Health & Wellness Management System

Transcription

1 Health & Wellness Management System 7762 Martinsburg Pike Shepherdstown, WV KRM Associates Inc. Phone: Fax:

2 KRM Associates, Inc. Woman-owned small business based in Shepherdstown, West Virginia. Healthcare Information Technology Network Security and Engineering IT Staffing and Support 21 years of healthcare data systems experience Department of Veterans Affairs (VA). West Virginia Department of Health and Human Resources. Shepherd University.

3 Open Source Healthcare and West Virginia VistA RPMS Public Domain Electronic Medical Record software operated by the Department of Veterans Affairs. Currently deployed in 7 state hospitals in West Virginia. VistA based solution developed by Indian Health Services, for ambulatory care. Operated in over 40 clinics within West Virginia. Only major installation outside of Indian Health Services.

4 Personal Health Record A Personal Health Record (PHR) is: A coordinated, detailed view of health information available to patients and authorized providers. Intended to empower individuals to take a more active role in the management of their medical information, increase coordination with medical providers, as well as improve the quality of their healthcare treatments and overall experience. Frequently presented as the Patient Portal. Common Features: Repository of Medical Records Communication with Provider Health Tracking and Monitoring Tools Rights Delegation Health Alerts Immunization Information Laboratory Results Self-Care tools Claims Information Research Tools Common Drawbacks: Patient Portal is tethered to provider s EHR, creating an information silo. If independent of any provider EHR, all information is self-entered

5 HealtheMe Evolution From Personal Health Record Health Information Exchange: Designed for exchange of health information. No inherent analytics or patient oversight. Patient Portal: Designed for basic clinical interactivity. Scheduling and communication features. No record review or interpretation. HealtheMe: Incorporates patient portal features. Ingests and incorporates patient information from diverse standardsbased, structured data sources (CDA, C32, CCR, etc.) Allows patient oversight of health information. Enables patient access to consolidated medical record, personal health information, and intelligent utilization/analysis.

6 HealtheMe Project Timeline West Virginia DHHR awarded Medicaid Transformation Grant Awarded in 2007, 3 year duration. Funds awarded to Shepherd University. KRM Associates Inc. acted as technical partner. Project Goals: Statewide analysis of existing EHR systems and functionality. Implementation of a Personal Health Record (PHR). Proof of Concept demonstration of PHR and EHR exchanging through HIE.

7 Use Case: Patient Reminders Patient reminders encourage proactive care. Patient reminders when they are due for next physical examination based on advanced directives received from EHR system. During routine examination, irregular mole found by physician and surgically removed. Caught early, can save tremendous medical costs. Phase I Costs Phase II Costs Phase III Costs Office Visit Punch Biopsy Pathologist Chest X-ray PET scan Dermatologist Chemotherapy Oncologist

8 Use Case: Treatment Duplication Consolidated records can prevent duplication. Consolidated view of medical information can identify duplicate prescriptions by reconciling generic and brand name drugs, accessible outside of care setting. Redundant medical tests reduced as providers can review tests from previous care settings. Patient can transport information across care settings. U.S. spends $700 billion on unnecessary medical tests, or 5% of GDP. Peter Orszag, Director of Congressional Budget Office. Redundant Medical Testing can expose patients to risk, such as redundant x-ray testing or biopsies.

9 Use Case: Patient Education and Self-Management Patient education and self-management tools. Promotes patient engagement which can result in improved health outcomes. Patient records, combined with communication tools, can increase patient participation and self-management. Patient directives can be better conformed to through tracking and milestones. More informed patients are better able to ask questions in care. Highly encouraged by AHRQ; can reduce medical mistakes. Patient-centered care associated with improved health status and increased efficiency of care.

10 HealtheMe Beginnings Based on Design from My HealtheVet. Utilizes federally developed standards for data exchange. Can interpret data from any Meaningful-Use Compliant EHR system. Built in open-source technologies. Leverages existing CMS investment thru Medicaid Transformation Grant

11 HealtheMe Design

12 HealtheMe Features Self Entered Medical Events

13 HealtheMe Features Clinical Medical Events

14 HealtheMe Features Sample Laboratory Data

15 HealtheMe Features Sample Health Calendar

16 Proof of Concept Data Exchange

17 HealtheMe: Current Status Current Initiatives Integration of C32 Support. Incorporation of CHIP enhancements Reconciliation of Implementations MHV Convergence Activities HealtheMe Contributed to OSEHRA under Apache 2 License with documentation and test cases. HealtheMe chosen by Indian Health Service as PHR to support meaningful Use Stage 2. VistA Community members contributing ideas and approaches for adoption VA Tiger team developing C32/CCDA capability thru Open Source to be incorporated into MHV and HEM as common clinical data set

