kurt salmon - get plugged in: defining your connectivity strategy - april 2013
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Kurt Salmon - Get Plugged in: Defining Your Connectivity Strategy - April 2013TRANSCRIPT
Get Plugged in: Defining Your Connectivity Strategy CHIME College Live 17 April 2013
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Topics
Introductions
Drivers
Strategies
Imperatives
Discussion
Introductions
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Introductions
Elaine Remmlinger Senior Partner
[email protected] 212-508-8374
Gerard Nussbaum Director, Technology Services
[email protected] 212-508-8371
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About Kurt Salmon: Information Technology
STRATEGY and PLANNING
VENDER SELECTION and
SUPPORT
REGULATORY COMPLIANCE
INFRASTRUCTURE and OPERATIONS
» Strategic and Tactical Planning » Physician-Hospital Alignment » Connecting Communities » Population Health and Care Coordination » Technology Planning for New Facilities » Business Intelligence and Analytics
» Vendor Selection and Contract Negotiation » Pre-implementation Planning
» Implementation Oversight
» Meaningful Use Achievement » ICD-10 Preparation
» Security and Privacy Compliance
» IT Transformation » Infrastructure Planning
» Right Sourcing » Interim Leadership
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About Kurt Salmon
Extensive, relevant EXPERIENCE » Academic, children’s, community, & national
health systems Change LEADERS
» Highly pragmatic and focused PROVEN team
» Careers spent supporting leading health systems and complex environments
Track record of SUCCESS » Rich history dating to 1947 » Over 75% of ongoing work with repeat clients
Strategy
Finance
Facility/Capital Asset Planning
Operations and Performance
Information Technology
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Objectives
» Understand the drivers for connectivity » Discuss potential connectivity strategies to achieve connectivity » Consider challenges and marketplace realities » Identify common themes and imperatives for moving forward
Drivers
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LAB TESTS
LAB
Drivers
Connectivity is a prime area of interest for providers of all types – from sole practitioners through large health systems and encompassing all stops along the care continuum
Inpatient EMR
PAPER PATIENT RECORD
Patient Portal
CLAIMS DATA
DRUG INFO
Specialty EMR
PRIMARY CARE
SPECIALIST
HOSPITAL
HOME HEALTH CARE PHARMACY
INSURER
PERSONAL HEALTH & WELLNESS
MGMT Ambulatory
EMR
HIE HIE
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Drivers
Numerous forces are impelling providers to develop and execute a connectivity strategy » Regulatory Drivers
– Meaningful Use Stage 2 – Accountable Care – Medicare Shared Savings Program/ – Value-Based Purchasing Readmission reduction program – EHR Donation
» Payment model shifts » Population health management » Community health improvement » Affiliated community physician strategy » Unifying the enterprise across the care continuum » Consumer care involvement
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Regulatory Drivers
Ability to exchange clinical information as structured data and provide health information to all participants is embedded in a number of recent and forthcoming regulations
» Directly required by Meaningful Use for physicians (EPs) and hospitals – Provide patients the ability to view online, download, and transmit their health information – Electronically transmit summary of care record for transitions in care
• Including with another provider with a different EHR – Secure electronic messaging to communicate with patients – Registry reporting (cancer registry, specialty registry) (EP only) – Structured electronic lab results to ambulatory providers (hospital only) – Public health reporting
• Syndromic surveillance, • Immunization reporting • Electronic lab reporting (hospital only)
– eRx (electronic prescribing) – also required by eRx incentive program (MIPPA)
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Regulatory Drivers
Proposed extension of the EHR Donation Stark exception/Anti-Kickback Statute safe harbor acts as a catalyst for community connectivity
» Currently expires 31 December 2013 » CMS/OIG proposing extension through end of 2016 » Interoperability is a foundation requirement of EHRs subject to donation » Will likely spark additional demand from community physicians for practice office
EMRs » Drives demand for connectivity » Connectivity will generally be greater for community physicians with hospital/health
system donated EHRs to drive affiliation strategy » Donated EHR may also be a lever for adherence to
– Clinical best practices – Quality reporting – Performance benchmarks
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Regulatory Drivers
Sharing health information is critical to the ability to manage patient health and achieve success under a number of payment-related regulations
» Relevant regulations include – Accountable Care – Medicare Shared Savings Program/ – Value-Based Purchasing Readmission Reduction Program
» Parallel non-regulatory programs (e.g., with private payors) require similar capabilities
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Regulatory Drivers (continued)
» Key capabilities – Provide information to cost-effectively manage care – Promote provider communication – Define dashboards and scorecards – Build performance transparency – Leverage algorithmic tools to identify need for intervention to arrest health decline – More closely monitor/track patients – Elevate patient to partner in their own health
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Patient Engagement
In addition to the regulatory incentives/requirements, better outcomes are generally available when the patient is actively involved in their own care
Patient Benefits » Engage patients in their care » Build relationships between patients
and providers » Increased access to clinical
information – Personal health records – Health library
» 24/7 access to – Scheduling – Bill pay – Messaging – Prescription refill requests
» Increased patient satisfaction
Practice Benefits » Increased practice efficiency
– Decreased phone call volume, – Ability to shift tasks to less busy times
