Partners Healthcare System Partners Healthcare System Topics and - - PDF document

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• Hospital

Hospital – – Examples at Harvard Examples at Harvard Affiliated Hospitals and Partners Affiliated Hospitals and Partners Healthcare System Healthcare System

蕭乃彰 Jack Hsiao, M.D., Ph.D. at 慈濟大學 醫學資訊學系 May 10, 2007

Jack Hsiao 蕭乃彰

蕭中正醫院 營運中心營運長 Faulkner / Brigham & Women’s Ob/Gyn

Associates 婦產科醫師

前 秀傳醫療體系副營運長/ 國際厚生執行長 Esplanade NewsLine Editor-In Chief 波士頓大學醫學院 (Boston University,

School of Medicine) M.D., Ph.D.

台北市立國語實驗國民小學

Topics and Contents

Harvard Affiliated Hospitals and Partners

Healthcare System

E-Health Models at Partners Healthcare Virtualization of Healthcare Industry Center for Integration of Medicine & Innovative

Technology and MIT’s Auto-ID in Healthcare

Northeast Proton Therapy Center and Cancer

Treatments

Partners Healthcare System Partners Healthcare System

• 哈佛大學的教學醫院 (Massachusetts General Hospital

(MGH), Brigham & Women’s Hospital (BWH) , and Dana-Farber/Partners CancerCare )

• 全美最大的以醫院為主的醫療研究機構 (US$680 million)
• 史上共有二十一位諾貝爾獎得主曾於 Partners 所屬醫

院工作或受訓

• U.S. News & World Report’s 前十大醫院年度評鑑,

ＭＧＨ & BWH是唯一位於同一城市 (Boston) 的綜合醫 院 ,連續17年(1989-2006)

Partners Healthcare System Partners Healthcare System ( (續） 續）

• 營運收入 (2006年)

32.1 (million, US$)

• 病床數

3,632

• 住院人次

163,892

• 門診人次

3,210,966

• 生產人次

23,050

• 手術人次

83,081 住院病人 41,090 非住院病人 41,991

• 醫師

6,806

• 住院醫師

1,632

• 臨床研究員

895

• 基礎醫學研究員

1,852

• 護理人員

6,925

• 工作人員

15,108 (教育,行政,法務,宣傳,財務等)

Partners Healthcare Partners Healthcare’ ’s Firsts s Firsts

1846 首先於手術使用麻醉 (MGH) 1896 全美首先使用X光作診斷(MGH) 1929 首先使用鐵肺來拯救小兒麻痺患者 (BWH) 1947 首先成功地運用人工洗腎機(血液透析器) (BWH) 1954 首例成功的人體器官移植 (BWH) 1960 首先發展子宮抹片的檢驗做為子宮頸癌的簡篩檢 (MGH) 1962 首例成功的骨盆腔修復手術 (MGH) 1964 首先發展血庫因應血液的長期需求 (MGH) 1968 首先展示遠距醫療 (MGH) 1970 首先發展並應用非侵入性的影像檢查 (包括 Positron Emission Tomography scanning (PET) 及 Magnetic Resonance Imaging (MRI)) (MGH)

Partners Healthcare Partners Healthcare’ ’s Firsts (cont.) s Firsts (cont.)

1981 首先自活體細胞製作人工皮膚 (MGH + MIT) 1996 首先使用術中核磁共振造影 (BWH) 1998 首先發展利用基因分析的技術治療腦瘤 (MGH) 2000 於愛滋病研究方面初期偵測出人類免疫不全病 的治療有突破性的發展 (MGH) 2001 使用質子光治療進行癌症放射線治療 (MGH) 2002 首先進行癌症標示的方法進行腫瘤治療 (DFC) 2003 首先發展全方位的 Complimentary and Alternative Medicine (CAM) 來進行腫瘤治療 (DFC)

Massachusetts General Hospital

• Founded in 1811, Massachusetts General Hospital (MGH) is recognized

as a world leader in academic medicine and has made pivotal contributions to the advancement of medicine throughout history.

• MGH provides sophisticated, multidisciplinary diagnostic and

therapeutic care in every medical specialty and subspecialty, including:

• Alzheimer's and Other Neurodegenerative Diseases
• Brain Tumor Center and Cancer Surgery Center
• Cardiovascular Research Center
• Center for Bone Marrow Transplantation
• Division of Abdominal Imaging and Intervention
• International Patient Center
• Orthopedic Surgery (ESWT Center)
• Pain Center
• Proton Beam Center
• Transplantation Biology Research Center

Brigham and Women’s Hospital

Brigham and Women's Hospital (BWH) is a world-renowned center

for advanced patient care, research, and medical education.

