THE CENTER OF CARE DELIVERY

Transcription

1 HOW TO PLACE PATIENTS IN THE CENTER OF CARE DELIVERY. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. C. LYDON NEUMANN STOCKHOLM 2010 DECEMBER 8

2 Session Objectives Acknowledge the forces confronting healthcare... fragmentation, increased complexity and cost pressures Recognize the value of organizing the Electronic Medical Record (EMR) Journey around the Patient vs.... being driven by the separate requirements of each contributing provider of care services Discuss the role of healthcare EMR and IT in improving the effectiveness of care delivery for Patients

3 The starting point is an health care industry facing mounting issues and problems Growing Health Concerns (pandemics, patient safety, product innovation) Fragmentation ti of Care Increasing Complexity of Care (diverse settings, changing care models) (co morbidity, devices, genetic treatments) Escalating Cost of Care (costly conditions, demographic factors) Inconsistent Care Standards (care protocols, intuition versus evidence model) Health Consumer Demands (informed patients, broader health lthdfiiti definition) 3

4 The starting point is an health care industry facing mounting issues and problems 70% of information generated in home or ambulatory testing never reaches medical record Significant numbers of very serious medication errors occur annually handwriting, decimal points, drug interactions 40 percent of people with chronic conditions have more than one such condition Prevalence of chronic illnesses will grow by as much as 26% in the next two decades Half of consumers use the internet to access health hinformation i Most physicians can come up with different strategies to treat simple medical conditions i 4

5 Transitioning care delivery processes Current health delivery Connected health delivery o o Fragmented Care that is centered Care that is centered around the needs of the patient around the needs of the Focused on wellness, health system prevention and chronic care o Focused on episodic care management o Traditional health care Diverse health care settings settings (hospitals, Health consumerism physician offices) Patient empowerment o Passive consumers through mobile technology o Silos of patient information Single source of truth about the patient 5

6 Market Trends Worldwide There are a number of forces accelerating movement towards a Connected Health environment Toronto HIAL developing Connect Toronto Invested 5.1 billion in Connecting for Health Program Spending cuts for doctors, hospitals, medicine, and administration will generate 3.5 billion in 2011 Widespread use of Telemedicine but no end to end solution Meaningful Use incentives driving EMR adoption Recovery Act Dollars driving development of HIE infrastructure Top hospitals coordinate care with US hospital s for Medical Tourism Many different organizations and systems to integrate Large Market Ministry integrating EHR for all 17 regions $125 billion plan to provide affordable healthcare for the entire population by 2020 Goal is to allow every Australian to have control over their Personal Health Records by 2013 MHLW, METI, and MIAC expected to develop national EHR strategy over next 5 10 years 6

7 Role of Integrated Care... address the needs of the Patient Patient Health Record (PHR) Electronic Health Records (EHR) Patient o Mobility o Remote Monitoring Regulatory Health Insurance Prevent Diagnose Monitor Care ics / Data Metr Health Care Products and Services (Fitness, Holistic, Chronic, Emergency) Sta andards Plan Integrate Enable Deliver Electronic Medical Records (EMR) 7

8 Patient centric EMR delivers... across allvenues of care Health Information Exchange National Initiatives Disease Registries Population Health Ambulatory / Outpatient ti t / Home based Care Closed Loop Medication Management CPOE / Alerts & Od Order Sets St Critical Care: ICU, Operating Room, Emergency Care Patient Acute / centric EMR Clinical Documentation (All health professionals) Inpatient t National Initiative Laboratory Imaging Clinical Decision Support & Analytics Evidence based Patient Safety Efficiency 8

9 Example: Patient Safety enabled by a Patient centric EMR combining Closed Loop Medication Concurrent Clinical Documentation Vital Signs Flowsheets Care Plans Order Sets Clinician Notes Controlled Medical Vocabulary Medication Administration (Bar Code / Auto ID / emar) CPOE (Computerized Physician Order Entry) Patient centric requires a single source of Truth Conflict Alerts? Drug to Drug? Drug to Food? Prescribing Drug to Test? Errors (70% of errors*) Pharmacy (Formulary) Five Rights Right Patient Right g Route Right Dose Right Time Right Medication Administration Errors (10% of errors*) Dispensing (Automated) Dispensing Errors (7% of errors*) Source: G M Kuo, et. al.; Quality and Safety in Health Care 2008;17: (a further 10% were documentation errors throughout the cycle, 3% were medication monitoring errors post medication administration) 9

10 Approach to Placing the Patient in the Center Empower People Liberate Data Connect Care

11 Remote monitoring & control In home platform Remote monitoring & control Stakeholders Health monitoring devices: Vital sign monitors Glucose monitors Emergency pendant Other devices Home computer: Video conferencing Broadband Data collection Connection Local alerts Remote response Control/Configure center: :Behavioral/environmental devices 24x7 operation with sensors qualified nursing staff Activity of everyday living (ADL) Predictive monitoring and Environmental state risk analysis software Medication compliance Clinical protocols and Mental/emotional health scripting High quality decision support tools for clinicians Phone TV Mobile Family caregivers Case managers/ home nurse Physicians Emergency responders 11

