Introduction to AxSys Health

Introduction to Accountable and Collaborative Care Solutions Across

the Globe

Ontario, Canada – Diabetes Chronic Disease Management

East Elmbridge & Mid Surrey Primary Care Trust -England

COPD Remote Monitoring Services

National Clinical Network for Cleft Services - Scotland

Managed Clinical Network for Cancer- Scotland

National Sexual Health System (NaSH) - Scotland

Total Knee Replacement Golden Jubilee Hospital - Scotland

AxSys Health is the North American division of AxSys Technology Ltd

Founded by physicians in the UK. Started operations in 2000

Approximately 250 employees across offices in UK, India and the US.

AxSys has produced a unique Collaborative and Coordinated Care platform called Excelicare

The Excelicare solution has delivered more than 30 discrete specialized clinical applications across more than 120 clients across the United States, Canada, Scotland, England, Ireland, and India

Most of the rest of the world has a single payer model – typically the government – with a single payer model the focus has been on the clinical side of care as opposed to the clinical and the payment of care

Managed Clinical Networks (MCN), a pre-cursor to ACOs are an important component in the support of better patient access and treatment through a coordinated care approach. The MCN concept was created in Scotland in 1999 by the Scottish Department of Health ◦ Their definition of MCNs is defined as “linked groups of health professionals and organizations from

primary, secondary and tertiary care, working in a coordinated manner, unconstrained by existing professional and Health Board boundaries, to ensure equitable provision of high quality clinically effective services throughout Scotland.”

◦ Like a fine wine, this definition has aged well and seems to translate into the current goals of ACOs.

Some features of a MCN include:

◦ The application integrates primary, secondary and tertiary care services

◦ A care plan is established which will serve all network stakeholders

◦ The care plan has the capability to incorporate evidence-based medical practices

◦ All participating members of the multi-disciplinary care team will have equality of access to the care plan (access rights can be granted, partly or whole)

◦ Multi-disciplinary team meetings are facilitated through the telemedicine and teleconferencing. Experts at remote sites are able to discuss the patient review patient notes simultaneously

◦ Automated generation of referral letters, summary documents and discharge letters

◦ Educational and patient advice leaflets can be accessed and distributed

Description:

Chronic Disease Management System (CDMS) started in 2010 for Diabetes and other chronic conditions – Connecting 100,000 providers, 15 Million patients and 1 Million patients with Diabetes

Objectives:

The creation of the CDMS-Diabetes reflects the number of Ontarians with diabetes; there are now more than one million - a total which has doubled over the last 10 years. The aim is to manage diabetes treatment and care effectively and economically, and to prevent the heart attacks, blindness and amputations.

Project Success Metrics – Benefits Realization

The CDMS-Diabetes is an interactive, real-time information tool to develop care plans and monitor clinical results to improve treatment. The system is building on eHealth Ontario's provincial identification and access systems infrastructure to ensure the secure identification of patients, providers and relevant diabetes healthcare services, based on common informatics standards and access technology.

Providers will be able to manage the care of patients with diabetes according to recommended guidelines, securely receive, produce reminders, alerts and reports to help improve the quality and safety of patient care.

The development of Ontario's CDMS will enable significant improvements to be achieved in the quality of services and real benefits to be delivered to patients.

As the first system of its kind in Canada, the CDMS solution will result in faster diagnoses, more effective treatment and improved management for Ontarians living with diabetes. Providing alerts to physicians will help them better care for their patients.

Connecting 100,000 providers, 15 Million patients and 1 Million patients with Diabetes

Security and Access Control

Enterprise Master Patient Index

Patient and Provider Demographics

Radiology

Laboratory

Patient

Access Consent

Providers

Claims

Description:

A COPD Community Service was initiated by East Elmbridge and Mid Surrey Primary Care Trust in 2004 in England to provide high quality personalized care to patients in the home setting to reduce inpatient care and focus on preventative rather than reactive acute care

Objectives:

Monitor severe COPD patients at home, patients and their caregivers were to be fully informed about their disease and options, and patients and caregivers were to be taught to recognize changes in condition

Project Success Metrics – Benefits Realization

Improved Patient Involvement- The platform empowered patients to become more

actively involved in their own care

Reduction in patient cost and time – lower costs and time incurred for patients travel to clinics for assessment and treatment

Move from Crisis management to Preventative collaboration - published results demonstrated the change on emphasis from ‘crisis management’ to a proactive ‘preventative partnership’

Reduced severity of exacerbations - 44% reduction with improved maintenance of lung function and quality of life

Reduced hospitalization – 40% reduction in admission for patients seen at home

Reduced LOS– reduced to 5.9 days a 26% reduction in bed days

Increased service deliver -80% of services delivered via phone or email, more patient involvement with same staff levels

Reduced duplication of effort - Care can be delivered anywhere and referrals made by email

Description:

Project established in 2000 to deliver interdisciplinary care between health professionals providing care for cleft lip and palate patients between the ages 0 and 20 years

