January 2009

Achieving the Vision of Connected Healthcare : Anantharaman S Iyer, Regional Director – India, InterSystems

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Many of the top hospitals, labs and healthcare providers around the world require mission-critical applications. Although, the term “mission-critical” is often misused while describing computer applications, the description is apt for healthcare industry. Healthcare applications often have life-or-death dimensions � a patient’s life can hinge on the instant availability and accuracy of information. It makes sense that professionals responsible for healing and saving people’s lives would only choose proven technology that meets the most stringent requirements for performance and reliability.

Intelligent software products are being used by leading healthcare institutions around the world to turn the vision of ‘connected healthcare’ into reality- improving patient care, and safety while reducing costs. Innovative technologies offer fast ways to create and integrate electronic health records (EHRs). By enabling connected healthcare, it becomes possible for test results and other critical clinical information to be delivered instantaneously to healthcare professionals at every point of care. Doctors are able to send electronic prescriptions to pharmacies, and connected systems can flag potentially harmful drug interactions and provide clinical guidelines.

Intelligent software solutions can eliminate the duplication of laboratory tests and other redundancies, expedite billing and payment, and maximise bed utilisation. Connected healthcare makes every process more efficient and reliable.

InterSystems’ products offer the reliability, scalability, ease of use, and performance required to create connected healthcare environments. These are discussed as further.

InterSystems TrakCare� is an advanced Web-based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. It is used by leading hospitals in 25 countries to bring exponential improvements to the care of every patient and to the productivity of every healthcare professional.

InterSystems Ensemble Integration Platform

Ensemble is the easiest and most efficient integration software to use because it’s not a stitched-together suite of separate parts. We created it as a single, architecturally consistent technology stack. Ensemble seamlessly combines a rapid application development environment with messaging, integration, business process orchestration (BPO), and business activity monitoring (BAM) capabilities. Designed with service-oriented and event-driven architectures in mind, Ensemble excels at quickly building and deploying connectable applications � healthcare solutions that leverage the functionality of existing applications, orchestrate new business processes, and integrate data from across the enterprise.

Ensemble offers unmatched performance because its technology stack includes InterSystems Cach�, the leading database in clinical applications worldwide. Ensemble provides all the technology needed to create composite applications or to share data among disparate systems, without having to first integrate multiple development and integration platforms. This fusion of previously independent technologies has only a single, rapid learning curve and dramatically reduces time-to-deployment and costs. At the same time, it lowers management overhead by enabling one to rapidly tailor integrated systems, without coding, using business process definitions, business rules, workflows, and other configuration settings.

Ensemble technology lets you rapidly enhance applications and systems with:

  • Rich Web interfaces
  • Adaptable workflow
  • Messaging via an extensible enterprise service bus (ESB)
  • Data transformation
  • Business Process Orchestration (BPO)
  • Business Activity Monitoring (BAM)
  • Business rules processing
  • Dashboards
  • Out-of-the-box integration with the most popular applications, databases, and technologies
  • High-performance data and metadata management
  • Web services and other service-oriented architecture (SOA) technology

Federal District Government of Brazil reaping quick benefits from InterSystems TrakCare implementation

Brasilia, the federal district of Brazil, is in the midst of an ambitious three-year project to modernise the delivery and administration of healthcare in the city. They are implementing InterSystems TrakCare� software and are already enjoying some of the benefits that come from having a state-of-the-art electronic patient record (EPR) system.

When complete, the Integrated GDF (Governo do Distrito Federal) Healthcare System will connect all the healthcare centres, diagnostic laboratories, public pharmacies, and hospitals of the Federal District.

It will also interface with national programs run by Brazil’s Department of Health. Each of the Federal District’s 2.5 million residents will be issued a “Citizen’s Health Card” that grants instant, secure access to all of their personal medical files.

Rapid Return-on-Investment

Jos� Roberto Arruda, Federal District Governor, thinks the project will bring the public healthcare system out of what he refers to as the “Stone Age,” but acknowledges that it comes at a price. “For this to work, a large job needed to be done first. We invested R$6 million in systems alone, and that much again in equipment and training,” he says. Fortunately, thanks to TrakCare’s modular architecture, the district government is already seeing significant cost savings and improved quality of care from the portions of the project that have been completed.

One prime example of this is the Test Portal, which allows patients and their doctors to access the results of laboratory tests over the Internet. So far, the Test Portal has been rolled out at the Base Hospital, several regional hospitals, and the Central Laboratory itself. Together, these hospitals account for 5.5 million of the over 8 million laboratory tests performed each year in the Federal District.

According to Jos� Geraldo Maciel, Secretary of Health for Federal District, “the old paper-based system resulted in 20% loss of test results even before they could be reviewed by a doctor. Moreover, when doctors ordered repeat tests, again 30% of results are reported to be lost.”

