Wednesday, November 10, 2010

#WHIT Healthcare innovation - real world lessons from Early EMR and HIE adopters

Getting closer to the finishing line at WHIT: 

11:00 am -
12:00 pm
KEYNOTE PANEL DISCUSSION: Health Care Innovation – Early Adopters of EMRs and HIEs Evaluate Successes, Failures and Lessons Learned
  • Key components to successful EMR implementation
  • Understanding and overcoming barriers to implementation
  • Best practices in data-sharing and information exchange
  • Evaluate bottom line impacts – ROI and results in quality of care
  • Technology adoption – what works and what doesn’t?
  • Overcoming privacy and security concerns
Moderator:
Jennifer Covich Bordenick
Chief Executive Officer
eHealth Initiative 

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Panelists:
Pamela Arora
Vice President and Chief Information Officer
Children's Medical Center of Dallas 

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Peter Basch, MD
Medical Director
MedStar Health 

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Mike Sauk
Chief Information Officer
University of Wisconsin Hospital and Clinics 

 View Biography

Sue Schade, MBA
Chief Information Officer
Brigham and Women's Hospital 

 View Biography

Peter Basch: Been using EMR since Mid 1990's. 

Pamela A: The organization believes in Technology. So there was leadership support.

Look at how you translate data to information to get value from the system.

Focus on System Ambassadors from amongst the early adopters.

Look at usability. don't make it "too many clicks"

Email in the patient Portal is not email. It is a workflow. You typically want to route email so it is screened before it gets to the doctor. The doctor is usually busy with patients so you want to be able to have the team or front office staff review and triage first.

Don't over design security. If not careful you end up defining roles that prevent users from getting to information for patient care that they need to see. Move to a trust but verify model?

Does the system have one page that "summarizes the patient story"

Peter B: Triangulate the doctor patient and screen. "Let's verify together"

The value of the EMR is when information is used to deliver better patient care.

"Process enable by Technology"

Pamela A: Think about how work shifts and move staff to handle the load. Work load will change over time. You need to plan for the transitions.

Jennifer C: What do you wish you had known before you started?

Peter B: It's going to be hard work. Be prepared for backlash - Remember you are working with a highly skilled workforce running a complex process that on the whole works. Dark days pass. 

Sue Schade: Think about whether a best of breed strategy is necessary.  Systems are improving so an enterprise solution may be more effective.

Mike Sauk: Deploy on a clinic/specialty basis so teams end up asking why they can't have what the other teams have. Budget for surgery furniture redesign. You don't want the doctor with their back to the patient in order to use equipment.

 IT or Business Led project - Sue S - It 's a partnership.

IT has expertise but the Docs and Clinicians  have to live with the product.
IT provides the information to enable an informed decision but the business leaders make the call.

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#WHIT @lygeia Riccardi moderating a panel - the Next gen of connected Health PHRs v EHRs

More from WHIT:

9:45 am -
10:30 am
KEYNOTE PANEL DISCUSSION: The Next Generation of Connected Health – Debating PHRs vs. EHRs
  • Transforming the flow of information for tomorrow’s consumer
  • Overcoming security and privacy concerns
  • Driving consumer innovation and participation in health and wellness
Moderator:
Lygeia Ricciardi
Principal, Clear Voice Consulting, LLC; 

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Panelists:
Bill Crounse, MD
Senior Director, Worldwide Health
Microsoft Corporation 

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Linda Fischetti, RN, MS
Chief Health Informatics Officer
Veterans Health Administration 

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Edward Glynn, MD
Ambulatory Medical Director of Informatics
Bon Secours Health System, Inc.
Also on the panel: Donna Cryer @dcpatient 

Wow - a Patient on the stage at WHIT!

Changing Demographics will drive adoption of electronic solutions. Changing Expectations will drive the change.

Bill C: when systems become transactional and data is provided FOR me then usage of PHR's / EHRs will take off.

