solutions webinar jan 16
TRANSCRIPT
C. Peter Waegemann EHR Visionary and Advocate
• One of 20 outstanding people who make healthcare better (HealthLeaders Magazine) • Former chair of 12 standards organizations • Father of ISO TC 215 • “The Ralph Nader of healthcare who tells the truth” (TEPR attendees) • Author of the book, Knowledge Capital in the Digital Society • International speaker and consultant • mHealth expert and HIT strategist
Practical Solutions
1985 1990 1995 2000 2005 2010
“Handbook of Record Storage
and Space Management”
published 1983
Joined Medical Records Institute
Two term Chair of ANSI HISB
Chair, Centre for Advancement of Electronic Health
Records UK/Europe
CEO
ISO TC 215
“Knowledge Capital in the Digital Society”
published
“Handbook of Information and Image
Management for the 1990s”
Over 100 articles and book chapter on EHRs/EMRs, mHealth and Participatory Health
Focus on mHealth mHealth
Initiative Focus on
Digital Society
Chaired 12 Standards
Committees SNOMED
International
CEO
First Chair of TEPR
Conference Patient Card Advocate
Personal Health Record: On card, on portable device, on mobile phone: Participatory Health
} Vision of CPR/EHRs was never implemented: Vision failed over 30 years. Not one fully interoperable and functional EHR has been completely implemented
} Documentation and functionality problems have never been resolved
} Financial incentives are used to entice providers to implement often inadequate and little-liked systems
} Patient involvement is no more than lip service } Healthcare is stuck in the 20th century and has to
reinvent itself to be part of the Digital Society of the 21st Century
Let me explain…
EHR/EMR Systems Don’t have to be !
Cutting-Edge
To be effective
Even a little computerization helps, however outdated and
inadequate
• 69% use a PC for interacting with patients • 55 % print out online material for patients • ? Use email with patients Source: HealthEd Academy
Implementation: What is Success?
All hospitals have an HIS computer system
EHR/EMR Systems
Don’t have to be !
Cutting-Edge
To be somewhat effective a little!
Of modern technology!
But a little effectiveness is not sufficient as we are facing a crisis
} Unbearable costs } Inadequate quality of care } Inefficiencies } Unhappy physicians } Unhappy support staff } Outdated HIT } Patronizing care processes
} “Consumers do (some of) the work” } New (often automated) communication } Virtual communities } Transparency
The Disconnect with the emerging Digital Society is another.
In a Digital Society
In stage 1, all memory and information processing (thinking) was taking place in the brain
In stage 2, books and documents supplemented the brain. Active interaction between information stored in the brain, information stored in books and information added on notes occurred. Books supported the brain.
In stage 3, most of the information is stored in WIC. The brain’s central function is to navigate the wealth of information, to create context of much of the data and to discern between various information according to one’s belief system.
No Doctor Can Memorize All Necessary Information
Human Intelligence Development
From my book Knowledge Capital in the Digital Society
Changes to our understanding of intelligence
Brain’s new role in dominating
the information field
Concept understanding
over memorizing
New educational paradigm New
intelligence systems
Transparency and
knowledge equality
WIC Literacy
WIC-based fact checking Emotional
motivators will be monitored and guided
Apps will guide people
Departure from linear
(book) information
capture From Knowledge Capital in the Digital Society
Cloud
Electrical algorithm processing units combined in integrated circuits make up the computer
Rules, processing and communication languages make up operating systems and software
Internet provides computer connectivity
Indexing makes digital information accessible
Mobile devices
Access all patient
data
Decision support for Diagnoses
Patient enters data
Orders
Medication management
Support for care plan
Referrals Care management
Eligibility
Guidelines and Protocols
Cost management
Follow-up communication
Patient instructions
Not just computers, not just the Internet, not mHealth, but the six elements that make up the World Information Community (WIC) in the Digital Society are together changing our life and our healthcare
} HIT has been pretty much stuck on old technologies and approaches. While other industries have reinvented themselves, healthcare has stayed with outdated approaches.
} All previous attempts at interoperability have failed. They will fail in the future until we consider new concepts.
