Beyond the EHR: Continuous Innovation for the Transition to Value-Based Care Session 118, Wednesday, March 7th11AM Theo Siagian, Director of HIE and Interoperability, Providence St. Joseph Health Matt Simon, Director, Connected Health Practice, Himformatics Lynda Rowe, Sr. Advisor Value-Based Markets, InterSystems 1
Conflict of Interest Theo Siagian, MBA Matt Simon, MHA Lynda Rowe, MS, MBA Has no real or apparent conflicts of interest to report. 2
Agenda Overview of Providence St. Joseph Health Building the Foundation for Innovation Creating an Innovation Community Examples of innovation to support value based care 3
Learning Objectives Describe the value of creating a patient centered asset that encompasses the continuum of care Identify how the EHR and the connected heath record complement one another Discuss the ways connected health records can enhance care delivery, improve patient outcomes, and manage population health and risk more effectively Describe the organizational structure and processes required to innovate in a value-based care environment 4
Overview of Providence St. Joseph Health 5
About Providence St. Joseph Health 6
Providence St. Joseph Network A network of 111,000 caregivers (all employees) serve in 50 hospitals, 829 clinics and a comprehensive range of services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. 7
Building the Innovation Foundation 8
What is Innovation? 9 https://www.ideatovalue.com/inno/nickskillicorn/2016/03/innovation-15-experts-share-innovation-definition/
Our external environment moves rapidly While we grapple with trying to keep up 10
Why innovate? There have been some major shifts that have occurred in healthcare over the past 10 years compelling organizations to change rapidly to respond Meaningful Use -> MIPS Accountable Care Organizations Bundled Payments Value-based contracts Clinically Integrated Networks 11
Success in value-based payment Establishing a network of providers that enables enhanced coordination of care. Creating a new partnership model with physicians that includes defined roles for physician leadership. Defining performance improvement initiatives to provide demonstrated value to the market. Providing a platform for joint contracting to support care redesign and performance improvement initiatives. Working together across multiple entities to share clinical data to ensure the greatest care possible to patients Negotiating with potential partners for risk-based contracts. 12
What are the challenges? According to one study, 82% of independent physician practices are not confident that their groups have the necessary connectivity, data analytics, and technology capabilities to successfully shoulder the financial risk requirements of quality payment programming 13
How do you meet those goals Create the structure for shared patient care and coordination Have the IT infrastructure that allows for data sharing across settings of care Control your destiny by owning your key assets Set up processes, structures that allow for innovation to rapidly respond to changes in the needs and challenges of evolving organizations 14
Senior center Social service agency Government Pharmacy Child protective services Prison Hospital Rehab Family Laboratory Payer Home care agency Physician Patient Researcher Nursing home Ambulance Schools Pharma/device company 15
Creating an Innovation Community 16
Foundation for Innovation A patient lives in a complex healthcare community They seek care in multiple settings and locations and are generally organization agnostic Creating a connected care record and aggregating the data provides a foundation for all care participants to understand the whole patient It enables the information needed to transform care delivery It allows the critical information to follow the patient It provides insight into populations as well as individual patients 17
By the Numbers 9 Million Patients 300+ Unique Data Sources 350+ Participating Entities 2500+ Contributing Providers 40+ Unique EHRs 18
PSJH Connected Health Record 9 million patients in: California Texas Longitudinal care record: 16 Hospitals 257 Physician practices 3 Imaging centers 2 National reference labs 9 Skilled nursing facilities 9 Community clinics 2 Regional information networks 19
CIN Provider Participation 90 % With a Signed Participation Agreement 70 % Contributing Encounter Data to the HIE 70 % Contributing LabCorp and/or Quest Data to the HIE 60 % Receiving Electronic Results and/or Sending Electronic Orders to/from the HIE 100% with Access to ShareVue 20
