Connected Health HCL s Approach to achieving meaningful use through Technology

Transcription

1 8 March, 2010 Connected Health HCL s Approach to achieving meaningful use through Technology

2 Contents Current State of Affairs 2 Redesigning the Care Delivery Model Leveraging Community Health Record 3 Connected Health A Maturity Model 4 Connected Health An Ideal Deployment Model 5 An Ideal EMR solution 6 Conclusion 7 About Healthcare at HCL 7 About Wellogic 7 About HCL Wellogic solution for connected healthcare 7 ABOUT HCL 11 Current State of Affairs Healthcare is one of the last few industries where inefficiencies are abundant in the care delivery value chain. This invariably leads to the inevitable cost escalation and poor clinical outcomes. Various statistics are available to substantiate this assertion. However it is indeed difficult to ascertain the reasons and come up with solutions. The facts are: Cost of care is ever increasing Access to patient clinical data at the point of care is mostly limited to data that is generated within a care delivery facility Care delivery with limited information Care coordination is again, limited within the delivery system Decision support at the point of care is almost non-existent Lack of data mining across claims data and clinical notes to identify areas of improvement and device solutions towards reducing costs and increasing care quality Lack of incentives and motivation among the majority of the providers to proactively participate in a connected community Most of legacy healthcare technologies/solutions and even, some contemporary technologies and products have created data silos Government funded programs enable financially sustainable health exchanges at local, state and federal levels

3 While technology might have limited role in addressing some of these issues, it does facilitate in the availability and accessibility of critical information needed by providers at the point of care. In some ways, availability of these newer models and technology actually facilitate in the redesigning of traditional healthcare delivery. Redesigning the Care Delivery Model Leveraging Community Health Record In a traditional office visit, providers were left with making many critical decisions in an isolated manner. It relied heavily on unreliable patient supplied information combined with locally generated clinical data. Furthermore, the provider has no reliable support system to make informed decisions in the course of delivering care that is based on historic evidences. The combination of limited view of clinical data and lack of a decision support system have been the leading causes of most of the contemporary issues that Healthcare faces now. What is needed is a redesign of care processes and work flow; providers will also need to adopt new ways of working and communicating within practices and across organizations. In the redesigned workflow model, a community health record is the foundation for all decision-making at the point of care. Starting with the patient, who researches online for her medical conditions populates her own personal health record with relevant information. Before the face-to-face office encounter could happen, the patient has the option to interact with her physician via the available patient portal, secure etc. She also uses the portal to access her past lab results and uses it to educate herself with commonly available information on her condition and treatment options. When she arrives at the office, she is an actively involved, informed patient.

4 Behind the scene, her community health record is being populated with other clinical data based on encounters elsewhere like at her specialist, her previous hospital visits, dispensed medications, lab results orders by other providers etc. The patient and the office staff collaborate over the portal to schedule the actual appointment. When the patient arrives at the office, her complete clinical record is available at the point of care. During the encounter, the provider is not provided with a complete view of her medical conditions, also has alerts; decision support tools based on standardized care rules. The outcome? Care coordination at its best offered in the most efficient and cost effective way, while minimizing errors. Therefore under this connected healthcare model, there is a new understanding and hence a new definition of EHR. It is not a comprehensive database of a patient s information, but rather a set of information technology services and solutions designed to ensure that providers at the point of care can share pertinent patient information. Furthermore, EHR is not intended to replace the manual and electronic point of service systems already utilized by health providers and delivery agencies but rather, to augment and integrate with them by improving access to information and services fostering care coordination and patient safety. Thus the EHR as traditionally know, is no longer a single system but an orchestrated set of enabling technologies, standards & processes. The Community Health Record is the underlying data-store that enables this connected health. Connected Health A Maturity Model A measurement model is necessary in any system that is undergoing rapid change. HCL offers this model to objectively assess the capabilities of various care delivery organizations ability towards providing standard of care while minimizing the costs. Level 1 Digital. These are the organizations that use electronic forms of clinical data. Data is generated and consumed within the entity. Data could be either in scanned image format or discrete data elements. Most EMR vendors can deliver this level of capability. Level 2 Shared. At this level, an organization is able to consume as well as contribute clinical data with external interested entities in a community. It implements security, privacy and consent models to ensure proper use of data and adherence to various governing laws. Data flows are bi-directional and supports both peer-to-peer as well as aggregated, single best community record models. Care coordination is possible at this level. Level 3 Meaningful. Semantic interoperability is achieved at this level to add context and meaning to the discrete data elements aggregated from participating entities. If community generated clinical data is merely accumulated and presented as a long list of values, it will stress the providers ability to discern any value out of it. It is the difference between listing Potassium levels from various labs and presenting it in a single time-based graph as part of a flow sheet.

