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Trisotech.com
Process Automation in Telemedicine:
Reducing Risks
John Svirbely, MD
Chief Medical Informatics Officer (CMIO),
jsvirbely@Trisotech.com
Denis Gagne
Chief Executive Officer (CEO),
dgagne@Trisotech.com
With the support of
With the participation of
Trisotech.com
Abstract
Trisotech Telemedicine Webinars Series
presented with Baxter SpA
Telemedicine is the practice of medicine using technology to deliver care at a distance. While telemedicine and its use are not new,
widespread adoption beyond simple telephone exchanges has been relatively slow. However, the current pandemic has forced
rethinking of how health care is delivered, while, new developments in technology have made remote care more accessible.
In this webinar series we will explore the application of the BPM+ Health set of standards to Telemedicine and the benefits that can
be expected. More specifically, we will explore how automation of telemedicine can improve efficiency, improve care, and reduce
risk.
Webinar 3: Process Automation in Telemedicine: Reducing risks.
Telecare carries a number of risks, including financial loss and threats to patient safety. While care of a known patient can control
many of these risks, certain practices may increase risks. In this webinar we will first demo automation that can alert the provider to
warning signs of a serious problem masquerading as a common complaint. A second automation example will look at postoperative
outpatient monitoring for early detection of a surgical site infection.
Presented by:
Dr. John Svribely, CMIO Trisotech
Denis Gagne, CEO & CTO Trisotech
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Trisotech.com
Introduction
Trisotech.com
TelemedicineSeriesRecap
In Webinar 1 of the series, we discussed Efficiency Improvements in Telemedicine
o Introduced some telemedicine concepts
o Introduced the BPM+ Health open standards
o Presented and demoed a model of Nurse Teletriage of the Ill-Appearing Infant
o Introduced Attended Tasks: Not giving up control for the sake of efficiency
In Webinar 2 of the series, we discussed Patient Care Improvements in Telemedicine
o Introduced some classifications of telemedicine
o Introduced how BPM+ Health complements the exsiting HL7 standards
o Presented and demoed a model of home parenteral nutritional support (TPN)
o Introduced Knowledge Entity Models: Providing disambiguation of terminology using
Vocabularies, Concept Maps and Rules
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Recordings and slides of Webinar 1 and Webinar 2 are available here: https://www.trisotech.com/webinars/
Trisotech.com
Todaywewantto discuss how to reduce risk in Telemedicine
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Trisotech.com
Telemedicine can reduce financial risks in
value-based care
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
• Reducing readmission
• Detecting complications early
• Coaching an unhealthy lifestyle
• Reducing patient dissatisfaction
• Improving quality and performance metrics
Trisotech.com
Example 1 – Reducing financial risk with
postoperative home monitoring
A goal at discharge is to avoid
readmission, or to detect a
complication as soon as possible.
Remote monitoring to detect early signs
of infection or other complications.
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Surgery Icon by Luis Prado from the Noun Project
Trisotech.com
Reducing malpractice liability while
optimizing outcomes for value-based care
Telecare of a known patient
involves acceptable risks.
What about the patient who is
completely unknown?
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Trisotech.com
Risk and the De Novo Acute Telemedicine Encounter
Risk may arrive in many ways:
 The clinician has never seen the patient before
(and may never see again).
 The patient has no relationship with the provider.
 Available information may be limited.
 The patient’s health risk is unknown.
 The clinician only has a short time with the
patient, so needs to do many things quickly.
 The clinician may have limited means of follow-
up.
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Trisotech.com
Mitigationof Risks
Telemedicine risks can be mitigated
by:
 Access to good documentation
 Good hand-off processes
 Detect red flags (early warnings)
 Get as much data as possible collated as a
patient summary
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Trisotech.com
Example 2
Red flags for Dyspepsia
Looking for warning signs that
may identify a common complaint
with a sinister cause.
Collect all available knowledge about a patient
Use automated processes to look for
significant patterns.
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Icon created by Whales Factory from Noun Project
Trisotech.com
Patient Summary
A Patient Summary is a standardized set of basic medical data that
includes the most important clinical facts required to ensure safe and
secure healthcare.
