Stephen E. Beller, Ph.D.

I thank you for your interest in this white paper. Following is some background information about my company and me, which I offer as means of introduction, so you can understand my reason for writing this paper.


Professionally, I’m a clinical psychologist, healthcare practitioner, researcher, and software inventor who serves as the President/CEO of National Health Data Systems, Inc. (NHDS), a privately held company founded in 1994.

In 1981, while a practicing psychologist, I began developing a healthcare information system to help me deliver the best possible care by better understanding my patients’ problems, determine the best courses of action, evaluate outcomes (the results/consequences of such actions), and continually learn from experience.

By the mid 1980’s, I had developed the key components of the Psychological Services Index™ (PSI) System and began using it in my practice. I soon realized there was more I wanted to know. Not only did I want a way to learn about my patients’/clients’ mental health problems, but I also wanted to a way to know about any related physiological (bodily, medical, somatic) factors that were affecting them. To accomplish this, a team of colleagues and I set out to create the first information technology providing a comprehensive, in-depth, “biopsychosocial” view of patients’ conditions and treatments. This led to a 15-year journey of intensive, cross-discipline R&D (research and development).

In the late 1990’s, we succeeded in developing a universal lifetime computerized patient record system with advanced decision support capabilities and a virtual forum supporting interdisciplinary collaboration. We named this software technology the Health Information Index™ (Hii™) System.

In the early 1990’s, as our country attempted to deal with the healthcare crisis of the 20th century, I realized that the efforts being proposed — managed care and capitation — would have to fail because these fiscal strategies didn’t focus on improving care effectiveness and safety. Neither did these strategies promote continuous quality improvement through the implementation of evidence-based practice guidelines, nor the use of information technology for knowledge-building and decision support. And they were fraught with dangers in which those who need healthcare most are the least likely to get it due to things like “cherry-picking,” in which insurers recruit the healthiest clients and avoid chronic patients with expensive health care needs and when providers focus on offering only the most profitable healthcare services while selectively choosing not to provide services that involve more risk, more medical attention or time, more expense those services that do not have a handsome return on investment; a problem that continues today.[[#_edn1|[i]]], [[#_edn2|[ii]]] Another serious problem is that these strategies squeeze providers by paying them to treat as many patients as possible for lowest cost, without adequate focus on the quality of care delivered. We now see the results of such failed strategies in our current 21st century healthcare crisis.

In 1993, I attempted to reach our country’s leaders with a healthcare reform proposal centered on a “national health data system” and creation of an “electronic health information network”[[#_edn3|[iii]]] which, by the way, is eerily similar our government’s recent call for a “national health information network” (NHIN). The proposal laid out a strategic blueprint for a system supporting collaborative teams of practitioners and researchers across the country using advanced information technologies to build a storehouse of scientific healthcare data. These data would be analyzed, discussed, and transformed into evidence-based practice guidelines, which would be disseminated to all providers. The technology I’d been developing was a step toward realizing this vision. I received no response from the government, however. A year later, we founded our company and named it National Health Data Systems (NHDS).

At the same time, we had begun introducing the PSI System to the mental healthcare field in an attempt to recruit a large group of healthcare professionals to form a collaborative practitioner-researcher network. Our mission was to have this network help evaluate and evolve the technology, and to use it for building a large biopsychosocial knowledgebase.
A key strategy of the network was to take a proactive approach with managed care companies by obtaining and using a wealth of scientific evidence and decision tools to support and justify clinical interventions. Unfortunately, the mental healthcare field was generally opposed to this approach and our attempts to establish the network failed. We then shifted our focus away from mental healthcare, per se, to opportunities in other healthcare fields, and beyond.

In 1997, I used the knowledge gained over the years to write a patent for the CP Split™ technology, which was granted a year later. The patent describes a uniquely flexible and efficient process for exchanging and presenting information, which is an ideal platform for supporting healthcare decision-making and knowledge-building in collaborative environments.

