Janie Appleseed

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October 15th, 2015

Agenda

Introduction

Goal of PilotTier PilotingActivity to PilotRole of Janie Appleseed in the pilot

Standards and Technologies Under Consideration

Logistics

Ecosystem

Defining Success

Resources/References

Janie Appleseed is a non-profit organization providing education and services which promote consumer health literacy for the information age. JanieAppleseed.net.

•Give personal health record (PHR) technology a good start.

•Foster patient empowerment and engagement with the aim of shifting focus from the treatment of illness to the promotion of wellness.

•Involve consumers in the adoption and meaningful use of health information technology.  

Lisa Nelson is an independent consultant, focused on the development and implementation of standards for health information exchange. HL7 Certified CDA Specialist and she holds a BA in Computer Science, an MBA with concentration in information systems, and an MS in Medical Informatics.

•Specializes in applications of the Clinical Document Architecture (HL7 CDA R2).

•Experienced with the development of electronic Clinical Quality Measures (eCQMs).

•Author of the C-CDA header template for the Patient Generated Document.

•Co-editor on the new C-CDA R2.1.

•Major contributor in the development of standards associated with Care Plan documents of all types.

Introduction: Pilot Team

Name Role Email

Lisa Nelson Beneficiary/Beneficiary advocate

Lisa@JanieAppleseed.netwww.LisaRNelson.com

Introduction: Organization

Who are you?•Janie Appleseed is Lisa Nelson – hence, consumer facing initiatives designed to offer the human interaction required to engage individuals in the use of new technology in ways that align with the latest standards being developed to foster interoperability.

What do you currently do?•Janie Appleseed offers consumer education that teaches consumers health literacy and computer skills needed to improve their lives through the use of personal health record (PHR) health information technology (HIT).

How are you involved in services and support?•We engage in two-way dialog with consumers about the use of electronic health records, teaching and listening at the same time.•We develop “user stories” that illustrate consumer views on meaningful uses of PHRs and HIT. •We develop and represent consumer requirements in the creation of consensus- based HIT standards.

How do you currently carry out eLTSS activities•We deliver consumer-oriented presentations and workshops designed to provide information, develop new computer skills, and solicit feedback that can be transformed into consumer requirements for HIT technology.•We help people think about, understand, and cross the “know-do gap” of new technology use.

…[Life]

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…[Life]

LongitudinalHealth Record

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Value Story: Adult for Youth

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Pilot Introduction: Business Drivers

The Janie Appleseed mission is to create a network of individuals who are “activated consumers”. Success is measured by:

•An increase in the number of connected individuals—acting as consumers representing the needs of their family and their personal needs.

•An increase in the extent to which consumers integrate the use of HIT systems in their day-to-day lives.

•An increase in the extent to which consumer needs are considered in the design of PHR systems.

•An increase in the number of opportunities where consumer input can have a greater impact on the development of new PHR systems.

•An increase in the number of other individuals within the HIT industry who are connected to foster this mission.

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Which Tier are you piloting?

• While addressing Tier 1 requirements, we expect to explore, clarify and document information flows that reach the individual and their families in order to understand how patient’s goals, preferences, and priorities contribute to the eLTSS care planning process and demonstrate the potential value added in a person’s life through the use of new technology.

• While addressing Tier 2 requirements, we would focus on developing and delivering

education needed to support consumer use of new technology offering more efficient access to eLTSS care plan information. We would support beneficiaries to use piloted technology and help them exchange digital information with provider facing systems. We would gather findings from the consumers’ experience and formulate feedback that could be used to improve the piloted technology implementations.

• While addressing Tier 3 requirements, we would focus on understanding and documenting

the outcomes in people’s lives when they are engaged in using new technology that offers real-time eLTSS care plan updates between beneficiaries, caregivers, providers and payers. While pilot vendors and organizations focus on delivering the eLTSS care plan systems, Janie Appleseed will focus on measuring and monitoring changes in consumer behaviors and health outcomes that are attained through the use of the new technology. We also hope to contribute to the design of measures developed to show how the data being shared can be used to support data analytics for clinical decision making and clinical quality management, to ensure that the evaluation of health outcomes and the effects on beneficiary and caregiver satisfaction are addressed in meaningful ways.

