meaningful use in the netherlands: ready for prime time??€¦ · jan a. hazelzet, md phd cmio...
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Meaningful Use in The Netherlands:
Ready for Prime Time??
Jan A. Hazelzet, MD PhD
CMIO
Patient & his Journey in Healthcare
General Hospitals
AcademicCenters
Patient
Categoral Hospitals
Parents
GP
Rehabilitation
Nursing Homes
Home Care
Our Healthcare = Fragmented, vertical silo’s, financially driven
Healthcare: Rapidly Increasing Complexity
Diagnostic and treatment options are expanding and changing
Chronic diseases and comorbid conditions are increasing
Care delivery has become increasingly fragmented
Health care safety, quality, and outcomes fall short of their potential
Growth rate of health care expenditures is unsustainable
Overtreatment / under treatment
Pace of change is too slow
Best Care at Lower Cost: The Path to Continuously Learning Health Care. IOM 2012
Health Information Technology?
Improved Care, Better
Outcomes, Lower Cost
IT
ConcertedAction
2014
20162018
Meaningful Use of IT
Improved Care, Better
Outcomes, Lower Cost
IT
ConcertedAction
Quality:
• Safety
• Efficacy
• Efficiency
• Patient Centered
• Timely
• Access
Value=
Patient relevant Outcome and Experience, vs Costs
Value & Evidence Based Healthcare
Medicine’s Triangle of Conflicting Expectations
Moses et al. JAMA. 2013;310:1947-1963
• Improving the Patient Experience of
Care (including Quality and Satisfaction)
• Improving the Health of Populations;
and
• Reducing the per Capita Cost of Health
Care.
“Introducing New Normal”
Current EMR’s are extended
Reimbursement Systems
Lacking Functionalities:
• Interoperability & HIE
• Automated quality & cost
measurement
• Smart analytic capacities
• Teamwork promotion
• Patient engagement
IOM Key Attributes
Primary Care=
Accessible
Coordinated
Sustained
Comprehensive
A partnership with patients
Person-centered
Integrated
Specific IT Needs
Adapted from Krist AH, et al. JAMIA 2014;21:764–771
JAMA, 2012; 307: 2593-4
“These systems have the potential to
transform health care delivery, but only if
they are designed with a new end in mind:
more integrated, safer care that engages
patients and reduces costs.”
Minimize Disease, improve Health
Holistic Approach
Society
Social
Psyche
Medical
19
Challenges - Language
???
српско писано говор је ћepиулица. даби
особа потпуно разумила-черилицу или
койи говор, питаотац треба да
разумиjе говор, граматику, семантику,
од тога говора. да би компютор
превео cваку горе спомометну део за
корист здравовен-свене сексиjе, било
би велико изазиваные.
EMR A EMR BCore dataset with standard
terminology………
Conceptual Model of the CCR
Document Identifying Information“From/To” info re Provider/Clinician
Reason for Referral/Transfer
Patient Identifying
Information
Insurance and Financial Info
Health Status of PatientDiagnosis/Problems/Conditions
Adverse Reaction/Alerts
Current Medications
Immunizations
Vital SignsLab Results
Procedures/Assessments
Extension
Care Documentation
Extension
Optional
Extension
Extension Eligibility, Co-payment, etc.
Med. Specialty-specific Info
Disease Management-specific Info
Extension
Extension
Extension
Extension
Extension
Extension
Institution-specific information
Med. Specialty-specific Info
Disease Management-specific Info
Personal Health Record Info Documented by the Patient
Care Documentation for Payers
(Attachments)
Personal Health Record Info
Documented by the Patient
Care Plan Recommendation
Optional
Extension
1
2
3
4
5
6
Mandated Core Elements of the CCRVersion 6– 10/31/03
Generic Core Data Set based on CCR, SNOMED CT & LOINC
http://www.nictiz.nl/gog http://ww.nfu.nl
Generic
information
(core set=CCR)
Disease / problem specific information
Usage
Patient Care
Transfer of patients
Research
Management
information
Quality indicators
Financial /
reimbursement
Etc.
Selec
-tion,
Aggr
egati
on
Deriv
ation
etc
Register once, unambiguously,IN (or close to) the primary process
Multiple Usage
Primaryprocess
Long term ideal
“A Robust Health Data Infrastructure”
JASON Report 2014:
Separate data from applications
Be agnostic as to the type, scale, platform, and storage of the data
Use public APIs and open standards, interfaces, and protocols
Encrypt data at rest and in transit
Separate key management from data management
Include with the data the corresponding metadata, context, and
provenance information
Represent the data as atomic data with associated metadata
Follow the robustness principle: be liberal in what you accept and
conservative in what you send
Provide a migration pathway from legacy EHR systems.
http://healthit.gov/sites/default/files/ptp13-700hhs_white.pdf
PatientCentered Care
IT
ConcertedAction
• National Coordination
• Standardization
• Regional Cooperation
Goal Directed Concerted Action
Dpt. Health,
Wellbeing &
Sport
Health IT
Coding,
Standards &
Guidelines
Committee
Health
Information
Council
ZIN
NICTIZ
Taskforce
Health Policy
&
IT
Coordinating
AgencyAssignment
Goals
Mandate
Leadership
Leadership
Leon
Orange
@JanHazelzet