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Device Vendor Opportunities in
Health IT Data Management
Data is becoming currency and device vendors shouldn’t
let health IT software firms own or control it
By Shahid N. Shah, CEO
NETSPECTIVE

Who is Shahid?
•
•
•

•

20+ years of software engineering and multidiscipline complex IT implementations (Gov.,
defense, health, finance, insurance)
12+ years of healthcare IT and medical devices
experience (blog at http://healthcareguy.com)
15+ years of technology management experience
(government, non-profit, commercial)
10+ years as architect, engineer, and
implementation manager on various EMR and EHR
initiatives (commercial and non-profit)

Author of Chapter 13, “You’re
the CIO of your Own Office”
www.netspective.com

2
NETSPECTIVE

What you’ll learn in this briefing
Data from devices is too important to be left to others

Background
•
•
•

•

A deluge of healthcare data is being
created as we digitize biology, chemistry,
and physics.
Data changes the questions we ask and it
can actually democratize and improve the
science of medicine, if we let it.
While cures are the only real miracles of
medicine, big data can help solve
intractable problems and lead to more
cures.
Healthcare-focused software engineering is
going to do more harm than good
(industry-neutral is better).

www.netspective.com

Key takeaways
•
•

•
•

Applications come and go, data lives
forever. He who owns, integrates, and
uses data wins in the end.
Data from devices is too important to
be left to software vendors, managed
service providers, and system
integrators.
There’s nothing special about health IT
data that justifies complex, expensive,
or special technology.
Spend freely on multiple systems and
integration-friendly solutions.
3
NETSPECTIVE

Manufacturer’s have a great deal to worry about
Your customer, competitors, and industry are all shifting

Customer is trapped by
their EHR vendors

Device vendors aren’t
benefiting from industry
trends

Customer base has
shifted from clinical to
clinical + IT + system
integration

Clinical customer goals
have shifted from basic
automation to advanced
process optimizations

Device manufacturer’s
access to regulated IT
and system integration
skills is limited

Struggling to find new
revenue sources as
hardware is
commoditized

www.netspective.com

4
NETSPECTIVE

Healthcare Industry / Market Trends

Major market and regulatory trends that are causing customers and competitors to shift

Device manufacturers must become experts on all of these terms

PPACA

ACO

PCMH

“Affordable Care
Act”

“Accountable
Care Org”

“Medical
Home”

Health
Home

www.netspective.com

mHealth

MU
“Meaningful Use”

PCPCC
“Patient Centered
Care”

5
NETSPECTIVE

NEJM believes doctors are trapped by EHRs

Don’t buy the argument that the “enterprise EHR” should maintain / own / manage all data

It is a widely accepted myth that medicine requires
complex, highly specialized information-technology (IT)
systems.
This myth continues to justify soaring IT costs,
burdensome physician workloads, and stagnation in
innovation — while doctors become increasingly bound
to documentation and communication products that are
functionally decades behind those they use in their
“civilian” life.
New England Journal of Medicine “Escaping the EHR Trap - The Future of Health IT”, June 2012
www.netspective.com

6
NETSPECTIVE

Trend Goal: Patient Engagement

How does your device help customers engage with their patients?

Superb Access to
Care
Patient Engagement
in Care

Clinical Information
Systems
www.netspective.com

•Patients can easily make appointments and select the day and time.
•Waiting times are short.
•eMail and telephone consultations are offered.
•Off-hour service is available.

•Patients have the option of being informed and engaged partners in their care.
•Practices provide information on treatment plans, preventative and follow-up care reminders,
access to medical records, assistance with self-care, and counseling.

•These systems support high-quality care, practice-based learning, and quality improvement.
•Practices maintain patient registries; monitor adherence to treatment; have easy access to lab
and test results; and receive reminders, decision support, and information on recommended
treatments.

Source: Health2 Resources 9.30.08

7
NETSPECTIVE

Trend Goal: Coordinated Care

How does your device help customers coordinate care across their partners?

Care Coordination

•Specialist care is coordinated, and systems are in place to prevent errors that occur when
multiple physicians are involved.
•Follow-up and support is provided.

