HIEs as an ACO Infrastructure & Results ICA has Experienced in HIE Deployment

Transcription

1 HIEs as an ACO Infrastructure & Results ICA has Experienced in HIE Deployment

2 Agenda Health Information Exchange in ACOs Why The Needs What Meeting the Needs A Platform Overview A view of the HIE landscape what s ICA see happening? Defining Value some research and case studies Questions and Answers

3 Why: The needs Informatics Corporation of America - Proprietary and Confidential Information

4 Why ACOs need an IT Infrastructure Paradigm Shifting ACOs move from a fragmented, transactional based revenue healthcare system paradigm to: a risk bearing system of health paradigm From a healthcare system to a system of health Informatics Corporation of America - Proprietary and Confidential Information 4

5 Current State Historical focus of EMR on automation Limited ability to support connectivity, data mining and clinical decision making In Press: Stead WW. Electronic Health Records. In: Rouse WB, Cortese DA, eds. Engineering the system of healthcare delivery. Tennenbaum Institute Series on Enterprise Systems, Vol. 3. Amsterdam: IOS Press; Informatics Corporation of America - Proprietary and Confidential Information 4

6 New Paradigm Match computational approach to the complexity of data Provide a platform that enables other systems to work more effectively Maximize the value of technology in existing and complete data in clinical workflow In Press: Stead WW. Electronic Health Records. In: Rouse WB, Cortese DA, eds. Engineering the system of healthcare delivery. Tennenbaum Institute Series on Enterprise Systems, Vol. 3. Amsterdam: IOS Press; Informatics Corporation of America - Proprietary and Confidential Information 5

7 ACO base needs for technology Role-based Security: Creating a trust environment Expanding stakeholders with information needs Clinical data exchange: ACO have a patient centric approach Sharing across care setting Data aggregation: Creating a longitudinal view of patient information Combining acute, ambulatory, payer and financial information Performance management: Clinical transforming data into point of care, actionable information. Financial creating score cards and dashboards based on both clinical and financial goals Reporting infrastructure: Clinical quality based monitoring on a real time basis Financial where are the dollars going? Financial infrastructure: Distribution of payments based on value and performance Informatics Corporation of America - Proprietary and Confidential Information 7

8 What: Meeting the needs Informatics Corporation of America - Proprietary and Confidential Information

9 HIE's value in meeting the needs Connectivity across the care continuum Clinical communication for care teams Dashboards to monitor care compliance Registries to manage chronic diseases High risk patient monitoring Patient engagement mechanisms Aggregated performance reporting engine Physician acquisition efficiencies Informatics Corporation of America - Proprietary and Confidential Information 9

10 The Value of HIE HIEs provide a platform for patient-centric care models Accountable Care Organizations Quality Improvement Meaningful Use Care Coordination Primary Care Home Data Exchange HIE Platform Informatics Corporation of America - Proprietary and Confidential Information 10

11 Putting it all Together Informatics Corporation of America - Proprietary and Confidential Information 25

12 Platform Overview Informatics Corporation of America - Proprietary and Confidential Information

13 Platform Overview Informatics Corporation of America - Proprietary and Confidential Information 22

14 Viral Growth of HIEs Informatics Corporation of America - Proprietary and Confidential Information

15 The Tennessee Experience Middle Tennessee ehealth Connect (MTeHC) CareSpark Knoxville Area HIE MidSouth ehealth Alliance MSeHA Chattanooga Area Southeast TN HIE

16 Results Informatics Corporation of America - Proprietary and Confidential Information

17 Could we have found a viable reason for the HIE concept?

18 Challenges Across the Years No low cost communications capabilities Not enough data to be shared for value No standards for exchanging data No measureable value based ROI Not enough data to be shared for value No standards for exchanging data No measureable value based ROI No standards for exchanging data No measureable value based ROI No measureable value based ROI Could they be the answer to the looming question?

19 What Research Tells Us Center for Information Technology Leadership (CITL) The Value of Health Information Exchange and Interoperability 2004 At Level 4 Interoperability defined as Machine-interpretable data (interoperable data exchange with standardized message formats and content) Between ambulatory clinics and labs - $31.8 billion Between clinics and radiology centers - $26.2 billion Between clinics and pharmacies - $ 2.7 billion Between physicians - $13.2 billion TOTAL ANNUAL SAVINGS - $73.9 billion Not included acute care, payer and public health

20 What Research Tells Us Center for Information Technology Leadership (CITL) The Value of Health Information Exchange and Interoperability 2004 Level 4 Implementation Steady State Interoperability Cumulative Annual Years 1 10 Starting Year 11 Benefit $613 billion $ 94.3 billion Cost $276 billion $ 16.5 billion Net Value $337 billion $ 77.8 billion

