beyond ehr - achieving operational efficiency

Callum Bir

Deloitte Consulting SEA

Beyond EHR

Achieving Operational Efficiency & Optimization

©2011 Deloitte Touche Tohmatsu Limited

Beyond EHR -

2

Start Time End Time Topic Speaker

8:30 9:00 Registration -

9:00 10:30 Business Case & Benefit Realization for EHR

across various stakeholders

Callum Bir, Deloitte

10:30 10:45 Morning Coffee -

10:45 12:30 Going Beyond EHR – Opportunities & Operating

Models

Callum Bir, Deloitte

12:30 13:30 Lunch -

13:30 14:30 Building Foundation going beyond EHR (Case-

Study)

Victor Chai, MOHH

14:30 15:30 Secondary Uses of Data: Pharmaceutical

Perspective

(Case Study)

Shirali Mewara, Deloitte

15:30 15:45 Afternoon Coffee -

15:45 16:00 Achieving Interoperability & Role of Standards Callum Bir, Deloitte

16:00 16:30 Singapore’s Approach to Standards

(Case Study)

Yu Chye Cheong, MOHH

16:30 17:00 US’s Approach to Standards (Case Study) Thiam Hwa Lim, HL7

17:00 17:30 Panel Discussion

Callum Bir

Deloitte Consulting SEA

Benefits for EHR across various Stakeholders

Realizing Benefits


Healthcare Market is experiencing a rapid transition in the clinical needs and

the use of technology for innovation

4

Health Reform Clinical Effectiveness

Chronic Disease

Management

Medication Safety and

Management

Growing Aging Population

Increasing Healthcare Costs

Increasing Lifestyle diseases

Innovation through Technology

Increasing focus on primary &

preventive care

Resource Shortage & Medical

Tourism

Shifting

Trends

Evolving

Focus

Emerging markets

E Health

Innovative Markets in the SEA region

Increasing Patient expectation Increasing Burden on Provider

Present-day scenario in Healthcare industry

Medical Tourism


Some of the Key Questions

5

Govt Health & Payers

•How do we make healthcare affordable?

• How do we increase capacity

•How do we improve seamless

coordination of care across the health

care continuum

•How do we keep our population healthy?

Patients

• How do I stay healthy?

• How do I better manage my disease

and improve my lifestyle (Chronic)

• How do I share my decision making?

• How do I “take-control” of my health

better?

Providers

• How we improve Quality of Care

•How do we Improve Patient Safety

• How do we improve operational /

clinical efficiency?

• How do we increase compliance?

Life Sc Companies

• How do we accelerate drug discovery,

development, and launch medicines

• How do we increase efficacy, and

safety?

• How do we accelerate innovation?


A Seemingly Logical “Trendline”

6

Level of Complexity/Involvement

Pre

su

med

Ben

efi

ts

The

Enterprise

Automation

Departmental

EnterpriseHospital-wide

Automation

Extend

the Core

Enterprise/Integrated

Delivery System-wide

Automation

Community-wide

Automation


It is expected that HIEs help reduce costs and enhance quality by providing physicians with needed information at the time treatment decisions are made

Potential U.S. net efficiency gain from use of HIEs:

>$55B per year or 3% of total healthcare expenditure of

$1.7 T

Typical HIE Benefits

Public Health

Improved population health

Improved wellness

Improved monitoring and safety

Payers and Employers

Reduced costs

Reduced MLR

Lower absenteeism

Efficiency

Providers

Reduced errors

Improved quality

Efficiency

Other (e.g., Life Sciences)

Faster routes-to-market

Sources: Center for Information Technology Leadership, Partners Health Care, Harvard (2004)

Community Health

Information Exchange

$55B

Outpatient EHR $25B

Inpatient EHR $6B

HIEs are also envisioned as a way for stakeholders to experiment with new economic

models


Fast facts (?)

The eHealth Initiative’s (eHI) 2008 survey found that fully operational HIEs are producing

results. The eHI also found in its survey that the HIE results are translating into positive

returns on investment for their stakeholders.

The survey results are given below:

69%

of the fully operational exchange

initiatives (29/42) experienced

reductions in health care costs.

52%

of fully operational exchange

efforts (22/42) report positive

impacts on health care delivery.

69%

of operational exchange efforts

(29/42) report a positive financial

return on their investment (ROI) for

their participating stakeholders.

A majority (69%) of the fully

operational exchange initiatives

(29/42) experienced reductions in

health care costs:

19 reduced staff time

11 decreased dollars spent on

redundant tests

5 documented a reduction in patient

admissions

5 decreased cost of care for chronic

care patients

About half (52%) of fully

operational exchange efforts

(22/42) report positive impacts on

health care delivery:

16 improved access to test results

13 improved quality of practice life

9 decreased support staff

8 improved compliance with chronic

care and prevention guidelines

6 reported better care outcomes for

Patients

4 reported a decrease in prescribing

errors

4 increased recognition of disease

outbreaks

A majority (69%) of operational

exchange efforts (29/42) report a

positive financial return on their

investment (ROI) for their

participating stakeholders:

13 reported an ROI for hospitals

9 reported an ROI for physicians

practices

6 reported an ROI for health plans

5 reported an ROI for independent

laboratories


Most direct benefits seem linked to streamlining information exchange

among HIE participants (Simulated Total)

Administrative savings

( e.g., filing / requesting

requests, retrieving patient

history, call-in of orders,

call-in of prescriptions )

Electronic adjudication of orders

Substitution to

generic drugs

Duplicate tests

reduction

Electronic receipt/

transmission of clinical

documentation

Increased patient safety


The grid illustrates anticipated benefits for a range of potential HIE services across stakeholder groups

Benefits for stakeholders groups

Service

Stakeholder

Clinical results

delivery

Clinical records

Care management

tools

Quality reporting

Public health reporting

Data aggregation

for research

Personal health

records

Physicians

Hospitals

Laboratories

Pharmacies

Payers

Employers

Researchers

Consumers

Benefit potential

High Medium Low

Anticipated magnitude of benefits of each service for stakeholder groups.

