Transforming Healthcare with Our Patients, Our People, Our Partners
Our HealthCare is Broken
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Transcript of Our HealthCare is Broken
Our HealthCare is Broken
Because of the way we pay for itIt’s going to get worse– Boomer Bulge is here– Chronic disease is >75% of costs
Country cannot sustain current pathMedicare/Medicaid Cuts will happen
Technology is just a tool, but it can help enable the needed process and payment changes– ACOs, EMRs, CDS, VBP, HIEs, etc.
Where should we focus first?
Click icon to add picture
What is Meaningful Use?Menu set: Select 5 of 10– Drug-formulary checks (one report)– Structured lab results (40%)– Patients by conditions (one report)– Send patient-specific education (10%)– Medication reconciliation (50%)– Summary care record at transitions (50%)– Feed immunization registries (one test)– Hospital Advance medical directives
• (50% > 65yrs.)– Send reminders to patients for preventative
and follow-up care (20% > 65yrs. < 5yrs.)– Patient electronic access to labs, problems,
meds and allergies (10% in 4 days)
Core set: All 15 Measures Required– Demographics (50%)– Vitals: BP and BMI (50%)– Problem list:
ICD-9-CM or SNOMED (80%)– Active medication list (80%)– Medication allergies (80%)– Smoking status (50%)– Patient clinical visit summary (50% in 3 days)– Hospital discharge instructions (50%)
- or -Patient with electronic copy (50% in 3 days)
– e-Prescribing (40%)– CPOE (30% including a med)– Drug-drug and drug-allergy interactions– Exchange critical information (perform test)– Clinical decision support (one rule)– Security risk analysis– Report clinical quality (BP, BMI, Smoke, 3
others)
20 things you must do to get money from the government and avoid penalties in the future
Stuff we should have been doing
What is an Accountable Care Organization?
• A defined team of caregivers responsible for a defined population’s health– Shared Savings (& risk)
• Improve overall health and thus lower costs• Incentive Alignment
– Better, consistent communications• Outcome measures • EMRs/Web• Medical Home models
– Access– Population management– Care plans & management– Self Care– Track care & referrals– Measured performance
Stuff we should have been doing
Why should Docs Care?
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Foundations for the Next Decade
Providers must generate population-level reports and analytics.
To effectively decrease costs and keep patients well, clinical data must be fluid, usable, and have consumer accountability.
Population Management
Coordinate Care and Engage Patients
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To measure and achieve quality targets, providers need the ability to integrate EBM, document processes, monitor & report on quality markers.
Monitor & Improve Quality
Providers must be able to understand how each provider is delivering care and manage the payment distribution to incent the correct outcomes.
Manage the Organization
Current Situation
• To Manage, you must Measure– Viable Input method, Analysis, and Display at low Cost– Growth in # of Measures and complexity strains resources
• Manual processes aren’t scalable for Data management– Data Warehouses and Interfaces are essential
• Computer Systems must understand context and situation– Problems, Meds, Labs, Procedures, Allergies, Orders
• Processes are Part of the Problem– Capture data in the same way every time– Right Data, place, time, person, method
Heartland Health Technology
Patient-Entered
dataEDIS
Physician Documentation
Pathologyimaging
Clinical/financialAnalytics EDW
RFID
Innovators 1
Early Adopters 2
ConsensusAdopters
3
CautiousAdopters 4
Late Adopters 5
IntegratedIP/OP EMR
RemoteICU
Inpatient EMR
Clinical datarepository
AmbulatoryEMRSmartphones
Mobile Systems
Point of CareCDS
CriticalCare IS
Device Mgmt
Laboratory IS
Radiology ISPACS
Pharmacy IS
Master patientindex
Surgical IS
CVIS
Bedsidecomputers
Purple = DoingGold = considering
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Bar Code Meds Mgmt
Inpt CPOE
E visits /Pt portal
ACO/MU workflows
Home Monitoring
Remote Presence Telemedicine
New partnerships
LACIE HIE
IncentivesProcesses
& Standards
Outcomes&
Quality Measures
Commun.systems
Providers and Patients
Current
Pay for procedures- Short visits- Illness care
Provider vs insurance vs patient
Fraud, poor quality and inefficiency rarely penalized
Ad hoc processes
Revolve around $
Silos rewarded
Whatever the user remembers from long ago
Manual extraction
Non specific
Retrospective weeks later
Small data sets
PaperFaxPhoneFace to Face or Repeat test orDo without
Long wait times
Decisions based on minimal data
IncentivesProcesses
& Standards
Outcomes&
Quality Measures
Commun.systems
Providers and Patients
Current
Pay for procedures- Short visits- Illness care
Provider vs insurance vs patient
Fraud, poor quality and inefficiency rarely penalized
Ad hoc processes
Revolve around $
Silos rewarded
Whatever the user remembers from long ago
Manual extraction
Non specific
Retrospective weeks later
Small data sets
PaperFaxPhoneFace to Face or Repeat test orDo without
Long wait times
Decisions based on minimal data
New
Pay for Health
Shared Savings
Efficiency rewarded
Payer, patient and provider aligned
Lean/Evidence based
Determined prior to care = fair
Available and updated
Real time Point of Care in EMR
Measures support competition
Population based but patient specific
Transparency required
EMR essential
Mobile
Team based
Can see alerts across complete data
Patient choice in treatment based on data
Maximize licenses
If we have that….
It’s more than just dashboards
Preventive and Health Maintenance Measures
User customizable components for
various workflows
What Needs to be Done?
Physician ScorecardsdPopulation in need with one
click
“Drill Down” Physician Quality Measure
comparisons
LACIE Provider View: Integrated with EMR
dSource of information
Linked reports
Give it to someone else
Actionable orders at
POC
Exclusions
Risk Calculation
Associated lab with meds
Clinical Decision Support at Point of Care
Population Summary for Qual Measures
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Customizable Filters
Individual Quality Measures and management
Who is at Risk?
Why, Again? • Example lifeline with poor diet, activity
level
• Lifeline with Health promotion – Prevention, exercise, diet– Best evidence based care
0 20 30 40 50 60 70 80 90
Vita
lity
Source: Extremely Scientific Guesswork, inc.
For CFOs – Lost productivity,
lower claims
For Patients – Happier, healthier
lives