Continuity of Care Maturity Model Going Beyond EMRAM

Transcription

1 Continuity of Care Maturity Model Going Beyond EMRAM H. Stephen Lieber President and CEO HIMSS Model supported by Presentation version Model Information

2 THE EUROPEAN EMR ADOPTION MODEL in 8 Stages to Highest Quality in Patient Care Paperless patient record environment for highest quality of care, data continuity & full HIE Full electronic clinical decision support, and highest medication safety Completely electronic diagnostic image management Electronic order entry with decision support and result reporting Clinical ordering and documentation especially nursing care A patient-centered electronic data repository Electronic diagnostic and pharmacy department information

3 What is Continuity of Care? Citizens perspective Non-disruption of care provided to a patient throughout his/her care journey, across care settings and care givers Industry perspective Alignment of healthcare resources across care settings orchestrated in a way that delivers the best healthcare services and value possible for a defined population under your care

4 The Industry Challenge

5 Our Solution A multidimensional maturity model promoting the key tenants of continuity of care

6 Multiple Model Stakeholders CIOs Technology Leaders CEO/COO/CFO/CSOs Administrators CMIO/CNO/CNIOs Clinical/Medical Leaders

7 Continuity of Care Maturity

8 Clinical Focus CCMM Clinical Focus Comprehensive pop-health. Completely coordinated care across all care settings. Integrated personalized medicine Dynamic intelligent patient record tracks closed loop care delivery. Multiple care pathways/protocols. Patient compliance tracking Community-wide patient record with integrated care plans, bio-surveillance. Patient data entry, personal targets, alerts. Shared care plans track, update, task coordination with alerts and reminders. eprescribing. Pandemic tracking and analytics. Multiple entity clinical data integration. Regional/national PACS. Electronic referrals, consent. Telemedicine capable. Patient record available to multi-disciplinary internal and tethered care teams. EMR exchange. Immunization and disease registries. Limited shared care plans outside the organization. Leverage 3rd party reference resources. Basic alerts. Engaged in EMRAM maturation

9 Governance Focus CCMM Governance Focus National and local policies are aligned. Policies address non-compliance. Best clinical practices are derived from care community healthcare data and operationalized across the community Policies in place for collaboration, data security, mobile device use, and interconnectivity between healthcare providers and patients Data governance across organizations Policies drive clinical coordination, semantic interoperability. Change management is documented and standardized Policies for CofC strategy, business continuity, disaster recovery, And security & privacy. Data governance is active Governance is informal, inconsistent and undocumented

10 IT Focus CCMM IT Focus Near real-time care community based health record and patient profile Organizational, pan-organizational, and community-wide CDS and population health tracking Patient data aggregated into a single cohesive record. Mobile tech engages patients. Community wide identity management All care team members have access to all data. Semantic data drives actionable CDS and analytics. Comprehensive audit trail Aggregated clinical and financial data. Medical classification and vocabulary tools are pervasive. Mobile tech supports point of care Patient-centered clinical data presentation. Pervasive electronic automated ID management for patients, providers, and facilities Some external data incorporated into patient record. Data is isolated

11 Methodology Defining the Care Community The population who s continuity of care is being profiled Define up to five care settings, such as 1. Primary Care 2. Acute Care 3. Home based Care 4. Urgent Care 5. Long Term Care Completing Survey Excel based ~250 compliance statements 11 categories Four pre-defined responses Not Applicable, Somewhat Applicable, Fully Applicable, Unknown

12 Example Survey

13 Results Scoring Sections Overall Results Stakeholder Results Care Setting Results Stage Level Overall Total 37% Stage 7 9% Stage 6 27% Stage 5 35% Stage 4 47% Stage 3 37% Stage 2 55% Stage 1 59% Stage 0 83% Overall Section Compliance Compliance by Stage

14 Example Results Overall Results Overall Governance Clinical Info Tech Total 37% Total 33% Total 36% Total 47% Stage 7 9% Stage 7 12% Stage 7 Stage 7 0% Stage 6 27% Stage 6 29% Stage 6 13% Stage 6 33% Stage 5 35% Stage 5 28% Stage 5 18% Stage 5 65% Stage 4 47% Stage 4 36% Stage 4 82% Stage 4 33% Stage 3 37% Stage 3 35% Stage 3 27% Stage 3 62% Stage 2 55% Stage 2 56% Stage 2 52% Stage 2 59% Stage 1 59% Stage 1 71% Stage 1 43% Stage 1 57% Stage 0 83% Stage 0 72% Stage 0 100% Stage 0 100%

