GTSI Technology

Leadership Series
From Mobility to
Homecare

Dr. Mark Blatt

Director
Healthcare Industry Solutions
Digital Health Group, Intel
 Agenda

Mobility Now
Mobile Point of Care Components and Trends
Form Factors to fit Workflows
Model for Measuring Business Value and ROI
Network Design Considerations
Customization vs. Standardization
Use Case Studies
Homecare: the next frontier
Closing Remarks
Mobile Point of Care (MPoC)
Workflow Transformation

PEOPLE

PROCESS TECHNOLOGY
MPoC: Five Components to Get to Solution

1
Right Hardware (w/ refresh roadmap)
2
Right Software (needs to fit with workflow/use case)
3
Connectivity (robust network design)
4
Integrated Solution (needs to fit with other pieces)
5
Workflow Transformation (people need to use it)
Mega-Trend: Extending Wireless Spectrum

WiMAX ZigBee

50km/31m Bluetooth,
CDMA2000, GPRS, GSM, CDPD, EDGE
Wireless USB
35km/22mi max
100m/330ft max
IEEE 802.16

Wireless Wide Area 30m/100ft

Network (WWAN)
Wireless Local Area
10m/30ft
Network (WLAN)
WiFi: IEEE
802.11a/b/g
Personal Area
Network (PAN)
Radio Frequency Identification (RFID)

Varies in Range
Wireless Medical Telemetry Service (WMTS)

Healthcare Shifts-Left & goes mobile without boundaries

Usage Models Drive Design of MPoC
Solution
Walk Around Wheel Around Walk and Dock
Patient Care & Office
Grab & Go Patient-2-Patient Room-2-Room
Usage Model
What We Have Heard:
Workflow Optimization Where are the Bottlenecks?

End of Shift
Handover

Admit
Asset Tracking Discharge
From ER

Medication
Management
Mobile Use Cases (what mobility can do at the bedside)
Reference Architectures (available)

1. Vital signs capturing using Bluetooth

2. Vital signs capturing using WiFi
3. Image capturing and input into EMR
4. RFID for user authentication and Single-Sign On (SSO)
5. Care team collaboration (communication using VoIP)
6. Patient and medication identification using barcode
7. Image (x-ray) review at bedside (PACS)
8. Bedside device ordering and patient transport request
9. Blood transfusion verification
10. Mobile ePaper
11. CPOE at bedside
12. Newborn tracking using RFID
MPoC in Action

Access 2 systems Capture vitals Drawing blood

Charting Nurse data entry Dr. data entry

What is the Best Device For My Needs?

Mobile Clinical Fixed

Tablet PCs Laptops
Assistant PCs
Mobility

Vital sign, I & O entry

Medication Administration

Template data-entry

Free-format text data-entry

Large diagnostic images

Data Inquiry

Manageability
Improving Handwriting Recognition
Improve handwriting recognition results by installing
Microsoft Dictionary Tool for Tablet PC (freeware) and
importing custom 9,883 Medical Term dictionary (.txt) from
Microsoft PowerToys for Windows XP Tablet PC Edition site
at:
URL: http://www.microsoft.com/windowsxp/downloads/powertoys/tabletpc.mspx
eForms and the MCA

Skilled Nursing Visit Signature Consent

Wound Care

Reimbursement Medical Charge Capture

The synergy of eForms and the MCA can help optimize workflows
Industry-Tested Approach to
Identifying Business Value
Business Value: Improved ability to achieve strategic business
objectives
Improve quality of care, patient safety, staff productivity, revenue,
costs
Business Value
= one or more of
Monetizable
Increased
Revenue
Quantifiable
(Growth)

All Benefits
Lower Costs/ Better Use of
Better Efficiency Assets
(Productivity) Not all benefits are quantifiable
Not all quantifiable benefits are monetizable

Business Value Model focuses on

monetizable benefits
Quick Summary TCO and ROI for MPOC
Workflow At the Royal Salford, UK
Salford Phlebotomy MCA Annual Savings
People Material Total
Phlebotomy 2,574 hrs 24,612 12,355 36,967
Lab 468 hrs 4,475 6,037 10,512
Total 3,042 hrs 29,086 18,392 47,479

Gross annual savings of 47,000 through >20% time

savings in Phlebotomy, 70,000 3yr NPV
Leading to one-year payback
Equal mix of savings due to productivity and reduction in
errors leading to fewer draws
Quality of Care aspect not quantified
Opportunity to compress Phlebotomy Order Life Cycle
leading to Workflow Optimization and further Quality of
Care benefits
MPOC VM Workflow Optimization
- After
Prior to
MCAMCA
Deployment
Deployment

