Continuity of Care.Going Beyond EMRAM

Transcription

1 Continuity of Care.Going Beyond EMRAM Dr. Richard Wedge CEO Health PEI John P. Hoyt, FACHE, FHIMSS Executive Vice President HIMSS James E. Gaston, MBA, FHIMSS Sr. Director Maturity Models HIMSS Analytics

2 Agenda Welcome and Opening Remarks John P. Hoyt Continuity of Care Maturity Model Overview James E. Gaston Practical Applications of CCMM for Health PEI Dr. Richard Wedge

3 We Started With EMRAM Created in 2005 Roadmap for CIOs & investment plan Inform government policy Push the Market 3

4 We Started With EMRAM 2015 Q Q3 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 3.7% 4.1% Physician documentation (structured templates), full CDSS (variance & compliance), Closed loop medication administration 23.6 % 25.4% 64% Full R-PACS 32.3 % 34.6% CPOE, Clinical Decision Support (clinical protocols) 13.2 % 10.3% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 18.2 % 17.3% CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 3.6 % 3.4% Ancillaries - Lab, Rad, Pharmacy - All Installed 1.9 % 1.8% All Three Ancillaries Not Installed 3.3 % 3.1% Data from HIMSS Analytics Database 2015 HIMSS Analytics N = 5464 N = 5454

5 We Started With EMRAM Canada EMR Adoption Model SM 2015 Q Q3 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0.2% 0.2% Physician documentation (structured templates), full CDSS (variance & compliance), Closed loop medication administration Full R-PACS CPOE, Clinical Decision Support (clinical protocols) 0.9% 1.1% 3.4% 0.9% 3.1% 1.7% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imagine, HIE capable Ancillaries Lab, Rad, Pharmacy All Installed 30.9% 30.7% 14.2% 31.3% 31.3% 14.1% All Three Ancillaries Not Installed 18.6% 17.5% Data from HIMSS Analytics Database 2015 HIMSS Analytics N = 641 N = 640

6 But What is After EMRAM? Hospitals Are a Silo an Expensive Silo $$$ Silos create other issues. Duplication of tests Missed information, such as allergies Non-coordinated care Medical errors What we want is an electronically enabled continuum of care 6

7 Healthcare Care

8 What is Continuity of Care? Citizens perspective Non-disruption of care provided to a patient throughout his/her care journey, across care settings and care givers Industry perspective Alignment of healthcare resources, across care settings, orchestrated in a way that delivers the best healthcare services and value possible for a defined population

9 Traditional Care Setting Orientation Isolated Decisions Errors Incorrect diagnosis Increased Costs Inefficient system usage Redundant services Uncoordinated Care Isolated care episodes Lost efficiencies Lost opportunity Systemic Inefficiencies Lacks health info. sharing Incomplete health picture Affiliated Ambulatory Private Practice Healthcare Center Regional Primary Care Acute Care Facility Specialty Hospital Outpatient Surgery Center Dental Care Center Same Day Surgery Emergency Department Emergency Care Center Pharmacy Care Center Patient Home Group Living Care

10 Coordinated Care Orientation Health Information Exchange Health information sharing Consolidated EMR Semantic interoperability Coordinated Patient Care Coordinated treatment Reduced Errors Care team alerts Advanced Analytics Population health Patient specific CDS Patient Engagement Personalized alerts, goals EMR access, input Mobile access Affiliated Ambulatory Private Practice Healthcare Center Regional Primary Care Acute Care Facility Specialty Hospital Outpatient Surgery Center Dental Care Center Same Day Surgery Emergency Department Emergency Care Center Pharmacy Care Center Patient Home Group Living Care

11 Patient Scenarios Traditional Episodes of Care Adela Heart Surgery Sent home with no way to monitor Roberto Head injury No radiology image sharing No EMR sharing Pat Multiple health complications Seeing multiple specialists Outcome Did not properly take medications Weight gain Emergency Department visit and readmission to hospital Outcome Medication conflict results in Emergency visit, additional x-rays and MRI, and admission Redundant tetanus shot given Episode undocumented No follow-up Outcome Lack of shared EMR and HIE results in care and medication conflicts Contradicting directives Confused patient Inefficient care

12 Coordinated Care Orientation Health Information Exchange Health information sharing Consolidated EMR Semantic interoperability Coordinated Patient Care Coordinated treatment Reduced Errors Care team alerts Advanced Analytics Population health Patient specific CDS Patient Engagement Personalized alerts, goals EMR access, input Mobile access

13 Coordinated Care Orientation Health Information Exchange Health information sharing Consolidated EMR Semantic interoperability Coordinated Patient Care Coordinated treatment Reduced Errors Care team alerts Advanced Analytics Population health Patient specific CDS Patient Engagement Personalized alerts, goals EMR access, input Mobile access Adela Heart Surgery Sent home with mhealth weight scale Care coordinator explains best practice follow-up treatment Outcome Weight tracked by technology, alerts sent if issues arise Care coordinator verifies adherence to medications and therapy regime CCMM Value Propositions Reduced chance of re-admission, medical issues Alerts for patient and core care team when problems arise Patient engagement facilitated Consistent coordinated care and care across all care settings

