Confidential © 2008 Radianse All Rights Reserved Revolutionizing the Delivery of Quality Healthcare...

Confidential © 2008 Radianse All Rights Reserved

Revolutionizing the Delivery of Quality Healthcare through Automation

AIDC 100October 15, 2008

Manuel Lowenhaupt, MD


“Even small healthcare institutions are complex, barely manageable places… large healthcare institutions may be the most complex organizations in human history.”

Peter Drucker


The Price of Progress

Life Expectancy• 9 year increase from 1960 - 2000

Infant Mortality

Clinical breakthroughs

We’ve made a lot of progress. . . But progress comes at a cost

Source:1. OECD High Perfoming Health Sudy

• 5x reduction from 1960 - 2000

• Heart disease, Cancer, Stroke• Minimally invasive procedures• Improved diagnostics• Promise of genomics • Expenditure doubled as % of GDP over past 30 years

• 120-200% growth in Pharma spend over past 10 years


Fragmented systems not delivering on Quality and Access

Emerging Crisis – Quality and Access

• Baby boomers/aging demographics will accentuate these problems

• Sustainability is provoking system level responses to policy, structure and delivery

• There is a shared sense of emerging ‘crisis’

Adverse events 16.6% of hospital

admissions 51% preventable Sub-Optimal Access “Access Block” Increasing surgical

listsRising Costs Funding for

hospitals Wage increase

Adverse events ~ 50-100K deaths p.a. US$17-29Bn p.a. cost

due to preventable event

Sub-optimal Access More than half of low-

wage earners lack coverage1

Rising Costs 13.9% of GDP

Adverse events NHS:- 850,000

events each yearSub-optimal Access 1 million people on

waiting listsRising Costs Grown by 4% per

annum since 1990

Common Challenges


Identification of Leading Performance Provider Trends

K. Increased Private / Public Sector Collaboration

High Level Trends / Characteristics of the High Performing Provider Market

C. Initiation of Broad-Based Health System Reform

D. Shifting Care Delivery Models

B. Increasing Influence of Consumers/Patients

E. Improved Patient Flow / Demand Management

I. Consolidation /Outsourcing of Provider Back-Office

F. Evolving Roles and Skills of Clinicians

H. Increase Investment and Effective Utilisation of Clinical IT

A. Evolution of Science, Medicine and Technology to Improve Treatment and Access

J. Improved Visibility, Reporting and Management of KPIs

G. Effective Leadership and Culture Change

Trend HypothesesTrend Hypotheses


Overarching Trend - Patient Centricity

Acute Facility(eg Nursing Home, Rehab, etc)

Primary Care Primary Care

Illustrative Patient Journey

Co

mm

un

ity

Co

mm

un

ity

Patient

EHR

GP ‘a’ Diagn ‘y’

Nurse ‘a’ Clinician ‘x’

Patient

ED Dr ‘a’ Surgeon ‘y’

Nurse ‘x’

Physio ‘x’

Patient

Rehab ‘a’ Clinician ‘c’

Nurse ‘s’ Physio ‘z’

Patient

GP ‘a’ Clinician ‘y’

Nurse ‘a’ Nurse ‘b’

Post-Acute Facility

Diagn ‘a’

• Prevention of disease. • Information sharing (clinical

and administrative) to improve health care quality, access and affordability.

• EHR available ‘anywhere, anytime’.

• Alignment of governments, companies, charities and non-governmental organisations

• Early detection and treatment of ‘high risk’ / chronic illness to reduce acute illness.

Concepts of Patient Centricity …

• Treatment by the most appropriate Health Channels (eg outpatient, hospital inpatient, etc)

• New ‘patient centric’ care models.• Comprehensive treatment of the

whole person, rather than ‘silo treatment’ by individual specialties.

• Clinical service streaming across setting

• Removal of ‘data silos’. Health information exchange securely enabled by technology advances.

• Hospital discharge pathways articulated

• Interconnection of acute & post acute clinicians

• Automated filing and archiving of claims upon discharge.

• Discharge summaries / notifications for all relevant clinicians.

• Continuous information sharing amongst appropriate personnel facilitated by EHR.

• Automated ‘home monitoring’ - IT systems / people / processes to promote healthy living and reduce re-admission.

“Systematizing” the Patient Journey

Structure ProcessOrientation Information


Clinician/Ward

Patient

Emerg.

Acute Inpatient

Nursing Home

RehabElective

InpatientAmbulat.

Inpatient

Ambulat.

