Frisse - One Step at a Time

  • Published on
    07-May-2015

  • View
    600

  • Download
    1

DESCRIPTION

HIMSS NW Conference Keynote - Mark Frisse, MD, Accenture Professor Biomedical Informatics, Vanderbilt University

Transcript

<ul><li>1.One Step at a Time Mark Frisse, MD HIMSS NW Technology &amp; Education Symposium 14 October, 2013 2013, Mark Frisse</li></ul> <p>2. theProgram KN: Frisse Big Data/Analytics Biz CaseICD-10Skill SetsPopulation MgmtOR / WA HIEACO ValueKN: Global to Local Clin AnalyticsState, Fed, LocalEHR ReplacementsAnalytics/ Pop HlthOHSUSecurityKN: Risk-Based Pop Mgmt 3. Analytics KN: Frisse Big Data/Analytics Biz CaseICD-10Skill SetsPopulation MgmtOR / WA HIEACO ValueKN: Global to Local Clin AnalyticsState, Fed, LocalEHR ReplacementsAnalytics/ Pop HlthOHSUSecurityKN: Risk-Based Pop Mgmt 4. Sustainability KN: Frisse Big Data/Analytics Biz CaseICD-10Skill SetsPopulation MgmtOR / WA HIEACO ValueKN: Global to Local Clin AnalyticsState, Fed, LocalEHR ReplacementsAnalytics/ Pop HlthOHSUSecurityKN: Risk-Based Pop Mgmt 5. Systems KN: Frisse Big Data/Analytics Biz CaseICD-10Skill SetsPopulation MgmtOR / WA HIEACO ValueKN: Global to Local Clin AnalyticsState, Fed, LocalEHR ReplacementsAnalytics/ Pop HlthOHSUSecurityKN: Risk-Based Pop Mgmt 6. Analytics, sustainability, &amp; systems KN: Frisse Big Data/Analytics Biz CaseICD-10Skill SetsPopulation MgmtOR / WA HIEACO ValueKN: Global to Local Clin AnalyticsState, Fed, LocalEHR ReplacementsAnalytics/ Pop HlthOHSUSecurityKN: Risk-Based Pop Mgmt 7. Keynote: Four parts TheTurbulenceForces driving changeTheConfusionUncertainties &amp; immature marketsSome vital AnElementsComponents for forging solutionsemergence Reaching our goals one step at a time 2013, Mark Frisse 8. theTurbulencecharacterized by conflict, disorder, or confusion; not controlled or calm; unsteady movement 2013, Mark Frisse 9. Turbulence: decades in the making SickInadequately prepared Cost Complexity OpacityExpectation Entitlement Moral Hazard 10. HITECH: a stimulus effortsource: http://dashboard.healthit.gov/onc/ 2013, Mark Frisse 11. The initiatives before us EHR HIE Care TransitionsMeaningful UseFinancesWorkforce 12. And we have given ourselves limited timeSource: Halamka JD. The Future of Standards. 2013, Mark Frisse 13. So we face local &amp; national challenges 2013, Mark Frisse 14. 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. 2013, Mark Frisse 15. 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. 2013, Mark Frisse 16. We are in the Northwest 2013, Mark Frisse 17. Summary: TurbulenceTitanic demographic and economic circumstances urge action.but how fast can culture change? 2013, Mark Frisse 18. theConfusionlack of understanding; uncertainty; the state of being bewildered Con-fusion: melting down and recreating 2013, Mark Frisse 19. Remarkable adoption of office-based EHRsOffice-based provider adoption: basic EHRs http://dashboard.healthit.gov/HITAdoption/ 2013, Mark Frisse 20. Remarkable adoption of hospital systemsUrban: 47.7% Rural: 33.5%http://dashboard.healthit.gov/HITAdoption/ 2013, Mark Frisse 21. MU: Penalty adjustments to PFSMeaningful Use: Penalty adjustments to Medicare Physician Fee Schedule (PFS) 2013, Mark Frisse Image source: Acumen Physician Solutions. http://www.acumenmd.com/avoiding-the-approaching-meaningful-use-penalty/ 22. Mixed results for HITECH state HIETripathi to HIT Policy Committee: State HIE program Status 2013, Mark Frisse 23. Some Pioneer ACOs are opting out7 Medicare Shared Savings 2 Opting out entirelysource: Advisory Board, September 2013. The population Health Leaders Reading List 2013, Mark Frisse 24. Inconsistent privacy policy implementation If the interpretation of any privacy policy is excessively risk-averse, authorized