Download pptx - Frisse - One Step at a Time

© 2013, Mark Frisse

One Step at a Time

Mark Frisse, MDHIMSS NW Technology & Education Symposium

14 October, 2013

the Program

KN: Frisse

Big Data/Analytics

Biz Case ICD-10 Skill Sets

Population Mgmt OR / WA HIE ACO Value

KN: Global to Local

Clin Analytics State, Fed, Local EHR Replacements

Analytics/ Pop Hlth OHSU Security

KN: Risk-Based Pop Mgmt

Analytics

KN: Frisse

Big Data/Analytics



KN: Global to Local




Sustainability

KN: Frisse

Big Data/Analytics



KN: Global to Local




Systems

KN: Frisse

Big Data/Analytics



KN: Global to Local




Analytics, sustainability, & systems

KN: Frisse

Big Data/Analytics



KN: Global to Local





Keynote: Four parts…

The Turbulence• Forces driving change

The Confusion• Uncertainties & immature markets

Some vital Elements• Components for forging solutions

An emergence• Reaching our goals – one step at a time


the Turbulence

characterized by conflict, disorder, or confusion; not controlled or calm;

unsteady movement

Old

ExpectationEntitlementMoral Hazard

Uninformed

Inadequatelyprepared

Sick

Turbulence: decades in the making

Diverse

CostComplexityOpacity


HITECH: a stimulus effort

source: http://dashboard.healthit.gov/onc/

ICD-10

Workforce

HIE

MeaningfulUse

Analytics

The initiatives before us

Privacy

Finances

Revenue Cycle

Care Transitions

EHR Standards

Consumers

© 2013, Mark FrisseSource: Halamka JD. The Future of Standards.

And we have given ourselves limited time


So we face local & national challenges


Even some supporters of the Affordable Care Act worry that the flaws in the system, if not quickly fixed, could threaten the fiscal health of the insurance initiative, which depends on throngs of customers to spread the risk and keep prices low.


The relationship of policy and technology

1997 (Paul Starr)

When [Clinton health care] reform collapsed, so did the momentum to build an information infrastructure for a new system.

Today (2013)

Is it possible that inadequate execution of HIT systems will place needed health care reforms at risk?

Starr, P., Smart technology, stunted policy: developing health information networks. Health Affairs (Millwood), 1997. 16(3): 91-105.


We are in the Northwest


Summary: Turbulence

Titanic demographic and economic circumstances urge action….but how fast can culture change?


the Confusion

lack of understanding; uncertainty; the state of being bewilderedCon-fusion: melting down and

recreating


Remarkable adoption of office-based EHRs

http://dashboard.healthit.gov/HITAdoption/Office-based provider adoption: basic EHRs


Remarkable adoption of hospital systems

http://dashboard.healthit.gov/HITAdoption/

Urban: 47.7%Rural: 33.5%


MU: Penalty adjustments to PFS

Meaningful Use: Penalty adjustments to Medicare Physician Fee Schedule (PFS)

Image source: Acumen Physician Solutions. http://www.acumenmd.com/avoiding-the-approaching-meaningful-use-penalty/


Mixed results for HITECH state HIE

Tripathi to HIT Policy Committee: State HIE program Status


Some Pioneer ACOs are opting out

7 – Medicare Shared Savings2 – Opting out entirely

source: Advisory Board, September 2013. The population Health Leaders Reading List


Inconsistent privacy policy implementation

CONSENT:- Context

- Information- Roles

- Relationships- Terms

USE:- Context

- Information- Roles

- Relationships- Terms

{A} {B}

InstitutionPolicies Contracts State Law Federal Law

If the interpretation of any privacy policy is excessively risk-averse, authorized health information may not be transmitted


Concerns rise from all quarters (as expected)

• Interoperability• Sustainability• ICD-10• Certification• Quality metric

simplification• HIPAA • Oversight & fraud• Government shut-down


The “hospital” mentality is pervasive

A B C D


Ambulatory care is more fragmented

A

BC

D?

Medicare beneficiaries see at least five different physicians and many more pharmacists, therapists, and other clinicians.

source: Pham, H.H., et al., Care patterns in Medicare and their implications for pay for performance. N Engl J Med, 2007. 356(11): p. 1130-9.


How fragmented is ambulatory care?

Slide: David Kibbe. http://www.directtrust.org/


Summary: Confusion

What works in some places does not easily work everywhereProgress is unevenly distributed


some vital Elements

a part of aspect of something – especially one that is essential or

characteristic


Change begins with us

• Patients & families• Providers• Plans• States• Federal Government• Vendors (broadly defined)• Integration & analytics groups• Quality bodies


Widespread agreement on many remedies

Lewin JC, Atkins G, McNeely L. The Elusive Path to Health Care Sustainability. JAMA. 2013;():-. doi:10.1001/jama.2013.280147.


HIE can create a single record

A

BC

D

Data are made available to those who require access


Sophisticated planning systems exist

© Mia Levy, 2013


Collaborative planning systems

© Mia Levy, 2013

Activation

Task Management

TaskPerformance

Analysis

Plan

TaskPerformance


A single record; a single plan

measurableoutcomes

a single, personalized plan of care for the individual


Our search for effective analytics

source: https://www.explorys.com/docs/data-sheets/explorys-overview.pdf NOT a product endorsement

https://www.explorys.com/docs/data-sheets/explorys-overview.pdf

https://www.explorys.com/docs/data-sheets/explorys-overview.pdf


Summary: Elements

We have components and new markets for HIE (e.g., ACOs, CINS, bundles)Planning paradigms can advance incrementally


an Emergence

the process of coming into being, or becoming important or prominent


Task: A new model for regional HIE?

Director other

HIE services

Frisse’s Hunch:• A number of “hub & spoke” HIE efforts

formed as a result of partnerships, ACO or CIN relationships

• Some MDs will belong to multiple clouds• Some MDs communicate only via Direct


Task: “Push” only to respond to “pull”

Value-based payment Aligned incentivesEfficient administrationAligned CMS and health plansConnectivitySystems thinkingEngineered approachesAnalytics & decision supportPatient / consumer engagement

NEEDSDESIGNSPRACTICES

Iterative cycles of systems-based interventions


Task: Solid foundations (Version 1.0)

• A systems view• Governance• Authentication & authorization• Directories• Record linkages• Simple messaging• Engineered privacy• Effective & efficient audit logs


Task: Improve provider quality of life

• A realistic near-term vision • Quick wins• First, do one or two things well• Minimize administrative burdens• No inaccurate / unnecessary

documentation• Automate simple quality reporting• Make fraud almost impossible


Task: Design for population management

• Early, demonstrable benefits• Governance & data use• Low-cost, secure connectivity• Meaningful metrics• Effective analytics• Consumer engagement• Incentives & behavioral economics


Summary: Emergence

Progress through renewed emphasis on our critical goals combined with a component-based, systems approach incrementally executed with tangible early results


Summarizing…

Turbulence• Demographics make this inevitableConfusion• Uncertainty is a by-product of changeElements• We have some components. Must focus on gaps

Emergence• We are proceeding …….. one step at a time


Frisse ME. Health Affairs 28.2 (2009): w379-w384.