In 1998, we developed the Joint Commission on Accreditation of Healthcare Organizations’ IMSystem, which evaluates hospital performance, and NHDS became an approved vendor. That same year, we developed a clinical pathways system for Merck UK, in alliance with UK physicians, which helps diagnose and treat certain heart problems, as well as determine which interventions are most cost-effective. We later developed computerized practice guidelines, case management, and treatment planner tools — all of which also focus on quality improvement. Because of these developments, we were able to integrate the PSI system with biomedical applications, to generate the Hii System, with its universal life-time, electronic health record with built-in decision support.

Sadly, I came up against great resistance from the American healthcare system for the past two decades as I presented our ideas and technologies. Although supported by a small network of healthcare visionaries, we were generally scorned or simply ignored by the healthcare industry — not because of poor technology or faulty ideas, but because the American healthcare system simply wasn’t ready for this type of change. So, while we continued to develop innovative solutions, we were rendered powerless as our healthcare system continued to deteriorate and our company struggled to survive. Why didn’t I give up long ago? Many said I should … it was a losing battle … the system would never change!

What kept me motivated during all these years of disappointment and frustration is a personal life mission to do whatever I can to help improve the world’s health and well-being by enabling delivery of affordable, high-quality healthcare for all people in all nations. If our country focuses sincerely on the same mission, I believe many of the problems we face at home and abroad would begin to repair themselves, and we wouldn’t have to be ashamed of the world we’re leaving our children.

Thankfully, a window of opportunity, for which I’ve been waiting a quarter century, has opened in the spring of 2005 with our government’s initiative to build a national health information network and other strategies to improve healthcare quality and control expenditures. This paper is our response to this opportunity. It presents a solution evolving over the past 15 years — focusing on a wellness model and quality through knowledge strategy that benefits all healthcare stakeholders — which is aligned with our mission to help improve the world’s health and well-being.

I can be reached at sbeller@nhds.com.
To your health,
Steve Beller

[[#_ednref1|[i]]] Mount Nittany Medical Center board of trustees. (Jan. 23, 2006) Cherry-picking medical services just increases health-care costs. Centre Daily Times. Available at http://www.centredaily.com/mld/centredaily/news/opinion/13682722.htm
[[#_ednref2|[ii]]] Krasner, J. (September 29, 2005). Study doubts healthcare bill - Pooled policies may hurt staff at small firms. The Boston Globe. Available at http://www.boston.com/business/healthcare/articles/2005/09/29/study_doubts_healthcare_bill/
[[#_ednref3|[iii]]] Beller, S.E. (1993). Plan for long-term health care reform and establishment of national health data system. Available at http://www.nhds.com/health/national_health_data_system.pdf

Sabatini J. Monatesti


I thank you for your interest in this white paper. I include background information about my company and me, that I offer as a means of introduction, so you can understand my reason for co-authoring this paper with Dr. Steven Beller; who I enjoy working with and who I have grown to trust through this process.

Professionally, I am a Management Consultant. I am an Information System Engineer, with a personal stake in the healthcare industry delivery process. As I grow older, I will be one of the 100,000,000 seniors who will rely on it for help at some point. Having health power of attorney for my di seased parents, I learned first hand the difficulties healthcare practitioner’s experience at the patient bedside because they do not have basic information technology tools. As President of ES Enterprises Inc., I believe we are at a threshold in Health Information Technology (HIT). I believe this white paper provides a blue print for action and a wake up call for all of us. I urge you to read it in its entirety and consider adding your ideas and concerns to a growing number of proponents for change regarding how best to “Cure the American Healthcare System.”

Though out my career, I designed systems in a team environment that solved business problems. Many were very complex. Some dealt with super computer, oil refinery models; some dealt with manufacturing processes, some with hardware/software development and still others with the transformation of enterprise business processes. In each instance a major paradigm shift occurred. In one instance an oil refinery model that required a week of computing power, running 24 hours per day, was reduced to just 30minutes with the results made available to engineer’s world wide in six seconds. The impact on refinery performance was significant having great economic benefit to the business. Other systems were used to ensure better communications between suppliers and customers for continued customer loyalty.

