Kurt Salmon - Get Plugged in: Defining Your Connectivity Strategy - April 2013

Get Plugged in: Defining Your Connectivity Strategy CHIME College Live 17 April 2013

| Copyright Kurt Salmon © 2013– All Rights Reserved

Topics

Introductions

Drivers

Strategies

Imperatives

Discussion

Introductions


Introductions

Elaine Remmlinger Senior Partner

[email protected] 212-508-8374

Gerard Nussbaum Director, Technology Services

[email protected] 212-508-8371


About Kurt Salmon: Information Technology

STRATEGY and PLANNING

VENDER SELECTION and

SUPPORT

REGULATORY COMPLIANCE

INFRASTRUCTURE and OPERATIONS

»  Strategic and Tactical Planning »  Physician-Hospital Alignment »  Connecting Communities »  Population Health and Care Coordination »  Technology Planning for New Facilities »  Business Intelligence and Analytics

»  Vendor Selection and Contract Negotiation »  Pre-implementation Planning

»  Implementation Oversight

»  Meaningful Use Achievement »  ICD-10 Preparation

»  Security and Privacy Compliance

»  IT Transformation »  Infrastructure Planning

»  Right Sourcing »  Interim Leadership


About Kurt Salmon

Extensive, relevant EXPERIENCE »  Academic, children’s, community, & national

health systems Change LEADERS

»  Highly pragmatic and focused PROVEN team

»  Careers spent supporting leading health systems and complex environments

Track record of SUCCESS »  Rich history dating to 1947 » Over 75% of ongoing work with repeat clients

Strategy

Finance

Facility/Capital Asset Planning

Operations and Performance

Information Technology


Objectives

»  Understand the drivers for connectivity »  Discuss potential connectivity strategies to achieve connectivity »  Consider challenges and marketplace realities »  Identify common themes and imperatives for moving forward

Drivers


LAB TESTS

LAB

Drivers

Connectivity is a prime area of interest for providers of all types – from sole practitioners through large health systems and encompassing all stops along the care continuum

Inpatient EMR

PAPER PATIENT RECORD

Patient Portal

CLAIMS DATA

DRUG INFO

Specialty EMR

PRIMARY CARE

SPECIALIST

HOSPITAL

HOME HEALTH CARE PHARMACY

INSURER

PERSONAL HEALTH & WELLNESS

MGMT Ambulatory

EMR

HIE HIE


Drivers

Numerous forces are impelling providers to develop and execute a connectivity strategy »  Regulatory Drivers

–  Meaningful Use Stage 2 –  Accountable Care –  Medicare Shared Savings Program/ –  Value-Based Purchasing Readmission reduction program –  EHR Donation

»  Payment model shifts »  Population health management »  Community health improvement »  Affiliated community physician strategy »  Unifying the enterprise across the care continuum »  Consumer care involvement


Regulatory Drivers

Ability to exchange clinical information as structured data and provide health information to all participants is embedded in a number of recent and forthcoming regulations

»  Directly required by Meaningful Use for physicians (EPs) and hospitals –  Provide patients the ability to view online, download, and transmit their health information –  Electronically transmit summary of care record for transitions in care

•  Including with another provider with a different EHR –  Secure electronic messaging to communicate with patients –  Registry reporting (cancer registry, specialty registry) (EP only) –  Structured electronic lab results to ambulatory providers (hospital only) –  Public health reporting

•  Syndromic surveillance, •  Immunization reporting •  Electronic lab reporting (hospital only)

–  eRx (electronic prescribing) – also required by eRx incentive program (MIPPA)


Regulatory Drivers

Proposed extension of the EHR Donation Stark exception/Anti-Kickback Statute safe harbor acts as a catalyst for community connectivity

»  Currently expires 31 December 2013 »  CMS/OIG proposing extension through end of 2016 »  Interoperability is a foundation requirement of EHRs subject to donation »  Will likely spark additional demand from community physicians for practice office

EMRs »  Drives demand for connectivity »  Connectivity will generally be greater for community physicians with hospital/health

system donated EHRs to drive affiliation strategy »  Donated EHR may also be a lever for adherence to

–  Clinical best practices –  Quality reporting –  Performance benchmarks


Regulatory Drivers

Sharing health information is critical to the ability to manage patient health and achieve success under a number of payment-related regulations

»  Relevant regulations include –  Accountable Care –  Medicare Shared Savings Program/ –  Value-Based Purchasing Readmission Reduction Program

»  Parallel non-regulatory programs (e.g., with private payors) require similar capabilities


Regulatory Drivers (continued)

»  Key capabilities –  Provide information to cost-effectively manage care –  Promote provider communication –  Define dashboards and scorecards –  Build performance transparency –  Leverage algorithmic tools to identify need for intervention to arrest health decline –  More closely monitor/track patients –  Elevate patient to partner in their own health


Patient Engagement

In addition to the regulatory incentives/requirements, better outcomes are generally available when the patient is actively involved in their own care

Patient Benefits »  Engage patients in their care »  Build relationships between patients

and providers »  Increased access to clinical

information –  Personal health records –  Health library

»  24/7 access to –  Scheduling –  Bill pay –  Messaging –  Prescription refill requests

»  Increased patient satisfaction

Practice Benefits »  Increased practice efficiency

–  Decreased phone call volume, –  Ability to shift tasks to less busy times

»  Improved provider-patient communication

»  Improved financials (increased collections)

