Connecting Payers, Providers, and Patients A Journey of Innovation

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Connecting Payers, Providers, and Patients A Journey of Innovation. John D. Halamka MD May 28, 2012. The Need for Innovation. Universal adoption of usable electronic health records Frictionless Healthcare Information Exchange Turning data into information, knowledge and wisdom - PowerPoint PPT Presentation

Transcript of Connecting Payers, Providers, and Patients A Journey of Innovation

  • Connecting Payers, Providers, and PatientsA Journey of InnovationJohn D. Halamka MDMay 28, 2012

  • The Need for Innovation Universal adoption of usable electronic health recordsFrictionless Healthcare Information Exchange Turning data into information, knowledge and wisdomEngaging patients and families in ways that add valueProtecting privacy

  • Universal adoption of usable electronic health recordsGetting the data inThe ideal form factorIntegration with workflowLeveraging the power of the care teamAgile continuous improvement of the products

  • Patient Profile Screen*

  • Problems*

  • Medications*

  • Medication History and Reconciliation*

  • Reports*

  • *

  • Care Plans

  • Frictionless Healthcare Information ExchangeThe View ApproachThe Push ApproachThe Pull Approach

  • The Massachusetts Statewide Health Information Exchange

  • Basic Commonwealth HIE ServicesProvider directoryCertificate repositoryDIRECT gatewayWeb portal mailboxRepository of physician names, entities, affiliations, and security credentialsRepository of security certificates for authorized users of HIE servicesAdaptor that transforms messages from one standard to another without decrypting the messageSecure, encrypted mailbox for users without standards-compliant EHRLookup servicesMessage-handling servicesHIE Services

  • Users have 2 ways to connectUser types2 methods of accessing HIE servicesEHR connects directlyBrowser access to webmail inboxPhysician practiceHospitalLong-term careOther providersPublic healthHealth plansLabs and imaging centers

  • Accelerating Use of HIEValue of statewide HIE network and services will increase exponentially with the number of users

    Removing adoption barriers is key to increasing number of usersUp-front cost and difficulty of system integration is significant barrier to adoption to most users, especially small practices and safety-net providers

    Can address this barrier through a variety of meansAlign all funding streams to maximize opportunities for synergyLeverage existing assetsBuild services where the users areLower the cost and ease the difficulty of using the statewide HISP

  • Roadmap for Statewide HIE ProgramIncreasing cost and complexityFacilitate normalization and aggregationEnable queries for recordsPhase 2Phase 3Phase 1

  • The Reality of Vendor ProductsEHR vendor roundtable held on December 16, 2011 Over 20 vendors participated in 4-hour sessionMix of ambulatory, hospital, and HIE vendors

    Goal was to understand vendors current and near-future interoperability capabilities and get feedback on MA approach

    FindingsThere is wide variation in vendor interoperability capabilitiesFew if any vendors have production Direct-enabled systems in place todayThere are no standardized approaches to integration with centralized provider directories or PKI infrastructureAll of the vendors supported a centrally coordinated approach to interface development and deployment

  • Turning data into information, knowledge and wisdomCentralized or distributed databases?Prospective or retrospective reporting?Structured or non-structured data capture?

  • A Centralized Database

  • Distributed Databases

  • Distributed Databases

  • Prospective Reporting

  • Retrospective Reporting

  • Structured Data Capture

    VITAL SIGNS: Blood pressure 110/70. Height 5 feet 3-1/2 inches, weight 122 pounds, and BMI is 21.5.CURRENT MEDICATIONS:1. Docusate sodium 100 mg b.i.d.2. Ferrous sulfate 325 mg b.i.d.3. Magnesium oxide 400 mg b.i.d.4. Aspirin 81 mg daily.5. Plavix 75 mg daily.10

  • Unstructured Data Capture

    MEDICATIONS:He currently takes 3% hypertonic saline nebs twice daily.Pulmozyme 2.5 mg nebs twice daily.He takes Bactrim 5 mL twice daily every Friday, Saturday, Sunday for PCP prophylaxis.He takes Zithromax 2.5 mL once daily every Friday, Saturday, Sunday for neutrophil modulation.He takes Zyvox 600 mg one tablet twice daily but is stopping on 9/12.11

  • The Role of Natural Language Processing and other evolving tools

  • Engaging Patients and FamiliesTethered and non-tethered personal health recordsHome care devicesCreating value - Open Notes, Passport to Trust

  • Protecting PrivacyThe challenge of BYODProtecting data at the server and the clientRespecting patient privacy preferences

  • The AnonymizerName: Rob SmithDOB: 6/7/1972cd5dced41028cb7ea51d52a888089d7300c9782a552a2d09b1b85e0d0db52ef37f2b6e48ea7d042bbe85e46ef2107da4

