Healthcare Beyond The Hospital and the ICT Infrastructure Needed to Support

Transcription

1 Healthcare Beyond The Hospital and the ICT Infrastructure Needed to Support Mark Blatt MD Worldwide Medical Director Intel Corporation Med-e-Tel April 2012

2 Agenda: Care Beyond The Hospital and the ICT Infrastructure Hospital at Home. Healthcare trends and the move to Care Beyond the Hospital The Evidence for Collaborative Care The ICT infrastructure for Collaboration and Care beyond he hospital Examples of Care beyond the Hospital Summary and Call to Action 2 A healthier tomorrow.

3 Why consider care outside the hospital As Healthcare costs increase it is reasonable to look at Treating patients in lowest cost setting consistent with quality and safety Improve patient satisfaction and patient centered care Evaluate patient at home prior to elective hospitalization to improve efficiency of hospital based care 3 A healthier tomorrow.

4 Hospital Care at Home: France Between 2005 and 2009, the number of HCH establishments in France doubled. This considerable development was encouraged by the lifting of various existing restrictions. Furthermore, the existence of HCH was made obligatory at a regional organizational level, serving to show the importance placed in this form of healthcare by health authorities. Finally, HCH establishments are not subject to quantitative achievements regarding their activity. Once they have received an authorization to begin their activity by the regional healthcare authorities (Agences Régionales de Santé) they are free to expand their activity within a given territory and in full respect of their established perimeter. 4 A healthier tomorrow.

5 HAH-OP: Hospital at home for older people HAHOP is a subset of HAH relating to the 65+ population (40% of users but representing 2/3 of the stays) (17). It targets older patients suffering from serious acute or chronic progressive diseases needing complex and/or intensive medical, nursing and social care (15 and 17). After controlling for case mix and age, studies showed that two thirds of rehabilitation hospital days could have been safely substituted by HAH stays (13) with similar services provided by HAH at a lower cost whether in rehabilitation or in acute hospitals (10, 13) while allowing patients a better quality of life (8, 9). Services are then provided by a multi-professional team under the supervision of a coordinating physician responsible for setting the care plan, while the coordinating nurse is responsible for its implementation by the HAH team (nurses, physiotherapist, occupational and speech therapist, psychologist). The nurse also coordinates care with others (if needed) self-employed professionals and with technical assistance providers (respiratory assistance, cardio monitoring, specific drugs and medications) (5, 15). A specific electronic record is used for follow up information. The coordinating team can be reached 24 hours a day Substituting 10,000 rehabilitation hospital beds by HAH beds could save 350 million per year (13). From 2006 to 2009 HAH initiatives grew from 166 to 271 home beds from 5,878 to 10,015 (4). The volume of number of HAH stays rose from 85,889 to 139,430 The volume of days (activity) grew from 1,948,210 to 3,298,104. Financial revenue grew from 385,979,339 to 652,368, A healthier tomorrow. _HospitalAtHomeForOlderPeople

6 Hospital at Home Concept (HAH) Care done at home instead of hospitalization Care to supplement an early discharge from the hospital or shorten an acute care admission Hospital care provided to the patient in his/her own home, involving technical care of a more or less complex or intensive nature, without which hospitalization would be required. Care coordination is vital between teams of care providers 6 A healthier tomorrow.

7 France and Managing Diabetes France signs a 4 year agreement with Heathways for diabetes management services Frances agreement with Heathways places the patient s physician at the center of the patients interaction with program staff and follow US Patient centered medical home principles (PCMH) 7 A healthier tomorrow.

8 New Payment and Care Delivery Models under consideration in USA Patient Centered Medical home (PCMH) General theme: Treat citizens in lowest cost settings appropriate to their needs and when possible keep them there Accountable Care Organizations (ACOs) 8 A healthier tomorrow.

9 The Patient-Centered Medical Home (PCMH) is a Model of Health Care Delivery The PCMH would 1. Be responsible for all of the patients health care needs: acute care, chronic care, preventive services, and end of life care working with teams of health care professionals. 2. Coordinate the care of its patients with specialists, lab/x-ray facilities, hospitals, home care agencies, and all other health care professionals on the patient care team. 3. Use health information systems to provide data and reminder prompts such that all patients receive needed services. 5. Patient Centered Primary Care Collaborative Intel Confidential

10 10 Intel Confidential

11 Care Beyond the Hospital The Evidence for Collaborative Care 11 A healthier tomorrow.

12 Patients Report Experiencing Poor Coordination Percent U.S. adults reported in past two years: Your specialist did not receive basic medical information from your primary care doctor Your primary care doctor did not receive a report back from a specialist Test results/medical records were not available at the time of appointment Doctors failed to provide important medical information to other doctors or nurses you think should have it No one contacted you about test results, or you had to call repeatedly to get results Any of the above Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2008.

13 Commonwealth Survey of PCPs How does the US compare with other in communications Percent reporting that they receive information back for almost all referrals (80% or more) to Other Doctors/Specialists: AUS CAN GER NETH NZ UK US Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

14 Evidence for Care Coordination 2007 prospective cohort study of 756 patients with life-limiting illnesses in California In the patient-centered group (358): 38% fewer admissions 36% fewer inpatient days 30% fewer ED visits 26% lower cost Sweeney L, Halpert A, Waranoff J. Patient-Centered Management of Complex Patients Can Reduce Costs Without Shortening Life. Am J Manag Care. 2007;13: A healthier tomorrow.

