Get Plugged in: Defining Your Connectivity Strategy. CHIME College Live 17 April 2013

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1 Get Plugged in: Defining Your Connectivity Strategy CHIME College Live 17 April 2013

2 Topics Introductions Drivers Strategies Imperatives Discussion Page 2 Copyright Kurt Salmon 2013 All Rights Reserved

3 Introductions

4 Introductions Elaine Remmlinger Senior Partner Gerard Nussbaum Director, Technology Services Page 4 Copyright Kurt Salmon 2013 All Rights Reserved

5 About Kurt Salmon: Information Technology STRATEGY and PLANNING» Strategic and Tactical Planning» Physician-Hospital Alignment» Connecting Communities» Population Health and Care Coordination» Technology Planning for New Facilities» Business Intelligence and Analytics VENDER SELECTION and SUPPORT» Vendor Selection and Contract Negotiation» Pre-implementation Planning» Implementation Oversight REGULATORY COMPLIANCE» Meaningful Use Achievement» ICD-10 Preparation» Security and Privacy Compliance INFRASTRUCTURE and OPERATIONS» IT Transformation» Infrastructure Planning» Right Sourcing» Interim Leadership Page 5 Copyright Kurt Salmon 2013 All Rights Reserved

6 About Kurt Salmon Extensive, relevant EXPERIENCE» Academic, children s, community, & national health systems Change LEADERS» Highly pragmatic and focused PROVEN team» Careers spent supporting leading health systems and complex environments Track record of SUCCESS» Rich history dating to 1947» Over 75% of ongoing work with repeat clients Strategy Finance Facility/Capital Asset Planning Operations and Performance Information Technology Page 6 Copyright Kurt Salmon 2013 All Rights Reserved

7 Objectives» Understand the drivers for connectivity» Discuss potential connectivity strategies to achieve connectivity» Consider challenges and marketplace realities» Identify common themes and imperatives for moving forward Page 7 Copyright Kurt Salmon 2013 All Rights Reserved

8 Drivers

9 Drivers Connectivity is a prime area of interest for providers of all types from sole practitioners through large health systems and encompassing all stops along the care continuum INSURER PERSONAL HEALTH & WELLNESS MGMT Patient Portal CLAIMS DATA HIE PRIMARY CARE Ambulatory EMR HIE Inpatient EMR HOSPITAL Specialty EMR SPECIALIST PAPER PATIENT RECORD DRUG INFO LAB TESTS HOME HEALTH CARE PHARMACY LAB Page 9 Copyright Kurt Salmon 2013 All Rights Reserved

10 Drivers Numerous forces are impelling providers to develop and execute a connectivity strategy» Regulatory Drivers Meaningful Use Stage 2 Accountable Care Medicare Shared Savings Program/ Value-Based Purchasing Readmission reduction program EHR Donation» Payment model shifts» Population health management» Community health improvement» Affiliated community physician strategy» Unifying the enterprise across the care continuum» Consumer care involvement Page 10 Copyright Kurt Salmon 2013 All Rights Reserved

11 Regulatory Drivers Ability to exchange clinical information as structured data and provide health information to all participants is embedded in a number of recent and forthcoming regulations» Directly required by Meaningful Use for physicians (EPs) and hospitals Provide patients the ability to view online, download, and transmit their health information Electronically transmit summary of care record for transitions in care Including with another provider with a different EHR Secure electronic messaging to communicate with patients Registry reporting (cancer registry, specialty registry) (EP only) Structured electronic lab results to ambulatory providers (hospital only) Public health reporting Syndromic surveillance, Immunization reporting Electronic lab reporting (hospital only) erx (electronic prescribing) also required by erx incentive program (MIPPA) Page 11 Copyright Kurt Salmon 2013 All Rights Reserved

