HIMSS Analytics Continuity of Care Maturity Model Going Beyond EMRAM

Transcription

1 HIMSS Analytics Continuity of Care Maturity Model Going Beyond EMRAM Jan-Eric Slot CIO Bernhoven Ziekenhuis Jörg Studzinski Senior Consultant HIMSS Analytics Model supported by Presented during MIC2015, Veldhoven, Netherlands, Oct 28th Model Information

2 Agenda Introduction to HIMSS and HIMSS Analytics Defining Continuity of Care The Industry Challenge and Our Approach to a Solution Introducing the Continuity of Care Maturity Model Acknowledging Multiple Stakeholders Survey Methodology Example Achievements Discussion

3 HIMSS WORLDWIDE AT A GLANCE Mission: Transform health through information technology Not-for-profit organization founded in 1961, headquartered in Chicago Providing global leadership for the use of information technology (IT) to optimize health and care outcomes Represents 54,000 individual and 600 corporate members, plus 250 not-for-profit partner organizations with a presence in 200+ countries all over the world

4 HIMSS BRANCHES FOR A HOLISTIC VIEW Optimizing health and care outcomes through IT Providers Payers Academia Individuals Industry Events HIMSS organizes events around the world on the most pressing issues facing health and healthcare. Media HIMSS provides and shares information on highly relevant aspects in the healthcare environment. Market Intelligence (Analytics) HIMSS supports improved decision making for healthcare organizations, technology solutions providers and others by delivering quality data and analytical expertise. Government Relations HIMSS educates policy leaders on how to harness the power of IT to enhance patient care, foster innovation, and transform a region s or country s health system. Professional Development HIMSS equips stakeholders to advance their careers with resources, education, mentoring, networking and certifications.

5 ABOUT HIMSS ANALYTICS Wholly-owned, not-for-profit subsidiary of the Healthcare Information and Management Systems Society (HIMSS) Collects and analyzes healthcare information related to IT adoption and environments in numerous countries Delivers thought leadership, services, and analytical expertise to the Healthcare IT Community Providers Government Consultancies Vendors

6 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 Provider perspective Alignment of healthcare resources, across care settings, coordinated in a way that delivers the best healthcare services and value possible for a defined population

7 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 General Practitioners Private Practices Community 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

8 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 General Practitioners Private Practices Community 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

9 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 Patrick 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 No follow-up Outcome Lack of shared EMR and HIE results in care and medication conflicts Contradicting directives Confused patient Inefficient 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

11 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 Continuity of Care 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

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 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 Continuity of Care 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

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 Patrick 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 Continuity of Care 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

14 Bernhoven applicatie landschap

15 toekomst visie Bernhoven

16 Continuity of Care Maturity Model Purpose Provide orientation: o Information/Knowledge: What characterizes continuity of care? o Benchmarking: What is our status? How are my peers doing? o Action/Strategies: What gaps need to be closed, when? Global applicability, local adjustments possible Complement existing EMR Adoption Models EMRAM A-EMRAM

17 Model Audiences Regional & National Health Authorities/ Ministries of Health Hospital Trusts / Integrated Delivery Networks (IDN) Health Management Organizations (HMOs) / Accountable Care Organizations (ACOs) (Private) care chains Large hospitals with tethered care providers

18 CCMM Pillars of Focus Health Info Exchange Patient Care Coordination Patient Engagement Analytics Org. Strategy Pan Organiz. Capabilities Policy Level Initiatives IT Systems Capabilities Standards / Interop. Security & Privacy

19 Continuity of Care Maturity

20 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

21 Governance Focus CCMM Governance Focus National and local policies are aligned. Policies address non-compliance. Best clinical practices are derived from care community healthcare data and operationalized across the community Policies in place for collaboration, data security, mobile device use, and interconnectivity between healthcare providers and patients Data governance across organizations Policies drive clinical coordination, semantic interoperability. Change management is documented and standardized Policies for CofC strategy, business continuity, disaster recovery, And security & privacy. Data governance is active Governance is informal and undocumented

