George Blumenthal - ulssasolo.ven.it · Linkem Overview 42MHz of frequency spectrum 84MHz of...

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George Blumenthal

mercoledì 21 marzo 2012

The Future of Healthcare IT Is in the

Clouds

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George Blumenthal


Cellular Communications International, Inc.

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“A Smashing Victory”Italia Oggi April 2, 1994

Omnitel Unitel*Points assigned by BAIN and Citibank 698.58 580.12Investments pledged Lit. 2 trillion Lit. 1.5 trillionFinancial bid Lit. 750 billion Lit. 707 billion

*Consortium led by Berlusconi 3


The HITECH Act$50,000,000,000+Funding To Revolutionize Healthcare I.T.

Grants$10 Billion

Entitlements$40 Billion

$25 Billion for Eligible Professionals

$15 Billion for Hospitals

For HIEs, Rural Broadband,Regional Extension Centers,Education and Training,Comparative Effectiveness Research

Sections 3011-3016Section 6001 and Titles I, XIISections 4101, 4102, 4201

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USA Germany Italy Israel

Health Care Costs $ 7,900 $ 4,200 $3,100 $ 2,700% GDP 17% 12% 10% 8%

Life Expectancy 78 80 82 82

Smokers 16% 22% 23% 20%Obesity 34% 15% 10% 14%Ambulatory Visits/Capita 4 8 7 6

Gross National Income/Capita $47,000 $38,000 $31,000 $28,000

The Cost of Healthcare Is Destroying The USA

5Source: OECD Health Data 2011


Expenditure Disparities

Mayo Clinic Cleveland Clinic Johns Hopkins Hospital

UCLA Medical Center

Medicare Spending $53,430 $55,330 $85,730 $93,840

Physician Visits 24 33 29 53Days in Hospital 12 15 17 19Hospital Beds 58 66 78 86

Source: The Dartmouth Atlas of Health Care 2008, as printed in Time Magazine June 29, 2009

End of Life Care Costs

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Front page – New York Times, 9-18-06

Elyria Has 3 Times the Rate of Angioplasties as Cleveland

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Healthcare Wastes

• 57% of patients must recount medical or personal information

• 30% of all U.S. healthcare costs go to duplicative care

• 26% of patients receive conflicting information

Source: Markle Foundation, Robert Wood Johnson Foundation, Achieving Electronic Connectivity in Healthcare, 2004

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U.S. Adults Receive 55% of

0

20

40

60

80

Overall Breast Cancer Hypertension Asthma Pneumonia Hip Fracture Diabetes Mellitus

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2339

5465

76

55

Overall Breast Cancer HypertensionAsthma Pneumonia Hip FractureDiabetes Mellitus

McGlynn, June 26, 2003

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Would You Fly Without a Checklist?

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Would You Fly if a 747 Crashed Every 12 Hours?

Annual Deaths

Hospital Acquired Conditions 180,000Lung Cancer 158,000Breast Cancer 40,200Pancreatic Cancer 36,800Traffic Accidents 33,000Prostate Cancer 32,000 AIDS 18,000

Total 318,000

“Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries” HHS Office of Inspector General

November 201011


70%

92%

64%

91%

Pneumonia Heart Failure20062003 20062003

Medicare Demonstration ProjectRecommended Care

12Source: Medicare/Premier Hospital Quality Incentive Demonstration (HQID)


• The rate of death declined from 1.5% to 0.8%

• Inpatient complications declined from 11% to 7%

Surgical Checklist

January 29, 2009

A Surgical Safety Checklist to Reduce Morbidity and Mortality

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0

2,0

4,0

6,0

8,0

16-18 months

1,4

7,7

Per 1000 Catheter Days

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Catheter-Related Bloodstream Infections in the ICU

December 28, 2006


eRX Is a “No-Brainer”

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Source: Kaushal, R. et al, “Electronic Prescribing Improves Mediation Safety in Community-Based Office Practices,” Journal of General Internal Medicine, 25(6): 530-6, February 26, 2010.

• 2 in 5 handwritten prescriptions had errors

• Prescription errors reduced from 43% to 7% with e-prescribing

Cornell Medical College

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eRX and Safety

• 3,000,000 adverse drug events (ADEs) and 190,000 hospitalizations per year could be prevented2

• 2.4% of hospitalized patients develop a clinically significant ADE1

• 8% of elderly U.S. patients are prescribed improper medications3

1. Classen, DC, et. al., Adverse drug events in hospitalized patients: excess length of stay, extra costs, and attributable mortality. JAMA. 1997; 277: 301-306.

2. “The Value of Healthcare Information Exchange and Interoperability,” CITL, Partners HealthCare System, Boston, MA. 2004 – Published and distributed by the Healthcare Information and Management Systems Society

3. Inappropriate Medication Prescribing for Elderly Ambulatory Care Patients By Margie Rauch Goulding, PhD. In: Archives of Internal Medicine (February 2004)

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• 75% reduction in allergic drug reactions and excessive dosages

• 45% reduced in the average time spent in the ICU

Kaiser eRX and Safety

Source: Clinical Information: Achieving the Vision, 2002; Kaiser Permanente

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Physician Benefits of eRX

• 50% of office phone calls are related to prescriptions1

• eRX can generate time savings of 1 hour per nurse and 30 minutes per file clerk per day2

1. The Physician’s eHealth Report, November/ December 20042. Rhode Island Electronic Prescribing Project

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The HITECH Act$50,000,000,000+Funding To Revolutionize Healthcare I.T.