However, not until my mom and dad became ill did I realize that the healthcare delivery process was broken. My experiences took place through out the 1990’s. I learned little things that struck me as crazy; for instance, it was possible for two physicians working with the same patient to offer up prescriptions that could interact in such a way as to cause an adverse reaction, even death. I was exposed to bed sore problems. These sores didn’t go away because skin integrity had broken down due to lack of nutrition, contributed to by a lack of feeders for patients suffering from dementia. I was exposed to errors due to overwork, lack of education regarding equipment, or omissions occurred because no one could read all the hand written scribble on charts nor respond quickly when an error occurred.

t seemed that there was a need for some good old process improvement and the introduction of easy to use information technology tools. Many were readily available but the industry hadn’t embraced them because of the many reasons outlined in this white paper. Being a small business, it is necessary to collaborate with other small business to survive. We are all very familiar with technology that enables us to communicate in real-time. But I quickly found out that the healthcare industry wasn’t very familiar with these tools. The industry deployed process technology that aligned itself with procedures performed in operating rooms and recovery rooms, etc., but everything was restricted to a silo. Nothing could talk to or share anything with anything else. In some cases, billing was delayed by months due to lost information.

It was in 2001 that ES Enterprises began to address these issues. I formed a consortium, similar to a farmer’s cooperative, to respond to requests made by the Insurance Industry, the Center for Medicare and Medicaid, the Office of National Coordination for Health Information Technology, and others. Together this team, lead by ES Enterprises constructed a pilot system known as Patient Health Information Network. It rolled out for demonstration purposes January 2004 at Loyola College in Maryland. Today this system is working and capable of changing the way healthcare is delivered. Our initial work regarding this system and the issues and challenges facing US healthcare is published, reference the International Journal of Electronic Healthcare. With this white paper, Steve and I take the NHDS and ES Enterprises Inc. healthcare vision to a new level of sophistication. Our technology will make a difference:
  • It will embrace wellness
  • It will react whenever an error or omission occurs and notify a responsible healthcare provide
  • It will promote communications, collaboration and interoperability
  • It will ensure that our first responders are able, in a disaster, to respond to the needs of a victim by leveraging patient information and tracking their movement from triage to trauma unit
  • That physicians and nurses will be able to leverage decision support tools to ensure they are applying best practice guidelines when developing care plans for their patients.
As a senior member of the IEEE, I am aware of the need for IEEE and the AMA, along with ANSI and the Certification Commission for Healthcare Information Technology (CCHIT) to identify the standards by which communications can occur securely and in context between and among healthcare providers. I am also aware that each of us must become an educated consumer of healthcare products and services, so that, as a mobile society you or I can receive the same care in Miami, Florida as we would receive in Berwick, Pennsylvania. We expect the best quality of care at the best price and we expect that our healthcare provider have access to our medical records so that they are able to provide the best care possible. It seems irresponsible for us to do anything else. How silly is it for each of us to rewrite our history every time we see a new healthcare provider, or for the healthcare industry to lament their lack of best practices.

I hope that as you read our white paper you to become a proponent for change. I recently presented a seminar titled, “Modern Medical Records” at a Northeast Pennsylvania, IEEE meeting. The audience during discussion believed that the onus was on the small rural community to step up and make a change in healthcare delivery. They believed as I do that regional health is a local matter. We are 100,000,000 souls. We live in rural America. We must demand better healthcare, and we must see that Health Information Technology (HIT) is used effectively at the Regional Health Information Organization (RHIO) level. As a member of the Pennsylvania eHealth Initiative (PAeHI), Business Analysis and Technology Committee, I hope to bring this mantra forward at our organization meeting April 5, 2006. I hope all of you who read this white paper will support these efforts.

Please contact me if you have any question, concern or expectation that you would like addressed. I can be reached at smonatesti@gmpexpress.net.
Regards,
Sabatini Monatesti