»  Meaningful Use Stage 2 –  Online access –  Secure communications

»  Satisfied patients


Population Health Management

To effectively manage population health rich information sets are required

Identify population to be managed and deliver care

Receive and distribute payments to different

entities

Perform risk stratification and monitor outcomes to

improve care delivery

Coordinate care delivery among different care settings for the given

patients


Private HIEs

»  Health systems are still actively building private connectivity solutions, including –  Portals –  Health information exchanges (HIEs)

»  HIEs with broader membership (e.g., regional/community, state/federal) often –  Do not deliver breadth of data exchange needed to support health system goals –  Have significantly longer decision making and upgrade cycles –  Raise issues of sustainability, raising risks for health system strategic initiatives

»  Despite some of the disadvantages, these multi-stakeholder HIEs remain key components of a connectivity strategy –  Provide wide catchment for broader populations

•  Important in retrospective at risk population assignment such as in the MSSP –  Support more effective/efficient care for patients not primarily aligned with the health system –  Functionality will evolve –  Provide core dial tone services that ease connectivity with the broader world

Strategies


Many Moving Parts

»  Integrated vs. best of breed / interoperable solutions »  Proprietary vs. community HIEs »  Sponsored community physician EHRs »  Single vs. multiple patient portals »  Aggregator / viewer solutions »  ACO solutions »  Analytics »  Legalities and policies


No Universal Connectivity Strategy

»  Key considerations in defining the appropriate connectivity strategy include –  Strategic enterprise priorities; for example:

•  Building a physician network •  Creating patient-centered care •  Preparing for payment reform •  Maximizing Meaningful Use benefits

–  Organizational structure/dynamics; for example: •  Multiple silos of care/diffuse •  Unified care delivery organization encompassing care continuum •  Merger / acquisition activity


No Universal Connectivity Strategy (continued)

–  EHR solution environment across the care continuum •  Care locus specific EHRs •  Single EHR •  Multiple EHRs, even in similar care environments •  Diverse EHRs across the community

–  Vendor marketplace status •  Integrated vs. interoperable •  Enterprise vs. best of breed solutions


Unifying the Enterprise

Lab Retail Pharmacy Physician

Clinics

Ambulatory Procedure Center

Home Wellness and Fitness Center

Diagnostic/ Imaging Center

Urgent Care Center

Lab

Hospital

IP Rehab

SNF

OP Rehab

Home Care


Real World Examples

To gain a flavor of the challenges and approaches, we will consider three real world examples

»  Disparate Solutions »  Partial Integration »  Enterprise and Community Integration


Scenario 1: Disparate Solutions

Other Providers Employed Physicians EHR

Patient Portal Other EHR Other EHR

Hospital EHR

Hospital EHR

Community HIEs

Payors

ACO

Other EHR Other EHR

Other EHR

Sponsored EHR

1.  Disparate Solutions »  EHRs »  Limited Data Sharing

2.  Shared Portal 3.  Separate ACO Solution 4.  Analytics Siloed

Community Physicians Clinical Enterprise


Scenario 2: Partial Integration

Other Providers

Employed Physicians EHR

Proprietary HIE

Multi-Hospital EHR

Community HIEs

Payors

ACO

Other EHR Other EHR

Other EHR

Sponsored EHR

1.  Single Integrated Hospital EHR

2.  Separate Physician EHRs

3.  Proprietary HIE 4.  Multiple Patient Portals 5.  Siloed Analytics


Enterprise

Patient Portal

Patient Portal


Scenario 3: Enterprise and Community Integration

Other Providers

Employed Physicians

Multi-Hospitals

Sponsored Community Physicians

Community HIEs

ACO

Other EHR Other EHR

Other EHR


Enterprise EHR

Patient Portal

1.  Enterprise EHR 2.  Shared Patient Portal 3.  Community HIE 4.  Enterprise Analytics

Payors

Imperatives


LAB TESTS

LAB

Connectivity Supports Enhanced Care Delivery

Inpatient EMR

PAPER PATIENT RECORD

PATIENT VITALS/ FAMILY HISTORY

CLAIMS DATA

DRUG INFO

Specialty EMR

PRIMARY CARE

SPECIALIST

HOSPITAL

HOME HEALTH CARE PHARMACY

INSURER

PERSONAL HEALTH & WELLNESS

MGMT Ambulatory

EMR

1. ALERTS •  Identifying care gaps

& alerting provider and/or patient

2. BUSINESS INTELLIGENCE

•  Looks at registries, population-based data to stratify patient risk

•  Looks at evidence-based clinical standards & defined quality standards to do quality reporting

3. CARE COORDINATION

•  Allows for care coordination workflows for communication between different providers

4. PATIENT ENGAGEMENT •  Allows for care coordination

workflows for communication between different providers

HIE HIE


Imperatives

Each situation differs; yet, there are some common imperatives that CIOs need to address.

»  This is hard –  Lots of parts –  Even highly integrated environments need to connect with other players –  Currently expensive and duplicative –  There will be multiple rounds of connectivity solutions as this area matures – remaining

flexible is key to managing the costs

»  Not solely a technical issue –  Clear enterprise business objectives and priorities are essential –  Need to build collaboration with numerous diverse stakeholders internally and externally –

who do not always share common goals –  Addressing the tangled legal thicket may slow progress

•  Trust relationships •  Data Sharing agreements •  Privacy and Security (HIPAA, state and local laws, plus patient perception)

»  Requires a companion analytics strategy

Kurt Salmon - Get Plugged in: Defining Your Connectivity Strategy - April 2013

Business

Transcript of Kurt Salmon - Get Plugged in: Defining Your Connectivity Strategy - April 2013