Linda F: VA asks their Vets want functionality they want using online survey tools.

Donna C: Patients are very practical - is it a good use of my time. What about Patient Efficiency!

Bill C: Payers are starting to "get it" change the payment system to change behavior

Bill C: The value doesn't come from EMR - it is what you do next that counts.

Linda F:  some "deviant" communities that have adopted EHRs at 2-3 times the national average. Rural areas often have their act together. Using technology to break down barriers of time, distance and geography.

Donna C: "when you give the same information to the same healthcare organization multiple time I am thinking - You could kill me"

Ed G: The industry has no incentive to share. It is up to the Consumer.

Ed G: We need to change business models 

Bill C/Linda F: It is not PHR v EHR it is PHR + EHR

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#whit Bill Crounse (@MicrosoftMD) talking about commodity IT in health

More from WHIT:

9:15 am -
9:45 am
KEYNOTE ADDRESS: How Commodity IT and the Net are Transforming Health and Health Care
  • Leaders and followers; progress made and opportunities ahead to improve global health with ICT
  • Looking beyond the EMR. It’s what we do next that counts!
  • Optimizing organizational efficiency, modernizing health information, connecting to consumers, and streamlining the delivery of health information and medical services
Bill Crounse, MD
Senior Director, Worldwide Health
Microsoft Corporation 

 View Biography

America is so far behind on Electronic Health Records....

Real time web - only 1.6B have adequate coverage.

Trends in e-Healthcare:

- online appointments scheduling
- web messaging with physician and support staff
- Access to lab and radiology
- Rx Refills
- Reminders and information therapy

ghc.org - MyGroupealth shown as an example of the future.

80% of patients online
30% of activity is now performed online rather than at doctors office.

Healthcare.gov- The government is stepping up.

Todd Park, CTO of HHS was included in a video interview.

President Obama, as his own suggestion, recorded a demo of using Healthcare.gov.

Reference also made to BlueButton initiative and how that data can be extracted and imported to PHRs like HealthVault.

HealthCare is going consumer-centric.

All the data for all of your life in one place.

MayoClinic HealthManager was shown (powered by HealthVault)

Showed an example of how health information and exercise can be recorded in custom trackers which users can use to correlate issues like Migraine with activity, diet, sleep and exercise.

HMSA in Hawaii recognized as using HealthVault powered by American Well for online care.

"The Power of Commodity"

- Unified Communications

EMR needs to be like Cable TV. Plug it in, pay subscription, use it.

Another example: Wound Management with satellite communications and community nurses. Saving hospitalization at rate of $72k per patient.

"To the Cloud"

Public or Private doesn't matter.

Put the patient at the center. Give them the PHR - Don't we eliminate the need for NHIN/HIE/RHIO?

As the patient moves through the system their data moves with them.... so much simpler.

We are moving to new user interfaces with anticipatory features.

Surface now evolving to No touch and 3D

now we have XBox Kinect.  It sits in your living room and follows your movements and knows who you are. Can provide video conferencing in the living room.

check out Bills. Healthblog http://blogs.msdn.com/healthblog

Medical Tourism is very real.  My thought is that American Well's online care technology is providing amazing potential for virtual medical tourism.

Health Insurance is a misnomer. You will always need to use the services covered by Health Insurance. 

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#WHIT Moving to meaningful use with MedPlus (Quest) Care360.