Commenting on financial implications of such system inefficiencies Maciel further adds that, “the 8.4 million tests that we perform each year cost the system about R$60 million. This waste represents a minimum annual loss of R$18 million. The portal will cut waste to zero by allowing users and/or healthcare professionals to access, at any moment and in real time, the complete patient record, including all laboratory test results. Results are available much faster too, often ready in less than a day. With the old paper-based system, patients typically used to wait for 15 to 30 days to get their test results.”

Significant savings are also being realised by efficiently managing the purchase of medicines, which costs the Federal District nearly R$220 million annually. According to Maciel, “about 20% of these resources are lost, and with them, another R$40 million.” By implementing TrakCare in healthcare centres, it will be possible to halt the distribution of medicine without a doctor’s prescription, or the distribution of the same medicine more than once to the same patient in different healthcare centres.”

Bed management is another area that is yielding cost reductions. Currently, all of the 257 intensive care beds in Brasilia (in 17 hospitals, of which 10 are public and 7 are private) are being regulated by the new government project in real time. The system has already brought savings to the tune of R$1 million with the management of ICU beds contracted in private hospitals. “Brasilia has around 4,000 beds in all of the hospitals of the system and the occupation per bed is 2.3 patients per month. We can set as a goal to double the occupation of each bed from 2.3 to 4.6 patients per month before the end of the Governor’s term, and hence effectively building 4,000 more beds in Brasilia without laying a single brick,” states Maciel.

The Federal District Sub-secretary of Health, Jo�o Luiz Arantes de Freitas, predicts that in three years, when the Integrated GDF Healthcare System is completely operational, the total savings will reach R$100 million per year.

A Model for The Nation

One of the most highly anticipated stages of the ‘Health Integration Project’ is the deployment of ‘Citizen Health Card’ system. A pilot project at the Gama Regional Hospital has issued health cards to approximately 100,000 inhabitants of the region. This program will gradually be rolled out to all of Brasilia’s 2.5 million residents, giving them instant, secure access to their personal electronic medical record.

However, it just doesn’t stop there. Officials on the federal level view Brasilia’s health integration project as a model to be adopted by the national ‘Single Healthcare System’. Says Jos� Carvalho Noronha, Federal Aide of Health Assistance and Attention, “here we are designing the structure that will guarantee every Brazilian citizen opportunities related to the care of their health. And, I am foreseeing, it is a short hop from here to implementing and having a user identification card, the national health card � starting with the Federal District.”

HealthShare is a comprehensive solution for aggregating and securely sharing clinical data across multiple organisations, enabling the rapid creation of an Electronic Health Record.

InterSystems TrakCare Web-based Healthcare Information System

InterSystems TrakCare� is an advanced Web-based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. It is used by leading hospitals in 25 countries to bring exponential improvements to the care of every patient and to the productivity of every healthcare professional.

TrakCare provides a complete enterprise-wide clinical and administrative solution, and its application modules easily and seamlessly connect with existing legacy systems and other best of breed applications. In addition, with its unique ‘FastTrak to EPR’ methodology, TrakCare enables an Electronic Patient Record to be deployed in record time.

TrakCare implementations range from single hospitals in numerous countries to a state-wide, fully integrated healthcare information system serving 6.5 million patients in Brasilia and its surrounding region. TrakCare can be readily adapted to varying public and private sector healthcare delivery approaches.

InterSystems HealthShare � Health Information Exchange Platform

When you work with InterSystems HealthShare�, you’re working with the leading software for connected healthcare – software that can help your organisation deliver better care while reducing costs.

HealthShare is the only software product that provides a fast path for creating electronic health record systems on a regional or national basis. This is a comprehensive solution for aggregating and securely sharing clinical data across multiple organisations, enabling the rapid creation of an Electronic Health Record.

To address the unique requirements of each system, HealthShare has the flexibility to work with a variety of architectures, and includes a rapid development and customisation environment.

With HealthShare, you’ll be able to take an incremental approach to deployment. You can preserve the separate systems that local healthcare professionals are accustomed to using, and rapidly transform them into connected regional or national systems. This means significant reductions in the cost, development time, and risk of creating and operating an electronic health record system.

Conclusion

Till the end of 2006, InterSystems was mostly known as a technology provider. Now with the inclusion of TrakCare� HIS (Hospital Information System) into its product offering in May 2007 (TrakCare is not sold in the United States as part of our friendly policy towards our other partners) and HealthShare HIE (Health Information Exchange) framework, InterSystems addresses the needs at all levels in the HealthCare value chain as explained in

Figure a.InterSystems at various level of healthcare value chain

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