12 Regulatory Drivers Proposed extension of the EHR Donation Stark exception/anti-kickback Statute safe harbor acts as a catalyst for community connectivity» Currently expires 31 December 2013» CMS/OIG proposing extension through end of 2016» Interoperability is a foundation requirement of EHRs subject to donation» Will likely spark additional demand from community physicians for practice office EMRs» Drives demand for connectivity» Connectivity will generally be greater for community physicians with hospital/health system donated EHRs to drive affiliation strategy» Donated EHR may also be a lever for adherence to Clinical best practices Quality reporting Performance benchmarks Page 12 Copyright Kurt Salmon 2013 All Rights Reserved

13 Regulatory Drivers Sharing health information is critical to the ability to manage patient health and achieve success under a number of payment-related regulations» Relevant regulations include Accountable Care Medicare Shared Savings Program/ Value-Based Purchasing Readmission Reduction Program» Parallel non-regulatory programs (e.g., with private payors) require similar capabilities Page 13 Copyright Kurt Salmon 2013 All Rights Reserved

14 Regulatory Drivers (continued)» Key capabilities Provide information to cost-effectively manage care Promote provider communication Define dashboards and scorecards Build performance transparency Leverage algorithmic tools to identify need for intervention to arrest health decline More closely monitor/track patients Elevate patient to partner in their own health Page 14 Copyright Kurt Salmon 2013 All Rights Reserved

15 Patient Engagement In addition to the regulatory incentives/requirements, better outcomes are generally available when the patient is actively involved in their own care Patient Benefits» Engage patients in their care» Build relationships between patients and providers» Increased access to clinical information Personal health records Health library» 24/7 access to Scheduling Bill pay Messaging Prescription refill requests» Increased patient satisfaction Practice Benefits» Increased practice efficiency Decreased phone call volume, Ability to shift tasks to less busy times» Improved provider-patient communication» Improved financials (increased collections)» Meaningful Use Stage 2 Online access Secure communications» Satisfied patients Page 15 Copyright Kurt Salmon 2013 All Rights Reserved

16 Population Health Management Coordinate care delivery among different care settings for the given patients Identify population to be managed and deliver care Perform risk stratification and monitor outcomes to improve care delivery Receive and distribute payments to different entities To effectively manage population health rich information sets are required Page 16 Copyright Kurt Salmon 2013 All Rights Reserved

17 Private HIEs» Health systems are still actively building private connectivity solutions, including Portals Health information exchanges (HIEs)» HIEs with broader membership (e.g., regional/community, state/federal) often Do not deliver breadth of data exchange needed to support health system goals Have significantly longer decision making and upgrade cycles Raise issues of sustainability, raising risks for health system strategic initiatives» Despite some of the disadvantages, these multi-stakeholder HIEs remain key components of a connectivity strategy Provide wide catchment for broader populations Important in retrospective at risk population assignment such as in the MSSP Support more effective/efficient care for patients not primarily aligned with the health system Functionality will evolve Provide core dial tone services that ease connectivity with the broader world Page 17 Copyright Kurt Salmon 2013 All Rights Reserved

18 Strategies

19 Many Moving Parts» Integrated vs. best of breed / interoperable solutions» Proprietary vs. community HIEs» Sponsored community physician EHRs» Single vs. multiple patient portals» Aggregator / viewer solutions» ACO solutions» Analytics» Legalities and policies Page 19 Copyright Kurt Salmon 2013 All Rights Reserved

20 No Universal Connectivity Strategy» Key considerations in defining the appropriate connectivity strategy include Strategic enterprise priorities; for example: Building a physician network Creating patient-centered care Preparing for payment reform Maximizing Meaningful Use benefits Organizational structure/dynamics; for example: Multiple silos of care/diffuse Unified care delivery organization encompassing care continuum Merger / acquisition activity Page 20 Copyright Kurt Salmon 2013 All Rights Reserved

21 No Universal Connectivity Strategy (continued) EHR solution environment across the care continuum Care locus specific EHRs Single EHR Multiple EHRs, even in similar care environments Diverse EHRs across the community Vendor marketplace status Integrated vs. interoperable Enterprise vs. best of breed solutions Page 21 Copyright Kurt Salmon 2013 All Rights Reserved

