himss analytics continuity of care maturity model – going ... · h. stephen lieber president and...

Copyright © HIMSS Analytics Copyright © HIMSS Analytics

Continuity of Care Maturity Model

Going Beyond EMRAM

Model Information

http://himssanalytics.org/CCMM

H. Stephen Lieber

President and CEO

HIMSS

Model supported by…

Presentation version 6-11-2015



THE EUROPEAN EMR ADOPTION MODEL

… in 8 Stages to Highest Quality in Patient Care

Electronic diagnostic and pharmacy

department information

A patient-centered electronic data

repository

Clinical ordering and documentation –

especially nursing care

Electronic order entry with decision

support and result reporting

Completely electronic diagnostic

image management

Full electronic clinical decision support,

and highest medication safety

“Paperless” patient record environment

for highest quality of care,

data continuity & full HIE


What is “Continuity of Care”?

Citizens’ perspective…

Non-disruption of care provided to a patient throughout his/her care journey, across care settings

and care givers

Industry perspective…

Alignment of healthcare resources across care settings orchestrated in a way that delivers the best healthcare services and value possible for a defined

population under your care


The Industry Challenge


Our Solution A multidimensional maturity model promoting the key tenants of continuity of care


Multiple Model Stakeholders

CIOs

Technology Leaders

CEO/COO/CFO/CSOs

Administrators

CMIO/CNO/CNIOs

Clinical/Medical Leaders


Continuity of Care Maturity

Copyright © HIMSS Analytics


Clinical Focus

Comprehensive pop-health. Completely coordinated care across

all care settings. Integrated personalized medicine

CCMM Clinical Focus

Dynamic intelligent patient record tracks closed loop care delivery.

Multiple care pathways/protocols. Patient compliance tracking

Shared care plans track, update, task coordination with alerts and

reminders. ePrescribing. Pandemic tracking and analytics.

Community-wide patient record with integrated care plans,

bio-surveillance. Patient data entry, personal targets, alerts.

Multiple entity clinical data integration. Regional/national PACS.

Electronic referrals, consent. Telemedicine capable.

Patient record available to multi-disciplinary internal and tethered

care teams. EMR exchange. Immunization and disease registries.

Limited shared care plans outside the organization. Leverage 3rd

party reference resources. Basic alerts.

Engaged in EMRAM maturation


Governance Focus

National and local policies are aligned.

CCMM Governance Focus

Policies address non-compliance.

Policies in place for collaboration, data security, mobile device use,

and interconnectivity between healthcare providers and patients

Best clinical practices are derived from care community healthcare

data and operationalized across the community

Policies drive clinical coordination, semantic interoperability.

Change management is documented and standardized

Policies for CofC strategy, business continuity, disaster recovery,

And security & privacy. Data governance is active

Governance is informal, inconsistent and undocumented

Data governance across organizations


IT Focus

Near real-time care community based health record and patient

profile

CCMM IT Focus

Organizational, pan-organizational, and community-wide CDS

and population health tracking

All care team members have access to all data. Semantic data

drives actionable CDS and analytics. Comprehensive audit trail

Patient data aggregated into a single cohesive record. Mobile tech

engages patients. Community wide identity management

Aggregated clinical and financial data. Medical classification and

vocabulary tools are pervasive. Mobile tech supports point of care

Patient-centered clinical data presentation. Pervasive electronic

automated ID management for patients, providers, and facilities

Some external data incorporated into patient record.

Data is isolated


Methodology

• Defining the “Care Community”

– The population who’s continuity of care is being profiled

• Define up to five care settings, such as…

1. Primary Care

2. Acute Care

3. Home based Care

4. Urgent Care

5. Long Term Care

• Completing Survey

– Excel based

– ~250 compliance statements

– 11 categories

– Four pre-defined responses

“Not Applicable”, “Somewhat Applicable”, “Fully Applicable”, “Unknown”



Example Survey



Results

Overall

Total 37%

Stage 7 9%

Stage 6 27%

Stage 5 35%

Stage 4 47%

Stage 3 37%

Stage 2 55%

Stage 1 59%

Stage 0 83%

Stage Level

Scoring Sections

Stakeholder Results

Care Setting Results

Overall Results

Compliance

by Stage

Overall Section

Compliance



Overall Results

Overall Governance Clinical Info Tech

Total 37% Total 33% Total 36% Total 47%

Stage 7 9% Stage 7 12% Stage 7 Stage 7 0%

Stage 6 27% Stage 6 29% Stage 6 13% Stage 6 33%







Example Results



Overall Results

Overall Recommendations The Client has made significant inroads at coordinating care in the primary care, and to a certain extent the acute care

setting. This is especially exceptional given that many of their patients have a free choice of providers, and physicians can

refer outside of the organization network.

