What is Consumer/Patient Advocacy?

Transcription

1 What is Consumer/Patient Advocacy?

2 What is Advocacy? Advocacy is a political process by an individual or group which aims to influence public-policy and resource allocation decisions within political, economic, and social systems and institutions. Source: Wikipedia

3 Healthcare I.T. Advocacy Day Occurred May 8 th, State Capital, Harrisburg Representation from WPAHIMSS, CPAHIMSS and DVHIMSS Chapters Met with twelve Senators/Representatives in order to discuss prevalent healthcare concerns Held first Virtual HIMSS Advocacy Day on site in the Senate Chambers

4 Legislative Asks

5 Ask #1: Support policies that promote and expand the use of telemedicine throughout PA. Spending in health care has risen over 40% in the last decade. The deployment of Telemedicine is expected to increase dramatically in healthcare over the next decade as a method of providing services to a rural population and reduce costs. We ask you to: Support the Expansion and use of Telemedicine and mhealth patient engagement to improve patient outcomes and reduce costs. Increase awareness of the value of reimbursing for Telemedicine encounters particularly among private insurance carriers

6 Telemedicine By 2013, 25 percent of patient encounters in North America, Europe, and Asia that can be conducted virtually will be. Gartner Research $232 Billion personalized medicine market to grow 11% annually.. telemedicine, health information technology and disease management services offered by traditional health and technology companies is estimated at $4 billion to $12 billion and could grow tenfold to over $100 billion by 2015 if telemedicine takes off. PricewaterhouseCoopers 6

7 Telehealth-Rapidly Evolving Advancing technology Breakdown of geographic boundaries Low barriers to entry Competition for new/changing markets Environment Telehealth/Telemedicine Traditional Relationships 7

8 Benefits of Telehealth Improves access to healthcare Supports patients and families Improves health outcomes Reduces healthcare costs Can assists with shortages of healthcare providers Patients found virtual visits similar to face-to-face visits on most measures Physicians were also highly satisfied with the virtual visit modality both patients and physicians could benefit if virtual visits were used as an alternative method of accessing primary care services Source: A randomized trial of virtual visits in a general medicine practice J Telemed Telecare 15(3): doi: /jtt Ronald F Dixon and James E Stahl, MGH-Beacon Hill Associates, Massachusetts, USA 8

9 Patient-Centered Continuum of Care Acute Care Destination Medicine Community-Based Care Specialty Outreach ( Face-to-face & Telemedicine) Ambulatory Care & Surgery Center Tertiary/Quaternary Medical Center TeleICU Urgent Care Center Multi- Specialty Clinic E-Visit MyGeisinger After-Hours Care Center Retail Clinic Specialty Center, e.g. Cancer or Sleep Community Practice Site Post-Acute & Transitional Care Outpatient Rehab Inpatient Rehab Adult Health Program & Day Center Imaging Center Home Care Wellness Hospice Retail Pharmacy Lab Outreach Site Work Site Clinic ProvenHealth Navigator

10 Placing telemedicine into a context ehealth Remote support: Portals (patient/md) Videos and mobile apps Targeted messaging EMR access Prevention and wellness Education and activation Anticipatory management Proactive outreach On-line PC encounters Critical/emergent services Specialty consults Remote monitoring Telemedicine Remote care: Diagnostic Therapeutic Async or live Telemedicine: Remote care delivery ehealth: Remote care support Telehealth: The combination of telemedicine and ehealth 10

11 Service line-based telemedicine Develop and Implement a Multi-Tier Telemedicine Framework: 1. Emergent Care TeleED, TeleStroke 2. Critical Care TeleNICU, TeleICU 3. IP and OP Specialty Consults Any relevant sub-specialty 4. Primary Care On-line care with 30-minute response 11

12 ASK #2: Support continued implementation of Electronic Health Records and Health Information Exchange throughout the Commonwealth, and expand to other key providers including long-term care, rehabilitation and behavioral health providers. While Pennsylvania ranks 4 nationally in EHR implementations, nationally only 6 percent of longterm care facilities, 4 percent of rehabilitation facilities, and 2 percent of psychiatric facilities have a basic electronic health record system. [9] Continue to support the state run and federally funded Medicaid meaningful use program for qualifying practices and facilities Encourage efforts to drive EHR adoption by long-term care, rehabilitation and behavioral health providers who are increasingly responsible for ensuring continuity of care. Support continued funding of Health Information Exchange needs at the state and regional levels.

