Overcome Challenges/Obstacles to Achieving Interoperability
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1 Overcome Challenges/Obstacles to Achieving Interoperability Session #86 Tuesday, February 21, 2017 Kathleen Sheehan, Program Director, Universal Health Services, Inc. Sindhu R. Kammath, MD, Clinical Informaticist, Universal Health Services, Inc. 1
2 Speaker Introduction Kathleen Sheehan, Program Director Acute Care Division Sindhu R. Kammath, MD, Clinical Informaticist Universal Health Services, Inc., founded in 1979, 240 facilities in US, Puerto Rico, the US Virgin Islands and the United Kingdom with over 70,000 employees. The focus of today s topic are the UHS acute facilities and providers that are meaningful users under the EHR Incentive Program. 2
3 Conflict of Interest Kathleen Sheehan and Sindhu R. Kammath, MD Have no real or apparent conflicts of interest to report. 3
4 Agenda Learning objectives Review HIMSS STEPS of Realized IT Benefits Introduction Interoperability overview 1 st generation challenges 2 nd generation challenges Next generation Conclusion Review HIMSS STEPS of anticipated Realized IT Benefits Q&A 4
5 Learning Objectives Compare and contrast current CMS and ONC interoperability specification to present-day challenges of deriving value from interoperability of health care information across the continuum of care Identify and create awareness of policy, design, implementation and adoption gaps of interoperability of health care information in its current state Propose more inclusive and less restrictive ways to improve the exchange of health care information across the care continuum 5
6 HIMSS STEPS Realized IT Benefits Provider Satisfaction with the esoc/ccd Scale 1=worst 5=best Organization/Display/Format: 2.5 Completeness of Information: 2.4 Clinical/Treatment Relevance: 3.0 Confidence/Accuracy: 2.5 Savings Reduce Duplication: 2.5 Improve Practice Efficiency: 2.3 Treatment Provider Sat. Savings Treatment 6
7 Introduction Interoperability is significant challenge Considered silver bullet $35.5 billion invested in healthcare IT since HITECH Groundwork has been laid Advance national healthcare imperatives Let s make meaningful exchange happen 7
8 Interoperability Overview Interoperability has evolved Foundational the connection Functional the standards Semantic the output and use Interoperability Pillars Foundational Functional Semantic 8
9 Interoperability Overview Cont d We have first-hand experience Eligible hospitals 24 Eligible providers 200+ UHS s acute division CA, NV, TX, FL, OK, SC, DC CEHRTs - 11 down to 8 Ambulatory providers: 4 vendors (started with 7) High-Specialty providers: 2 vendors Acute hospitals: 1 vendor CAH hospitals: 1 vendor 9
10 Interoperability Overview Cont d Evolving 1 st generation proprietary Secure 2 nd generation commodity Federated model Next generation 10
11 1 st Generation Challenges LTC/Nursing Home Home Care & Hospice Behavioral Hospital Provider 14, , , , ,400 1 EH Adoption Rate: ~ 90% 3 EP Adoption Rate: ~ 59% Other Community Health 11 1 AHA as of Kaiser Family Found 3 HealthIT Dashboard
12 2016 Performance 1 st Generation Challenges Cont d CEHRT adoption rates of EPs hinders performance 35% 30% 25% 20% 15% 10% 5% 0% HIE 2016 Performance by CEHRT 0% 0% CEHRT 1 CEHRT 2 17% CEHRT 3 19% CEHRT 4 25% 26% CEHRT 5 CEHRT 6 30% 30% CEHRT 7 CEHRT 8 Spec Spec Amb CAH Amb Amb Amb Acute 12
13 1 st Generation Challenges Cont d Secure (Direct) source of exchange Ease of use 3-point patient matching is weak HISPs don t publish secure addresses HISPs marketing exchange capability to non CEHRT providers 13
14 1 st Generation Challenges - Cont d Stage 2 & 3 Meaningful Use 2014 & 2015 edition Patient Name Referring/Transitioning Provider Reason for Referral (EP) Procedures Encounter Diagnosis Immunizations Lab Results Vital Signs Smoking Status Functional Status Demographics Care Plan and Care Team Medications Medication Allergies Problems 14
15 1 st Generation Challenges Cont d Four examples pinged our markets for samples and received four Let s look at the information relative to these characteristics Visual display Usefulness Relevance Content and volume of data Accuracy and confidence 15
16 1 st Gen Inbound CCD Example #1 16
17 Outbound CCD Example #2 32 pages of information 2009 to medications - active, discontinued and expired meds 30 sets of vital signs 15 procedures not sorted by date 20 pages of lab results 8 pages of 315 diagnosis codes A second 4 page document containing H&P and progress note had to be sent Procedure history Vital Signs 17
18 Inbound CCD Example #3 18
19 Inbound CCD Example #4 Table of Contents Reason for Referral Encounter Details Active Allergies and Adverse Reactions - as of 10/20/2016 Current Medications - as of 10/20/2016 Active Problems - as of 10/20/2016 Resolved Problems - as of 10/20/2016 Immunizations - as of 10/20/2016 Social History Medications at Time of Discharge Plan of Care Results Visit Diagnoses 19
20 1 st Generation Challenges Cont d 4 examples Key Takeaways 20
21 1 st Generation Challenges Con t Another example of unintended consequences of the stimulus model Fragmented stores of health info MU example each EP/EH has a portal obligation I have PCP and need 3 specialist referrals - all MUsers but do not share CEHRT. I get outpatient testing at two hospitals who are Musers but don t share the same CERHT. Card. I now have 6 portal accounts.?? PC P GI Opt. Hospital 21
22 1 st Generation Challenges Cont d Key challenge takeaways The health record is piecemealed, fragmented Pieces of health info are pushed from EHR to EHR, or EHR to portal each storing parts Where to get the full story or the right info? What source is best? 22
23 2 nd Generation Challenges Industry readies for Stage 3 with improved exchange mechanism Federated models decentralize interoperability and information sharing Moves healthcare from proprietary to commodity-based model Query-based pull model 23
24 2 nd Generation Challenges Cont d But federated model membership is voluntary Again barriers Ideal only if membership is all inclusive What if my community has partial enrollment from CEHRT vendors? 24
25 Next Generation P P P 25
26 Next Generation Cont d This single repository can be the patient s portal It might be called the Perpetual Health Record It has intelligence It organizes, files, prepares, displays, selfcorrects, reconciles, archives It evaluates information on context; stores and represents based on relevance 26
27 Conclusion Key Takeaways We need a single place for the health record Avoid passing We need to get all providers to exchange Productize, package and sell exchange capabilities We need to exchange better info Digitize, codify We need to come up with a standard look and feel We need to identify what the most relevant and useful data 27
28 Stage 3 Anticipated Benefits for the Value of Health IT Provider Satisfaction with the esoc/ccd (Scale 1/worst - 5/best) Completeness of Information: 3.0 Clinical/Treatment Relevance: 3.5 Savings Reduce duplicative testing: 3.75 Treatment Provider Sat. Savings 28
29 Questions 29
30 Evaluation Please complete evaluation forms 30
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