1. health and fitness

HOW TO PLACE PATIENTS IN HOW
TO PLACE PATIENTS IN
THE CENTER OF CARE DELIVERY
C. LYDON NEUMANN
STOCKHOLM
2010 DECEMBER 8
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Session Objectives
• Acknowledge the forces confronting healthcare . . . fragmentation, increased complexity and cost pressures
• Recognize the value of organizing the Electronic Medical Record (EMR) Journey around the Patient vs. . . . being driven Record (EMR) Journey around the Patient
vs. . . . being driven
by the separate requirements of each contributing provider of care services
• Discuss the role of healthcare EMR and IT in improving the effectiveness of care delivery for Patients
effectiveness of care delivery for Patients
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The starting point is an health care industry facing mounting issues and problems…
g
g
p
Growing Health Concerns
(pandemics, patient safety,
product innovation)
F
Fragmentation of Care
t ti
fC
I
Increasing Complexity of Care
i C
l it f C
(diverse settings,
changing care models)
(co‐morbidity, devices,
genetic treatments)
Escalating Cost of Care
Escalating Cost of Care
Inconsistent Care Standards
Inconsistent Care Standards
(costly conditions,
demographic factors)
(care protocols, intuition versus
evidence model)
Health Consumer Demands
(informed patients,
b d h lth d fi iti )
broader health definition)
3
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The starting point is an health care industry facing mounting issues and problems…
g
g
p
70% of information generated in home or
generated in home or ambulatory testing never reaches medical record
Significant numbers of very serious medication errors occur annually
medication errors occur annually ‐
handwriting, decimal points, drug interactions
40 percent of people with chronic conditions have more than one such condition
such condition Most physicians can come up with different strategies to treat simple medical conditions
di l
di i
Prevalence of chronic illnesses will grow by as much as 26% in the next two decades
Half of consumers use the internet to access health information
h l hi f
i
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4
Transitioning care delivery processes
Current health delivery
Connected health delivery
o Fragmented
o Care that is centered around the needs of the health system
y
o Focused on episodic care
o Traditional health care settings (hospitals, tti
(h it l
physician offices)
o Passive consumers
o Silos of patient information
¾ Care that is centered around h
d f h
i
the needs of the patient
¾ Focused on wellness, prevention and chronic care p
management
¾ Diverse health care settings
¾ Health
H lth consumerism
i
¾ Patient empowerment through mobile technology g
gy
¾ Single source of truth about the patient
5
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Market Trends ‐ Worldwide
There are a number of forces accelerating movement towards a Connected Health environment
towards a Connected Health environment
•
Toronto HIAL developing Connect Toronto
•
•
Invested £5.1 billion in Connecting for Health Program
•
Spending cuts for doctors, hospitals, medicine, and administration will generate €3.5 billion in 2011
Widespread use of Telemedicine but no end‐to‐end solution
•
•
•
Meaningful Use incentives driving EMR g
adoption
Recovery Act Dollars driving development of HIE f
infrastructure
•
•
Top hospitals coordinate care with US hospital s for Medical Tourism
Many different y ff
organizations and systems to integrate –
Large Market
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•
•
MHLW, METI, and MIAC expected to develop national EHR strategy over next 5 –
10 years
y
$125 billion plan to provide affordable
affordable healthcare for the entire population by 2020
Ministry integrating EHR for all 17 regions
for all 17 regions
•
Goal is to allow every Australian to have control over their Personal Health Records by 2013
6
Role of Integrated Care . . . address the needs of the Patient
address the needs of the Patient
Metrics / Data
Prevent
P i
Patient
Diagnose
o Mobilityy
• Regulatory
g
y
o Remote Monitoring • Health Insurance
Monitor
Care
Health Care Products and Services
(Fitness Holistic Chronic Emergency)
(Fitness, Holistic, Chronic, Emergency)
Plan
Integrate
Enable
Staandards
ƒ Patient Health Record (PHR)
ƒ Electronic Health Records (EHR)
Deliver
Electronic Medical Records (EMR)
(
)
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Patient‐centric EMR delivers
Patient‐
centric EMR . . . across all venues of care
across all venues of care
Health Information Exchange
Critical Care: National Initiatives
• Disease Registries
• Population Health
p
CPOE / Alerts & Od S t
& Order Sets
ICU, Operating Room, Emergency Care
National Initiative
• Laboratory
• Imaging
Patient
Ambulatory / Acute / ‐centric EMR
centric EMR
O t ti t /
Outpatient / I
Inpatient
ti t
Clinical Home‐based Closed Loop Documentation Care
Medication (All health Management
professionals)
Clinical Decision Support & Analytics
Evidence‐based
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Patient Safety
Efficiency
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Example: Patient Safety enabled by a Patient‐
centric EMR combining Closed Loop Medication
centric EMR combining Closed Loop Medication
Concurrent Clinical Documentation
Conflict Alerts?