13 Expand use of E.H.R. and H.I.E. E.H.R. Meaningful Use covers Acute Hospitals, Primary Care Physicians, Pediatrics Need to close gaps in coverage in other Transition of Care Services: Specialty Physician Services LTACH s Long Term Care Home Health Rehabilitation

14 Benefits of EHR Obtaining practice and patient data quickly Ready access to all information Puts practices in a stronger position to participate in accountable care organizations (ACOs) Allows external reporting of various metrics to payers to justify care-coordination fees and pay-for-performance bonuses

15 Health IT State Summaries Office Based Providers Adoption & Utilization of EHRs

16 Persistent Issues Most EHR systems today have been designed to create a billable note rather than efficiently collecting and analyzing clinical administrative data to support clinical decision-making. To get these systems to support proactive patient care takes vision, customization and ongoing commitment to continuous quality improvement.that doesn t come in the box. Patient s data is not within one EHR. to maximize the value of health information variable clinical data must be standardized and integrated. they don t provide all the pieces necessary for a learning health care system. They do not focus on standardizing and integrating data from disparate sources, and their ability to transmit or exchange data is limited.

17 Stages of Meaningful Use Improved outcomes Data capturing and sharing Advanced clinical processes Stage 3 Stage 2 Stage 1

18 What is in the Stage 2 Rule New clinical quality measures New clinical quality measure reporting mechanisms Payment adjustments and hardships Medicare Advantage program changes Medicaid program changes

19 What Stage 2 Means to You New Criteria Starting in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for two or three years will need to meet meaningful use for Stage 2 criteria. Improving Patient Care Stage 2 includes new objectives to improve patient care through better clinical decision support, care coordination and patient engagement. Saving Money, Time, Lives EHRs are projected to save our health care system money, save time for doctors and hospitals, and save lives.

20 Expansion in Long Term Care & Behavior Health Adoption has been slower Statewide efforts with pilots to increase the exchange of health information among these settings QIO Special Project to exchange CCDs in LTC Navigant pilot to exchange CCDs in BH and LTC

21 Patient Engagement Patient engagement will be the cornerstone to meaningfully using an EHR Engaged patients are empowered patients New requirements will help to foster that engagement

22 Patient Perspective Accenture surveyed 1,100 U.S. adults about their desire for online tools that will help them self-manage their care. Patient Experience/Perception Respondents agreed Want to use technology to self-manage health care 90% Want to preserve in-person interactions with doctor 85% Want online access to health records 83% Want doctor to manage their health records 48% Prefer to manage own health information 44% Don t know if services are available online 33% AMEDNEWS.COM 7/12/12 - by Pam Dolan

23 Patient Portal

24 Meaningful Use Promotes Patient Engagement Stage 1 requirement was 50 percent Stage 2 is now a requirement

25 Future Requirements Remote monitoring is included in Stage 3 recommendation

26 Health Information Exchange

27 The Case for HIE Health Information Exchange Copyright 2012 Keystone Health Information Exchange Fragmentation and silos 27

28 Keystone Health Information Exchange Erie Warren McKean Potter Tioga Bradford Susquehanna Crawford Wayne Mercer Venango Clarion Forest Jefferson Elk Cameron Clinton Lycoming Sullivan Columbia Wyoming Luzerne Lackawanna Pike Lawrence Butler Clearfield Centre Union Montour Carbon Monroe Beaver Armstrong Indiana Mifflin Snyder Northumberland Schuylkill Northampton Lehigh Allegheny Westmoreland Cambria Blair Huntingdon Juniata Perry Dauphin Lebanon Berks Bucks Washington Montgomery Cumberland Greene Fayette Somerset Bedford Fulton Franklin Adams York Lancaster Chester Delaware Philadelphia 38 Unique Healthcare Companies 20 Hospitals 173 Physician Practices 28 Home Health locations 70 Long Term Care Facilities 1 Pharmacy and 1 LTACH

29 HIE Community Connections Primary Care Physician EMR Labs Orders and Results Independent Health Facility Imaging Long-term Care Physical Therapy Community Connections Master Patient Index Document Registry Document Repository Other HIE Patient Personal Health Records Payers Medicaid/ Medicare Private Pharmacy eprescribing Medication History Specialty Practice EMR ereferral Academic Medical Center Community Hospital Government Quality and Efficiency Public Health Copyright 2013 Keystone Health Information Exchange

