connecting payers, providers, and patients a journey of innovation
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Connecting Payers, Providers, and Patients A Journey of Innovation. John D. Halamka MD May 28, 2012. The Need for Innovation. Universal adoption of usable electronic health records Frictionless Healthcare Information Exchange Turning data into information, knowledge and wisdom - PowerPoint PPT PresentationTRANSCRIPT
Connecting Payers, Providers, and PatientsA Journey of Innovation
John D. Halamka MDMay 28, 2012
The Need for Innovation
• Universal adoption of usable electronic health records
• Frictionless Healthcare Information Exchange
• Turning data into information, knowledge and wisdom
• Engaging patients and families in ways that add value
• Protecting privacy
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Universal adoption of usable electronic health records
• Getting the data in• The ideal form factor• Integration with workflow• Leveraging the power of the care
team• Agile continuous improvement of the
products
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Patient Profile Screen
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Problems
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Medications
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Medication History and Reconciliation
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Reports
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1010
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Care Plans
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Frictionless Healthcare Information Exchange
• The “View” Approach• The “Push” Approach• The “Pull” Approach
The Massachusetts Statewide Health Information Exchange
Berkshire Health System
Atrius
NEHEN
SafeHealth
Fallon ClinicUMass Memorial
Statewide HISPSecure Certificate Management
WebPortal
Provider/EntityDirectory
Auditlog
BIDMCPartners
Direct Gateway Services
EOHHS NwHIN
MD
MD
MD
MDMD
MDMD MD
MassHealth DPH
Basic Commonwealth HIE Services
Provider directory
Certificate repository
DIRECT gateway
Web portal mailbox
Repository of physician names, entities, affiliations, and security credentials
Repository of security certificates for authorized users of HIE services
Adaptor that transforms messages from one standard to another without decrypting the message
Secure, encrypted mailbox for users without standards-compliant EHR
“Lookup” services
“Message-handling” services
HIE Services
Users have 2 ways to connect
Provider directory
Certificate repository
DIRECT gateway
Web portal mailbox
HIE ServicesUser types
2 methods of accessing HIE services
EHR connects directly
Browser access to webmail inbox
Physician practice
Hospital
Long-term careOther providersPublic healthHealth plans
Labs and imaging centers
Accelerating Use of HIE
Value of statewide HIE network and services will increase exponentially with the number of users
Removing adoption barriers is key to increasing number of users
– Up-front cost and difficulty of system integration is significant barrier to adoption to most users, especially small practices and safety-net providers
Can address this barrier through a variety of means
•Align all funding streams to maximize opportunities for synergy
•Leverage existing assets
•Build services where the users are
•Lower the cost and ease the difficulty of using the statewide HISP
Roadmap for Statewide HIE Program
•Create infrastructure to facilitate data aggregation/analysis
•Will support Medicaid CDR and quality measure infrastructure
•Will support vocabulary translation services (lab, RX)
Increasing cost and complexity
Facilitate normalization and aggregation
Enable queries for records
Information Highway
•Create infrastructure to enable secure transmission (“directed exchange”) of clinical information
•Will support exchange among clinicians, public health, and stand-alone registries
•Focus on breadth over depth
Analytics and Population Health
•Create infrastructure for cross-institutional queries for and retrieval of patient records
Search and Retrieve
Phase 2
Phase 3
Phase 1
The Reality of Vendor Products
• EHR vendor roundtable held on December 16, 2011 – Over 20 vendors participated in 4-hour session– Mix of ambulatory, hospital, and HIE vendors
• Goal was to understand vendors current and near-future interoperability capabilities and get feedback on MA approach
• Findings– There is wide variation in vendor interoperability capabilities– Few if any vendors have production Direct-enabled systems in
place today– There are no standardized approaches to integration with
centralized provider directories or PKI infrastructure– All of the vendors supported a centrally coordinated approach to
interface development and deployment
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Turning data into information, knowledge and wisdom
• Centralized or distributed databases?• Prospective or retrospective
reporting?• Structured or non-structured data
capture?
BIDPOQDC
A Centralized Database
Distributed Databases
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Distributed Databases
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Prospective Reporting
Retrospective Reporting
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Structured Data Capture
•VITAL SIGNS: Blood pressure 110/70. Height 5 feet 3-1/2 inches, weight 122 pounds, and BMI is 21.5.
•CURRENT MEDICATIONS:1. Docusate sodium 100 mg b.i.d.2. Ferrous sulfate 325 mg b.i.d.3. Magnesium oxide 400 mg b.i.d.4. Aspirin 81 mg daily.5. Plavix 75 mg daily.
