Transformational Information and Communication Technologies (ICT) to

Support the Medical Home

March 2009Vince Kuraitis JD, MBA

Better Health Technologies, LLChttp://e-CareManagement.com blog (208) 395-1197

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Overview

I. Level Setting – Current Status of Technology Inside/Outside the PCMH

II. Thesis: A Virtual, Integrated PCMH III. Possible Paths to Virtual Integration IV. Discussion

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I. Level Setting – Current Status of Technology

Inside/Outside the PCMH

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Technology Outside the PCMH —Convergence

CONSUMER TECHINFRASTRUCTUREInternetSmart housesPersonal communications

devices -- PDAs, cell phones, etc.

Broadband -- cable, DSL, satellite

Digital cameras, videoWireless -- 802.11, Bluetooth,

RFID, etc.Voice recognition, etc.

eHEALTH APPLICATIONS Electronic Health Records (EHRs)Personal Health Records (PHRs)Remote patient monitoringHealth 2.0Fitness/wellness/preventionSelf care supportPhysician/patient secure messagingHome telehealth/telecareDecision support systemse-Prescribinge-Disease Managemente-Clinical TrialsPredictive modelingComputerized Physician Order EntryQuality evaluation web sitesPatient reminder systems, etc.

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Focal Points for ConvergenceHome Networks, Smart Phones, EHRs

PHR/EHRSmart

Phone

HomeNetwork

CONSUMER eHEALTH

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Technology Inside the PCMH

– Mindset: EHR & registry are foundational technologies for PHR

– EHR adoption levels low

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PCMH Provider Readiness

Measuring the Medical Home Infrastructure in Large Medical Groups - Rittenhouse, et.al., Health Affairs, 27.5.1246

Measured 4 of 7 PCMH Components1. Infrastructure – physician directed medical practice2. Care Coordination/integration3. Quality and Safety4. Enhanced Access

“Our data suggest that relatively low levels of infrastructure exist in large medical groups to support the PCMH and highlights the gap between the current state of medical practice and widespread adoption of the PCMH”

Proprietary & Confidential Slide # 7

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2 Schools of Thought HOW Best to Spend Fed HIT Stimulus $$

Incumbents (Cats)• Pay for technology: fund IT

& providers will use IT to improve quality and reduce costs

• EHR/ software as foundational technology

• Provider centric HIT investment needed

• Client-server, enterprise model architecture

• Current systems adequate & will improve

Disruptive Innovators (Dogs)• Pay for desired outcomes:

change financial incentives & IT will naturally follow

• EHR not necessarily foundational; many other options less complex

• Patient centric HIT investment needed

• Web browser as platform, cloud computing

• Danger in investment in current clinical systems

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Synthesis is Possible

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II. Thesis: A Virtual, Integrated PCMH

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Examine current PHR adoption

• Typical 2- 5%• Best Practice

– Kaiser: 30%– Group Health Cooperative (GHC): 50%

• Why?

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Features/Functionality of Kaiser & GHC PHRSs (as of mid 2008)

GHC KaiserPHR X XEHR integration (patient view) X XSecure patient/physician messaging X XPrescription renewal X XLab/test results X XRequest for Dr. appointment X XIntegrated consumer health content X XHealth Risk Assessment X XCaregiver/parental access X XReview of insurance benefits X xAppointment scheduling x XMedication management XBehavior change programs XAfter visit summary xView x-ray, MRI, CT x

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Network Effects(Tipping Point)

Source: Shapiro, C. Varian, H. Network Effects 1998

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Personal Health Information Platform

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Evidence on Value of Integration

• “...systems tended to have a positive effect when they provided a complete feedback loop that included:– Monitoring of current patient status. – Interpretation of this data in light of established, often

individualized, treatment goals. – Adjustment of the management plan as needed. – Communication back to the patient with tailored

recommendations or advice. – Repetition of this cycle at appropriate intervals.

• Systems that provided only one or a subset of these functions were less consistently effective.”

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IV. Possible Paths to Virtual Integration

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...Observe the Early Emergence of Collaborative Care Management Networks

• Characteristics– Multi-payer participation – Common clinical guidelines/shared care processes – Common IT infrastructure enabling information exchange and

shared workflow (highly desirable today, essential in the future)

– Aligned financial incentives and shared accountability across providers

– Trust and shared responsibility• Many embryonic examples

– Institute for Clinical Systems Improvement , Minnesota– State Chronic Care Initiatives: Iowa, Pennsylvania, Vermont,

Washington, Rhode Island, Colorado, others– Improving Performance in Practice initiatives– Accountable Care Organizations (Elliott Fisher, Dartmouth)– Patient Centered Medical Home (PCMH) initiatives

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Watchlist

• National health care reform legislation• Impact of HITECH legislation• Development and adoption of cost, quality,

patient satisfaction metrics, e.g., – NQF developing care coordination measures, e.g.,

CTM-3 care transition measurement– NCQA PPC

• Adoption of personal health information platforms (Google, MS, etc.)

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Role of vendors, health plans, others

• Existing vendors to physicians: EHRs, registry, practice management, etc.

• One stop shopping vendors• DM companies• Network integration companies• ...expect others

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“...the healing professions are in the midst of a major sea-change, a once-in-a-century

shift: We’re moving from ‘medicine practiced as individual heroism’ to

‘medicine as a team sport’”

Brent James MD, Intermountain Healthcare

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IV. Discussion

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APPENDIX ABetter Health

Technologies, LLC

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Better Health Technologies, LLC

• Technology and health care delivery are shifting:  – From: Acute and episodic care delivered in hospitals

and doctors’ offices– To: Chronic disease and condition management

delivered in homes, workplaces, and communities• BHT provides consulting, business development,

and speaking services to assist companies in:  1) Understanding the shift 2) Positioning – what’s the right strategy, tactics, and business model? 3) Integrating your offering into the value chain – what are the right partnerships?

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BHT ClientsPre-IPO CompaniesRMD NetworksHealthPostCardiobeat EZWebSensitronLife NavigatorMedical Peace Stress Less DiabetesManager.com CogniMed Caresoft Benchmark Oncology SOS Wireless Click4Care eCare Technologies The Healan GroupFitsenseElite Care Technologies

Established organizationsIntel Digital Health GroupSamsung Electronics, South Korea -- Global Research Group -- Samsung Advanced Institute of Technology -- Digital Solution CenterAmedisysAscension Health SystemMedtronic -- Neurological Disease Management -- Cardiac Rhythm Patient ManagementSiemens Medical SolutionsPhilips ElectronicsJoslin Diabetes CenterGSKDisease Management Association of America PCS Health SystemsVarian Medical SystemsVRIWashoe Health SystemS2 SystemsCorpHealthPhysician IPACentocor

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END