30 The KeyHIE Value KeyHIE is trusted, operated, neutral and transparent with its participants A phenomenal composition of partners willing to make a change to the healthcare community Experienced staff and management with consistent oversight Proven technology : Caradigm (Orion Health), Get Real Health Built on best practices: HL 7 standards, Geisinger backbone, State and Federal approved policies and ONC guidance and support KeyHIE has established mechanisms to ensure that the its policies and practices and applicable federal and state laws and regulations are adhered to. Promotes inclusive participation and adequate stakeholder representation in the development of policies and practices. Copyright 2013 Keystone Health Information Exchange 30

31 KeyHIE Services HIE for Providers Connected EHRs HIE for Patients View HIE Documents Receive Alerts/Notices Direct Messaging Scan/upload docs Publish Documents Consume Documents Direct Messaging View HIE Documents Patient Education Health Reminders Direct Messaging Medication History Scan/upload documents Copyright 2012 Keystone Health Information Exchange

32 HIE for Patients View selected information from the Keystone Health Information Exchange (KeyHIE ) Sign up to receive automatic, annual flu shot reminders Exchange secure s with your care team Upload paper records (the 3-ring binder ) Access reliable online information (MedlinePlus) Copyright Keystone Health Information Exchange Copyright 2012 Keystone Health Information Exchange 32

33 Feedback Quick access to more complete patient data from other healthcare providers What do physicians say about KeyHIE? Less time collecting information i.e. phone calls, faxes, etc. Supports Meaningful Use for HIE Avoid re-work i.e. repeat taking of histories Fewer canceled appointments due to missing information Copyright 2012 Keystone Health Information Exchange Copyright 2013 Keystone Health Information Exchange

34 Feedback What do hospital administrators say about KeyHIE? Quick access to patient information from other healthcare facilities Reduces expensive manual information processing costs (e.g. phone calls and faxing). Access to prior diagnostic testing for comparisons Expedites patient information to Emergency Departments; improves ED throughput Supports Meaningful Use using HIE Minimizes unnecessary/avoidable services related to DRGs Copyright 2012 Keystone Health Information Exchange Copyright 2013 Keystone Health Information Exchange

35 Until we have E.H.R. s in the Post-Acute sector:

36 Background LTPAC to HIE Developed with AHIMA, HHS, and S&I (LCC workgroup) HL7 Balloted. Nationally available Web service. LTPAC MDS or OASIS Clinical Summary HIE Copyright 2012 Keystone Health Information Exchange 36

37 Background Dissemination Dissemination requirements: National standard to transform MDS and OASIS to clinical summary format Provide implementation guides and schemas Create effective toolset for widespread adoption Copyright 2012 Keystone Health Information Exchange

38 Runs automatically: Self-service tools Help desk support KeyHIE Transform TM Easy to use Copyright 2012 Keystone Health Information Exchange

39 Ask #3: Align State Privacy and Security laws and regulations with Federal requirements to pave the way for inter- and intra-state health information exchange. The existing patchwork quilt of complex state privacy laws is expected to undermine growing public expectations about the ability of their healthcare providers to securely share information. We ask you to: Support efforts by the Pennsylvania ehealth Partnership Authority to ensure the secure exchange of health information. Support efforts to educate public and private stakeholders about protecting their own health information and securely exchanging health information.

40 Align Privacy Laws to Support Exchange HIPAA is designed to protect patient privacy while allowing for the exchange of information for treatment, payment or healthcare operations. Many states have an Opt-out policy to exchange patient information for treatment Pennsylvania recently passed Senate Bill 8 to be an Opt-out State, HOWEVER it does not include the 3 Super Protected Areas.

41 Align Privacy Laws to Support Exchange Three Super Protected Areas are: HIV Treatment Drug and Alcohol Treatment Psychotherapy Treatment Meaning we need to exclude this information for information sharing in Pennsylvania Difficult to control for a number of reasons: Psychiatric units in hospitals Physician notes may reference 3 Super Protected Areas Medications or Lab results may reference as well

42 Align Privacy Laws to Support Exchange Discussions with Legislators to consider removing the barrier to the Super Protected Areas Research what other states have done to remove this barrier Continue to educate Legislators and Patient Advocacy Group as to the value of patient information sharing to support quality outcomes and drive down cost of healthcare.

43 Ask #4: Leverage Pennsylvania HIMSS Chapter (CPAHIMSS, DVHIMSS and WPAHIMSS) members as a resource : To address questions related to Health I.T. Health Information Exchange and Privacy & Security related issues. Count on us for expert counsel & support!

44 Questions?