Primary Care

Primary Care

Co

mm

un

ity

Co

mm

un

ity

Post- Acute Care

The Patient Journey

• Regional referral networks• Coordination through Contact Centres• Waiting list management/ theatre utilisation• Patient flow protocols• Real time KPI’s and escalation

End to End Patient and Demand Management

End to End Patient and Demand Management


Radianse System

Ethernet LANHospital standard

Receivers

Server

Active-RFID tags transmit at 433MHz to provide accurate location & low- cost, easy to wear tags

Receivers send data to the server via LAN or WiFi leveraging existing network infrastructure

WiFi Access Point

Web-based Applications

Web-based application are available over standard browsers

Copyright © 2006 , Radianse, Inc. All rights reserved. Feedback to

Detailed View for ED

Orders & Labs

>>

>>

Exam 1 J ohnson, Mike Smith, Samuel TriagedM – 46Y J ones, Susan 11:05 Chest Pain

Exam 4 Fredrick, J ohn Rueter, Charles Triaged M – 64Y J ones, Susan 10:12 Headache

Room 2 Cummins, Debora Smith, Samuel Waiting for Admit F – 31Y J ones, Susan 11:01 Trauma

3/11/07 11:13

Prospective Patient Flow Manager tm

[email protected]

Bed

2

1

4

Room 3 Smith, Samuel Waiting for Admit F – 31Y J ones, Susan 11:01 Trauma 4

Room 4 Cummins, Debora Rueter, Charles Waiting for Admit F – 31Y J ones, Susan 11:01 Trauma 4

Room 5 Cummins, Debora Smith, Samuel Waiting for Admit F – 31Y J ones, Susan 11:01 Trauma 4

Room 6 Smith, Samuel J ones, Susan

4

ED StatusPatient Name

Gender - Age

Complaint

Nurse

Triage Level

Physician

Arrival Time

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKG

EKG

EKG

EKG

Xray

Xray

CBC

CBC

CBC

Group by: None All ,Show for: All

Update



Orders & Labs

>>

>>

>>

>>




3/11/07 11:13


[email protected]

Bed

2

1

4





4


Gender - Age

Complaint

Nurse

Triage Level

Physician

Arrival Time

EKGEKGCTCTXrayXray RespResp CBCCBC

UAUASMACSMAC EnzyEnzyABGABGCoagCoag

C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput

EKGEKG

EKGEKG

EKGEKG

EKGEKG

XrayXray

XrayXray

CBCCBC

CBCCBC

CBCCBC


UpdateUpdate

Location resolver calculates location & populates database All information is

available via intranet, SMS, paging or XML

ID Tags

Ethernet LANHospital standard

Receivers

Server

Active-RFID tags transmit at 433MHz to provide accurate location & low- cost, easy to wear tags

Receivers send data to the server via LAN or WiFi leveraging existing network infrastructure

WiFi Access Point

Web-based Applications

Web-based application are available over standard browsers



Orders & Labs

>>

>>




3/11/07 11:13


[email protected]

Bed

2

1

4





4


Gender - Age

Complaint

Nurse

Triage Level

Physician

Arrival Time

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKG

EKG

EKG

EKG

Xray

Xray

CBC

CBC

CBC


Update



Orders & Labs

>>

>>

>>

>>




3/11/07 11:13


[email protected]

Bed

2

1

4





4


Gender - Age

Complaint

Nurse

Triage Level

Physician

Arrival Time



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput

EKGEKG

EKGEKG

EKGEKG

EKGEKG

XrayXray

XrayXray

CBCCBC

CBCCBC

CBCCBC


UpdateUpdate

Location resolver calculates location & populates database All information is

available via intranet, SMS, paging or XML

ID Tags


Orders

Lab

Schedule

ADT

Outcomes

Financial

Quality

Efficiency

Equipment StaffPatients

Radianse Context Engine



Orders & Labs

>>>>

>>>>




3/11/07 11:13


[email protected]

Bed

2

1

4





4


Gender - Age

Complaint

Nurse

Triage Level

Physician

Arrival Time



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput

EKGEKG

EKGEKG

EKGEKG

EKGEKG

XrayXray

XrayXray

XrayXray

CBCCBC

CBCCBC

CBCCBC

CBCCBC


UpdateUpdate

Asset Management Patient Flow & Logistics Clinical Effectiveness10:00 D

14:00 D

14:30 D

11:30 B10:42 O

363368373376378380382

07/07/07 11:3007/07/07 14:0007/07/0707/07/07 13:00

388 07/07/07 10:00

10:00 D

13:00 D0:30 B0:30 B0:30 B

PTPT

XRXR OROR

Radianse Applications

Benchmarking/Operational and Clinical Analytics

Radianse Solution Set

… …

… …


401 403 405 407 409

402 404 406 408 410

Room-level Accuracy With Radianse

• 433 MHz (UHF band)• Set aside by FCC• Decades of UHF medical use• No interference with other

equipment or systems• Excellent indoor properties• Excellent body worn properties

Confidential © 2008 Radianse All Rights Reserved.


