CAS Quarterly Meeting Financials

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An Open and Secure Mobile Platform for Healthcare
Patient Safety Initiatives
Jeff Sutherland, Ph.D.Chief Technology Officer
Turning the Promise of Mobile Computing into a
Reality
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Technology OpportunitiesFaster, Better, Cheaper

• The average large healthcare delivery system does
  not bill for gt10 of procedures rendered. ROI for
  charge capture at the point of care is 400-600
  the first year.
• Mobilization of medical data is the fastest (and
  perhaps only) path to widespread physician
  adoption of patient safety initiatives.
• Order capture will have a higher ROI than charge
  capture and physicians can spend more time with
  the patient.
• An alternate way to view rollout of CPOE is to
  start with mobile results, add vitals and I/O,
  and layer on order capture (while waiting for
  CPOE system to be installed).
• Development and install cycles can be as short as
  a few weeks for minor enhancements or upgrades, 3
  months for major enhancements or new installs.

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Mobile Platform RequirementsAggregate,
Integrate, Interoperate

• A common mobile platform is required to aggregate
  third party and end user applications on a single
  device. Physicians want one device of their
  choice.
• Open standards are required to integrate
  independently authored third party applications
  on a single handheld device. Physicians want
  single signon, patient context management, and
  seamless interoperability of patient data
  modules.
• Business models are needed to allow a single
  physician, a three person development team in a
  garage, a healthcare application provider, or
  a large HIS enterprise vendor to interoperate
  with a common mobile platform, integrate
  previously installed systems, and support
  evolutionary replacement or upgrade of existing
  infrastructure.

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Platform BenefitManaging Application Portfolios

• TaskKeeper
• NoteKeeper
• PlanKeeper
• RxKeeper
• Procedure-Keeper
• 3rd Party Apps

• ChargeKeeper
• LabKeeper
• DxKeeper
• InfoKeeper
• MemoKeeper
• 3rd Party Apps

Personal Applications
Enterprise Applications
mPI
One Mobile Device
One User Interface
Any Device

• Any Transport
• Ethernet cradles
• 802.11
• Bluetooth
• Cellular

Single Signon Context sharing Hard encryption
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Mobile Platform Features
MultipleDevice Types
N Applications
SDK
SingleSign on
ApplicationInteroperability
Patient ContextManagement
MobileDevice
Security
Application Framework
Handheld Data Store
MobileCommunications
MobilePatient Index
Mobile Services
TransportWireless orEthernet
HIPAA Security
CentralAdministration
Messaging Alerting
Web Facilities
Personalization
Transactions
Web Services Integration Interfaces
JAVA
XML
HTML
Business Logic
Patient Objects
Cerner
Wellogic
UCR/Meditech
Adapter Components/Open API
CareGroup
McKesson
Seimans
Epic
IDX
Mobile Legacy Integration
Mobile ClinicalRepository
MobilePatient Index
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PatientKeeper Platform Solutions
PatientKeeper/Cerner Solution
PatientKeeper/UCR Solution
PatientKeeperLite Solution
PatientKeeperHandheld
PatientKeeperHandheld
PatientKeeperHandheld
UCR NetResultDesktop
CernerDesktop
PK Desktop
PK Mobilizer
PK Mobilizer
PK Mobilizer
UCR NetResult Server
WDAC
Millennium Objects
XML / JAVA Transactions
DBOne
MediTech Magic System
CernerMillenniumRepositories
Synapse
MediTech Magic Repositories
Incoming HL7 Messages
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NIST Layered Security

• Mirror institutions security model
• Authentication / access controls
• Audit trails
• Certification of applications
• Token-based beaming of data
• Encrypted storage
• Encrypted transmission

Mobilizer Platform Components
PatientKeepersSoftwareDevelopment Kits
Common User Interface
Messaging Alerts
DataSharing
InfraredPrint
BarcodeScanning
Security
Encryption Transport
Wired
Wireless
Encryption Transport
CentralAdministration
Personalization
Audit Trail
Security
Reporting
Clinical DataRepository
HIS Scheduling
HIS Pharmacy
HIS Billing
HIS Lab
Back-End Systems
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SDK Expands Portfolio
MobilizerSDK
Developedby PatientKeeper
Developedby Third-Party
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Extending CCOW Standard to Mobile Computing
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ChargeKeeper ROI StudiesNorth Shore/LIJ Health
System

• Study Background 86 Inpatient Physicians / 22
  Departments Participated in Study
• Results
• 888 increase in revenues/physician/month,
  primarily revenue captured that was previously
  lost through manual, inefficient processes (1
  million annually for physicians in study group
  3.5 million when applied across potential user
  base)
• 4.9-to-1.0 benefit to cost ratio demonstrated
  (cash flow)
• Excludes decrease in lag time 8 days
• Excludes enhanced productivity/workflow
• User Satisfaction Survey 4.5 on scale of 1-to-5
• Status
• Now ramped up to 286 physician users and multiple
  institutions. Another 75 users go online in
  September.

