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IBM R&D Labs in Israel

The New Generation of EHR - Driving Healthcare Transformation

Organized by IBM Research – Haifa, University of Haifa, Cleveland Clinic, and Rambam Medical Center
Hosted by IBM Research – Haifa
in collaboration with the Israeli Association for Medical Informatics
December 6, 2012
IBM Research - Haifa, Israel

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9:00 Registration

9:30 Welcome Remarks,
Aya Soffer, IBM Research – Haifa
Yaron Bar-El, Rambam Medical Center
Mark Low, GCIC / Cleveland Clinic

Amnon Shabo, IBM Research – Haifa

Part 1: Understanding the New Generation of EHR

09:45 From Clinical Models to Software to EHRs to Portable Queries: A Seamless Tool Chain,
Thomas Beale, Ocean Informatics and openEHR Foundation

Speaker Bio: Thomas Beale's early experience was in CMM level 4 engineering of real-time control systems. He has also worked in some of the largest financial enterprises in Australia, in both a strategic advisory capacity and on project implementation. He has worked in e-health since 1994, when he was the technical advisor for the Good European Health Record (GEHR) project. Since 1998, he has been involved in international e-health standards development (OMG, HL7, CEN, IHTSDO), including as an IHTSDO Technical Committee member 2009-2012. He has worked on the openEHR architecture since 2001, and is the chief technical editor, as well as having designed the archetype formalism (ADL) and reference compiler, now in use by CEN and ISO.

He is currently:
  • Chief Technical Officer (CTO) of Ocean Informatics, based in London
  • openEHR Specification Program Lead
  • member the IHTSDO Implementation and Innovation committee.

10:15 Leveraging EHR and Connected Applications for Decision Support Systems Across the Enterprise,
Gary Fingerhut, GCIC / Cleveland Clinic

Speaker Bio: Gary M. Fingerhut is the general manager responsible for the commercialization of information technologies.

With more than 25 years of technical and management leadership experience in the software industry, Gary was General Manager and vice president for Axentis, a Wolters Kluwer business, the professionals first choice for information, tools, and solutions that help professionals deliver quality results more efficiently; a $5 billion (2010) company with 19,000 employees worldwide. Gary was instrumental as a co-founder of Axentis, a software provider of on-demand solutions used by life science customers and other highly regulated industries to minimize their exposure to risk and to optimize business performance. Prior to the acquisition of Axentis by Wolters Kluwer in 2009, Gary served as chief technology officer at Axentis from 1999 - 2005 and as senior vice president from 2006 - 2009.

Prior to joining Axentis, Gary was a senior executive at Complient and chief executive officer of Business Technologies Incorporated, a software-development and technology-consulting firm that provided web application development services.

10:45 Coffee Break

11:15 EHRs and PHRs as Enablers of Futuristic Guideline-Based DSSs,
Mor Peleg, University of Haifa

Abstract: During the past 15 years, clinical decision-support systems (DSS) that are based on evidence-based clinical guidelines have been used to deliver patient-specific recommendations to care providers during patient encounters. In order to be effective, second generation DSSs have been integrated with electronic health records (EHRs) such that the guideline-based recommendations could be provided based on EHR data, without requiring physicians to reenter patient data into the DSS. In this talk I will describe futuristic guideline-based decision support research that we have been conducting as part of the FP7 ICT Integrated "MobiGuide project: Guiding Patients Any Time Everywhere". I will focus on how EHRs and Personal Health Records (PHRs) support such futuristic DSSs.

The novelties in the MobiGuide DSS include (a) delivery of DS to patients and not only to care providers, (b) personalization of guidelines to the patients' preferences and their personal context as well as the technological state of the MobiGuide system, (c) distribution of decision-support between a main DSS Server and a light-weight DSS operating on a Smartphone, (d) semantically-integrated Personal Health Record (PHR) that integrates data from hospital EMRs, wearable monitoring devices, DSS events, and temporal data abstractions, and (e) intelligent data and process mining algorithms that learn from past care process execution and suggests ways in which clinical guidelines could be improved.

Speaker Bio: Mor Peleg is Assoc. Prof. at the Department of Information Systems at the University of Haifa since 2003. She received her BSc (1991) and MSc (1994) degrees in Biology and a Ph.D in Information systems Engineering (1999) all from the Technion, and completed her post-doctoral studies in biomedical informatics at Stanford University (1999-2003). She has been Dept. Head during 2009-12. Her research concerns knowledge representation, clinical guideline-based decision support systems, ontologies, knowledge and data integration, and goal-based process improvement. She is the coordinator of the FP7 ICT IP MobiGuide project: Guiding Patients Any Time Everywhere. In 2005 she was awarded the New Investigator Award by the American Medical Informatics Association on her role in the development of the GLIF3 guideline modeling language. She is a member of the editorial boards of Journal of BioMedical Informatics and Methods of Information in Medicine. Her research has appeared in journals such as JAMIA, JBI, AI in Medicine, Intl J of Med Inform, IEEE TSE, IEEE TKDE.