Grants$10 Billion

Entitlements$40 Billion

$25 Billion for Eligible Professionals

$15 Billion for Hospitals

For HIEs, Rural Broadband,Regional Extension Centers,Education and Training,Comparative Effectiveness Research

Sections 3011-3016Section 6001 and Titles I, XIISections 4101, 4102, 4201

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Medicaid Is at the Center of Healthcare

The MITA Business Architecture, May 8, 2006

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2010 2011 2012 2013 2014 2015 2016 2017

ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2ARRA1 Medicaid2

Bonus $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

ARRA Medicare3ARRA Medicare3ARRA Medicare3ARRA Medicare3ARRA Medicare3ARRA Medicare3

Bonus $44,000 $44,000 $39,000 $24,000Penalty -1% -2% -3%

ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4ePrescribing4

Bonus 2% 1% 1% 0.5%Penalty -1% -1.5% -2% -2% -2% -2%

Total Annual PenaltiesTotal Annual PenaltiesTotal Annual PenaltiesTotal Annual Penalties -1% -1.5% -2% -3% -4% -5%

Bonuses and Penalties for Eligible Professionals

1. American Recovery and Reinvestment Act of 20092. Assumes 30% of patient volume is in underserved areas or communities3. Assumes Medicare Part B revenues exceeds $25,0004. ePrescribing and PQRI bonuses and penalties are a percentage of Medicare Part B revenues received 22


15 Core Objectives

20 Objectives to Accomplish Stage 1 MU*

5 of 10 Menu Objectives

1 Core Objective Requires

Satisfying 6 of 44 Clinical Quality

Measures

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*Meaningful Use


Clinical Quality Measures Numerators / Denominators

NQF 0013

Hypertension: Blood Pressure Measurement

1/1No exclusions

NQF 0028

Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention

1/1 for a1/1 for bNo exclusions

NQF 0421

Adult Weight Screening and Follow-Up

2/2Possible exclusions

NQF 0018

Controlling High Blood Pressure 1/1No exclusions

NQF 0027

Smoking and Tobacco Use Cessation, Medical Assistance

2/2No exclusions

NQF 0061

Diabetes: Blood Pressure Management

1/1Possible exclusions

Core ObjectivesC01 CPOE for Medication Orders 30%

C02 Drug Interaction Checks Enable functionC03 Maintain Problem List 80%

C04 Permissible Prescriptions 40%C05 Active Medication List 80%C06 Medication Allergy List 80%C07 Record Patient Demographics 50%C08 Record Vital Signs 50%C09 Record Smoking Status 50%C10 Clinical Quality Measures-CQMs

(from within this Objective you must choose six measures)

C11 Clinical Decision Support Rule 1

C12 Electronic Copy of Health Information

50%C13 Clinical Summaries 50%C14 Electronic Exchange of Clinical

Information1 test

C15 Protect Electronic Health Information

1 risk analysis

Menu Objectives

M01 Drug Formulary Checks Enable function

M03 Patient Lists 1 report

M04 Patient Reminders 20%

M07 Medication Reconciliation 50%

M09 Immunization Registries Data Submission

1 test

ChecklistObjectives for Stage 1 MU

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Rules-Based Engines

• Measures are added each year• Measures are adjusted from year

to year• Measures are retired

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Imagine MD Secure N-Tier Architecture


Imagine MD Provides 4 Real-Time Levels of Assurance of MU

1. MU Indicators2. Patient level compliance dashboard3. Provider level compliance dashboard4. Dashboards provide necessary steps

to achieve compliance for each MU objective

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Real-Time Meaningful Use Dashboard

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ICD-10 Enhanced Precision and Accuracy

ICD-9

ICD-10

MRN 0345798H&P

ConsultOrders

Progress Notes

MRN 0345798H&P

ConsultOrders

Progress Notes

Dog

Dog - Large

Dog - Medium

Dog - Small

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Multiple Language Capability

English Russian

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Page Code with place holders

User Preferred

Language

P h r a s e Code

LanID1 (English)

LanID2 (German) L a n I D 2 (Portuguese)

1 Personal Details Persönliche Angaben Detalhes pessoais

2 Show History Historie anzeigen Mostrar Histórico

3 MRN MRN MRN

4 Status Status Status

5 Primary Provider Primary-Anbieter Provedor primário

Phrases Data Table

Page Display Engine

Multiple Language Capability

English German Portuguese


Italian

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Prescription Code

Personal ID

Note for Pharmaceutical Association

Exceptions

Data of Filings

Type of Prescription

Transmission to Central Repository

Prescription

Diagnosis and ICD 9-CM Code

Electronic Interconnection of Doctors

Regulatory Reference – Mandatory Data To Be Transmitted Electronically

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Progetto Tessera Sanitaria Web Services per la Trasmissione dei Certificati di Malattia all’INPS

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Linkem Overview

42MHz of frequency spectrum

84MHz of frequency spectrum

License holder of 84MHz of spectrum covering 80% of the population and 42MHz of spectrum covering the remaining 20%

Over €190 million of capital funded to date

FOR MORE INFORMATION PLEASE VISIT OUR WEBSITE:

WWW.LINKEM.COM

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http://www.linkem.com/

http://www.linkem.com/

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Key to Icons: Location of TI DSLAMs Linkem customers who do not have access to DSL Linkem customers who have access to DSL, but have

reported DSLAM which is nearing saturation DSLAM which has reached full saturation Locations of Linkem’s BTS 38


Brescia

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Latina




Latina

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Avezzano




Avezzano

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Avezzano

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WiMAX “Dish” for WiFi in

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Outdoor “Dish”

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George Blumenthal


The Future of Healthcare IT Is in the

Clouds

47

George Blumenthal


George Blumenthal - ulssasolo.ven.it · Linkem Overview 42MHz of frequency spectrum 84MHz of...

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