MPOC Workflow Optimization can

Reduce number of phlebotomists (by 2)
Increase the number of draws by 27-33% (50-60 draws)
Improve capacity management and timeliness of blood draws
Measuring Up the MCA

60% clinician productivity 65% clinician productivity

83% manual transcription of

patient vital signs

62% clinician productivity

25% patient vital sign charting

accuracy
15% productivity and efficiency Compliance with medication
administration guidelines

The MCA demonstrates results

Source: Intel News Release, Studies Show Mobile Clinical Assistant from Intel and Motion
Improves Care Delivery and Clinician Productivity, December 4, 2007
 Mobile
Technologies
Network Design Considerations

How do you handle multiple devices on the

network including personal devices?
How do you manage to secure your wireless
environment?
How do you create a wireless environment robust
enough to handle current and future demands?
Whats the point of a wireless environment
anyway?
When Wireless is Deployed Poorly
Loss of connectivity
Cold spots -> poor roaming
Crashed applications and systems -> lower clinical
satisfaction
Low Throughput
Slow system responsiveness
Application time-out
Security loop hole
Data theft -> Hospital Liability

Takes very little to frustrate customers

 Mobile Usage Model Characteristics
Walk-around Wheel-around Hybrid Room
Office
Level of Mobility Room-to-room Room-to-room and Office
Roaming
Roaming Roaming Roaming
Targeted User
Office Worker,
Nurse/Clinician/MD MD/Specialist or Remote MD

Characteristics
Roaming Aggressiveness

Authentication and Encryption

Virtual Private Networking

Throughput Requirements

Application Sensitivity to Latency

Quality of Service

Remote Manageability
Relevance to User: Low Medium High

Usage models dictate wireless requirements

Site Survey
Conducted before deployment
and production
Analyzes
Signal Strength (coverage)
Signal-to-Noise Ratio
Data Rate
Signal Overlap
Signals in a specific channel
Roaming Prediction
SW Tools available:
www.ekahau.com
www.airmagnet.com

The most crucial step in a wireless deployment

RF Spectrum Noise
Frequency Source
50/60 Hz All mains powered electrical equipment
~200 kHz Magnetic card security readers
~1 MHz Surgical diathermy (heating tissue via EM induction)
27 MHz Continuous shortwave physiotherapy diathermy
~50 MHz Pagers
~70-200 MHz Ambulance radios
~400 MHz TETRA radios
850, 900, 1800, 1900 Cell phones (GSM mobile phones)
MHz
2.45 GHz Microwave physiotherapy diathermy and microwave
ovens, consumer cordless phones, Bluetooth devices,
802.11 b/g
5.0 GHz 802.11 a/n
20 GHz Automatic doors
Numerous sources of electromagnetic interference
exists; site surveys are very critical
Coverage Areas

Key External Spaces

Nurses Station Patient Rooms

Building Connectors,
Elevators, Staircases

Others:
Hallways
OR Theaters
Waiting rooms
Common Spaces (for shift Cafe/Cafeteria
changes)

Follow the workflows to determine coverage areas to

provide roaming availability
Customization vs. Standardization

How much customization do you allow?

Do you drive for uniformity and standardization or
do you support individual customizations?
When you change one workflow, how does it
affect the adjacent workflows?

Why do we need to address this issue?

As Much As You Can Drink!!!
MCA in Home Care
Value Proposition
Improved documentation Increased patient face time
Quicker time to reimbursement Lower operational costs

Challenges
Lower and slower
reimbursements due to POC Documentation
documentation errors and Wireless Access to EMR
omissions
E -E Claims Submission
Patient care errors from
Real Time Dynamic
incomplete information
Scheduling
Low patient satisfaction due to
Task Based Charge
longer wait times
Capture

Technology Partners
OEM Home Care EMR
Infrastructure eforms
 MCA in Pharma
Value Proposition
Research and Development Sales Force Automation
Clinical Trials Lower operational costs

Challenges
R&D processes costly, slow,
often paper based. Real time
collaboration less than ideal R&D Documentation
Clinical trails management RT Wireless data synch
tools and processes remain Ultra mobile eClincials
manually intensive, costly and documentation
slow Real Time Dynamic
Scheduling
Sales force gets minimal FTF Improved meds
time with clinicians sampling SCM