Team Care

•Integrated and coordinated team care depends on a free flow of communication among
physicians, nurses, case managers and other health professionals (including BH specialists).
•Duplication of tests and procedures is avoided.

Patient Feedback

•Patients routinely provide feedback to doctors; practices take advantage of low-cost, internetbased patient surveys to learn from patients and inform treatment plans.

Publically available
information

•Patients have accurate, standardized information on physicians to help them choose a practice
that will meet their needs.

www.netspective.com

8
NETSPECTIVE

Why care about MU?

If you’re not talking about MU you’ll find it harder to get in the door

“Enable significant and measurable improvements in population
health through a transformed delivery system.”

2011

2015

MU Stage 1

MU Stage 2

MU Stage 3

No Impact

www.netspective.com

2013

Indirect Impact:
Start planning for
MU

Direct Impact:
Device integration
proposed
9
NETSPECTIVE

There’s money in MU
Devices can and should be “MU capable”

www.netspective.com

10
NETSPECTIVE

Fit into CIO’s strategic framework

In the future your devices won’t be sold into customers without CIO approval

Source: The Advisory Board
www.netspective.com

11
NETSPECTIVE

Implications of health IT trends
PPACA

ACO

Software

Regulated IT and Systems
Integration Services

MU
Health
Home
www.netspective.com

PCMH
mHealth

DATA

Evidence Based Medicine
Comparative Effectiveness

12
NETSPECTIVE

Don’t give up data to others without a fight

Software vendors, systems integrators, and others don’t have your best interest in mind
Device
Teaming

Cloud
Services

Patient
Self-Management
Platforms

SSL VPN

Patient Context
Monitoring

Device Gateway
(DDS, XMPP ESB)
,

Device
Data
Data Transformation (ESB, HL7)

Remote
Surveillance

Management
Dashboards

HIT
Integration

Report
Generation
Device reimbursement

www.netspective.com

Enterprise Data
RCM, Financials,
EHRs

Device
Management

Cross Device
App Workflows

Device Utilization
Device profitability

Alarm
Notifications

Device Inventory
13
NETSPECTIVE

New revenue centers in software and services
Build the right roadmap so that you don’t leave new revenue on the table

2 year ranking comparison of Top 30 HIT firms by offering type. Pure play firms are failing behind

100%

Focus on
Services and
Solutions is
the way to go

80%
60%

Up

% of all
firms by 40%
offering

Down
Flat

20%

Ranking
YoY

0%
Hardware

Software

Services

Source - The 2012 Healthcare Informatics 100 ranks the leading 100 vendors by revenues derived from healthcare IT products and services earned in the U.S.
www.netspective.com

14
Start small but think big

Market your devices as data generators that
can help change medical science
NETSPECTIVE

We’re digitizing biology
Last and past decades

Digitize
mathematics

Digitize
literature

Digitize social
behavior

Predict human
behavior

Gigabytes and petabytes
www.netspective.com

This and future decades

Digitize biology

Digitize
chemistry

Digitize physics

Predict
fundamental
behaviors

Petabytes and exabytes
16
NETSPECTIVE

We’re just getting started

Will you be ready for the coming data deluge and can you differentiate your device?
Social Interactions
Biosensors

Economics

Phenotypics

Since 1970,
pennies per
patient

Since 1980s,
pennies per
patient

• Business focused data
• Retrospective
• Built on fee for service models
• Inward looking and not focused
on clinical benefits

www.netspective.com

• Must be continuously collected
• Mostly Retrospective
• Useful for population health
• Part digital, mostly analog
• Family History is hard

Genomics
Since 2000s,
started at $100k
per patient, <$1k
soon

• Can be collected infrequently
• Personalized
• Prospective
• Potentially predictive
• Digital
• Family history is easy

Proteomics
Emerging

• Must be continuously collected
• Difficult today, easier tomorrow
• Super-personalized
• Prospective
• Predictive

17
NETSPECTIVE

Data changes the questions we ask

Simple visual facts
www.netspective.com

Complex visual facts

Complex computable
facts
18
NETSPECTIVE

Implications for scientific discovery
The old way
Identify problem

Identify data

Ask questions

Generate questions

Collect data

Mine data

Answer questions
www.netspective.com

The new way

Answer questions
19
NETSPECTIVE

We’re in the integration age
We’re not in an
app-driven
future but an
integrationdriven future.

