HIMSS ‘09 Session 52 Patient-controlled Health Record Banks: An Answer to the HIT Privacy Problem?
Health Record Banks: Business Considerations
31
Health Record Banks: Business Considerations William A. Yasnoff, MD, PhD, FACMI Managing Partner, NHII Advisors Adjunct Professor, Division of Health Sciences Informatics Johns Hopkins University WCIT Guadalajara, Mexico September 30, 2014 © 2014
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William A. Yasnoff, MD, PhD, FACMI WCIT 2014, Guadalajara, Mexico
Transcript of Health Record Banks: Business Considerations
Health Record Banks: Business Considerations
William A. Yasnoff, MD, PhD, FACMI
Managing Partner, NHII Advisors
Adjunct Professor, Division of Health Sciences Informatics
Johns Hopkins University
WCIT
Guadalajara, Mexico
September 30, 2014
© 2014
2 © 2014
3 © 2014
Overview: “Big Data” has Value Need critical mass (“Big”)
Most of population
Need repository with comprehensive records for each person (“Data”)
0
20
40
60
80
100
0 20 40 60 80 100
Va
lue o
f In
fo (
%)
Completeness of Information (%)
Value vs. Completeness of Health Information
Source: Yasnoff WA: Health Information Infrastructure. In Biomedical Informatics:
Computer Applications in Healthcare and Medicine, Fourth Edition (Shortliffe &
Cimino, eds.). New York: Springer-Verlag, 2014, pp. 423-441.
4 © 2014
Funding Options for Health Information Infrastructure 1. Public funding
Additional taxes unpopular
2. Capture health care savings
One stakeholder’s “savings” is another’s “lost revenue”
Timing, magnitude, and distribution of savings
– Unproven
– Difficult to predict
3. Leverage new value of comprehensive electronic patient records
5 © 2014
Health Record Banking: Community Paradigm Shift
Fetch & Show
• Based on manual “fetch & fax”
• Inefficient & expensive
• Prone to error (record sources unavailable)
• Impractical to search data
• Hard to protect patient privacy
• No sustainable business model
Repository
• Based on “deposit to account”
• Efficient & inexpensive
• Reliable & secure
• Searchable for public health & research
• Privacy assured via patient control
• Each community has one (or more) health record banks
• Each patient has an account
in a single health record bank
Health Record Bank
6 © 2014
http://www.healthbanking.org/video1.html
What is a Health Record Bank?
7 © 2014
Health Record Bank (HRB)
Secure community-based repository of complete health records
Access to records fully controlled by patients (or designee)
“Electronic safe deposit boxes”
Information about care deposited once when created
Operation simple and inexpensive
Enables effective business models by leveraging value of “Big Data”
8 © 2014
Health Record Bank Architecture
Patient Records
Clinician EHR
Patient Encounter
HRB
1
3
2
Diagram © Health Record Banking Alliance, 2013. Used by permission.
9 © 2014
Clinical Encounter
Health Record
Bank
Clinician EHR
System
Encounter Data
Entered in EHR
Encounter
Data sent to
Health
Record Bank
Patient
Permission? NO
DATA NOT
SENT
Clinician
Inquiry
Patient data
delivered to
Clinician
YES
optional
payment
Clinician’s Bank Secure
patient
health data
files
Health Record Bank Operation
10 © 2014
HRB Rationale Operationally simple
Records immediately available
Deposit new records when created
Enables value-added services
Patient control
Trust & privacy
Stakeholder cooperation (HIPAA in U.S.)