22 Clinical Focus CCMM Clinical Focus Comprehensive pop-health. Completely coordinated care across all care settings. Integrated personalized medicine Dynamic intelligent patient record tracks closed loop care delivery. Multiple care pathways/protocols. Patient compliance tracking Community-wide patient record with integrated care plans, bio-surveillance. Patient data entry, personal targets, alerts. Shared care plans track, update, task coordination with alerts and reminders. eprescribing. Pandemic tracking and analytics. Multiple entity clinical data integration. Regional/national PACS. Electronic referrals, consent. Telemedicine capable. Patient record available to multi-disciplinary internal and tethered care teams. EMR exchange. Immunization and disease registries. Limited shared care plans outside the organization. Leverage 3rd party reference resources. Basic alerts. Engaged in EMRAM maturation

23 IT Focus CCMM IT Focus Near real-time care community based health record and patient profile Organizational, pan-organizational, and community-wide CDS and population health tracking Patient data aggregated into a single cohesive record. Mobile tech engages patients. Community wide identity management All care team members have access to all data. Semantic data drives actionable CDS and analytics. Comprehensive audit trail Aggregated clinical and financial data. Medical classification and vocabulary tools are pervasive. Mobile tech supports point of care Patient-centered clinical data presentation. Pervasive electronic automated ID management for patients, providers, and facilities Some external data incorporated into patient record. Data is isolated

24 Methodology Defining the Care Community The population who s continuity of care is being profiled Define up to five care settings, such as 1. Primary Care 2. Acute Care 3. Home based Care 4. Urgent Care 5. Long Term Care Completing Survey Excel based Respond to ~230 compliance statements 10 categories such as Care Coord., Pt Engagement, Analytics, HIE, Org. Strategy, Security & Privacy, etc Five pre-defined responses Not Enabled, Minimally Enabled, Somewhat Enabled, Mostly Enabled, Fully Enabled

25 Example Survey

26 Scoring Tutorial 8 Stage model, like the EMRAM model Lowest is Stage 0, highest Stage 7 Overall and stage level progress reported as a percentage Conveys overall progress against all requirements Color scale represents % progress against each stage Shows areas of strength and opportunity Passing a stage requires 70% On that stage and all previous stages or > compliance Your Stage standing is the highest stage passed Accommodates different approaches in priorities, resources types, and Total 37% Stage 7 9% execution of healthcare advancements Stage 6 27% Stage 5 35% Stage 4 47% Stage 3 37% Overall Results Scoring is hierarchical Stage 2 55% Stage 1 59% Stage 0 83% Stage Progress (example data) Total 37% Stage 7 9% Stage 6 27% Stage 5 35% Stage 4 47% Stage 3 37% Stage 2 55% Stage 1 59% Stage 0 83% Care Setting Results Stakeholder Results Governance Clinical Info Tech Primary Care Acute Care Post-Acute Care Home Based Care Long Term Care Total 17% Total 31% Total 10% Total 15% Total 8% Total 16% Total 38% Total 33% Stage 7 10% Stage 7 10% Stage 7 0% Stage 7 20% Stage 7 20% Stage 7 12% Stage 7 Stage 7 0% Stage 6 15% Stage 6 24% Stage 6 7% Stage 6 7% Stage 6 7% Stage 6 12% Stage 6 40% Stage 6 13% Stage 5 7% Stage 5 16% Stage 5 7% Stage 5 9% Stage 5 0% Stage 5 8% Stage 5 19% Stage 5 39% Stage 4 14% Stage 4 46% Stage 4 0% Stage 4 14% Stage 4 7% Stage 4 16% Stage 4 43% Stage 4 35% Stage 3 34% Stage 3 50% Stage 3 24% Stage 3 24% Stage 3 6% Stage 3 28% Stage 3 41% Stage 3 42% Stage 2 28% Stage 2 63% Stage 2 9% Stage 2 41% Stage 2 31% Stage 2 34% Stage 2 43% Stage 2 40% Stage 1 44% Stage 1 86% Stage 1 47% Stage 1 33% Stage 1 14% Stage 1 45% Stage 1 54% Stage 1 70% Stage 0 60% Stage 0 40% Stage 0 60% Stage 0 50% Stage 0 40% Stage 0 50% Stage 0 50% Stage 0 75%