The International Patient Summary (IPS) is a minimal and non-
exhaustive Patient Summary, specialty-agnostic, condition-independent,
but readily usable by all clinicians for the unscheduled (cross-border)
care of a patient.
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
https://international-patient-summary.net/
Trisotech.com
International Patient Summary (IPS)
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
https://international-patient-summary.net/
ISO: https://www.iso.org/standard/79491.html
HL7: http://hl7.org/fhir/uv/ips/
IHE: https://www.youtube.com/watch?v=ietJYemBKpQ
An International Patient Summary contains the following
data:
 General information about the patient
 (e.g. name, birth date, gender)
 A medical summary consisting of the most important
clinical patient data
 (e.g. allergies, current medical problems, medical implants, or major
surgical procedures during the last six months).
 A list of the current medication
 including all prescribed medicines that the patient is currently taking.
 Information about the Patient Summary itself
 e.g. when and by whom the Patient Summary was generated or
updated. This data is also used for protocol and security purposes.
Trisotech.com
Introduction to Business Process
Automation
Trisotech.com
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
© 2020 Object Management Group
Established to foster the sharing and
promulgation of best-practices around
modeling and sharing:
• shareable pathways,
• clinical pathways,
• automatable clinical guidelines, and
• other healthcare knowledge
A robust and thriving community-of-
practice of healthcare institutions,
professional societies, and vendors
www.BPM-Plus.org
Trisotech.com
Setting some BasicTerminology
Workflow
Automation
Decision
Automation
Open Standards
DMN
(DECISION MODEL AND NOTATION)
Decision tables and logical expressions
BPMN
(BUSINESS PROCESS MODEL AND NOTATION)
Prescriptive sequence of activities
CMMN
(CASE MANAGEMENT MODEL AND NOTATION)
Declarative unstructured event-condition-action
Technology enabled
orchestration of activities, able
to react to business events.
Both may have humans in the loop or not.
(Referred to as Knowledge Workers.)
Technology enabled decisions,
returning answers given some
inputs.
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Trisotech.com
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
BPM+ Value Add
Data
Intelligent
Healthcare
Automation
Computable Data
Aggregated Data
Data Automation
Information Automation
Orchestration of knowledge
Workflow and Decision Automation
Data in clinical context
• EMR 1
• EMR 2
• Devices
• Wearables
• Diagnostics
• Claims
• Common schema
• Identity resolution
• Medical resources
• Metadata
• Context
• Events awareness
• Tasks and activities
• Roles and responsibilities
• Decisioning
• Case management
• Event orchestration
• AI and ML
Trisotech.com
Models
Unattended and Attended
Services
CDS Hooks Card
Pre-fetch
FHIR enabled
BPM+ Services
Emulates an eHR or eMR
Subject Matter Expert Healthcare Professional
BPM+ and FHIR
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
FHIR® Accelerator
Concept Map
Vocabulary
Rules
Trisotech.com
Dyspepsia
Automation Example
Trisotech.com
Disambiguation
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Concept Map- Vocabulary -Rules
Trisotech.com
BPM+ Models
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Workflow and Decision Automation
Trisotech.com
FHIR® Accelerator
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Trisotech.com
FHIR® Accelerator
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Trisotech.com
Demo - Dyspepsia
Trisotech is the leader in Clinical Workflow
and Decision Automation with its one click
deployment of automated services
Trisotech.com
Conclusions
We hope that we have demonstrated how:
 Telemedicine has inherent risks that can be mitigated, while it can
mitigate risks associated with value-based care.
 Automated detection of warning signs (“red flags”) can identify a
high-risk patient.
 The Patient Summary (IPS) can help to quickly fill gaps in a
patient’s information.
 BPM+ Health standards combined with HL7 Standards offers
access to the right data at the right time.
PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
Trisotech.com
Any questions?
THANKS!