Partners

Big Pharma eforms

MCA provides new workflow options for Pharma

 Merck: Mobile Convergence Device Project
Background
Heavy reliance on inefficient paper based workflows in evaluated labs
No access to eNotebook; Risk of contamination from paper

Prior deployments of mobile technology devices in labs unsuccessful

Opportunity with Intels new Mobile Clinical Assistant (MCA) platform and C5 from Motion Computing

Description and Prediction

Hypothesis is that a mobile convergence device will lead to increase in
productivity and optimization of workflows, while reducing data errors
and waste when deployed in the research laboratory environment
Prototyping methodology employed for the project
Time studies were conducted with selected users to develop baselines for evaluation of productivity gains
MCA C5 devices and wireless infrastructure were deployed for use by the test groups
After a period of utilization the time study was repeated to gather updated metrics and process changes
A survey was conducted to gather qualitative data from test users

Outcome
C5 with supporting wireless network proven a success in research labs
Enables our scientists to focus on value added research work in labs
Reduces inefficient processes, waste, protocol submission time
100% electronic records and electronic lab notebook (ELN) integration;
Increase searchability of researcher data; Maximizes ELN investment
Demand for device exists now and positioned well for future demand
Challenges Facing Research Labs

Research labs face many

inefficiencies because:
No access to eNotebook
within the lab
Large reliance on paper-based
processes
Limited access to information
technology at the bench
Contamination / Safety Risks
Print protocol
Scanning photos
process
process

Recopy paper
records process Photo
taking
process

Manual
calculation
process
Biochemistry PCR Protocol
Before C5
Biochemistry PCR Protocol
After
Before
C5 with
C5ELN
 Experiment Analysis
ONE PROCESS (PCR Protocol) AVERAGE PROTOCOL (ENTIRE
Process: Taking picture of amplified gels PROCESS)
Without C5 With C5 Average amount of time required to sign and
submit completed protocol in ELN
1. Retrieve hood/stand for 1. Take picture of
camera gels with C5 Without C5 With C5
2. Setup hood on light 2. Save picture to
3. Load film into empty camera network share
4. Mount camera on hood 2 weeks 1 day
5. Take picture
6. Wait for Polaroid to develop
7. Evaluate picture for shutter
quality
8. Carry photo to scanner
9. Startup software
10. Scan picture
11. Save image to network share
Single Process: 9 min Single Process: 1.10 min

TOTAL EXP 2:35:00 TOTAL EXP

2:03:00

TIME SAVINGS \ COST AVOIDANCE (Differences)

One FTE Department (20 FTE)
Time Savings Cost Avoidance * Time Savings Cost Avoidance *

Day 32 min $40.60 10.67 hrs $811

Week 160 min $203 53.3 hrs $4,051
Month 12 hrs $879 231 hrs $17,583
 Recopy paper Contamination
Printing /
results into ELN Monitoring
hanging sheets
Report

Referencing
sheets

Binding Assay Experiment

Before C5
Binding
Binding Assay
Assay Experiment
Experiment
After
Before
C5 with
C5ELN
Experiment Analysis
4 PROCESS ANALYSIS AVERAGE PROTOCOL (ENTIRE
PROCESS Without C5 With C5 PROCESS)
Setup 11.32 min 5.33 min Average amount of time required to sign and
experiment submit completed protocol in ELN
Referencing 2.7 min 35 sec Without C5 With C5
Protocols
Beta Counter 7.5 min 1.42 min 3 4 months 2 days
interactions GOING GREEN SAVINGS WITH C5
Finalize 11.37 1 min One FTE Department (20 FTE)
protocol
in ELN Paper Gloves Paper Gloves
4 Processes: 32.89 min 4 Processes: 8.33 min Day 9 10
TOTAL EXP TOTAL EXP Week 45 50
5:45:00 3:36:00 Mont 203 225 4050 4500
h
Year 2430 2700 48600 54000
sheets

TIME SAVINGS \ COST AVOIDANCE (Differences)

One FTE Department (20 FTE)
Time Savings Cost Avoidance * Time Savings Cost Avoidance *