18 HealtheMe: C32 Support C32 Project Developed as component of creating a Longitudinal Data Infrastructure (LDI) for Comparative Effectiveness Research (CER) AHRQ/IHS project targeting rural populations. In collaboration with Westat Vangent: Created a C32 extractor for RPMS; in beta deployment Created C# parser for C32 records: designed data schema to support it. Currently in alpha

19 HealtheMe: C32 Support. C32 Project Next Steps. Currently delivering documentation; project development largely complete. Reconciliation of current data structure and this schema. Enables support for both CCR and C32/C83 records in the PHR. Far more robust data becomes enabled with this schema (e.g. prescription refill quantities, patient support information, insurance information on file). Database print function developed as part of project for QC purposes. Renders a text-based blue button printout from the database of a patient record.

20 HealtheMe: CHIP Enhancements Enhancements to support deployment throughout West Virginia. Data delegation and authorizations Enables care coordinators to be granted access to patient data Workflow: Care Coordinator requests access to patient, which can be approved, or denied by the patient Patients able to manage which users have access to their data and remove them when needed Explicit authorization and rights revocation architecture could support incorporation of additional end-users (e.g. family) in future.

21 HealtheMe: CHIP Enhancements. Demo: PHR Care Coordinator extensions Care Coordinator Interface Patient Data Access Workflow Care Coordinator request Patient Approval Notification Care Coordinator able to access on approval Care Coordinator removing a patient from their care

22 HealtheMe: Further CHIP Enhancements Enhancements to support deployment throughout West Virginia. Care Notebook data capture Tool used by CHIP patients and their caretakers to track healthrelated information Currently a fully manual process contained on hardcopy Converting to digital format for ease of use, portability Emergency Phone Numbers Treatment History Health Coverage Info Specialists Information Care Providers Tracking Family History Nutrition Tracking Employment Information Rest/Social/Stress tracking Goals & Life Transitions Education History School Information Respiratory Needs Communications Needs Mobility Needs & more..

23 HealtheMe: Reconciliation. Reconciliation of Implementations Each implementation customized. Exercise at Shepherd. Record Import/Chat at Clay. Need to define gold disk. Benefits Allows all implementations to support all features. Creates a coherent patch stream. Drastically eases production support and scalability. Positions for release into open-source.

24 HealtheMe: Future Roadmap Managing Priorities Priorities may change over time based upon stakeholder input and contribution. High Priority Building the community Implement new system architecture Support additional deployment environments Meaningful Use Blue Button Medium Priority Secure messaging Document upload Section 508 compliance Low Priority Mobile device integration

25 HealtheMe: Future Roadmap Engage potential adopters & contributors Building the community (HIGH) Private Sector Non-profit Organizations Federal Agencies Academic Institutions HealtheMe Platform

26 HealtheMe: Future Roadmap The HealtheMe Platform Implement new system architecture (HIGH) Promote open ecosystem of many interconnected components Loose coupling (flexible & pluggable)

27 HealtheMe: Future Roadmap Support additional deployment environments (HIGH) Accommodate need to swap stack components Open source & proprietary Priority given to open source Remove existing dependencies HealtheMe Platform Application Container Glassfish JBoss? Database MySQL SQL Server????

28 HealtheMe: Future Roadmap Expand & harmonize data types Moving toward Meaning Use (HIGH) HealtheMe currently supports the ASTM CCR format for data exchange Semantic mappings developed for RPMS (Clay County deployment) Add support for additional formats HITSP C32 HL7 CCDA HITSP C32 HL7 CCDA Meaningful Use Stage 2 ASTM CCR

29 HealtheMe: Future Roadmap Implement Blue Button technology Blue Button (HIGH) Share common standard for information exchange Empower users to control and transport records Leverage functionality of both systems as they converge

30 Project Blue Button: Future Architecture. Reusable Components and Interfaces. Path to reduction of technical debt. Enables third party development.

31 Questions? Visit the Community! Source Code: Documentation: Suggest Features: