Technical requirements for comprehensive multimedia telemedicine system

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IT Transforming Power for Industries From
Telemedicine to E-Health
Georgetown
Seong K. Mun, PhD ISIS Center Georgetown
University smun01_at_georgetown.edu
ISIS Center Team of 15 faculty and 70 staff
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Information Age

• Under Formation
• Struggle Underway
• Some Examples from Other Industries
• Hard to Make any Projections
• Still Very Young (About 100 years)
• Outcome Unknown

Very Powerful Transforming Capability
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Industries in Info Age

• Transformed
• successful and not so
• New Industries
• Industries on the net community

What will happen to healthcare? Is it going to be
a transformation?
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Evolution of Business ModelsIT as a Transforming
Tool
Digital Devices Communication
Video Conferencing Data/Image Processing Telemedic
ine
Digital Information System Integrated
Healthcare Teleradiology Filmless Hospital
Virtual Clinic Global Radiology Transaction
Management
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Goals of T-Med

• Improve Access
• Doctors and Information
• Access to Patients and Diseases
• Improve Quality
• Better Outcome
• Reduce Cost Overall Cost

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Two Types of ApplicationOperational

• Real Time (VTC)
• Acute Illness and Emergency
• Other Specialty
• Store and Forward
• Chronically Ill 70 of Health Budget
• Routine Radiology, Pathology

What is wrong with this? What is our
assumption? One-way model.
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Drivers Technology

• Availability of High Speed Links
• 19.2 kbps to T-1 lines
• Availability of Digital Input Devices
• Digital Imaging Devices
• Digital Video Devices

Emerging Digital Age
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Refugee Health
Global MRI Network NGI
Congestive Heart Failure Home
Diabetes Management at Home
Diplomatic Telemedicine in Africa
Telemedicine Demo in Russia
Disaster Relief in Kenya
Medical Education in Latin America ACTS
Renal Dialysis Center and Home Dialysis
Rural Health Kidney Stone Disease
Post Surgery Follow Up
Mission Project Diabetes Project with UH
Teleradiology DEPRAD, Bosnia, Hungary, Germany
PACS Filmless Digital Hospital
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General Assessment

• Access to Care
• Acceptable Technology
• Demanding Logistics, TV Production
• High Costs Tech, Ops, Staffing
• Technology Insertion Requires Appropriate
  Operational Environment
• Access to Patient and Information
• Not a primary focus so far

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Key Issues

• Technology Good
• Business Process (E) Poor
• Business () Very Poor
• Clinical Relevance OK
• Overall Costs High

Technology is one of many requirements!
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Revisiting the Assumptions

• Patients access to Physicians
• Initial Focus
• How about Physicians access to Patient?
• Health Record
• Genetic Information
• Life Style Information
• Others

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Radiology Case Study

• Digital Filmless Hospital
• Teleradiology
• Global (Virtual) Radiology Service

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US DoD PACS
North Atlantic
Ft. Lewis (MAMC)
Ft. Drum
Western
West Point
Great Plains
Ft. Monmouth
Carlisle Barracks
Ft. Greely
Aberdeen
Site R
Ft. Wainwright
Ft. Meade
Ft. Detrick
WRAMC
Ft. Knox
Ft. Belvoir
Ft. Leavenworth
Ft. Eustis
Ft. Lee
Ft. Carson
Ft. Leonard Wood
Ft. Riley
Ft. Irwin
Ft. Bragg
Ft. Campbell
Southeast
Ft. Richardson
Ft. Gordon
Ft. Sill
Ft. Jackson
Redstone
Ft. McPherson
Ft. Huachuca
Ft. Stewart
Ft. Benning
Ft. Hood
WBAMC
Ft. Polk
Ft. Rucker
Ft. Sam Houston (BAMC)
Pacific
Shape
Tripler (TAMC)
Wuerzburg
121st General Hospital
Landstuhl
Heidelberg
No PACS Activity
9 outlying locations
Europe
Activity In-Process
Vincenza
Livorno
Camp Zama
PACS Implemented
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Global Teleradiology
Stand-alone Nigh Hawk / On-call Coverage Expert
/ Second Opinion Global Virtual Radiology
Service by Workload Sharing and Reallocation
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Enter Internet!