Source: State-level HIE Value & Sustainability Interim Report, AHIMA


Reducing cost is possible while improving population-based outcomes

HIEs are important enablers of the healthcare delivery ecosystem

11

Consumerism

Focus: Transparency, PHRs, Incentives, Value

Coordination of Care

Focus: Primary Care 2.0 Model (The New “Medical Home”)

Comparative Effectiveness / Evidence-Based Medicine

Focus: (1) Personalized Medicine; (2) Comparative Effectiveness; Episode Based Payments to Acute Organizations

Health Care Information Technology

Focus: EHR, HIEs, ICD-10

• Respond to transparency & PC 2.0 - Connected care

- Rx reimportation

- Medical tourism

• PHR (Shared Decision Making)

• Incentives - Experience rating & differential

premiums

- Healthy behavior rewards

• Complimentary/Alternative Medicine

• New medical homes

• Reimbursement realignment

• Primary care workforce

• MD led clinical care coordination

• 3 –7 NMEs per year

• Center for comparative

effectiveness

• Knowledge management

• Prepare for tort reform

• Decreased errors

• Decreased care gaps

• Reduced malpractice

premiums

• Improved efficiency

1

3

2

4


Healthcare in the future may have very different delivery and reimbursement

models

12

Experimentation Period

Fee-for-service, individual encounters Bundled payments, performance/

Volume-based payments outcome-based payments,

Volume risk proactive health management, patient

accountability

Performance risk

Individuals

Populations

Healthcare Reform

Consumer Perspectives

13

Technology will change lifestyle of

chronic care patient and enable self-care....

©2011 Deloitte Touche Tohmatsu Limited 15

What Citizens want?

Interest in online tools and services and in

tools and aids to support self-managed care


Interest varies by generation and country in using a smart phone or PDA to

monitor their health if they are able to access medical records and download

information about their medical condition and treatments.


Consumers are highly interested in using a medical device that would

enable them to check their condition and send information to their doctor

electronically through a computer or cell phone via the Internet

17 Deloitte


Self-Care

Growth drivers

• Consumerism

• Increased Expectation from patients and more

importantly, care givers

• Ubiquitous computing

Barriers

• Lack of awareness of benefits

• Data Governance, Ownership, and regulatory

frameworks still needs to be worked out

• Lack of Sustainable business models

• Still in early stages of development

Technology-enabled self-care


Chronic Care Lifestyle

Growth drivers

• Increased access to healthcare and health-

related information, particularly for hard-to-

reach populations

• Increase mobile (voice) coverage and adoption

Barriers

• Relatively untapped market

• Limitation on care delivery on phone

http://www.youtube.com/user/ProjectHealthDesign#p/u/16/VNdkgOuui00

Regular follow-up, Mobile Monitoring ,

Lifestyle choices for chronic patients


Evidence Based Care

Growth drivers

• Significant innovation in Med Tech industry

• Rapidly growing Chronic Disease patients in

Asia

• Improved ability to diagnose and track diseases

Barriers

• Lack of complete end-to-end operator service

• Largely Silo approach till date

http://www.youtube.com/user/ProjectHealthDesign#p/u/12/rYkuswN8wMY

Personal monitoring device to alert

and guide to make improvements

in health or treat a condition.

Provider Perspectives

21


It has also well documented quality issue

280,000 people will get the wrong advice today in a doctor’s office 2,800 people will be harmed today by a medication error Over 98,000 people will die this year in hospitals from a preventable medical mistake

20% of labs and x-rays are done because prior results are unavailable 1 in 7 hospitalizations occur because information about patient is not available On average. Americans receive the care recommended for their conditions only 54.9% of the time Translation of medical research into practice is slow—average of 17 years. For instance, nearly one-

third of patients with congestive heart failure are discharged from the hospital without ACE inhibitors, even though it has been known for a decade that these drugs provide life-saving benefits

Leading Causes of Death1

Deaths

Estimated

Deaths Due to

Medical Errors

in Hospitals

1 Heart Disease 727,000

2 Cancer 540,000

3 Strokes 160,000

4 COPD 109,000

5 Accidents/Adverse Effects 97,000 High (98,000)

6 Pneumonia 86,000

7 Diabetes 63,000

8 Motor Vehicles 43,000 Low (44,000)

9 Firearms 32,000

10 Suicide 31,000

…

14 AIDS 17,000

1 National Vital Statistics Report. Center for Disease Control and Prevention (CDC). Deaths Final Data

for 1997. Volume 47, number 19. P. 1 - 105. June 30, 1999.