For more information see

11:40 Use of EHR Data to Analyze Gaps in Adherence to Clinical Guidelines,
Zeev Waks, IBM Research – Haifa

Abstract: Clinical decision support systems (CDSSs) are gaining popularity as tools that assist physicians in optimizing medical care. Designed by domain-expert physicians, CDSSs are typically based on clinical practice guidelines that comply with evidence-based medicine. Despite the above, deviations from CDSS recommendations are abundant across a broad spectrum of disorders, raising the question as to why this phenomenon exists. In this talk I will discuss this gap in adherence to CDSS recommendations by examining the physician prescriptions for 1329 adult soft-tissue sarcoma patients in northern Italy. I will show how different disease parameters influence adherence levels, particularly prognostic markers. Finally, I will provide data regarding the rate of adoption of new guidelines by physicians, and comment on how this may affect care. Identifying distinct patient cohorts that are prone to lower adherence levels to CDSS recommendations may be used to enhance medical care by directing physician attention to at-risk patients.

Speaker Bio: Zeev Waks, PhD, joined IBM in 2011 as a research scientist in the Biomedical Informatics group. He currently researches clinical decision support systems and medical treatment programs for a spectrum of disorders, especially oncology. This work includes clinical trial evaluation, retrospective studies, clinical guideline analysis, and working with electronic patient records. Prior to IBM, Zeev obtained his PhD in Systems Biology from Harvard University and a B.Sc. in Biotechnology Engineering, summa cum laude, from the Technion Institute of Engineering. During his PhD studies, Zeev acquired extensive experience in life sciences, particularly in the domains of neurobiology, microbiology, molecular biology, cell biology, and systems biology. Dr. Waks has authored multiple publications in leading scientific journals.

12:05 Innovations in Rambam's EHR System,
Sara Tzafrir & Shlomi Israelit, Rambam Medical Center

12:30 EHR as an Integrated Solution for a Multidisciplinary Call Center,
Haya Barkai, Maccabi HMO

13:00 Open Discussion: Moderator: Yaron Denekamp,
Panelists: Part 1 speakers

13:30 Lunch

Part 2: Sustainability of Longitudinal and Cross-Institutional EHRs

14:30 The Various Constellations of Sustaining Lifelong EHRs with a Singleton Summary Layer,
Amnon Shabo, IBM Research - Haifa

14:45 The Israeli Health Information Exchange Project,
Nachman Ash, Israel Ministry of Health

Abstract: Israel has an advanced infrastructure of information systems in the health sector. All four HMOs use EMRs for medical encounters in the primary care and all hospitals have hospital information systems with different levels of clinical documentation. Nevertheless there is very little exchange of electronic clinical data and information between organizations.

In my talk I will describe the national efforts to establish exchange of health information between organizations and will elaborate on the current project which is supposed by the end of 2013 to put Israel in a place where all HMOs and general hospitals transform personal health data in order to improve continuity of care.

Speaker Bio: Dr Ash (51 YO) received his MD degree from the Sackler Medical School in Tel Aviv University in 1986. He completed his residency in Internal Medicine in Sheba Medical Center in 1997, and graduated the Harvard-MIT Division of Health, Sciences and Technology, Boston, USA receiving the MS degree in Medical Informatics in 2001. Dr. Ash has also graduated the National Defense College in 2005 and received a Masters degree in political sciences from the University of Haifa.

Dr. Ash has been a military physician for 25 years, and retired in the rank of Brigadier General on Oct. 2011, after completing intensive 4 years as the Surgeon General of the IDF.

On January 1st, 2012, Dr. Ash joined the Ministry of Health as a senior Deputy Director General for Medical Informatics. In this position he is responsible for Health Information Technology and Information Management in the Israeli health system.

15:00 Advancements in Preservation of Digital Medical Records,
Eliot Salant, IBM Research – Haifa and Haya Barkai, Maccabi HMO

Abstract: Huge amounts of electronic patient data are currently being produced annually, and this trend will continue to grow exponentially as more hospitals start migrating to paperless environments, and as new technologies, such as low cost gene sequencing and continuous monitoring data, become prevalent.

This talk with deal with some of the issues that healthcare institutions will have to deal with to maintain this digital information over time, as well as examine a research prototype implementation of a preservation system to address these issues, and is currently being developed under IBM's technical leadership as part of a large European Union sponsored program.

Speaker Bio: Eliot Salant is the Project Coordinator for European Union, FP7-sponsored project, ENSURE, which deals with long term digital preservation. He holds a B.Eng in Mechanical Engineering from McGill University, a MSc. in Biomedical Engineering from the Technion - Israel Institute of Technology, and an M.S. degree in Computer Science from Union College. He has held a variety of managerial and technical positions at IBM.

15:15 Coffee Break

15:30 Open Discussion: Moderator – Haim Nelken,
Discussants: Nachman Ash, Pnina Vortman, Amnon Shabo

16:00 Closing Remarks,
Pnina Vortman, IBM Research – Haifa