Making Collaborative Health a Reality

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Making Collaborative Health a Reality
Microsoft Collaborative Health Customer Showcase
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Introductions

• Andrea Pettett
• CEO, New Zealand Health IT Cluster
• Matt Hector-Taylor
• CEO, Healthphone Limited
• Mark Simmons
• Principal Solutions Architect
• The Simpl Group Limited

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A Fragmented World
End of episode
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Our ideal Collaborative World
In the Collaborative Model, the patient is at the
centre
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Current manual processes are costly
Referral
Schedule specialist assessment
Patient assessment
Order lab tests
View test results
Paper based referral Key referral data Manual
confirmation to referrer Triage referral
Schedule appointment at mutually convenient
time Phone/letter to patient to confirm
appointment Reminder call/letter re appointment
Request manual patient notes Complete assessment
form Manually copy patient details onto
assessment form File hardcopy record
Complete admin components of lab test form Select
required tests on form Fax/send form to lab Give
patient a copy of the form File test order for
later matching (confirm receipt of lab test order
at lab) (remind patient to have tests) Update
manual patient notes File patient notes
Admin receive test results Locate patient
file Notify clinician of results Match the order
to the results Analyse the results File results
into patient record Manually file patient
record (match for billing purposes)
Equivalent processes in a non-computerized
setting
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And take time away from care
Decisionsupport
Plancare
Prescribedrugs
Patientinteractionwith care plan
. . .
. . .
Read guidelines Assess case against
guidelines Recommend actions Document analysis
and store Approve and supplement recommended
treatment Review and finalize guideline findings
Convert guideline recommendations to treatment
actions Document treatment actions Manually
schedule treatment actions Educate patient re
treatment actions Enter bring-ups in manual
file Finalize care plan actions
Schedule regular follow-up visits Phone/write to
patient to remind re performing tests etc Respond
to abnormal results at scheduled follow-ups or
acute events
Complete admin components of prescription
form Select required drugs on form Fax/send form
to pharmacy Prescribe drugs Give patient a copy
of the prescription File prescription order for
later matching (confirm receipt of prescription
at dispensing location) (remind patient to
collect prescription) Update manual patient
notes File patient notes
Equivalent processes in a non-computerized
setting
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Collaborative Health puts time
Referral
Schedule specialist assessment
Patient assessment
Order lab tests
View test results
Triage referral
Schedule appointment at mutually convenient time
Complete assessment form
Select required tests on form
Analyse the results
Value-added clinical steps
Complete admin components of lab test
form Fax/send form to lab Give patient copy of
form File test order for later matching (confirm
receipt of lab test order at lab) (remind patient
to have tests) Update patient notes File patient
notes
Admin receive test results Locate patient
file Notify clinician of results Match the order
to the results Analyse the results File results
into patient record Manually file patient
record (match for billing purposes)
Phone/letter to patient to confirm
appointment Reminder call/letter re appointment
Paper based referral Key referral data Manual
confirmation to referrer
Request manual patient notes Complete assessment
form Manually copy patient details onto
assessment form File hardcopy record
Redundant (manual) steps
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where it adds value!
Decisionsupport
Plancare
Prescribedrugs
Patientinteractionwith care plan
. . .
. . .
Assess case against guidelines Recommend
actions Review and finalize guideline findings
Finalize care plan actions Educate patient re
treatment actions
Respond to abnormal results
Prescribe drugs
Value-added clinical steps
. . .
Read guidelines Document analysis and
store Approve and supplement recommended treatment
Convert guideline recommendations to treatment
actions Document treatment actions Manually
schedule treatment actions Educate patient re
treatment actions Enter bring-ups in manual
file Finalize care plan actions
Schedule regular follow-up visits Phone/write to
patient to remind re performing tests etc Respond
to abnormal results at scheduled follow-ups or
acute events
Complete admin components of prescription
form Select drugs on form Fax/send form to
pharmacy Give patient copy prescription File
prescription order for later matching (confirm
receipt of prescription at dispensing
location) (remind patient to collect
prescription) Update patient notes File patient
notes
Redundant (manual) steps
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An even more ideal world

• Wouldnt it be even better if all of this was
• Standards based
• Private and secure
• Off the shelf and low cost
• Easy to implement
• Low risk
• Multi-organisational
• Plug and play
• So thats what we set out to do

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Collaboration Overview

• Use off-the-shelf Microsoft technologies to
  enable an HL7 V3 compliant flow of information
  between settings of care and information systems
  for a chronic disease (diabetic) patient
• primary
• secondary
• tertiary
• clinical support

