CLIFF KAUFMAN

Health IT Seminar Review

Focus on NC

NC Strategy for HITSteve Cline, DDS, MPHHIT Coordinator, NC DHHS

Using Telehealth Technology for RehabilitationHelen Hoenig MD, MPH

Durham VA Med Ctr Duke University

CCNC Informatics CenterAnnette DuBard, MD, MPHNorth Carolina Community Care Networks, Inc.

NCB PreparedSteve Potenziani, PhDExecutive Director, NCB-Prepared Collaborative

NC Strategy for HIT

Improved healthcare quality

Better health outcomes Individuals

Populations

Control costs

Better engage health care consumers

Paper is inefficient

Duplicate tests

Medical errors

Lack of information

Too much information

Consumer engagement

Quality-Quality-Quality

GOALS PROBLEMS

The 12-Step Approach

1. Admit we have a problem

2. Must get clinical information into an electronic sharable format.

3. Incentivize targeted providers to adopt EHRs and meaningful use

4. Create a new standard for EHR vendors

5. Build a mechanism for sharing health information electronically

6. Make sure healthcare providers know how to use the new systems

7. Make sure the network has the capacity for all these new users

8. Make good use of the data (Data Analytics)

9. Make good use of the technology to improve health

10. Children as a priority

11. Learn from the leaders

12. Sustainability

Keys to Success

EHR Adoption

Consumer Engagement

Change Leadership

Strengthen the “Trust Fabric” of health info exchange

GOOD USE OF THE DATA!

And the Winner Is . . . • Whoever can figure out how to take the tsunami of new health

data that is heading our way and turn it into actionable health information.

• Whoever can help us move from surveillance and reaction to event prediction and prevention.

Telehealth Technology for Rehabilitation

It is difficult for persons with physical disability, particularly in remote areas, to access health care.

High cost and burden of travel.

Limited rehab specialists in remote areas.

Clinicians have limited insight into how individual is functioning in home environment.

Telehealth is comprised of diverse technologies that allow health care to be provided in situations where distance separates those receiving services from those providing services.

Telehealth changes the location for providing health care services from the doctor’s office or hospital to the local clinic or the patient’s own home.

Public Health Problem

What is Telehealth?

Telehealth Encounters by VA Providers

Telehealth – Rehab Clinical Trials

Telerehabilitation for exercise & functional training:

4 RCTs with Televideo alone or with other Teletechnology.

4 different populations (geriatric gait disorder, post-stroke, ICU survivor, post-op orthopedic surgery).

Non-inferiority in clinical outcomes compared to Standard PT.

Better functional outcomes , performance-based & self report, compared to Usual Care (no PT).

Equipment reliability and visual clarity a challenge in all studies

Teletechnology QI Study

3 types physical function tested Fine motor coordination: finger taps (front view)

Gross motor coordination: gait (lateral view)

Spatial relationship: cane height (front & lateral views)

Reliability & validity determined

3 common Internet speeds (64, 384, 768 kps)

In person (community standard) and slow motion videotape (gold standard)

Internet bandwidth had a strong effect on validity and reliability for the fine motor and gross motor tasks.

Fine motor coordination - Reliability & Validity comparable to Standard Care @768 kps

Gross motor coordination (gait ) – Validity not comparable to Standard Care

Still spatial relationships - Reliability & Validity comparable to Standard Care at all of the bandwidths

Teletechnology Infrastructure

Security

HIPPA

Full face image and/or Voice = PHI

Can’t post cell phone video to U-tube for review

Skype isn’t HIPPA compliant

Costs

Equipment

Internet access

Who pays?

CCNC Informatics Center

Develop a better healthcare system for NC starting with public payers

Strong primary care is foundational to a high performing healthcare system

Additional resources needed to help primary care manage populations

Must build better local healthcare systems ( public-private partnership). Community Care is a clinical partnership, not a regulatory management agency.

Physician leadership is critical. Providers who are expected to improve care must have ownership of the improvement process

Achieve savings through better quality and efficiency of care

Timely data is essential to success

Information Support for Patient-Centered Care

CCNC Informatics Center Data Flow

HC Data for Population Mgmt and QI

1. Identification of High-Risk/ High-Opportunity Patients for Targeted Services (Examples: Identification of individuals with above-expected preventable utilization, Hypertension Self-Management Support)

2. Cost/utilization performance measurement coupled with actionable information (Examples: Pharmacy Initiatives, In-patient and ED Reporting)

3. Quality Measurement and Feedback coupled with actionableinformation (Examples: Practice Views with County, Network, and State Benchmarks; i.e., % eye exams for diabetes patients)

ID of Patients for Case Mgmt

= Historical or predicted costs for an individual

$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K

Historically, case management efforts have been targeted at the highest utilizers

$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K

$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K

$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K

CRG#1

CRG#2

CRG#3

Expected potentially preventable costs

Priority patients for care management

NCB Prepared

A Public/Private Consortium (UNC, NCSU, SAS, DHS) focused on bio-surveillance – accurately detect and rapidly analyze biological hazards to ensure public health and safety.

• Improve early recognition of outbreaks augmenting bio-surveillance

• Improve situational awareness• Faster and more accurate information

for decision makers• Integration with emergency

management and law enforcement

Analytics – Reactive vs. Proactive

Data Value

Get DataUse AnalyticsProvide Information

Food PharmaFinance Pub HealthEMS News

PROCESS

CLIENT OPPORTUNITIES (?)

Focus on NC – Recurring Themes

Government (US & NC) Funding

Fundamental Change tied to Technology

Big Data used predictively not reflexively

Improve patient care

Security

Cost Models

Opportunities!