5 Level 4 Activated. Clinical decision support elevates an organizations capability to this level. Rules engines that utilize standards of care as prescribed by various quality institutes in conjunction with community generated data elements will recommend patient specific, episode specific care. Evidence based quality measures are proactively presented at the point of care, at the time of care delivery, rather than after the fact. Point-of-care information is easily available to evaluate quality of care delivery in light of historical and presenting clinical picture. Level 5 Leveraged. At this level, a data warehouse function leverages de identified community patient records to provide population level insight. This allows for federal, state and local agencies to respond to public health emergencies, including disasters and pandemic diseases. It also allows for accelerating the dissemination of clinical and scientific research results to government, industry and the scientific community. Connected Health An Ideal Deployment Model On-ramp to connected Health. Establishing a community in a local setting has to be approached in a gradual manner. As organizations mature in their capability model as defined earlier, available technology should be an enabler for getting them from paper based records and workflows based on them to electronic medical records and workflows that span organizations. To avoid the usual conversion costs, it is recommended for providers with paper-based records to be given a portal access to the community record via a provider portal. This allows for provider to instantly get a community wide view of the patient s data from various care providing entities. This low cost step will allow the provider to adjust his/her workflow to begin to rely on data generated from outside the office. In this step, providers will not be able to generate any new orders or progress notes. In the subsequent step, an EMR Lite, again deployed via the web allows for the provider to add decision support tools, alerts and reminders etc. to the community record. Care coordination and quality of care improves as automated decision support capabilities are added. Community EMR Portal (View Only) EMR Lite

6 Finally, a full functional ambulatory EMR system cold then be deployed allowing for locally generated data to be part of the community. At this step, the provider is actively interacting by consuming as well as contributing to the community records. Platform as a Service (PaaS). As noted earlier, under the new paradigm, the new EMR should not be viewed as an application but rather a system of technologies and services made available to enable care coordination within a community. This implies that there will be a slew of higher-level applications like CM/DM and Image exchange etc. These will reside side-by-side with the traditional clinical tools like flow sheets and progress notes. A meaningful model would then have to deploy the core HIE services as a platform allowing for the community participants themselves to deploy higher-level applications appropriate for them. An Ideal EMR solution Community record: EMR vendors cannot continue to create new silos of clinical data. Any EMR that must meet federal mandates like care coordination must be based on clinical data gathered, assembled and presented from a community of caregivers. Meaningful presentation: Aggregating clinical data is one thing. But if all it does is to chronologically list discrete clinical data from various entities, then the provider is left with making sense of these increased amounts of information. Listing all lab results from hospitals and other providers is not enough. But they need to be tied to symptoms, medications taken at that time, particular episodes allows for the provider to garn meaningful information. They could be trended over time improving point-of-care decision-making. Context aware, ontology mapped presentation of discrete clinical data is essential in any community based medical record. User Interface: Contemporary EMRs may have unintended consequences for care coordination, such as creating information overload that complicates providers efforts to discern key clinical information. And managing information overflow from EMRs is a challenge for clinicians. EMR application need not have to be a complex monolithic application that resembled an ERP system rather than a decision support system in a fast-based office setting. Providers, given their availability of time, need user interfaces that are uncluttered, and intuitive. Standards: While many evolving standards are available in EMR and HIE, HCL recommends the following minimal set of standards that a solution must conform to: IHE-XDS Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing IHE-XDS Lab IHE Laboratory Report Document Sharing IHE-RFD IHE Retrieve Form for Data Capture IHE-PIX IHE Patient Identification Cross-Referencing IHE-RAD XDS-I IHE Cross-Enterprise Sharing of Images

7 IHE-NAV IHE Notification of Document Availability IHE-XDS-MS IHE Medical Summary Document Sharing IHE-PDQ IHE Patient Demographics Query Conclusion While the EMR adoption rate in the US is still around 15 to 20 percent, this is the ideal point to do it right, the first time. Learning from other industries, which have gone ahead in the technology adoption curve, healthcare organizations should completely avoid building brand new silos as they transition from paper based to electronic medical records. HCL believes that technology can have a great role in achieving the holy grail of healthcare reducing costs and improving care. A community based health record approach, enabling technologies and an incremental adoption model can reap greater benefits. The true intended objectives of Managed Care in the US could finally be achieved by the connected healthcare model. About Healthcare at HCL The Healthcare Practice is the fastest growing industry focus within HCL. It consists of 1,800+ associates to provide solutions and services to the healthcare and life science industry, across the globe. Our team of Techno-domain experts provides end-to-end services in areas such as consulting, package selection & implementation, systems integration, application development and maintenance, testing services, business process outsourcing and infrastructure support services to the Payer, Provider & ISV s addressing these industries. About Wellogic Wellogic provides industry-certified interoperability and pointof-care solutions for connecting the healthcare community and enabling safety, efficiency, and convenience in care delivery. Wellogic s award-winning web-based connectivity solutions for physicians and caregivers, patients, health systems and health information exchanges are consistently recognized as the most usable, flexible and scalable solutions available, and are used daily to deliver safer, more cost-effective care for millions of patients. For more information, visit About HCL Wellogic Solution for Connected Healthcare HCL America, in partnership with Wellogic, offers industries most comprehensive solution for connected healthcare. Its offerings is based on the following principles: 1. A full functional, ambulatory EMR delivered over the web, on a subscription model 2. An EMR that natively works off of a community health record