He who
integrates the
best, wins.

Source: Geoffrey Raines, MITRE
www.netspective.com

20
Don’t become a commodity sensor company

Educate your customers about the importance of
medical device data
NETSPECTIVE

Obvious sources of data

Your device data needs to fit in and integrate across a wide variety of existing customer data
Clinical systems

Consumer and
patient health
systems

Core transaction
systems

Decision
support systems
(DSS and CPOE)

Electronic
medical record
(EMR)

Managed care
systems

Medical
management
systems

Materials
management
systems

Clinical data
repository

Patient
relationship
management

Imaging

Integrated
medical devices

Clinical trials
systems

Telemedicine
systems

Workflow
technologies

Work force
enabling
technologies
www.netspective.com

22
NETSPECTIVE

Architect for next generation sources of data

Your device data needs to fit in and integrate across a wide variety of new sources of data
Clinical trials data
(failed or successful)

Secure Social Patient
Relationship
Management (PRM)

Patient
Communications,
SMS, IM, E-mail,
Voice, and Telehealth

Patient Education,
Calculators, Widgets,
Content
Management

Blue Button, HL7,
X.12, HIEs, EHR, and
HealthVault
Integration

E-commerce, Ads,
Subscriptions, and
Activity-based Billing

Accountable Care,
Patient Care
Continuity and
Coordination

Patient Family and
Community
Engagement

Patient Consent,
Permissions, and
Disclosure
Management
www.netspective.com

23
NETSPECTIVE

Your device is a great source of data
Understand how your data compares to other data sources
Patient

Source

Self reported by
patient

Health
Professional

Observations by
HCP

Labs &
Diagnostics

Specimens

Medical Devices

Real-time from
patient

Biomarkers /
Genetics

Specimens

Errors

High

Medium

Low

Low

Low

Time

Slow

Slow

Medium

Fast

Slow

Reliability

Low

Medium

High

High

High

Kilobytes

Kilobytes

Kilobytes

Megabytes

Gigabytes

Gigabytes

Gigabytes

Uncommon

Uncommon

Discrete size
Streaming size

Availability

www.netspective.com

Uncommon

Common

Somewhat
Common

24
NETSPECTIVE

Application focus is biggest mistake

The customer needs are changing from simple automation to complex process improvements

Application-focused IT instead of Data-focused IT is causing business problems.
Silos of information exist across
groups (duplication, little sharing)

Clinical
Apps

Billing
Apps

Lab
Apps

Other
Apps

Healthcare Provider Systems

Patient
Apps

Partner Systems

Poor data integration across
application bases
www.netspective.com

25
NETSPECTIVE

The Strategy: Modernize Integration

Be sure you fit into your customer’s data architecture and governance needs

Need to get existing applications to share data through modern integration
techniques

Clinical
Apps
NCI
App

Billing
Apps

Lab
Other
Apps
Apps
NEI
App
Healthcare Provider Systems

Patient
Apps
NHLBI
App

Partner Systems

Master Data Management, Entity Resolution, and Data Integration
Improved integration by services
that can communicate between applications
www.netspective.com

26
NETSPECTIVE

Data-centric device architecture

Extensibility and adaptability will be key in a data-centric world

5

Device Components

• Presence
• Messaging
• Registration
• JDBC, Query
Sensors

Storage

Event Architecture

Display

6

App
#1

App
#2

Plugins

4

Location
Aware

Connectivity Layer (DDS, HTTP, XMPP)

3
Device OS
(QNX, Linux, Windows)

www.netspective.com

3rd Party Plugins

Web Server, IM Client

1

7

Plugin Container

2

Security and Management Layer

27
NETSPECTIVE

Ensure your devices fit in a modern IT architecture
Don’t give up your device data to others without a fight
Device
Teaming