  • Patient Identifiers Are First AnonymizedLabResultsOutcomesRecord #A-701Record #B-9103ObservationsRe-Constructed IdentitiesFEATURES:Mark Randy Smith, M. Randal Smith123 Main Street713 731 5577DOB 06/07/74Sensors

  • Patient Identifiers Are First AnonymizedLabResultsOutcomesRecord #A-701Record #B-9103Cd5dced41028cb 00c9782a552a2 7f2b6e48ea7d0 0d06b31faa7cB5e341a4b0c00c9782a552ObservationsRe-Constructed IdentitiesFEATURES:Mark Randy Smith, M. Randal Smith123 Main Street713 731 5577DOB 06/07/74Sensors

  • Identity Resolution Occurring Post AnonymizationCd5dced41028cb 00c9782a552a2 7f2b6e48ea7d0 0d06b31faa7cB5e341a4b0c00c9782a552LabResultsOutcomesRecord #A-701Record #B-9103ObservationsRe-Constructed IdentitiesSensorsFEATURES:Mark Randy Smith, M. Randal Smith123 Main Street713 731 5577DOB 06/07/74

  • Patient Linkage Data is Not Stored in Clear TextCd5dced41028cb 00c9782a552a2 7f2b6e48ea7d0 0d06b31faa7cB5e341a4b0c00c9782a552LabResultsOutcomesObservationsRe-Constructed IdentitiesSensorsRecord #A-701Record #B-9103

  • Patient Linkage Data is Stored AnonymizedCd5dced41028cb 00c9782a552a2 7f2b6e48ea7d0 0d06b31faa7cB5e341a4b0c00c9782a552LabResultsOutcomesObservationsRe-Constructed IdentitiesSensorsRecord #A-701Record #B-9103

  • Maximizing Discovery - Minimizing Disclosure!Record #A-701MatchesRecord #B-9103Discovery

  • The Challenges We FaceV = Volatility. The nature and dynamics of change, and the nature and speed of change forces and change catalysts.U = Uncertainty. The lack of predictability, the prospects for surprise, and the sense of awareness and understanding of issues and events.C = Complexity. The multiplex of forces, the confounding of issues and the chaos and confusion that surround an organization.A = Ambiguity. The haziness of reality, the potential for misreads, and the mixed meanings of conditions; cause-and-effect confusion.

  • Questions?

    http://[email protected]

    High level real-time view of info from registration, scheduling and clinical systems.Demographics, providers, proxy, pharmacy for eRXAllergies, medications, problem list, recent results, recent encounters Alerts for patients who are admitted, anti-coagulated, diabetic, prenatal or have abx resistance (MRSA, VRE, etc)Service specific problem lists.Add , edit, inactivate, delete, combine. Add comments.Associate notes to problem(s) in a patients list. This allows clinicians to easily view notes related to a specific problem or problemsRestrict and un-restrict the display of a problemView active and inactive medicationsInteraction/Allergy alertsAdd, modify, renew, inactivate, hold medicationsDocument that the medication list was reviewed with the patientReconcile inpatient meds after dischargeAdd medications as Recording Only (prescribed by another provider)E-prescribe to retail and mail orderIdentify formulary medications based on the patients insuranceReports = narrative resultsView and print clinical reports. Select time frame, sort by report type, ordering provider, status. View PACS Radiology Images via Centricity Web ViewerView Endoscopy Reports and Images stored in 3rd party systemView reports from other Caregroup hospitalsProvides integrated view of results from within and outside the HISSome sheets have additional disease management and alerting features, e.g., diabetes, anticoag, narcoticsTasks allow providers to efficiently manage their queue of signed notes, discharge summaries and orders to be signed, review messages sent by other webOMR users and manage their patient related to do list.This is also the option used to access the Test Results Tracking System which electronically routes Radiology, Cardiology, Cytology and Pathology results to the ordering and responsible providers for their review and action.The registry is a longitudinal asset that is built at the patient level. As new data is available and integrated, the patient is the key unit of analysis and storage. That data can then be analyzed and aggregated to describe care at a doctor level, or a disease population level, or a plan level.

    Inside that registry is data in blocks that will look very much like medical record. Vitals, labs, diagnoses, procedures. But it will also include data from the admin side costs, eligabilty, and other demographics.

    The layer in red are the new data elements that we create and capture as part of the loading process. These are the True and False answers, new combinations of elements, counts of activity, or the lack thereof (sometimes its more important to see whats not happening). Its also additional analyses like risk scoring of patients. These are stored alongside the basic care and cost data as a rich set of analytic variables that support a range of uses for management and providers.

    (transition) This data is made available through a scorecard structure.High level real-time view of info from registration, scheduling and clinical systems.Demographics, providers, proxy, pharmacy for eRXAllergies, medications, problem list, recent results, recent encounters Alerts for patients who are admitted, anti-coagulated