Room-level Accuracy

EquipmentPeople

EDUNIT

Waiting

Reception

Triage

Triage

Tre

atm

ent

Tre

atm

ent

Treatment

Treatment

Waiting

Reception

Triage

Triage

Tre

atm

ent

Tre

atm

ent

Treatment

Treatment

? ?

Nursing Station Patient Room

Dirty Utility

Clean UtilityPatient Room

Patient Room

Patient Room

Nursing Station Patient Room

Dirty Utility

Clean UtilityPatient Room

Patient Room

Patient Room

In the ED In the unit … versus …Waiting for triageTriaged Being treatedWaiting for transfer

… versus …Clean & availableDirty Being used

Exciter problem


Interference-free Operation

“ISM equipment is concentrated in the 2400 MHz band. Equipment operating in this band will suffer from reduced throughput and interference degradation if too many systems are expected to share this very popular slice of spectrum.”

Healthcare Facility MeasurementsA Case Study: Radio Frequency Site Survey, Spectrum Analysis, and Measurements in the Hospital By Mark Gibson

Radianse WiFi

Measured Spectrum Utilization in Hospitals


Real-time Location Technologies

Low support cost

Standard infrastructure

Secure RF network

Interference free operation

Disposable patient tag

Operates with ID tag covered/blocked

Long battery life with fast update

Small, light ID Tags

Room-level accuracy

InfraredUltrasoundZigbeeWiFiRadianse

Line-of-sight2.4GHz433MHzTECHNOLOGY COMPARISON

× × ×

× × ×

×

× × ×

×

× ×

× × ×

×

× × ×

× ×

?

Pra

ctic

al P

eop

le T

rack

ing

Inst

all &

Su

pp

ort


Find Application


15:49 –Room dirty

Dirty Msg to housekeeping & supervisor

In process Available

Radianse msg: 3 East, Room 387 available

Msg to bed coordinator

Key

15:49 –Room dirty

Dirty Msg to housekeeping & supervisor

In process Available

Radianse msg: 3 East, Room 387 available

Msg to bed coordinator

Key

Patient Flow Application

Confidential © 2008 Radianse All Rights Reserved Copyright © 2007 , Radianse, Inc. All rights reserved. Feedback to


Orders & Labs

>>

>>

Exam 1 J ohnson, Mike Smith, Samuel M – 46Y J ones, Susan 11:05 Head laceration

Exam 4 Fredrick, J ohn Rueter, Charles Triaged M – 64Y J ones, Susan 10:12 Flu symptoms

Room 2 Weinberg, Sally Smith, Samuel Being Treated F – 43Y West, Patty 11:21

Left-side numbness Thrombolytic administered

2/11/08 12:13

Radianse Reveal tm

[email protected]

Bed

2

1

4

Room 3 Doe, J ane Smith, Samuel Being Treated F – 18Y J ones, Susan 11:01

Chest Pain Late for Cath Lab4

Room 4 Cummins, Debora Rueter, Charles Being treated F – 31Y West, Patty 11:01 Bloody Stool

Room 5 J ones, Ted Smith, Samuel Being treated M – 27Y Martin, Kelly 10:37 Trauma 4

Room 6 Smith, Samuel Martin, Kelly

4


Gender - Age

Complaint

Nurse

Triage Level

Physician

Arrival Time

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKGCTXray Resp CBC

UASMAC EnzyABGCoag

C20

Sput

EKG

EKG

CBC

CBC


Update

Waiting for TriageBeing TriagedWaiting for ED BedWaiting for DoctorWaiting for DoctorBeing Treated XrayWaiting for ED room

2

CT

ABG



Orders & Labs

>>

>>

>>

>>

Exam 1 J ohnson, Mike Smith, Samuel M – 46Y J ones, Susan 11:05 Head laceration

Exam 4 Fredrick, J ohn Rueter, Charles Triaged M – 64Y J ones, Susan 10:12 Flu symptoms

Room 2 Weinberg, Sally Smith, Samuel Being Treated F – 43Y West, Patty 11:21

Left-side numbness Thrombolytic administered

2/11/08 12:13

Radianse Reveal tm

[email protected]

Bed

2

1

4

Room 3 Doe, J ane Smith, Samuel Being Treated F – 18Y J ones, Susan 11:01

Chest Pain Late for Cath Lab4

Room 4 Cummins, Debora Rueter, Charles Being treated F – 31Y West, Patty 11:01 Bloody Stool