15 ED Visits by Source of Care and Income

16 Evidence for Care Coordination Geisinger Health System in Pennsylvania 36 primary care practices with NCQA Level 3 PCMH certification vs control practices Positive results: 40% reduction in 30-day readmissions 20% reduction in (total) admissions 7% lower costs Arvantes, J. Geisinger Health System Reports That PCMH Model Improves Quality, Lowers Costs. AAFP News Now. May 26, A healthier tomorrow.

17 New West Physicians (Denver, CO) 76 Providers (41 FP, 17 IM, 8 Hospitalist, 10 mid levels) Level 1 PCMH NCQA (pending) Extended Hour and After hrs Access (24x7) EMR is all offices connected to hospital, labs, path EPrescribing and electronic prescription delivery Quality improvement CDM programs $4.4M cumulative HIT investment ($11M incr. rev 07-09) Centralized coordinated Post discharge and follow up with 24 hrs (including we deliver your meds) Daily team meetings: 30 minute review of the day RESULT: 1% 30 day readmit rate (usual 6-18%+) American Hosp Association Jan 2011 ACO Case Study: New Physicians West 17 A healthier tomorrow.

18 Healthcare Beyond The Hospital ICT Infrastructure To Support

19 Data Flow to Support Care Coordination for Better Outcome Gather & Store Data EMPOWER citizens Share the Data Patient, Provider and Family Mobilize Data

20 Data Flow to Support Care Coordination for Better Outcome Gather & Store Data EMPOWER citizens Share the Data Mobilize Data

21 Our End-To-End Story Care Coordination Across the Continuum Health Checkup Clinical Decision Support Emergency Self Check & Control Data Exchange Personal Health Record Patient-Centric Care Data Exchange Clinic Electronic Health Record Data Repository Home Community Hospital Visiting Care Pharmacy Long term Care Academic Hospital Research Remote Diagnostic

22 Pocketable SIZE Portable Thoughts On Mobile Users/Usages In Hand Usage Frequent/ Short Sessions Nurse/MD Simple patient monitoring, paging, CPOE Smartphones and Handhelds MD Viewing EMR/ images, patient monitoring, CPOE Tablets USER EXPERIENCE Nurse EMR viewing and simple editing, CPOE, emar MCA + Table Top Usage Fewer/Longer Sessions Nurse/ Administrators EMR viewing and simple editing, scheduling Netbooks MD (specialist) Viewing/Editing for EMR and PACS Notebooks Some Convergence Basic/Medium Internet FUNCTIONALITY Multi-Function Immersive/Visual Internet + MCAs have a variety of processors from Atom to Core i5 & i7 vpro

23 Productive Real time Collaboration

24 Possible Collaborative Workflows EMS: treat in place: EMT/ doc / homecare nurse/ community care worker ED Discharge to home : doc/ homecare nurse/ community care worker ED Admit: ED nurse / floor nurse / transportation Consults Acute inpatient: doc/doc/therapists/ pharmacist/ etc) Consults Chronic Disease outpatient: doc/ doc/ therapists/ homecare nurse / community care worker/ etc Homecare: doc/ homecare nurse/ community care worker

25 Healthcare Security & Privacy Across Desktop Virtualization Options Virtual Container Application Virtualization OS Image Streaming Virtual Hosted Desktop Terminal Services Client or Server Client or Server Server Server Server Risk Isolation Strategy Virtual Containers Virtual App Isolation Client / Server Client / Server Client / Server Able to Work Offline Yes Yes No No No Manage and Patch Centralized Centralized Centralized Centralized Centralized User Session Availability Data Sync with Server Data Sync with Server Session on Server Session on Server Session on Server PHI at Rest 25 2nd Generation Intel Core vpro Processor Family Based PCs Support ALL Desktop Virtualization Models

26 26 Healthcare Beyond The Hospital Examples of Collaboration

27 A Collaborative Workflow Example: Ambulance to Hospital Real time communications between EMS and hospital based care givers improves Door-Balloon time by enabling a Negative 44 minute door-ekg time Clinical Outcome: Average patient ejection fraction was over 50% Remotely managed mobile PC with attached ECG sensors 27 View all Dell case studies at: dell.com/casestudies

28 Prague EMS Mobile Technologies Car PC Tablet PC Electronic Mission Record

29 Employing new mobile initiatives at at the point-of-care The Clinique Esquirol-Saint- Hilaire case Agen, FRANCE November 2011

30 November 2011 A better hospital experience with advanced consultation in the home Benefits of tablet PCs: - Better organisation of hospitalisation conditions better resource planning - Avoid overstay and associated financial burdens - Better patient care - Related information can be sent directly to the EHR - Better definition of associated pathologies - Networking with outside health organisations (rehabilitation centres ) : immediate sharing of information - Early preparation of admittance requirements

31 SUMMARY To enable car outside the hospital Collaborative workflows are where you want to go Embracing and leading the change to Collaboration requires the right mobile tools and ICT infrastructure The change to Collaborative work shifts the locus of care and changes the work you do Mobile computing is more than simple data look up. Real time collaborative care has value Data consumption/ creation at the point of care are a good start GATHER SHARE MOBILZE EMPOWER 31

32 Call to Action Within you organization, your culture how might collaborative workflows enable more efficient care, in lower costs settings that is more convenient for the patient WHAT COLLABORTIVE WORKFLOW MAKES SENSE FOR YOU TO LOOK AT How would you get started moving towards collaboration? 32

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