22 Unifying the Enterprise Hospital Ambulatory Procedure Center Retail Pharmacy Physician Clinics Lab IP Rehab SNF Home Wellness and Fitness Center Diagnostic/ Imaging Center Urgent Care Center Home Care OP Rehab Page 22 Copyright Kurt Salmon 2013 All Rights Reserved

23 Real World Examples To gain a flavor of the challenges and approaches, we will consider three real world examples» Disparate Solutions» Partial Integration» Enterprise and Community Integration Page 23 Copyright Kurt Salmon 2013 All Rights Reserved

24 Scenario 1: Disparate Solutions Other Providers Community HIEs Employed Physicians EHR Other EHR Other EHR Other EHR Patient Portal Hospital EHR Other EHR Other EHR Sponsored EHR Hospital EHR Community Physicians Clinical Enterprise Payors ACO 1. Disparate Solutions» EHRs» Limited Data Sharing 2. Shared Portal 3. Separate ACO Solution 4. Analytics Siloed Page 24 Copyright Kurt Salmon 2013 All Rights Reserved

25 Scenario 2: Partial Integration Other Providers Community HIEs Employed Physicians EHR Other EHR Other EHR Other EHR Sponsored EHR Proprietary HIE Patient Portal Patient Portal Enterprise Multi-Hospital EHR Community Physicians Clinical Enterprise ACO 1. Single Integrated Hospital EHR Payors 2. Separate Physician EHRs 3. Proprietary HIE 4. Multiple Patient Portals 5. Siloed Analytics Page 25 Copyright Kurt Salmon 2013 All Rights Reserved

26 Scenario 3: Enterprise and Community Integration Other Providers Community HIEs Other EHR Other EHR Other EHR Patient Portal Enterprise EHR Employed Physicians Multi-Hospitals Sponsored Community Physicians Community Physicians Clinical Enterprise ACO Payors 1. Enterprise EHR 2. Shared Patient Portal 3. Community HIE 4. Enterprise Analytics Page 26 Copyright Kurt Salmon 2013 All Rights Reserved

27 Imperatives

28 Connectivity Supports Enhanced Care Delivery 1. ALERTS Identifying care gaps & alerting provider and/or patient INSURER PERSONAL HEALTH & WELLNESS MGMT PATIENT VITALS/ FAMILY HISTORY PRIMARY CARE Ambulatory EMR Inpatient EMR HOSPITAL 3. CARE COORDINATION Allows for care coordination workflows for communication between different providers CLAIMS DATA HIE HIE Specialty EMR SPECIALIST 2. BUSINESS INTELLIGENCE Looks at registries, population-based data to stratify patient risk Looks at evidence-based clinical standards & defined quality standards to do quality reporting PAPER PATIENT RECORD HOME HEALTH CARE DRUG INFO PHARMACY LAB TESTS LAB 4. PATIENT ENGAGEMENT Allows for care coordination workflows for communication between different providers Page 28 Copyright Kurt Salmon 2013 All Rights Reserved

29 Imperatives Each situation differs; yet, there are some common imperatives that CIOs need to address.» This is hard Lots of parts Even highly integrated environments need to connect with other players Currently expensive and duplicative There will be multiple rounds of connectivity solutions as this area matures remaining flexible is key to managing the costs» Not solely a technical issue Clear enterprise business objectives and priorities are essential Need to build collaboration with numerous diverse stakeholders internally and externally who do not always share common goals Addressing the tangled legal thicket may slow progress Trust relationships Data Sharing agreements Privacy and Security (HIPAA, state and local laws, plus patient perception)» Requires a companion analytics strategy Page 29 Copyright Kurt Salmon 2013 All Rights Reserved

30 Page 30 Copyright Kurt Salmon 2013 All Rights Reserved

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