8 3. A deployment model that leverages and works with existing systems 4. A proven health integration platform that is flexible, integrated and integratablet 5. Reduced cost of entry 6. Backed by a world-class implementation and support services The HCL-Wellogic offering framework Clinicians Patients Care Managers HIE Prolong Catalyst Visage Insight Synapse Third Party Aps. HIE Works HCL Wellogic core services for Connected Healthcare HIE PaaS Solution Components HIE Synapse - A modular healthcare integration platform HIE Catalyst - A clinical knowledge platform and Rules Engine HIE Visage - A modular, open, and adaptable secure application platform HIE Insight - A Web-based medical imaging toolkit HIE Consult Provider view into HIE - Clinical workflow, EMR, EMR lite and provider portal HIE Rapport Patient view into HIE PHR, Provider communication HIE PaaS HCL s global hosting service offered as a Platform as a Service (PaaS) HIE Works HCL s comprehensive implementation, integration, testing, certification, and training services HIE Prolong HCL s application and compliance monitoring and support service Solution Differentiators Total solution Software, Service, Support The only NHIN-connected HIE with an integrated EHR, PM, tethered PHR Three User Experiences Consult (providers), Rapport (patients), Engage (Care Mangers)

9 Meet ALL of the Meaningful Use criteria required by 2013, RIGHT NOW! Including CPOE, PHR, CCD, Decision Support & Quality Measures 18 out of the box clinical services e.g. MPI, Record locator serv. EMR Lite, referrals, results etc. Offered in three different models: Integrated Solution Based on licenses SaaS Hosted and managed by HCL PaaS Platform as a Service Hosted by clients, allows for custom clinical and administrative applications to be developed and deployed Easy on-ramping Start with Provider or Patient portal, as participation increases upgrade to EMR Lite, Full functional EMR then deploy any of the available 18 HIE services for a robust connected health care Utilization of standards including ASTM X.12N, HL7, NCPDP, XML, CCR, CCD, IHE, NHIN and DICOM CCHIT Certified full functional EMR Creative subscription model allows for financially sustainable HIEs Integrated and Integratable Meets the needs of those who want a complete solution and those who want to leverage existing products (e.g. existing MPI) Deployable under any architectural model including Federated, Centralized, and Hybrid models Community level MPI that reconciles at the application level Scalable and adaptable architecture - Based on SOA based platform and leverages contemporary frameworks and technologies (e.g. Ruby on Rails) Best in class user interface for faster adoption Integrated clinical decision support system

10 10 HCL s World-class Deployment and Support Services HCL offers a full range of operations, management and support services: The Data Factory - To manage data, message, and transaction flows across the exchange, to reconcile ambiguously identified providers, patients, and organizations, and to monitor data queues to ensure timely delivery of messages. The Content Factory - To create and manage code sets, nomenclatures, and order catalogs across the community, and to publish updates to participating care providing organization information systems. The Analytics Factory - To conduct routine security and access control audits, and to prepare and deliver routine and ad-hoc population-level reports and data sets to appropriate participating organizations. The Support Center - To provide 24x7 support to end users of the EMR, physician and patient portals and of the exchange. Data Center - ASP Hosting at State of the Art Production Environments, located globally. For further information contact: healthcare@hcl.in or visit:

11 11 ABOUT HCL HCL Technologies HCL Technologies is a leading global IT services company, working with clients in the areas that impact and redefine the core of their businesses. Since its inception into the global landscape after its IPO in 1999, HCL focuses on transformational outsourcing, underlined by innovation and value creation, and offers integrated portfolio of services including software-led IT solutions, remote infrastructure management, engineering and R&D services and BPO. HCL leverages its extensive global offshore infrastructure and network of offices in 26 countries to provide holistic, multi-service delivery in key industry verticals including Financial Services, Manufacturing, Consumer Services, Public Services and Healthcare. HCL takes pride in its philosophy of Employee First which empowers our 55,688 transformers to create a real value for the customers. HCL Technologies, along with its subsidiaries, had consolidated revenues of US$ 2.5 billion (Rs. 11,833 crores), as on 31st December 2009 (on LTM basis). For more information, please visit About HCL Enterprise HCL is a $5 billion leading global Technology and IT Enterprise that comprises two companies listed in India - HCL Technologies & HCL Infosystems. Founded in 1976, HCL is one of India s original IT garage start-ups, a pioneer of modern computing, and a global transformational enterprise today. Its range of offerings spans Product Engineering, Custom & Package Applications, BPO, IT Infrastructure Services, IT Hardware, Systems Integration, and distribution of ICT products across a wide range of focused industry verticals. The HCL team comprises over 62,000 professionals of diverse nationalities, who operate from 26 countries including over 500 points of presence in India. HCL has global partnerships with several leading Fortune 1000 firms, including leading IT and Technology firms. For more information, please visit