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2	What is The Diagnostic Information System? A patented standard reporting format that unifies test results from all data sources for users at all points of care Allows for complete cumulative patient information to be electronically accessed and more easily analyzed Shared information that integrates test results data on all levels (data, application, system and network) increasing efficiency, accuracy and productivity.
3	Company History A physician-driven and financed Subchapter S corporation, founded in Rhode Island by Robert D. Coli, MD and a group of physicians and other private investors. Recipient of two consecutive United States Patents (first from June 29, 1979 to June 29, 1999 and current extending from April 9, 1998 to April 9, 2018) Up-front patent licensing fee paid in August 2000 by Idexx Veterinary Clinical Labs. Working prototypes for common “MICROCHEM” tests developed in two Rhode Island hospitals and now under development by a leading local EHR/PMS vendor
4	The Bottom Line Time and cost savings Provides ease of use, access and sharing Quality summaries leading to fewer data errors and duplicate tests Improved workflow and efficiency for caregivers and outcomes for patients
5	The Pressing Problem Patient test result data from many dispersed sources Leads to critical information being missed 30% of clinicians’ time is spent gathering and organizing data At least 20% of tests are redundant (unnecessary duplicates of others already done but not accessible)
6	The Tested Solution Easily accessible clinical data anytime, anywhere Time, energy and error saving enables better care Integrates and logically displays complete test results information A mission-critical application designed by physicians for physicians Intuitive and user friendly interface
7	A Transition from “Old” to “New”
8	The Results
9	More than Meets the Eye Creating standards-based, technical computer system interoperability presents only the first challenge For end users, the standardization, integration and design logic and quality of the user interface is equally, if not more important.
10	“Usability” for Clinicians is Critical Only a high quality user interface and its logical data integration can facilitate workflow and maximize productivity Added value of clinically indexed cumulative results in a standard format VERSUS all existing variable formats displaying fragmented (raw) data
11	Diagnostic Test Results What DIS will provide (I) MICROCHEM Tests Five cumulative test categories (standardized and clinically integrated) Tests on X axis and dates on Y axis (categories 1, 2, and 3) Tests in four standard columns on Y axis and dates also on Y axis (for categories 4 and 5) An average of 80 percent media reduction (pages and screens) and major improvement in readability and trend analysis demonstrated at KCMH (1979) and RWGH (1995) Opportunity for integrated test ordering (“integrated CPOE”) and Clinical Decision Support System (CDSS) applications (II) SUBSPECIALTY Tests Fifteen cumulative test categories (standardized and clinically integrated by organ system)
12	The Integrated Diagnostic Information System Format (I.) MICROCHEM TESTS: (90% of testing volume) 1) Basic Hematology Tests* (21 individual tests) Coulter: Hgb Hct WBC Platelets RBC MCV MCH MCHC DIFF/MORPH: Polys Bands Lymphs Monos Eos Basos other RBC PLAT MISC: Stool OB Retic Ct ESR Fe IBC Ferritin B12 Folate COAG: PTA APTT BT Fibrinogen FDP Thr. time 2) Urinalysis ROUTINE: App PH SGR Gluc Keto Prot Hgb Bile MICRO WBC RBC Bact Casts Epc Other 3) Basic Chemistry Tests* (31 individual tests) CHEM-1 Glucose BUN creat Na K CL CO2 Base excess Osm(s)/Osm(U) ABG’s PH PCO2 PO2 O2 Sat CO2 content Bicarb Base Excess CHEM-II: Ca PO4 uric Mg Amylase Lipase Chol TG HDL LDL CHEM-III Bili-T Bili-D SAP GGTP SGPT SGOT LDH CPK PROTEINS TP Alb Glob Alpha1 Alpha 2 Beta Gamma 4) Special Chemistry Tests* (3,500 individual tests) TESTS RESULTS REFERENCE RANGES UNITS 5) Microbiology Tests ORIGIN MICRO CULTURE SENSITIVITIES * the specific subcategory content and format specified in the U.S. patent claims.
13	The Integrated Diagnostic Information System Format II.) SUBSPECIALTY TESTS: (10% of testing volume) 1) Cardiovascular 2) Respiratory 3) Digestive 4) Endocrine 5) Hemic & Lymphatic 6) Nervous 7) Eye & Ocular Adnexa, Auditory 8) Musculoskeletal 9) Integumentary 10) Urinary 11) Male/Female Genital 12) Maternity Care & Delivery 13) Immunology 14) Pathology; Cytopathology; Transfusion Medicine 15) Genomic Medicine
14	If It’s Worth Doing, It’s Worth Doing Right Challenge: To efficiently manage the billions of annual results of the thousands of different diagnostic tests Imperative: Today’s emerging interoperable HIE era must avoid perpetuating the test results "Tower of Babel" hallmark of the paper-based and "information silo" era.
