it for bending the healthcare cost curve
TRANSCRIPT
IT for Bending the Healthcare Cost Curve: The High Needs, High Cost Approach
Presented by: Douglas Morrison, CPA,CMA, Ph.D(c)
Co-authors: Karim Keshavjee, Aziz Guergachi, Shams Mohammed
February 17, 2017
ITCH Conference , University of Victoria, B.C.
LINK TO OPEN-ACCESS PAPER:
Keshavjee K, Morrison D, Mohammed S, Guergachi A. IT for Bending the
Healthcare Cost Curve: The High Needs, High Cost Approach. Stud Health
TechnolInform. 2017;234:178-182. PubMed PMID: 28186037.
Agenda
Introduction
The Problem
Anderson’s 8 Attributes of Successful Healthcare Organizations caring for HCHN Patients
Review elements and opportunities to address HNHC patients
Proposed InfoClin Health Informatics and IT Framework
A Historical Functional Department DMU Model
A Regional IT Effectiveness Framework
Discussion and Feedback
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The Problem –The High Cost of Care
Not all high cost, high needs patients are at End of Life
High cost, high needs (HNHC) patients include
People with severe disabilities
People with complex chronic conditions
People with severe mental disorders
Most have some sort of socio-economic deprivation
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CONTRARY TO POPULAR OPINION…
Our Questions: Request for you feedback
Are Anderson’s 8 characteristics of HNHC Patient Programs Broad Enough?
Have we missed any key elements in the IT architectural framework?
Is the IT architecture adequate or in need of redesign for HNHC patients?
What more is required in our IT architectural framework ?
How do we get to our goal of addressing the IT infrastructure needs to support HNHC patients?
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1. Ability to Target HNHC Patients
Integrated Regional mandate and funding model
Psycho-social integrated care model
Track and follow up with Patient and Family
Proactive to keep patient involvement and commitment to change
Infrastructure, transformation, informatics and clinical services
Proactive and interactive technologies
2. Creative Environment for Successful Leadership
Pushes control down to expert-manager level
Multi-threaded matrix provider model supported by community based technology.
Requires patient’s family advocate interaction
Triad consultant model for ongoing information management and clinical outcomes evaluation
Local clinical informatics consultant experts
Mapping Anderson’s 8 Attributes
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3. Structure Program to Improve Team Communications
Patient and family advocate communications
Community care orientation with links to key information sources to track progress
IT to facilitate early behavioural changes in the patient
Drive iterative clinical processes through collaborative push technologies via Web Services
4. Strategic Use of Data
Proactive use of decision support data to evaluate states of change
Integrated and aggregated data across providers
Context and environment specific informatics models
Patient and clinical outcome performance evaluation
Localized information and mathematical models specific to targets and metrics
Mapping Anderson’s 8 Attributes
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5. Interaction with Patients and Family
Web services IT infrastructure with links to key information sources
Plot patient progress and outcome targets according to targets in a patient centred score card
Empower family to take ownership for change through collaboration with NPs and RNs.
NPs and RNs push the communications via Web interactions.
6. Transitions of Care
Patients push questions and requests via mobile devices
Patient census checking across providers
Trends and way points to manage care plan across nurse practitioners and allied health managers
Empowering family through AI and quarterly progress evaluation
Easy respite and home care coordination
Mapping Anderson’s 8 Attributes
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7. Periodic Updates
Clinical value and performance evaluation on a yearly basis
Artificial Intelligence to compile data and provide critical path analysis
Education and reference library updates from agencies providing directed content from decision support specialists
Corporate performance scorecards with new measures and metrics beyond utilization management, access and LOS.
8. Physicians Spend More Time with Patients
Distribute authority and responsibility via collaborative IT
Streamline clinical workflow across team with yearly review of practices using decision support consultants on a local basis
Integrated IT architectures to track utilization, demand, access and intensity by physician-patient roster
IT infrastructure supports clinical professionals on a case by case basis - “Build up and Tear down on a Needs basis”
Mapping Anderson’s 8 Attributes
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IT Framework for Regional HCHN Patient Care Keshavjee et al.
Understanding Inter relationships between Health Informatics, Bureaucratic Structure and Information Technology
Redesign of the historical decision making model to encompass a regional organization to manage HNHC Patient Wellness
Reference: Ancarani A., Di Mauro C., Giammanco M.D. Impact of managerial and organizational aspects on hospital wards’ efficiency: Evidence from a case study, European Journal of Operational Research,194(2009) 280-293.
Regional IT Effectiveness Framework
Hospital Functional Department Structure
Program ManagementDMU
Functional BudgetProgram Budget
Goals/Constraints
Production and Clinical CareWorkflow Collaboration
Regional Communication Bus + Data Aggregation + Integration + IT Infrastructure
Adjust General Orders & Processes
Regional Health Governance Community Patient Management
Clinical Financial Performance Evaluation
Patient Critical Path E.H.R.Patient Scorecard
Utilization & Efficiency Management
Care Management Collaboration
Allied Health Provider Functional Department Structure
Program ManagementDMU
Functional BudgetProgram Budget
Goals/Constraints
Production and Clinical CareWorkflow Collaboration
Primary Care TeamFunctional Department Structure
Program ManagementDMU
Functional BudgetProgram Budget
Goals/Constraints
Production and Clinical CareWorkflow Collaboration
Conclusion
We have mapped Anderson et al.’s 8 attributes of organizations successful with HNHC patients to an idealized IT infrastructure
We have then mapped existing IT infrastructures in Canada to the idealized IT infrastructure
This gives regional players a roadmap to take their existing infrastructures and migrate them to new, value added infrastructures that can support high value activities known to improve care of HNHC patients
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