27 Information Tech Stakeholder Achievements Total 33% Stage 7 0% Stage 6 13% Stage 5 39% Stage 4 35% Stage 3 42% Stage 2 40% Stage 1 70% Stage 0 75% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Info Tech Stakeholders Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Primary Care Acute Care Post Acute Care Home Based Care Long Term Care Info Tech Primary Care Acute Care Post Acute Care Home Based Care Long Term Care Total 38% Total 55% Total 23% Total 22% Total 23% Stage 7 0% Stage 7 0% Stage 7 0% Stage 7 0% Stage 7 0% Stage 6 25% Stage 6 25% Stage 6 8% Stage 6 8% Stage 6 0% Stage 5 58% Stage 5 67% Stage 5 21% Stage 5 17% Stage 5 33% Stage 4 32% Stage 4 55% Stage 4 27% Stage 4 36% Stage 4 27% Stage 3 30% Stage 3 90% Stage 3 50% Stage 3 20% Stage 3 20% Stage 2 36% Stage 2 77% Stage 2 23% Stage 2 32% Stage 2 32% Stage 1 67% Stage 1 75% Stage 1 83% Stage 1 67% Stage 1 58% Stage 0 75% Stage 0 100% Stage 0 75% Stage 0 75% Stage 0 50%

28 Example Results IT Stakeholder Recommendations Information Technology stakeholders support clinical stakeholder initiatives and implement governance stakeholder policies and strategy. There is a delicate balance between maintaining and optimizing operational systems while extending and modernizing capabilities and technology. Stage 1 Recommendations 1) Implement master patient, physician, and facility identification strategy in support of the sharing of data across the continuum of health 2) Integrate external reference data into analytics environment (registries, immunization, census, population health, etc ) Stage 2 Recommendations 1) With collaboration from governance and clinical stakeholders begin to build a patient-centered clinical data repository with data from most parts of the organization including associated, affiliated, and tethered providers in support of building analytics capabilities and patient engagement (i.e.: patients log into one interface and sees consolidated clinical information) Stage 3 Recommendations 1) Pervasively implement medical classification and vocabulary tools in support of discrete standardized data (e.g. CPT, ICD, SNOMED, LOINC, others ; national standard compliance if applicable)

29 Acute Care Setting Achievements Acute Care Overall Governance Clinical Info Tech Total 40% Total 31% Total 48% Total 55% Stage 7 7% Stage 7 10% Stage 7 Stage 7 0% Stage 6 30% Stage 6 24% Stage 6 56% Stage 6 25% Stage 5 29% Stage 5 16% Stage 5 19% Stage 5 67% Stage 4 51% Stage 4 46% Stage 4 56% Stage 4 55% Stage 3 56% Stage 3 50% Stage 3 55% Stage 3 90% Stage 2 63% Stage 2 63% Stage 2 50% Stage 2 77% Stage 1 80% Stage 1 86% Stage 1 73% Stage 1 75% Stage 0 56% Stage 0 40% Stage 0 50% Stage 0 100% Recommendations Work with Info Tech Stakeholders to document and implement an overarching information and communications technology strategy Develop master patient, provider and facility indexes that are common Develop an overarching care coordination strategy, focusing on higher volume care settings and eventually extending into all care settings Develop care plans that can be shared and leveraged across all care settings as appropriate Build a patient-centered data repository supporting analytics, patient engagement, and coordinated care Aggregate clinical and financial patient data into repository, including some externally sourced data Further expand multi-level clinical decision support systems (CDSS) including into other care settings (e.g.: across acute care facility service lines, in all facilities) Provide actionable clinical decision support and advanced analytics (batch and on-demand), including drug interaction, age and sex appropriate findings, and diagnosis recommendations

30 Continuity of Care Assessment Measures continuity of care across key care settings Aligned with three key stakeholder groups Scalable from small populations to large Prescriptive direction for improving Care Coordination Health Information Exchange Analytics Patient Engagement

31 Continuity of Care Maturity Model Workshop When: 5 november 2015 Time: uur uur Where: Hotel Princeville Breda (NL) Costs: 125,00 excl lunch - 145,00 incl. lunch Who: James Gaston (HIMMS Analytics) Jan-Eric Slot (MB MSc MBA CIO Bernhoven)

32 Know. Understand. Prepare. Change with CCMM Jan-Eric Slot CIO Bernhoven Ziekenhuis Jörg Studzinski Senior Consultant HIMSS Analytics