Cloud
Services

Patient
Self-Management
Platforms

SSL VPN

Patient Context
Monitoring

Device Gateway
(DDS, XMPP ESB)
,

Device
Data
Data Transformation (ESB, HL7)

Remote
Surveillance

Management
Dashboards

HIT
Integration

Report
Generation
Device reimbursement

www.netspective.com

Enterprise Data
RCM, Financials,
EHRs

Device
Management

Cross Device
App Workflows

Device Utilization
Device profitability

Alarm
Notifications

Inventory
28
Visit
http://www.netspective.com
http://www.healthcareguy.com
E-mail shahid.shah@netspective.com
Follow @ShahidNShah
Call 202-713-5409

Thank You

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Med Device Vendors Have Big Opportunities in Health IT Software, Services, and Data Management,

  • 1. Device Vendor Opportunities in Health IT Data Management Data is becoming currency and device vendors shouldn’t let health IT software firms own or control it By Shahid N. Shah, CEO
  • 2. NETSPECTIVE Who is Shahid? • • • • 20+ years of software engineering and multidiscipline complex IT implementations (Gov., defense, health, finance, insurance) 12+ years of healthcare IT and medical devices experience (blog at http://healthcareguy.com) 15+ years of technology management experience (government, non-profit, commercial) 10+ years as architect, engineer, and implementation manager on various EMR and EHR initiatives (commercial and non-profit) Author of Chapter 13, “You’re the CIO of your Own Office” www.netspective.com 2
  • 3. NETSPECTIVE What you’ll learn in this briefing Data from devices is too important to be left to others Background • • • • A deluge of healthcare data is being created as we digitize biology, chemistry, and physics. Data changes the questions we ask and it can actually democratize and improve the science of medicine, if we let it. While cures are the only real miracles of medicine, big data can help solve intractable problems and lead to more cures. Healthcare-focused software engineering is going to do more harm than good (industry-neutral is better). www.netspective.com Key takeaways • • • • Applications come and go, data lives forever. He who owns, integrates, and uses data wins in the end. Data from devices is too important to be left to software vendors, managed service providers, and system integrators. There’s nothing special about health IT data that justifies complex, expensive, or special technology. Spend freely on multiple systems and integration-friendly solutions. 3
  • 4. NETSPECTIVE Manufacturer’s have a great deal to worry about Your customer, competitors, and industry are all shifting Customer is trapped by their EHR vendors Device vendors aren’t benefiting from industry trends Customer base has shifted from clinical to clinical + IT + system integration Clinical customer goals have shifted from basic automation to advanced process optimizations Device manufacturer’s access to regulated IT and system integration skills is limited Struggling to find new revenue sources as hardware is commoditized www.netspective.com 4
  • 5. NETSPECTIVE Healthcare Industry / Market Trends Major market and regulatory trends that are causing customers and competitors to shift Device manufacturers must become experts on all of these terms PPACA ACO PCMH “Affordable Care Act” “Accountable Care Org” “Medical Home” Health Home www.netspective.com mHealth MU “Meaningful Use” PCPCC “Patient Centered Care” 5
  • 6. NETSPECTIVE NEJM believes doctors are trapped by EHRs Don’t buy the argument that the “enterprise EHR” should maintain / own / manage all data It is a widely accepted myth that medicine requires complex, highly specialized information-technology (IT) systems. This myth continues to justify soaring IT costs, burdensome physician workloads, and stagnation in innovation — while doctors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their “civilian” life. New England Journal of Medicine “Escaping the EHR Trap - The Future of Health IT”, June 2012 www.netspective.com 6
  • 7. NETSPECTIVE Trend Goal: Patient Engagement How does your device help customers engage with their patients? Superb Access to Care Patient Engagement in Care Clinical Information Systems www.netspective.com •Patients can easily make appointments and select the day and time. •Waiting times are short. •eMail and telephone consultations are offered. •Off-hour service is available. •Patients have the option of being informed and engaged partners in their care. •Practices provide information on treatment plans, preventative and follow-up care reminders, access to medical records, assistance with self-care, and counseling. •These systems support high-quality care, practice-based learning, and quality improvement. •Practices maintain patient registries; monitor adherence to treatment; have easy access to lab and test results; and receive reminders, decision support, and information on recommended treatments. Source: Health2 Resources 9.30.08 7
