The Healthcare Services Platform Consortium (HSPC) Oscar Diaz, VP and GM, SOA Suite, Canada and Latin America

Transcription

1 The Healthcare Services Platform Consortium (HSPC) Oscar Diaz, VP and GM, SOA Suite, Canada and Latin America

2 The Healthcare Services Platform Consortium THE CONSORTIUM 9-Sep-14

3 Healthcare Services Platform Consortium When: Tuesday, May 21, 2013 (1:00-3:30pm, MDT) Where: Intermountain Healthcare s Central Offices* 36 South State Street Salt Lake City, Utah *Conference call and WEBEX will be available Stan Huff, MD Chief Medical Informatics Officer Intermountain Healthcare Chris Wood, MD IS Medical Director Intermountain Healthcare Vishal Agrawal, MD President Harris Health Care Solutions Oscar Diaz VP, General Manager Harris Health Care Solutions Huff # 3

4 The Problem Technology drag on medicine

5 Transforming Healthcare Information Management IHC 9/9/2014

6 The Healthcare Services Platform Consortium An HCO led and vendor agnostic Healthcare Enterprise/Vendor/Venture Collaborative The Consortium : Stands on the shoulders of the work Harris/IBM has implemented at the VA/DoD, the Canada Infoway HIAL, University Health Network/eHealth Ontario and work on SOA at other large scale HCOs such as Intermountain, Mayo, Dignity, Kaiser and others Leverages a common architectural model Creates a three tiered partnership model: Healthcare Enterprise, small to large scale vendors, venture community Business Drivers and Benefits Creates aligned incentives Accelerates development and consumption of new workflow services based applications Shares development risk by implementing a Collaborative Innovation model Monetize assets of producer organizations Support of enterprise, regional and community Clinical Integration Network Models HSP Benefits Delivers a scalable SOA based architecture that is healthcare specific Maintains a consistent architecture and development environment for creating reusable applications Layers on top of and leverages existing application frameworks 9-Sep-14

7 VA/MHS SOA SUITE Technology at Scale Accelerate delivery and adoption of technology by using a common architectural model Move to web based modular, integrated, imbedded workflows Deliver Workflow Centric, Adaptive Technologies that are customizable by the user Maintain intimacy with workflow requirements through the healthcare consortium stakeholders Move rapidly with a community of developers to reach a critical mass of application/services within 1-2 years 9-Sep-14

8 The Consortium Concept The Harris Services Integration Platform Consortium Technology Harris IBM Telus Oracle Bidirectional Technology Transfer Laboratory And Product Consumption Intermountain LSU Jackson Healthcare Cleveland Clinic HSIP Venture Funding Consortium Optimization Workflow Departmentals Market Segments Identity MDM Workflows RAD Oncology Analytics and DSS Pharma Payor High Value Applications ICU MGT OR MGT Cardiology Drug Information System Systems Integration Services Companies Strategy LSS/SOA Delivery Practice

9 Technology Village of Contributors Associate Members Siemens Allscripts Cerner Cognitive Medical NextJ Other Vendor Partners Open Source Community

10 HSPC Interested Parties Vendor Governance Board HSPC Governance Board Venture Funding Consortium Governance Board 9-Sep-14

11 The SOA Foundation Concept Diabetes CHF Stroke Care Pathways Oncology Results Management Order Management ehealth Medical Home Image Management Common Architecture (SOA) Medication Management Medication Problem Allergy Reconciliation Cerner Epic eclinicalworks Registration Web Services Enabled ENTERPRISE SERVICE BUS Auth MDM 9-Sep-14 Event MGT Identity Service State MGT Workflow Management Vocabulary Service Decision Support EDW Data Entry

12 Data Layer 9-Sep-14

13 HSPC The Harris Services Integration Platform Consortium A CASE STUDY: FAA SOA DEPLOYMENT SWIM CONSORTIUM 9-Sep-14

14 9-Sep-14

15 HSPC The Healthcare Services Platform Consortium A CASE STUDY: HIMSS Sep-14

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17 Network Topology

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19 HSPC The Harris Services Integration Platform Consortium A CASE STUDY: BOSTON MEDICAL CENTER 9-Sep-14

20 Boston Health Net: Integrated Delivery Network Partnership among: Boston Medical Center/Harris 15 Boston area Community Health Centers Boston University School of Medicine