} We need to move from EHR/EMR/MU strategies to 21stcentury strategies.
} New strategies will require a combination of national efforts and individual provider efforts.
Key functionalities users get from
IT • Renewals • Scanning • e-prescribing • Medical tracking • Easier use • Lower cost • Billing system integration
Source: MRI and Capterra InfoNewt
What Providers should demand from IT
• Care and decision support • Easier documentation • Easy ordering of tests/
medications/therapies/etc. • Transparency and direct
integration of back office • Simple connectivity to
pharmacies and other care associates
• Easier and secure communication with patients
• Higher efficiency and lower cost
• Systems doctors love
} e-Prescribing (eRx) Drug interaction
checking Formulary management Refills/repeats
} Physician order entry Diagnostic tests and
procedures } Results management Abnormal results
warning Trending/graphing
} Summary lists Allergies Medications Problems
} Clinical and administrative workflow tasking
} Charge capture/billing Medical necessity Automated coding E&M coding
1. Manage Patient Demographics 2. Manage Medication List 3. Manage allergy and adverse reaction 4. Manage patient history 5. Summarize a record (Capture and
Create a CCR) 6. Manage Clinical Documents and
notes 7. Capture External Documents
(Document imaging) 8. Capture of External Images
(Radiology) 9. Generate and record patient-specific
instructions 10. Order medication 11. Order diagnostic tests 12. Manage order sets 13. Manage results 14. Manage consents and authorizations 15. Manage patient advance directives 16. Support standard care plans 17. Capture variances from standard care
plans, guidelines, protocols 18. Support for drug interaction 19. Support for medication or
immunization administration and supply
20. Support for non-medication ordering (referrals, care management)
21. Present alerts for disease management, preventive services and wellness
22. Notifications and reminders for disease management, preventive services, and wellness
23. Clinical task assignment and routing 24. Inter-provider communication 25. Pharmacy communication 26. Provider demographics 27. Scheduling 28. Report Generation 29. Health Record Output 30. Encounter Management 31. Rules-driven financial and administrative
coding assistance 32. Eligibility verification and determination of
coverage 33. Manage practitioner/patient relationship 34. Clinical decision support system guidelines 35. Entity Authorization 36. Enforcement of confidentiality 37. Data retention, availability, destruction 38. Audit trail 39. Extraction of data 40. Current users
HIT Developments
Communication
Patient Involvement
Efficiencies
Cost Savings
Better Quality of Care
Apps link to
formularies
Browser link to
Internet
Apps support care
process
New data capturing methods
Care team communication
Customized communication
with care associates
Real-time communication
with payers
Major educational campaign to
educate patients
New communication pattern between
providers and patients
Customized communication of patients with
payers
Efficiencies through modern Internet-based technologies
Reduction or elimination of
documentation bottleneck
Real-time financial
transactions
Reduction or elimination of
duplicate services
Reduction or elimination of
duplicate services
Reduction of wasteful services through communication
E-care providing better quality of
care
Better adherence to guidelines and
protocols
Less time spent on documentation
– time for care processes
Better communication reduces errors
What Needs to be Done
} Widely achieved but needs refinement } Lesson: Successes bypassed traditional paths } First mHealth applications
Mobile apps link to formularies
• Drug databases • Currently most used apps
• Reference programs • Many medical books transferred into apps
• Educational apps • Lots of apps for students and CE apps
} Understanding the vision } Widely achieved but needs refinement } Needs easier navigation } Gap between computer-savvy docs and old-
fashioned approaches
At the point-of-care: Browser link to Internet
} Despite the mHealth hype, few implementations
} Vision } Integration into HIS systems is a problem
Apps to support care processes
} Documentation cost and problems } Future of transcription? } Goal: Documentation that is less costly and
easier } Waiting for “the big solution”
New data capturing methods
} Ending “lone opinions” and information silos } The false promise of Telemedicine } Establishing the care team
