1 / 39

Connecting Payers, Providers, and Patients A Journey of Innovation

Connecting Payers, Providers, and Patients A Journey of Innovation. John D. Halamka MD May 28, 2012. The Need for Innovation. Universal adoption of usable electronic health records Frictionless Healthcare Information Exchange Turning data into information, knowledge and wisdom

fia
Download Presentation

Connecting Payers, Providers, and Patients A Journey of Innovation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Connecting Payers, Providers, and PatientsA Journey of Innovation John D. Halamka MD May 28, 2012

  2. The Need for Innovation • Universal adoption of usable electronic health records • Frictionless Healthcare Information Exchange • Turning data into information, knowledge and wisdom • Engaging patients and families in ways that add value • Protecting privacy

  3. Universal adoption of usable electronic health records • Getting the data in • The ideal form factor • Integration with workflow • Leveraging the power of the care team • Agile continuous improvement of the products

  4. Patient Profile Screen 5

  5. Problems 6

  6. Medications 7

  7. Medication History and Reconciliation 8

  8. Reports 9

  9. 10

  10. Care Plans

  11. Frictionless Healthcare Information Exchange • The “View” Approach • The “Push” Approach • The “Pull” Approach

  12. Berkshire Health System UMass Memorial Secure Certificate Management Direct Gateway Services Audit log Provider/Entity Directory Web Portal MD MD MD MD MD MD MD MD BIDMC MassHealth Partners DPH EOHHS SafeHealth NEHEN Atrius NwHIN Fallon Clinic Statewide HISP The Massachusetts Statewide Health Information Exchange

  13. Basic Commonwealth HIE Services HIE Services Repository of physician names, entities, affiliations, and security credentials Provider directory “Lookup” services Repository of security certificates for authorized users of HIE services Certificate repository Adaptor that transforms messages from one standard to another without decrypting the message DIRECT gateway “Message-handling” services Secure, encrypted mailbox for users without standards-compliant EHR Web portal mailbox

  14. HIE Services Provider directory Certificate repository DIRECT gateway Web portal mailbox Users have 2 ways to connect User types 2 methods of accessing HIE services Physician practice EHR connects directly Hospital Long-term care Other providers Public health Health plans Browser access to webmail inbox Labs and imaging centers

  15. Accelerating Use of HIE Value of statewide HIE network and services will increase exponentially with the number of users Removing adoption barriers is key to increasing number of users • Up-front cost and difficulty of system integration is significant barrier to adoption to most users, especially small practices and safety-net providers Can address this barrier through a variety of means • Align all funding streams to maximize opportunities for synergy • Leverage existing assets • Build services where the users are • Lower the cost and ease the difficulty of using the statewide HISP

  16. Create infrastructure to facilitate data aggregation/analysis • Will support Medicaid CDR and quality measure infrastructure • Will support vocabulary translation services (lab, RX) • Create infrastructure to enable secure transmission (“directed exchange”) of clinical information • Will support exchange among clinicians, public health, and stand-alone registries • Focus on breadth over depth • Create infrastructure for cross-institutional queries for and retrieval of patient records Analytics and Population Health Search and Retrieve InformationHighway Roadmap for Statewide HIE Program Phase 1 Phase 2 Facilitate normalization and aggregation Phase 3 Enable queries for records Increasing cost and complexity

  17. The Reality of Vendor Products • EHR vendor roundtable held on December 16, 2011 • Over 20 vendors participated in 4-hour session • Mix of ambulatory, hospital, and HIE vendors • Goal was to understand vendors current and near-future interoperability capabilities and get feedback on MA approach • Findings • There is wide variation in vendor interoperability capabilities • Few if any vendors have production Direct-enabled systems in place today • There are no standardized approaches to integration with centralized provider directories or PKI infrastructure • All of the vendors supported a centrally coordinated approach to interface development and deployment

  18. Turning data into information, knowledge and wisdom • Centralized or distributed databases? • Prospective or retrospective reporting? • Structured or non-structured data capture?