15	The Logical Solution Fully standardize and clinically integrate the user interface format Ensure that RHIOs/HIEs, EHRs, PHRs and CDMSs can efficiently display lifetime patient test results in the same way for physician and patient viewing and sharing. The patented DIS^sm methodology was designed, and has been perceived by test users as the clinically logical and interoperable solution to an IT problem shared by all RHIOs/HIEs, EHRs, PHRs and the NHIN “network of networks”.
16	Solving the Diagnostic “Tower of Babel”
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18	Executive Summary: “A Proposal to Standardize the Reporting and Sharing of Diagnostic Test Results" Sharing Test Results Information in the Same Way
19	Vision Statement Standardize and clinically integrate the display of all diagnostic tests for the statewide RI HIE Project by granting the U.S. patent rights to the state as an in-kind contribution. Rhode Island will develop and deploy this nationally replicable, clinically logical display format and share it with other leading HIEs and their contracted HIT vendors. Rhode Island and other states will produce private sector income to sustain HIE operations and expand its services by sharing in royalty payments based on sales of the DIS format in other states.
20	Goal and Objective The goal: Solve an important industry problem for the first time in Rhode Island by displaying and sharing all test results in the same standardized and clinically logical way to end-users. (“Anytime, Anywhere Test Results,”) Share the DIS technology solution with RHIOs and HIE-contracted HIT vendors in all other states. (“Lifetime Test Results 24/7”). The objective: Generate private sector funds to sustain long-term HIE operations in Rhode Island and other states by licensing, developing and using a physician optimized clinical HIT innovation. (“Doing well by doing good”).
21	Today’s Situation The nation’s most pressing problems in healthcare cost and quality require more than just incremental innovations. Disruptive simplification technology innovations, including the DIS clinical standard format, technical transmission IT standards, HIT systems certification,and a secure HIT infrastructure will all work over time to support a value-based competitive healthcare marketplace. (www.hhs.gov/valuedriven) Only such a market, by properly aligning stakeholder incentives, capital sources and the interests of HIT buyers and vendors can ensure the development and sustained improvement of a robust national HIT infrastructure.
22	How Did We Get Here? Paper Bureaucracy and “Information Silo” Era: Reporting and sharing of patient test results in the $2+ trillion U.S. healthcare industry based on paper, telephones and fax machines. (”The excellence of the status quo is a sentimental illusion.”—Donald Berwick, MD): Ambulatory and hospital EHRs and the few fully operational HIEs display share and print test result reports using a variable, fragmented format design. No standardized, clinically logically format is yet available that integrates (unifies) results from different data sources. (Legacy industry business model: “Physicians want customization, not standardization.”) Universally negative results for all stakeholders: Unacceptable rates of test duplication (14-30%) and medical errors and an enormous waste of time and money. (“The definition of insanity is doing the same thing over and over again and expecting a different result.”—Albert Einstein) Emerging Interoperable HIE Era: Data integration and interface usability are paramount and sharing all healthcare data types in the same way is mandatory. (“Know where to find the information and how to use it. That’s the secret of success”—Albert Einstein)
23	Two Available Options: High Costs & Risks: HIEs, the NHIN, EHRs and PHRs perpetuating the status quo by reinventing the test results reporting “wheel” 500+ times. Low Costs & Risks: Immediately solve the test results problem statewide and generate sustainable private sector earned income for RI HIE Project operations by partnering with the DISCompany EDS, InterSystems Corp. and Health Language, Inc.
24	Strategy and Next Steps: Strategy of multiple public-private patent licensing partnerships offers the Rhode Island HIE Project and its emulators in other states low risk and high ROI in creating an essential clinical IT functionality with tangible financial, patient safety and quality of care benefits. Multiple Tangible Benefits: Rhode Island as the first state-level HIE to solve the test results information management problem. Replicable in all other states and internationally. Creating a new sustainable private funding source and an additional electronic success story from the Rhode Island EDC’s Business Innovation Factory (BIF). NEXT STEPS: Collaborating with RIQI, RIDOH, and their chosen IT vendors EDS, InterSystems Corp. and Health Language, Inc. to incorporate the unique DISfunctionality into the Rhode Island HIE Project infrastructure. Continuing the development, testing and roll-out of the DIS standard format in Rhode Island as a value-added feature of Polaris Medical Management’s Epichart EHR, other CCHIT-certified EHRs and the ERcard, LLC stand-alone PHR.
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26	The Results
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