Applied Health Informatics Through the Lens of an Integrated Care Delivery System

Transcription

1 Applied Health Informatics Through the Lens of an Integrated Care Delivery System Andrew Masica, MD, MSCI VP, Chief Clinical Effectiveness Officer Baylor Scott & White Health

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3 Learning Objectives Provide context on the importance of applied health informatics for care delivery organizations in operational innovation and research efforts Demonstrate the role of integrated delivery systems in accelerating the impact of health informatics on daily patient care Present brief case studies of applied informatics at Baylor Scott & White Health (including lessons learned) Discuss key opportunities for the health informatics community to support and collaborate with integrated care delivery systems 3

4 Baylor Scott & White Health (BSWH) More than 500 patient care sites including 43 hospitals in North and Central Texas 5.3 million patient encounters annually 34,000 employees 6,000 affiliated physicians Scott & White Health Plan $8.3 billion in total assets $5.8 billion in total net operating revenue 4

5 The Imperative 5

6 Increasing Demand for Health Care 6 6

7 $900 Billion in Waste Source: Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307:

8 Shift to Value Based Reimbursement Value=Quality/Cost 8

9 Practice Adoption Gap Care Delivery Knowledge 9

10 The IHI Triple Aim Better Care for Individuals As described by the six dimensions of health care performance listed in the Institute of Medicine s 2001 report Crossing the Quality Chasm : safety, timeliness, effectiveness, efficiency, equity, and patient centeredness (i.e. STEEEP Health Care). Better Health for Populations Through attacking the upstream causes of so much of our ill health. Reducing Per Capita Costs Costs should be reduced by eliminating waste, needless hassle, and what does not make sense in our health care system. Costs should not be reduced by eliminating any helpful care or by increasing the risk of harm (i.e. flat cuts in reimbursement do not meet this parameter). 10

11 The Health IT Paradox for Delivery Systems 11

12 Common Forms of Applied Health IT Electronic Health Records (EHRs) Analytics (use of Big Data ) Patient Portals Biotechnologies 12

13 US Deployment of EHRs 13

14 Mixed Reviews of EHR Impacts to Date Buntin et al, Health Affairs

15 Analytics A systematic approach to discover and communicate meaningful patterns in data. Descriptive (reports) Predictive (modeling identifies a future state) Prescriptive (results guide intervention) 15

16 More Information is Better? Volume, Velocity, Variety.and Veracity! 16

17 Patient Portals 17

18 Remote Monitoring 18

19 Impact Greatest in High Risk Populations 19

20 Biometrics 20

21 Omics 21

22 Clinical Decision Support Clinical Decision Support is a process for enhancing health related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery. Information recipients can include patients, clinicians and others involved in patient care delivery; information delivered can include general clinical knowledge and guidance, intelligently processed patient data, or a mixture of both; and information delivery formats can be drawn from a rich palette of options that includes data and order entry facilitators, filtered data displays, reference information, alerts, and others. Improving outcomes with clinical decision support: an implementer s guide. Second Edition. HIMSS

23 IT Platforms Converge in ACOs Accountable Care is a method of health care reimbursement that holds providers responsible for delivering high quality, low cost care ACOs are provider led organizations with a strong base of primary care that are measured by quality and total per capita costs across the full continuum of care for a population of patients Integration and coordination are the cornerstones of ACO operations Reliable and progressively more sophisticated health IT will be required to support ACOs 23

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25 ACO Success Mandates a Robust Data Model Advisory Board Issue Brief: Implications of Accountable Care for Biopharmaceutical Firms Innovators Council/Complimentary/Impact of Accountable Care On Pharmaceutical Business 25

26 How Providers are Measured in ACOs Advisory Board Issue Brief: Implications of Accountable Care for Biopharmaceutical Firms Innovators Council/Complimentary/Impact of Accountable Care On Pharmaceutical Business 26