Low cost facilitates business model
Can include EHR incentive options to assure all-electronic data
– Pay for deposits
– Provide Internet-accessible EHRs
11 © 2014
How HRBs Create Value
Health Record Bank provides free/subsidized EHRs for physicians
More complete electronic health record information Enables delivery of
optional services with compelling value
Patients sign up for free HRB accounts (recommended by physicians)
Enables physicians to provide better patient care
$
12 © 2014
HRB Revenue Sources
1. Individuals
2. Health Care Professionals
3. Hospitals
4. Health Plans
5. Health Insurers
6. Public Health Departments
7. Policymakers
8. Researchers
9. Advertisers
13 © 2014
HRB Services: 1. Individuals
Reminders & Alerts
Peace of Mind
– Loved ones notified of emergency treatment
Prevention Advisor
– Reminders of needed tests and procedures based on demographics and medical records
Medication Refills (may be sponsored)
– Text messages when due
14 © 2014
HRB Services: 2. Health Care Professionals
Automatic patient reporting of normal/unchanged lab results
Patient intervention alerts
Quality measures
15 © 2014
HRB Services: 3. Hospitals
Access to patient summary in Emergency Department
Medication reconciliation
Patient intervention alerts
Reduce costly record requests
Quality measures
Targeted prevention/population health
16 © 2014
HRB Services: 4. Health Plans
Patient intervention alerts
Quality measures
Sponsorship of premium HRB services for members reduced costs
Targeted prevention/population health interventions
17 © 2014
HRB Services: 5. Health Insurers
Patient intervention alerts
Quality measures
Sponsorship of premium HRB services for members reduced costs
Targeted prevention/population health interventions
Analysis of de-identified utilization data
18 © 2014
HRB Services: 6. Public Health Departments Surveillance
Disease/condition incidence/prevalence
Treatment effectiveness in population
Targeted prevention initiatives
19 © 2014
HRB Services: 7. Policymakers
Monitor effects of policy changes
Assess cost and value of care
Assess effectiveness of prevention efforts
20 © 2014
HRB Services: 8. Researchers
Find subjects for clinical trials
Aggregated statistics in population
Correlations
Trends
Monitor for adverse events
21 © 2014
HRB Services: 9. Advertisers
Targeted messages based on disease/condition (with patient permission)
Services of interest
Discounts
Special offers
22 © 2014
HRB Business Model Example
Costs (with >= 1,000,000 subscribers)
Operations: $6/person/year
EHR incentives: $10/person/year
– Cloud-based EHR $5K/physician/year
– In U.S., 300 million population/600K physicians = 500 people/physician
– $5K EHR/500 people = $10/person/year
Total cost $16/person/year
23 © 2014
HRB Business Model Example Revenue
Reminders & Alerts: >= $18/person/year ($60/year x 30% penetration)
– “Peace of mind” alerts ($20/year)
– Preventive care reminders ($20/year)
– Medication reminders ($20/year)
Researcher Queries: >$5/person/year
Advertising: ~$3/person/year (option to opt out for small fee)
Total revenue = $26/person/year
No need to assume/capture any health care cost savings (!!)
24 © 2014
HRB Business Model Example
Bottom Line
Total cost = $16/person/year
Total revenue = $26/person/year
Net profit $10/person/year
$10,000,000/year with 1,000,000 subscribers
25 © 2014
Pro Forma Example (Houston)
($1,000)
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47
"Expenses ($K)"
"Revenue ($K)"
"Net ($K)"
Month
Initial Capital: $4.4 MM
Breakeven: 16 months
EBITDA Year 4: $41 MM+
26 © 2014
27 © 2014
Health and Promotion Prevention Initiative (HAPPI)
Link HRB with Community Population Health Organizations
Use HRB profits to fund population health
E.g., half of profits for 1 million population = $5,000,000/year
Aligns interests of healthcare stakeholders IF there are incentives for population health
28 © 2014
How does a HAPPI work?
PATIENT CONTROL
CENTRAL REPOSITORY
Stakeholder Cooperation
ensures
Electronic Patient Data
provides
Benefits
1. Clinical: Quality,Costs
2. Reminders/Alerts
3. Research
produces
pay for
enables
Prevention (stakeholder need)
empowers
Privacy
protects
Financial
Incentives ensure
Key
Design
Decisions
Initial Steps:
1. Free/subsidized EHRs for physicians
2. Physicians recruit patients for free HRB accounts
29 © 2014
Summary “Big Data” has value
Need critical mass (“Big”)
Need repository with comprehensive electronic patient records (“Data”)
Possible mechanisms for funding HII
Taxes unpopular
Capture health care savings untenable
Health Record Banks facilitate business models by generating value from data
Revenue from many stakeholders
Health Record Banks can be profitable WITHOUT capturing health care savings
30 © 2014
Paradigm Shift Fetch & Show
• Based on manual “fetch & fax”
• Inefficient & expensive
• Prone to error (record sources unavailable)
• Impractical to search data
• Hard to protect patient privacy
• No sustainable business model
Repository
• Based on “deposit to account”
• Efficient & inexpensive
• Reliable & secure
• Searchable for public health & research
• Privacy assured via patient control
Health Record Bank
