Electronic Health Records Today We ve implemented - now what? Andrew M. Wiesenthal, MD, SM Director, Deloitte Consulting, LLP awiesenthal@deloitte.com 1 Copyright 2015 Deloitte Development LLC. All rights reserved.
Agenda The case for standardization Return to the business case Population management and delivery system integration Patient engagement Dynamic life care plans It s all about me exactly me Information technology evolution becomes business as usual
I don t care if you get it right. I care if you get it the same. Brent James, MD, Intermountain Health Care Source: personal communication.
The Case for Standardization--Current Ideal The Shared Myth: Physicians are a combination of Sherlock Holmes and the Lone Ranger Brilliant deductive logician, in command of all facts (relevant or otherwise) Magnificent knight errant, always fighting alone for what is right and always winning The Reality is a Pale Shadow of the Myth
The Case for Standardization--Current Reality The Ugly Truth: Physicians are often a combination of the blind men examining the elephant and the Earp brothers Truly working in partial darkness, in the absence of all the facts, reasoning from pattern recognition The antihero gunslinger, uncontrolled, doing what they think is good, generally succeeding but sometimes maiming or killing in the process Bridging the Gap between Reality and the Ideal Requires Culture Change Supported by Standardization
Changing the Culture of Medicine Medicine must become a team sport if patients are to receive the highest quality, safest care leading to the best possible outcome There are >30,000 medical journals published regularly Occasionally, they present new information of benefit to patients No one can possibly find all relevant knowledge, and certainly no one can achieve total mastery The entire network of people who could care for someone must be engaged Doctors, nurses, extenders, pharmacists, clerks, social workers, community service providers, teachers, and especially friends and family Hilary Clinton was right it Takes a Village
Standardization the Fabric that Enfolds For the Health care enterprise to enable the Village, standardization must permeate all levels Data Model Transmission of Data Generation of Information Analysis and Reporting Customized to Audience Models of Care and Care Processes for Particular Circumstances and Conditions Governance of/promotion of Variation These are the Building Blocks of a Learning Health System
Examples to Support this Approach What empiric evidence do we have? Progress in Pediatric Oncology Progress in Integrated Delivery Systems Explicit Learning Health System Designs Mass Public Health The Governance of Customization and Deviation from Standards The Definition of Insanity Repeating the Same Process Over and Over, Expecting the Result to be Different
Role of Health Care Leaders What is a poor Dutch health care executive to do? Understand What Standardization Means in all the Appropriate Levels Understand the Degree to Which Standardization already Exists in Your Organization, Your Region, and Your Country Convene Clinical Operational Leadership to Build a Roadmap to Standardization Enliste political leaders and patients Build a Relevant Local Business Case and Invest Wisely Drive Toward Sanity Expose, Analyze, and Correct Failures, Celebrate Successes
Return to the Business Case If you ve already implemented an EHR Why did you do it? Have you realized that goal? If you haven t yet implemented What do you plan to achieve? How will assure that you realize that plan
Population Management and Delivery System Integration Where is the real action in health care? Standardization forms a critical foundation for good population management Integration of population care across primary care and secondary is essential (and a problem in the Dutch delivery system?) Kaiser Permanente gross statistics: 10M members 300K hospitalizations/year 40M ambulatory visits/year 40% of touches are electronic Every patient has a dynamic life care plan that is accessible to all stakeholders
Patient Engagement and Mass Customization How will you develop and use data to characterize and target populations? How will you perform in-reach? Who is actually doing care management? How will you perform outreach? Secure messaging Social media Support groups for the chronically ill Delivery of prevention measures and care reminders Apps for patients and their caregivers How will all this data interact with the EHR?
Information Technology Evolution is Business as Usual You have implanted a new central nervous system into your delivery system How will you refine your reflexes as you solve operational problems? How will you prioritize which population-based issues to address first, second, and third? How will you alter your investment strategy? Away from bricks and mortar Away from equipment Toward technology that is flexible, customizable by both you and the individuals you care for
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THANK YOU! Andrew M. Wiesenthal, MD, SM Director, Deloitte Consulting, LLP awiesenthal@deloitte.com 15 Copyright 2015 Deloitte Development LLC. All rights reserved.