Maccabi Healthcare Services v Maccabi is the second largest HMO in Israel. It covers 1. 85 million people (24. 5% 0 f the population) v It is a recognized health fund within the framework of the Israeli National Health Insurance Law v Maccabi is responsible for providing insurance cover for all services included in the public basket of services v It supplies services to its members both via its own facilities and through outside providers
The Maccabi Heathcare System is Highly Computerized v Every provider uses the Maccabi Electronic Medical Record v Every transaction with the patient is computerized v The Central Medical Record contains all computerized patient data –gives doctor access to all information on the patient v The E-Laboratory-electronic referrals, automatic test results to doctor’s computer, patient website v The E- Prescription v E- Consultation v Telemedicine v Alerts and Reminders v Patient Website including Patient Health Record
Chronic Diseases Is the Major Threat and Challenge of our Century v Nearly 70 -80% of health care costs are a result of chronic disease v Chronic Disease accounts for 60% of all deaths and 43% of the global burden of disease v 70% of the disease burden is from 5 chronic conditions v Congestive heart failure v Asthma v Coronary artery disease. v Diabetes v Depression v People with chronic conditions only receive 56. 1% of recommended care v Disease management is a High Priority everywhere to reduce complications and deaths
Chronic Disease Management using ed. BPM v Modern approaches to disease management focus on “patient empowerment” v Two types of technologies in use today: § Remote monitoring of patients using sensors/devices that transmit to professional call center § Patient websites with structured programs for DM v The ed. BPM approach: complex event processing disease management web-based program to assimilate information from multiple source events (sensors, patient input, doctor’s electronic record), macro level analysis as complex event, take action in real time.
Scenario – Diabetes Management Harry Jung is a married man of 50 who was diagnosed with Diabetes Mellitus type 2 ten years ago. He is generally careful about his diet, has a regular exercise regimen and his Hb. A 1 c levels indicate that his disease is in control and stable. He is enrolled in an interactive web-based (Ea. SSY ed. BPM platform) diabetes disease management program. He weighs himself once a week and the results are transmitted to the program. Likewise, he measures his blood pressure once a week and he measures his sugar levels daily with a glucometer. These measures are transmitted and entered into his interactive disease management program. He has been instructed to enter the system once a month to monitor his overall trends and provide a subjective report about his well being.
This month, he entered the program, and upon entry it notified him that although he had not yet reached levels that would generate an alert, he is exhibiting a steady trend of increase in glucose levels as well as a small but steady increase in his weight. The program also informs him that he has not had an eye checkup in over a half a year, he has not had a foot checkup in more than a year and he is overdue for his Hb. A 1 c test. Therefore, he is instructed to make an appointment with his doctor. The program connects him automatically to the doctor's web-based appointment system so that he can schedule an appointment. In addition, the program will ask him additional questions about his diet and exercise regime and give him interim instructions to follow in the meantime until he has his appointment with his doctor.
Scenario Action 1: Weekly transmission glucose levels, Blood Pressure to internet DM program Event Type: Date, time, Data - glucose level, BP, height, weight Source: Sensors and medical devices in patient’s home Business processes: Comparison of input with norms. Time series comparison Human Dialogue: Trend analysis and result Action 2: Bimonthly update of program from doctor’s electronic medical record Event Type: Date, time, test results, treatments, date last performed, drugs Source: Electronic medical record doctor’s computer Business processes: Comparison of information with business rules for required intervals for performing tests, treatments, visits, compare test results with norms Human Dialogue: Generation of exception list ( lack of conformity to rules) Action 3: Henry Jung opens internet DM site for monthly review Event Type: Date, time, recognition of patient entry (user name, password) Source: patient’s home computer Business processes: processing of accumulated results of information, correlation between trends of results from devices, tests, exception list from EMR Human Dialogue: Presentation of results to Henry
Scenario Action 4: Henry Initiates interactive program, questions and answers Event Type: alerts: steady increase in glucose levels and weight; notification that he is overdue for tests, checkups Source: Disease management program Business processes: answers to Henry’s questions, automatic connection with Henry’s doctor’s web appointment schedule Human Dialogue: Options for appointments Action 5: Henry chooses a time and date for doctor appointment and eners it Event Type: makes appointment in response to patient choice of date and time Source: Henry’s input from home computer Business processes: Process and confirm time and date op appointment in doctor’s appointment calendar according to rules governing the appointment Human Dialogue: Notification of doctor’s clinic and confirmation to Henry of appointment with optional reminder to cellular phone
Patient Nurse Case Management Record Confirmation Doctor Input Drugs, Vital Signs within Parameters Devices Report EMR Web Input Analysis Deviation from Parameters Moderate within Parameters Severe Re measure Continued Deviation from Parameters Notify Nurse Ask for Additional info from Patient Instructions for Resting , Changes in Drugs, Eating etc. Follow Up Update EMR and Case Management Record Alert OR Schedule Visit in Doctor`s Clinic Doctor Nurse Order Ambulance, Notify ER
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