To Err is Human’ - Selected Strategies to

Improve Medication Safety


Patient Specific

Automated

Produced for every patient, at every

visit, regardless of the Reason for Visit

An example of a patient-specific HIE-enabled point of care Clinical Decision

Support - CINA


Targeted reminders for nursing staff allow better leverage of provider time and more efficient workflow

Labs, Calculations and Diagnostic Procedures pertinent to the Action Items are displayed for easy reference

Goals Not Met are highlighted for quick reference and visibility

Diagnoses and Meds are prioritized to highlight chronic conditions


EHRs specifically designed for direct use by physicians such as computerized physician order

entry (CPOE) and physician documentation are critical to enhance patient safety and care quality

Non-intercepted serious medication

errors per 1,000 patient days

Before CPOE After CPOE

7.6

1.1

86% decline

Preventable Adverse Drug Events

per 1,000 patient days


2.9

1.1

62% decline

Percentage of Eligible Patients

Receiving Pneumococcal Vaccination

No CPOE

Reminder

CPOE

Reminder

0.8%

36%

Percentage of Eligible Patients

Receiving Subcutaneous Heparin

18.9%

32%

No CPOE

Reminder

CPOE

Reminder

Source: Clinical Advisory Board

Prompting Best Clinical Practice

Building a Stronger Safety Net


Percentage of Oral H2-Blocker Orders Using Nizatidine

Weeks

1.1

CPOE alert to preferred

H2 blocker introduced

1.1

Physician Order to Receipt by Pharmacy


3.4

hours

0.5 hour

Physician Order to Delivery to Patient

Care Areas

4.6

hours 32%


Source: Clinical Advisory Board

Reducing Time to Deliver Care

Encouraging Cost-effective regimens or Less-Costly Drugs

1.4 hour

1 2 3 5 7 9 11

20% 18% 12%

80% 68% 83% 90%

Estimated annual

Savings: $75,000

CPOE (Continued)


Total EHR benefit projections are significant

COST DECREASE FACTORS

Cost Decrease - 1

Conservative Medium Aggressive Reduce Medication Error by implementing Physician Order Entry

124,564 124,564 124,564 A Total Adjusted Admissions

0.37 0.37 0.37 B Medication Error per 100 Admissions

$ 2,262 $ 2,262 $ 2,262 C Clinical Cost per Medication Error

3.08% 3.08% 3.08% D % of Medication Errors with Associated Litigation Costs

$ 50,105 $ 50,105 $ 50,105 E Litigation and Damages cost per Medication Error Resulting in Litigation

50.00% 60.00% 85.00% F Percent Decrease in Medication Error per 100 admissions

$ 876,536 $ 1,051,843 $ 1,490,111 Additional Annual Cost Savings = (AxB/100xCXF)+(AxB/100xDxExF)

Cost Decrease - 2

Conservative Medium Aggressive Reduce Duplicate Lab and Radiology Orders through on line order entry and results availability

$ 3,943 $ 3,943 $ 3,943 A Laboratory Cost per Adjusted Admission

$ 2,854 $ 2,854 $ 2,854 B Radiology Cost per Adjusted Admission

124,564 124,564 124,564 C Total Adjusted Admissions

10.00% 15.00% 20.00% D % Reduction in Lab Expense by Decreasing Duplicate Lab Orders

10.00% 15.00% 20.00% E % Reduction in Radiology Expense by Decreasing Duplicate Radiology Orders

$84,666,151 $126,999,226 $169,332,302 Additional Annual Cost Savings Benefit = (AxCxD)+(BxCxE)

Cost Decrease - 3

Conservative Medium Aggressive Reduce Transcription Costs by Automating Transcription through direct entry into the CIS

$1,318,712.00 $1,318,712.00 $1,318,712.00 A Current Transcription Costs (Medical Records and departmental)

30.00% 50.00% 75.00% B % Reduction in Transcription Costs

$395,614 $659,356 $989,034 Additional Annual Cost Savings Benefit = AxB

Cost Decrease - 4

Conservative Medium Aggressive Reduce Average Expense per Adjusted Admission

124,564 124,564 124,564 A Total Adjusted Admissions

$ 17,081 $ 17,081 $ 17,081 B Average Expense per Adjusted Admission

2.00% 3.00% 4.00% C % Decrease in Average Expense per Adjusted Admission

$42,554,179 $63,831,269 $85,108,358 Additional Annual Cost Savings = AxBxC


Total benefit projections are significant Cost Decrease - 5

Conservative Medium Aggressive

Reduce Medical Record Costs by Reducing Chart Pull Staff, Eliminating Storage and Supply

Cost.

22.40

22.40

22.40 A Total Medical Records Chart Pull FTEs

$ 31,355 $ 31,355 $ 31,355 B Average Salary per Medical Record Chart Pull FTE

26% 26% 26% C Average Benefit Load per Medical Record Chart Pull FTE

54.00

54.00

54.00 D # Medical Records per Square Foot

272,722.00

272,722.00

272,722.00 E # Medical Records

$ 51.54 $ 51.54 $ 51.54 F Annual Cost per Square Foot

$ 498,697.00 $ 498,697.00 $ 498,697.00 G Annual Cost for Medical Record Forms, Folders, and Other Miscellaneous Supplies

40.00% 60.00% 75.00% H Reduction in Chart Pulls

$1,112,980 $1,289,973 $1,422,718 Additional Annual Cost Savings = [AxHxBX(1+C)]+(E/DxF)+G