  19. BIDPO QDC A Centralized Database

  20. Distributed Databases

  21. Distributed Databases

  22. Prospective Reporting

  23. Retrospective Reporting

  24. Structured Data Capture • VITAL SIGNS: Blood pressure 110/70. Height 5 feet 3-1/2 inches, weight 122 pounds, and BMI is 21.5. • CURRENT MEDICATIONS: 1. Docusate sodium 100 mg b.i.d. 2. Ferrous sulfate 325 mg b.i.d. 3. Magnesium oxide 400 mg b.i.d. 4. Aspirin 81 mg daily. 5. Plavix 75 mg daily. 10

  25. Unstructured Data Capture • MEDICATIONS: • He currently takes 3% hypertonic saline nebs twice daily. • Pulmozyme 2.5 mg nebs twice daily. • He takes Bactrim 5 mL twice daily every Friday, Saturday, Sunday for PCP prophylaxis. • He takes Zithromax 2.5 mL once daily every Friday, Saturday, Sunday for neutrophil modulation. • He takes Zyvox 600 mg one tablet twice daily but is stopping on 9/12. 11

  26. The Role of Natural Language Processing and other evolving tools

  27. Engaging Patients and Families • Tethered and non-tethered personal health records • Home care devices • Creating value - Open Notes, Passport to Trust

  28. Protecting Privacy • The challenge of BYOD • Protecting data at the server and the client • Respecting patient privacy preferences

  29. Anonymizer Rob Smith 6/7/1972 Robert 7/6/1972 1972 Variants 0d06b31faa7c44682d770706640465d2 B5e341a4b0cdf0e8de7b6f957818d746 bd0ec72f2424729efa7baac9a636970a The Anonymizer Name: Rob Smith DOB: 6/7/1972 cd5dced41028cb7ea51d52a888089d73 00c9782a552a2d09b1b85e0d0db52ef3 7f2b6e48ea7d042bbe85e46ef2107da4

  30. Mark Randy Smith DOB: 06/07/74 123 Main Street 713 731 5577 M. Randal Smith DOB: 06/07/74 713 731 5577 Patient Identifiers Are First Anonymized Re-Constructed Identities Observations Sensors Lab Results Record #A-701 FEATURES: Mark Randy Smith, M. Randal Smith 123 Main Street 713 731 5577 DOB 06/07/74 Outcomes Record #B-9103

  31. Patient Identifiers Are First Anonymized Re-Constructed Identities Observations Sensors Cd5dced41028cb … 00c9782a552a2 … 7f2b6e48ea7d0 … … Lab Results Record #A-701 0d06b31faa7c… B5e341a4b0c… 00c9782a552… … FEATURES: Mark Randy Smith, M. Randal Smith 123 Main Street 713 731 5577 DOB 06/07/74 Outcomes Record #B-9103

  32. Identity Resolution Occurring Post Anonymization Re-Constructed Identities Observations Sensors Cd5dced41028cb … 00c9782a552a2 … 7f2b6e48ea7d0 … … Lab Results Record #A-701 0d06b31faa7c… B5e341a4b0c… 00c9782a552… … FEATURES: Mark Randy Smith, M. Randal Smith 123 Main Street 713 731 5577 DOB 06/07/74 Outcomes Record #B-9103

  33. FEATURES: Mark Randy Smith, M. Randal Smith 123 Main Street 713 731 5577 DOB 06/07/74 Patient Linkage Data is Not Stored in Clear Text Re-Constructed Identities Observations Sensors Cd5dced41028cb … 00c9782a552a2 … 7f2b6e48ea7d0 … … Lab Results Record #A-701 0d06b31faa7c… B5e341a4b0c… 00c9782a552… … Record #B-9103 Outcomes

  34. FEATURES: Cd5dced41028cb7ea51… 00c9782a552a2d09b1b… 7f2b6e48ea7d042bbe8… … Patient Linkage Data is Stored Anonymized Re-Constructed Identities Observations Sensors Cd5dced41028cb … 00c9782a552a2 … 7f2b6e48ea7d0 … … Lab Results Record #A-701 0d06b31faa7c… B5e341a4b0c… 00c9782a552… … Outcomes Record #B-9103

  35. Policy Controls Policy Controls Observations Sensors Mark Randy Smith DOB: 06/07/74 123 Main Street 713 731 5577 Lab Results Record #A-701 M. Randal Smith DOB: 06/07/74 713 731 5577 Outcomes Record #B-9103 Maximizing Discovery - Minimizing Disclosure! Discovery Record #A-701 Matches Record #B-9103

  36. The Challenges We Face • V = Volatility. The nature and dynamics of change, and the nature and speed of change forces and change catalysts. • U = Uncertainty. The lack of predictability, the prospects for surprise, and the sense of awareness and understanding of issues and events. • C = Complexity. The multiplex of forces, the confounding of issues and the chaos and confusion that surround an organization. • A = Ambiguity. The haziness of reality, the potential for misreads, and the mixed meanings of conditions; cause-and-effect confusion.

  37. Questions? http://geekdoctor.blogspot.com jhalamka@caregroup.harvard.edu

More Related