21 PHASE I Color Key Referring provider Referring coordinator Specialty coordinator Specialty clerk Specialty Nurse Specialty practice assistant Specialty provider Patient visits the physician Need referral Provider completes an order request via the Centricity letters module Provider prints the letter and gives it to the patient number Provider routes it to the referral coordinator in Centricity Send appointment notification letter to the patient Identify the patient s insurance recorded in the EMR Insurance? Authorization required? Method of obtaining insurance information and authorizations Phone Call applicable insurance carrier - verify insurance coverage and eligibility Website Refer patient to PFS Access applicable website - verify insurance coverage and eligibility Patient is eligible? Refer patient to PFS Patient acquires financial assistance or is self-pay? Fax referral request to specialty clinic Patient is eligible? Authorization needed prior to scheduling? Obtain authorization number via website Patient acquires financial assistance or self-pay? Reject referral and notify referring provider and patient Call specialty clinic for fax reciept Refer patient to PFS tify provider and patient, cancel referral and request new referral request for different facility/specialty provider Ineligible facility/ specialty provider Reason? Authorization number obtained? Authorization needed prior to scheduling? Fax referral request to specialty clinic Procedure not covered Locate fax from referral coordinator Re-fax referral request to specialty clinic Patient acquires financial assistance or is self-pay? Fax referral request to specialty clinic Cancel referral and notify provider and patient Fax referral request to specialty clinic Obtain authorization number via phone Call specialty clinic for fax reciept Fax located? tify referral coordinator of missing fax Reject referral and notify referring provider and patient Call specialty clinic for fax reciept Call specialty clinic for fax reciept Authorization number obtained? Reason? Ineligible facility/ specialty provider tify provider and patient, cancel referral and request new referral request for different facility/specialty provider Locate fax from referral coordinator Re-fax referral request to specialty clinic Procedure not covered Verify and assess referral request Locate fax from referral coordinator Re-fax referral request to specialty clinic Locate fax from referral coordinator Re-fax referral request to specialty clinic Fax referral request to specialty clinic Cancel referral and notify provider and patient Fax located? tify referral coordinator of missing fax Obtain patient Print referral Check Review referral for confirmation Patient PHASE II Visit Type? Office visit Complete? summary PHASE III appointment Confirm insurance Visit Type? completeness (mostly arrives? information schedule automated) Procedure Review referral for completeness Complete? Call referring provider for additional information Obtain information and fill in gaps Call patient to verify receipt of prep information/understanding and review medications and conditions Issues? Cancel appointment Complete prep tify referral coordinator tify referring provider Referral information complete and correct? Contact referral coordinator for additional information Obtain required information from referring provider Fax located? tify referral coordinator of missing fax Fax located? tify referral coordinator of missing fax Call specialty clinic for fax reciept Verify assess referral request Reschedule and notify patient Required information obtained? Verify assess referral request Verify assess referral request Locate fax from referral coordinator Referral complete and correct? Contact referral coordinator for additional information Who requests appointment? Referral Coordinator Reject referral and notify referring provider and patient Referral information complete and correct? Contact referral coordinator for additional information Referral information complete and correct? Contact referral coordinator for additional information tify referral coordinator of missing fax Fax located? Check insurance eligibility Required information obtained? Patient Await phone call from patient for appointment scheduling Verify appointment preferences Obtain required information from referring provider Obtain required information from referring provider Verify and assess referral request Insured? Refer patient to PFS Schedule patient s appointment in IDX and send automated notification letter Check insurance eligibility Required information obtained? Check insurance eligibility Required information obtained? Referral information complete and correct? Contact referral coordinator for additional information Referral Coordinator Who requests appointment? Patient acquires financial assistance or self-pay? Update appointment as a no-show Patient contacted? Patient Procedure Visit type? Insured? Insured? Refer patient to PFS Obtain required information from referring provider Verify appointment preferences Await phone call from patient for appointment scheduling Reject referral and notify referral coordinator Send letter to patient and referral coordinator Fax or send procedure preparatory instructions to the patient Refer patient to PFS Who requests appointment? Patient acquires financial assistance or self-pay? Reject referral and notify referral coordinator Check insurance eligibility Required information obtained? Schedule patient s appointment in IDS and send automated notification letter tify provider of rejected referral Office visit Referral Coordinator Patient Procedure Nurse sees the patient for triage tify the referral coordinator of appointment date and time Referral Coordinator Who requests appointment? Patient acquires financial assistance or self-pay? Reject referral and notify referral coordinator Verify appointment preferences Await phone call from patient for appointment scheduling tify provider of rejected referral Insured? Refer patient to PFS Visit type? Office visit Patient Procedure Send appointment notification letter to the patient and attach to patient s chart Verify appointment preferences Await phone call from patient for appointment scheduling tify referring provider and patient Schedule patient s appointment in IDX and send automated notification letter Referral Coordinator Who requests appointment? Patient acquires financial assistance or self-pay? Fax or send procedure preparatory instructions to the patient tify the referral coordinator of appointment date and time Patient Schedule patient s appointment in IDX and send automated notification letter Visit type? Office visit Verify appointment preferences Await phone call from patient for appointment scheduling Reject referral and notify referral coordinator Obtain authorization number via phone Procedure Visit type? Office visit Fax or send procedure preparatory instructions to the patient tify the referral coordinator of appointment date and time Schedule patient s appointment in IDS and send automated notification letter tify provider of rejected referral Authorization obtained? Reason? Ineligible facility/ specialty provider tify provider and patient, cancel referral and request new referral request for different facility/specialty provider Procedure Procedure not covered Fax or send procedure preparatory instructions to the patient tify the referral coordinator of appointment date and time Send appointment notification letter to the patient Visit type? Procedure tify specialty coordinator of authorization number Cancel referral and notify provider and patient Office visit Obtain authorization number via website tify the referral coordinator of appointment date and time Fax or send procedure preparatory instructions to the patient Send appointment notification letter to the patient Authorization obtained? Reason? Ineligible facility/ specialty provider tify provider and patient, cancel referral and request new referral request for different facility/specialty provider Send appointment notification letter to the patient Procedure not covered tify specialty coordinator of authorization number Cancel referral and notify provider Check patient s Send specialist Collect copayment note Create specialist Office visit vitals and place in Perform office visit note to referring Close referral exam room provider Issues? Urgent? Immediately resolvable? Cancel appointment and reschedule Procedure is performed Resolve issues tify referral coordinator tify referring provider and patient Send appointment notification letter to the patient PHASE II BMC Process Models As-is Should-Be