Cost Decrease - 6

Conservative Medium Aggressive Reduce Pharmacy Costs through Generic Substitutions and Changes to Dosages and Forms

$ 2,854.00 $ 2,854.00 $ 2,854.00 A Pharmacy Expense per Adjusted Admission

124,564.00

124,564.00

124,564.00 B Total Adjusted Admissions

6.00% 10.00% 15.00% C

% Reduction in Pharmacy Expense per Admission due to Generic Substitutions and changes to

dosages and forms

$21,330,339 $35,550,566 $53,325,848 Additional Annual Cost Savings Benefit = AxBxC

Cost Decrease - 7

Conservative Medium Aggressive Reduce Nursing Overtime Expense by Increasing Productivity

123,250

123,250

123,250 A Annual Nurse Overtime Hours

$ 53.00 $ 53.00 $ 53.00 B Average Cost per Nurse Overtime Hour

5.00% 8.00% 10.00% C Productivity Increase

$326,613 $522,580 $653,225 Additional Annual Cost Savings Benefit =AXBXC

Cost Decrease - 8

Conservative Medium Aggressive Reduce Labor Costs Through Revenue Cycle Efficiencies.

175.90

175.90

175.90 A Total Revenue Cycle FTEs

43,710

43,710

43,710 B Average Revenue Cycle FTE Salary

28% 28% 28% C Revenue Cycle FTE Benefit Load

5.00% 10.00% 20.00% D % Decrease in Revenue Cycle FTEs

$ 490,148 $ 980,295 $ 1,960,590 Additional Annual Cost Savings Benefit = AxBx(1+C)xD


Total benefit projections are significant Cost Decrease - 9

Conservative Medium Aggressive Reduction in Materials Management Cost by Reducing Form and Paper Demand

1,000,000.00 1,000,000.00 1,000,000.00 A Total Paper, Forms, and Other Materials Management Cost

20.00% 30.00% 40.00% B % Materials Management Cost Reduction

$200,000 $300,000 $400,000 Additional Annual Cost Savings = AxB

REVENUE INCREASE FACTORS

Revenue Increase - 1

Conservative Medium Aggressive Increase Net Revenue through Decrease in Untimely Filings

2,954,388,312

2,954,388,312

2,954,388,312 A Total Annual Inpatient Gross Revenue

992,024,075

992,024,075

992,024,075 B Total Annual Inpatient Net Revenue

6,933,919

6,933,919

6,933,919 C Annual Untimely Claims Gross Write-Offs ($)

20.00% 40.00% 60.00% D % Decrease in Untimely Claims Filings

$465,654 $931,308 $1,396,962 Additional Annual Revenue Benefit =(B/A)xCxD

Revenue Increase - 2

Conservative Medium Aggressive Increase Net Revenue through Increase in Gross Revenue Charge Capture

$ 2,954,388,312 $ 2,954,388,312 $2,954,388,312 A Total Annual Inpatient Gross Revenue

$ 992,024,075 $ 992,024,075 $ 992,024,075 B Total Annual Inpatient Net Revenue

0.40% 0.50% 0.90% C % increase in Gross Revenue Capture

$ 3,968,096 $4,960,120 $8,928,217 Additional Annual Net Revenue Benefit =AxCxB/A

One Time Revenue Increase - 3

Conservative Medium Aggressive One Time Increase in Cash Collections by Decreasing Discharged-Not-Final-Billed AR

$ 992,024,075 $ 992,024,075 $ 992,024,075 A Total Annual Inpatient Net Revenue

72

72

72 B Current Days in Net AR

2.00% 5.00% 6.00% C % Decrease in Days in Net AR

$3,919,175 $9,797,936 $11,757,524 Additional One Time Cash Benefit = A/365xBxC

Revenue increase - 4

Conservative Medium Aggressive

Increase in Net Revenue by reducing denied days and rebilling due to better

coding/documentation

6,231.00 6,231.00 6,231.00 A Total Annual Denied Days

19,724,726.00 19,724,726.00 19,724,726.00 B Estimated Annual Dollars associated with denied days

15.00% 20.00% 30.00% C % Decrease in Denied Days

$2,958,709 $3,944,945 $5,917,418 Additional Annual Net Revenue = B/AxAxC

Community Wide Analytics

30


Prevention

Screening & Early

Detection Treatment & Palliation

Key: Better than National rate/Target Equal to or slightly worse than National rate/Target Significantly worse than National rate/Target Improving Steady Declining