12 Wellness & health management on the go MiCoach GlucoPhone LifeWatcher 12

13 From episodic to continuous interactions. 13

14 Connect Care Across the Ecosystem Health System Community Physicians

15 Examples of Personal Health Records (PHR)

16 Sample of a Provider sponsored PHR 16

17 Impacts on Strategies in Technology... Electronic Health Record (EHR) Value National Integration (e.g. CeHis Sweden) Regional Integration (e.g. SLL, VGR, RS) Entity/Facility Automation (e.g. Hospital) County Automation (e.g. All healthcare facilities, Acute, Clinics, Primary Care, Home, etc.) Departmental Automation (e.g. Lab, Radiology) No Automation Depth of Information: Detailed Information, Narrow exposure involving limited players Level of Integration Breadth of Information: Summarized /subset of data, Broad exposure involving numerous players/organizations 17

18 and one that represents an opportunity to improve care efficiency and effectiveness Critical needs addressed by interoperable health records, as cited by US Office of National Coordinator Health Information Technology (ONCHIT): Avoid medical errors Improve use of resources Accelerate diffusion of knowledge Reduce variability in access to care Advance consumer role Strengthen privacy anddataprotection data Promote public health and preparedness

19 Two Organizations that have achieved extraordinaryclinical Benefits using their EMR Kaiser Permanente KP HealthConnect sample regional results Group Health Cooperative Patient Centered Medical Home (PCMH) 19

20 Kaiser Permanente Kaiser is now the largest integrated delivery system in the US, serving over 8.6 million members across the country. 35 hospitals, >15,000 physicians, and >160,000 employees In 2003 they released the strategic plan that laid the framework for using technology and service transformation to create a care dli delivery model dlthat t was more patient/consumer centric, t/ promising its members: Home as the hub Integration and leveraging Secure and seamless transitions and Customization In 2003, they began their KP HealthConnect journey 20

21 Kaiser Permanente KPHealthConnect Results 33 HIMSS EMR Adoption Level Stage 7 Hospitals Sample Administrative Results Saved costs for printed forms almost immediately >95 percent reduction in dictation costs Kaiser Permanente is now building new hospitals without medical record storage areas, reducing archival storage space by 54% Sample Clinical Results Provide patients t with test tresults within two days instead of a week or longer Reduced the rate of medication errors by 57 percent Trimmed by 12 percent outpatient lab utilization Reduced ambulatory visits by 26% in Hawaii Region 21

22 Group Health Cooperative Group Health Cooperative is a consumer governed, nonprofit health care system Coordinates care and coverage in the Pacific Northwest Serves more than 600,000 patients Using its EMR, they initiated a Patient Centered Medical Home (PCMH) demonstration project in 2007 that included changes in: Care delivery Virtual medicine Chronic care management Visit preparation and Patient outreach Practice management Telephone call management Patient huddles Standard management practices Source: Reid et al. Health Affairs, May

23 Group Health Cooperative Year Two PCMH Results 29% reduction in emergency room visits 6% fewer hospitalizations $10.30 total savings per patient per month 50% ROI Estimated $40 M/year in cost savings Lessons learned Adaptive leadership Investment in primary care Change management Patient centered EMR Source: Reid et al. Health Affairs, May

24 Achieving Clinical IT Benefits: Common Themes Each organization Had a clear sense of purpose and vision Engaged gg a captive group of physicians in the design and execution of its programs Invested in an EMR solution that could capture integrated patient data Committed to changes in healthcare delivery processes and culture Didn t forget the patients each of these organizations has robust PHR (Patient Health Record) capability Had the will to measure monitor improve NOTE: Much ofthis work continues following implementation 24

25 A New Model of EMR Support EMR Delivery and Support Portfolio Value Proposition Implementation Integration & Configuration Adoption Clinical Transformation Support / Optimization Clinical Focused Support Free up budget to get more done Connected Health H.I.E. Clinical Analytics Ambulatory / Primary Care Connection Drive value out of EMR investment 25

26 Top 5 Lessons Learned from HIMSS Analytics EMR Adoption Model Stage7 Hospitals 1. Training is integral to success. 2. Communicate expansively to get everyone on board. 3. Responsive to the caregivers. 4. It s all about the patient. 5. Get the right people at the table. Source: 2010 HIMSS Survey of Senior IT Executives at HIMSS Level 7 Hospitals 26

27 Putting it all together.... So what does allthis mean? EMR implementations ti are a journey Leading organizations have shown us that the real work begins after you go live Organizations that have been most successful in achieving clinical and operational goals have invested heavily in optimization, enhancements, and a new breed of IT staff Clinically/operationally aware they understand clinical operations as well as the applications Patient centric they solve real world problems in real time Analytics focused they measure and monitor The challenge: These resources are hard to find, particularly in the current market 27

28 The Healthcare Ecosystem The electronic flow of health related data across the continuum of care will improve the quality and efficiency of healthcare delivery Connected Health Hospital Connected Health Remote Care Connected Health Authorities Connected Health Patient Connected Health Life Sciences and Research Public Connected Health Connected Health Funder or Payer (Public or Private) Connected Health Clinician 28