Specialty Practice Centers including:

• Breast Cancer Research Center
• Center for Chest Diseases
• Center for Reproductive Biology
• Center for Women's Mental Health
• Gynecology and Oncology
• Orthopedic and Arthritis Center
• Pediatrics
• Women’s Health Services

Dana-Farber CancerCare

Dana-Farber CancerCare is dedicated to providing the highest quality

care and the most advanced treatments for adults with cancer.

Many kinds of cancer and blood disorders are treated within the 12

disease programs that are the cornerstone of Dana-Farber CancerCare:

• Breast Cancer
• Endocrine Cancer
• Gastrointestinal Cancer
• Genitourinary Cancer
• Gynecologic Cancer
• Head and Neck Cancer
• Melanoma
• Neurologic Cancer
• Sarcoma
• Thoracic Cancer

Partners’ Partners

Brigham and Women’s Hospital Cambridge Hospital Dana-Farber/Partners CancerCare Emerson Hospital Faulkner Hospital Hallmark Health System Massachusetts General Hospital McLean Hospital Newton-Wellesley Hospital North Shore Children’s Hospital Salem Hospital Shaughnessy-Kaplan Rehabilitation Hospital Spaulding Rehabilitation Hospital Union Hospital + Major Teaching Affiliate of Harvard Medical School

Partners’ Intra-Hospital Programs

• Largest cancer care program in the U.S.
• 12,000+ new cancer patient each year
• Over 700 active clinical trails at BWH

and MGH, and 300 at Dana-Farber

• Implementations of advanced technology:

proton bean therapy, intra-operative radiotherapy with a dedicated linear accelerator, intro-operative MRI for brain tumor surgery

Partners’ Intra-Hospital Programs (cont.)

Clinical & Research Programs

• AIDS Research Center
• Center for Human Genetics
• Center for Innovative Minimally Invasive

Therapy Clinical Trials (CRNet)

• Online list of open trials by therapeutic

area

• Online submit and enrollment

Online Symposia

• Grand Rounds and CME

Partners’ Intra-Hospital Programs (cont.)

Graduate Medical Education

• Joint Residency and Fellowship Programs

Institute of Health Professions

• Physical therapy, speech-language

pathology, and clinical investigation Continuing Medical Education

• Projects with Harvard Medical School
• Dept. of Continuing Education

Partners’ Intra-Hospital Programs (cont.) Partners International

• International Patient Referral

Service

• Center for International Healthcare

Education Partners Telemedicine

• Online specialty consultations
• Video conference / multimedia
• Video-on-demand

Partners’ Intra-Hospital Programs (cont.)

• Conduct negotiations for affiliated

hospitals

• Resolving legal issues
• Public relations and marketing

efforts

• Publications
• Resource/finance management
• Physician access programs

Partners’ Intra-Hospital Programs (cont.)

Center for Integration of Medicine & Innovative Technology (CIMIT)

• Collaboration between Partners Healthcare &

Massachusetts Institute of Technology (MIT)

• Applied research focus on:

* Cardiac disease * Stroke * Trauma/critical care * Tissue engineering * Medical simulation * Image guided therapy * Evident-based medicine

Current e Current e-

• Operations

Operations

• Lab results, MRIs, prescriptions, medical

histories, outpatient exam records, and other patient data are stored on the hospital computer system.

• Doctors with Internet connection and the

security clearance to view patient’s record, to communicated with each other and patients.

• Patients form online support groups to

communicate with each other over the hospital systems.

Internet Remote Control Internet Remote Control

• Doctors at Partners Healthcare Group can log on

to the Web to place orders, view patient records, and read medical literature; to monitor the accuracy and cost-effectiveness of their orders just as it does for hospital personnel.

• Hospitals can check with insurers about

patients’ eligibility for coverage, bypassing phones and faxes; as a result, insurance-claim rejections have fallen 5-11% over the last few years.

Electronic Medical Records Electronic Medical Records (EMRs) (EMRs)

• EMRs have become core to all clinical work at

Partners Healthcare System hospitals.

• All exam rooms are quipped with computers,

which doctors use to order prescriptions and access reference materials on the web; when an outpatient consultation is complete, the doctor dials a phone number and dictates a record of the visit. Typists or voice recognition software then transcribe the verbal report, and the text becomes an official part

• f the patient’s records.

EMRs (cont.) EMRs (cont.)