Dr. John Svirbely, MD
Chief Medical Informatics Officer (CMIO),
jsvirbely@Trisotech.com
Denis Gagne
Chief Executive Officer (CEO),
dgagne@Trisotech.com

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Process Automation in Telemedicine Reducing Risks

  • 1. Trisotech.com Process Automation in Telemedicine: Reducing Risks John Svirbely, MD Chief Medical Informatics Officer (CMIO), jsvirbely@Trisotech.com Denis Gagne Chief Executive Officer (CEO), dgagne@Trisotech.com With the support of With the participation of
  • 2. Trisotech.com Abstract Trisotech Telemedicine Webinars Series presented with Baxter SpA Telemedicine is the practice of medicine using technology to deliver care at a distance. While telemedicine and its use are not new, widespread adoption beyond simple telephone exchanges has been relatively slow. However, the current pandemic has forced rethinking of how health care is delivered, while, new developments in technology have made remote care more accessible. In this webinar series we will explore the application of the BPM+ Health set of standards to Telemedicine and the benefits that can be expected. More specifically, we will explore how automation of telemedicine can improve efficiency, improve care, and reduce risk. Webinar 3: Process Automation in Telemedicine: Reducing risks. Telecare carries a number of risks, including financial loss and threats to patient safety. While care of a known patient can control many of these risks, certain practices may increase risks. In this webinar we will first demo automation that can alert the provider to warning signs of a serious problem masquerading as a common complaint. A second automation example will look at postoperative outpatient monitoring for early detection of a surgical site infection. Presented by: Dr. John Svribely, CMIO Trisotech Denis Gagne, CEO & CTO Trisotech PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
  • 4. Trisotech.com TelemedicineSeriesRecap In Webinar 1 of the series, we discussed Efficiency Improvements in Telemedicine o Introduced some telemedicine concepts o Introduced the BPM+ Health open standards o Presented and demoed a model of Nurse Teletriage of the Ill-Appearing Infant o Introduced Attended Tasks: Not giving up control for the sake of efficiency In Webinar 2 of the series, we discussed Patient Care Improvements in Telemedicine o Introduced some classifications of telemedicine o Introduced how BPM+ Health complements the exsiting HL7 standards o Presented and demoed a model of home parenteral nutritional support (TPN) o Introduced Knowledge Entity Models: Providing disambiguation of terminology using Vocabularies, Concept Maps and Rules PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS Recordings and slides of Webinar 1 and Webinar 2 are available here: https://www.trisotech.com/webinars/
  • 5. Trisotech.com Todaywewantto discuss how to reduce risk in Telemedicine PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
  • 6. Trisotech.com Telemedicine can reduce financial risks in value-based care PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS • Reducing readmission • Detecting complications early • Coaching an unhealthy lifestyle • Reducing patient dissatisfaction • Improving quality and performance metrics
  • 7. Trisotech.com Example 1 – Reducing financial risk with postoperative home monitoring A goal at discharge is to avoid readmission, or to detect a complication as soon as possible. Remote monitoring to detect early signs of infection or other complications. PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS Surgery Icon by Luis Prado from the Noun Project
  • 8. Trisotech.com Reducing malpractice liability while optimizing outcomes for value-based care Telecare of a known patient involves acceptable risks. What about the patient who is completely unknown? PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
  • 9. Trisotech.com Risk and the De Novo Acute Telemedicine Encounter Risk may arrive in many ways:  The clinician has never seen the patient before (and may never see again).  The patient has no relationship with the provider.  Available information may be limited.  The patient’s health risk is unknown.  The clinician only has a short time with the patient, so needs to do many things quickly.  The clinician may have limited means of follow- up. PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
  • 10. Trisotech.com Mitigationof Risks Telemedicine risks can be mitigated by:  Access to good documentation  Good hand-off processes  Detect red flags (early warnings)  Get as much data as possible collated as a patient summary PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
  • 11. Trisotech.com Example 2 Red flags for Dyspepsia Looking for warning signs that may identify a common complaint with a sinister cause. Collect all available knowledge about a patient Use automated processes to look for significant patterns. PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS Icon created by Whales Factory from Noun Project
  • 12. Trisotech.com Patient Summary A Patient Summary is a standardized set of basic medical data that includes the most important clinical facts required to ensure safe and secure healthcare. The International Patient Summary (IPS) is a minimal and non- exhaustive Patient Summary, specialty-agnostic, condition-independent, but readily usable by all clinicians for the unscheduled (cross-border) care of a patient. PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS https://international-patient-summary.net/
  • 13. Trisotech.com International Patient Summary (IPS) PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS https://international-patient-summary.net/ ISO: https://www.iso.org/standard/79491.html HL7: http://hl7.org/fhir/uv/ips/ IHE: https://www.youtube.com/watch?v=ietJYemBKpQ An International Patient Summary contains the following data:  General information about the patient  (e.g. name, birth date, gender)  A medical summary consisting of the most important clinical patient data  (e.g. allergies, current medical problems, medical implants, or major surgical procedures during the last six months).  A list of the current medication  including all prescribed medicines that the patient is currently taking.  Information about the Patient Summary itself  e.g. when and by whom the Patient Summary was generated or updated. This data is also used for protocol and security purposes.