27 Truly Bending the Cost Curve Miller, How to Create an Accountable Care Organization,

28 Applied Informatics Examples at BSWH 28

29 Development of Enterprise Data Warehouse (EDW) 29

30 Maynard G, SHM VTE QI Resource Room, 30

31 ICU Delirium Project 31

32 Structured Documentation to Facilitate Workflows 5 32

33 Real Time Information for Measure Vention 33

34 Delirium Bundle Uptake Adherence (%) Basic Sites Enhanced Sites 34

35 Clinical Decision Support: Glycemic Control 35

36 Electronically Derived Reports

37 Baylor Scott and White Patient Portals NTX CTX BSWQA afilliated Hospital HTPN (ambulatory) Oncology (ambulatory) Hospital and Ambulatory Ambulatory Various EMR systems Various Portal Products > 260,000 accounts > 300,000 accounts Data unavailable

38 Improving Access-to-Care Consumer-driven access initiatives reach beyond traditional access points Traditional Access Point Office Visit Retail Clinics ED Consumer Oriented Access Points Team-based Care Patient Access Center Extended Hours evisits Telehealth 38

39 Platforms for Analytics Data Aggregation Measure Computation Risk Stratification Member Website MSSP Quick Reports CMS ACO Measures Exploration/Visualization Claims Analytics Interoperability 39

40 Examples of Analytics Output Physician dashboard with drill through Administrative dashboard with drill through Executive Scorecard JOC Physician Engagement Network Utilization with drill through Predictive Modeling / Risk Stratification

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42 BSWH Core Laboratories 42

43 Novel Biotechnology Discovery Biosignature Platform: Robust, Versatile and Validated Validated Clinical Applications Autoimmune Cancer Infectious Disease Cardiology Other Lupus Melanoma TB (latent or acute) Cardiac Disease Organ SOJIA Staphylococcus aureus transplantation Septicemic melioidosis Kawasaki Disease Multiple Clinical Uses Stratification of patient Prognosis Diagnosis Monitoring treatment 43

44 EHRs as tools for Research Access to rich clinical datasets less resource intensive population screening applicable in many study designs Linkage of discrete observations limited NTX capacity pre ACO Important limitations: loss of pre EHR history missing values developed for frontline care deceptive sample sizes Pooling data from multiple sites 44

45 PCORnet National Patient Centered Clinical Research Network Distributed network of 11 Clinical Data Research Networks (CDRNs) and 18 Patient Powered Research Networks (PPRNs) Created to improve the nation s capacity to conduct patient centered comparative effectiveness research (CER) 45

46 CDRN App Suite Details Patient App Research App Engagement Mode: HiOH- join patient network Consumer Healthclinic/system defined interactive content Tablet version syncs with EHRs in clinic Research Mode: Recruitment - consents, screening Trial participation - scheduling, surveys, reminders/prompts Mobile version enables direct patient access Logs in users through tablet Notifications of patients consented to be contacted Recruitment: Performs screening and eligibility Trial Management: Enrolls patients, collects trial data, tracks trial tasks HiOH Portal Web-based platform that provides patients with: Access to Patient App engagement and research functions General & study specific data results and analytics Researcher Portal Web-based platform that provides researchers with: Access to Research App research functions Study specific data results and analytics 46

47 Looking Forward: Opportunities 47

48 Translational Roadmap JAMA May 21;299(19): doi: /jama The "3T's" road map to transform US health care: the "how" of high quality care. Dougherty D, Conway PH. 48

49 For Your Elevator Speech Synthesis Integration Workflow Value 49

50 Closing Thoughts Installation [of any new system or approach] is hard, and mainly technical Implementation is really hard, and mainly organizational Transition (lasting change) is incredibly hard, and purely human Transformation is a state of profound new personal and enterprise behavior Marc Overage MD PhD, Regenstrief Institute, Inc: A Healthcare Laboratory and a Community of Scholars 50

51 Questions? 51