More from WHIT

8:20 am -
9:15 am
OPENING KEYNOTE PANEL DISCUSSION: Moving Towards Meaningful Use One Step at a Time - Lessons from the Practice Front Lines
  • Utilizing information to improve quality, satisfaction, and efficiency by redesigning and reengineering the delivery of care through innovation and information technology
  • Hear first-hand experience from a small practice provider on their adoption process and how they dealt with issues related to capital, workflow, data security, interoperability and other challenges
  • Assess the role of one payer in supporting physician adoption before Meaningful Use was established and the complementary eHealth program that was designed to advance physician technology innovation
  • Examine a new EHR approach that enables faster implementation, physician adoption and access to ARRA incentives

Paulo Andre, MD
Attending Neurologist, Neurological Services P.C., 
MetroWest Medical Center,
Vice President,
MetroWest Healthcare Alliance 

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Meera Kanhouwa, MD, MHA, FACEP
Medical Information Officer
MedPlus, a Quest Diagnostics company 

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Gregory S. LeGrow
Director, eHealth Innovation
Blue Cross Blue Shield of Massachusetts 

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Greg LeGrow talking about Care360 EHR pilot at BCBSMA

Only 32% of small physicians have an EHR solution.

Lessons learned:
- Active Physician Champions are vital 
- Sponsorship and Financial Subsidies
- Choice of Lab and Radiology to address lock in fears
- Provider Advisory Group online community to increase level of engagement and peer support

Dr Paulo Andre:

EHR features required:
- Web Based
- Share data across the network not just in a practice
- Clinical notes
- Clinical messages
- Tests: Lab results, images etc.

Most EHRS made it difficult to share online, had a big learning curve, disrupted workflow and productivity, were complex and expensive ($500/month and $40k/Doctor)

They wanted something as simple and flexible as gmail.

MedPlus Care360 provides:
- web-based
- Easy sharing
- Disease Registry and able to send HEDIS quality feedback via EHR Message system
- Flexible data input: type, Speech recognition or upload transcriptions
- No impact to patient throughput - workflow doesn't impede workload
- Online upgrades make it easy to maintain
- Intuite and minimal training needed.
Phase 1: e-perscribe, Messaging
Phase 2: EHR with notes.

- Accessible from iPhone and iPad.

MetroWest experience:

100 Physicians in 40 Facilities selected Care360
74 from 30 facilities have activated Care360.
59 Physicians at 27 facilities are using Care360 daily.
Paper to Electronic transition in 4 weeks.

Meera Kanhouwa, MedPlus:

MedPlus: >160k physicians and >70,000 Practices
>120 EMRs

MedPlus is an IT subsidiary of Quest Diagnostics.

Average time to deploy is 16 business days.

94% of all US Practices are 5 physicians or less.

4,500 physicians in Maryland are connected.

- 40B Lab Results for 120M patients.
- Medication History, inc. Vaccines and allergies.

Quest connects to Google Health, KEAS and Microsoft HealthVault.

Care360 Mobile on iPhone/iPad.

Partnership with HP to deploy equipment and connectivity.

Actively involved with RECs.

Subscription based system. Data is not held hostage.

Care360 is a hosted single instance system. Every physician (172,000+) on Care360 is in the network. 

Interesting note:
10 Physician referrals increase a hospital bottom line by $1 M to $1.5M.

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#WHIT bright and early session on Accountability through Analytics

More from the last day of #WHIT...

A presentation by MDI and Analytics Partners on Accountability through Analytics

Lisa Davis, CEO of Analytics Partners and Cary Smith, VP of Business Architecture at MDI.

7:15 am -
8:10 am
BREAKFAST MARKET INSIGHT: Healthcare Reform: Leveraging Analytics to Optimize ACO Operations
Learn how data warehousing and analytics can help you address today’s most challenging healthcare reform initiatives.
  • Drive better outcomes through evidence-based guidelines and clinical performance measures
  • Use benchmarks to increase efficiency in contracting with health plans and providers
  • Monitor and manage adherence to regulatory guidelines
Lisa Davis
Chief Executive Officer and Founder
Analytics Partners 

 View Biography

Both companies are based in Jacksonville, FL.

MDI started developing networks and analytics for prisons. MDI offers a Software as a Service Analytics solution. They have an interesting claims analysis drill down based around a body map.