Prostate Cancer

Incidence Rate

Lung Cancer

Incidence Rate

Adult

Smoking Rate

Adolescent

Smoking Rate

Advice to

Quit Smoking

Pharmacotherapy to

Quit Smoking

Adult Obesity

Rate

Cancer Incidence Rate

All Sites

Breast Cancer

Incidence Rate

Breast Cancer

Screening Rate

Hist. Assessment

Breast Cancer

Colorectal Cancer

Screening Rate

Advanced Stage

Colorectal Cancer Dx

Early Stage Breast

Cancer Diagnosis

Advanced Stage Breast

Cancer Diagnosis

Clean Margins Breast

Conserving Surgery

Needle Biopsy for

Breast Cancer

Timely Breast

Cancer Biopsy

Pathology Reports for

Breast Cancer

Path Compliance

For Specimens


Colorectal Cancer


Lung Cancer

Breast Cancer Staged

Before Treatment

Lung Cancer Staged

Before Treatment

Participation in

Clinical Trials

Inappropriate Hormonal

Therapy - Prostatectomy

Appropriate EBRT

Prostate Cancer

EBRT/Hormone Therapy

Prostate Cancer

Adjuvant Radiation

Breast Consv. Surgery

Adjuvant Hormone Ther

Invasive Breast Cancer

Adjuvant Chemotherapy

Breast Cancer

Mammography After

Treatment

Cancer Pain

Assessment

Prevalence of Pain

Among Cancer Patients

Hist. Assessment

Colorectal Cancer


Colorectal Cancer

Cancer Deaths

In Hospice

Hospice

Length of Stay


Prostate Cancer

Colorectal Ca. Staged

Before Treatment

Colonoscopy

After Treatment

All Cancers

Mortality Rate

Breast Cancer

Mortality Rate

Colorectal Cancer

Mortality Rate

Lung Cancer

Mortality Rate

Prostate Cancer

Mortality Rate

Prostate Cancer Staged

Before Treatment

Breast Cancer

Survival Rate

Colorectal Cancer

Survival Rate

Lung Cancer

Survival Rate

Prostate Cancer

Survival Rate

Diagnosis &

Staging

Colorectal Cancer

Incidence Rate

Many Benefits:

Improved quality of care/patient safety

Cost reduction (e.g., redundant tests)

Enhanced operational efficiencies (pulling information, reporting, etc.)

Population Management Community-wide disease

management Disease surveillance Etc.