The EHR and a shared record work together Primary Care Connected Health Record Specialist Sub-Acute Electronic Health Record (IDN): Clinical Documentation Revenue Cycle Management Clinician Workflow Management Back-office Workflow Management 21 Social Services Payer
Organizational Framework Creating a strong legal, compliance, and governance framework was the first step to scalability Achieving a critical mass of acute data and adding valuable services created incentive for ambulatory providers to participate Participation was mandatory for Clinically Integrated Network (CIN) members Clinical and regulatory priorities are driving post-acute and ancillary connectivity Sheer volume of data and a reputation for innovation are driving partnership conversations 22
Innovation Engagement Find a business sponsor with a stake in value based success Engage advisory boards comprised of care team leadership to champion solutions and advise enhancement Build a Product Management function to own solutions and manage releases Deploy an engagement team to listen to the customer and build the pipeline of new features 23
Platform Product Management Business sponsors define product vision and goals. Initiatives define the effort required to achieve the goals, and usually span over several releases PSJH manages separate release schedules for ShareVue (clinical viewer) and its Platform Services products Features are captured as ideas from across the organization and validated with key stakeholders before inclusion in a release Our goal is to avoid shiny objects, achieve business goals, and advocate for our customers 24
Sample Product Roadmap ShareVue Platform Services Split User Manager Role (HelpDesk/MedStaff) UptoDate Integration Alert ED Encounter Diabetes Quality Measure Set Vaccination Group Providence (LA) HL7 Data Contribution Alert Hospital Discharge Quality Measure Dashboard LabCorp 2nd Copy Distribution PACS Image Link Integration Phase I Alert Palliative Care Order Delivery TigerText Secure Text Integration ShareVue Printing Providence (LA) HL7 Data Contribution Attribution File Based Data Type Pre- Adjudicated Claims Data Full Description Display for Severity Provisioning Electronic Form Phase I Results Delivery to EHR Bi-Directional Immunization Interface OCPRHIO Document Query/Response Phase I CIN Protocols Integration Closed Loop Orders Alert - Sepsis Q1 Release Under Consideration 25
Innovation Examples 26
Performance improvement dashboards Monitor population performance Quality metrics for continuous clinical performance management Learn, innovate, and improve Proactively and efficiently manage cohorts Alerts and notifications ShareVue portal for care coordination Provide personalized, coordinated care Deliver actionable information to care givers Results delivered within clinical workflows 27
Real-Time Care Coordination Create notifications for multiple attributed populations Extend beyond encounters to notification of new diagnosis, out-ofrange results or complex criteria, across settings Deliver alerts into care team workflows, via EHR, secure text or email link Rapid configuration process enables ability to configure, test and pilot notifications A growing library of notifications builds upon early success and accelerates advancement 28
Enhancing Clinical Value ShareVue offers web access to the connected health record from anywhere New features are released quarterly, prioritized for clinical value and ease-of-use 29
Performance Improvement Connected Health dashboards add clinical data insight to value based decision making The CIN uses the data to identify strategic performance advantages and network contracting opportunities Providers use data to maximize MIPS scores and risk-based contracting success 30
From Proof-of-Concept to General Availability Care managers in Texas receive notifications when insurance-attributed patients are admitted or registered at any Covenant facility Diabetes and CHF clinical pathways are available to providers in ShareVue 6 diabetes quality measures, calculated using HIE clinical data and validated for HEDIS definitions, are being validated for use as leading indicators for performance improvement Pre-op users streamline workflow and reduce duplicate testing through real-time access to HIE data in epreop 31
Questions Theo Siagian, Director of HIE and Interoperability, Providence St. Joseph Health, Theo.Siagian@stjoe.org, https://www.linkedin.com/in/theosiagian Matt Simon, Director, Connected Health Practice, Himformatics msimon@himformatics.com, https://www.linkedin.com/in/simonmatt Lynda Rowe, Sr. Advisor, Value Based Markets, InterSystems, Lynda.Rowe@intersystems.com, https://www.linkedin.com/in/lyndarowe 32
Thank you 33