21 What We ve Experienced Bassett Healthcare Reduced Administrative Costs and Increased Quality Bassett Healthcare has distributed healthcare assets across a geography the size of Vermont. Having electronic health information resulted in: Reduced record pulls Reduced currier service fees Reduced duplication of labs and other diagnostic exams Increased through put of referral patients Elimination of shadow charts

22 What We ve Experienced Lourdes Hospital, Paducah, KY Administrative Efficiencies with Flow Sheets RNs logged into 5-7 systems and transcribed information onto paper based flow sheets for inpatient rounding. Expected results: Reduced nurse overtime and increased job satisfaction Reduction in transcribed errors More timely information for physician rounding Reduced supply costs More efficient rounding and increased MD satisfaction To date Lourdes has experienced a 90% adoption rate by their ambulatory physicians and extenders

23 What We ve Experienced Lourdes Hospital, Paducah, KY

24 What We ve Experienced Health Information Exchange Montana Emergency Department Length of Stay ED MDs logged into 7-9 systems, information within the ED system was not available to floor personnel and f/u care was difficult to coordinate. Expected Results: Reduced time in ED Reduction in duplicate tests Reduction in medications ordered and administered Research at ASU confirms a 22.4% reduction in ED length of stay* * CMIO - Study: EMR functionality matters in the ER, Author: Jeff Byers, Tuesday, August

25 What Memphis Experienced To date, Memphis has logged over seven million encounters (130,000/month) for over 2.8 million total patients An aggregated longitudinal medical record available at all 14 emergency departments and all participating primary-care locations. The aggregated database now contains over 5 years of data. Data is now readily available for use by approved Memphis members when treating/caring for patients. The Memphis database contains nearly 42 million chart documents including such medical information as acute care discharge, emergency department and outpatient encounter summaries; radiology reports and laboratory results. December 2010 AMIA Presentation by Dr. Mark Frisse ICA - Proprietary and Confidential Information 25

26 What has it done? Saved lives (anecdotal) Changed workflow Changed test ordering behavior Reduced radiographic tests Reduced testing for some specific conditions Reduced admissions Technology model is being adopted in other regions Found ambulatory connectivity a great challenge Our lessons are applicable to Vanderbilt and other institutions not just to exchanges December 2010 AMIA Presentation by Dr. Mark Frisse ICA - Proprietary and Confidential Information 26

27 Case Controlled Study of ED Usage Hypothesis HIE use even in its early stages, will have an economic impact on participating institutions Methods Case-control study (2 year period) Findings Significant decrease in hospital admissions Decreased rate of radiographic and laboratory testing in some instances Net societal financial savings offset operational costs December 2010 AMIA Presentation by Dr. Mark Frisse ICA - Proprietary and Confidential Information 27

28 WEEKLY IMPACT At a 6.8% Use Rate at least 7 fewer hospitalizations at least 4 fewer lab testing decisions) at least 3 fewer body CT scans at least 1 less head CT scan at least 11 additional chest x-rays December 2010 AMIA Presentation by Dr. Mark Frisse ICA - Proprietary and Confidential Information 28

29 IMPACT In Dollars at least $2.8 million savings (at avg. admission cost $4,926) (only $40 - $60 thousand net savings in radiographic tests and labs) Annual savings at least $1.8 million savings at avg. cost HIE operational costs only $1.5 million December 2010 AMIA Presentation by Dr. Mark Frisse ICA - Proprietary and Confidential Information 29

30 Average Cost of Emergency Department Supplies Clinical Supplies Medical Safety Apparel - $ 9,250 Syringes - $ 21,000 Sutures - $ 5,000 Total $ 35,250 Administrative Supplies Printing - $ 2,800 Administrative Supplies - $ 25,500 Cleaning materials - $ 4,000 Total $ 32,300 HIE Ongoing costs Maintenance & license - $ 33,900 ICA - Proprietary and Confidential Information 30

31 What Vanderbilt Experienced Vanderbilt Medical Center Ventilator Acquired Pneumonia Protocol Dashboards Within the first 6 months of implementing the dashboards there were 71 cases of VAP prevented resulting in: Reduction in hospital days Reduction in ICU days Cost savings - $1.6MIL SAVED LIVES - 11 Within 18 months all 4 hospitals saw a 56% reduction in VAP

32 What Vandebilt Experienced Vanderbilt Medical Center Diabetic Disease Protocol Dashboards Dashboards were created with 8 protocol indicators including HbA1C, eye exams, foot exams, etc. for 10,000 patients within the diabetic panels of all physicians - within six months: Pre Post Annual foot exam compliance 55% 95% Chronic disease and age/gender specific preventive dashboards have been rolled out as a result

33 Disease Dashboard

34 Questions? ICA - Proprietary and Confidential Information 34