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PatientKeeper PersonalTestbed of 45,000 clinical
users

• All essential medical data on a Palm Pilot or
  PocketPC.
• Designed to integrate with global medical data
  system.
• Provider care, home care, and military care.
• Harvard Medical School students are graded on
  information in this application. 100 adoption.

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Patient Safety Step 1Aggregate Results from
Backend Systems
Clinical Suite
ChargeKeeper

• Quick access to critical results and patient
  information.
• LabKeeper
• DxKeeper
• RxKeeper
• NoteKeeper
• TestKeeper
• AllergyKeeper
• VitalsKeeper
• OrderStatus
• StatusKeeper

• Capture charges at the point of care with
  advanced code edits and transaction management.

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Patient Safety Step 2Rapid Deployment of
Mobile Order Capture Drives Adoption

• Provide simple, intuitive, order capture based on
  order sets for majority of orders. Seamlessly
  integrate with desktop for more complex orders.
• Mobile order capture is hybrid application. Most
  data resides on the device from synchronization.
  Multiple transactions occur in real time for
  order submission.
• Drug interaction checking and rules can fire on
  the mobile device and/or work in tandem with
  backend CDR rules engine.
• Real time transaction submits order to
  appropriate back end processor and back end
  alerting and messaging provides warnings and
  order status.
• When connectivity not available order is queued
  on mobile device for later processing.

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Mobile Order Capture Benefits

• It is mobile. With optional wireless connection
  such as 802.11 and Bluetooth, the device can
  allow for real time access to the data any where
  in the hospital even when the clinician is
  walking. Even if there are many desktops in the
  hospital, the clinician has to find a free
  station and sit down.
• It is personal. Because the device belongs to the
  user, it can be configured to match the
  clinicians specialty and personal preferences.
• It is reliable. Always connected applications can
  abort due to glitches in connectivity. A rich
  client infrastructure can ensure the successful
  completion of the ordering or alerting before
  establishing the connection to submit or retrieve
  data. It is more reliable and the users efforts
  are never wasted.
• It is fast. The rich client handheld application
  is not restricted by wireless connection
  bandwidth that is typically compromised by too
  many concurrent active users. The user only takes
  up the bandwidth when sending or retrieving
  orders or alerts.

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Patient Safety Step 3Integrate with CDR
products

• Modify orders. For orders that need to be signed
  or modified based on pharmacy or nurse feedback,
  the user can quickly modify the order parameters
  or sign the order.
• View orders with status and alerts. For
  physicians or nurses, the user can view the order
  statuses and review the alerts with each order.
• Integrate with clinical rule engines.
• Integrate with payer rule engines. If selected,
  the payer rules will ensure diagnoses are
  properly filled. Formulary, depending on the
  insurance type and payer, will ensure the
  appropriate drugs are selected, both the
  inpatient and outpatient settings. The rule
  engine can be installed locally on the device.
• Integrate with alerts. Most inpatient or
  outpatient systems have alerts to facilitate
  error activity notification.
• Holding bin for clerk processing. For clients
  that do not have complete CPOE implementations,
  the holding bin can facilitate the clerk order
  entry or bypass the process for certain order
  types. This feature eliminates the paper process.

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Clinician Value Proposition

• Value to clinician users
• Applications-based (efficiency, error-reduction,
  lost revenue, etc.)
• Common UI and patient-centricity(Increase
  adoption and reduce training)
• Access to greater functionality sooner
• Not painted in a corner integrate best of
  breed mobile applications
• Flexibility to create own applications(e.g.,
  protocols to influence physician behavior)

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Hospital Value Proposition

• Value to hospital decision makers
• Centralized administration
• Enterprise-wide controls to help manage the
  organic growth of PDAs (e.g., HIPAA)
• Not painted in a corner
• Integrate best of breed mobile applications
• Develop own applications
• Force another vendor to port their application to
  a common framework
• Often PatientKeeper Personal is already in use

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Developer Value Proposition

• Value to the developer community
• Lowered barrier to entry for application creation
• Shorten time to market
• Create portfolio effect Crossing the Chasm
• A installed base to sell into distribution
  channel
• Leverage with component technology vendors
  (e.g., encryption, Infrared printing, barcode
  scanning, wireless networks, etc.)

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An Open and Secure Mobile Platform for Healthcare
Patient Safety Initiatives
Thank You