Four Axes of Health Improvement - University of Hawaiistrev/ICS614/materials/07... · Political,...
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9/8/2008 1 Is there a link?? Dennis J. Streveler, Ph.D. University of Hawai`i Conference on Quality in Health Care – Manila – October 2007 Four Axes of Health Improvement Improving Access to health services Ensuring Equity in providing health services Increasing Cost-Efficiency Improving Quality of Care The Language of Quality… Inputs Outputs Outcomes Clinical Quality (health indicators) Perceived Quality (“patient satisfaction”) A QUALITY Burger! BK QUAD STACKER: 1,000 Calories 620 Calories from Fat 68g Fat 30g Saturated Fat 3 g Trans Fat 240 mg Cholesterol 1,800 mg Sodium 1 g Fiber What is Quality? “You will know it when you see it!” Measuring Quality: A Brief History Cancer Survival Rates Nosocomial Infection Rates WHO Health Indicators (e.g. IMR, MMR…) [USA] NCQA HEDIS Measures (from claims data) “Report cards” “Patient Safety” measures (after the IOM report) [USA] AHRQ Quality Indicators (QIs) “Pay-for-Performance” Global Trends in Infant Mortality, 1999 0 20 40 60 80 100 120 140 160 180 10 100 1000 10000 100000 per capita GDP, US$ infant mortality rate Sierra Leone Angola Guinea Namibia Botswana Latvia Sri Lanka Gabon China Slovak Rep. Ghana Courtesy of The World Bank Philippines [34, $1200] (2004)
Transcript of Four Axes of Health Improvement - University of Hawaiistrev/ICS614/materials/07... · Political,...
9/8/2008
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Is there a link??
Dennis J. Streveler, Ph.D.University of Hawai`i
Conference on Quality in Health Care – Manila – October 2007
Four Axes of Health Improvement Improving Access to health services Ensuring Equity in providing health services Increasing Cost-Efficiency
Improving Quality of Care
The Language of Quality… Inputs Outputs Outcomes
Clinical Quality (health indicators) Perceived Quality (“patient satisfaction”)
A QUALITY Burger!BK QUAD STACKER:1,000 Calories620 Calories from Fat68g Fat30g Saturated Fat3 g Trans Fat240 mg Cholesterol1,800 mg Sodium
1 g Fiber
What is Quality? “You will know it when you see it!”
Measuring Quality: A Brief History Cancer Survival Rates Nosocomial Infection Rates WHO Health Indicators (e.g. IMR, MMR…) [USA] NCQA HEDIS Measures (from claims data) “Report cards” “Patient Safety” measures (after the IOM report) [USA] AHRQ Quality Indicators (QIs) “Pay-for-Performance”
Global Trends in Infant Mortality, 1999
0
20
40
60
80
100
120
140
160
180
10 100 1000 10000 100000
per capita GDP, US$
infa
ntm
ort
alit
yra
te
Sierra Leone
AngolaGuinea
Namibia
BotswanaLatvia
Sri Lanka
Gabon
China
Slovak Rep.
Ghana
Courtesy of The World Bank
Philippines[34, $1200](2004)
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Selected HEDIS measures [USA]: Antidepressant Medication Management Beta Blocker Treatment Breast Cancer Screening Cervical Cancer Screening Cholesterol Management After Acute Cardiovascular
Events Childhood Immunization Status Comprehensive Diabetes Care Follow-up After Hospitalization For Mental Illness Prenatal and Postpartum Care
Five Characteristics Determine the “Value”of Good Health Information
Relevance of the information to the needs of thehealth system decision-making
Coverage, both geographical and by program/servicecomponent
Completeness of the information Accuracy of the information Timeliness of the information
THE STRATEGIC APPROACH: INTEGRATION
The systems we build must work together in order toenjoy their full value.
Strategy Intervention
Set standards for datacollection
Collect the mostvaluable data (not toomuch, not too little)
Create a center whichfocuses on the analysisof these data (“datawarehouse”)
Act on the results!
“Health Data Dictionary”
“Data Inventory”
“Health Data Warehouse”
“Information for Action!”
Principles Interventions Health information
should flow directly fromhealth delivery operations.
There must be a feedbackloop of information tothose providing the data.
An HMIS system is only asgood as its users!
To be sustainable, anInformation Systemrequires maintenance, anda support center.
Build Clinic InformationSystems, HospitalInformation Systems, andultimately an ElectronicHealth Record
Create a bottom-up as wellas a top-down datareporting structure
Build a Computer LiteracyCenter and ComputerTraining Center
Build a Support Center
Components“HARD” COMPONENTS: Hardware Software Telecommunications
Equipment Supplies
“SOFT” COMPONENTS: Health care delivery
process re-design Introduction of an
“information culture” Computer-ready buildings Budgeting for
sustainability Training and retraining Updates and support
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Iran’s “Vital horoscope”
Primary Health Clinic,near Isfahan, Iran, 2002
Cairo, Egypt:
Clinic InformationSystem withphysician access,1999
Jeseniče,Slovenia:
OnlineInsuranceKiosk withSmart Cardaccess,2001
Nuku`alofa,Kingdom of Tonga, 2003
May 9, 2007
Shanghai, China:Electronic Patient Record,Ruijin Digital Hospital, 2004
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Quality, some final remarks We will improve quality only if we demand an
improvement in quality!
We will improve quality only if we invest inimprovements to quality!
We will improve quality only if we are committed toaggressively using the health data which we collect!
