Our HealthCare is Broken

1. Our HealthCare is Broken • Because of the way we pay for it • It’s going to get worse • Boomer Bulge is here • Chronic disease is >75% of costs • Country cannot sustain current path • Medicare/Medicaid Cuts willhappen • Technology is just a tool, but it can help enable the needed process and payment changes • ACOs, EMRs, CDS, VBP, HIEs, etc.

2. Where should we focus first?

3. What is Meaningful Use? 20 things you must do to get money from the government and avoid penalties in the future • 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) • 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) Stuff we should have been doing

4. 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

5. Why should Docs Care?

6. Foundations for the Next Decade 1 Monitor & Improve Quality To measure and achieve quality targets, providers need the ability to integrate EBM, document processes, monitor & report on quality markers. 2 Coordinate Care and Engage Patients To effectively decrease costs and keep patients well, clinical data must be fluid, usable, and have consumer accountability. 3 Manage the Organization Providers must be able to understand how each provider is delivering care and manage the payment distribution to incent the correct outcomes. 4 Population Management Providers must generate population-level reports and analytics.

7. 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

8. Heartland Health Technology Purple = Doing Gold= considering Remote Presence Telemedicine Bedside computers Home Monitoring Ambulatory EMR Smartphones Mobile Systems E visits /Pt portal CVIS Clinical/financial Analytics EDW Device Mgmt Point of Care CDS Bar Code Meds Mgmt ACO/MU workflows LACIE HIE Clinical data repository Critical Care IS New partnerships Laboratory IS RFID Inpt CPOE Physician Documentation Master patient index Radiology IS PACS EDIS Patient- Entered data Remote ICU Integrated IP/OP EMR Inpatient EMR Pharmacy IS Surgical IS Pathology imaging Early Adopters 2 Innovators 1 Consensus Adopters 3 Cautious Adopters 4 Late Adopters 5

11. If we have that….

12. It’s more than just dashboards

13. Preventive and Health Maintenance Measures User customizable components for various workflows

14. What Needs to be Done?

15. Physician Scorecards “Drill Down” Physician Quality Measure comparisons dPopulation in need with one click

16. LACIE Provider View: Integrated with EMR dSource of information Linked reports

17. Clinical Decision Support at Point of Care Risk Calculation Actionable orders at POC Exclusions Give it to someone else Associated lab with meds

18. Population Summary for Qual Measures Customizable Filters Individual Quality Measures and management

19. Who is at Risk?

20. Why, Again? • Example lifeline with poor diet, activity level • Lifeline with Health promotion • Prevention, exercise, diet • Best evidence based care For CFOs – Lost productivity, lower claims Vitality 0 20 30 40 50 60 70 80 90 For Patients – Happier, healthier lives Source: Extremely Scientific Guesswork, inc.