  • 8. NETSPECTIVE Trend Goal: Coordinated Care How does your device help customers coordinate care across their partners? Care Coordination •Specialist care is coordinated, and systems are in place to prevent errors that occur when multiple physicians are involved. •Follow-up and support is provided. Team Care •Integrated and coordinated team care depends on a free flow of communication among physicians, nurses, case managers and other health professionals (including BH specialists). •Duplication of tests and procedures is avoided. Patient Feedback •Patients routinely provide feedback to doctors; practices take advantage of low-cost, internetbased patient surveys to learn from patients and inform treatment plans. Publically available information •Patients have accurate, standardized information on physicians to help them choose a practice that will meet their needs. www.netspective.com 8
  • 9. NETSPECTIVE Why care about MU? If you’re not talking about MU you’ll find it harder to get in the door “Enable significant and measurable improvements in population health through a transformed delivery system.” 2011 2015 MU Stage 1 MU Stage 2 MU Stage 3 No Impact www.netspective.com 2013 Indirect Impact: Start planning for MU Direct Impact: Device integration proposed 9
  • 10. NETSPECTIVE There’s money in MU Devices can and should be “MU capable” www.netspective.com 10
  • 11. NETSPECTIVE Fit into CIO’s strategic framework In the future your devices won’t be sold into customers without CIO approval Source: The Advisory Board www.netspective.com 11
  • 12. NETSPECTIVE Implications of health IT trends PPACA ACO Software Regulated IT and Systems Integration Services MU Health Home www.netspective.com PCMH mHealth DATA Evidence Based Medicine Comparative Effectiveness 12
  • 13. NETSPECTIVE Don’t give up data to others without a fight Software vendors, systems integrators, and others don’t have your best interest in mind Device Teaming Cloud Services Patient Self-Management Platforms SSL VPN Patient Context Monitoring Device Gateway (DDS, XMPP ESB) , Device Data Data Transformation (ESB, HL7) Remote Surveillance Management Dashboards HIT Integration Report Generation Device reimbursement www.netspective.com Enterprise Data RCM, Financials, EHRs Device Management Cross Device App Workflows Device Utilization Device profitability Alarm Notifications Device Inventory 13
  • 14. NETSPECTIVE New revenue centers in software and services Build the right roadmap so that you don’t leave new revenue on the table 2 year ranking comparison of Top 30 HIT firms by offering type. Pure play firms are failing behind 100% Focus on Services and Solutions is the way to go 80% 60% Up % of all firms by 40% offering Down Flat 20% Ranking YoY 0% Hardware Software Services Source - The 2012 Healthcare Informatics 100 ranks the leading 100 vendors by revenues derived from healthcare IT products and services earned in the U.S. www.netspective.com 14
  • 15. Start small but think big Market your devices as data generators that can help change medical science
  • 16. NETSPECTIVE We’re digitizing biology Last and past decades Digitize mathematics Digitize literature Digitize social behavior Predict human behavior Gigabytes and petabytes www.netspective.com This and future decades Digitize biology Digitize chemistry Digitize physics Predict fundamental behaviors Petabytes and exabytes 16
  • 17. NETSPECTIVE We’re just getting started Will you be ready for the coming data deluge and can you differentiate your device? Social Interactions Biosensors Economics Phenotypics Since 1970, pennies per patient Since 1980s, pennies per patient • Business focused data • Retrospective • Built on fee for service models • Inward looking and not focused on clinical benefits www.netspective.com • Must be continuously collected • Mostly Retrospective • Useful for population health • Part digital, mostly analog • Family History is hard Genomics Since 2000s, started at $100k per patient, <$1k soon • Can be collected infrequently • Personalized • Prospective • Potentially predictive • Digital • Family history is easy Proteomics Emerging • Must be continuously collected • Difficult today, easier tomorrow • Super-personalized • Prospective • Predictive 17