• Current medications, history of disease, known allergies,

and other doctors and specialists seen would all be rolled into a single electronic file, among with medical images like X-rays and MRIs.

• Would ensure a better patient care because EMRs could

be obtained across the Web if a patient was sick or injured while away from home, patients could be notified immediately and promptly switched to new treatments, specialists could view medical images moments after they were taken.

Cost Cost-

• Effective

Effective

• To computerize its clinical order-entry system,

Harvard affiliated Brigham and Women’s Hospital spent US$2 million and US$500,000/yr to maintain the system

• BWH estimates that its streamlined order-entry

system saves between $5 million to $10 million annually – by alerting physicians to less expensive treatment options and potential errors (that doesn’t factor in the reduced exposure to potentially huge damage awards for medical errors).

Cost Cost-

• Effective (cont.)

Effective (cont.)

• The virtual elimination of paper-file transport

saves Partners Healthcare System between US$9,000 to $20,000 a year per doctor; the costs: between US$3,000 - $4,000 per doctor.

Security Issues Security Issues

• Could the system keep

confidential electronic files from ending up in the wrong hands?

• The answer is a qualified yes at

Partners Healthcare System hospitals: physician communication and patient files are encrypted and fire-wall protected, in fact, some doctors complain that they have trouble accessing some information they should have granted permission

• f obtaining.

Better Patient Relation Better Patient Relation Management (PRM) Management (PRM)

• Communication with doctors over the Web, a Web-based

system has been testing to provide a secure space to store all communications between doctors and patients.

• Patients form chat rooms, discussion groups, and support

groups.

• A breast-cancer pilot project: patients are discharged by

given Sony PictureBook computers with built-in video cameras, BWH doctors and nurses can monitor the patients’ recovery daily – provide patients peace of mind to know that they are video call away from their providers in the postoperative period, they feel more comfortable being discharged a few days earlier.

PRM (cont.) PRM (cont.)

• Pilot program with LifeMasters lets diabetes

patients relay blood sugar data over the Internet.

• LifeChart program on asthma monitor: patients

blow into the mouthpiece of a handheld device, then the device records, digitizes, and transmits two critical parameters, forced expiratory volume and peak flow, to their doctors or respiratory therapists.

TeleMedicine TeleMedicine

• Online consultation between overseas hospitals and

Harvard-based doctors, so called the store-and-delivery system for second-opinion consultations.

• Digitally transmitted images could make diagnosis

more reliable if the images were taken outside the U.S.

• Informatics program would help to facilitate

international patient referral services.

Multi-Media Streaming and Conferencing

• Durable - Archival Library/Legacy Materials
• Standards Based
• Cross Platform Interoperability
• Enterprise-Wide
• Any Time/Any Where Departmental Presentations 24x7
• Multipoint Capability
• Documentable (Usage/Compliance)
• High Quality Audio and Video
• Secure & Confidential
• Cost Effective and Efficient Medium

Multi-Media Streaming and Conferencing (cont.)

Health Profession Training Human Resource Training Clinical Trial Protocols Treatment Protocols Patient Education Patient Registration Wireless Remote Management “Virtual” Family Visitation Continuing Medical Education Seminars, Symposia, Workshops Regulatory/Certifying Agencies

Virtualization of Healthcare Industry

To extend healthcare-related administrative

services and patient care through the Internet

To deliver medical education and services

through the Internet: Healthcare <-> eHealthcare

P-to-P Model: Physicians to Physicians,

Physicians to Patients, Patients to Patients

To collaborate real entity

hospitals with virtual world

Virtualization of Healthcare Industry (cont.)

Virtual Medical Community Virtual Medical Campus (CME, e-Leaning) Virtual Hospital (Administration, Research,

Operation, Clinical)

E-MarketPlace for Healthcare

• Relatively large and scalable market size
• Provide enhancement value services (e.g. financial

management, e-factoring by financial institutes)

• Resources integration abilities (e.g. logistics)
• Integrate medical logistics centers to upgrade the quality of

delivery (just-in-time delivery) and save the cost in storage (point-to-point delivery, e.g. nurse stations)

• Flexibility in business operating models (e.g. multi-point

exchanges)

• Group Purchasing Organization (GPO) in place hospitals

may reduce their purchasing cost

• Utilize platform to process product listing, sales, marketing,

and management

Center for Integration of Medicine & Innovative Technology

Mission: To improve patient care by bringing together scientists,

engineers and clinicians to catalyze development of innovative technology, emphasizing minimally invasive diagnoses and therapy

Application of Auto-ID Technology to Healthcare

MIT’s Auto-ID envision an intelligent infrastructure that AUTOMATICALLY links objects to the Internet and centralized data center. Allows physical objects to communicate to one another based on low-cost electronic tags, UNIQUE object identification numbers, common networking languages to revolutionize the supply chain, logistics, security, and inventory.