Conflict Alerts?
¾ Vital Signs
Vital Signs
CPOE
Drug to Drug?
¾ Flowsheets
(Computerized Physician Order Entry)
Drug to Food?
¾ Care Plans
Drug to Test?
¾ Order Sets
≠ Prescribing
g
¾ Clinician Notes
Errors (70% of errors*)
¾ Controlled Medical Vocabulary
Medication
Administration
(Bar Code / Auto ID / eMAR)
Five Rights
9Right Patient
9Right Route
g
9Right Dose
9Right Time
9Right Medication
Patient‐‐centric
Patient
requires a single source
of Truth
≠ Administration (
f
Errors (10% of errors*)
Dispensing
Pharmacy
(Formulary)
≠ Dispensing
Errors (7% of errors*)
(Automated)
Source: G M Kuo, et. al.; Quality and Safety in Health Care 2008;17:286‐290 (a further 10% were documentation errors throughout the cycle, 3% were medication monitoring errors post medication administration)
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Approach to Placing the Patient in the Center
Empower People
Empower People
Liberate Data
Connect Care
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Remote monitoring & control St k h ld
Stakeholders
Remote monitoring & control
In‐home platform
Phone
Health monitoring devices:
• Vital sign monitors
• Glucose monitors
Glucose monitors
• Emergency pendant • Other devices
Email
Case managers/ home nurse
Home computer:
•
•
•
•
:Behavioral/environmental sensors
• Activity of everyday living (ADL)
• Environmental state
• Medication compliance
• Mental/emotional health Family caregivers
Video conferencing
Data collection
Local alerts
Control/Configure devices
Broadband Connection
Remote response center:
• 24x7 operation with qualified nursing staff
q
g
• Predictive monitoring and risk analysis software
• Clinical protocols and scripting
• High quality decision support tools for clinicians
support tools for clinicians
TV
Physicians
Mobile
Emergency responders
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11
Wellness & health management on the go MiCoach
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GlucoPhone
LifeWatcher
12
From “episodic” to “continuous” interactions p
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13
Connect Care Across the Ecosystem
Health System
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Community Physicians
Examples of Personal Health Records (PHR)
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Sample of a Provider sponsored PHR
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16
Impacts on Strategies in Technology . . .
Electronic Health Record (EHR)
Electronic Health Record (EHR)
National Integration
(e.g. CeHis Sweden)
Value
Regional Integration
(e.g. SLL, VGR, RS)
County Automation
(e.g. All healthcare facilities, Acute, Clinics, Primary Care, Home, etc.)
Entity/Facility Automation
(e.g. Hospital)
Departmental Automation
(e.g. Lab, Radiology)
No Automation
Depth of Information:
Depth of Information:
Detailed Information, Narrow exposure involving limited players Copyright © 2010 Accenture All Rights Reserved
Breadth of Information:
Summarized /subset of data, Broad exposure involving numerous players/organizations Level of Integration
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… and one that represents an opportunity to improve care efficiency and effectiveness
improve care efficiency and effectiveness
Critical needs addressed by interoperable
interoperable health records, as cited by US Office of National Coordinator Health Information Technology (ONCHIT):
–
Avoid medical errors
Avoid medical errors
–
Improve use of resources
–
Accelerate diffusion of knowledge
–
Reduce variability in access to care
–
Advance consumer role
–
Strengthen privacy and data protection
Strengthen privacy and data protection
–
Promote public health and preparedness
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Two Organizations that have achieved
extraordinary Clinical Benefits using their EMR
extraordinary Clinical Benefits using their EMR
• Kaiser Permanente —
– KP HealthConnect sample regional results
• Group Health Cooperative —
p
p
– Patient Centered Medical Home (PCMH)
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19
Kaiser Permanente
• Kaiser
Kaiser is now the largest integrated delivery system in the US, serving is now the largest integrated delivery system in the US serving
over 8.6 million members across the country.