22 SOA Foundation Data Governance and Model Driven Development Instrumented Workflow and Analytics Collaborative Development Business Modeling and Simulation Clean hand-off to IT with Business Models, Metrics Govern services throughout the SOA lifecycle, find and reuse for IT flexibility Integrated deployment of policies, rules, and services based on an SOA platform Workflow and Choreography Feedback for continuous improvement and optimization Business Monitoring, Dashboards, Analytics Real time collaboration and management of business processes

23 Seamless Service Orientation with BPM and SOA Services are building blocks Reuse of existing assets Flexibility to change Utilizes both Technical & Business Services Business Model Patient Referral Summary Referral List Schedule Visit CHCs Referral Coordinators Specialty Clinic Report back to Referring Physician External Obtain Authorization Validate Insurance Process Schedule Visit User Interface (Portal) Workflows Process Management Application & Data Webservices

24 Analytics

25 Analytics at the Point of Service 25

26 Integrated tification, Review and Entry

27 Final Results Adoption Curve 1800 users in 8 weeks

28 The Bottom Line Increase Referral Follow-through $6,476,022 Reduced cost of Operation $908,460 $ 7,384,482 Expedited Operations and Quicker Schedules t in ROI ROI 3 Years >5:1 Improved Quality and Safety Improved Satisfaction t in ROI t in ROI Grant Funding $543,535 $769,520 Investment In Kind $90,905

29 9-Sep-14 Summary Discussion

30 9-Sep-14 HSPC Organizational Update

31 The Healthcare Services Platform Consortium Formation Draft Agreements Intermountain sponsored the writing of the initial documents Review by Harris legal Under review by Initial Founding Members legal Initial Founding Members Intermountain LSU Jackson healthcare Harris 501 (c) 3 Formed as a 501 (c) 3 incorporated in Delaware Formation of the Board of Directors Selected from members at large Bylaws and Organization An evolutionary process Input will be continuous Publishing agreements after initial member reviews 9-Sep-14