Important Characteristics of Auto- ID Technology

Unlike conventional bar-codes, no human interventional or manipulation by e-tags and readers. Seamless, it operates continuously through out the environment rather than just at the check-points or exits (Electronic Article Surveillance, EAS) system. Adoption of various standards: Uniform Code Council (UCC), the European Article Number (EAN) Association, the American National Standards Institute (ANSI), and the International Standards Organization (ISO), as well as commercial consortium and industry groups.

Auto-ID’s Major Components

* Electronic tags (E-Tag)

• Radio Frequency Identification (RFID)

* Electronic Product Code (EPC)

• 96 bit – 128 bit (large enough to enumerate all
• bjects on the Earth)

* Physical Markup Language (PML)

• Structured Query Language (SQL), HyperText ,

Markup Language (HTML), eXtensible Markup Language (XML) * Object Naming Service (ONS)

• Links the EPC with its associated PML data file.

Applications in Healthcare

* Item Identification and Tracking

• Incubators, anesthesia carts, portable ultrasound,

endoscopes, aspirators, insufflators, defibrillators, surgical instruments, and wheel chairs. * Continuity of Care

• Medicine as segments care in specific domains, each

separate and detached from each other. Patient records, monitoring/display information, are not shared or provided in a common format. Using common languages, standards and protocols, data would be transmitted and received in known formats across hospitals, healthcare systems, and international borders.

Applications in Healthcare (cont.)

* Patient Identification and Location

• Tracking patient movement for critically monitored cases,

could be helpful in providing efficient care and treatment (bedside display or PDA). Hospital administrator to monitor overall occupancy of the building, patient flow, and general movement on the floors for future expansion

• r renovation.

* Sensors and Telemetry

• Clinical states (basic Airway, Breathing, and Circulation,

blood chemical analysis, and medical measuring and imaging), physiological states (EKG, blood oxygen saturation, temperature, body position, fluid levels, and muscle activity)

Applications in Healthcare (cont.)

* Drug Validation

• Drug record and validation process could be

performed automatically to alter for possible errors. * Anti-Counterfeiting

• Unique Electronic Product Code used (one and
• nly one EPC code in the entire network)

* Healthcare at Home

• Aberrant readings could trigger a wearable sensor

to analyze an EKG trace for heart failure, arrhythmia, ischemia, or myocardial infarction. If sub-clinical changes are observed, the system may advise an adjustment in medication, together an automatic office visit scheduling.

Northeast Proton Therapy Center Clinical Advantages

Improved dose localization – Less dose to normal tissue – Less toxicity to normal tissue

Improves Rx tolerance: Uninterrupted Rx

– Allows integration with systemic chemotherapy

Reduces late effects ( i.e. growth arrest in children)

Permits dose escalation to tumor – Higher tumor control

Non-Small Cell Lung Cancer IMXT IMPT

PHOTONS PROTONS

MEDULLOBLASTOMA

100 60 10

PHOTONS PROTONS

Standard Photons Standard Protons

Rectal Cancer Hepatocellular Cancer

Standard Photons Standard Protons

IMXT IMPT MAXILLARY SINUS

Dose Difference

An Ivy League of Their Own An Ivy League of Their Own

How have these hospitals overcome the constraints of cost,

time, physician reluctance, and all the other factors that have prevented the Internet from being widely adopted in U.S.’

• ther medical facilities?
• They are affiliated with Harvard U. Medical School, has

some some of the leading medical minds to develop its computer systems, donors who invest millions each year, and corporations eager to test their new medical electronics products on-site.

Partners’ Alliance with OmniHealth Group (video clip)

Thank You! Thank You!

Q & A Session

Few question your beloved Prof. Shen has asked in

advance for his fellow 慈濟大學醫資系 students:

• Q. 醫院需要哪些資訊學生人才?
• Q. 醫資在 (1) 生物醫學資訊, (2)資訊科技, (3) 醫學資

訊系統, (4) 網路通訊應用, 及 (5) 生醫工程與訊號 處理的專業領域能為e-Hospital 和 e-Healthcare industry 做什麼?

• Q. e-Healthcare 需要哪些資訊技術是醫生很需要，而

不會排斥的?

• Q. e-Healthcare 人力需求狀況？ 學生就業應注意哪

些面談技巧? (and more…)