– 35 hospitals, >15,000 physicians, and >160,000 employees
– In 2003 they released the strategic plan that laid the framework for using technology and service transformation to create a care d li
delivery model that was more patient/consumer‐centric, d l th t
ti t/
ti
promising its members:
•
•
•
•
Home as the hub
Integration and leveraging
Secure and seamless transitions and
Customization
• In 2003, they began their KP HealthConnect journey…
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Kaiser Permanente
KP HealthConnect Results
KP HealthConnect Results
• 33 HIMSS EMR Adoption Level ‐
p
Stage 7 Hospitals
g
p
• Sample Administrative Results
– Saved costs for printed forms almost immediately
– >95 percent reduction in dictation costs
– Kaiser Permanente is now building new hospitals without medical record storage areas, reducing archival storage space by 54%
• Sample Clinical Results
– Provide patients with test results within two days instead of a P id
ti t ith t t
lt ithi t d
i t d f
week or longer
– Reduced the rate of medication errors by 57 percent
Reduced the rate of medication errors by 57 percent
– Trimmed by 12 percent outpatient lab utilization
– Reduced ambulatory visits by 26% in Hawaii Region y
y
g
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Group Health Cooperative
•
•
Group Health Cooperative is a consumer‐governed, nonprofit health care system
t
– Coordinates care and coverage in the Pacific Northwest
– Serves more than 600,000 patients
Serves more than 600,000 patients
Using its EMR, they initiated a Patient Centered Medical Home (PCMH) demonstration project in 2007 that included changes in:
– Care delivery
• Virtual medicine
Chronic care management
• Chronic care management
• Visit preparation and Patient outreach
– Practice management
• Telephone call management
• Patient huddles
• Standard management practices
g
p
Source: Reid et al. Health Affairs, May 2010
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Group Health Cooperative
Year Two PCMH Results
Year Two PCMH Results
•
•
•
•
•
29% reduction in emergency room visits
29%
reduction in emergency room visits
6% fewer hospitalizations
$10 30 total savings per patient per month
$10.30 total savings per patient per month
50% ROI
$
/y
g
Estimated $40 M/year in cost savings
• Lessons learned
– Adaptive leadership
– Investment in primary care
– Change management
– Patient‐centered EMR
Source: Reid et al. Health Affairs, May 2010
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Achieving Clinical IT Benefits: Common Themes
• Each
Each organization…
organization
– Had a clear sense of purpose and vision
– Engaged a captive group of physicians in the design and g g
p
g p p y
g
execution of its programs
– Invested in an EMR solution that could capture “integrated” patient data
patient – Committed to changes in healthcare delivery processes and culture
– Didn’t forget the patients
patients — each of these organizations has robust PHR (Patient Health Record) capability
(
) p
y
– Had the will to measure‐monitor‐improve
•
NOTE: Much of this work continues following
NOTE: of this work continues following implementation
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A New Model of EMR Support
EMR Delivery and Support Portfolio
Implementation
Integration & Integration
&
Configuration
Connected Health H.I.E. Copyright © 2010 Accenture All Rights Reserved
Adoption
Support / Optimization
Clinical Clinical
Transformation
Clinical‐Focused Clinical‐Focused
Support
Clinical Analytics
Ambulatory / y/
Primary Care Connection
Value
Proposition
‘Free up budget to get more done’
‘Drive
Drive value out of value out of
EMR investment’
25
Top 5 Lessons Learned from HIMSS Analytics
EMR Adoption Model ‐ Stage 7 Hospitals EMR Adoption Model Stage 7 Hospitals
1. Training is integral to success. 2. Communicate expansively to get everyone on board. 3 Responsive to the caregivers. 3.
Responsive to the caregivers
p
patient. 4. It’s all about the patient
5. Get the right people at the table. Source: 2010 HIMSS Survey of Senior IT Executives at HIMSS Level 7 Hospitals
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Putting it all together . . . .
So what does all this mean?
So what does all this mean?
• EMR
EMR implementations are a journey
i l
t ti
j
• Leading organizations have shown us that the real work begins after you ‘go
after you go live
live’
• Organizations that have been most successful in achieving clinical and operational goals have invested heavily in optimization, enhancements, and a “new breed” of IT staff
– Clinically/operationally aware—they understand clinical operations as well as the applications
well as the applications
– Patient‐centric—they solve real world problems in real time
– Analytics‐focused—they measure and monitor
• The challenge: – These resources are hard to find, particularly in the current market
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The Healthcare Ecosystem
The electronic flow of health related data across the continuum of care will improve the quality and efficiency of healthcare delivery
the quality and efficiency of healthcare delivery
Connected Health Hospital
Connected Health Authorities
Connected Health Remote Care
Connected Health Patient
Connected Health
Life Sciences and Research
Connected Health
Funder or Payer
(Public or Private)
Public Connected Health
Connected Health
Clinician
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