• Easier Access to Communication
• But Limited Band-width
• Ubiquitous Computing
• Beyond Point to Point Communication

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Expanding Enterprise
Payers
Clinical Research
Mercy Hospital
Government Agencies
Public Health
University Hospital
City Hospital
DPT
Research and Education
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What is Information Economy?How is it powered?
Followed by Agricultural Economy Powered by
Animals Manufacturing Economy Powered by
Engines on Fuels
Powered By Ubiquitous Coordination
Technology Information, Communication and
Computing Technology
New Industry Emerges and Old Ones Must
Transform New Business Process Needed
Where are we in healthcare?
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What does/can IT do to business processes?

• Bureaucracy to Ad-hoc-cracy
• Flatter Organization
• Info Do it yourself
• Consumers do part of the job
• Externalizing labor cost
• Self care, home care
• More Power to End Users
• More Responsibilities to the End Users

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Key Activities for Mass ProductionTraditional
Health System
Standardization
Specialization
Synchronization
Concentration
Centralization
Era of Bureaucracy
Serialization
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Organizational Impact
Adhocracy Information Age
Bureaucracy Mass Production
What is this?
Medical Center Model Is It Obsolete?
Distributed Patient Centric Model Is it workable?
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Attributes of Future Health Care

• Distributed System
• Knowledge Based- Bidirectional
• Patient Driven, Customized
• More Self Care
• More Prevention
• More Choices Patient Education

Consistent with generic IT evolution
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Analysis Results Instructions
Data, Questions

• Physician at GUMC

• Patient at Home or Work

Good Technology Not Compatible with Process Great
Self Management Tools
Home Monitoring
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Advanced IT (I-2) Demonstration Projects - NLM

• Fundamental Limitations on Internet
• Quality of Service on the Net
• Authentication and Authorization
• Information Sharing in VO
• Network Security
• New Emerging Application
• Disease Surveillance

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Project Sentinel
Baseline or Heightened Case
Project 6
Project 2 3
Applications /use case
Project 4
Authentication /Authorization Middleware
Distribution Middleware/Web/Grid
Information Distribution
Government Agencies
Hospitals
Acquiring Sites
.
WHC
GU
Others
DOH
Project 5
Future Data Sources/Argus
PIDS
Mosquito
Avian
Data Sources
Satellite Inquiry
International Threat Info
Patient Info
Project 1
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IT-Architecture
TOMORROW
App A
App B
TODAY
App B
App A
Web-based
Hosp B
Hosp A
Hosp A
Hosp B

• Web or Grid services allow for sharing data
  and/or computing resources
• Highly scalable infrastructure
• Integrated data sources thru Grid
• Access privileges thru VO based on attributes and
  agreements
• Dynamic adaptation to diverging security
  requirements

Patient Info A
Patient Info B
Patient Info A
Patient Info B

• Web-based Applications
• Limited scalability
• VPN access common
• Limited integration of data sources
• Users assigned to each system w/separate
  login/access

• Client-server applications
• Stand alone systems
• Clinical patient info only
• Users assigned to each system w/separate
  login/access

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Project Sentinel Issues DemandingTechnical
Solutions in Virtual Organization

• Different Organizational Missions Activities
• Different Operational Environment
• Potential Distrustful Relationships
• Client to Server or Peer to Peer
• Different Rules of Delegation of Authorities and
  Privileges

New Business Model Needed? Desired? Non-Technical
Barriers
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IT Industry and HealthcareSimilar Evolution Paths

• Standard interface of machines
• System Integration
• Activity Automation
• IT for Business Process
• End to end productivity
• New Business Model

• DICOM and HL-7
• Filmless Operation
• IHE for Business Process
• Workflow
• Department Productivity
• Enterprise Info. Mgmnt
• New Business Model?

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Evolution of Business Models
Hospital IT Solutions
Regional National IT Solutions
Departmental IT Solutions
Physician Offices and Patients
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Policy Directions for Congress?

• Patients
• Healthy Responsible Life Style
• Health Care Industry and Government
• Standards in Business Processes
• Research Community and Partners
• Business Transforming RD
• Physicians and Offices
• IT Investment Incentives and Training
• IT Industry
• Improved Infrastructure and Open Access

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Acknowledgements

• National Library of Medicine, NIH
• TATRC, US Army
• National Cancer Institute, NIH
• NIBIB, NIH
• Health Affairs, Department of Defense
• Department of State
• DC Department of Health

Contact smun01_at_georgetown.edu