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Collaboration Overview

• Incorporates 10 collaboration points between 6
  systems
• Demonstrates a plug and play infrastructure
• Enables patient interaction with their care plan

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Key topics

• Structure, governance and implementation
• Showcase overview
• Technical features
• Demonstration of highlights
• Benefits and lessons
• Next steps

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Collaboration Challenges

• Getting the parties together managing conflict
• Agreeing the contract terms payments
• What to do with shared IP
• Warranties indemnities
• The funding model
• Multiple funding agencies
• Seed funding the concept design
• Management/ governance
• Delivery

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Role of the Cluster

• The New Zealand Health IT Cluster
• Governance
• Coordination single point of contact
• Contracting with Microsoft, project participants,
  and NZTE FRST
• Funding conduit
• Marketing initiatives

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The Contracting Framework

• Cluster as central contracting agency
• Letter of Intent agreed with Microsoft
• Development agreement with Microsoft
• Funding agreements with NZTE and FRST
• Services Agreement with vendors with mirrored
  obligations

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Overview of Patient Flow
Robert Zane
Presents at family physician practice
Presents at emergency department
Active management of care plan
Family Physician
Community / Ambulatory
Cardiac event in a tertiary setting
Electronic referral to regional diabetes service
Retrieve EMR Record
Electronic discharge summary
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Overview of Systems Collaborating
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The Technical Challenge

• Provide an integrated view of information from
  disparate systems
• No lead system ie no single central database
• No superset of information/ no single record
  source
• The plug and play challenge from Microsoft

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Plug and Play Conceptual Model
Decision Support System 1
Decision Support System n
Health Collaboration Engine
Event 2 CSA 1
Event 1 CSA 2
Event 1 CSA 1
Clinical Support System 1
Patient Mngt System 1
Event n CSA n
Message Management Services
Health Services Directory
Clinical Support System 2
Patient Mngt System 2
Clinical Support System n
Patient Mngt System n
CSA Collaboration System Adaptor
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Messaging approach

• Clinical payloads are HL7 V3 compliant as far as
  possible
• Also use same format for Health Services
  Directory non-clinical payloads
• The payload is encrypted and not accessible to
  the Collaboration Engine

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Collaboration System Adaptors

• Provide
• Message transport protocol translation
• Message protocol implementation
• Message content mapping
• Encryption / decryption

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Health Services Directory

• A web service exposing directory services
• A database containing
• Register of Health Users
• Register of Service Providers
• Register of messaging schemas
• A schema repository for all message schemas
• Is loosely coupled, so also uses Collaboration
  System Adaptors

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Collaboration Technology

• Orchestration through BizTalk 2006
• Development in Visual Studio 2005
• Collaboration adaptors depend on the technologies
  in collaborating systems
• Collaborating systems use.Net, ASP, Cold Fusion,
  FoxPro, and Healthphones use of elements of the
  MS Office and Server stack

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Showcase key features

• We have time to show only a few key features
  today
• Informed decision making for acute events
  primary and community health event summaries
  accessible in hospital systems
• Accurate capture of administrative and clinical
  information closing the loop on lab outreach
  orders and results

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Showcase key features

• Better decisions, less mistakes decision
  support with rich data, resulting in an
  individualized, clinician editable, actionable
  care plan
• Patient engagement in their community based care
• Closing the information loop, hospital summaries
  in primary and community systems

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What have we achieved?

• Pragmatic governance of a complex multi-vendor
  collaboration project
• The project demonstrates
• Federated, standards-based, patient oriented,
  Electronic Health Record
• Use of off the shelf Microsoft technologies to
  reduce cost and risk
• Aligned to support clinical priorities
• Delivery of Plug and play capability
• Patient engagement in their own care usingmobile
  devices
• Planning for implementation at the firstcustomer
  site is under way

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Expected Benefits

• Reduced administration and low value time spent
  by clinicians
• Cost savings through elimination of redundant
  testing
• Reduction in errors, mismatched and lost results,
  non-fulfilled prescriptions
• Complete information at point of care in
  facility or in community

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Expected Benefits

• Confident management of community-based patients
  by exception
• Improved consistency and quality of care
• Improved clinical indicators Hba1C
• A research and measurements stream is going to be
  in place at the first customer to quantify and
  report on these

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Summary

• The collaboration architecture built on Microsoft
  technologies works and the federated,
  collaborative model is sound
• Strong programme management is essential
  (supported by a shared vision of the outcomes
  from the governance group) particularly to manage
  competing vendor priorities
• Clinical needs must drive the collaborations
• Collaboration standardsneed to be set (and
  enforced)