The HIE is also a tool for community-wide analytics


3-1

Prevention

Screening

& Early

Detection Diagnosis Treatment & Palliation

Prostate Cancer

Incidence Rate

Lung Cancer

Incidence Rate

Colorectal Cancer

Incidence Rate

Adult

Smoking Rate

Adolescent

Smoking Rate

Advice to

Quit Smoking

Pharmacotherapy to

Quit Smoking

Adult Obesity

Rate


All Sites

Breast Cancer

Incidence Rate

Hist. Assessment

Breast Cancer

Breast Cancer

Screening Rate

Colorectal Cancer

Screening Rate

Advanced Stage


Early Stage

Breast Cancer Dx

Advanced Stage

Breast Cancer Dx

Clean Margins


Needle Biopsy for

Breast Cancer

Timely Breast

Cancer Biopsy


Breast Cancer

Path Compliance

For Specimens


Colorectal Cancer


Lung Cancer


Before Treatment

Lung Cancer Staged

Before Treatment

Participation in

Clinical Trials



Appropriate EBRT

Prostate Cancer


Prostate Cancer

Adjuvant Radiation





Breast Cancer

Mammography After

Treatment

Cancer Pain

Assessment

Prevalence of Pain


Hist. Assessment

Colorectal Cancer


Colorectal Cancer

Cancer Deaths

In Hospice

Hospice

Length of Stay


Prostate Cancer


Before Treatment

Colonoscopy

After Treatment

All Cancers

Mortality Rate

Breast Cancer

Mortality Rate

Colorectal Cancer

Mortality Rate

Lung Cancer

Mortality Rate

Prostate Cancer

Mortality Rate


Before Treatment

Breast Cancer

Survival Rate

Colorectal Cancer

Survival Rate

Lung Cancer

Survival Rate

Prostate Cancer

Survival Rate

Home

3-1 Adult Smoking Rate

Source: Behavioral Risk Factor Surveillance Survey, 2006

20.0% 19.9%

22.2%

12.0%

0.00%

5.00%

10.00%

15.00%

20.00%

US GA Exchange Healthy

People 2010

Target

Next

More Proprietary and confidential


Breast Cancer

Survival Rate

Colorectal Cancer

Survival Rate

Lung Cancer

Survival Rate

Prostate Cancer

Survival Rate

3-1Trend

Prevention

Screening

& Early


Prostate Cancer

Incidence Rate

Lung Cancer

Incidence Rate

Colorectal Cancer

Incidence Rate

Adult

Smoking Rate

Adolescent

Smoking Rate

Advice to

Quit Smoking

Pharmacotherapy to

Quit Smoking

Adult Obesity

Rate


All Sites

Breast Cancer

Incidence Rate

Hist. Assessment

Breast Cancer

Breast Cancer

Screening Rate

Colorectal Cancer

Screening Rate

Advanced Stage


Early Stage

Breast Cancer Dx

Advanced Stage

Breast Cancer Dx

Clean Margins


Needle Biopsy for

Breast Cancer

Timely Breast

Cancer Biopsy


Breast Cancer

Path Compliance

For Specimens


Colorectal Cancer


Lung Cancer


Before Treatment

Lung Cancer Staged

Before Treatment

Participation in

Clinical Trials



Appropriate EBRT

Prostate Cancer


Prostate Cancer

Adjuvant Radiation





Breast Cancer

Mammography After

Treatment

Cancer Pain

Assessment

Prevalence of Pain


Hist. Assessment

Colorectal Cancer


Colorectal Cancer

Cancer Deaths

In Hospice

Hospice

Length of Stay


Prostate Cancer


Before Treatment

Colonoscopy

After Treatment

All Cancers

Mortality Rate

Breast Cancer

Mortality Rate

Colorectal Cancer

Mortality Rate

Lung Cancer

Mortality Rate

Prostate Cancer

Mortality Rate


Before Treatment

3-1 Adult Smoking Rate

Source: Behavioral Risk Factor Surveillance Survey, 2006

10%

12%

14%

16%

18%

20%

22%

24%

26%

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

US GA ExchangeHealthy

People 2010

Target

Home Back Next

Less

Proprietary and confidential


Breast Cancer

Survival Rate

Colorectal Cancer

Survival Rate

Lung Cancer

Survival Rate

Prostate Cancer

Survival Rate

3-2 Peer Comparisons

Prevention

Screening

& Early


Prostate Cancer

Incidence Rate

Lung Cancer

Incidence Rate

Colorectal Cancer

Incidence Rate

Adult

Smoking Rate

Adolescent

Smoking Rate

Advice to

Quit Smoking

Pharmacotherapy to

Quit Smoking

Adult Obesity

Rate


All Sites

Breast Cancer

Incidence Rate

Hist. Assessment

Breast Cancer

Breast Cancer

Screening Rate

Colorectal Cancer

Screening Rate

Advanced Stage


Early Stage

Breast Cancer Dx

Advanced Stage

Breast Cancer Dx

Clean Margins


Needle Biopsy for

Breast Cancer

Timely Breast

Cancer Biopsy


Breast Cancer

Path Compliance

For Specimens


Colorectal Cancer


Lung Cancer


Before Treatment

Lung Cancer Staged

Before Treatment

Participation in

Clinical Trials



Appropriate EBRT

Prostate Cancer


Prostate Cancer

Adjuvant Radiation





Breast Cancer

Mammography After

Treatment

Cancer Pain

Assessment

Prevalence of Pain


Hist. Assessment

Colorectal Cancer


Colorectal Cancer

Cancer Deaths

In Hospice

Hospice

Length of Stay


Prostate Cancer


Before Treatment

Colonoscopy

After Treatment

All Cancers

Mortality Rate

Breast Cancer

Mortality Rate

Colorectal Cancer

Mortality Rate

Lung Cancer

Mortality Rate

Prostate Cancer

Mortality Rate


Before Treatment

14.4%

17.2%

23.0%

16.0%

0%

5%

10%

15%

20%

25%

Exchange Georgia U.S. Average Healthy

People 2010

Target

3-2 Adolescent Smoking Rate: percent of youths age

13-17 who currently smoke

Source: (Georgia, US) YBRSS survey, 2005

Back Next Home

More



Breast Cancer

Survival Rate

Colorectal Cancer

Survival Rate

Lung Cancer

Survival Rate

Prostate Cancer

Survival Rate

3.2 Trend

Prevention

Screening

& Early


Prostate Cancer

Incidence Rate

Lung Cancer

Incidence Rate

Colorectal Cancer

Incidence Rate

Adult

Smoking Rate

Adolescent

Smoking Rate

Advice to

Quit Smoking

Pharmacotherapy to

Quit Smoking

Adult Obesity

Rate


All Sites

Breast Cancer

Incidence Rate

Hist. Assessment

Breast Cancer

Breast Cancer

Screening Rate

Colorectal Cancer

Screening Rate

Advanced Stage


Early Stage

Breast Cancer Dx

Advanced Stage

Breast Cancer Dx

Clean Margins


Needle Biopsy for

Breast Cancer

Timely Breast

Cancer Biopsy


Breast Cancer

Path Compliance

For Specimens


Colorectal Cancer


Lung Cancer


Before Treatment

Lung Cancer Staged

Before Treatment

Participation in

Clinical Trials



Appropriate EBRT

Prostate Cancer


Prostate Cancer

Adjuvant Radiation





Breast Cancer

Mammography After

Treatment

Cancer Pain

Assessment

Prevalence of Pain


Hist. Assessment

Colorectal Cancer


Colorectal Cancer

Cancer Deaths

In Hospice

Hospice

Length of Stay


Prostate Cancer


Before Treatment

Colonoscopy

After Treatment

