The GE Athlete Management Solution (AMS) collects multiple kinds of data, including imaging scans, patient vitals, and venue, event and sport-specific information, and provides real-time dashboards that can help inform medical staff and allow them to personalize treatment for athletes while identifying trends in injury and illness across the Games.
Innovations of Olympic Healthcare –
Interview with Ray Bender, a hero of Athlete Management Solution (AMS)
Director of Product Development at GE Research Circle Technologies
1. Please introduce yourself.
Hello? My name is Ray Bender. I have 30 years of expertise in the industry converging healthcare and IT technologies. After working as a pharmacist in the beginning of my career for 5 years, I joined the US Air Force and jumped into this healthcare-IT industry. I helped develop the US Department of Defense’s first EMR system in 1987, almost 30 years ago. I’m proud of the fact that the EMR system is still being used, while old systems usually fade away after certain periods of time. This can be an important milestone for me that proves my team and I worked well together.
After joining GE, I led a product development team in the pharmacy software business, and also supported six sigma program. Moving to the field of hospital system, I started on commercial EMR project. The system that my team developed was based on the GE EMR used by the USOC, and was modified for the Rio 2016 Olympic Games to support Brazilian Portuguese. Specifically tailored to the needs of the PyeongChang 2018 Olympic Winter Games, it was decided that a new EMR should be developed and I became to lead the team responsible for the project.
2. You have been working in the healthcare IT field for a long time. What are some commonalities and differences between the past system and the current one?
Before answering the question, I want to stress again that I’m also a pharmacist. The main role of a pharmacist is to protect patients. According to one research, clerical errors at a pharmacy were those that most frequently occurred among various medical errors during 1980. At that time, people working at a pharmacy frequently misread others’ written prescriptions or mistakenly wrote down what they were told on the phone – the actual meaning or critical content to be delivered was lost in this process. This is the background for EMR solution to be developed, providing an important rationale that certain safety solution is critical. Many pharmacies started to remove their old system requiring hand-written prescriptions and use more digital/automatic system to help provide advanced safety and efficiency. This was what I’ve been mostly interested in over the past 30 years.
3. GE has provided EMR system tailored to the needs of the Olympic Games since the Olympic Winter Games Sochi 2014. What kinds of insights did you get from the system installation?
What I’ve importantly learned was the role of a cloud system. GE’s EMR solution developed for the Rio Olympic Games was a client-server system which had numerous limitations in various aspects. For example, users should be at a hospital to log in not just the EMR but also its connected network and system. Constraints related to space were really huge.
Another important insight was the importance of hardware such as tablets. Imagine that a patient is lying on the wallside of a medical office and there’s a computer equipped with the EMR solution on the other side of a desk. A doctor should walk to the patient to do a checkup and return to his or her desk to input some data. He or she should repeat the same thing again for further checkups while simultaneously doing other tasks such as writing down medical information of a patient in a memo pad. This was a common scene at the Rio Olympic Games that doctors have walked up and down between patients and computers, which was less efficient.
If a solution supports tablets, doctors or medical officials can put medical records of patients and input data into the tablets, directly from the patient bed. They also can track past records / data. It will become possible for them to access resources that they want to reach through tablets.
These two lesson learns are the most important insights provided to my team and I from the past experiences.
4. Is GE’s AMS for the PyeongChang Olympic Games also supporting tablets?
Yes. The AMS supports tablets in a flexible way. We could develop a new one for the past technologies to be equipped for tablets, however, it was hard for us to smoothly migrate the system. That’s why we developed the solution from scratch, which is fully customized to be operated in tablets. Now if clinicians use a tablet with Internet connectivity such as mobile or WiFi, they can easily access the AMS anywhere and at any time.
GE has discussed with one professional sports federation about the use of the AMS. One of their requirements was to use the AMS even on a plane. Since they usually face a hectic schedule, they have to input data and analyze them while they are on a plane to other locations. To make this possible, two things are important – the one is to use tablets and the other one is to have access to a cloud system anywhere and at any time the Internet is available.
Of course, this can be different depending on user situations. Most of the EMR that are commonly used have to meet regulatory requirements of each country so that they have quite complicated and sophisticated characteristics. While advancing the AMS for the Olympic Games, GE strived to develop a solution focusing on providing information to help physicians treat patients rather than emphasizing the aspect of a mere formality.
5. You have developed a new AMS in a short period of time, please explain the methodology used for the development.
I would like to call it as ‘Modified Agile’ methodology. The ‘Agile’ methodology itself sometimes requires irrelevant behaviors. Therefore, I would like to point out that our project has adopted the ‘Modified Agile’ approach, highly focused on directly involving the customer at every step. (Agile development: a methodology that promotes repetitive development throughout the life cycle of the project)
Our team started with a big picture. We had our first meeting on January 15, 2017 and we had to face a difficult situation which was to develop a completely different solution just in 10 months from the scratch. This came as a challenging schedule for us. Started with a blank sheet of paper, and ran through pilot-tests, the solution was used by physicians to gather information to help treat patients in a limited test capacity the beginning of November 2017, and finally placed in full use at the Olympic venue at the end of January 2018. We completed all of the procedures in just 1 year.
We closely collaborated with the development team in Budapest, Hungary, and held a bi-monthly meeting to discuss the next steps for the programming. In other words, the cycle of the program change was about 60 days. We also held weekly meetings with IOC in order to provide an opportunity to be closely engaged with AMS. We also prepared so that IOC can run several tests over every features – from beginning to end – that GE have developed.