Dennis Streveler, University of Hawai`i
PROMIS 1970PROMIS 1970 –– Larry Weed, VTLarry Weed, VT
MIS, El Camino Hospital, Mountain View CA, first 1972
Clinic, Katowice, Poland, 2006
bar-coding
Steps to Information Nirvana
Identify DataSources
Calculate theCost/Benefit ofcollecting the
data
Define how eachData Source
WILL be used
Build /modifythe HMIS
Create theDatawarehouse
Build capacity toanalyze the Data
VISUALIZE thedata
Make the dataavailable to
decision-makersalong with
recommendedactions
Define NationalPriorities Define Quality Choose Health
Indicators
Evaluatethe Impact
Modify thestrategy asnecessary
Iterate
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May 9, 2007
1.Payer
Systems
2.ProviderSystems
3. Interface andCommunication
THE HEALTH INSURANCE ENVIRONMENT The Role of the Payer Claims processor - “the bank” – “the intermediary” Risk aggregator
Educator – beneficiary, provider Monitor The Incentivizer
Case manager Active intervention Cause célèbre ?
Our biggest problem: Our biggest problems: Insurance coverage/affordability
Continuity of care Referrals to higher levels of care Returns to lower levels of care Follow-ups, compliance
Dumping Lucrative patient grabs
Tobacco control initiative: “smokers’ droop”
WHO Rankings:
1. France2. Italy3. San Marino4. Andorra5. Malta6. Singapore7. Spain8. Oman9. Austria10. Japan
31. Finland32. Australia33. Chile34. Denmark35. Dominica36. Costa Rica37. United States of America38. Slovenia39. Cuba40. Brunei
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THE UHCAMPUS IS
84%SMOKE FREE!
May 9, 2007 Distressed Beach near Gaza City, 2004
Uvurkhangai aimag, central Mongolia, 2003
Tajikistan:Porud Health Center, 2003
Ministry of Finance, Manama, Kingdom of Bahrain, 2001
May 9, 2007
Shahrud, Iran:“The Digital Hospital”
Radiology Digital Archiving,2002
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Telecardiology at Hospital #3 Heart Center,Ulaan Baatar, MongoliaNovember 2003
May 9, 2007
Telemedicine Center, MOPH, Nonthaburi, Thailand, Feb 2001
ICS 614 Project PresentationDecember 4, 2004
Lisa Yoda
Interview results:Is Home-based Telemedicine
1924
83 years ago!
• Consumer-oriented,longitudinal health record
• Emergency information
• Clipboard Replacement
• Immunization Tracker
• Event manager & healthreminders & trackers
• Consumer-defined accessrights
“My Health Record”
CONSUMERSCONSUMERS
ConsumerHealth Record
PHYSICIANSPHYSICIANS
Hospitals
Labs
Pharma
Health Plan
The Harvard Conference on American Health Care, Nov 3, 2000The Harvard Conference on American Health Care, Nov 3, 2000The Harvard Conference on American Health Care, Nov 3, 2000The Harvard Conference on American Health Care, Nov 3, 2000
Remember…Technology often gives us back
what
technology had taken away!
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May 9, 2007
1.Payer
Systems
2.ProviderSystems
3. Interface andCommunication
THE HEALTH INSURANCE ENVIRONMENT
1.Payer
Systems
2.ProviderSystems
THE HEALTH INSURANCE ENVIRONMENTREQUEST FOR
PAYMENT(CLAIM)
PROVIDERPAYMENT
Transaction example:Transaction example:
May 9, 2007
Transaction example:
1.Payer
Systems
2.ProviderSystems
THE HEALTH INSURANCE ENVIRONMENT
ENROLLMENT
ELIGIBILITY
Provider SystemProvider SystemProvider System Functionality
FUNCTIONALITY TODAY:Patient registration and rosteringEligibility checkingClaims / encounter creationClaims / encounter submissionAppointment schedulingPayment processingContract monitoringBusiness unit-level management informationCentral budgetary controlInventory managementClinical functionality
FUTURE POTENTIAL FUNCTIONALITY:Virtual longitudinal lifelong electronic patient recordsSupport for clinical practice guidelinesTelemedicine and teleconsultationVideo teleconferencingMedical research resources
Payer SystemPayer System Functionality
Registration and Eligibility
Premium Collection
Contracting and Contract Management
Claims Adjudication
Provider Payments
Utilization Management
Quality Management
Financial Management and Analysis, Accounting, Financial and ActuarialProjections
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Virtual re-integration “EMR”A Referral “system” (“code share”)RHIOs/Shared visit index
(e.g. Holomua Project)Shared clinical summaryElectronic medical record (EMR)Personal health record (PHR)
First EMR attempt? Morris Cullen, MD
Kaiser-Permanente, HaywardClinic, Northern California, 1956
51 years ago!
Holomua2005.10.06: AHRQ Awards Over $22.3
Million in Health Information ...The Holomua project in Hawaii will implement
a health IT system to improve the flow ofinformation among patients, communityhealth centers and hospitals ...www.hhs.gov/news/press/2005pres/20051006.html - 22k
Political, and economic, reality …NEW YORK TIMES July 10, 2007
A State Finds No Easy Fixes on Health CareBy KEVIN SACKGov. Edward G. Rendell of Pennsylvania, whocampaigned as a health care reformer, is learning thatto contain costs is to pluck dollars from someone’spocket.
Obstacles: Lack of data Cost of data input Lack of data standards HIPAA constraints
Defensive medicine Lack of a focus on quality Lack of a culture of quality Lack of political will!
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COSTS: The “Iceberg” Challenge
Source: Binseg Wang
RecognizedCosts
HiddenCosts
Remember… The EMR is no panacea! What data are available? How can the data be shared? Data entry is not free!
Dennis J. Streveler, Ph.D.University of Hawaii