In order to make significant progress to improve continuity of care, it is recommended that the Client pursue tighter

relationships with organizations that control other care settings, and these relationships must foster health information

exchange, shared best practice care plans, as well as care team communication and coordination.

1. Continue building relationships with key/critical providers of healthcare that represent other care settings where ACO

patients seek care

2. Extend governance activities and electronic capabilities that support care coordination outside the organization

3. Create documented Information and Communications Tech. (ICT) strategies and operational plans, addressing…

• Internal ICT architecture and infrastructure design

• A strategy and process for internal IT system integration design

• Business continuity and disaster recovery

• For effective integration of data from any data source, including those not anticipated, into the patient's EMR

4. Enable health related data exchange between separate healthcare organizations leveraging secure electronic exchange

5. Extend access so that Citizens / patients have online access to…

• A complete pan-organizational Personal Health Record (PHR) via one viewer or presentation method

• Can update their medical records with personal information and control access

• Allow relatives or social/home care workers to update their patient record

Governance stakeholders pave the way for Information Technology stakeholders and their associated capabilities which are

the foundation for Clinical stakeholders to facilitate coordinated care. It is a positive sign to see Governance at Stage 2

overall, slightly ahead of the other stakeholder groups and making progress to enable their success.

Example Results



Stakeholder Results - Governance

Governance

Primary Acute Sub-Acute Care Urgent Retail Care Home Care

Total 64% Total 62% Total 9% Total 8% Total 20%

Stage 7 30% Stage 7 30% Stage 7 0% Stage 7 0% Stage 7 0%








Governance Recommendations Governance stakeholders are making strides in the Primary and Acute care settings, achieving Stage 3 efforts, but then

progress falls off in other ancillary settings where the client has little to no influence or control. In the home care setting

there is good progress but it is spread thinly across many stages.

To surpass Stage 3 in the Primary and Acute care settings…

1. Work with IT stakeholders and acute care partners to develop an agreed upon set of standards and frameworks for

healthcare and related financial data, interoperability and data exchange

• Technical standards to fully engage and encompass all ICT systems

• Data standards to embrace all types of clinical and related financial data

• Care standards that outline clinical practice guidelines and care protocols Develop a documented strategy

and processes for data center (local and/or third party) disaster recovery and network redundancy, with

routine verification and testing

2. Refine the strategy and process to make tele-health, including telemedicine, available for remote consultations, tele-

monitoring, home care support, and chronic disease management

3. Create collaborative policies with other care settings that outline standards for protecting the security of data (virus

protection, encryption, physical security, etc…)

Example Results



Primary Care Setting Results

Recommendations Master these activities by building on current progress and momentum to….

1. Create a patient-centered dynamic intelligent record that drives and tracks closed-loop care delivery among the

entire patient care team beyond acute and primary care to include community pharmacies, patient / patient

relatives, rehabilitation, social & home care, elderly homes, etc…

2. Extend shared care plans across providers within, as well as those tethered to the organization

3. Extend coordinated care plans that are managed and include Evidence Based Practices and Programs (EBP)

4. Extend access so that citizens / patients have online access to provide electronic consent and manage access

privileges to their medical record

Advance these activities by starting initiatives that address these capabilities:

1. Extend access so that Citizens / patients have online access to…

• A complete pan-organizational Personal Health Record (PHR) via one viewer or presentation method

• Update their medical records with personal information

• Allow relatives or social/home care workers to update the patient record

2. Capture a significant portion of clinical data in structured format

3. Integrate and use Natural Language Processing (NLP) capabilities where appropriate

Overall Governance Clinical Info Tech

Total 63% Total 64% Total 54% Total 70%

Stage 7 21% Stage 7 30% Stage 7 Stage 7 0%








Example Results


Scalable from Facilities to Countries

Provider Facility

Provider Network

Accountable Care Org.

Integrated Delivery Network

Province/Cluster/Region

Ministry of Health

State/Country


James E. Gaston, MBA, FHIMSS

Senior Director, Maturity Models

HIMSS Analytics

[email protected]

Know. Understand. Prepare. Change…with CCMM

John P. Hoyt, FACHE, FHIMSS

Executive Vice President

HIMSS

[email protected]

mailto:[email protected]

mailto:[email protected]

himss analytics continuity of care maturity model – going ... · h. stephen lieber president and...

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