All Cancers

Mortality Rate

Breast Cancer

Mortality Rate

Colorectal Cancer

Mortality Rate

Lung Cancer

Mortality Rate

Prostate Cancer

Mortality Rate


Before Treatment

0%

5%

10%

15%

20%

25%

30%

35%

40%

1991

1993

1995

1997

1999

2001

2003

2005

2007

U.S. Georgia

Exchange Healthy people 2010

3-2 Adolescent Smoking Rate: percent of youths age 13-

17 who currently smoke

Source: YBRSS survey, 2005

Back Next Home

Less



Breast Cancer

Survival Rate

Colorectal Cancer

Survival Rate

Lung Cancer

Survival Rate

Prostate Cancer

Survival Rate

3-3 Advice to Quit

Prevention

Screening

& Early


Prostate Cancer

Incidence Rate

Lung Cancer

Incidence Rate

Colorectal Cancer

Incidence Rate

Adult

Smoking Rate

Adolescent

Smoking Rate

Advice to

Quit Smoking

Pharmacotherapy to

Quit Smoking

Adult Obesity

Rate


All Sites

Breast Cancer

Incidence Rate

Hist. Assessment

Breast Cancer

Breast Cancer

Screening Rate

Colorectal Cancer

Screening Rate

Advanced Stage


Early Stage

Breast Cancer Dx

Advanced Stage

Breast Cancer Dx

Clean Margins


Needle Biopsy for

Breast Cancer

Timely Breast

Cancer Biopsy


Breast Cancer

Path Compliance

For Specimens


Colorectal Cancer


Lung Cancer


Before Treatment

Lung Cancer Staged

Before Treatment

Participation in

Clinical Trials



Appropriate EBRT

Prostate Cancer


Prostate Cancer

Adjuvant Radiation





Breast Cancer

Mammography After

Treatment

Cancer Pain

Assessment

Prevalence of Pain


Hist. Assessment

Colorectal Cancer


Colorectal Cancer

Cancer Deaths

In Hospice

Hospice

Length of Stay


Prostate Cancer


Before Treatment

Colonoscopy

After Treatment

All Cancers

Mortality Rate

Breast Cancer

Mortality Rate

Colorectal Cancer

Mortality Rate

Lung Cancer

Mortality Rate

Prostate Cancer

Mortality Rate


Before Treatment

100%

85%

75%

80%

85%

90%

95%

100%

Exchange Healthy People 2010 Target

3-3 Smokers who receive advice to quit

Back Next Home



Breast Cancer

Survival Rate

Colorectal Cancer

Survival Rate

Lung Cancer

Survival Rate

Prostate Cancer

Survival Rate

3-4 Pharmacotherapy

Prevention

Screening

& Early


Prostate Cancer

Incidence Rate

Lung Cancer

Incidence Rate

Colorectal Cancer

Incidence Rate

Adult

Smoking Rate

Adolescent

Smoking Rate

Adult Obesity

Rate


All Sites

Breast Cancer

Incidence Rate

Hist. Assessment

Breast Cancer

Breast Cancer

Screening Rate

Colorectal Cancer

Screening Rate

Advanced Stage


Early Stage

Breast Cancer Dx

Advanced Stage

Breast Cancer Dx

Clean Margins


Needle Biopsy for

Breast Cancer

Timely Breast

Cancer Biopsy


Breast Cancer

Path Compliance

For Specimens


Colorectal Cancer


Lung Cancer


Before Treatment

Lung Cancer Staged

Before Treatment

Participation in

Clinical Trials



Appropriate EBRT

Prostate Cancer


Prostate Cancer

Adjuvant Radiation





Breast Cancer

Mammography After

Treatment

Cancer Pain

Assessment

Prevalence of Pain


Hist. Assessment

Colorectal Cancer


Colorectal Cancer

Cancer Deaths

In Hospice

Hospice

Length of Stay


Prostate Cancer


Before Treatment

Colonoscopy

After Treatment

All Cancers

Mortality Rate

Breast Cancer

Mortality Rate

Colorectal Cancer

Mortality Rate

Lung Cancer

Mortality Rate

Prostate Cancer

Mortality Rate


Before Treatment

88.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Exchange

3-4 Smokers who are recommended pharmacotherapy to

assist in quitting smoking

Back Next Home

Advice to

Quit Smoking

Pharmacotherapy to

Quit Smoking


EHR Technical Characteristics

38


The Generic HIE reference architecture depicts a basic architecture with its various

services and security components that make up the HIE.

Generic HIE reference architecture

Stakeholders Business services

Demographics e-Prescribing and

medications Immunizations

Lab

orders/Results

Infrastructure services

Security management Messaging

Audit logging Monitoring Business rules

Exception handling

Channels

Interactive voice

response (IVR)

Fax

Web service

Electronic Data

interchange (EDI)

Call center

Web/HTTP (Portal)

File transfer protocol

(FTP)

Disease

management

Admit/Visit/

Discharge notes Allergies Radiology

Diagnostic Imaging Scheduling

Data services

Decision support Messaging data

Data warehouse Business intelligence Audit/Logging data

Distributed services

Record locator

service (RLS) Terminology

Enterprise master

patient index (EMPI) Consent management Alerts

Identity management

Medical management

Clinics

Labs

Centers for Medicare

and Medicaid Services (CMS)

Patients

State

Agencies/Programs (Medicaid, Pharmacy

Benefits Management,

Eligibility, Child Welfare, Foster Care, etc.)

Hospitals

Payers EMR Lite

Electronic medical

record (EMR)


HIE sample logical architecture


HIE Data Architecture Types

Federated/decentralized Model No centralized data repository. Each stakeholder keeps its own data within its walls and queries

assemble data on the fly. It is an easy model for stakeholders to accept…with major issues

related to presenting the data in a normalized, significant way and with acceptable performance

Stakeholder A

Stakeholder B

Stakeholder C

Centralized Model

Each stakeholder sends its agreed upon data to a central data repository where data

is “cleansed” and normalized. Typically, analytical software sits on top of the central

data repository for longitudinal analysis.

Stakeholder A

Stakeholder B

Stakeholder C

Operational Database

Central data repository

Virtual or Partitioned Centralized Model

Each stakeholder sends its agreed upon data to a central data repository where data is “cleansed”

and normalized. Yet, this central data repository is virtual or the physical central repository is

partitioned in such a way that a given stakeholder controls its own data partition and could easily

take it back if required.

Stakeholder C

Central but partitioned

data repository

Each stakeholder sends an agreed upon subset of patient data to a

central data repository where data is “cleansed” and normalized. Part of

the patient data remains decentralized with record locator

service/centralized metadata indicating where these decentralized

components are.