14 Coordinated Care Orientation Health Information Exchange Health information sharing Consolidated EMR Semantic interoperability Coordinated Patient Care Coordinated treatment Reduced Errors Care team alerts Advanced Analytics Population health Patient specific CDS Patient Engagement Personalized alerts, goals EMR access, input Mobile access Roberto Head injury No radiology image sharing No EMR sharing Outcome Stitches removed in primary care setting Wound checked for infection, healing Outcome EMR + medication reconciliation (emar) prevents adverse drug event Tetanus shot noted in EMR history CCMM Value Propositions Reduce redundant healthcare services (x-rays, MRI, tetanus shot) No adverse medication reaction Ongoing up to date EMR for future care Consistent coordinated care and care across all care settings

15 Coordinated Care Orientation Health Information Exchange Health information sharing Consolidated EMR Semantic interoperability Coordinated Patient Care Coordinated treatment Reduced Errors Care team alerts Advanced Analytics Population health Patient specific CDS Patient Engagement Personalized alerts, goals EMR access, input Mobile access Pat Multiple health complications Seeing multiple specialists Outcome While still seeing multiple providers, all informed of all activities Best care practice protocol put in place Alerts for patient and core care team when problems arise CCMM Value Propositions All providers and care teams have access to all medical info Patient engagement facilitated Efficient care from core care team facilitated by coordinated care Pop health analytics identifies best care practices, which are able to be managed and merged Consistent coordinated care and care across all care settings

16 Continuity of Care Maturity Copyright HIMSS Analytics

17 Multiple Model Stakeholders Administrators CEO/COO/CFO/CSOs Forge agreements, policies, and standards that allow and enable progress Drive clinical activities that enable and enhance coordinated care, pop health Clinical/Medical Leaders CMIO/CNO/CNIOs Technology Leaders CIOs Build out Information & Technology that facilitates key strategies

18 Health PEI CCMM Survey Profile Population profiled the Care Community Health PEI s population for this survey was defined as the residents of Prince Edward Island that are eligible to receive and receive mental health and addiction services. Assessment care settings Primary Care Community Mental Health Acute Care Off-Island Care 18

19 Continuity of Care Value Proposition Continuity of Care Assessment Prescriptive direction for improving Care Coordination Health Information Exchange Analytics Patient Engagement Stakeholder group actionable directives & alignment Care Settings actionable directives Scalable across populations and care settings

20 Continuity of Care Going Beyond EMRAM Dr. Richard Wedge CEO Health PEI

21 Continuity of Care Maturity Model.Going Beyond EMRAM Health PEI is Prince Edward Island s provincial health authority Manages the delivery of all healthcare for PEI residents Acute Care Mental Health and Addictions Ambulatory Care Primary Care Public Health Long Term Care Home Care Physician Services (including off Island Care) 21

22 The Health PEI Strategic Plan Establishes a vision of One Island health system supporting improved health for Islanders. 22

23 Continuity of Care.Going Beyond EMRAM Health PEI currently has a single electronic health record (EHR) in acute care using the Cerner Millenium software This EHR completes the goal of One patient, One record The EHR is accessible by all clinical staff in hospitals and their community offices/homes. ICU, Maternal/Newborn and Anesthesia continue to be a mainly paper-based system 23

24 Reason for Participation in the HIMSS Analytics CCMM survey Opportunity to see some measurement of the effectiveness of our health system as it relates to the continuity of care spectrum. 24

25 Survey collection process Assigned a lead to coordinate the survey from Health PEI The lead worked with the Health PEI IT Consultants for each area to pre-populate each area s survey to the extent possible. Executive Leadership Team from Health PEI identified team members for each area of focus. Teams from each area met and verified what has been prepopulated, complete the remaining items to the extent possible, and identify any questions/comments along the way that needed clarification with HIMSS staff Teams then met with HIMSS Analytics staff when they were on site to answer questions and resolve any concerns. 25

26 Results Progress toward Stage 1-2 compliance statements ~45-56% Information Technology stands out with the highest compliance for Stage 1 & 2 Clinical stakeholders have highest overall compliance of 3 stakeholder groups Good spread of compliance across all stages Overall compliance with all compliance statements in all care settings 24% 26

27 Highlights From Clinical Perspective Continuity of patient care is highest in acute care - within and between acute care facilities Other areas Primary care, Long term care & Home care are more challenged to provide continuity of care in an efficient and effective manner Gaps in patient s ability to access information self care, educational and results (for example diagnostic) 27

28 Closing the Acute Care Gaps The closing of existing EHR gaps include the evolution of the solutions already in place. The teams supporting these solutions regularly carry out work to incrementally improve functionality and robustness. 28

29 Health PEI Strategic IM/IT Plan The next and highest priority within PEI s EHR portfolio is to select, procure and implement a single provincial Electronic Medical Record (EMR) solution for primary care. This EMR will be integrated with our current acute care based Clinical Information System 29

30 Health PEI Strategic IM/IT Plan PEI s EMR solution will be the key foundational element for the implementation of a Personal Health Record (PHR) a secure portal through which an individual can personally view and interact with his or her electronic health record. For the subset of Islanders who choose to enroll and begin using a PHR, they will be able to securely access and augment their health information in order to promote and facilitate self management of their care. 30

31 Continuity of Care.Going Beyond EMRAM Dr. Richard Wedge CEO, Health PEI John P. Hoyt, FACHE, FHIMSS Executive Vice President HIMSS James E. Gaston, MBA, FHIMSS Sr. Director Maturity Models HIMSS Analytics