Internal care team communication
} How to bring modern communication into your organization
External care team
communication
1. Identification: Photo identification, online ID, etc.
2. Patient-Provider 3. Provider-Patient 4. Provider-Provider 5. Provider-Payer 6. Payer-Patient 7. Public Health-Provider and
Provider-Public Health 8. Patient-Public Health
Patient Provider
Other Providers
Payer
Public Health
Other Care Members
Pharmacy
Others
} Complaints from Vendors and Providers and Patients
} Time to adjust HIPAA to realities of the digital society
Real-time communication
with payers
• Real-time financial transactions • Virtual eligibility determination • Virtual charge capture • Virtual adjudication
Customized connectivity with
care partners
Needed The one-click connection with care partners such as
• Pharmacies • Hospitals • Lab • Therapists • Other Providers
By texting and email
} Patients must be allowed and encouraged to be fully informed about their health. They must be given full transparency in the care process, both in medical and financial data.
Cost Containment, Efficiencies, even Quality of Care depend on One Element:
Patients
} Why can’t we spend $100 million on educating patients about participation in their healthcare? ◦ Information in every waiting room and exam room ◦ A national advertising campaign ◦ Providers must do their part
Major educational campaign to
educate patients
New communication pattern between providers and patients
• Digital communication of the 21st century • Text messages
• Automated confirmations and reminders • Email • Integrated apps
Move from periodic visits to continuous and managed e-visits
} Cost options should always be available for both providers and patients
} Transparency: Make patients aware of how much a procedure costs so they can make informed decisions, budget, and speak up when the money is wasted
Customized communication of patients with
payers
} Let the patient do the work: Documentation, Appointment Scheduling, etc.
} Reduce duplication } Efficiency
Efficiencies through modern Internet-based
technologies
} National efforts to develop a solution } Pressure on leading companies
Reduction or elimination of
documentation bottleneck
} Cut the Gordian Knot } National effort to include all stakeholders
Real-time financial
transactions
} Across providers and within provider organizations
} Emergency Departments
Reduction or elimination of
duplicate services
} Analyze what went wrong } National efforts to manage health costs } National efforts toward a new direction in
HIT } What providers should do } What payers should do } Patients
} Analyze how to improve and/or integrate MU } Consensus development on new strategy } Consensus development on reworking HIPAA } National discussion on standards
developments } Analysis of future role of ONC
} Paradigm shift towards patients ◦ Create patient network community ◦ New communication methods
} Create internal care team policies and systems
} Improve EMR System
} The new paradigm } The future is in digital care communities
IRTUAL HEALTH SERVICES
ARKETING HEALTH SERVICES
UTOMATED APPOINTMENT SYSTEMS
PROVIDER’S PATIENTS = INFORMATION COMMUNITY DOCTORS’ SPECIALTY KNOWLEDGE = CAPITAL PARTICIPATING PATIENTS = RESOURCES
HEALTHCARE CANNOT CONTINUE TO BE ONE-SIDED TRANSPARENCY = COMMUNICATION, COMMUNICATION CARE MANAGEMENT VS. INDIVIDUAL WHIMS
} Policy for apps } Browser strategy and help } Data capture: Transcription, alternatives } Patient outreach ◦ Collect mobile phone numbers ◦ Create new communication agreements ◦ Automated text and email systems ◦ Communication policies ◦ Patient educational material
} Care team policies and systems } Customized communication with pharmacies,
hospitals, labs, etc. } Appointment system } Business intelligence
} Need for national attention to the lack of HIT openness
} Inefficiencies, old modules, technologies of the 1990s
} Individual organizations breaking away are generally not successful
} How to overcome industry interests and vested group thinking
} Obamacare and change to ICD 10 offer great opportunities
} Need for a national framework for a payment system that each competing company can adjust to its marketing and business strategy
} Transparency to providers and patients } Real-time eligibility determination, charge
capture, and adjudication } New communication in informing the patient
the costs of care
} Most of the current EMR/HIT systems are outdated, inadequate and do not fit into the digital society
} We are heading toward a major seismic shift in healthcare
} National re-thinking and redesign is needed ◦ Mandating interoperability ◦ Opening the HIS industry to competition ◦ National campaign to involve patients ◦ Efforts to redefine HIPAA for the digital society ◦ Mandating transparency
} Providers should start now implementing digital society healthcare features