We were able to promptly develop an improved program module, however, there were also modules that take a certain period of time to be fully built. We had to limit the work scope to 60 days in order to complete the development. This was because the demonstration could be proceeded only after the development has been completed within 60 days. If we can’t do demonstration, then the development cannot be completed either. For this reason, we divided the programs into small parts so that they could be demonstrated at the internal meetings as well as weekly meetings with IOC. Therefore, IOC was able to actually check on every factors and pieces while we are developing the solution.
If a customer comments “oh no, no, no, this is not what we wanted,” on even a small part and piece of throughout the development, we have to start over everything from the beginning.
This is the part where I think the ‘Modified Agile’ methodology is important.
Of course, we also held training sessions for IOC. Because IOC had already verified everything directly on the solution through development process, the training session was just a simple check up to ensure whether they fully understand the overall workflow of AMS. Nothing was really unexpected, IOC has understandings of every feature and secured an outstanding AMS system.
6. One of the key factors of AMS is easy entry of the data. What kind of data that the user can verify from AMS?
On February 1, 2018, Polyclinic (Olympic Hospital) for the Olympic Winter Games PyeongChang 2018 officially opened. Let’s assume that a Korean doctor at the Polyclinic enters patient data in Korean. If that patient visits Polyclinic some other time later, she or he may encounters one of the IOC doctors who speak English. At this time, the clinician can see the data in English. In other words, doctors can check on the patient data in their own language. Doctors can also advise the patient to take more physical therapy after examination. Doctors will see the patient’s initial injury and all other related details as well as the additional physiotherapy prescriptions and etc. That could work in language that doctors prefer.
It doesn’t matter which language that the doctors use the system. Everything is being set up in the language that doctors prefer to use. This is the data in which that clinicians can enter and verify. Physicians at the National Olympic Committee (NOC) can enter data, however, the patient data is only accessible and limited to those physicians of who has same nationality. Therefore, the doctor from the US Olympic Committee would not be able to view the data of Hungarian nor Korean patients. If one can access to the competitor’s data, it could create another problem.
7. If the prescription of the athlete is associated with the allergies or doping, does AMS provide any signal of warning to clinicians?
All medicine and drugs are limited to the prescription formulary by IOC and POCOG. A prescription that exceeds such formulary cannot be created. Only drugs meet such guideline can be ordered.
Prescriptions are being provided after screening from three different perspectives. First, the system alerts clinicians when they order drugs associated with allergies based on the patient information. Second is the drug-drug interactions. The system alerts clinicians when they order two different drugs that potentially create negative reaction. The third is based on World Anti-Doping Agency (WADA) list. The system notifies clinicians when they select a prohibited drugs which is also listed under WADA.
Also, the actual prescription has a special form at the bottom for prohibited medications. It doesn’t mean that clinicians cannot prescribe drugs because they have been banned, but doctors should have enough knowledge and background information to proceed with the prescription. Therefore, it can be seen as a type of warning gesture. Of course, for under certain circumstances, clinicians can proceed with the prescriptions despite the warning signs – however it is only for necessary situation.
8. AMS has evolved to integrate medical data with sports data. How could you maintain the integrity of the sports data?
When clinicians enter the medical data, they can select a coded menu or input the additional text if needed. in this case, it is possible to maintain the integrity of the medical data because clinicians simply choose the symptoms. However, it comes difficult to maintain data integrity when entering the sports data- containing details of athletes and Olympic stadiums- with medical data simultaneously.
Let’s take an example of the subset of sport data. Of course, we expect to collect and expand more data after the Olympic games, IOC uses the code set for the specific sports data subsets that IOC is willing to secure. This is a code set with long-time collected data through papers which has been tuned more detail. There will be changes in the future, but IOC has an important code sets which are being used by every doctors. Basically, the same principle applied to medical data also apply to sports data.
9. What is the future of EMR?
I will answer the question from two perspectives. In the short term, this will be the case of events ranging from two to three weeks, such as the Olympics. For this purpose, the data could be collected and be further refined with a purpose of improving workflows and etc. In this case, we could track on the data generated during the Game, which is usually last several weeks, but not on someone’s life for several years. Of course, there may be more data that we decide to collect, since analysing the data is possible through AMS.
In the longer term, there is the National Olympic committee (NOC), who have a long-term perspective. There may be more meaningful data with long-term patient records. This means different than having 2 to 3 weeks of data. If they were to keep on track with athletes associated with Olympics for 4 to 6 years, they will be able to collect a greater kinds of data. They can also be informed what has happened at a particular point in time, being able to secure more comprehensive information.
Another example of the future evolution is wearable devices. For instance, the solution can be integrated with rehabilitation exercise machines. Sensors could be attached to the legs of the patient, and the data could be connected with a laptop. In this case, the patient may not need to visit physical therapist to do the rehabilitation exercise. If he or she exercises, the data could be naturally transferred to the therapist through the cloud environment, and the therapist could analyze the patient data. If the exercise seemed not successful, the therapist always could contact the patient and correct it. Also, when a certain type of exercise is over, the therapist could suggest another exercise. We also would like to combine the data in the sense of such partnership. We are also discussing with organizations in relation to cardiac ultrasound and electrocardiogram (EKG). In terms of products, I could say that AMS is the direction of evolution.