Room 5 J ones, Ted Smith, Samuel Being treated M – 27Y Martin, Kelly 10:37 Trauma 4

Room 6 Smith, Samuel Martin, Kelly

4


Gender - Age

Complaint

Nurse

Triage Level

Physician

Arrival Time



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput

EKGEKG

EKGEKG

CBCCBC

CBCCBC


UpdateUpdate

Waiting for TriageBeing TriagedWaiting for ED BedWaiting for DoctorWaiting for DoctorBeing Treated XrayXrayWaiting for ED room

2

CTCT

ABGABG

Whiteboard Application


Clinical EffectivenessRadianse managed workflow

Target door-to-balloon time = n minutesPatient arrives with chest pain

Registered & paired with Radianse ID tag

Arrival time and patient location captured

MI protocol initiated, alerts cath lab team

Assets for cath lab are automatically inventoried

Doctor located & alerted to cath lab

Auto match of right patient, equipment, staff & device made in cath lab

Interventionist performs procedure



Orders & Labs

>>>>

>>>>




3/11/07 11:13


[email protected]

Bed

2

1

4





4


Gender - Age

Complaint

Nurse

Triage Level

Physician

Arrival Time



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput

EKGEKG

EKGEKG

EKGEKG

EKGEKG

XrayXray

XrayXray

XrayXray

CBCCBC

CBCCBC

CBCCBC

CBCCBC


UpdateUpdate

Family-centric view of progress & timeliness of careCopyright © 2006 , Radianse, Inc. All rights reserved. Feedback to


Orders & Labs

>>>>

>>>>




3/11/07 11:13


[email protected]

Bed

2

1

4





4


Gender - Age

Complaint

Nurse

Triage Level

Physician

Arrival Time



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput



C20C20

SputSput

EKGEKG

EKGEKG

EKGEKG

EKGEKG

XrayXray

XrayXray

XrayXray

CBCCBC

CBCCBC

CBCCBC

CBCCBC


UpdateUpdate

Time in minutes


Benchmarking & Analysis


Information Technology DepartmentCopyright 2007. All rights Reserved 29

Delay in Minutes: ADT vs. RFIDDelay in Minutes: ADT vs. RFID

• 67% greater than 20 minutes– 35% > 20-40 minutes

– 23% 40-120 minutes

– 9% >120 minutes

Mount Sinai Bed Turn-Around Time

Customer challenge • Excessive time from discharge to new admission• Prolonged turn-around times with ED congestion


• Before (measured): Weekday (mode): 45 min Weekend (mode): 60 min Range: 15 -> 525 min

• Tracking towards: Weekday (mode): 35 min (20%) Weekend (mode): 45 min (25%) Range: 15 -> 500 min

Providence HospitalBed Management and Turnover

Customer challenge • ED diversions, wait times, left-without-being-seen• Multiple phone calls to coordinate patient placement


• Real-time tracking of equipment, patients and staff – “OR of the Future”

• 40% improvement in OR throughput• Billing for Anesthesia time• “Zone of Patient Safety”

– “Office of the Future”– Performance Improvement – workflow studies

• Stroke pathway adherence• Needle localization for breast-biopsy

Customer challenge • Difficult to monitor, complex care processes • Provider information overload• Limited resources leading to delays in care

Massachusetts General HospitalComplex Care Delivery


Multi-Site StudyHow Med/Surg Nurses Spend Their Time

• 37 hospitals participated with 21,955 hrs of data collected

• 801 nurses participated in Radianse study track

Simulation analysis with spaghetti diagram

Results: Accurately quantified

nursing workflow and activities

Identified waste and variation in actions and movement

Provided metrics for nurses and unit performance improvement

Customer challenge • Identify nurse work patterns to develop both architectural & workflow improvements

• Provide opportunities for more patient interaction time


Predictable & Sustainable Results

Process Support

Pre

dic

tab

ility

an

d

Su

sta

inab

ility

of

Res

ult

s

None Automated, Transparent& Seamless

Low

Inco

nsis

ten

tH

igh

Manual Input

TraditionalProcess

Improvement

Process Support

Pre

dic

tab

ility

an

d

Su

sta

inab

ility

of

Res

ult

s

None Automated, Transparent& Seamless

Low

Inco

nsis

ten

tH

igh

Manual Input

TraditionalProcess

Improvement IS

Typical process improvement

Radianse based improvement

• Objective data• Measurable results• Ongoing measurement

& support

Confidential © 2008 Radianse All Rights Reserved Revolutionizing the Delivery of Quality Healthcare...

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Transcript of Confidential © 2008 Radianse All Rights Reserved Revolutionizing the Delivery of Quality Healthcare...