLE APPLICATION – HIV MANAGEMENT
Care Solutions CLIMATE – HIV is a clinical application development by 6PM which manages the long
term HIV patient condition and tracks their treatment in a consolidated HIV care record. The application
concept is to provide all the patient information in one screen or patient dashboard – their CD4, viral
load, treatment, diagnosis, allergies, resistance as well as consulting physician notes. The physician
can analyse the effectives of drug combination treatment against the viral load impact and determine
resistances and responsiveness within a very simple to use single interface. In this way CLIMATE-HIV
combines everything a physician needs so that their primary focus is the patient.
Connecting this application to the HIP allows for the potential of HIV management to be offered at a
national level.
5.6.3 AN EXAMPLE APPLICATION – CHRONIC DISEASE MANAGEMENT
wHospital CDN (Chronic Disease Network) is an advanced data sharing environment developed to enable
sharing and continuity of care for all chronic disease patients. Enabling this function will allow to record
and monitor population’s diseases using focused web form of Central EMR and/or HL7 integration engine
to connect all clinical activity in Georgia.
The CDN will be a regional/national provisioned service, collecting data relating to diseases for example,
diabetes, cardiovascular disease, chronic respiratory disease, cancer.
5.7 ENABLING NATIONAL HEALTHCARE ANALYTICS
As data collected in the HIP grows the importance of realising the greatest value of the data being held is
leveraged. Its not just about collecting the data for a historic view of “what happened”. The next step is to
start to look at “what is going to happen”, and how do I improve and optimise the service delivery.
16
5.7.1 POTENTIALLY PREVENTABLE EVENTS
Leveraging the Big Data capabilities of EMC Greenplum Unified Analytics Platform connected to the HIP
one can analyse greater amounts of diverse data. Bringing everything together, not just the individuals
personal medical history, but also their drug interactions, their geographical factors of locations and
services, regional historical data, their citizen records within all governmental departments, aggregating
social and economic factors within the region/country, as well as international factors produced by OECD,
the EU and WHO. Leveraging all these data sources increases the overall quality of care and delivery of
care significantly.
Potentially Preventable Events include
• Predictive Readmission Management
• Predicting readmission at the point of original admission
• Predictive Days in Hospital
• Length of Stay estimations
• Predictive (Elective) Surgeries
• Identify patients who will likely choose elective surgeries
• Identify patients who will likely not benefit from surgery
• Predictive Complications
• Identify patients at risk for medical complications
• Predictive Hospital Acquired Infection (HAI)
• Risk score of likelihood to suffer from sepsis, MRSA, C. difficile
• Predictive Illness / Disease Progression
• Identify patients at risk for advancement in disease states
• Identify causal factors of illness / disease progression
• Identification of possible co-morbid conditions
5.7.2 DECISION SUPPORT SYSTEMS FOR DOCTORS
Capturing the full medical history of citizens within the HIP is only the beginning. To then aggregate and
anonymise these captured care pathways allows for the success and failure of treatments at all stages of
care delivery. This data can become highly valuable to act as an entry point into Decision Support Systems
for clinicians. The ability to provide point of care with a patient, and then to correlate and compare their
current state to a very large sample of all similar patients at similar stages of their condition to quantify
the, “what if?” when deciding on the next treatment plan.
This not only acts as a major benefit to trainee doctors, but also acts at a nationwide referral/second
opinion engine – where next stage diagnosis is built into the system. For example in a university hospital
scenario during off peak hours new doctors are in place as they build their experience. It can be seen that
these new learning doctors send more people to exams during these times due to lack of experience and
confidence. With a DSS style solution in place exposing a consolidated view of what was the next decision
for a patient whose conditions are very similar, these learning doctors can obtain more confidence in their
diagnosis, and there is a cost benefit connected to a reduction in exams, tests, studies only for verification
purposes.
EMC does not propose it make recommendations in medicine, the concept here is to present what has
been the next step for patients of the past and current, to deliver a broader view to the clinician of the
options available, which have been exercised by their peers at a national level.
17
6. SUMMARY
EMC look forward to working with you discover your healthcare IT strategy, understand your current
challenges, and work together in articulating how we can partner to improve your healthcare service
delivery.
All comments are welcome, further questions are encouraged. Thank you for the opportunity to present
you with this paper.
18