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Unstructured Data Capture
•MEDICATIONS:1.He currently takes 3% hypertonic saline
nebs twice daily.2.Pulmozyme 2.5 mg nebs twice daily.3.He takes Bactrim 5 mL twice daily every
Friday, Saturday, Sunday for PCP prophylaxis.
4.He takes Zithromax 2.5 mL once daily every Friday, Saturday, Sunday for neutrophil modulation.
5.He takes Zyvox 600 mg one tablet twice daily but is stopping on 9/12.
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The Role of Natural Language Processing and other evolving
tools
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Engaging Patients and Families
• Tethered and non-tethered personal health records
• Home care devices• Creating value - Open Notes, Passport
to Trust
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Protecting Privacy
• The challenge of BYOD• Protecting data at the server and the
client• Respecting patient privacy
preferences
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The Anonymizer
Name: Rob SmithDOB: 6/7/1972
cd5dced41028cb7ea51d52a888089d7300c9782a552a2d09b1b85e0d0db52ef37f2b6e48ea7d042bbe85e46ef2107da4
Anonymizer
Rob
Smith
6/7/1972
Robert
7/6/1972
1972
0d06b31faa7c44682d770706640465d2B5e341a4b0cdf0e8de7b6f957818d746bd0ec72f2424729efa7baac9a636970a
Variants
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M. Randal SmithDOB: 06/07/74713 731 5577
Mark Randy SmithDOB: 06/07/74123 Main Street713 731 5577 Lab
Results
Outcomes
Record #A-701
Record #B-9103
ObservationsRe-Constructed Identities
FEATURES:Mark Randy Smith,
M. Randal Smith123 Main Street
713 731 5577DOB 06/07/74
Sensors
Patient Identifiers Are First Anonymized
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LabResults
Outcomes
Record #A-701
Record #B-9103
Cd5dced41028cb …00c9782a552a2 …7f2b6e48ea7d0 ……
0d06b31faa7c…B5e341a4b0c…00c9782a552……
Patient Identifiers Are First Anonymized
ObservationsRe-Constructed Identities
FEATURES:Mark Randy Smith,
M. Randal Smith123 Main Street
713 731 5577DOB 06/07/74
Sensors
33
Cd5dced41028cb …00c9782a552a2 …7f2b6e48ea7d0 ……
0d06b31faa7c…B5e341a4b0c…00c9782a552……
Identity Resolution Occurring Post Anonymization
LabResults
Outcomes
Record #A-701
Record #B-9103
ObservationsRe-Constructed Identities
Sensors
FEATURES:Mark Randy Smith,
M. Randal Smith123 Main Street
713 731 5577DOB 06/07/74
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FEATURES:Mark Randy Smith,
M. Randal Smith123 Main Street
713 731 5577DOB 06/07/74
Cd5dced41028cb …00c9782a552a2 …7f2b6e48ea7d0 ……
0d06b31faa7c…B5e341a4b0c…00c9782a552……
Patient Linkage Data is Not Stored in Clear Text
LabResults
Outcomes
ObservationsRe-Constructed Identities
Sensors
Record #A-701
Record #B-9103
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FEATURES:Cd5dced41028cb7ea51
…00c9782a552a2d09b1b
…7f2b6e48ea7d042bbe8
……
Cd5dced41028cb …00c9782a552a2 …7f2b6e48ea7d0 ……
0d06b31faa7c…B5e341a4b0c…00c9782a552……
Patient Linkage Data is Stored Anonymized
LabResults
Outcomes
ObservationsRe-Constructed Identities
Sensors
Record #A-701
Record #B-9103
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Record #A-701Matches
Record #B-9103
Discovery
M. Randal SmithDOB: 06/07/74713 731 5577
Mark Randy SmithDOB: 06/07/74123 Main Street713 731 5577 Lab
Results
Outcomes
Record #A-701
Record #B-9103
Observations Sensors
Policy Controls
Policy Controls
Maximizing Discovery - Minimizing Disclosure!
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The Challenges We Face
• V = Volatility. The nature and dynamics of change, and the nature and speed of change forces and change catalysts.
• U = Uncertainty. The lack of predictability, the prospects for surprise, and the sense of awareness and understanding of issues and events.
• C = Complexity. The multiplex of forces, the confounding of issues and the chaos and confusion that surround an organization.
• A = Ambiguity. The haziness of reality, the potential for misreads, and the mixed meanings of conditions; cause-and-effect confusion.
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