health information may not be transmittedInstitution PoliciesContractsState Law{A}Federal Law{B}CONSENT: - Context - Information - Roles - Relationships - TermsUSE: - Context - Information - Roles - Relationships - Terms 2013, Mark Frisse 25. Concerns rise from all quarters (as expected) Interoperability Sustainability ICD-10 Certification Quality metric simplification HIPAA Oversight &amp; fraud Government shut-down 2013, Mark Frisse 26. The hospital mentality is pervasiveABC 2013, Mark FrisseD 27. Ambulatory care is more fragmented C DB ? AMedicare 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. 2013, Mark Frisse 28. How fragmented is ambulatory care?Slide: David Kibbe. http://www.directtrust.org/ 2013, Mark Frisse 29. Summary: ConfusionWhat works in some places does not easily work everywhere Progress is unevenly distributed 2013, Mark Frisse 30. some vital Elementsa part of aspect of something especially one that is essential or characteristic 2013, Mark Frisse 31. Change begins with us Patients &amp; families Providers Plans States Federal Government Vendors (broadly defined) Integration &amp; analytics groups Quality bodies 2013, Mark Frisse 32. Widespread agreement on many remediesLewin JC, Atkins G, McNeely L. The Elusive Path to Health Care Sustainability. JAMA. 2013;():-. doi:10.1001/jama.2013.280147. 2013, Mark Frisse 33. HIE can create a single record Data are made available to those who require accessC DBA 2013, Mark Frisse 34. Sophisticated planning systems exist 2013, Mark Frisse Mia Levy, 2013 35. Collaborative planning systems AnalysisPlanActivationTask Management Task Performance 2013, Mark Frisse Mia Levy, 2013 36. A single record; a single plan a single, personalized plan of care for the individualmeasurable outcomes 2013, Mark Frisse 37. Our search for effective analyticssource: https://www.explorys.com/docs/data-sheets/explorys-overview.pdf NOT a product endorsement 2013, Mark Frisse 38. Summary: ElementsWe have components and new markets for HIE (e.g., ACOs, CINS, bundles) Planning paradigms can advance incrementally 2013, Mark Frisse 39. an Emergencethe process of coming into being, or becoming important or prominent 2013, Mark Frisse 40. Task: A new model for regional HIE? Frisses Hunch: A number of hub &amp; 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 DirectDirect or other HIE services 2013, Mark Frisse 41. Task: Push only to respond to pullPRACTICESDESIGNSNEEDSValue-based payment Aligned incentives Efficient administration Aligned CMS and health plans Connectivity Systems thinking Engineered approaches Analytics &amp; decision support Patient / consumer engagementIterative cycles of systems-based interventions 2013, Mark Frisse 42. Task: Solid foundations (Version 1.0) A systems view Governance Authentication &amp; authorization Directories Record linkages Simple messaging Engineered privacy Effective &amp; efficient audit logs 2013, Mark Frisse 43. 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 2013, Mark Frisse 44. Task: Design for population management Early, demonstrable benefits Governance &amp; data use Low-cost, secure connectivity Meaningful metrics Effective analytics Consumer engagement Incentives &amp; behavioral economics 2013, Mark Frisse 45. Summary: EmergenceProgress through renewed emphasis on our critical goals combined with a componentbased, systems approach incrementally executed with tangible early results 2013, Mark Frisse 46. Summarizing Turbulence Demographics make this inevitable Confusion Uncertainty is a by-product of change Elements We have some components. Must focus on gapsEmergence We are proceeding .. one step at a time 2013, Mark Frisse 47. Frisse ME. Health Affairs 28.2 (2009): w379-w384. 2013, Mark Frisse </p>