Cary Smith: 

Incentives emerging for Value-based decisions. Evidence-based medicine. NCQA put out draft standards that may influence ACO management.

Accountable Care Organizations will be judged based on their performance. 

A fascinating discussion ensued with the audience. A quick summary.... When patients have developed a condition measurements around the condition don't necessarily improve the outcome. The best option is to identify the condition and work out how to measure the pre-cursors to the condition and watch for it in order to take corrective action early. However, up to now the spending on lifestyle coaching has not paid off. I believe that the reason it has not paid off is that we have not worked out how to integrate the coaching in to the "Rhythm of life" of those individuals.

Is Medical Home a competitor to ACOs?

Companies appear to be ready to move forward with ACOs regardless of the outcome of the recent elections.

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#WHIT The final day of the conference and I am the only person here with an iPhone App that connects to my PHR

More from #WHIT....

8:10 am -
8:20 am
Co-Chairperson’s Welcome and Opening Remarks
Jennifer Covich Bordenick
Chief Executive Officer
eHealth Initiative 

 View Biography

I appear to be the only person in the audience with an iPhone App that has a link to my health record....

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Tuesday, November 09, 2010

#WHIT closing session from Day 2

More from WHIT:

Availity (who recently purchased RealMed) talking about connectivity between HealthPlan, Provider and Patient.

4:45 pm -
5:30 pm
CLOSING KEYNOTE PANEL DISCUSSION: Payer and Provider Collaboration – Pioneering Partnerships Advancing Cost Savings and Achieving Better Outcomes
  • Payment models to promote cost savings and better quality of care
  • Leveraging the power of providers and plans coming together to contain the rising cost of health care
  • Payer initiatives to incentivize improved quality and cost savings
  • Identifying and overcoming challenges
Catherine Peper, CISSP, CISM
Vice President of Health Information Technology
Blue Cross Blue Shield of Florida 

 View Biography

Joseph Taylor, CEBS, RHU, HIA
Vice President, Enterprise Business Process, Enterprise Health Care Management
Health Care Service Corporation 

 View Biography

Craig Schneider - Moderator

Catherine Peper taling about next generation of HIT systems 
- Industry Standards codes and formats
- PCMH and other emerging models

Competitors have to cooperate

Multi-Payer solutions are essential.

"Payers spend a lot to look different. Providers and integrators spend a lot to make payers look the same."

Availity & Humana drive market leading adoption:

Electronic Transactions:
97% E&B
90% Claims Submissions
72% claims status
70% E remittance Advice (big focus area)
36% EFT
25% Auth/Certs
26% e-RX
10% CareCalc
<1% ACP

Driving to 95% of all transactions being Electronic.

New in 2011:
- Enhanced Clinical Reviews
- Coordination of Benefits (e-COB)
- Care Opportunities / gaps in real time
- e-Campaign/contact management
- e-Appeals

Challenges:
ANSI 5010 - 1/1/2012
ICD-10  - 10/1/2013

Extreme Standardization coming immediately afterwards.

AHIP: ICD-10 will cost average Health Plan $12/Member

Alternative Care Delivery, Financing and Funding:

- Patient centered Medical Home
- e-visits / online  care / telemedicine
- Accountable Care Organizations
- Gain Sharing
- Bundled Payments
- Collaborative Care

We need to address standardization of clinical quality measures otherwise we will drown clinicians. 

Joe Taylor: VP and Enterprise Process Leader - CEBS

In clinical - If you build it they don't come. You have to integrate and meet the clinician where they want to be. 

We need a coordinated Partnership, Technology and Reimbursement Strategy

Practice Criteria and capabilities:
How ready is the practice? Access, EMR, NCQA criteria etc.
Shared Data on Gaps in Care via Clinical Connectivity - can you leverage MedDecision, Availity etc.
Use of High Value Efficient services - Specialist, Hospitalists, Ancillaries

Joe Taylor: Not sure how HIEs will work in practice. 

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