  • 18. NETSPECTIVE Data changes the questions we ask Simple visual facts www.netspective.com Complex visual facts Complex computable facts 18
  • 19. NETSPECTIVE Implications for scientific discovery The old way Identify problem Identify data Ask questions Generate questions Collect data Mine data Answer questions www.netspective.com The new way Answer questions 19
  • 20. NETSPECTIVE We’re in the integration age We’re not in an app-driven future but an integrationdriven future. He who integrates the best, wins. Source: Geoffrey Raines, MITRE www.netspective.com 20
  • 21. Don’t become a commodity sensor company Educate your customers about the importance of medical device data
  • 22. NETSPECTIVE Obvious sources of data Your device data needs to fit in and integrate across a wide variety of existing customer data Clinical systems Consumer and patient health systems Core transaction systems Decision support systems (DSS and CPOE) Electronic medical record (EMR) Managed care systems Medical management systems Materials management systems Clinical data repository Patient relationship management Imaging Integrated medical devices Clinical trials systems Telemedicine systems Workflow technologies Work force enabling technologies www.netspective.com 22
  • 23. NETSPECTIVE Architect for next generation sources of data Your device data needs to fit in and integrate across a wide variety of new sources of data Clinical trials data (failed or successful) Secure Social Patient Relationship Management (PRM) Patient Communications, SMS, IM, E-mail, Voice, and Telehealth Patient Education, Calculators, Widgets, Content Management Blue Button, HL7, X.12, HIEs, EHR, and HealthVault Integration E-commerce, Ads, Subscriptions, and Activity-based Billing Accountable Care, Patient Care Continuity and Coordination Patient Family and Community Engagement Patient Consent, Permissions, and Disclosure Management www.netspective.com 23
  • 24. NETSPECTIVE Your device is a great source of data Understand how your data compares to other data sources Patient Source Self reported by patient Health Professional Observations by HCP Labs & Diagnostics Specimens Medical Devices Real-time from patient Biomarkers / Genetics Specimens Errors High Medium Low Low Low Time Slow Slow Medium Fast Slow Reliability Low Medium High High High Kilobytes Kilobytes Kilobytes Megabytes Gigabytes Gigabytes Gigabytes Uncommon Uncommon Discrete size Streaming size Availability www.netspective.com Uncommon Common Somewhat Common 24
  • 25. NETSPECTIVE Application focus is biggest mistake The customer needs are changing from simple automation to complex process improvements Application-focused IT instead of Data-focused IT is causing business problems. Silos of information exist across groups (duplication, little sharing) Clinical Apps Billing Apps Lab Apps Other Apps Healthcare Provider Systems Patient Apps Partner Systems Poor data integration across application bases www.netspective.com 25
  • 26. NETSPECTIVE The Strategy: Modernize Integration Be sure you fit into your customer’s data architecture and governance needs Need to get existing applications to share data through modern integration techniques Clinical Apps NCI App Billing Apps Lab Other Apps Apps NEI App Healthcare Provider Systems Patient Apps NHLBI App Partner Systems Master Data Management, Entity Resolution, and Data Integration Improved integration by services that can communicate between applications www.netspective.com 26
  • 27. NETSPECTIVE Data-centric device architecture Extensibility and adaptability will be key in a data-centric world 5 Device Components • Presence • Messaging • Registration • JDBC, Query Sensors Storage Event Architecture Display 6 App #1 App #2 Plugins 4 Location Aware Connectivity Layer (DDS, HTTP, XMPP) 3 Device OS (QNX, Linux, Windows) www.netspective.com 3rd Party Plugins Web Server, IM Client 1 7 Plugin Container 2 Security and Management Layer 27
  • 28. NETSPECTIVE Ensure your devices fit in a modern IT architecture Don’t give up your device data to others without a fight Device Teaming Cloud Services Patient Self-Management Platforms SSL VPN Patient Context Monitoring Device Gateway (DDS, XMPP ESB) , Device Data Data Transformation (ESB, HL7) Remote Surveillance Management Dashboards HIT Integration Report Generation Device reimbursement www.netspective.com Enterprise Data RCM, Financials, EHRs Device Management Cross Device App Workflows Device Utilization Device profitability Alarm Notifications Inventory 28