  • 15. Trisotech.com PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS © 2020 Object Management Group Established to foster the sharing and promulgation of best-practices around modeling and sharing: • shareable pathways, • clinical pathways, • automatable clinical guidelines, and • other healthcare knowledge A robust and thriving community-of- practice of healthcare institutions, professional societies, and vendors www.BPM-Plus.org
  • 16. Trisotech.com Setting some BasicTerminology Workflow Automation Decision Automation Open Standards DMN (DECISION MODEL AND NOTATION) Decision tables and logical expressions BPMN (BUSINESS PROCESS MODEL AND NOTATION) Prescriptive sequence of activities CMMN (CASE MANAGEMENT MODEL AND NOTATION) Declarative unstructured event-condition-action Technology enabled orchestration of activities, able to react to business events. Both may have humans in the loop or not. (Referred to as Knowledge Workers.) Technology enabled decisions, returning answers given some inputs. PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
  • 17. Trisotech.com PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS BPM+ Value Add Data Intelligent Healthcare Automation Computable Data Aggregated Data Data Automation Information Automation Orchestration of knowledge Workflow and Decision Automation Data in clinical context • EMR 1 • EMR 2 • Devices • Wearables • Diagnostics • Claims • Common schema • Identity resolution • Medical resources • Metadata • Context • Events awareness • Tasks and activities • Roles and responsibilities • Decisioning • Case management • Event orchestration • AI and ML
  • 18. Trisotech.com Models Unattended and Attended Services CDS Hooks Card Pre-fetch FHIR enabled BPM+ Services Emulates an eHR or eMR Subject Matter Expert Healthcare Professional BPM+ and FHIR PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS FHIR® Accelerator Concept Map Vocabulary Rules
  • 20. Trisotech.com Disambiguation PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS Concept Map- Vocabulary -Rules
  • 21. Trisotech.com BPM+ Models PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS Workflow and Decision Automation
  • 22. Trisotech.com FHIR® Accelerator PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
  • 23. Trisotech.com FHIR® Accelerator PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
  • 24. Trisotech.com Demo - Dyspepsia Trisotech is the leader in Clinical Workflow and Decision Automation with its one click deployment of automated services
  • 25. Trisotech.com Conclusions We hope that we have demonstrated how:  Telemedicine has inherent risks that can be mitigated, while it can mitigate risks associated with value-based care.  Automated detection of warning signs (“red flags”) can identify a high-risk patient.  The Patient Summary (IPS) can help to quickly fill gaps in a patient’s information.  BPM+ Health standards combined with HL7 Standards offers access to the right data at the right time. PROCESS AUTOMATION IN TELEMEDICINE: REDUCING RISKS
  • 26. Trisotech.com Any questions? THANKS! Dr. John Svirbely, MD Chief Medical Informatics Officer (CMIO), jsvirbely@Trisotech.com Denis Gagne Chief Executive Officer (CEO), dgagne@Trisotech.com