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Innovations in connected eHealth
Adj. A/Prof Walter KmetCEO WentWest, WSPHN
IPHCRC16th March 2016
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“One of the great challenges in healthcare technology is that
medicine is at once an enormous business and an exquisitely human endeavour; it requires the ruthless
efficiency of the modern plant and the gentle hand holding of the parish priest; it is about science, but also
about art; it is eminently quantifiable and yet stubbornly not”
Robert Wachter, The Digital Doctor
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Innovations in connected eHealth
1. Context of our work
2. Role of shared care planning
3. LinkedEHR
4. Progress and Challenges
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A picture of the challenges
Demand
Changing in nature
AccessRemoving barriers
EquitySocial determinants
Between now and 2050 the number of older people (65 to
84 years) is expected to double
Most chronic diseases
are preventable
Intersection of health &
communications
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PHN Framework: Identifying opportunities for health system improvement in western Sydney
Western Sydney PHN –Health system Improvement opportunities
Whole-of-system (Macro level): Enhanced structural integration across the various health services serving the population of western Sydney and covering both private and public health sectors.
Care/population groups (Meso level): Enhanced service integration for targeted health initiatives including local and national priority focus areas and/or sub-populations that have been identified as a result of PHN population needs analyses.
Patient-centric integrated and coordinated care (Micro level): Improved delivery of patient-centric health services to individuals and their carers through a coordinated set of care interventions that ensure the right care is provided in the right place at the right time.
Advocacy
Commissioning
Integration
Western Sydney PHN – Health
system Improvement opportunities
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The building blocks of a successful integrated care system
Support with Enablers
Payment Governance Information Leadership Support
“Quadruple Aim”
Organise Delivery
Protocols
Care plans
Performancereview
Carecoordinationand delivery
Understand Needs
Low risk
Moderate risk
High risk
Very low risk
Very high risk
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• Adoption of an evidence based approach to achieving good quality primary care for the community
• Engaging and investing in leadership at all levels –especially GP Leaders
• Linking the model to:- What we do and can do
more of- What changes are needed
and how we can make them
- A platform for integrated care
• Promoting networks of practices
• Sustaining the effort
Building Blocks for High-Performing Primary Care *
*Wllard & Bodenheimer 2012
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The information challenge –some observations
• Understanding general practice/primary care data
- Creating reliable and accurate sources
• Sharing across organisational boundaries
- Even greater complexity when associated with care coordination
• Integrating, not just collating
• Associating information collection with best practice care pathways
- Living documents to achieve the quadruple aim
• Up to date infrastructure
• “My integration is your fragmentation”
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Innovations in connected eHealth
1. Context of our work
2. Role of shared care planning
3. LinkedEHR
4. Progress and Challenges
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A shared care plan is a structured, comprehensive plan developed jointly by the patient and their family/carer and health professional(s). It may
include a summary of personal health information, a person’s health goals, and the treatment and follow up care
they receive.
National Health IT Board NZ
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Optimising the solution for consumers will mean disregarding boundaries
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Rethinking Primary Care
Source: UCSF Center for Excellence in Primary Care.
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Our vision of Primary Care for the future
“Primary care will have at its heart active collaboration between
healthcare professionals and the people they care for. This patient-
focused approach will require collaboration between professionals
and strong team working, both within and across organisational boundaries.”
Source: Primary Care Workforce Commission UK - 2015
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Shared care plans and teams
• Direct service provision verses care coordination
- Aligning payments systems to integrated care strategies
• Primary care/general practice clinical leadership
• Role definition among professionals, generalists, specialists and sub specialists
- New roles such as nurse practitioners and physician assistants
• Engaging and activating consumers through better information transparency
• Shared care planning platforms
- eHealth/EMRs aligning to clinical pathways
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Innovations in connected eHealth
1. Context of our work
2. Role of shared care planning
3. LinkedEHR
4. Progress and Challenges
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LinkedEHR – a shared care planning tool
• It’s development was led by GP leaders who at time felt existing products did not meet needs
- Commissioned Ocean Informatics to develop for WSydney
• Ability for simultaneous viewing/updating by team caring for the person
- Uses Clinical Management System and TopBar
• Can be accessed by browser, in the GPs “neighbourhood”
- Sending eRederrals, to be accessed through hospital systems
• Same security and privacy as the national MyHR
• Can read a patient’s MyHR.
- Will soon be sending Shared Health Summaries to MyHR
• Captures lost revenue by closing the loop for various PIPs
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Example, dynamic shared care plan
Health Summary
Care Plan
Clinical Metrics
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Additional Features
A comprehensive clinical decision support system (HealthPathways) embedded
By June of 2016, LinkedEHR will be integrated with the Telstra Health Gateway collecting consumer entered data and delivering an accessible SCP
A Risk Stratification feature to assesses the risk of hospitalisation being developed
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Innovations in connected eHealth
1. Context of our work
2. Role of shared care planning
3. LinkedEHR
4. Progress and Challenges
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Building capacity and capability
There is a need for general practice to adapt rapidly so that it operates at a scale that can
provide a platform for integrated care.
(Kings Fund 2011)
Finding ways to build leadership amongst primary health
care providers and working with early adopters
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Practice Capability: steps on the journey
Pen Licences
186 Practices
Pat Cat ‘Active’
120 Installed
Integrated Care
Contracts
52 Signed
LinkedEHR
Registered
218 GP158 AHP
45 Nurse
Total421
PCMH Engaged
15 transformin
g
15 more engagin
g
Health Pathways
4,000 new and returning users
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Western Sydney Integrated Care Program
Mar 2016 update
GP Practices
51 (38%)
GPs 175
Enrolments – GP Practice: January
GP Practices Total Number Enrolled YTD
Target (Total)
Number of GPs Enrolled YTD
Total 52 135 135
Level 1 28 30 100
Level 2 24 45 35
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Investing in technology and innovations
OO + NT = COOJack Cochran
OS + NMC = NCM
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Partnerships
Find common cause with partners and be prepared to share sovereignty
(Kings Fund 2013)
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What is general practice responsible for – how we fund primary care
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Thank you
@WKmet
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As the Western Sydney Primary Health Network,WentWest is focused on addressing both regionaland national health challenges. Together withhealth professionals, partners from both thehealth and hospital sector, consumers and thebroader community, WentWest seeks to identifygaps and commission solutions for better healthoutcomes.
