Under the eight-year deal with dbMotion, UPMC has licensed the Israeli vendor's technology, made an equity stake in the company, and will launch new co-development projects, with the potential of those jointly created products later being commercialized.
The remaining value of UPMC's initiative is related to other resources, products, and services involved with the interoperability project.
DbMotion will also set up U.S. headquarters near or in UPMC facilities in Pittsburgh, for which UPMC will provide people resources, including 130 clinicians, tech professionals, and other staff.
DbMotion's service-oriented architecture-based middleware and software tools will provide UPMC with a flexible platform allowing doctors, nurses, and other caregivers to easily access integrated patient data from disparate systems across UPMC's 19 hospitals and 400 physicians' offices. The data will arm doctors and nurses with more comprehensive and relevant information on which to base treatment decisions to better comply with best care practices.
Currently, UPMC uses electronic medical record systems and other clinical applications from more than 120 vendors, says UPMC CIO Dan Drawbaugh. "And we anticipate that in the subspecialty area, that number will only increase as we deploy new best-in-class applications," he says.
In the health care world, as in other sectors, the bigger the mix of applications used from multiple vendors, the more difficult it can be to share that information. But in health care, the challenges aren't just because of differences in the software; they're complicated by patient privacy rules, medical lingo, process workflow, and other considerations.
For instance, medical terms can mean different things to different people depending on the context in which a term is used. If the word "pain" shows up in a patient record, what does that mean? asks Jay Srini, UPMC VP of emerging technologies. Is the pain due to an illness, or did a treatment like chemotherapy cause the pain?
UPMC hopes that health care industry specificity built into the dbMotion software can help provide clinicians with "contextual context" when they access patient data, says Srini. The health care industry has many nuances that need to be considered in patient care decisions, she says. The software can help put these nuances in context.
DbMotion's software supports both centralized and federated data models, meaning it can provide access to data in distributed settings and centralized databases. The technology will provide UPMC's clinicians with secure "longitudinal views" of patients' data in all care settings, such as in the hospital or a doctor's office, regardless of the multiple sources of the data. For a doctor treating a patient in an office, that could mean seeing a single report listing all lab work that was done for a patient, even if the tests were ordered by other physicians and performed at multiple labs using disparate lab systems.
By providing this data integration, dbMotion's technology will reduce the number of different data sources that clinicians need to check to access the various pieces of information needed for their patients' "clinical pathways," says Duane Falk, UPMC Information Services Division VP in charge of the interoperability project. "Right now, access to data isn't as automated as we'd like," he says.
UPMC likely chose dbMotion's SOA technology over the SOA products offered by larger vendors such as IBM because of the health care-related specificity dbMotion's middleware provides, says Wes Rishel, a VP and research director at Gartner.
"Software tool sets that have health care specifications already built in can save a lot of work and time with interoperability projects," says Rishel. In many cases, "it's the difference between projects being feasible and not being feasible."
UPMC's strategy to integrate clinical data from its disparate systems using dbMotion's technology might also serve as a role model for regional health information technology organizations (RHIOs) tackling the same data-sharing challenges.
"UPMC is a complex organization with a heterogeneous environment that's probably even more complex than many RHIOs," says Rishel. That's because UPMC, which was among earlier adopters of electronic health record systems, uses software from several vendors, including Siemens, Epic, and Cerner, as well as dozens of clinical applications from other vendors. The complexity at UPMC as a single organization mirrors the mix-and-match systems that many health care providers are dealing with when they aim to share patient data with each other in RHIOs.
UPMC's equity investment in and co-development work with dbMotion isn't unusual. Over the last several years, UPMC has made a number of investments in, or signed co-development deals with, innovative health IT-related companies. Among those ventures is Stentor, an enterprise picture-archiving and communications system vendor whose products are based on technology developed at UPMC in the late 1990s.
Drawbaugh says UPMC's deal with dbMotion is "synergistic" with the eight-year, $402 million pact that UPMC signed in the spring of 2005 with IBM. In that deal, IBM is consolidating UPMC's IT operations while increasing capacity of storage and other systems. That pact also has the two companies investing millions of dollars in co-development work for new IT tools. But so far, the companies haven't moved forward in commercializing any joint developments.
As for UPMC's co-development work with dbMotion, the companies will focus on several efforts, including advanced enterprise clinical decision support tools; "cohort detection" software, which helps identify patient candidates for clinical trials; and transition care software that allows data to be shared among caregivers as patients move to different care settings such as home care. The two companies will also collaborate on new applications used by medical specialists, including oncologists.
To date, UMPC is dbMotion's largest U.S.-based customer, says dbMotion CEO Yuval Ofek. But dbMotion's products are used widely in Israel, and the company provides data-sharing capabilities for 60% of the Israeli health care market, he says.