Day 129 min $163.58 43 hrs $3,271

Week 645 min $818 215 hrs $16,358
Experiment Analysis

Survey Results
Surveys were deployed to users at
conclusion of pilot
Four users of C5 devices in study surveyed
 Top 10 Dos and Donts
Do
1. Understand intended use case(s) for going Mobile
2. Software and Form factor must fit with intended use case
3. Wireless Network must be upgraded for ultra mobile
4. Plan for iterations
5. Look for ripple effects
6. Focus on workflows and how they overlap
7. Consider both current and future (unknown) needs
8. Seek input from all customers
9. Engage executive leadership and governance processes
10. Do more!!
 Top 10 Dos and Donts
Dont
1. Don't make decisions about workflow just from IT perspective
(include all stakeholders to map priority workflows)
2. Dont try to do this by the seat of your pants
3. Dont let IT be the Champion of this effort
4. Dont ignore existent RF devices and patterns
5. Dont forget to make security discussions broad-based
6. Dont forget to broadly survey wireless technologies and their
purported next steps
7. Dont ignore your application vendors engage them early and
often
8. Dont forget to test the technologies with your stuff
9. Dont leave SLAs out of your environment and planning
10. Dont avoid asking numerous questions the answers often
change!
 Intel Health
Homecare: The Next Frontier

Copyright 2008, Intel Corporation. All rights reserved.

What is Telemedicine?
Here in Abuja (capital of
Nigeria) we have immediate
access to a vast amount of
medical experts, healthcare
education & information, and
support from other
physicians
How can we take all these
resources and share them
immediately and
effectively with our rural
hospitals and
clinics?...Telemedicine

Using technology to connect people to healthcare

Telemedicine Models: Improving Access

Asynchronous model:
Tele-radiology
Tele-pathology
Tele-psychiatry
Industry efforts
Case Complexity

Tele-ophthalmology over last 20 years

Real-time model:
Colds/Flus
Diarrhea
A different Hypertension checkups
approach AIDs/HIV/Malaria
Maternal/Child health

Clinic Patient Volume

Homecare: Personal Health Technologies

PHRs: a good start

Video conferencing (secure video phone)
Remote Sensors
DSS: Patient education and empowerment
Virtual encounters
Web base Services.
Reminders
Patient education

Promoters
 Telemedicine Stages
Infrastructure Basic Multimedia Virtual Care
Face-Face Remote data Multiple
Gathering by LOB Vitals Gathering AV Conferencing V-care Networks
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4
Traditional face Office may be Multiple sensors Increased access Increases access
to face visits (electronically) with integrated to care; Cost to care, Dramatic
with clinician at linked to ancillary data screens avoidance; cost avoidance
the medical care providers Improved quality (v-care = minimal
Clinical Decision
mainframe like lab or of care overhead),
Support SW ;
(hospital or pharmacy to get improved quality
clinical Convenience
clinic) inter-visit data on of care
treatment plans;
pts. Patient data
Follow ups and branching EMR / PHR,
integrated with
CDM require May have sensor algorithms integrated w/ labs,
EMR and PHR
repeat return in pts home (e.g. pharmacy,
Managed by
visits scale / BP cuff); Complex radiology, long
exception: CDM
Continua term care
Very little Pt sends data & Patient compliant
interaction doctor responds. Improved med
empowerment peripherals
between adherence;
Structured chat. with data
clinicians and pt Greater scope of automated refills
feedback
between visits May be ICD remote medical
Pt education services (PT, OT, Alliances with
device that is
Nutritional, bricks and mortar
remotely Sensor
Specialty systems
checked betwn standards
visits Consults) E-Commerce
(Continua)

Non regulated Regulated

 Legal Disclaimer

The Intel Health Guide

a) requires a broadband connection in the
patients home to enable communications
with the care team and back-end data
hosting;
b) is designed for use by health care
professionals and their patients and should
only be used under the guidance of a
health-care professional;
c) is not intended for emergency medical
communications or real-time patient
monitoring.

Intel Confidential
 Intel Health Guide
The Intel Health Guide connects patients and their care teams
for personalized care management at home

Intel Health Intel Health Care

Guide Management Suite

Medical
Peripherals
Patient Educational
Content
Intel Confidential
CLOSING
REMARKS
Summary
Mobility in healthcare matters (more and more)

Mobile Workflow transformation requires:

Clear understanding of the preexisting workflows
Clear vision of what you are trying to accomplish
Strong stakeholder involvement; pick the right
processes; pick the best technologies
Homecare and virtual encounters are coming
Rising costs and growing issues with access will
demand new care delivery models
 Q&A

Dr. Mark Blatt

Director
Healthcare Industry Solutions
Digital Health Group, Intel