15 Example Results Overall Results Overall Recommendations The Client has made significant inroads at coordinating care in the primary care, and to a certain extent the acute care setting. This is especially exceptional given that many of their patients have a free choice of providers, and physicians can refer outside of the organization network. In order to make significant progress to improve continuity of care, it is recommended that the Client pursue tighter relationships with organizations that control other care settings, and these relationships must foster health information exchange, shared best practice care plans, as well as care team communication and coordination. 1. Continue building relationships with key/critical providers of healthcare that represent other care settings where ACO patients seek care 2. Extend governance activities and electronic capabilities that support care coordination outside the organization 3. Create documented Information and Communications Tech. (ICT) strategies and operational plans, addressing Internal ICT architecture and infrastructure design A strategy and process for internal IT system integration design Business continuity and disaster recovery For effective integration of data from any data source, including those not anticipated, into the patient's EMR 4. Enable health related data exchange between separate healthcare organizations leveraging secure electronic exchange 5. Extend access so that Citizens / patients have online access to A complete pan-organizational Personal Health Record (PHR) via one viewer or presentation method Can update their medical records with personal information and control access Allow relatives or social/home care workers to update their patient record Governance stakeholders pave the way for Information Technology stakeholders and their associated capabilities which are the foundation for Clinical stakeholders to facilitate coordinated care. It is a positive sign to see Governance at Stage 2 overall, slightly ahead of the other stakeholder groups and making progress to enable their success.

16 Example Results Stakeholder Results - Governance Governance Primary Acute Sub-Acute Care Urgent Retail Care Home Care Total 64% Total 62% Total 9% Total 8% Total 20% Stage 7 30% Stage 7 30% Stage 7 0% Stage 7 0% Stage 7 0% Stage 6 61% Stage 6 65% Stage 6 0% Stage 6 7% Stage 6 13% Stage 5 60% Stage 5 50% Stage 5 5% Stage 5 0% Stage 5 24% Stage 4 71% Stage 4 71% Stage 4 14% Stage 4 14% Stage 4 7% Stage 3 68% Stage 3 64% Stage 3 10% Stage 3 8% Stage 3 26% Stage 2 91% Stage 2 88% Stage 2 34% Stage 2 19% Stage 2 47% Stage 1 100% Stage 1 97% Stage 1 53% Stage 1 56% Stage 1 50% Stage 0 100% Stage 0 90% Stage 0 70% Stage 0 50% Stage 0 50% Governance Recommendations Governance stakeholders are making strides in the Primary and Acute care settings, achieving Stage 3 efforts, but then progress falls off in other ancillary settings where the client has little to no influence or control. In the home care setting there is good progress but it is spread thinly across many stages. To surpass Stage 3 in the Primary and Acute care settings 1. Work with IT stakeholders and acute care partners to develop an agreed upon set of standards and frameworks for healthcare and related financial data, interoperability and data exchange Technical standards to fully engage and encompass all ICT systems Data standards to embrace all types of clinical and related financial data Care standards that outline clinical practice guidelines and care protocols Develop a documented strategy and processes for data center (local and/or third party) disaster recovery and network redundancy, with routine verification and testing 2. Refine the strategy and process to make tele-health, including telemedicine, available for remote consultations, telemonitoring, home care support, and chronic disease management 3. Create collaborative policies with other care settings that outline standards for protecting the security of data (virus protection, encryption, physical security, etc )

17 Example Results Primary Care Setting Results Overall Governance Clinical Info Tech Total 63% Total 64% Total 54% Total 70% Stage 7 21% Stage 7 30% Stage 7 Stage 7 0% Stage 6 48% Stage 6 61% Stage 6 13% Stage 6 33% Stage 5 64% Stage 5 60% Stage 5 38% Stage 5 92% Stage 4 78% Stage 4 71% Stage 4 100% Stage 4 68% Stage 3 68% Stage 3 68% Stage 3 50% Stage 3 100% Stage 2 87% Stage 2 91% Stage 2 83% Stage 2 86% Stage 1 95% Stage 1 100% Stage 1 85% Stage 1 100% Stage 0 100% Stage 0 100% Stage 0 100% Stage 0 100% Recommendations Master these activities by building on current progress and momentum to. 1. Create a patient-centered dynamic intelligent record that drives and tracks closed-loop care delivery among the entire patient care team beyond acute and primary care to include community pharmacies, patient / patient relatives, rehabilitation, social & home care, elderly homes, etc 2. Extend shared care plans across providers within, as well as those tethered to the organization 3. Extend coordinated care plans that are managed and include Evidence Based Practices and Programs (EBP) 4. Extend access so that citizens / patients have online access to provide electronic consent and manage access privileges to their medical record Advance these activities by starting initiatives that address these capabilities: 1. Extend access so that Citizens / patients have online access to A complete pan-organizational Personal Health Record (PHR) via one viewer or presentation method Update their medical records with personal information Allow relatives or social/home care workers to update the patient record 2. Capture a significant portion of clinical data in structured format 3. Integrate and use Natural Language Processing (NLP) capabilities where appropriate

18 Scalable from Facilities to Countries Province/Cluster/Region Ministry of Health State/Country Provider Facility Provider Network Accountable Care Org. Integrated Delivery Network

19 Know. Understand. Prepare. Change with CCMM John P. Hoyt, FACHE, FHIMSS Executive Vice President HIMSS James E. Gaston, MBA, FHIMSS Senior Director, Maturity Models HIMSS Analytics