» Improved provider-patient communication
» Improved financials (increased collections)
» Meaningful Use Stage 2 – Online access – Secure communications
» Satisfied patients
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Population Health Management
To effectively manage population health rich information sets are required
Identify population to be managed and deliver care
Receive and distribute payments to different
entities
Perform risk stratification and monitor outcomes to
improve care delivery
Coordinate care delivery among different care settings for the given
patients
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Private HIEs
» Health systems are still actively building private connectivity solutions, including – Portals – Health information exchanges (HIEs)
» HIEs with broader membership (e.g., regional/community, state/federal) often – Do not deliver breadth of data exchange needed to support health system goals – Have significantly longer decision making and upgrade cycles – Raise issues of sustainability, raising risks for health system strategic initiatives
» Despite some of the disadvantages, these multi-stakeholder HIEs remain key components of a connectivity strategy – Provide wide catchment for broader populations
• Important in retrospective at risk population assignment such as in the MSSP – Support more effective/efficient care for patients not primarily aligned with the health system – Functionality will evolve – Provide core dial tone services that ease connectivity with the broader world
Strategies
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Many Moving Parts
» Integrated vs. best of breed / interoperable solutions » Proprietary vs. community HIEs » Sponsored community physician EHRs » Single vs. multiple patient portals » Aggregator / viewer solutions » ACO solutions » Analytics » Legalities and policies
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No Universal Connectivity Strategy
» Key considerations in defining the appropriate connectivity strategy include – Strategic enterprise priorities; for example:
• Building a physician network • Creating patient-centered care • Preparing for payment reform • Maximizing Meaningful Use benefits
– Organizational structure/dynamics; for example: • Multiple silos of care/diffuse • Unified care delivery organization encompassing care continuum • Merger / acquisition activity
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No Universal Connectivity Strategy (continued)
– EHR solution environment across the care continuum • Care locus specific EHRs • Single EHR • Multiple EHRs, even in similar care environments • Diverse EHRs across the community
– Vendor marketplace status • Integrated vs. interoperable • Enterprise vs. best of breed solutions
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Unifying the Enterprise
Lab Retail Pharmacy Physician
Clinics
Ambulatory Procedure Center
Home Wellness and Fitness Center
Diagnostic/ Imaging Center
Urgent Care Center
Lab
Hospital
IP Rehab
SNF
OP Rehab
Home Care
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Real World Examples
To gain a flavor of the challenges and approaches, we will consider three real world examples
» Disparate Solutions » Partial Integration » Enterprise and Community Integration
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Scenario 1: Disparate Solutions
Other Providers Employed Physicians EHR
Patient Portal Other EHR Other EHR
Hospital EHR
Hospital EHR
Community HIEs
Payors
ACO
Other EHR Other EHR
Other EHR
Sponsored EHR
1. Disparate Solutions » EHRs » Limited Data Sharing
2. Shared Portal 3. Separate ACO Solution 4. Analytics Siloed
Community Physicians Clinical Enterprise
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Scenario 2: Partial Integration
Other Providers
Employed Physicians EHR
Proprietary HIE
Multi-Hospital EHR
Community HIEs
Payors
ACO
Other EHR Other EHR
Other EHR
Sponsored EHR
1. Single Integrated Hospital EHR
2. Separate Physician EHRs
3. Proprietary HIE 4. Multiple Patient Portals 5. Siloed Analytics
Community Physicians Clinical Enterprise
Enterprise
Patient Portal
Patient Portal
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Scenario 3: Enterprise and Community Integration
Other Providers
Employed Physicians
Multi-Hospitals
Sponsored Community Physicians
Community HIEs
ACO
Other EHR Other EHR
Other EHR
Community Physicians Clinical Enterprise
Enterprise EHR
Patient Portal
1. Enterprise EHR 2. Shared Patient Portal 3. Community HIE 4. Enterprise Analytics
Payors
Imperatives
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LAB TESTS
LAB
Connectivity Supports Enhanced Care Delivery
Inpatient EMR
PAPER PATIENT RECORD
PATIENT VITALS/ FAMILY HISTORY
CLAIMS DATA
DRUG INFO
Specialty EMR
PRIMARY CARE
SPECIALIST
HOSPITAL
HOME HEALTH CARE PHARMACY
INSURER
PERSONAL HEALTH & WELLNESS
MGMT Ambulatory
EMR
1. ALERTS • Identifying care gaps
& alerting provider and/or patient
2. BUSINESS INTELLIGENCE
• Looks at registries, population-based data to stratify patient risk
• Looks at evidence-based clinical standards & defined quality standards to do quality reporting
3. CARE COORDINATION
• Allows for care coordination workflows for communication between different providers
4. PATIENT ENGAGEMENT • Allows for care coordination
workflows for communication between different providers
HIE HIE
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Imperatives
Each situation differs; yet, there are some common imperatives that CIOs need to address.
» This is hard – Lots of parts – Even highly integrated environments need to connect with other players – Currently expensive and duplicative – There will be multiple rounds of connectivity solutions as this area matures – remaining
flexible is key to managing the costs
» Not solely a technical issue – Clear enterprise business objectives and priorities are essential – Need to build collaboration with numerous diverse stakeholders internally and externally –
who do not always share common goals – Addressing the tangled legal thicket may slow progress
• Trust relationships • Data Sharing agreements • Privacy and Security (HIPAA, state and local laws, plus patient perception)
» Requires a companion analytics strategy
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