Objectives:

Provide a single record for a patient, accommodate clinical imaging, generate email and letter alerts to remind clinicians of their particular responsibility at specific times, and support and facilitate audit and outcome assessment

Project Success Metrics – Benefits Realization

Improved communication – sharing of information across care providers

Improved standards of care- a single source of patient information to monitor and analyze outcomes

Improved coordinated care - Interdisciplinary treatment planning and care has improved due to use of the platform

Improved efficiencies - more effective use of clinicians’ time as well as the patients, their parents and caregivers

Improved data access – minimized risk of data fragmentation over multiple sites, reduced cost, time and effort incurred by offline data entry and replication

Better patient satisfaction – through improvement in the organization of clinics and coordination among specialties

Improved reporting – Reports and analysis on a national basis

Care Plan from Birth to 20 Year Old

Description:

Managed Clinical Network (MCN) project established in 1999 to integrate all cancer settings across the West of Scotland, to have the patient at the core of the system, to implement care pathway protocols in conjunction with National datasets, and to incorporate multidisciplinary team (MDT) meetings within the care pathway. Covers 50% of the population of Scotland – 2.5 Million people. Connecting 5 regions and 10 hospitals

Objectives:

Establish clinical meetings using video conferencing, provide a secure clinical information system to record the patient history and store clinical information and medical images. Provide means of informing primary, secondary and tertiary care teams of ongoing cancer care

Project Success Metrics – Benefits Realization

Reduced travel and delays – The MDT discuss individual cases without extensive

travel patients are referred and seen without delay

Equitable access to care- Patients are guaranteed that they will receive specialist review regardless of geography and that all clinicians involved in their care participate in establishing and reviewing their care plans

Improved care delivery- the speed of delivery of the treatment plan has improved as all relevant information such as laboratory reports and pathology is recorded and collated through one central system

Improved education – Clinicians have benefited from the sharing of knowledge through the cross specialty discussions and the meetings also provide an excellent training ground for junior doctors and other clinical staff who attend

Improved data quality – through a central repository with better audit trail and introduction of standardization and accountability

Inverclyde

Hospital

Argylle & Clyde HB

SCI-Store

PMI / LABS

EP

Slave

ServerMSMQ

WS (SOAP)

Glasgow

Royal

Infirmary

Beatson

Oncology

Centre

Southern

General

Hospital

Stobhill

Hospital

Forth Valley HB

Falkirk

Hospital

Stirling

Royal

Infirmary

Hairmyres

Hospital

Lanarkshire HB

Wishaw

Hospital

Crosshouse

Hospital

Ayrshire & Arran HB

iSoft EXPRESS

PAS (x3)iSoft TELEPATH

LABS

Clinisys

CHEMOCARE

Varian

VARIS RT

Exceliport Integration

Slave Server

ODBC ODBC

ODBC

FTP

MSMQ

SCI-Store

PMI / LABS / RIS

WS (SOAP)

EP

Slave

Server

MSMQ

SIEMENS

PACS

DICOM3

EP

Slave

ServerDICOM3

REVIVE

LABS/RIS

EP

Slave

ServerMSMQ,

DICOM

DICOM 3

COMPAS

PAS

GE CT

GE MRI

TELNET

ODBC

Description:

Managed Clinical Network (MCN) and integrated Sexual Health Enterprise Patient Record System (EPR) for Sexual Health project established in 2007 to integrate all Sexual Health clinics settings across all of Scotland.

Objectives:

The NaSH system is a key component of the National Sexual Health Strategy - ‘Respect and Responsibility: A Strategy and Action Plan for Improving Sexual Health’, launched in 2005.

This strategy set out a framework for improving sexual health in Scotland by enhancing access to information and services whilst enabling flexibility for local services to respond to local requirements.

It also highlighted the need to be able to review existing data and develop a data collection framework to provide a more accurate picture of sexual health and wellbeing in Scotland, in terms of both sexual ill health and behaviours and attitudes.

Project Success Metrics – Benefits Realization

Improved Clinical Care with patient focused processes and modern communication tools.

Streamlining of services enabling improved throughput and availability.

More effective use of staff resources and more efficient clinical staff training

Increased ability to share patient data across services.

Removal of multiple manual record keeping systems.

Ability to address some clinical governance issues more effectively.

Improved service security.

Reduction in resource required to complete coding.

Improved ability to access and share patient clinical information.

Reduced requirement for duplicate entry of patient data and better quality of data.

Increased use of national data standards.

Reduction in number of potential diverse clinical systems.

More efficient and increased integration of systems.

Improved resilience and support for clinical systems.

Get more value from strategic infrastructure products.

Increased clinical buy-in and usage of IM&T.

Better public health information.

ACOs, Patient Centered Medical Homes, and Bundled Payment methodologies are Collaborative Care Solutions that have their precursors both in the US and abroad

Need to analyze what worked in a single payer model there and what will work in a multi-payer model here

Focus on cooperation while being cognizant of the competitive realities in the U.S.