Stakeholder A

Stakeholder B

Stakeholder C

Central subset

data repository

Hybrid Model Stakeholder A

Stakeholder B

Stakeholder C

Operational Database Edge Database

Federated Hybrid Model Each stakeholder sets up a mirrored database on the facility’s edges

where data can be cleansed and normalized per the exchange’s

standards. It is this database that is used to query data from the

Exchange.

1

2 3

4

4

Stakeholder A

Stakeholder B


Below are key points and takeaways for each architecture types

HIE Data Architecture Takeaways

Federated Centralized Hybrid

Participating organization

retains control of their

healthcare information

Stakeholders retain

control over the patient

data

Data security is

considered to be less

complex

Generally uses a form of

Record Location Service

(RLS)

HIE entity has control of

the healthcare information

Stakeholders decide the

patient data to share

Data security is more

complex

Not a preferred option for

stakeholders as they don’t

have control of the data

(Co-Mingling of data)

Data analytics is easier

Variable types and level

of connectivity

Stakeholders decide the

patient data to share

Data security is more

complex than Federated

A preferred option as it

allows leveraging existing

HIOs

Data analytics is easier

Current State of EHRs

43


Many EHRs are still in the early deployment phases (estimated allocation)

44

Phase 4:

OPERATIONS

Phase 3: IMPLEMEN- TATION

Phase 2: DETAILED DESIGN

Phase 1: STRATEGY & PLANNING

Phase 0: FEASIBILITY

Phase 5:

OPERATIONS

Phase 4: IMPLEMEN- TATION

Phase 3: DETAILED DESIGN

Phase 2: STRATEGY & PLANNING

Phase 1: FEASIBILITY

PROGRESSION OF PHASES

No broad community support

No clear objective

No self-sustainable business model

Privacy concerns

No clear value for physicians


Many complex, interrelated characteristics

45

FEASIBILITY

STRATEGY &

PLANNING

DETAILED

DESIGN

IMPLEMENTATION

OPERATIONS

GOVERNANCE:

FUNCTIONAL:

TECHNOLOGY:

PRIVACY/SECURITY:

How the Exchange is structured, how decisions are made, and the rules

that guide relationships among stakeholders, between old and new

participants, the governance model it will follow

Definition of an agreed upon vision, definition of core features and

functions that constitute HIE, definition of strong value propositions for

each key stakeholder type…

How is the Exchange architected, how it deals with standards, the set of

services it must incorporate, etc…

How will privacy/data access be defined, how will secure data exchange

be implemented, definition of patient consent policies, etc…

FINANCIAL: Definition of a self-sustainable financial model, definition of a balance

ROI among stakeholders, definition of mechanisms to counter first

mover disadvantage, etc.…

Disruptive Innovation

in Healthcare

Callum Bir

Director,

Life Sciences & Healthcare


Disruptive Innovation


Social Networking

48

Facebook drives more traffic online than Google

https://www.deloitte.com/view/en_US/us/Industries/health-care-providers/center-for-health-solutions/disruptive-innovations/2fbc755f3c1b9210VgnVCM100000ba42f00aRCRD.htm


Compare hospitals & doctors?

Percent who compare physicians and hospitals before making a selection and

most trusted sources of medical information compared to other sources


Facebook

Building fan pages for specific causes,

organizations or products; sharing

recreation-oriented campaigns


YouTube

Posting educational videos

and testimonials


Patients Like Me

52

PatientsLikeMe is a data-driven social

networking health site that enables its

members to share condition, treatment,

and symptom information in order to

monitor their health over time and learn

from real-world outcomes. Members are

able to find and connect with patients like

them, gain social support, and learn first-

hand about ways to cope and manage.

PatientsLikeMe aims to help patients

answer the question: "Given my status,

what is the best outcome I can hope to

achieve, and how do I get there?"

PatientsLikeMe

Type Private

Founded 2004

Headquarters Cambridge,

Massachusetts,USA

Key people Ben Heywood, Co-Founder,

President

James Heywood, Co-Founder,

Chairman

David S. Williams III, Chief

Marketing Officer, Head of

Business Development

Robert Palladino, Chief

Financial Officer

Paul Wicks, PhD., R&D

Director

Slogan "Patients Helping Patients Live

Better Every Day"

Website patientslikeme.com

Type of site social networking

Launched October 10, 2005

Current status Active

http://en.wikipedia.org/wiki/Social_networking


http://en.wikipedia.org/wiki/Types_of_business_entity

http://en.wikipedia.org/wiki/Private_company

http://en.wikipedia.org/wiki/Cambridge,_Massachusetts

http://en.wikipedia.org/wiki/Cambridge,_Massachusetts

http://en.wikipedia.org/wiki/USA

http://en.wikipedia.org/wiki/James_Heywood_(chief_executive)

http://en.wikipedia.org/wiki/Slogan

http://www.patientslikeme.com/



Twitter

Doctors & Citizens access

most latest from trusted sources.

Less is more..

.


Linked-in

Recruiting talent,

announcing staff news

Case Studies – Mobility

55


Examples of how Technology is Changing how we may look at EHRs

56


NSW Emergency Waiting Times Mobile Site

57


Department of Health and Human Services Tasmania

improve the quality of patient care while also increasing organisational efficiency in

their hospitals.

58

Transiting from Patient Oriented Care to

Consumer Model of Care ….

beyond ehr - achieving operational efficiency

Health & Medicine

health care costs

health care delivery

partners health care

quality of care

care continuum

health plans

operational hies

reported better care