October 2015 – April 2016

Standards Under Consideration:

• Tier 1– Paper Forms, Paper Advance Directives– Scanned copies or pdf files that can be shared by mail, fax, e-mail,

drop-box, etc.

• Tier 2– Unstructured CDA documents (Level 1)– CDA Documents with structured body sections (Level 2)– BB+ Push, Direct, HIE or Portal-enabled sharing

• Tier 3:– CDA Documents with structured body sections and machine readable

entries– More advanced security (DS4P, OAuth2, BB+ Pull)– Structured data processing (CDS) (FHIR)

Goal of the Pilot

Opportunities to envision and specify how consumers will participate in the flow of information and to envision all that is required to integrate new HIT technology into the way we live.

User Story 2

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Beneficiary/Advocate VDT

Opportunities to envision and specify how consumers will participate in the flow of information and to envision all that is required to integrate new HIT technology into the way we live.

Pilot Workflow

Achieve coordination of care that includes patient involvement•People contribute and receiving information digitally to: request, inform, choose, accept or request alternatives, confirm, update, view, download and transmit their care plan.

– Head in the direction set by MU Stage 3• Identify, Record, and Access Information Documents• Reference and Link Documents• Record and Access Information Directly Shared by a Patient

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What are you intending to pilot

• Which one(s) apply?– Create Plan– Approve/Authorize Plan/Services– Access, View, Review Plan– Update Plan

• Have you identified a Service provider with which to work? – MyDirectives.com (for Advance Directives)– Others welcome

• Do you know if they have an electronic system?– MyDirectives.com produces a digital advance care plan document– All consumer-facing applications welcome

• Do you know which sub-domains from the Functional Requirements document will you pilot? – Content experience in many areas: Work, Community, Choice & Decision Making, Relationships, Self-Direction,

Demographics, Person-Centered Profile, Medication, ADLs/IADLs, Safety, Behavioral Needs, Restrictions, Service, Financial/Payer Information, Service Information, Family Information, Community Connections, Access & Support Delivery, Information & Planning, Health

What role do you play in the pilot

What role do you play in your pilot?•Janie Appleseed could be engaged to help a pilot:

– Support pilot initiation and population of the Requirements Technical Matrix to include and address consumer requirements

– Support pilot design to make it possible to engage real consumers in the role of Beneficiary/Advocate

– Support development of “Value Stories” describing the use of the eLTSS solution from the consumer’s point of view

Pilot Ecosystem

• MyDirectives.com – a system allowing consumers to create advance care plans• PHR systems• Portal systems for Beneficiaries and Beneficiary Advocates• Consumer’s PC/laptop• Consumer’s Fax Machine• US Postal Service • Consumer’s Scanner• Consumer’s e-Mail, (Consumer-controlled Direct Address)• Consumer’s i-phone or android

Pilot Logistics:

• Timeline:– Complete round-one pilot by April 2016:

• Participate in Kick off: October 2015• Engage with Partners/Providers doing a pilot- October-December 2015• Support pilot planning and analysis; completion of Requirements Technical Matrix: March 2016• Develop consumer-oriented “Value Stories” based on Pilot: April 2016

• Challenges:– Time constraints:

• Specific, focused consultation tasks at key points in the pilot– Provide supporting input in December – April

• Development of consumer Value Stories in March-April

Call Now!I’ll be standing by.401-219-1165

How do you define success

• Demonstrate that including the consumer in a technology pilot improves the quality of the pilot and produces outcomes that more clearly demonstrate how patient-centered care improves patient-experience, increases population health management, and decreases per capita cost of care

Patient Centered

Care

Population Health Per Capita Cost

Experience of Care

Achieve improvement in all aspects of the triple aim.

Helpful References

• www.JanieAppleseed.net

• A consumer-driven culture of health: the path to sustainability and growth http://dupress.com/articles/future-of-us-health-care/

• A service that enables consumers to make and share their advance care plans: www.MyDirectives.com

• Listing of PHR solutions: http://www.janieappleseed.net/tools.html

• Janie Appleseed’s contact information:– e-mail: Lisa@janieappleseed.net– phone: 401-219-1165